bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Wireless Near-Infrared Spectroscopy to Predict Wound Prognosis in Diabetic Foot Ulcers
Authors: Lin Bor-Shyh , Chang Chang-Cheng , Tseng Yuan-Hsi , Li Jhe-Ruei , Peng Yun-Shing , Huang Yao-Kuang
Published: December 2019

OBJECTIVE

To use wearable near-infrared spectroscopy (NIRS) to determine the effect of Buerger exercises on diabetic foot ulcer (DFU) healing.

METHODS

Study authors enrolled 50 consecutive patients in a 1-year prospective observational study of DFUs. The patients were divided into groups by their arterial statuses: group A (no peripheral arterial disease [PAD]), group B (PAD without angioplasty), and group C (PAD with angioplasty). Tissue perfusion was assessed through wireless wearable NIRS to determine the effects of Buerger exercises on wound healing.

MAIN RESULTS

The patients in group C were older, were more likely to have had an amputation, and had more severe wounds than did the patients in other groups. The requirements of insulin injection for diabetes mellitus control differed significantly (P = .024) among the three groups. At the end of the survey, 19 patients (38%) had unhealed DFUs. The NIRS revealed that most nonhealed patients in groups B and C shared higher resting hemoglobin levels and tissue blood volume and lower tissue oxygen concentration, which indicated inflammation accompanied by higher blood flow and oxygen consumption. Notably, the nonhealed patients in group C showed paradoxically reduced hemoglobin and tissue blood volume after the exercises.

CONCLUSIONS

Although DFUs remain a challenge to treat, NIRS may prove valuable in predicting wound healing by identifying risk factors for poor wound prognosis, such as reduced hemoglobin and tissue blood volume after exercise.
Overactive Bladder
Authors: Al Hussein Al Awamlh Bashir , Al Hussein Alawamlh Omar , Lee Richard , Lee Una J.
Published: December 2019

Overactive bladder (OAB) syndrome is a condition that involves urinary urgency, usually accompanied by increased daytime frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. This condition is multifactorial, and several theories exist that explain the pathophysiologic process underlying the condition. Because the prevalence of the condition is high among women across all age groups, obstetrician–gynecologists will encounter women with OAB syndrome and should be able to evaluate and treat this condition. The appropriate management often is based on the degree of bother and severity of symptoms in an individual patient. This monograph will delineate the general characteristics of OAB syndrome from its epidemiology to potential causes and provide a detailed discussion of the evaluation of the patient with various diagnostic modalities and the range of available treatment options.
Stable childhood osteochondral lesions of the talus: short-term radiographic outcomes suggest risk for early osteoarthritis
Authors: Edmonds Eric W. , Phillips Lee , Roocroft Joanna H. , Bastrom Tracey P. , Pennock Andrew T. , Chambers Henry G.
Published: December 2019

Recent literature suggests that adults do not necessarily develop osteoarthritis if they have an osteochondral lesion of the talus (OLT). The purpose of this study was to determine if children with OLT are at risk to develop any radiographic evidence of early joint degeneration despite treatment efforts. Fifty-six ankles were identified over 6 years with stable OLT that underwent operative treatment. Preoperatively, each lesion was classified according to Berndt-Hardy for radiographs, Hepple for MRI, and Ferkel and Sgaglione for computed tomography. Radiographs were also evaluated for physeal status, OLT characteristics (location, border, size), and signs of osteoarthritis (Kellgren and Lawrence Scale). Despite incomplete treatment to radiographic resolution, the Kellgren-Lawrence scores still worsened in 23% of the children (pre-op score: mean 0.42 and median 0 versus post-op score: mean 0.69 and median 1). No risk factors (preoperative classification, age, physeal patency) were associated with advancing radiographic evidence of articular degeneration utilizing univariate analysis. However, a classification and regression tree analysis revealed that a patient age of 11.5 years old could be predictive of advancing Kellgren–Lawrence scores with one-third of older children worsening (P = 0.038). Despite active treatment of OLT, the ultimate prognosis is guarded with approximately one out of four children advancing their Kellgren and Lawrence score during treatment. In contrast to the natural history of adult OLT, the short-term advancement of degenerative disease in childhood OLT suggests a potentially different outcome and warrants further investigation into better treatment methods to preserve ankle health in these young patients.
Comparison of surgical and nonsurgical containment methods for patients with Legg-Calvé-Perthes disease of the onset ages between 6.0 and 8.0 years: Salter osteotomy versus a non-weight-bearing hip flexion-abduction brace
Authors: Kaneko Hiroshi , Kitoh Hiroshi , Mishima Kenichi , Matsushita Masaki , Hattori Tadashi , Noritake Koji , Ishiguro Naoki , Yoshihashi Yuji
Published: December 2019

