bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue Acquisition During EBUS-TBNA
Authors: Pickering Edward M. , Holden Van K. , Heath Jonathon E. , Verceles Avelino C. , Kalchiem-Dekel Or , Sachdeva Ashutosh
Published: December 2018

Background:

Previous studies have shown that needle gauge size has no significant impact on diagnostic yield during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Our objective was to determine whether cell blocks obtained via the new Flex 19G EBUS-TBNA needle would contain more cellular material based on cell area compared with those obtained from a 21G needle.

Methods:

A prospective analysis of patients undergoing EBUS-TBNA at our institutions was performed. Sampling of the same lesion(s) with both the Flex 19G and 21G needles was performed in an alternating manner. In total, 47 patients with suspected lung cancer or mediastinal/hilar lymphadenopathy were included with a total of 83 lesions biopsied. Cell block area was calculated using the Aperio ImageScope software.

Results:

Mean cell area in the Flex 19G group was 7.34±12.46 mm2 compared with 5.23±10.73 mm2 in the 21G group (P=0.02). In the malignant subgroup, the average cell area was 16.16±16.30 mm2 in the Flex 19G group versus 11.09±15.55 mm2 in the 21G group (P=0.02). No significant difference was noted in the mean cell area within the nonmalignant subgroup, 1.80±3.01 mm2 in the 19G group versus 1.56±1.79 mm2 in the 21G group (P=0.60).

Conclusion:

The cell area obtained via the 19G needle was significantly larger than that obtained with the 21G needle. Further multicenter randomized studies are needed to identify the utility of the Flex 19G needle in diagnosing/subtyping lymphoproliferative disorders and adequacy for molecular testing in non–small cell lung cancer.
Differential expression of circulating long non-coding RNAs in patients with acute myocardial infarction
Authors: Zhong Zhixiong , Hou Jingyuan , Zhang Qifeng , Li Bin , Li Cunren , Liu Zhidong , Yang Min , Zhong Wei , Zhao Pingsen
Published: December 2018

Long noncoding RNAs (lncRNAs) are non-protein coding transcripts regulating various critical physiological and pathological processes, yet limited information is available about lncRNAs expression in acute myocardial infarction (AMI). We aimed to identified differentially expressed lncRNAs in blood samples of patients with AMI to assess their diagnostic value. Differential expression of lncRNAs in peripheral blood mononuclear cells (PBMC) of patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) was compared by RNA sequencing method and validated by real-time polymerase chain reaction (PCR). The area under the receiver operating characteristic curve (ROC) was used to evaluate diagnostic accuracy. Gene ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of lncRNA-coexpressed mRNAs were conducted to determine the related biological modules and pathological pathways. RNA sequencing data showed that 58 lncRNAs were differentially expressed between NSTEMI patients and STEMI patients, including 42 upregulated lncRNAs and 16 down-regulated lncRNAs. The ROC curves showed that ENST00000508020.2, LNC_001265, LNC_001526, and LNC_002674 could distinguish AMI patients with preferable sensitivity and specificity. GO enrichment analysis of lncRNA-coexpressed mRNAs indicated that the biological modules were correlated with cell adhesion, calcium ion homeostasis, complement receptor mediated signaling pathway, and immune system process. KEGG pathway analysis indicated that the lncRNAs-co-expressed mRNAs were involved in the regulation of peroxisome proliferators-activated receptors (PPAR) signaling pathway, mTOR signaling pathway, Insulin signaling pathway, HIF-1 signaling, and chemokin signaling pathway. Our results are in line with the previous findings, suggesting that differential expression of lncRNAs would be helpful to understand the molecular mechanism of AMI and might be useful biomarkers for noninvasive diagnostic application. Further studies are still needed to verify our findings and hypothesis.
High prevalence of IgE sensitization against house dust mites in pregnant women
Authors: Yeh Chang-Ching , Wu Keh-Gong , Wang Peng-Hui
Published: December 2018

There is an increase in prevalence and financial burden of childhood atopic disorders in recent years. Understanding allergic conditions of pregnant women is important for developing strategies for prevention and management of allergy-related diseases. However, little is currently known about the atopic conditions in pregnant women.

The sera from 46 pregnant women were analyzed for allergen-specific IgE antibodies using the Optigen assay and SDS-PAGE immunoblot analysis.

