bluuebunny/crossref_metadata_2025 huggingface dataset:
Transport and Preservation Comparison of Preloaded and Prestripped-Only DMEK Grafts
Authors: Català Pere , Vermeulen Wessel , Rademakers Timo , van den Bogaerdt Antoon , Kruijt Pieter Jan , Nuijts Rudy M. M. A. , LaPointe Vanessa L. S. , Dickman Mor M.
Published: May 2020

Purpose:

This study compares the effect of the transport of conventionally prestripped Descemet membrane endothelial keratoplasty (DMEK) tissue with the DMEK revolutionary advanced Preloadable Injection Device (RAPID) preloaded transport system from Geuder AG (Heidelberg, Germany). Endothelial cell loss, tissue integrity, endothelial cell phenotype, and viability were assessed and compared.

Methods:

Twelve DMEK grafts were prestripped by the cornea bank and transported using the following 2 conditions: conventional flask (n = 6) or a preloaded transport cartridge (DMEK RAPID, n = 6). After transport, tissues were analyzed for cell density; denuded areas; immunolocalization of corneal endothelial markers, such as ZO-1, CD166, and Na+/K+ ATPase; histology analysis; and cell viability staining with Hoechst, calcein AM, and ethidium homodimer.

Results:

Endothelial cell loss (10.35% vs. 9.15%) did not differ between transport conditions. Histological analysis confirmed the integrity of the Descemet membrane and endothelial cell layer with both transport conditions. Similarly, the corneal endothelial cell mosaic was conserved in both conditions. The ZO-1 tight junctions confirmed the integrity of the confluent corneal endothelial cell monolayer. CD166 and Na+/K+ ATPase detection with immunofluorescence was also comparable. A similar percentage of dead cells was reported in both conditions (18.1% vs. 16.73%). Moreover, the surface covered with calcein-positive cells (59.02% vs. 61.95%) did not differ between transport conditions.

Conclusions:

Our results suggest that DMEK grafts can be prestripped or preloaded into a novel transport cartridge and shipped to the clinic with comparable endothelial cell loss, phenotypical marker expression, and viability to the conventional prestripped donor tissue.
Korean language specific dysarthria associated with idiopathic peripheral facial palsy
Authors: Lee Dong-Woo , Oh Ja-Young , Han Mi-Hyang , Kim Da-Ye , Lee Jae-Woo , Jang Dae-Hyun
Published: May 2020

To investigate the patterns of dysarthria in Korean patients with idiopathic peripheral facial palsy.

Seventy-eight patients diagnosed with idiopathic peripheral facial palsy within the onset of symptom to 7 day time frame were prospectively enrolled. The initial symptom of facial palsy was examined by the House-Brackmann scale. All patients were tested by Urimal-Test of Articulation and Phonology-2 (U-TAP-2), which is specialized for the evaluation of dysarthria in Korean language - Hangeul - when the patients first visited and were followed up at 4 weeks after the onset, respectively. The facial electromyography was performed after 7 days, since the presentation of the first symptom. Electric stimulation therapy and simple facial exercise education were performed in all patients as routine treatments for facial palsy with or without dysarthria. The patterns of dysarthria were analyzed by initial and follow-up U-TAP-2 results, respectively.

Among 78 patients, 50 patients (64.1%) had dysarthria in the first assessment. The 6 consonants and 3 vowels were errored in U-TAP-2 test. The bilabial consonants “ㅃ”[p] or “ㅍ” [ph] were substituted with labiodental consonant [f], and palate-alveolar consonants were replaced by alveolar consonants - “ㅊ”[t

JOURNAL/medi/04.03/00005792-202005220-00004/inline-graphic1/v/2024-05-21T181312Z/r/image-tiff

h] to “ㅌ”[th]. Bilabial consonant “ㅁ”[m] was replaced by velar nasal consonant “ㅇ”[ŋ]. Liquid consonant was altered to nasal sound. For example, “ㄹ”[r] is replace by “ㄴ”[n]. The velar consonant “ㄲ”[k] was pronounced as “ㅋ” [kh]. The diphthong vowels “ㅟ”[ɥi], “ㅚ”[ø], or “ㅘ”[wa] were pronounced as monothong “ㅣ” [i], “ㅐ”[ε], or “ㅏ”[a], and “못”[mot] is slowly pronounced. After 4 weeks, 14 patients still showed pronunciation errors in 5 consonants and 3 vowels. The most common error was substitution.

Among 78 patients with idiopathic peripheral facial palsy, 50 patients had dysarthria and 14 out of 50 patients with dysarthria lasted more than 4 weeks. Five consonants (“ㅁ”, “ㅊ”, “ㅍ”, “ㄹ”, “ㄲ”) and 3 vowels (“ㅘ”, “ㅗ”, “ㅟ or ㅚ”) were still mispronounced after 4 weeks, and most common error was substitution. Therefore, speech evaluation and speech therapy specialized for errors in high frequency of consonants and vowels are needed in patients with idiopathic peripheral facial palsy, in Korea.
Treatment of Type 2 diabetes with Tianqi Jiangtang Capsule
Authors: Piao Chunli , Zhang Qi , Jin De , Shao Mengsu , Bi Chaoran , Wang Li , Tang Cheng , Lian Fengmei , Tong Xiaolin
Published: May 2020

Background:

Tianqi Jiangtang Capsule is a commonly used Chinese patent medicine for the treatment of type 2 diabetes mellitus (T2DM) in China. The purpose of this study is to systematically evaluate the clinical efficacy and safety of Tianqi Jiangtang Capsule in the treatment of type 2 diabetes mellitus.