Since bone healing potential decreases with age, patients with Legg-Calvé-Perthes disease should receive treatment appropriate to their age group. Nonsurgical treatment is commonly applied to patients under 6.0 years of age at the onset and surgical treatment is recommended for those over 8.0 years of age, but it remains unclear which is better for those between 6.0 and 8.0 years. The aim of this retrospective study was to compare outcomes of Salter osteotomy and a non-weight-bearing brace in this age group. Inclusion criteria were unilateral Legg-Calvé-Perthes disease patients who were 6.0–8.0 years of age at the onset, who had more than 50% femoral head involvement without hinge abduction, and who underwent either Salter osteotomy (n = 35) or a non-weight-bearing hip flexion-abduction brace (n = 18). Radiological and clinical outcomes at skeletal maturity were compared between the two groups. The mean follow-up durations were 9.4 years in the Salter osteotomy group and 10.0 years in the brace group. There was no significant difference in the modified Waldenström classification at the beginning of treatment and the Catterall and modified lateral pillar classifications evaluated at the fragmentation stage between the groups. At skeletal maturity, the Stulberg classification, the sphericity deviation score, femoral head overgrowth, and the articulo-trochanteric distance were similar between the groups, but the Salter osteotomy group showed significantly smaller lateralization of the femoral head and better acetabular shape and coverage than the brace group: femoral head lateralization (P < 0.001), acetabular depth-to-width ratio (P = 0.002), Sharp angle (P < 0.001), lateral acetabular shape (P = 0.027), acetabular head index (P < 0.001). There was no significant difference in hip pain and motion between the groups. In this age group, Salter osteotomy provides better femoral head position and acetabular shape and coverage than a non-weight-bearing brace.
Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China
Authors: Lin Shen , Zhang Heng , Rao Chen-Fei , Chen Si-Peng , Qiao Shu-Bin , Yan Hong-Bing , Dou Ke-Fei , Wu Yong-Jian , Tang Yi-Da , Yang Xin-Chun , Shen Zhu-Jun , Liu Jian , Zheng Zhe
Published: December 2019

Background:

The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients.

Methods

: We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission.

Results:

From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45–0.86;P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52–1.25;P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51–1.23;P = 0.308).

Conclusions:

In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making.

Clinical trial registration:

NCT02880605. https://www.clinicaltrials.gov.
Spiradenoma With Adenoid Cystic Carcinoma–Like Features
Authors: Hopkins Christina , Moyer Amanda , Huttenbach Yve Thaller
Published: December 2019

Spiradenoma is a benign cutaneous adnexal neoplasm that characteristically presents as a painful dermal nodule, often on the head or trunk. It has a distinct histologic phenotype and management involves surgical excision with low risk of recurrence. In comparison, adenoid cystic carcinoma (ACC) is a low-grade malignancy manifesting as an often painless subcutaneous mass with potential for local invasion, perineural extension, and high rates of recurrence after excision. We report the case of a 63-year-old male patient with a recurrent, painful hematoma-like cyst overlying the left lower extremity tibial tuberosity. A firm nodule was located at the base of the cyst, which was histologically consistent with spiradenoma. Interestingly, the lesion contained multifocal ACC-like components composed of epithelial basaloid cells surrounding pseudocystic structures filled with mucinous material. The ACC-like components did not demonstrate infiltration or perineural invasion. To the best of our knowledge, this is the second publication in the English literature regarding spiradenoma with an ACC-like pattern. Although a benign entity, knowledge of this morphological variant of spiradenoma is essential for diagnostic accuracy in these cases. If a limited biopsy captures only the ACC-like component of a spiradenoma, the lesion may be incorrectly diagnosed as ACC.
Subtotal Nasal Reconstruction Using a Custom 3-Dimensional Porous Polyethylene Construct
Authors: Walton Robert L. , Seelaus Rosemary , Robinson Brent R.
Published: December 2019

Subtotal loss of the nose is a devastating occurrence. Traditional approaches to reconstruction have employed techniques that sequentially restore the nasal lining, support and external cover using autologous tissues. The results can be quite variable and are heavily weighted on surgical experience and expertise. We report a case of subtotal nasal reconstruction using a computer generated, 3-D printed porous polyethylene (PPE) scaffold. The patient is a 64-year-old man who presented with a sub-total nasal defect following excision of recurrent basal cell carcinoma. The missing parts comprised the distal half of the composite nose including the nasal floor and lining. The replacement nose was constructed on the patient’s right radial forearm. A computer generated PPE nasal scaffold was prelaminated with a forearm flap for lining and a free temporal fascial flap and skin graft for external cover. Following healing, nostrils were created and the nasal construct was then microsurgically transferred to the face. At 18 months post-op, the reconstructed nose has remained stable and functional with excellent aesthetic appearance. The implications for use of 3-D scaffolds for composite nasal reconstruction are enormous.
Photopeak Efficiency and Coincidence Summing Factors for HPGe Detectors Using Bulk Sources
Authors: Alharshan Gharam A.
Published: December 2019

In the field of gamma-ray spectroscopy with high-purity germanium detectors, used to measure the activity when the sample to be measured has low radioactivity, volumetric sources are widely used. To determine the sample activity, the full-energy peak efficiency is needed. Bulk sources are very common for low-level radioactivity measurements in activation analysis and environmental samples. The main problem with these measurements is that coincidence effects are large for close source-detector geometries. Ignoring these effects can lead to an error typically of a factor of 2 in the determination of 60Co and 88Y activity, which was used in this work in the calibration process. Extensive experimental readings have been carried out, and bulk gamma aqueous sources containing several radionuclides covering the energy range from 60 to 1,840 keV were used. By comparison, the experimental (present work) and theoretical (published) full-energy peak efficiency values are in good agreement; the overall percentage error is less than 6%.
Reduction of Occupational Exposure Using a Novel Tungsten-Containing Rubber Shield in Interventional Radiology
Authors: Kijima Kenta , Krisanachinda Anchali , Tamura Mikoto , Monzen Hajime , Nishimura Yasumasa
Published: December 2019