Results from the Optigen assay showed that 20 (43%) of the 46 serum samples analyzed demonstrated IgE reactivity against mite p (Dermatophagoides pteronyssinus) (95%), mite f (D farinae) (95%), house dust (60%), cat (25%), shrimp (20%), crab (15%), cockroach (10%), dog (5%), latex (5%), willow black (5%), and timothy grass (5%). Nineteen of the 20 Optigen-positive sera demonstrated IgE reactivity against both the house dust mites D pteronyssinus and D farina, with 10 of them having a high IgE CLA class value of 4. IgE reactivity to the house dust mite D pteronyssinus was confirmed in SDS-PAGE-immunoblots, which correlated well with the intensity of IgE-binding to the 15-kDa D pteronyssinus component and to the purified recombinant Der p 2 major house dust mite allergen.

A high prevalence of IgE sensitization against house dust mites during pregnancy is noted, which is worthy of clinical attention. Children of IgE-sensitized mothers should be closely monitored for development of allergenic disorders.
Conventional 99mTc-(hydroxy) methylene diphosphate remains useful to predict osteosarcoma response to neoadjuvant chemotherapy
Authors: Kubo Tadahiko , Furuta Taisuke , Sakuda Tomohiko , Ochi Mitsuo , Adachi Nobuo
Published: December 2018

Background:

The current standard of chemotherapy response evaluation holds the most important prognostic factor to be the histological assessment of the tumor necrosis of the excised lesion, but the major challenge is to find an early prognostic factor that will allow the adjuvant treatment regimen to be adjusted. The objective of this systematic review is to provide an up-to-date and unprecedented summary of the value of 99mTechnetium-methylene diphosphate or -hydroxymethylene diphosphate (99mTc-MDP/HMDP) scintigraphy for the preoperative evaluation of osteosarcoma response to chemotherapy.

Methods:

Studies evaluating the alteration ratio (percentage change of the Tc-99m -MDP/HMDP uptake between before and after neoadjuvant chemotherapy) to predict the histological response of osteosarcoma to chemotherapy were searched for in MEDLINE, EMBASE, and Web of Science. A meta-analysis of individual patient data (IPD) was performed to determine the optimal cut-off point from the receiver operating characteristic (ROC) curve. Additionally, aggregate data (AD) meta-analysis was performed to compare the value of 99mTc-MDP/HMDP scintigraphy with that of other quantitative modalities, such as dynamic magnetic resonance imaging (MRI), 201Tl scintigraphy, and 18F-FDG PET-CT.

Results:

Seven studies with 154 patients were included for the IPD meta-analysis. The optimal cut-off point of the alteration ratio was 31.0%. Five studies with 123 patients were considered for the AD meta-analysis. The pooled sensitivity and specificity were 0.76 (95% CI, 0.63–0.86) and 0.89 (95% CI, 0.79–0.95), respectively. There was a significant difference between the good and poor responders in terms of the diagnostic odds ratio. The summary ROC curve demonstrated that the area under curve (AUC) was 0.892, indicating excellent diagnostic accuracy.

Conclusion:

Our findings have suggested that conventional 99mTc-MDP/HMDP scintigraphy remains as useful as recent quantitative modalities to predict the histological response of osteosarcoma to neoadjuvant chemotherapy.
Successful treatment with temozolomide in an elderly woman with advanced pulmonary large-cell neuroendocrine carcinoma
Authors: Wei Juan , Dong Xiao Fang , Hu Zu Liang , Tang Sheng , Lu Yi Fang
Published: December 2018

Rationale:

Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is a rare type of lung cancer, and 40% of patients are in stage IV at initial diagnosis. It has an extremely poor prognosis with a 1-year survival rate of 27%. Patients with LCNEC are predominantly male, older, and heavy smokers. There has been no clinical trial conducted to determine the best treatment for advanced LCNEC. Temozolomide (TMZ) has been successfully used to treat a variety of malignancies, such as glioblastoma multiforme, astrocytoma, non-small-cell lung carcinoma. However, its efficacy in advanced stage pulmonary LCNEC has rarely been studied.

Patient concerns:

We present the rare case of a 69-year-old woman with advanced pulmonary LCNEC. She complained of recurrent dry cough for more than 1 month.

Diagnoses:

After chest computed tomography (CT) and biopsies of supraclavicular lymph nodes, the diagnosis of stage IIIB LCNEC of the lung was made.

Interventions:

Four cycles of chemotherapy with etoposide and cisplatin was administered as the first-line regimen. As the disease progressed, we administered icotinib and liposomal paclitaxel. Finally, we administrated TMZ as the third-line regimen.