Methods:

Randomized controlled trials (RCTs) of Tianqi Jiangtang Capsule in the treatment of type 2 diabetes mellitus were retrieved. According to the requirements of Cochrane Manual, the included literature was assessed and meta-analyzed with RevMan 5.3 software.

Results:

(1) Meta-analysis included 8 RCTs and 1029 participants.

(2) There were two studies on adverse reactions.

(3) Meta-analysis showed that Tianqi Jiangtang Capsule could significantly reduce HbA1c (n = 1029; MD, −0.31; 95% CI, [−0.43 to −0.19]; P < .00001; I2 = 0%). FBG (Z = 4.28 (P < .0001), MD = 0.78, 95%CI[−1.14 to −0.43]). 2hPG [OR = −1.25, 95% CI [−1.25 to −0.65], Z = 6.26 (P < .00001)] compared with the control group.

Conclusions:

According to the results of this study, Tianqi Jiangtang Capsule combined with antidiabetic agents may have a better therapeutic effect on diabetes mellitus than antidiabetic agents alone, but due to the low methodological quality and limited number of studies, more high-quality studies are needed to verify it.
Dynesys system vs posterior decompression and fusion for the treatment of lumbar degenerative diseases
Authors: Wang Hongbo , Peng Jun , Zeng Qingshen , Zhong Yanchun , Xiao Chunlin , Ye Yongjun , Huang Weimin , Liu Wuyang , Luo Jiaquan
Published: May 2020

Background:

The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. The purpose of this study is to evaluate the clinical efficacy between Dynesys and posterior decompression and fusion for lumbar degenerative diseases.

Methods:

The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software was used for data analysis.

Results:

A total of 17 studies were included in the meta-analysis. There were no significant differences in Oswestry disability index and visual analogue score for leg pain, visual analogue score for back pain, L2–S1 ROM between Dynesys and fusion group. Operation time, blood loss, length of stay and complications in the Dynesys group were significantly less than that in the fusion group. Adjacent-segment degeneration in the fusion group was significantly higher than that in the Dynesys group. In addition, postoperative operated segment ROM was significantly less in the fusion group as compared to the Dynesys group.

Conclusions:

Our meta-analysis suggests that Dynesys system acquires comparable clinical outcomes compared to fusion in the treatment of lumbar degenerative diseases. Moreover, compared with fusion, Dynesys could remain ROM of surgical segments with less operation time, blood loss, length of stay, adjacent-segment degeneration, and lower complication. Further studies with large samples, long term follow up and well-designed are needed to assess the two procedures in the future.
Successful rescue using tracheal intubation cannula for severe central airway stenosis after tracheotomy
Authors: Li Hai-Feng , Xing Bao-Peng , Song Li-Sha , Wang Wei , Liu Bao-Hua
Published: May 2020

Introduction:

Central airway stenosis is a life-threating requiring immediate medical intervention. There are several options for treating central airway stenosis, including rigid bronchoscopy, bronchoscopic high-power laser therapy, high-frequency electric needle knife, and balloon-expanding stents. However, interventional techniques may be unavailable in an emergent situation or at smaller local hospitals. In this case report, we publicly demonstrate for the first time that a tracheal intubation catheter may be applied as a temporary alternative to interventional bronchoscopic treatment.

Patient concerns:

A 72-year old male patient was admitted with a 1-year history of intermittent dyspnea, which was exacerbated for one day. One day prior to admission to our hospital, the patient presented with cyanosis due to an exacerbation of dyspnea.

A tracheotomy was performed and the patient had been carrying a tracheotomy cannula for 6 months.

Diagnosis:

The ventilator alarm indicated high airway resistance and the nurses were unable to insert the suction pipes into the airway. Immediate fiberoptic bronchoscopy showed diffuse edema and stenosis of the inferior tracheal airways.

Interventions:

Tracheal intubation was used to temporarily replace the tracheotomy cannula, which successfully expanded the narrowed airways.

Outcomes:

The blood oxygen saturation returned to normal, and dyspnea was quickly relieved.

Conclusion:

In emergent situations, tracheal intubation catheters may be used in patients with post-tracheotomy central airway stenosis, not only for surviving the most dangerous phase but for also prolonging the survival time for further treatments.
Antidepressant use and colorectal cancer morbidity and mortality
Authors: Chen Lin , Li Xun , Li Chengbin , Zou Chuanxin
Published: May 2020

The risk of colorectal cancer associated to antidepressant use remains unclear. The purpose of this meta-analysis was to investigate the risk of colorectal cancer associated to antidepressant use.

Medline, Embase, Web of Science, and Cochrane Database were accessed from the dates of their establishment to October 2018, to collect study of antidepressant use and colorectal cancer morbidity and mortality. Then a meta-analysis was conducted using Stata 12.0 software.