This study investigates whether a novel tungsten-containing rubber shield could be used as substitute shielding material in interventional radiology to reduce the occupational exposure of operators to scattered radiation from a patient. The tungsten-containing rubber is a lead-free radiation-shielding material that contains as much as 90% tungsten powder by weight. Air kerma rates of scattered radiation from solid-plate phantoms, simulating a patient, were measured with a semiconductor dosimeter at the height of the operator’s eye (1,600 mm from the floor), chest (1,300 mm), waist (1,000 mm), and knee (600 mm) with and without tungsten-containing rubber shielding (1–5 mm thickness). The tungsten-containing rubber and a commercial shielding material (RADPAD) were affixed onto the phantom on the operator’s side, and reductions in air kerma rates were compared. Reduction rates for tungsten-containing rubber shielding with thicknesses of 1, 2, 3, 4, and 5 mm at each height level were as follows: 70.37 ± 0.40%, 72.17 ± 0.29%, 72.95 ± 0.31%, 72.58 ± 0.35%, and 73.63 ± 0.63% at eye level; 76.36 ± 0.19%, 77.13 ± 0.10%, 77.36 ± 0.14%, 77.62 ± 0.25%, and 77.66 ± 0.14% at chest level; 67.78 ± 0.31%, 68.12 ± 0.19%, 68.88 ± 0.28%, 68.97 ± 0.14%, and 68.85 ± 0.45% at waist level; and 0.14 ± 0.94%, 0.72 ± 0.56%, 1.08 ± 0.74%, 1.77 ± 0.80%, and 1.79 ± 1.82% at knee level, respectively. Reduction rates with RADPAD were 61.80 ± 0.67%, 60.33 ± 0.61%, 64.70 ± 0.25%, and 0.14 ± 0.66% at eye, chest, waist, and knee levels, respectively. The shielding ability of the 1 mm tungsten-containing rubber was superior to that of RADPAD. The tungsten-containing rubber could be employed to minimize an operator’s radiation exposure instead of the commercial shielding material in interventional radiology.
Brain Abscess Caused by Resistant Streptococcus pneumoniae
Authors: Jain Hanish , Gada Kunal , Fazili Tasaduq , Eranki Ambika
Published: December 2019

Brain abscess can have multiple sources such as traumatic brain injury, prior neurosurgical procedure, contiguous spread from a local source, or hematogenous spread of a systemic infection. Streptococcus pneumoniae has been isolated from brain abscesses with hematogenous spread from paranasal sinusitis. This case encompasses an unusual presentation of a resistant S. pneumoniae isolate causing brain abscess in a patient with a history of neurosurgical procedure highlighting challenges in empiric therapy, further management, and outcomes.
Aspirin use and pancreatic cancer risk
Authors: Sun Jinjin , Li Yanxun , Liu Lili , Jiang Zhijia , Liu Geng
Published: December 2019

Objectives:

Although there is evidence that aspirin might be able to prevent pancreatic cancer, the findings have been inconsistent. In this paper, we conducted a meta-analysis of observational studies to examine the relationship between aspirin use and the risk of pancreatic cancer.

Methods:

We identified potential studies by searching the MEDLINE, EMBASE, and Wangfang (Chinese database) database (from 1967 to March 2017) and by reviewing the bibliography of relevant publications. Random effects model was used to calculate odds ratio (OR) and 95% confidence interval. The Cochran Q statistic (significance level atP < .1) was used to assess heterogeneity in this study. The author adopted weighted regression method of Egger to assessed publication bias.

Results:

A total of 12 studies involving 4748 pancreatic cancer cases, were included in the meta-analysis. The study reflected that there was no signification association between aspirin use and mortality risk of pancreatic cancer. Aspirin use might reduce the incidence of pancreatic cancer. Specifically, there was a high signification association between frequent aspirin use and reduced pancreatic cancer incidence, without heterogeneity. In addition, there was a high signification association between duration of aspirin use more than 5 years and reduced pancreatic cancer incidence, without obvious heterogeneity among the original studies.

Conclusions:

In summary, this meta-analysis suggested that the aspirin use might be negatively related to the incidence risk of pancreatic cancer. Specifically, the frequency and duration of aspirin use might play an important role in decreasing the incidence of pancreatic cancer.
Acupuncture for reduction of opioid consumption in chronic pain
Authors: Lee Seunghoon , Jo Dae-Hyun
Published: December 2019

Background:

This review aims to evaluate the effectiveness and safety of acupuncture treatment for reducing opioid consumption in patients with chronic pain.

