bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing peripheral fibers, pain sensitivity, central sensitization, and descending inhibition in Native Americans: main findings from the Oklahoma Study of Native American Pain Risk
Authors: Rhudy Jamie L. , Lannon Edward W. , Kuhn Bethany L. , Palit Shreela , Payne Michael F. , Sturycz Cassandra A. , Hellman Natalie , Güereca Yvette M. , Toledo Tyler A. , Huber Felicitas , Demuth Mara J. , Hahn Burkhart J. , Chaney John M. , Shadlow Joanna O.
Published: October 2019

Native Americans (NAs) have a higher prevalence of chronic pain than other U.S. racial/ethnic groups, but there have been few attempts to understand the mechanisms of this pain disparity. This study used a comprehensive battery of laboratory tasks to assess peripheral fiber function (cool/warm detection thresholds), pain sensitivity (eg, thresholds/tolerances), central sensitization (eg, temporal summation), and pain inhibition (conditioned pain modulation) in healthy, pain-free adults (N = 155 NAs, N = 150 non-Hispanic Whites [NHWs]). Multiple pain stimulus modalities were used (eg, cold, heat, pressure, ischemic, and electric), and subjective (eg, pain ratings and pain tolerance) and physiological (eg, nociceptive flexion reflex) outcomes were measured. There were no group differences on any measure, except that NAs had lower cold-pressor pain thresholds and tolerances, indicating greater pain sensitivity than NHWs. These findings suggest that there are no group differences between healthy NAs and NHWs on peripheral fiber function, central sensitization, or central pain inhibition, but NAs may have greater sensitivity to cold pain. Future studies are needed to examine potential within-group factors that might contribute to NA pain risk.
Ovarian Cancer Classification Using Serum Proteomic Profiling and Wavelet Features A Comparison of Machine Learning and Features Selection Algorithms
Authors: Alqudah Ali Mohammad
Published: October 2019

Ovarian cancer is one the common cancers that in women such pathological disease within an organ might lead to noticeable changes in the proteomic patterns in serum. Mass spectrometry is the most important tool to understand the proteomic profiles proteomic changes; mass spectrometry extracts complex and informative functional data; and the most significant features of it are the peaks. This article presents a comparison of 4 widely used machine learning (ML) algorithms and 2 feature selection algorithms. The ML algorithms were applied on low-resolution surface-enhanced laser desorption/ionization–time-of-flight data sets for ovarian cancer diagnosis, by extracting wavelet features from spectrometer data and feeding them to the classifiers. The comparison is done by fusion of both selected features using the different algorithms with the classifiers, and then they were compared by measuring their classification test accuracy, sensitivity, and specificity values. Results show that all the presented ML algorithms performed well, with different feature selection algorithms all exceeding 90% accuracy.
Screening for Anal Cancer in Women With a History of Vulvar High-Grade Squamous Intraepithelial Lesions
Authors: Proctor Lily , Grennan Troy , Albert Arianne , Miller Dianne , Sadownik Leslie , Lee Marette
Published: October 2019

Objectives

The primary obkective was to determine the prevalence of (a) a positive anal cancer screen and (b) histological anal high-grade squamous intraepithelial lesion (HSIL) in women undergoing surveillance for previously diagnosed and treated human papillomavirus (HPV)-associated vulvar HSIL. The secondary objective was to determine the patients' acceptability of the screen.

Materials and Methods

This is a single-institution, cross-sectional pilot study. Women, aged 30 to 80 years, with a history of biopsy-proven vulvar HSIL were invited to undergo screening for anal cancer. Positive screen characterized by abnormalities in any of the following: anal high-risk HPV (HR-HPV); anal cytology; and digital anorectal examination. All women with an abnormal screen were referred for high-resolution anoscopy. All women completed a postscreen questionnaire.

Results

Fifty-seven patients were recruited. The median (interquartile range) age was 61.5 (51.0–68.0) years. The prevalence of a positive screen was 56.1% (95% CI = 43.3%–68.2%). Of the 32 screen-positive patients, 12 had both abnormal cytology and HR-HPV, 3 had positive HR-HPV alone, and 17 had abnormal cytology alone. Of the 29 patients with a positive screen who went on to anoscopy, the prevalence of anal HSIL was 33.3% (95% CI = 19.2%–51.2%). The prevalence of anal HSIL among all of those who had screening (N = 57) was 18.2% (95% CI = 10.2%–30.3%). The examination was well tolerated with 100% of patients, indicating that they would have the screening again.

Conclusions

Women with vulvar HSIL have an increased risk of developing anal HSIL. Larger studies are needed to define optimal screening protocols as well as algorithms for management in high-risk populations.
Clinical Characteristics of Different Primary Constipation Subtypes in a Chinese Population
Authors: Jiang Ya , Tang Yurong , Lin Lin
Published: October 2019

Goal:

To investigate the clinical characteristics of different primary constipation subtypes, including symptom clusters, psychological problems, quality of life (QOL), and to explore the role of constipation symptoms and the mental state in the QOL of constipation subtypes.

Background:

Patients with chronic constipation (CC) may be unsatisfied with their therapy and suffer recurrent symptoms. Different constipation subtypes require different treatments; therefore, it is important to identify the features of different constipation subtypes.