A total of 11 publications involving 109,506 participants were included. The meta-analysis showed that antidepressant use was not associated with colorectal cancer morbidity (relevant risk (RR): 0.97; 95% confidence interval (CI): 0.94–1.01) and mortality (RR: 1.08; 95% CI: 0.99–1.17). Subgroup analysis showed selective serotonin reuptake inhibitor (RR: 0.99; 95% CI: 0.96–1.03) or serotonin norepinephrine reuptake inhibitor (RR: 1.04; 95% CI: 0.86–1.26) were not associated with colorectal cancer risk; however, TCA was associated with colorectal cancer risk decrement (RR: 0.92; 95% CI: 0.87–0.98). Furthermore, the results also showed that antidepressant use was not associated with colorectal cancer risk in Europe and North America (RR: 0.97; 95% CI: 0.92–1.02) and Asia (RR: 1.00; 95% CI: 0.95–1.26). Additionally, a dose-response showed per 1 year of duration of antidepressant use incremental increase was not associated with colorectal cancer risk (RR: 0.96; 95% CI: 0.87–1.09).

Evidence suggests that antidepressant use was not associated with colorectal cancer morbidity and mortality. The cumulative duration of antidepressant use did not utilized played critical roles.
Role of long non-coding RNA NEAT1 in the prognosis of prostate cancer patients
Authors: Bai Junchao , Huang Guangyi
Published: May 2020

Prostate cancer is the second leading cause of cancer-related deaths among male population worldwide, its incidence and lethality steadily increase. Nuclear enriched abundant transcript 1 (NEAT1) is a long non-coding RNA (ncRNA), located on chromatin 11. It has been found to function as an oncogene in different kinds of cancer. However, until now, the clinical significance of NEAT1 has not been investigated in prostate cancer.

Paired tissue specimens of prostate cancer and matched normal prostate tissues were obtained from 130 patients with prostate cancer between 2014 and 2019 at The Fourth Affiliated Hospital Zhejiang University, School of Medicine. Group means were compared using the Student t test. Chi-Squared test was used for analyzing the correlation of the expression of NEAT1 with clinicopathologic features of prostate cancer patients. Survival data was analyzed using the Kaplan–Meier estimate and log-rank P was calculated. Cox regression model was used for univariate and multivariate analysis for factors related to overall survival.

The expression of NEAT1 was increased significantly in prostate cancer tissues, compared with adjacent normal prostate tissues (P < .001). NEAT1 expression was significantly associated with TNM stage (P = .005), lymph nodes metastasis (P = .005), distant metastasis(P = .003), and Gleason score (P = .001). Overall survival rate was significantly lower for prostate cancer patients with a high expression level of NEAT1 than those with a low NEAT1a expression level (P = .048). In multivariate analysis, the results showed that the expression of NEAT1 was an independent prognostic factor for overall patient survival (HR: 2.111, CI: 1.735–10.295, P = .039).

In the present study, NEAT1 is identified as an important lncRNA that may predict the prognosis of patients with prostate cancer.
Diagnosis and treatment of pure arterial malformation
Authors: Liu Tian-Yi , Xu Ning , Wan Zheng , Zhang Zhe-Ming , Xu Jian-Jun , Meng Hao , Wang Hong-lei
Published: May 2020

Rationale:

The incidence of pure arterial malformations is relatively low, and few cases have been reported. Only 2 cases with pure arterial malformation have been reported to receive surgery or endovascular treatment.

Patient concerns:

We report 3 cases and review the relevant literatures. The head examinations of the patients suggested the presence of high-density shadows in front of the pons and midbrain, the dilation of the supraclinoid segment of the right internal carotid artery, and moyamoya in the left brain with an aneurysm-like expansion located on the left posterior communicating artery respectively. After admission, head digital subtraction angiography (DSA) was performed.

Diagnoses:

Digital subtraction angiography (DSA) for these 3 patients showed that the left posterior communicating artery, the supraclinoid segment of the right internal carotid artery, and the left posterior communicating artery appeared dilated, tortuous, and spirally elongated. In addition, the lesions in the latter 2 patients were accompanied with local aneurysmal changes.

Interventions:

Two patients were given conservative treatment, and another patient was given endovascular treatment. A head DSA was reviewed 6 months after therapy.

Outcomes:

The prognosis status of the 3 patients was good. Two patients in the conservative treatment group showed no changes in the lesions on head DSA examination. The DSA examination of the third patient indicated that the vascular remodeling of the diseased vessels was good, the blood vessels were unobstructed, and the aneurysms had disappeared.

Lessons:

Pure arterial malformations mostly occur in young women and may involve any blood vessels in the brain. It can be accompanied with local aneurysms and calcification. The patients are often given conservative treatment but need to be reviewed regularly. However, it is beneficial to give endovascular treatment to the patients with local aneurysms.
Impact of herbs and dietary supplements in patients with fibromyalgia
Authors: Yang Juan , Bauer Brent A. , Wu Qinglong , Xiong Donglin , Wahner-Roedler Dietlind L. , Chon Tony Y. , Ganesh Ravindra
Published: May 2020

Background:

Fibromyalgia (FM) is a common chronic pain condition that seriously affects the quality of patient lives. Its etiology, pathogenesis, and treatment still remain uncertain. Dietary supplements have been widely trialed for symptom relief for FM. The review aims to synthesize the previous literature publications to assess the impact of herbs and dietary supplements on FM patients.

Methods:

We will conduct a literature search in the following databases PubMed, MEDLINE, EMBASE, Cochrane Library, Scopus, and Global Health from database inception to December 2019. Clinical studies published in the English language that used human participants and address the efficacy, safety, and acceptability of herbs and dietary supplements on individuals with FM will be included. The risk of bias and quality assessment of each trial will be evaluated. If trials are enough, a meta-analysis will be conducted using software RevMan5.3, Cochrane Collaboration.