Methods:

We will search the following electronic databases from their inception to November 2019: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, the China National Knowledge Infrastructure (a Chinese database), the Japan Science and Technology Information Aggregator (a Japanese database), and five Korean databases (KoreaMed, Research Information Service System, Korean Studies Information Service System, Database Periodical Information Academic, and Oriental Medicine Advanced Searching Integrated System). Randomized controlled trials comparing acupuncture to no treatment, sham acupuncture, and other active interventions for the reduction of opioid consumption in chronic pain patients will be included. The risk of bias will be assessed using the Cochrane risk of bias tool. The primary outcomes will include the prescribed or consumed dose of opioids and withdrawal symptoms related to opioid reduction. A meta-analysis will be performed to estimate a pooled effect, if possible.

Conclusion:

This study may provide important practical guidance for patients, practitioners, and health-policy makers regarding the use of acupuncture in opioid taper support programs.

Dissemination:

The results will be disseminated through a peer-reviewed journal or conference presentations.

Trial registration number: PROSPERO 2019: CRD42019143486
Contribution of MTR A2756G polymorphism and MTRR A66G polymorphism to the risk of idiopathic male infertility
Authors: Ren Zheng-Ju , Zhang Yan-Ping , Ren Peng-Wei , Yang Bo , Deng Shi , Peng Zhu-Feng , Liu Liang-Ren , Wei WuRan , Dong Qiang
Published: December 2019

Background:

Methionine synthase reductase gene (MTRR A66G) polymorphism and methionine synthase gene (MTR A2756G) polymorphism have shown an association with idiopathic male infertility risk in several ethnic populations. However, their small sample sizes and inconsistent outcomes have prevented strong conclusions. We performed a meta-analysis with published studies to evaluate the associations of the 2 single nucleotide polymorphisms (SNPs) and idiopathic male infertility risk.

Methods:

A thorough literature search was performed up to Jun 21, 2019 with Medline, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medical literature (CBM), China Science and Technology Journal Database (VIP), and Chinese literature (Wan Fang) databases. Odds ratio (OR) and 95% confidence interval (95% CI) were used to assess the strength of associations.

Results:

Seventeen studies including 3269 cases and 3192 controls met the inclusion criteria. Our meta-analysis showed that the MTR A2756G mutation may contribute to genetic susceptibility to the risk of idiopathic male infertility in Non-Asians, but not to Asian population, whereas the MTRR A66G polymorphism may be unrelated to idiopathic male infertility in both Non-Asian and Asian populations. In the stratified analysis by infertility type, the MTR A2756G polymorphism was a risk factor for both non-obstructive azoospermia (NOA) and oligoasthenoteratozoospermia (OAT) patients. However, the MTRR A66G polymorphism is associated with risk for OAT in Asian, but not in Non-Asian population.

Conclusion:

This meta-analysis suggested that the MTR A2756G and MTRR A66G polymorphisms were risk factors for idiopathic male infertility. Studies with larger sample sizes and representative population-based cases and well-matched controls are needed to validate our results.
Surgical treatment of spontaneous brainstem hemorrhage
Authors: Hao Guangshan , Xu Zhentao , Zhu Jianxin
Published: December 2019

Rationale

The improvement of microneurosurgery and neuroimaging, as well as neuronavigation and neurophysiological monitoring, enables neurosurgeons to safely and accurately resect lesions on the brainstem.

Patient concerns

A 54-year-old man, with 2-year history of hypertension, presented with sudden loss of consciousness for 1.5 hours.

Diagnoses

Spontaneous brainstem hemorrhage.

Interventions

We performed posterior fossa decompression together with hematoma evacuation in the super early stage for the patient.

Outcomes

The patient regained normal spontaneous breathing function after surgery. And he needed help for daily activities with hemiplegia of right limb at three-month follow-up.

Lessons

The hematoma evacuation together with posterior fossa decompression in the super early stage maybe a good treatment for patients in a deep coma with a large hematoma at the dorsal side.
Comparative effectiveness of simultaneous integrated boost vs sequential intensity-modulated radiotherapy for oropharyngeal or hypopharyngeal cancer patients
Authors: Kuo Yao-Hung , Liang Ji-An , Wang Tang-Chuan , Juan Chun-Jung , Li Chia-Chin , Chien Chun-Ru
Published: December 2019

There were 2 common radiotherapy dose fractionation strategies in head-and-neck cancer patients (such as oropharyngeal cancer [OPC] or hypopharyngeal cancer [HPC]) treated with radiotherapy: intensity-modulated radiotherapy using simultaneous integrated boost (IMRT-SIB) and sequential IMRT (IMRT-SEQ). There is a lack of high-level clinical evidence to compare IMRT-SIB vs IMRT-SEQ specifically for OPC or HPC patients. The present study investigated the survival outcomes of OPC or HPC patients receiving definite concurrent chemoradiotherapy (CCRT) with either IMRT-SIB or IMRT-SEQ via a population-based propensity score (PS)-based analysis.

The localized stage OPC or HPC patients diagnosed between 2011 and 2015 were identified based on the Health and Welfare Data Science Center database in Taiwan. These patients received definitive CCRT with either IMRT-SIB or IMRT-SEQ. We constructed a PS-matched cohort (1:1 for IMRT-SIB vs IMRT-SEQ) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT-SIB and IMRT-SEQ during the entire follow-up period. We also evaluated other disease outcome or subgroups.