Study:

CC patients (n=206) visiting our gastroenterology clinic were studied. CC subtypes were diagnosed using the Rome-IV criteria. We used validated questionnaires to investigate the symptom severity, mental state, and QOL of patients. QOL was assessed with the Patient Assessment of Constipation Quality of Life (PAC-QOL) and SF-36 questionnaire. Results of symptom, mental and QOL scores are expressed as means with 95% confidence interval.

Results:

Three groups of CC patients differed in their constipation scoring system and the Patient Assessment of Constipation Symptoms (PAC-SYM) total scores, and both were significantly higher in the functional defecation disorder (FDD) group compared with that in the normal transit constipation (NTC) group. FDD patients tended to have more severe “abdominal symptoms,” “rectal symptoms” than NTC group. No significant difference in General Anxiety Disorder 7-item or Patient Health Questionnaire-9 results was found among the 3 groups. Significantly more patients with FDD suffered more “physical discomfort” and had poorer QOL in the “physical function” dimension of SF-36. FDD and NTC patients mainly showed associations between CC-related QOL and constipation severity, while slow transit constipation patients’ QOL was significantly associated with anxiety and depression.

Conclusion:

Patients with FDD suffer more severe constipation symptoms and have a lower QOL than patients in other CC subgroups. FDD and NTC patients’ QOL is mainly linked to constipation symptoms, while that of slow transit constipation is mainly related to mental states such as anxiety and depression.
Gastric emptying scintigraphy results may influence the selection of the type of bariatric surgery
Authors: Khiyani Neeraj , Tulchinsky Mark , Hava Sana , Ho Truong An , Dadparvar Simin
Published: October 2019

Bariatric surgery (BAS) may result in adverse outcomes that include appearance of gastrointestinal (GI) symptoms and/or failure to reach the weight reduction goal. This retrospective study tested the hypothesis that pre-operative gastric emptying (GE) abnormality is responsible for adverse post-surgical outcomes.

Pre-operative GE was performed using the standard solid-meal GE scintigraphy (GES) in 111 consecutive patients (105 females and 6 males, mean age 46.2 years, range 20–70 years) who were evaluated for BAS. All underwent BAS – 93 had laparoscopic sleeve gastrectomy (LSG) and 18 had Roux-en-Y (ReY) gastric bypass. All had short-term (3-6 months) and long-term (up to 54 months) follow-up with review of symptoms, physical, and laboratory examinations. Chi-square analysis was performed. P-value < .05 was considered significant.

Of the 111 patients, 83 had normal and 28 had abnormal pre-op GES. Sixty-eight were asymptomatic and 43 were symptomatic prior to surgery. Following surgery, 81 patients were asymptomatic and 30 were symptomatic at long-term follow-up. There was no significant difference between pre-op GE results and post-surgical adverse clinical outcome (p = ns). However, GES results seem to have guided the selection of surgical procedure significantly (P = .008).

Pre-operative GE study was not a strong predictor of clinical outcome in BAS. Although, it influenced the type of surgery, as when the GES was abnormal, the patient was more likely to undergo ReY and when GES was normal, they favored LSG. Interestingly, many of our symptomatic patients at 6 months post-op were asymptomatic after long-term follow-up.
Internal hernia from the interureteric space after robot-assisted radical cystectomy and urinary diversion
Authors: Tsai Li-Hsien , Li Wei-Juan , Chen Guang-Heng , Hsieh Po-Fan , Chang Chao-Hsiang
Published: October 2019

Rationale:

Radical cystectomy and urinary diversion remains the definite management for muscle invasive bladder urothelial cancer. Internal herniation caused by ureteral adhesion is an extremely rare complication after the procedure. To the best of our knowledge, this is the first case report of small bowel obstruction and internal herniation occurring between bilateral ureters and urinary diversion after robot-assisted radical cystectomy (RARC).

Patient concerns:

A 64-year-old woman presented with symptom of small bowel obstruction such as nausea, vomiting, and abdominal fullness after RARC and Indiana pouch. Another 61-year-old man presented with left obstructive hydronephrosis and recurrent pyelonephritis after RARC and ileal conduit.

Diagnosis:

Both patients received computed tomography scans and the results were suggestive of small bowel herniation between bilateral ureters and urinary diversion.

Interventions:

The 2 patients underwent open ureterolysis and internal hernia reduction. During the operation, bowel loop herniation between the interureteral spaces were found.

Outcomes:

Both patients recovered smoothly after second operation.

Lessons:

The incidence of internal herniation may increase by the growing use of RARC. Suitable stoma position, appropriate length of ureter dissection, and retroperitonealization can help prevent this complication.
Step-advanced rectangular flap
Authors: Zhang Yanlong , Liu Yang , Tian Shuwei , Song Lianxin , Peng Aqin
Published: October 2019

Soft-tissue defects overlying the Achilles tendon are common complications after bicycle or motorcycle spoke injuries in children and usually require surgical management by various flaps. There is no apparent consensus on the optimal choice of flaps for these injuries. We designed a novel step-advanced rectangular flap to reconstruct small to moderate soft-tissue defects around the Achilles tendon. This study was performed to review our experience and evaluate the clinical effectiveness of the step-advanced rectangular flap.