Result:

Our review will be the first attempt to facilitate evidence-based management using herbs and dietary supplements to treat patients with FM.

Conclusion:

The findings may provide a framework for future research and clinic practice in FM management.

PROSPERO registration number:

CRD42020149941
A multi-center, randomized, double-blind, placebo-parallel controlled trial for the efficacy and safety of shenfuqiangxin pills in the treatment of chronic heart failure (Heart-Kidney yang deficiency syndrome)
Authors: Guo Lijun , Yuan Hui , Zhang Dawu , Zhang Jian , Hua Qi , Ma Xiaochang , Chen Keji
Published: May 2020

Background:

Heart failure (HF) is the final stage of various cardiac diseases with poor prognosis. The integrated traditional Chinese medicine (TCM) and western medicine therapy has been considered as a prospective therapeutic strategy for chronic heart failure (CHF). There have been small clinical trials and experimental studies to demonstrate the efficacy of Shenfu Qiangxin Pills (SFQX) for treating CHF, however, there is still a lack of further high-quality trial. This paper describes the protocol for the clinical assessment of SFQX in CHF (heart-kidney Yang deficiency syndrome) patients.

Methods:

A randomized, double-blind, parallel-group, placebo-controlled, multi-center trial will assess the efficacy and safety of SFQX in the treatment of CHF. 352 patients with CHF (heart-kidney Yang deficiency syndrome) from 22 hospitals in China will be enrolled. Besides their standardized western medicine, patients will be randomized to receive treatment of either SFQX or placebo for 12 weeks. The primary outcome is the plasma N-terminal pro-B-type natriuretic peptide levels, which will be measured uniformly by the central laboratory. The secondary outcomes include composite endpoint events (hospitalization due to worsening HF, all-cause mortality, other serious cardiovascular events), echocardiography indicators, grades of the New York Heart Association (NYHA) functional classification, the 6-minute walk test (6MWT) results, Minnesota Living With Heart Failure Questionnaire and TCM syndrome scores.

Discussion:

The integrated TCM and western medicine therapy has developed into a treatment model in China. The rigorous design of the trial will assure an objective and scientific assessment of the efficacy and safety of SFQX in the treatment of CHF.

Trial registration:

Chinese Clinical Trial Registry: ChiCTR2000028777 (registered on January 3, 2020).
STAPLAg: a convenient early warning score for use in infected patients in the intensive care unit
Authors: Zhang Keji , Lv Dan , Deng Yuxiao , Zhu Changqing , Gao Yuan , Huang Yuan , Xu Xinhui
Published: May 2020

Sepsis is a life-threatening disease in the intensive care unit (ICU). The current diagnostic criteria for sequential organ failure assessment (SOFA) scores do not reflect the current understanding of sepsis. We developed a novel and convenient score to aid early prognosis.

Retrospective multivariable regression analysis of 185 infected emergency ICU (EICU) patients was conducted to identify independent variables associated with death, to develop the new “STAPLAg” score; STAPLAg was then validated in an internal cohort (n = 106) and an external cohort (n = 78) and its predictive efficacy was compared with that of the initial SOFA score.

Age, and initial serum albumin, sodium, PLR, troponin, and lactate tests in the emergency department were independent predictors of death in infected EICU patients, and were used to establish the STAPLAg score (area under the curve [AUC] 0.865). The initial SOFA score on admission was predictive of death (AUC 0.782). Applying the above categories to the derivation cohort yielded mortality risks of 7.7% for grade I, 56.3% for grade II, and 75.0% for grade III. Internal (AUC 0.884) and external (AUC 0.918) cohort validation indicated that the score had good predictive power.

The STAPLAg score can be determined early in infected EICU patients, and exhibited better prognostic capacity than the initial SOFA score on admission in both internal and external cohorts. STAPLAg constitutes a new resource for use in the clinical diagnosis of sepsis and can also predict mortality in infected EICU patients.

Registration number:

ChinCTR-PNC-16010288.
A large subchorionic hematoma in pregnancy
Authors: Liu Yu , Tong An , Qi Xiaorong
Published: May 2020

Introduction:

Subchorionic hematoma (SCH) is a rare type of intrauterine hematoma, usually with limited impact on fetuses and pregnant women. But massive hematoma causes significant space occupying effect, affects blood supply of the fetus and finally may lead to fetus demise.

Patient concerns:

In this case report, we reported a 22-year-old pregnant woman presented to our hospital with complaint of irregular lower abdominal pain.

Diagnosis:

Ultrasonography and magnetic resonance imaging confirmed an intrauterine mass with a compressed growth-restricted fetus.

Interventions:

The patient underwent diseases induced labor after confirmation of fetus demise by ultrasonography.

Outcomes:

Histopathological examination of the mass revealed a SCH.

Conclusion:

Though small SCH can be found in quite a few pregnant women and is usually harmless, enormous hematoma can result in adverse pregnancy outcomes. It may be difficult, in some cases, to differentiate it from uterine tumors or placental tumors by means of ultrasonography and magnetic resonance imaging, especially when the mass is hyperechoic under ultrasonography. This case report stresses the importance of regular examinations of pregnant women.
Fenofibrate monotherapy-induced rhabdomyolysis in a patient with post-pancreatitis diabetes mellitus
Authors: Zhou Jingjing , Li Dongfeng , Cheng Qiansong
Published: May 2020

Rationale:

Fibrates are widely used to control hypertriglyceridemia and mixed dyslipidemia alone or in combination with statins. These drugs have rare, but severe and potentially vital adverse reactions of rhabdomyolysis and secondary acute renal failure (ARF). The objective of this article is to analyze this adverse effect of fibrates and ensure the safety of drug use.