Outcomes:

The patient showed partial response after 5 months. She has survived for 19 months from the time of diagnosis with a good performance status.

Lessons:

TMZ appears to be an efficacious option to treat elderly patients with advanced LCNEC.
A comparative study on the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain in patients with laparoscopic cholecystectomy
Authors: Kamali Alireza , Ashrafi Taha Hojati , Rakei Siamak , Noori Gholamreza , Norouzi Afsaneh
Published: December 2018

Background:

Today, the ever-expanding technology is inevitably shadowing on all aspects of human life. This study was aimed to compare the prophylactic effects of paracetamol and dexmedetomidine for controlling hemodynamics during surgery and postoperative pain.

Methods:

The study population consisted of 132 patients aged 18 to 70 years and from both genders, who were candidates for emergency cholecystectomy or elective surgery. Group A consisted of 66 patients who received dexmedetomidine, and Group B included 66 patients with paracetamol administration. The amount of postoperative pain was measured on the basis of visual analog scale, arterial blood pressure, as well as heart rate at recovery and 4, 12, and 24 hours after surgery.

Results:

The mean age in the 2 groups was similar and almost equal to 52 years; there was no difference in the sex ratios in both groups (P > .05). Pain score in the paracetamol group was significantly lower than that in the dexmedetomidine group (P = .04); nevertheless, there were no group differences in the mean scores of pain during these hours (P > .05). The median opioid use in 24 hours after operation in the paracetamol group was lower when compared with that in the dexmedetomidine group, and the mean duration of analgesia in the paracetamol group was higher when comparing with dexmedetomidine group. Furthermore, in both groups, mean arterial pressure and preoperative PR interval were similar at various times.

Conclusion:

The findings demonstrated that both regimens of drugs can control the hemodynamic status of patients during laparoscopic cholecystectomy, which provides effective postoperative analgesia for pain management.
Corneal dysplastic melanosis associated with recurrent corneal erosions
Authors: Lee Hyo Kyung , Lee Cheol , Kim Mee Kum
Published: December 2018

Rationale:

Pigmented lesions of conjunctiva and cornea can be observed in various conditions, from the benign nevus to malignant melanoma. Pigmented acquired melanosis (PAM) is one of them, which is a neoplastic proliferation with malignant transformation potential of melanocytes. However, to our knowledge, there has been no report as to a disturbance of corneal barrier function caused by PAM. Here we report a case of corneal PAM which led to recurrent corneal erosions.

Patient concerns:

A 60-year-old woman was referred with a 4-month history of intractable recurrent epithelial erosions in the left eye. She denied any history of ocular trauma or surgery. Slit-lamp examination showed small epithelial defects and loose epithelium of overlying pigmented corneal lesions. The pigmentations were scattered in the corneal epithelial layer, from limbus to the central cornea.

Diagnosis:

Conservative treatment with therapeutic contact lens and oral doxycycline did not completely cure the corneal erosion. En bloc resection of the pigmented epithelium with cryotherapy and temporary amniotic membrane transplantation were performed. Histopathologic examination demonstrated pigmented melanocytes with mild atypia, scattered mainly in the corneal basal epithelium. Immunohistochemically, the cells were positive for Melan A/MART-1 and negative for CD68 and S100. The Ki-67 proliferation index was low. Therefore, it was diagnosed as primary acquired dysplastic melanosis causing epithelial barrier dysfunction.

Interventions:

We performed en bloc resection of the pigmented epithelium with cryotherapy and temporary amniotic membrane transplantation.

Outcomes:

After the resection, recurrent corneal erosions and epithelial loosening were completely resolved. Although some pigmented lesions were recurred in the limbal epithelium at 8 o’clock, corneal erosion did not recur during the follow-up for 9 months.

Lessons:

Our report suggests that primary acquired dysplastic corneal melanosis may cause epithelial dysfunction resulting in recurrent corneal epithelial erosions.
Identifying risk factors of lateral lymph node recurrence in clinically node-negative papillary thyroid cancer
Authors: Ryu Young Jae , Kang Shin Jae , Cho Jin Seong , Yoon Jung Han , Park Min Ho
Published: December 2018

There is still debate regarding the role of routine central lymph node (LN) dissection in treating clinically node-negative papillary thyroid cancer (PTC). The aim of this study was to investigate the risk factors for lateral recurrence after total thyroidectomy and prophylactic bilateral central LN dissection in clinically node-negative PTC patients.