From May, 2014 to September, 2016, 12 consecutive children with soft-tissue defects overlying the Achilles tendon caused by spoke injuries were treated with the step-advanced rectangular flap. The patients’ general information, surgical details, and postoperative complications were recorded. The Mazur evaluation system was used to assess clinical outcomes.

All patients were followed up for ≥12 months (range 12–38 months). All flaps survived completely. Superficial infection occurred in 2 patients and healed by second intention after dressing changes; the other patients’ surgical wounds healed by primary intention. The scars around the flaps in 2 patients were remarkable, and all others showed good results in terms of flap color and texture. Ankle function was normal, and satisfactory results were obtained in all cases. According to the Mazur evaluation system, the results were excellent in 9 patients and good in 3, with an excellent and good rate of 100% at 12 months postoperatively.

The rectangular advancement flap appears to be a simple and reliable method for small to moderate soft tissue defects overlying the Achilles tendon in children.
Combination of COX-2 inhibitor and metformin attenuates rate of admission in patients with rheumatoid arthritis and diabetes in Taiwan
Authors: Lu Chieh-Hua , Chung Chi-Hsiang , Lee Chien-Hsing , Su Sheng-Chiang , Liu Jhih-Syuan , Lin Fu-Huang , Tsao Chang-Huei , Hsieh Po-Shiuan , Hung Yi-Jen , Hsieh Chang-Hsun , Chien Wu-Chien
Published: October 2019

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease associated with increased prevalence of type 2 diabetes mellitus (T2DM). Here, we investigated the effect of the combination of cyclooxygenase (COX)-2 inhibitors and metformin on the rate of admission in patients with RA and T2DM and compared it with that of only COX-2 inhibitors.

In total, 1268 subjects with RA and T2DM under COX-2 inhibitor and metformin therapy were selected from the National Health Insurance Research Database of Taiwan, along with 2536 patients as 1:2 sex-, age-, and index year-matched controls without metformin therapy. Cox proportional hazard analysis was used to compare the rate of admission during the 10 years of follow-up.

At the end of the follow-up, 72 enrolled subjects (1.89%) had admission, including 9 from the combination group (0.71%) and 63 from the COX-2 inhibitor group (2.48%). The combination group was associated with a lower rate of admission at the end of follow-up (P < .001). Cox proportional hazard regression analysis revealed the lower rate of admission for subjects under combination therapy (adjusted hazard ratio of 0.275; 95% confidence interval = 0.136-0.557, P < .001).

Patients with RA and T2DM receiving the combination of COX-2 inhibitors and metformin were associated with lower admission rate than those on COX-2 inhibitors alone, and this effect may be attributed to the decrease in the levels of proinflammatory factors.
The relationship between physical activity intensity and domains with cardiac autonomic modulation in adults
Authors: Tebar William R. , Ritti-Dias Raphael M. , Saraiva Bruna T. C. , Gil Fernanda C. S. , Delfino Leandro D. , Damato Tatiana M. M. , Aguilar Beatriz A. S. , Silva Stéfany C. B. , Mota Jorge , Vanderlei Luiz Carlos M. , Christofaro Diego G.D.
Published: October 2019

Introduction:

Cardiac autonomic modulation is an important marker of cardiovascular health and the practice of physical activity is a fundamental tool for good maintenance or increments in this marker. However, it is not clear in the literature whether different intensities and different domains of physical activity are related in the same way to cardiac autonomic modulation.

Objectives:

This randomized epidemiologic study will examine the relationship between cardiac autonomic modulation and different intensities and domains of physical activity in a representative sample of adults.

Methods:

The sample of study will consist of 252 subjects aged from 18 years and above. The sample will be randomized through census sectors in which the neighborhoods, streets, and houses will also be randomized. Cardiac autonomic modulation will be assessed by heart rate variability and the intensity (mild, moderate, intense) of physical activity will be evaluated by means of accelerometers, while the different domains of physical activity (physical activity at work, occupational activities) will be evaluated through a questionnaire. The relationship between cardiac autonomic modulation and different physical activity intensities, as well as the different domains will be analyzed by linear regression, considering a statistical significance of 5% and a 95% confidence interval. This research protocol is registered in ClinicalTrials.gov at number NCT03986879.
Induced complete remission faster in adult patients with acquired pure red cell aplasia by combining cyclosporine A with corticosteroids
Authors: Wu Xuemei , Yang Yan , Lu Xingyu , Yin Hua , Wang Suli , Wang Shuai , Hong Ming , Zhu Yu , Lu Ruinan , Qiao Chun , Wu Yujie , He Guangsheng , Li Jianyong
Published: October 2019

To evaluate whether the adult patients with acquired pure red cell aplasia (PRCA) could benefit more from cyclosporine A (CsA) combined with corticosteroids (CS) than CsA or CS alone.

Seventy-three patients were evaluated in 2 institutions (6 patients lost to follow-up).

The induction therapy included CsA (n = 21), CS (n = 21), or CsA combined with CS (n = 31), and remission was achieved in 16/21 (76.2%), 10/21 (47.6%), and 21/31 (71.0%) patients, respectively. Higher complete remission (CR) rate was achieved in CsA combined with CS group than in CS group (61.3% vs 19.0%, P = .003). Patients achieved CR faster in CsA combined with CS group than in CS group or CsA group (median time, 1 month vs 2 month vs 3 month, P = .010). By multivariate analysis, CsA combined with CS therapy and primary PRCA were the influence factors for CR rate. Twenty-seven patients relapsed due to discontinuation or tapering therapy, and 19 patients regained response by increasing the dose of original regimens or changing to other immunosuppressive therapy. Complete remission to induction therapy was a correlative factor for death (P = .035).