Our study population constituted 200 patients with well balance in observed covariables. The HR of death when IMRT-SIB was compared to IMRT-SEQ was 1.23 (95% confidence interval 0.84–1.80, P = .29). The results were similar for other disease outcome or subgroups.

We found the survival outcome might be comparable for those treated with IMRT-SIB vs those treated with IMRT-SEQ.
Diagnostic value of neutrophil-lymphocyte ratio in preeclampsia
Authors: Zheng Wen-Fei , Zhan Jingqiong , Chen Aihua , Ma Huigai , Yang Huaijie , Maharjan Rashmisha
Published: December 2019

Background:

Neutrophil-lymphocyte ratio (NLR) is one of the markers of systemic inflammation. Recent studies have associated NLR with diagnosis of preeclampsia (PE). However, due to small sample sizes and different research design, the diagnostic value of NLR in PE patients is not well understood. In this study, we evaluate the potential diagnostic value of NLR in PE.

Methods:

We searched PubMed, Embase, Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI) databases, Wanfang data, VIP database and China Biomedical Literature Database systematically for relevant literatures up to May 20, 2018. All analyses were conducted using Meta-DiSc1.4 and Stata 12.0 software. Sensitivity, specificity and other measures of accuracy of NLR for the diagnosis of PE were pooled. Meta-regression was performed to identify the sources of heterogeneity.

Results:

This meta-analysis included a total of 7 studies. The pooled sensitivity and specificity were 0.74 (95% CI 0.71–0.76) and 0.64 (95%CI 0.61–0.68), positive likelihood ratio, 2.62 (95%CI1.79–3.84); negative likelihood ratio, 0.34 (95%CI 0.24–0.48); diagnostic odds ratio, 8.44 (95%CI 4–17.78), and area under the curve was 0.82. Meta regression showed that sample size was the main source of heterogeneity. Deeks funnel plot showed that there was no statistical significance for the evaluation of publication bias (P = .16).

Conclusion:

Current evidence suggests that the diagnostic accuracy of NLR has unsatisfactory specificity but acceptable sensitivity for diagnosis of PE. Further large-scale prospective studies are required to validate the potential applicability of using NLR alone or in combination other markers as PE diagnostic biomarker and explore potential factors that may influence the accuracy of NLR for PE diagnosis.
Liposomal Irinotecan + 5-FU/LV in Metastatic Pancreatic Cancer
Authors: Macarulla Mercadé Teresa , Chen Li-Tzong , Li Chung-Pin , Siveke Jens T. , Cunningham David , Bodoky György , Blanc Jean-Frédéric , Lee Kyung-Hun , Dean Andrew , Belanger Bruce , Wang-Gillam Andrea
Published: December 2019

Objectives

The NAnoliPOsomaL Irinotecan (NAPOLI-1) study (NCT01494506) was the largest global phase 3 study in a post-gemcitabine metastatic pancreatic adenocarcinoma (mPAC) population (N = 417). The subanalyses reported here investigated the prognostic effect of tumor characteristics and disease stage, prior treatment characteristics, baseline patient characteristics on survival outcomes in NAPOLI-1, and whether liposomal irinotecan (nal-IRI) + 5-fluorouracil/leucovorin (5-FU/LV) benefited patients with mPAC across subgroups.

Methods

Post hoc analyses were performed in the NAPOLI-1 population (4 across tumor characteristics and disease stage, 6 across prior treatment characteristics, and 4 across patient baseline characteristics). Survival outcomes were estimated by Kaplan-Meier analysis and patient safety data were evaluated.

Results

Mortality and morbidity risk was lower on nal-IRI+5-FU/LV treatment across subgroups. Exceptions were patients who had received prior nonliposomal irinotecan and those who had undergone prior Whipple procedure (overall survival hazard ratio = 1.25 and 1.23, respectively). Decreased appetite, liver metastases, and number of measurable metastatic lesions seemed to be prognostic of survival in this population. Subgroup safety data were generally comparable with those in the overall NAPOLI-1 safety population.

Conclusions

A diverse population of patients with mPAC that progressed on gemcitabine-based therapy benefited from nal-IRI+5-FU/LV versus 5-FU/LV, potentially helping guide treatment decisions for challenging cases.
Primary and Metastatic Pancreatic Cancer Cells Exhibit Differential Migratory Potentials
Authors: Park Joo Kyung , Hank Thomas , Scherber Cally M. , Lillemoe Keith D. , Fernández-del Castillo Carlos , Warshaw Andrew L. , Toner Mehmet , Irimia Daniel , Thayer Sarah P. , Liss Andrew S.
Published: December 2019

Objectives

Pancreatic ductal adenocarcinoma (PDAC) is characterized by early metastatic spread in more than 50% of patients. In this study, we sought to understand the migratory properties of (non)metastatic PDAC cells and determine whether the migration of cancer stem cell (CSC) populations accounts for the aggressive nature of this disease.

Methods

The migratory abilities of primary and metastatic PDAC cell lines were investigated using a microfluidic device and time-lapse photography. The velocity, time of delay of mobilization, and number of migratory cells were analyzed. Cancer stem cell subpopulations were isolated by fluorescence-activated cell sorting and their migratory properties compared with their non-CSC counterparts.