We retrospectively collected the medical records of 1406 PTC patients who underwent total thyroidectomy and prophylactic bilateral central LN dissection between January 2004 and December 2008. We used Cox- proportional hazards regression analyses to inspect the predictive factors for recurrence.

During a median follow-up of 107 months (range, 13–164 months), 68 (4.8%) and 37 (2.6%) patients experienced recurrence in any lesion and in lateral neck LN, respectively. Male, main tumor size >1 cm, nodal factors (pathologic N1a, positive delphian LN, and LN ratio >0.15), lymphovascular invasion, and extrathyroidal extension (ETE) were significantly associated with lateral neck LN recurrence in univariate analysis. Multivariate analysis showed that male (hazard ratio [HR], 2.217; 95% confidence interval [CI], 1.057–4.647; P = .035), main tumor size >1 cm (HR, 2.257; 95% CI, 1.138–4.476; P = .020), pathologic N1a (HR, 5.957; 95% CI, 2.573–13.789; P < .002), minor ETE (vs no ETE; HR, 3.027; 95% CI, 1.315–6.966; P = .009), and gross ETE (vs no ETE; HR, 4.058; 95% CI, 1.685–9.774; P = .002) were independent predictors for lateral neck LN recurrence.

Among patients with pathologic N1a, those with LN ratio of more than 0.55 had worse lateral neck LN recurrence-free survival. Lateral neck LN recurrence in clinically node-negative PTC patients is predicted by the factors of male, main tumor size >1 cm, ETE, and pathologic N1a.
Clinical effects of mindfulness meditation and cognitive behavioral therapy standardized for insomnia
Authors: Cheong Moon Joo , Lee Go-Eun , Kang Hyung Won , Kim Sooim , Kim Hye Kyung , Jo Han-ik , Kang Yeonseok , Kim Jae-Hyo , Baek Hyeon-Gi
Published: December 2018

Introduction:

This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of mindfulness meditation and cognitive behavioral therapy programs as a psychological intervention for insomnia disorders.

Methods and analysis:

We will search the following 11 electronic databases without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. Furthermore, we will also search 5 Korean-language databases (Oriental Medicine Advanced Searching Integrated System, Korean studies Information Service System, Research Information Service System, Korean Medical Database, and Korea Citation Index). The study selection and data extraction will be performed independently by 2 authors. The study quality assessment and evaluation of the quality of evidence for the main findings will be performed independently by 2 authors using the Cochrane tool for assessing risk of bias and predefined criteria (the Grading of Recommendations Assessment, Development, and Evaluation approach). Data synthesis and analysis will be performed using RevMan Version 5.3. Data will be synthesized by either a fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. If any plan for documenting important protocol amendments changes, the researchers will have a revision agreement and then register the modification in the International Prospective Register of Systematic Reviews (PROSPERO).

Ethics and dissemination:

Ethical approval will not be required because individual patient data are not included and because this protocol is for a systematic review. The findings of this systematic review will be disseminated through conference presentations.

PROSPERO registration number: CRD42018111217.
Multiple cavernous hemangiomas of the lung and liver mimicking metastasis
Authors: Zhuang Bo-wen , Li Wei , Chen Zhi-feng , Cao Chuang-jie , Xie Xiao-yan , Xie Xiao-hua
Published: December 2018

Rationale:

Cavernous hemangiomas are benign vascular malformations that usually involve the skin, subcutaneous tissue, and liver. Described herein was multiple masses in the lung and liver mimicking metastasis, which was proved to be cavernous hemangiomas histologically.

Patient concerns:

A 78-year-old man with complaint of dizziness for 3 days was referred to the local hospital for medical attention.

Diagnoses:

Multiple masses in the lung and liver was diagnosed pathologically as cavernous hemangioma.

Interventions:

Because of the benign pathological characteristic and multiple distribution, no treatment except some symptomatic treatment for dizziness was administered.

Outcome:

After more than 2 years of follow-up visits, the patient had no apparent symptoms and was healthy.

Lessons:

Proper diagnosis of multiple cavernous hemangiomas is essential. The final diagnosis depends on the pathology results. The most appropriate management is follow-up. Surgical treatment is suitable for large or symptomatic lesions which can result in satisfactory prognoses.
A case report of endoscopic therapy for radiation-induced hemorrhagic gastritis in patient with recurrent hepatocellular carcinoma
Authors: Liang Ma , Liwen Zhang , Juan Dai , Yun Zhuang , Yanbo Ding , Jianping Chen
Published: December 2018

Rationale:

Radiation-induced hemorrhagic gastritis is an infrequent cause of upper gastrointestinal bleeding and difficult to manage. The current standard treatment has not been well established.