CsA combined with CS produced faster and higher CR rate in treating adult patients with PRCA than did CsA or CS alone.
Sleep quality and nocturnal pain in patients with hip osteoarthritis
Authors: Martinez Riley , Reddy Nisha , Mulligan Edward P. , Hynan Linda S. , Wells Joel
Published: October 2019

Osteoarthritis (OA) is a common condition of the hip. Patients with hip OA often report nocturnal pain, yet little is known how it affects sleep quality. The purpose of this paper was to assess how hip arthritis affects sleep quality. We hypothesized that hip pain caused by hip OA affects sleep quality in adult patients.

This is a prospective, cross-sectional study of patients who were diagnosed with hip OA. Patients were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), hip outcome score (HOS), and modified Harris hip score (mHHS). Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). A multiple regression model was used to assess factors associated with poor sleep quality.

A total of 106 patients were analyzed. All patients had a Tonnis grade of 2 or 3 and American Society of Anesthesiologists (ASA) classification of 2. WOMAC, HOS, and mHHS were significantly and negatively correlated with PSQI. The multiple regression model, WOMAC, short form health survey vitality, ASA classification, and history of obstructive sleep apnea were associated with poor sleep quality (R = 0.60, P < .001).

Patients with hip OA, who report a symptomatic hip, are susceptible to reduced sleep quality. There is a correlation between worsening HOSs and sleep quality. The WOMAC score is a significant predictor of poor sleep quality. Patients with poor hip metrics should be screened for sleep disturbance.
Polymorphic variants conferring genetic risk to cervical lesions support GSTs as important associated loci
Authors: Tian Sijuan , Yang Xiaofeng , Zhang Li , Zhao Juan , Pei Meili , Yu Yang , Yang Ting
Published: October 2019

To analyze the association between glutathione S-transferases polymorphisms and the risk of cervical lesions.

Case-control studies focusing on the association between glutathione S-transferase polymorphisms and the risk of cervical lesions were collected from the PubMed, Web of Science, Cochrane Library, Embase, Medline, CNKI, VIP and Wanfang databases from inception to August 2018. Pooled odds ratios and 95% confidence intervals were employed to evaluate the strength of the association. Subgroup analysis and sensitivity analysis were used to test the potential discrepancy and robustness, respectively.

A total of 30 studies comprising 3961 patients and 4726 healthy controls satisfied the inclusion criteria. Of these, 6 studies contained information aboutGSTP1, 27 studies contained information aboutGSTM1, and 22 studies contained information aboutGSTT1. Our results supported that there was no statistical association betweenGSTP1polymorphism and the risk of cervical lesions (odds ratio [OR] = 1.08,P = .40). TheGSTM1null variant showed increased susceptibility to cervical lesions (OR = 1.45,P < .001). Subgroup analysis revealed that theGSTM1null variant caused cervical lesions among HPV infection cases (OR = 1.69,P = .02) and among the Chinese and Indian populations (OR = 2.24 and OR = 1.87, respectively,P < .001). TheGSTT1null variant increased the risk of cervical lesions in smokers (OR = 1.52,P = .03). TheGSTT1null genotype was also related to high-grade intraepithelial neoplasia (HSIL) and cervical cancer risk (OR = 1.30 and OR = 1.78, respectively,P < .05).

TheGSTM1null variant caused cervical lesions, especially among HPV infection cases and among the Chinese and Indian populations. TheGSTT1null variant increased the risk of cervical lesions in smokers and was also related to HISL and cervical cancer risk.
Color density spectral array for early evaluation of prognosis of patients with coma in pediatric intensive care unit
Authors: Wang Jiangtao , Hao Xiaosheng , Zhang Yanfeng , Liu Guiling , Chen Yinbo , Qu Ge , Li Chunnv , Liang Jianmin
Published: October 2019

The aim of this study was to assess the bedside brain function monitoring of color density spectral array (CDSA) for early prognostic evaluation of coma patients in pediatric intensive care unit (PICU).

Forty-two consecutive pediatric coma patients were enrolled. The individual conscious state was evaluated according to the Glasgow coma scale (GCS). CDSA parameters including CDSA pattern (CDSAP), sleep–wake cycle (SWC), sleep stage (SS), and drug-induced fast wave activity (DIFWA) were recorded. Three months later, prognosis was evaluated according to pediatric cerebral performance category (PCPC) score, based on which the patients were divided into FP-group (favorable prognosis) and PP-group (poor prognosis).

The changeable type of CDSAP, appearance of SWC, SS, and DIFWA were significantly correlated with favorable prognosis. Both GCS and SWC were significantly correlated with the prognosis. However, there was substantial overlap in GCS between FP-group and PP-group. Although the absence of SWC was statistically an independent risk factor for poor prognosis but with a high false positive rate (0.143), a linear logistic regression showed the odds ratio of GCS for predicting prognosis was 0.93 (95% confidence interval: 0.48–1.80; P = .83) and that of SWC was 0.12 (95% confidence interval: 0.03–0.47; P = .03). Furthermore, the absence of SWC was correlated with poor prognosis in nonintracranial infection patients.