Results

Primary cancer cells exhibited higher velocities, greater number of migratory cells, and a shorter time of delay of mobilization in comparison to metastatic cell lines. Characterization of CSC populations revealed primary PDAC cell lines were composed of fewer CD133+ and CD24+CD44+ CSC subpopulations than metastatic cells. Moreover, migratory analysis of CSC subpopulations revealed lower velocities, fewer migratory cells, and a greater time of delay of mobilization than non-CSC.

Conclusions

Primary cancer cells demonstrate enhanced migratory abilities in comparison to metastatic PDAC cells. Those differences may result from lower CSC subpopulations in primary cells because CSC populations demonstrated impaired migratory abilities in contrast to non-CSC.
Reducing Medication Error Through a Collaborative Committee Structure: An Effort to Implement Change in a Community-Based Health System
Authors: Hanifin Rikki , Zielenski Christopher
Published: December 2019

Objectives:

This article describes a methodology for implementation and sustainment of continuous quality improvement initiatives through committee structures aimed at reducing medication error rates.

Methods:

A committee structure was developed in a collaborative effort to analyze and reduce medication error rates. Interdisciplinary teams comprised of frontline staff met regularly to identify and resolve trending medication safety events and prepare and deliver education for staff. Continuous quality improvement initiatives supported by these committees included technical handling and administration of medication, medication reconciliation, and enhancements to standardized treatment protocols. Data were collected through a voluntary electronic safety event reporting system between March 2013 and March 2016, to evaluate the rate of medication errors and near-misses.

Results:

A retrospective analysis of reported medication errors and near-misses was conducted. The medication error rate significantly declined over the study period as the rate of near-misses conversely increased.

Conclusions:

Initiatives supported by the oversight of collaborative committees were successful in decreasing medication error rates.
Assessment of the Relationship Between the Coronary Venous and Arterial Systems Using 256-Slice Computed Tomography
Authors: Bai Wei , Xu Xiao , Ma Heng , Zhong Lin , Xie Haizhu , Sun Chunjuan , Shi Yinghong , Che Kaili , Liu Meijie , Yang Jun
Published: December 2019

Objectives

To investigate the coronary venous system (CVS) and its spatial relationship with coronary arteries by using 256-slice computed tomography (CT).

Methods

One hundred one patients underwent coronary CT angiography by using a 256-slice CT. In each patient, the CVS and its spatial relationship with coronary arteries were analyzed. We measured the diameters and angulations of the coronary sinus (CS), great cardiac vein, anterior interventricular vein (AIV), left marginal vein, posterior vein of the left ventricle (PVLV), and posterior interventricular vein (PIV), and the distances, respectively, from the CS ostium and from the crossing point to the ostium of corresponding tributaries.

Results

The following 5 pairs of veins and arteries had a higher frequency of intersecting compared with others: the CS/great cardiac vein and the left circumflex coronary artery (97.1%), the AIV and the diagonal or ramus branch (92.1%), the PIV and the posterior branch of left ventricle artery (88.1%), the left marginal vein and the circumflex or circumflex marginal (73.9%), and the PVLV and the circumflex or circumflex marginal (31.6%). The other 2 pairs had a higher frequency of running parallel to each other: the AIV and the left anterior descending artery (76.2%) and the PIV and the posterior descending artery (54.4%). Most tributaries were lateral to their corresponding arteries at the crossing point except for the AIV. For the PVLV and PIV, the distances from the crossing point to the ostium of corresponding veins when the veins were lateral to the arteries were smaller than those when the veins were medial to the arteries (P< 0.05).

Conclusions

The CVS and its anatomical relationship with the coronary arterial system can be examined with details by using a 256-slice CT, which has important clinical implications.
Two Laterally Based Flap Otoplasty for Protruding Ear Correction
Authors: Ersen Burak
Published: December 2019

The postauricular fascial flap as supportive or stand-alone technique provides natural, symmetrical-looking ears with minimal complications and recurrence. However, the posterior fascial flap otoplasty is not applicable for all protruding ear deformity types. It is particularly advantageous in terms of anti-helix creation yet does not have a satisfactory effect for correction of conchal hypertrophy. In this paper, it was aimed to describe a new technique, solely focuses on overcoming the conchal hypertrophy problem during protruding ear repair.

A total of 12 patients (8 male and 4 female) underwent otoplasty with the same surgeon between May 2017 and May 2018. All otoplasties were performed bilaterally. Patients with conchal hypertrophy and anti-helical effacement were included into this study to evaluate the efficiency of the new technique.

A total of 12 patients (8 male and 4 female) underwent otoplasty with described technique. Patients ages ranged from 18 to 30 years, with a median of 27.6 years. None of the patients suffered from early postoperative complications, such as skin necrosis, suture extrusion, hematoma, or wound infection. There was only 1 patient with the complaint of asymmetry at the late postoperative period and unilateral revision otoplasty was performed.