Patient concerns:

We described a 32-year-old male patient with hemorrhagic gastritis induced by external radiotherapy for hepatocellular carcinoma recurrence.

Diagnoses:

The endoscopic examination showed a diffuse area of bleeding in the gastric antrum.

Interventions:

After failure of conventional hemostasis treatment, we successfully stopped the hemorrhage with repeated endoscopic argon plasma coagulation (APC) combined with low-dose polyglycerol sclerotherapy.

Outcomes:

The patient was followed up for 6 months to date without recurrence.

Lessons:

Based on this case, we think that endoscopic APC combined with low-dose polidocanol sclerotherapy can be tried as a treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.
Mass spectrometry identification of potential biomarker proteins in the 150-kD electrophoretic band in patients with schizophrenia
Authors: Xu Ruihuan , Liang Jingwen , Luo Yi , Wan Xing , Li Kang , Qi Liguo , Yuan Wenbin , Chen Jianxia , Wu Ze , Wang Mingbang , Zhou Jiaxiu , Xie Yingjun , Zhou Shaoming , He Fusheng
Published: December 2018

Background:

Diagnosing schizophrenia is primarily based on the presentation of defined signs and symptoms, none of which is pathognomonic for this group of syndromes. However, few significant genome-wide associations between schizophrenia and individual have detected. Protein profiling of candidate serum biomarkers in schizophrenia is therefore an area of great interest.

Methods:

In the present study, we used a combination of 7% polyethylene glycol (PEG) enrichment of immune complexes and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) to separate abnormal band, then analyse the band with liquid chromatography mass spectrometry (LC-MS).

Results:

There is a special 150-kD electrophoretic band in patients with schizophrenia, bipolar disorder, or depression relative to healthy controls (each 30 samples). Analysis of the band using LC-MS resulted in the identification of 11 serum proteins whose abundance was altered between patients and controls. Among them, 8 proteins (CFH, CFB, cDNA FLJ75416, zinc finger protein 729, isoform 2 of nidogen-1, diaphanous-1, cDNA FLJ77762, and cDNA FLJ58411) were up regulated, while one protein (isoform 1 of collagen alpha-1 (II) was down regulated in patients with schizophrenia, but only zinc finger protein 729 has statistics significance (P < .05). No differences were noted with regard to thrombospondin-1 or collagen alpha-2 (I) among the 3 groups. These proteins take part in several biological functions such as focal adhesion, complement cascades, ECM-receptor interaction, and Staphylococcus aureus infection.

Conclusions:

The 150-kD electrophoretic band or zinc finger protein 729 may become biomarkers in patients with schizophrenia. In the future increasing sample size and function research of zinc finger protein 729 should be executed continuously.
Association between physical activity and stroke in a middle-aged and elderly Chinese population
Authors: Yu Lingling , Liang Qian , Zhou Wei , Huang Xiao , Hu Lihua , You Chunjiao , Li Juxiang , Wu Yanqing , Li Ping , Wu Qinghua , Wang Zengwu , Gao Runlin , Bao Huihui , Cheng Xiaoshu
Published: December 2018

Background:

Accumulating evidence has reported that physical activity (PA) is effective in reducing stroke and mortality. However, whether PA levels are associated with stroke in middle-aged and elderly people in Jiangxi Province of China remains unclear. In the present study, we evaluated the association between PA and the risk of stroke in Jiangxi Province of China.

Methods:

A cross-sectional survey was conducted in Jiangxi Province of China from November 2013 to August 2014, using standardized questionnaire forms and physical measurements. Self-reported PA was assessed using the international PA questionnaire. A history of stroke was self-reported by answering the questionnaire. Multivariate logistic regression analysis was performed to evaluate the association between PA levels and the risk of stroke after adjustment for sociodemographic characteristics, lifestyle factors, and disease-related risk factors.

Results:

A total of 10,398 participants (4240 men and 6158 women, aged 45 to 97 years) completed the International Physical Activity Questionnaire (IPAQ). Compared with low-intensity PA, vigorous PA was associated with graded reduction in the risk of stroke (odds ratio [OR] of 0.763, 95% confidence interval [CI] 0.717–0.812, P < .001 for trend). However, there were no significant differences between individuals in the low-intensity PA and moderate-intensity PA group (P > 0.05).