Patient concerns:

We report a case of rhabdomyolysis and ARF due to fenofibrate monotherapy in a 68-year-old female with post-pancreatitis diabetes mellitus and review reported cases of rhabdomyolysis correlated with fibrates monotherapy.

Diagnosis:

The patient was diagnosed with rhabdomyolysis associated with fenofibrate monotherapy as confirmed by symptoms of fatigue and muscle pain, and elevated levels of myoglobin and creatine kinase.

Interventions:

Fenofibrate therapy was discontinued. Moreover, intravenous fluids, urinary alkalization, and diuretic were performed.

Outcomes:

The symptoms were completely relieved, and relevant laboratory indexes returned to normal range during follow-up.

Lessons:

Physicians should be aware of the side effect of rhabdomyolysis of fibrates, and patients should also be informed about this potential side effect, especially for patients with high-risk factors. A favorable outcome can be achieved by timely diagnosis and prompt treatment.
Direct acting antiviral HCV treatment does not influence renal function
Authors: Driedger Matt , Galanakis Chrissi , Cooper Curtis
Published: May 2020

HCV infection is associated with chronic kidney disease due to several mechanisms. Patients treated with interferon-based regimens demonstrate improved renal function and reduced incidence of chronic kidney disease. There is scarce evidence on the effect of direct acting antiviral regimens (DAAs) on renal function.

We evaluated serial measures of renal function in a cohort of HCV-infected participants following completion of DAA-based treatment regimens.

Measures of glomerular filtration rate (GFR) were estimated by the CKD-EPI equation. Data was recorded at end of treatment, and at 6–12 months, 12–24 months, and greater than 24 months following treatment completion. Group-based trajectory modeling was used to determine distinct GFR trajectories. Predictors of group membership were determined by multinomial regression analysis.

Six trajectories were identified. One trajectory comprising 27% of the cohort demonstrated declining renal function and the others demonstrated no change in renal function over time. Baseline GFR did not predict SVR. Diabetes was associated with lower post-treatment GFR but patients with diabetes did not demonstrate a decrease in GFR over the period of evaluation. Cirrhosis and SVR were not significant predictors of GFR or GFR trajectory.

There is no clinically relevant change in renal function among the majority of HCV-infected patients following completion of DAA-based treatments. Renal function does not influence the efficacy of DAA-based regimens. No consistent effect of DAA treatment and/or SVR on renal function was observed over a 2-year period following treatment completion.
The expression of epidermal growth factor receptor 1 and human epidermal growth factor receptor 2 based on tumor location affect survival in gastric cancer
Authors: Li Guo-Cai , Jia Xu-Chun , Zhao Qing-Chuan , Zhang Hong-Wei , Yang Peng , Xu Long-Long , Pang Fang-Ning , Sun Jian-Bing
Published: May 2020

To investigate the different expression of epidermal growth factor receptor 1 (EGFR) and human epidermal growth factor receptor 2 (HER2) in gastric cancer based on tumor locations and its impact on patients survival.

Gastric cancer is heterogeneous disease, recent years have established a molecular classification and described distribution of molecular subtypes in stomach. However, the difference of EGFR and HER-2 expression among tumor location is still unknown.

Between January 2010 and August 2014, 2477 consecutive patients with gastric cancer were treated in our surgery department. The tumor locations were classified into 4 groups: cardia, fundus, corpus, and antrum. Based on tumor locations, the clinicopathologic characteristics, EGFR and HER-2 expression, and follow-up data were analyzed by univariant analysis and Kaplan-Meier analysis retrospectively.

There were difference of gender, age, Borrmann type, pathological type, differentiation, T-stage, tumor size, gastrectomy method, and complications among the locations. The positive rate of EGFR expression in fundus was 18.18%, which was lower than cardia (46.21%), corpus (43.62%), and antrum (48.83%) (P < .001). The 5-year survival rate in EGFR positive patients was 50.8%, which was significantly lower than EGFR negative patients (64.0%, P = .021). The positive rate of HER-2 expression in cardia was 48.15%, which was significantly higher than fundus (37.5%), corpus (35.45%), and antrum (38.54%) (P = .009), but HER-2 expression did not correlate with 5-year survive (P = .548).

Our results suggest that there exist difference of EGFR and HER-2 expression based on tumor locations, and the distribution of EGFR impact on patients survival. Emphasizing the role of EGFR and HER-2 in the context of location contribute to make appropriate treatment strategy and improve prognosis of gastric cancer.
The gastrointestinal endoscopy satisfaction questionnaire captures patient satisfaction as a key quality indicator of gastrointestinal endoscopy
Authors: Veldhuijzen Govert , de Jong Mike J.P. , Roosen Cariline M. , Siersema Peter D. , Drenth Joost P.H. , van Esch Aura A.J.
Published: May 2020

Background

Patient satisfaction is a crucial indicator of gastrointestinal endoscopy quality. The gastrointestinal endoscopy satisfaction questionnaire (GESQ) was validated for the assessment of patient satisfaction undergoing endoscopy in English with good validity. We translated and validated the GESQ in Dutch.