Our study found that several CDSA factors are associated with prognosis of coma patients in PICU. SWC may be a potential indicator for evaluating the prognosis of coma patients in PICU.
Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients
Authors: Jiang Rongjuan , Sun Yan , Wang Huaiming , Liang Min , Xie Xianfeng
Published: October 2019

Background:

Evidence suggests that dry CO2 insufflation during laparoscopic colorectal surgery results in greater structural injury to the peritoneum and longer hospital stay than the use of warm, humidified CO2. We aimed to test the hypothesis that warm, humidified CO2 insufflation could reduce postoperative pain and improve recovery in laparoscopic colorectal surgery.

Methods:

One hundred fifty elderly patients undergoing laparoscopic colorectal surgery under general anesthesia from May 2017 to October 2018 were randomly divided into 3 groups. The primary outcomes were resting pain, cough pain, and consumption of sufentanil at 2, 4, 6, 12, 24, and 48 hours postoperatively. Quality of visual image, hemodynamic changes, esophageal temperature, mean skin temperature, mean body temperature, recovery time, days to first flatus and solid food intake, shivering, incidence of postoperative ileus, length of hospital stay, surgical site infections, patients and surgeon satisfaction scores, adverse events, prothrombin time, activated partial thromboplastin time, and thrombin time were recorded.

Results:

Group CE patients were associated with significantly higher early postoperative cough pain and sufentanil consumption than the other 2 groups (P < .05). Compared with group CE, patients in both groups WH and CF had significantly reduced intraoperative hypothermia, recovery time of PACU, days to first flatus and solid food intake, and length of hospital stay, while the satisfaction scores of both patients and surgeon were significantly higher (P < .05). Prothrombin time, activated partial thromboplastin time, and thrombin time were significantly higher in group CE from 60 minutes after pneumoperitoneum to the end of pneumoperitoneum than the other 2 groups (P < .05). The number of patients with a shivering grade of 0 was significantly lower and grade of 3 was significantly higher in group CE than in the other 2 groups (P < .05).

Conclusion:

Use of either warm, humidified CO2 insufflations or 20°C, 0% relative humidity CO2 combined with forced-air warmer set to 38°C during insufflations can both reduce intraoperative hypothermia, dysfunction of coagulation, early postoperative cough pain, sufentanil consumption, days to first flatus, solid food intake, and length of hospital stay.
Polydeoxyribonucleotide injection in the treatment of patients with carpal tunnel syndrome
Authors: Huh Joonyoung , Shim Kwang Seok , Cho Hyun-jung , Lee Byung Joo , Park Donghwi
Published: October 2019

Background:

Corticosteroid injection is beneficial in treating carpal tunnel syndrome (CTS) due to its anti-inflammatory effects. However, its side effects limit widespread usage. Recently, several studies have found that polydeoxyribonucleotide offers anti-inflammatory capabilities with fewer side effects, making it an ideal alternative. Nevertheless, there has been no study on its effectiveness in patients with CTS. Therefore, we evaluate the effectiveness of polydeoxyribonucleotide in patients with CTS. Based on the criteria, 30 patients with CTS who received two-consecutive polydeoxyribonucleotide injections (with a week interval) were initially included.

Method:

Patients with CTS were investigated retrospectively. To evaluate the effectiveness of polydeoxyribonucleotide in patients with CTS, numeric rating scale (NRS), cross-sectional area (CSA) of the median nerve, and severity and functional status scores of CTS based on the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were assessed.

Results:

There was a significant improvement in the NRS, CSA, and functional and severity scores of BCTQ after two-consecutive polydeoxyribonucleotide injections (P < .05).

Conclusion:

In conclusion, although more research is needed to evaluate the effectiveness of polydeoxyribonucleotide in patients with CTS, the findings here suggest that polydeoxyribonucleotide may be a viable alternative to corticosteroids in patients with CTS.
Outcomes of laparoscopic repeat liver resection for recurrent liver cancer
Authors: Peng Yufu , Liu Fei , Wei Yonggang , Li Bo
Published: October 2019

Background:

With the improvements of surgical instruments and surgeons’ experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer.

Methods:

A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data.

Results:

A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: −33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = −187.33 mL; 95%CI: −249.62 to −125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06–1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23–0.76; P = .004), and shorter hospital stays (WMD = −2.31; 95%CI: −3.55 to −1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99–114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups.

Conclusions:

LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.
The investigation of diet recovery after distal gastrectomy
Authors: Kim Tae-Han , Lee Young-Joon , Bae Kyungsoo , Park Ji-Ho , Hong Soon-Chan , Jung Eun-Jung , Ju Young-Tae , Jeong Chi-Young , Park Tae-Jin , Park Miyeong , Kim Ji Eun , Jeong Sang-Ho
Published: October 2019

This study aims to investigate the adaptation process of the alimentary tract after distal gastrectomy and understand the impact of remnant stomach volume (RSV) on diet recovery.

One year after gastrectomy, although patients’ oral intake had increased, the RSV was decreased and small bowel motility was enhanced. Patients with a larger RSV showed no additional benefits regarding nutritional outcomes.