In this study it was aimed to demonstrate a new technique which contains one posterior perichondrio-adipo-dermal flap and 1 perichondreal flap. The technique is highly advantageous if the patient suffers from both conchal hypertrophy and anti-helical effacement. It was seen that the described technique is practical and efficient for patients who both has conchal hypertrophy and anti-helical effacement.

Level of Evidence:

III, therapeutic study.
Pre-Expanded Latissimus Dorsi Myocutaneous Flap for Total Scalp Defect Reconstruction
Authors: Xiao Yang , Xiao Haitao , Wan Haifeng , Zeng Qian , Zhang Yange , Xu Xuewen
Published: December 2019

Scalp defects can be caused by various factors, and reconstruction options for scalp defects include skin grafts, local flaps, tissue expanders, and free flaps. However, currently, it is widely accepted that the use of free flaps is the most feasible method for extensive scalp defect reconstruction. While multiple flaps have been used to reconstruct scalp defects, the reconstruction of total scalp defects still remains challenging. Pre-expansion of free flaps offers several advantages, including increasing flap size and thinning of the tissue for better contour, and is particularly important in scalp reconstruction. This report describes the successful management of total scalp defect reconstruction that involved the entire frontal, parietal, occipital, and temporal regions using a pre-expanded latissimus dorsi myocutaneous flap in a 40-year-old female patient. Over 2 years of follow-up, the transplanted flap survived well and the patient eventually achieved excellent cosmetic appearance, with satisfactory durable coverage. She was able to wear a hairpiece and hat without any wound breakdown. Our report indicates that microsurgery using pre-expanded latissimus dorsi myocutaneous flap transfer is a reliable and safe choice for total scalp reconstruction, allowing reconstruction with a single-flap, an excellent aesthetic effect, and abrasive resistance.
Strategy for the Treatment of Zygomatic-Coronoid Ankylosis
Authors: Santos Anderson Maikon de Souza , Mendes Bruno Coelho , Lima-Neto Tiburtino José de , Paiva Marcos Antônio Farias de , Villarim Natália Lins de Souza , Santos Murilo Quintão dos , Faverani Leonardo Perez , Hochuli-Vieira Eduardo
Published: December 2019

Zygomatic-coronoid ankylosis is a rare complication in maxillofacial trauma. Currently, less of 30 cases reported in the literature. The aim of this study was to report a case of zygomatic-coronoid ankylosis after trauma. A 26-year-old male, with zygomatic-coronoid ankylosis after 7 years of facial trauma, was treated by intraoral bilateral coronoidectomy. However, the literature continues to discuss the best approach, intraorally or extraorally. This study observed that the intraoral approach was easily performed and without complications.
Bio-DIA: A web-based tool for data and algorithms integration
Authors: Dantas Thiago , da Silva Vandeclécio Lira , Fonseca André Faustino , Morais Diego A A , Signoretti Alberto , Blanco Wilfredo
Published: December 2019

Data science is historically a complex field, not only because of the huge amount of data and its variety of formats, but also because the necessity of collaboration between several specialists to retrieve valuable information. In this context, we created Bio-DIA, an online software to build data science workflow process focused in the integration of data and algorithms. Bio-DIA also facilitates the reusability of information/results obtained in previous process without the need of specific skills from the computer science field. The software was created with Angular at the front-end, Django at the back-end together with Spark to handle and process a variety of big data formats. The workflow/project is specified through XML file. Bio-DIA application facilitated the collaboration among users, allowing researcher’s groups to share data, scripts and information.

Availability

https://ucrania.imd.ufrn.br/biodia-app/. Login: bioguest, password: welcome123.
Educational attainment reduces the risk of suicide attempt among individuals with and without psychiatric disorders independent of cognition: a multivariable Mendelian randomization study with more than 815,000 participants
Authors: Rosoff Daniel B. , Kaminsky Zachary A. , Lohoff Falk W.
Published: December 2019

Background

Rates of suicidal ideation, attempts and completions are increasing and identifying causal risk factors continues to be a public health priority. Observational literature has shown that educational attainment (EA) and cognitive performance (CP) can influence suicide attempt risk; however, due to residual confounding and reverse causation, the causal nature of these relationships is unknown.

Methods

We perform a multivariable two-sample Mendelian randomization (MR) analysis to disentangle the effects of EA and CP on suicide attempt risk. We use summary statistics from recent genome-wide association studies (GWAS) of EA, CP, household income versus suicide attempt risk in individuals with and without mental disorders, with more than 815,000 combined study participants.

Results

We found evidence that both EA and CP significantly reduced the risk of suicide attempt when considered separately in single variable MR (SVMR) (Model 1 EA odds ratio (OR), 0.524, 95% CI, 0.412-0.666,P= 1.07⨯10−7; CP OR, 0.714, 95% CI, 0.577-0.885,P= 0.002). When simultaneously analyzing EA,CA, and adjusting for household income but not comorbid mental disorders (Model 1), we found evidence that the direct effect of EA, independent of CP, on suicide attempt risk was greater than the total effect estimated by SVMR, with EA, independent of CP, significantly reducing the risk of suicide attempt by almost 66% (95% CI, 43%-79%); however, the effect of CP was no longer significant independent of EA (Model 1 EA OR, 0.342, 95% CI, 0.206-0.568,P= 1.61×10−4; CP OR, 1.182, 95% CI, 0.842-1.659,P= 0.333). Further, when accounting for comorbid mental disorders (Model 2), these results did not significantly change: we found EA significantly reduced the risk of suicide attempt by 55% (35%-68%), a lower point estimate but still within the 95% confidence interval of Model 1; the effect of CP was still not significant (Model 2 EA OR, 0.450, 95% CI, 0.314-0.644,P< 1.00×10−4; CP OR, 1.143, 95% CI, 0.803-1.627,P= 0.475).