Methods

The original GESQ was translated in Dutch according to the WHO guidelines. First, an internal validation of the Dutch GESQ (D-GESQ) was established by the think-aloud method and subsequent expert panel analysis. Next, the D-GESQ was embedded in the computer-based education (CBE) program in our unit, with 30-day interval after endoscopy. Adult patients, informed via CBE after undergone endoscopy, were included. Exclusion criteria were conscious sedation, limited language skills, no e-mail address available, dementia and visual impairment. For statistical analysis, several psychometric analyses were performed to identify the underlying dimensions and assessed the questionnaire for reliability and validity.

Results

In total, 227 of 1065 patients completed the D-GESQ, a response rate of 21.3%. Men comprised 52.6% (n = 129) of patients. Mean age was 62.7 ± 11.54 years. In total, 180 patients (79.3%) had previously undergone endoscopy, with 157 (87.2%) of them two or more times. The exploratory factor analysis showed the 21 questions could best be clustered into five clusters instead of four in the original GESQ. The D-GESQ had an overall Cronbach α of 0.88, confirming the high internal validity.

Conclusion

The Dutch version of the GESQ showed high internal validity and practicality. We recommend the D-GESQ for routine use in endoscopy practice to improve quality of patient care.
Investigating the Clinical Significance and Research Discrepancies of Balance Training in Degenerative Cerebellar Disease
Authors: Barbuto Scott , Kuo Sheng-Han , Stein Joel
Published: May 2020

Objective

The aims of this study were to understand the clinical significance of balance training in degenerative cerebellar disease and to analyze inconsistencies among published data.

Design

Five databases were searched from inception to October 8, 2019. Cochrane guidelines informed review methods, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The Australian National Health and Medical Research Council Evidence Hierarchy, PEDro scale, and Joanna Briggs Institute Critical Appraisal Tools were used to evaluate methodological quality. Outcome measures examined included ataxia severity, gait speed, and balance.

Results

Fourteen articles were identified that met inclusion criteria. The quality of evidence was moderate to high, with recent articles being of higher quality. Nine of 12 articles showed statistical improvements in ataxia severity (reduction ranging from 1.4 to 2.8 in the Scale for the Assessment and Rating of Ataxia points), three of eight showed statistical improvements in gait speed (average increase of 0.1 m/sec), and six of nine showed improvements in balance measures (average increase of 1.75 in Berg Balance Scale and 1.5 in Dynamic Gait Index).

Conclusion

Most studies showed statistical and clinically significant ataxia severity improvements in subjects who performed balance training. The amount of balance challenge and frequency of training were important factors in determining the extent of training benefit. Gait speed may also improve if walking exercises are included in the balance training, but more studies need to be conducted. Balance measures statistically improved with training, but these improvements did not meet criteria for clinical significance.

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) Describe the cause(s) of discrepancies in the literature regarding the benefits of balance training in degenerative cerebellar disease; (2) Determine if benefits from balance training are clinically meaningful for individuals with cerebellar degeneration; and (3) Understand the best practices gleaned from the current literature regarding balance training for these diseases.

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 of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Maintaining a high inspired oxygen fraction with the Elisée 350 turbine transport ventilator connected to two portable oxygen concentrators in an austere environment
Authors: Cardinale Michaël , Cungi Pierre-Julien , Bordes Julien , Cohergne Fabien , Schmitt Sarah , Langlois Alix , Meaudre Eric , Lacroix Guillaume
Published: May 2020

BACKGROUND

Management of critically ill patients requiring mechanical ventilation in austere environments or during disaster response is a logistic challenge. Availability of oxygen cylinders for mechanically ventilated patient may be difficult in such a context. A solution to ventilate patients requiring high fraction of inspired oxygen (FiO2) is to use a ventilator able to be supplied by a low-pressure oxygen source connected with two oxygen concentrators (OCs). We tested the Elisée 350 (ResMedBella Vista, Australia) ventilator paired with two Newlife Intensity 10 (Airsep, Ball Ground, Georgia) OCs and evaluated the delivered FiO2 across a range of minute volumes and combinations of ventilator settings.

METHODS

The ventilators were attached to a test lung, OC flow was adjusted with a Certifier FA ventilator test systems from 2 to 10 L/min and injected into the oxygen inlet port of the Elisée 350. The FiO2 was measured by the analyzer integrated in the ventilator, controlled by the ventilator test system. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered FiO2.

RESULTS

The Elisée 350 ventilator is a turbine ventilator able to deliver high FiO2 when functioning with two OCs. However, modifications of the ventilator settings such as an increase in minute ventilation affect delivered FiO2 even if oxygen flow is constant on the OC.

CONCLUSION

The ability of two OCs to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders to ventilate patients requiring an FiO2 of ≥80% in austere place or during disaster response.

LEVEL OF EVIDENCE

Feasibility study on test bench, level V.
Use of bilobed partial resuscitative endovascular balloon occlusion of the aorta is logistically superior in prolonged management of a highly lethal aortic injury
Authors: Zilberman-Rudenko Jevgenia , Behrens Brandon , McCully Belinda , Dewey Elizabeth N. , Smith Sawyer G. , Murphy James M. , Goodman Andrew , Underwood Samantha J. , Rick Elizabeth A. , Madtson Brianne M. , Thompson Michelle E. , Glaser Jacob J. , Holcomb John B. , Schreiber Martin A.
Published: May 2020

BACKGROUND

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable technique for management of noncompressible torso hemorrhage. The major limitation of the current unilobed fully occlusive REBOA catheters is below-the-balloon ischemia-reperfusion complications. We hypothesized that partial aortic occlusion with a novel bilobed partial (p)REBOA-PRO would result in the need for less intraaortic balloon adjustments to maintain a distal goal perfusion pressure as compared with currently available unilobed ER-REBOA.