We prospectively enrolled patients who underwent distal gastrectomy with Billroth II reconstruction to treat gastric cancer at a tertiary hospital cancer center between September 2009 and February 2012. Demographic data, diet questionnaires, computed tomography (CT), and contrast fluoroscopy findings were collected. Patients were divided into 2 groups according to the RSV calculated using CT gastric volume measurements (large vs small). Dietary habits and nutritional status were compared between the groups.

Seventy-eight patients were enrolled. Diet volume recovered to 90% of baseline by the 36th postoperative month, and RSV was 70% of baseline at 6 months after surgery and gradually decreased over time. One year after surgery, small bowel transit time was 75% compared to the 1st postoperative month (P < .05); however, transit time in the esophagus and remnant stomach showed no change in any studied interval. Compared to patients with a small RSV, those with a large RSV showed no differences in diet volume, habits, or other nutritional benefits (P > .05).

Diet recovery for distal gastrectomy patients was achieved by increased small bowel motility. The size of the remnant stomach showed no positive impact on nutritional outcomes.
Long-Term Functional Outcome After Pancreatoduodenectomy for Periampullary Carcinoma With Morphological Correlation
Authors: Saluja Sundeep Singh , Kiran Shashi , Mishra Pramod Kumar , Ramaswamy Dinesh , Varshney Vaibhav Kumar , Godhi Satyajit , Sisodia Kshitij
Published: October 2019

Objective

The aim of the study was to evaluate the long-term functional outcome (exocrine and endocrine) and morphological changes in remnant pancreas after pancreatoduodenectomy and its clinical impact.

Methods

Periampullary carcinoma patients with minimum follow-up of 2 years and without recurrence were included (N = 102). Exocrine insufficiency includes clinical steatorrhea and fecal elastase-1 (FE-1) levels; endocrine insufficiency, glucose levels and glycated hemoglobin; and morphological changes, main pancreatic duct (MPD) diameter and thickness of remnant pancreas.

Results

The mean (standard deviation) follow-up period was 59 (26) months. Of the 102 patients, 81 (80%) had severely deficient FE-1 (0–100 μg/g). The preoperative MPD was significantly more and thickness of remnant pancreas was significantly less in patients with severely deficient FE-1. Overall, 15.6% (16/102) developed steatorrhea and improved on enzyme replacement therapy. The presence of MPD stricture (P = 0.008) and weight loss (P = 0.001) were significantly associated with steatorrhea. New-onset diabetes was seen in 17% (15/90) patients, of whom 3 of 5 developed it after 4 years (range, 4–7 years). The blood glucose was controlled on oral hypoglycemics in 2 (10/15) of 3 patients.

Conclusions

The assessment by FE-1 indicates loss of exocrine function in more than 90%, whereas only 1 of 6 developed steatorrhea and new-onset diabetes. Morphological changes especially MPD stricture affect the functional status of remnant pancreas.
Parecoxib Improves the Outcomes of Acute Mild and Moderate Pancreatitis
Authors: Tan Jie-hui , Zhou Lei , Kan He-ping , Zhang Guo-wei
Published: October 2019

Objectives

The aim of this study was to evaluate the role of parecoxib in patients with different severities of acute pancreatitis (AP).

Methods

A total of 772 eligible patients with AP were divided into 4 groups: mild and moderately AP (MAP) treated with parecoxib (group A, n = 236), MAP without parecoxib treatment (group B, n = 453), severe AP (SAP) treated with parecoxib (group C, n = 28), and SAP without parecoxib treatment (group D, n = 55). Patients in group A were exactly matched with patients in group B by propensity score matching, similar to the matching between group C and group D.

Results

The morbidity of abdominal infection in group A was significantly lower as compared with that in group B (P < 0.050). The progression of MAP to SAP significantly decreased in group A than group B (P < 0.050). No significant differences were observed between group C and group D. The risk factors independently related to the progression of MAP included alcoholic/high-fat dietary (P = 0.028) and parecoxib administration (P = 0.011).

Conclusions

Early administration of parecoxib could reduce the morbidity of complications among patients with MAP. Parecoxib may prevent the progression of MAP to SAP and improve its outcomes.
Risk Factors Associated With Progression Toward Endocrine Insufficiency in Chronic Pancreatitis
Authors: Gutama Barite W. , Yang Yi , Beilman Gregory J. , Freeman Martin L. , Kirchner Varvara A. , Pruett Timothy L. , Chinnakotla Srinath , Downs Elissa M. , Trikudanathan Guru , Schwarzenberg Sarah J. , Hodges James S. , Bellin Melena D.
Published: October 2019

Objective

Little data exist describing the change over time in islet function and glycemic control in patients with chronic pancreatitis (CP).

Methods

In 325 CP patients who underwent 2 mixed meal tolerance tests and/or glycated hemoglobin (HbA1c) levels, we estimated the rate of change in metabolic measures per 6 months and assessed the association between potential risk factors for diabetes and rate of change using multivariate regression models.

Results

Per 6-month time, HbA1c increased by 0.062% with a standard error of 0.029% (P = 0.037) and the ratio (area under the curve (AUC) C-peptide to AUC glucose from mixed meal tolerance testing) decreased by 0.0028 with a standard error of 0.0011 (P = 0.014). We observed more rapid decline in smokers (AUC C-peptide, P = 0.043) and patients with surgical drainage (AUC glucose, P = 0.001; ratio, P = 0.03) or with calcific pancreatitis (HbA1c, P = 0.003). In multivariate models, AUC C-peptide and ratio declined at a greater rate in smokers and HbA1c in those with pancreatic calcifications (both P < 0.05).