Conclusions

Our results show that even after accounting for comorbid mental disorders and adjusting for household income, EA, but not CP, is a causal risk factor in suicide attempt. These findings could have important implications for health policy and prevention programs aimed at reducing the increasing rates of suicide.
A robust gene expression signature to predict proteasome inhibitor benefit in Multiple Myeloma
Authors: Ubels Joske , Sonneveld Pieter , van Vliet Martin H. , de Ridder Jeroen
Published: December 2019

Many cancer drugs only benefit a subset of the patients that receive them, but are often associated with serious side effects. Predictive classification methods that can identify which patients will benefit from a specific treatment are therefore of great clinical utility. We here introduce a novel machine learning method to identify predictive gene expression signatures, based on the idea that patients who received different treatments but exhibit similar expression profiles can be used to model response to the alternative treatment. We use this method to predict proteasome inhibitor benefit in Multiple Myeloma (MM). In a dataset of 910 MM patients we identify a 14-gene expression signature that can successfully predict benefit to the proteasome inhibitor bortezomib, with a hazard ratio of 0.47 (p = 0.04) in class ‘benefit’, while in class ‘no benefit’ the hazard ratio is 0.91 (p = 0.68). Importantly, we observe a similar classification performance (HR class benefit = 0.46, p = 0.04) in an independent patient cohort which was moreover measured on a different platform, demonstrating the robustness of the signature. Moreover, we find that the genes in the discovered signature are essential, as no equivalent signature can be found when they are excluded from the analysis. Multiple genes in the signature are linked to working mechanisms of proteasome inhibitors or MM disease progression. In conclusion, our method allows for identification of gene expression signatures that can aid in treatment decisions for MM patients and provide insight into the biological mechanism behind treatment benefit.
Variance and Scale-Free Properties of Resting-State BOLD Signal Alter after Fear Memory Acquisition and Extinction
Authors: Tetereva Alina , Kartashov Sergey , Ivanitsky Alexey , Martynova Olga
Published: December 2019

Previous studies showed differences in brain dynamics during rest and different tasks. We aimed to find changes of variance and scale-free properties of blood oxygenation level-dependent (BOLD) signal between resting-state sessions before and after fear learning and fear memory extinction in twenty-three healthy right-handed volunteers. During a 1-hour break between MRI-scanning, subjects passed through fear extinction procedure, followed by Pavlovian fear conditioning with weak electrical stimulation. After preprocessing, we extracted the average time course of BOLD signal from 245 regions of interest (ROI) taken from the resting-state functional atlas. The variance of the BOLD signal in and Hurst exponent (H), which reflects the scale-free dynamic, were compared in resting states before after fear learning. Six ROIs showed a significant difference in H after fear extinction, including areas from the fear and memory networks. In consistency with the previous results, H decreased during fear extinction but then increased higher than before, specifically in areas related to fear extinction network, whereas the other ROIs restored H to the initial level. The BOLD signal variance showed distinct behavior: the variance in subcortical regions increased permanently, while cortical areas demonstrated a decreasing variance during fear extinction and the reverse growth in resting state after fear extinction. A limited number of ROIs showed both changes in H and the variance. Our results suggest that the variability and scale-free properties of the BOLD signal are sensitive indicators of the residual brain activity related to the recent experience.
Independent Yet Synergistic Roles of Synaptotagmin-1 and Complexin in Calcium Regulated Neuronal Exocytosis
Authors: Ramakrishnan Sathish , Bera Manindra , Coleman Jeff , Rothman James E. , Krishnakumar Shyam S.
Published: December 2019

Calcium (Ca2+)-evoked release of neurotransmitters from synaptic vesicles requires mechanisms both to prevent un-initiated fusion of vesicles (clamping) and to trigger fusion following Ca2+-influx. The principal components involved, namely the vesicular fusion machinery (SNARE proteins) and the regulatory proteins (Synaptotagmin-1 and Complexin) are well-known. Here, we use a reconstituted single-vesicle fusion assay to delineate a novel mechanism by which Synaptotagmin-1 and Complexin act independently but synergistically to establish Ca2+-regulated fusion. Under physiologically-relevant conditions, we find that Synaptotagmin-1 oligomers bind and clamp a limited number of ‘central’ SNARE complexes via the primary binding interface, to introduce a kinetic delay in vesicle fusion mediated by the excess of free SNAREpins. This in turn enables Complexin to independently arrest the remaining free ‘peripheral’ SNAREpins to produce stably clamped vesicles. Activation of the central SNAREpins associated with Synaptotagmin-1 by Ca2+is sufficient to trigger rapid (<100 msec) and synchronous fusion of the docked vesicles.