METHODS

Anesthetized (40–50 kg) swine randomized to control (no intervention), ER-REBOA, or pREBOA-PRO underwent supraceliac aortic injury. The REBOA groups underwent catheter placement into zone 1 with initial balloon inflation to full occlusion for 10 minutes followed by gradual deflation to achieve and subsequently maintain half of the baseline below-the-balloon mean arterial pressure (MAP). Physiologic data and blood samples were collected at baseline and then hourly. At 4 hours, the animals were euthanized, total blood loss and urine output were recorded, and tissue samples were collected.

RESULTS

Baseline physiologic data and basic laboratories were similar between groups. Compared with control, interventions similarly prolonged survival from a median of 18 minutes to over 240 minutes with comparable mortality trends. Blood loss was similar between partial ER-REBOA (41%) and pREBOA-PRO (51%). Partial pREBOA-PRO required a significantly lower number of intraaortic balloon adjustments (10 ER-REBOA vs. 3 pREBOA-PRO,p< 0.05) to maintain the target below-the-balloon MAP. The partial ER-REBOA group developed significantly increased hypercapnia, fibrin clot formation on TEG, liver inflammation, and IL-10 expression compared with pREBOA-PRO.

CONCLUSION

In this highly lethal aortic injury model, use of bilobed pREBOA-PRO for a 4-hour partial aortic occlusion was logistically superior to unilobed ER-REBOA. It required less intraaortic balloon adjustments to maintain target MAP and resulted in less inflammation.
Penetrating injury to the cardiac box
Authors: Kim Jennie S. , Inaba Kenji , de Leon Luis Alejandro , Rais Cyrus , Holcomb John B. , David Jean-Stéphane , Starnes Vaughn A. , Demetriades Demetrios
Published: May 2020

BACKGROUND

A penetrating injury to the “cardiac box” is thought to be predictive of an injury to the heart; however, there is very little evidence available to support this association. This study aims to evaluate the relationship between penetrating trauma to the cardiac box and a clinically significant injury.

METHODS

All patients presenting to a Level I trauma center from January 2009 to June 2015 who sustained a penetrating injury isolated to the thorax were retrospectively identified. Patients were categorized according to the location of injury: within or outside the historical cardiac box. Patients with concurrent injuries both inside and outside the cardiac box were excluded. Clinical demographics, injuries, procedures, and outcomes were compared.

RESULTS

During this 7-year period, 330 patients (92% male; median age, 28 years) sustained penetrating injuries isolated to the thorax: 138 (42%) within the cardiac box and 192 (58%) outside the cardiac box. By mechanism, 105 (76%) were stab wounds (SW) and 33 (24%) were gunshot wounds (GSW) inside the cardiac box, and 125 (65%) SW and 67 (35%) GSW outside the cardiac box. The overall rate of thoracotomy or sternotomy (35/138 [25.4%] vs. 15/192 [7.8%], p < 0.001) and the incidence of cardiac injury (18/138 [13%] vs. 5/192 [2.6%], p < 0.001) were significantly higher in patients with penetrating trauma within the cardiac box. This was, however, dependent on mechanism with SW demonstrating a higher incidence of cardiac injury (15/105 [14.3%] vs. 3/125 [2.4%], p = 0.001) and GSW showing no significant difference (3/33 [9.1%] vs. 2/67 [3%], p = 0.328]. There was no difference in overall mortality (9/138 [6.5%] vs. 6/192 [3.1%], p = 0.144).

CONCLUSION

The role of the cardiac box in the clinical evaluation of a patient with a penetrating injury to the thorax has remained unclear. In this analysis, mechanism is important. Stab wounds to the cardiac box were associated with a higher risk of cardiac injury. However, for GSW, injury to the cardiac box was not associated with a higher incidence of injury. The diagnostic interaction between clinical examination and ultrasound, for the diagnosis of clinically significant cardiac injuries, warrants further investigation.

LEVEL OF EVIDENCE

Prognostic study, Level IV, Therapeutic V.
Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury
Authors: Kerwin Andrew J. , Zuniga Yohan Diaz , Yorkgitis Brian K. , Mull Jennifer , Hsu Albert T. , Madbak Firas G. , Ebler David J. , Skarupa David J. , Shiber Joseph R. , Crandall Marie L.
Published: May 2020

BACKGROUND

Cervical spinal cord injury (CSCI) is devastating with ventilator-associated pneumonia being a main driver of morbidity and mortality. Laparoscopic diaphragm pacing implantation (DPS) has been used for earlier liberation from mechanical ventilation. We hypothesized that DPS would improve respiratory mechanics and facilitate liberation.

METHODS

We performed a retrospective review of acute CSCI patients between January 2005 and May 2017. Routine demographics were collected. Patients underwent propensity score matching based on age, Injury Severity Score, ventilator days, hospital length of stay, and need for tracheostomy. Patients with complete respiratory mechanics data were analyzed and compared. Those who did not have DPS (NO DPS) had spontaneous tidal volume (Vt) recorded at time of intensive care unit admission, at day 7, and at day 14, and patients who had DPS had spontaneous Vt recorded before and after DPS. Time to ventilator liberation and changes in size of spontaneous Vt for patients while on the ventilator were analyzed. Bivariate and multivariate logistic and linear regression statistics were performed using STATA v10.