Conclusions

We observed a measurable decline in β-cell function and glycemic control in patients with CP. Patients with a history of tobacco smoking, surgical drainage, or pancreatic calcification may be at highest risk.
The Prevalence of Nonalcoholic Fatty Pancreas by Endoscopic Ultrasonography
Authors: Sotoudehmanesh Rasoul , Tahmasbi Afshin , Sadeghi Ahmad , Hosseini Hamed , Mohamadnejad Mehdi
Published: October 2019

Objectives

Pancreatic steatosis or fatty pancreas refers to the fat accumulation in the pancreas, which can lead to inflammation and fibrosis, β-cell dysfunction, fibrosis, and, possibly, pancreatic cancer. This study aimed to study the prevalence of fatty pancreas and its risk factors in patients referred to an endosonography center.

Methods

During 18 months, 228 patients who were referred to our endosonography center for various reasons were evaluated for fatty pancreas. Fatty pancreas was defined as hyperechoic pancreas echotexture compared with spleen echotexture. Demographic characteristics, past medical history, and laboratory measurements were compared between groups with and without fatty pancreas to determine the risk factors for fatty pancreas.

Results

The prevalence of fatty pancreas was 25.9%. Patients with fatty pancreas had a significantly higher mean level of uric acid (P = 0.04), frequency of ischemic heart disease (P = 0.03), hyperlipidemia (P = 0.04), frequency of fatty liver (P < 0.001), and aortic intima thickness (P = 0.01). There was no significant difference in age, sex, body mass index, smoking status, substance abuse, and use of oral contraceptives in the 2 groups.

Conclusions

Fatty pancreas is a common disorder. There are meaningful relationships between coronary artery disease, nonalcoholic fatty liver, and atherosclerosis with fatty pancreas.
Analysis of Real-World Treatment Patterns, Healthcare Resource Utilization, and Costs Between Octreotide and Lanreotide Among Patients With Neuroendocrine Tumors
Authors: Huynh Lynn , Cai Beilei , Cheng Mu , Lax Angie , Lejeune Dominique , Duh Mei S. , Kim Michelle K.
Published: October 2019

Objective

The aim of the study was to assess treatment patterns, healthcare resource utilization, and healthcare costs among patients with neuroendocrine tumors (NETs) receiving long-acting octreotide versus lanreotide, overall and in patients with carcinoid syndrome (CS).

Methods

A provider-based claims database was used to identify NET patients who first initiated long-acting octreotide or lanreotide (index date) from January 2015 to November 2017. Propensity-score matching 1:1 was used. Patients with CS were identified from the previously mentioned matched cohorts. Time-to-treatment discontinuation (TTD) was estimated using Kaplan-Meier analyses. Per-patient-per-month rates of healthcare resource utilization were compared using rate ratios from multivariable Poisson regression models. Multivariable linear regression models were used to compare mean monthly cost differences.

Results

The median TTD was similar between the 2 matched cohorts (N = 543 each; long-acting octreotide = 19.2 months, lanreotide = 17.5 months, P = 0.58). Significantly fewer NET-related outpatient visits (rate ratio = 0.95, P = 0.005) and significantly lower total healthcare costs (mean monthly cost difference: all-cause = US −$3701, NET-related = US −$3752, Ps < 0.001) were observed in the long-acting octreotide cohort than lanreotide. Similar results were found in CS patients.

Conclusions

Patients on first-line long-acting octreotide and lanreotide had similar TTD. Long-acting octreotide was associated with significantly lower total healthcare costs than lanreotide.
Anterior Chamber Angle Evaluation Using Gonioscopy: Consistency and Agreement between Optometrists and Ophthalmologists
Authors: Phu Jack , Wang Henrietta , Khuu Sieu K. , Zangerl Barbara , Hennessy Michael P. , Masselos Katherine , Kalloniatis Michael
Published: October 2019

SIGNIFICANCE

In our intermediate-tier glaucoma care clinic, we demonstrate fair to moderate agreement in gonioscopy examination between optometrists and ophthalmologists, but excellent agreement when considering open versus closed angles. We highlight the need for increased consistency in the evaluation and recording of angle status using gonioscopy.

PURPOSE

The consistency of gonioscopy results obtained by different clinicians is not known but is important in moving toward practice modalities such as telemedicine and collaborative care clinics. The purpose of this study was to evaluate the description and concordance of gonioscopy results among different practitioners.

METHODS

The medical records of 101 patients seen within a collaborative care glaucoma clinic who had undergone gonioscopic assessment by two clinicians (one optometrist and either one general ophthalmologist [n = 50] or one glaucoma specialist [n = 51]) were reviewed. The gonioscopy records were evaluated for their descriptions of deepest structure seen, trabecular pigmentation, iris configuration, and other features. These were compared between clinicians (optometrist vs. ophthalmologist) and against the final diagnosis.