Conclusions:

Compared with low PA, vigorous PA, but not moderate PA, was associated with a lower risk of stroke in middle aged and elderly people in southern China, specifically among men. These findings suggested that increasing PA is beneficial.
Effectiveness and safety of Injinoryung-San-Gagambang (Yinchen Wuling powder) decoction on stroke patients with elevated serum liver enzymes
Authors: Chu Hongmin , Park Chanran , Kim Cheolhyun , Sung Kang-Keyng , Lee Sangkwan
Published: December 2018

Rationale:

Injinoryung-San-Gagambang (IJORS) effectively improves hepatic dysfunction caused by polypharmacy in stroke patients.

Patient concerns:

We present 3 cases of hepatic dysfunction caused by polypharmacy, one of which was a 51-year-old man with cerebellum infarction and pneumonia as a complication of stroke. He took multiple medications because of baseline diseases. After recurrence of pneumonia, his laboratory tests showed abnormal aminotransferase levels. Another patient was an 81-year-old woman with cerebral infarction at the right-middle cerebral artery. She was also taking >5 medications. Her laboratory tests conducted on admission showed abnormally elevated aminotransferase levels. The last patient was 77-year-old man with cerebral infarction at the left-middle cerebral artery. He also had an abdominal aneurysm, a thoracic aortic aneurysm, and a myocardial infarction. After taking multiple medications including healthy functional foods, his laboratory tests showed abnormally elevated aminotransferase levels.

Diagnosis:

Diagnosis is conducted with the result of laboratory test including blood count, chemistry test.

Interventions:

All 3 patients received the same herbal treatment (IJORS decoction) for 1 to 3 weeks.

Outcomes:

All 3 patients’ abnormal serum aminotransferase level were significantly improved by IJORS decoction treatment while keeping other medicines.

Lessons:

IJORS can be considered as an effective treatment for hepatic dysfunction induced by numerous medications in stroke patients.
Feasibility and strategy of common hepatic artery lymph node dissection in thoracolaparoscopic esophagectomy for thoracic esophageal squamous cell cancer
Authors: Han Zi-Yang , Kang Ming-Qiang , Lin Jiang-Bo , Chen Shu-Chen , Chen Sui , Yu Shao-Bin
Published: December 2018

Controversy about the adequate extent of lymph node (LN) dissection persists in surgery for thoracic esophageal squamous cell carcinoma (ESCC). The present study estimates the feasibility and strategy of common hepatic artery LN dissection during ESCC surgery.

The clinical data of 482 patients with ESCC, who underwent thoracolaparoscopic esophagectomy at Fujian Medical University Union Hospital, were retrospectively selected. Among the 482 ESCC patients, 224 patients underwent thoracolaparoscopic esophagectomy with routine common hepatic artery LN dissection (cohort 1), while 258 patients underwent the same procedure without common hepatic artery LN dissection (cohort 2). The proposed operation method was introduced to safely dissect the common hepatic artery LN. Both univariate and multivariate analyses were performed to analyze the clinicopathological factors correlated to the common hepatic artery LN metastasis.

The main postoperative complications were pneumonia, anastomotic leakage, vocal cord palsy and cardiovascular disease. There was no significant difference in the incidence of major postoperative complications between the 2 cohorts (P >.05), and the incidence was similar in a number of reports. The metastatic rate of common hepatic artery LNs was 4.91%, which was relatively lower. Based on the logistic regression analysis of 5 factors, tumor location and T classification were risk factors for common hepatic artery LN metastasis (P <.05).

Routine common hepatic artery LN dissection is safe and feasible during a thoracolaparoscopic esophagectomy for ESCC. Although the metastatic rate is lower, common hepatic artery LN dissection should be performed for lower thoracic ESCCs, especially for tumors that invade the outer membrane.
Entecavir-based combination therapies for chronic hepatitis B
Authors: Luo Aoran , Jiang Xiaoyan , Ren Hong
Published: December 2018

Background:

Currently, there is no consensus on the efficacy and safety of the entecavir (ETV) monotherapy versus the ETV-based combination therapy for chronic hepatitis B.