RESULTS

Between July 2011 and May 2017, 37 patients that had DPS were matched to 34 who did not (NO DPS). Following DPS, there was a statistically significant increase in spontaneous Vt compared with NO DPS (+88 mL vs. −13 mL; 95% confidence interval, 46–131 mL vs. −78 to 51 mL, respectively; p = 0.004). Median time to liberation after DPS was significantly shorter (10 days vs. 29 days; 95% CI, 6.5–13.6 days vs. 23.1–35.3 days; p < 0.001). Liberation prior to hospital discharge was not different between the two groups. The DPS placement was found to be associated with a statistically significant decrease in days to liberation and an increase in spontaneous Vt in multivariate linear regression models.

CONCLUSION

The DPS implantation in acute CSCI patients produces significant improvements in spontaneous Vt and reduces time to liberation from mechanical ventilation. Prospective comparative studies are needed to define the clinical benefits and potential cost savings of DPS implantation.

LEVEL OF EVIDENCE

Therapeutic IV.
Impact of Postoperative Continuous Renal Replacement Therapy in Lung Transplant Recipients
Authors: Katahira Masato , Hirama Takashi , Eba Shunsuke , Suzuki Takaya , Notsuda Hirotsugu , Oishi Hisashi , Matsuda Yasushi , Sado Tetsu , Noda Masafumi , Sakurada Akira , Sidhu Aman , Okada Yoshinori
Published: May 2020

Background.

Acute kidney injury (AKI) is a common complication after lung transplant (LTx), and continuous renal replacement therapy (CRRT) is increasingly of use to critically ill patients who have developed AKI. However, the optimal timing or threshold of kidney impairment for which to commence CRRT after LTx has been uncertain. There has also been limited information on the impact of CRRT among LTx recipients (LTRs) introduced in the early posttransplant period on survival, graft function, and renal function. We aimed to review LTRs who developed AKI requiring CRRT postoperatively and followed their long-term outcomes at Tohoku University Hospital (TUH).

Methods.

Medical records of consecutive patients who underwent LTx at TUH between 2000 and 2018 were reviewed, with follow-up to 2019 inclusive.

Results.

Although mortality in those who required CRRT (n = 21) was increased versus those who did not require CRRT (n = 85)(P = 0.024), conditional survival beyond 3-month posttransplant was not affected (P = 0.131). Additionally, the cumulative incidence of chronic lung allograft rejection (P = 0.160) and the development of chronic kidney disease (P = 0.757) were not significant between groups.

Conclusions.

The initiation of CRRT posttransplant may be a useful strategy to preserve cardiac and optimize volume management among critically ill patients.
Beyond the connectome: A map of a brain architecture derived from whole-brain volumetric reconstructions
Authors: Brittin Christopher A. , Cook Steven J. , Hall David H. , Emmons Scott W. , Cohen Netta
Published: May 2020

Animal nervous system organization is crucial for all body functions and its disruption can manifest in severe cognitive and behavioral impairment. This organization relies on features across scales, from nano-level localization of synapses, through multiplicities of neuronal morphologies and their contribution to circuit organization, to the high level stereotyped connections between different regions of the brain. The sheer complexity of this organ means that to date, we have yet to reconstruct and model the structure of a complete nervous system that is integrated across all these scales. Here, we present a complete structure-function model of the nematodeC. elegansmain neuropil, the nerve ring, which we derive by integrating the volumetric reconstruction from two animals with corresponding synaptic and gap junctional connectomes. Whereas previously the nerve ring was considered a densely packed tract of axons, we uncover internal organization into 5 functional bundles and show how they spatially constrain and support the synaptic connectome. We find that theC. elegansconnectome is not invariant, but that a precisely wired core circuit is embedded in a background of variable connectivity, and propose a corresponding reference connectome for the core circuit. Using this reference, we show that the architecture of theC. elegansbrain can be viewed as a modular Residual Network that supports sensory computation and integration, sensory-motor convergence, and brain-wide coordination. These findings point to scalable and robust features of brain organization that are likely universal across phyla.
Real-space quantum-based refinement for cryo-EM: Q|R#3
Authors: Wang Lum , Kruse Holger , Sobolev Oleg V. , Moriarty Nigel W. , Waller Mark P. , Afonine Pavel V. , Biczysko Malgorzata
Published: May 2020

Electron cryo-microscopy (cryo-EM) is fast becoming a major competitor to X-ray crystallography especially for large structures that are difficult or impossible to crystallize. While recent spectacular technology improvements are leading to significantly higher resolution of three-dimensional reconstructions, the average quality of cryo-EM maps is still on the low-resolution end of the range compared to crystallography. A long-standing challenge for atomic model refinement has been the production of stereochemically meaningful models for this resolution regime. Here we demonstrate how including accurate model geometry restraints derived fromab initioquantum-chemical calculations (HF-D3/6-31G) can improve the refinements of an example structure (chain A of 3j63). The robustness of the procedure is tested for additional structures with up to 7k atoms (3a5x, and chain C of 5fn5) by means of the less expensive semi-empirical (GFN1-xTB) model. Necessary algorithms enabling real-space quantum refinement are implemented in the latest version ofqr.refineand are described herein.

Synopsis

The implementation of quantum-based real-space refinement inqr.refineis described.