RESULTS

Overall, 51.9 and 59.8% of angles were graded identically in terms of deepest visible structure when comparing between optometrist versus general ophthalmologist and optometrist versus glaucoma specialist, respectively. The concordance increased when considering ±1 of the grade (67.4 and 78.5%, respectively), and agreement with the final diagnosis was high (>90%). Variations in angle grading other than naming structures were observed (2.0, 30, and 3.9% for optometrist, general ophthalmologist, and glaucoma specialist, respectively). Most of the time, trabecular pigmentation or iris configuration was not described.

CONCLUSIONS

Fair to moderate concordance in gonioscopy was achieved between optometrists and ophthalmologists in a collaborative care clinic in which there is consistent feedback and clinical review. To move toward unified medical records and a telemedicine model, improved consistency of record keeping and angle description is required.
Correlation of p16 Expression on Cancer and Stromal Cells With Clinicopathologic and Immunohistochemical Features of Lobular Breast Carcinoma
Authors: Harbhajanka Aparna , Lamzabi Ihab , Bitterman Pincas , Reddy Vijaya B. , Ghai Ritu , Gattuso Paolo
Published: October 2019

Background:

Cancer-associated fibroblasts, play a central role in the tumor-stroma interaction and promote tumorigenesis. However, it is still unclear how these processes are regulated. The aim of this study is to investigate p16 expression in cancer and stromal cells of invasive lobular carcinoma (ILC).

Design:

Clinicopathologic parameters and immunohistochemical stains for estrogen receptor (ER), progesterone receptor, E-cadherin, and human epidermal growth factor receptor 2 of 70 ILC cases were retrieved. In addition, immunohistochemical were performed for p53, p16, and cyclin D1. The p16 expression in cancer and stromal cells were correlated with different clinicopathologic parameters.

Results:

Of the 70 cases, 8 cases were p16− cancer and stromal cells, 14 cases p16− cancer and p16+ stromal cells, 14 cases p16+ cancer and p16− stromal cells, and 34 cases p16+ cancer and stromal cells. Thirty-one of the 59 cases showed axillary lymph node metastases. Nodal involvement, recurrence, and metastasis of ILC with p16+ cancer cells and p16− stromal cells were more frequent compared with other groups. ILC with p16+ cancer and p16− stromal cells were frequently negative for ER, progesterone receptor, and cyclin D1, p53 positive and triple negative compared with other groups. There was no recurrence and metastasis in ILC with p16− cancer and p16+ stromal cells. ILC with p16+ cancer and stromal cells were significantly node negative and were positive for ER and cyclin D1 compared with other groups.

Conclusions:

ILC with p16+ cancer and p16− stromal cells were characterized by frequent nodal involvement, recurrence, and metastatic propensity. These results suggest that p16, has novel anticancer properties capable of suppressing cancer cell migration and invasion and pharmacologic restoration of p16 level in stromal fibroblasts may be exploited as therapeutic strategy to prevent nodal or distant metastasis.
Pediatric Rehabilitation Therapies Differ in Intensity
Authors: Ambuehl Maria , van Hedel Hubertus J. A. , Labruyère Rob
Published: October 2019

Objective

When investigating dose-response relationships in rehabilitation studies, dose is often equated with duration of therapy. However, according to the American College of Sports Medicine, dose consists of the factors frequency, intensity, time, and type. Thereby, especially quantification of intensity needs improvement to have a more precise estimate of the dose. Thus, the aim was to investigate the intensity during mobility-focused, real-life pediatric rehabilitation therapies.

Design

Eleven participants (5 girls, 12.5 ± 2.1 yrs old) with neurological disorders and independent mobility wore accelerometers at wrists and ankles and a portable heart rate monitor during several of the following therapies: sports therapy, mobility-focused physiotherapy, medical training therapy, and robot-assisted gait training. Intensity of physical activity was quantified by activity counts (measured via accelerometers) and heart rate.

Results

Therapy duration did not correlate with intensity. At the same time, we found significant differences between intensities of different therapies.

Conclusion

Different therapies elicit different levels of intensity in children with neuromotor disorders. Heart rate and activity counts are suited to estimate the intensity of a therapy and provide complementary information. We recommend against using the duration of a therapy as a proxy for the dose to make statements about dose-response relationships.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Appraise the importance of measuring the intensity of various types of inpatient rehabilitation therapy for determining the dose; (2) Describe the differences in intensities between different training forms and name factors that influence this intensity; and (3) Discuss the influence of the functional level of a patient on his/her potential to engage in physically intensive therapy sessions.

Level

Advanced.

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Endoscopy-Assisted Intraoral Removal of Elongated Styloid Process: Mini-Invasive Surgical Treatment of Eagle Syndrome
Authors: Terenzi Valentina , Giovannetti Filippo , Barbera Giorgio , Raponi Ingrid , Valentini Valentino
Published: October 2019

The aim of this work is to illustrate a transoral mini-invasive approach to safely remove elongated styloid process in Eagle syndrome. A 34-year-old Asian male came to our center referring pharyngeal and cervical pain on the right side on swallowing and opening the mouth. Computed tomography showed elongation of the right styloid process. Surgical removal was performed through endoscopy-assisted intraoral approach using a pituitary curette to perform dissection and piezosurgery for the osteotomy. Surgical intervention was completed in 25 minutes. Postoperative period was uneventful except for transient (12 hours) right facial palsy that resolved spontaneously. Two months after surgery, patient referred resolution of symptoms. This technique is easy to perform and permits to obtain good result with reduction of surgical time and with low risk of complication.