Methods:

A comprehensive literature search was performed on the comparison of ETV-based combination therapy and monotherapy for chronical hepatitis B (CHB) patients in the PubMed, Embase, Web of Science, the Cochrane Libraries, and the Chinese BioMedical Literature Database. Both dichotomous and continuous variables were extracted, and pooled outcomes were expressed as odds ratio (OR) or mean difference (MD).

Results:

We included randomized clinical trials (RCTs) and cohorts involving Group A: nucleos(t)ide-naive patients (four RCTs, n = 719 patients), Group B: nucleos(t)ide-resistant patients (four cohorts, n = 196 patients), and Group C: entecavir-treated patients with undetectable hepatitis B virus DNA (two RCTs and two cohorts, n = 297). Group A. ETV monotherapy was better for rates of undetectable HBV DNA, while the rates of the HBV DNA levels at the end of treatment, HBeAg Loss, ALT normalization were similar between the two groups [MD, −0.85 (95% CI, −0.173–0.03); OR, 0.92 (95% CI, 0.24–3.56); OR, 1.31 (95% CI, 0.17–9.82)]; Group B. ETV monotherapy was better for rates of undetectable HBV DNA, while the rates of the HBV DNA levels at the end of treatment, HBeAg Loss, ALT normalization were similar; Group C. The ETV-based combination therapy was better for the rate of HBV DNA relapse.

Conclusion:

Based on the current data, ETV-based combination therapy seemed to be no better than ETV monotherapy. Further studies are needed to verify this conclusion.
Efficacy and safety of Shen-Song-Yang-Xin capsule for treating arrhythmia in the elderly patients with coronary heart disease
Authors: Zeng Zhicong , Zhuang ZhenJie , He YingXian , Yang ZhaoJun , Song Yinzhi
Published: December 2018

Background:

Coronary heart disease (CHD) is a major cause of mortality worldwide. Shen-Song-Yang-Xin capsule (SSYXC) has received extensive attention as an alternative therapy in improving myocardial ischemia and hypoxia effectively. In addition, there has been no systematic review or meta-analysis of SSYXC in the treatment of the elderly patients with cardiac arrhythmias in coronary heart disease (CHD). Therefore, we carry out a protocol of a proposed study based on the referred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that aims to systematically evaluate the efficacy and safety of SSYXC in the elderly patients with cardiac arrhythmias in CHD.

Methods:

Two researchers will search 9 electronic databases (PubMed, Medline, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Database) to identify all studies that meet the inclusion criteria and were published before October 2018. The literature selection process will be reported in accordance with the PRISMA guidelines. After information extraction and methodological quality evaluation, we will use Stata 12.0 software (STATA Corporation, College Station, TX) to synthesize the data. The primary outcomes will include effective rates of treatment and improvements of electrocardiogram or 24 hours dynamic electrocardiogram result, and secondary outcomes will include improvement of relevant serological indexes, heart function classification and adverse events.

Results:

The data synthesis results will objectively illustrate the efficacy and safety of SSYXC in the elderly patients with cardiac arrhythmias in CHD.

Conculsion:

The findings will provide a reference for the use of SSYXC in the treatment of the elderly patients with cardiac arrhythmias in CHD.

Registration:

PROS-PERO CRD42018112570.
Antiphospholipid syndrome combined with acute coronary syndrome
Authors: Shan Yuan , Wang Ping , Liu JingHua
Published: December 2018

Rationale:

Antiphospholipid syndrome (APS) combined with acute coronary syndrome (ACS) is rarely reported.

Patient concerns:

One male patient with APS was admitted to our hospital, who had recent unstable angina (UA).

Diagnosis:

The preliminary diagnosis of ACS and UA (BraunwaldiB) was then made.

Interventions:

This patient received secondary preventative therapy for coronary heart disease (CHD) in combination with percutaneous transluminal coronary angioplasty (PTCA) and implantation of NeoVas Bioresorbable Coronary Scaffold.

Outcomes:

The patient was followed up, without new UA episodes were observed at 6 months, 1 year, and 2 year after surgery, respectively.

Lessons:

It was thus concluded that percutaneous coronary intervention (PCI) is effective for APS patients and NeoVas scaffold implantation is presumed safe.
ALK-negative urachal inflammatory myofibroblastic tumor in an elderly female
Authors: Wang Kai , Zhou Hui , Lu Yuanan , Lu Qi , Zhang Cheng , Zhou Xiaochen , Xia Shuyan , Wang Gongxian
Published: December 2018

Rationale:

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue lesion, originally reported in the lungs. Occurrence of the IMT was also documented in the digestive system, but rare in the urinary system, especially in the urachus, and little is presently known about IMT.

Patient concerns:

This study reported a very rare case of urachal IMT in an elderly female patient at the age of 77 who was diagnosed with a lower abdominal mass 2 months ago.

Diagnosis:

The preoperative diagnosis was urachal carcinoma, which was confirmed to be anaplastic lymphoma kinase (ALK) negative urachal IMT by postoperative histopathology and immunohistochemistry tests.

Interventions:

Laparoscopic radical urachal carcinoma resection and partial bladder resection was performed under general anesthesia, and the tumor was completely removed.

Outcomes:

There was no recurrence and metastasis over 22 months of follow-up.

Lessons:

The urachal IMT occurs mainly in males and nonelderly people with ALK positive while in females with ALK negative. The most common clinical manifestations of urachal IMT are lower abdominal masses; it is very important to distinguish whether the tumor originates from the bladder or the urachus, because the surgical treatment options are completely different. Currently the complete surgical removal of the tumor is the best treatment option for urachal IMT. No other adjuvant therapy is required after operation. All urachal IMT after follow-up showed no recurrence and metastasis, suggesting a good prognosis. However, IMT has malignant potential and it requires a long-term close follow-up check.
Dabigatran as an alternative for atrial thrombosis resistant to rivaroxaban
Authors: Sun Huan , Zhao Qini , Wang Yanjing , Lakin Robert , Liu Xueyan , Yu Ming , Yang Hongliang , Gao Dongmei , Chen Weiwei , Gao Guangyuan , Yan Mengjie , He Yuquan , Yang Ping
Published: December 2018

Rationale:

Anti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined.

Patient concerns:

A 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium.

Diagnoses:

Cardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography.

Interventions:

He was prescribed rivaroxaban (20 mg daily) as treatment, and dabigatran (150 mg twice daily) was used when the thrombus was found to be non-response to rivaroxaban.

Outcomes:

The rivaroxaban did not diminish the atrial thrombus, and dabigatran was given instead which finally eliminated the thrombus.

Lessons:

Individualized responsiveness to NOACs should be considered and paid more attention to during clinical practice.
Association of neck dissection with survival for early stage N0 tongue cancer
Authors: Xie Yufei , Shen Gang
Published: December 2018

The management of the node negative neck in patients with tongue cancer remains a complex and controversial issue, especially in those with early stage tumors. Patients with negative cervical lymph nodes generally have a good prognosis. However, in patients without neck dissection, neck recurrences may occur after excision of the primary tumor due to occult cervical metastases. It often results in poor salvage therapy options and short survival. We used Surveillance, Epidemiology, and End Results data from 2004 to 2013 to investigate the association of neck dissection with survival among early stage tongue cancer patients with negative lymph node metastasis. A total of 4274 eligible patients were subdivided into 2 groups according to their neck management strategies: neck dissection and observation. Univariate and multivariate Cox proportional hazards regression models were used to determine the independent factors of survival. The Kaplan–Meier method was employed for survival analysis. In the overall cohort, patients who underwent neck dissection had better survival than those who were managed with observation in both tongue cancer specific survival and overall survival. After adjusting for confounding variables, neck dissection strategy remains an independent prognostic factor for better survival. When stratifying the patients according to age, gender, race, marital status, histologic grade, stage and radiotherapy, patients in the neck dissection group had significantly better survival than those in the observation group. Neck dissection may improve survival for early stage tongue cancer patients with negative lymph node metastasis. These results may assist clinicians in selecting the most appropriate neck management strategy for individual patients.
A screw-view model of navigation aid retrograde transpubic screw fixation for anterior pelvic ring fracture
Authors: Yu Tong , Qu Yang , Zhang Xi-Wen , Wang Yao , Jiang Qi-Yao , Jiang Zhen-De , Zhu Xiu-Jie , Zhao Jian-Wu
Published: December 2018

Rationale:

The purpose of this study was to evaluate the accuracy of a retrograde transpubic screw fixation assisted by a screw-view model of navigation in treating a pelvic fracture.

Patient concerns:

A 30-year-old female patient injured in a motor vehicle accident, displayed symptoms characterized by swelling and pain of the pudendum.

Diagnoses:

The patient was diagnosed with a fracture of the pubic ramus.

Interventions:

We used a screw-view model of navigation to assist our retrograde transpubic screw fixation in this patient.

Outcomes:

In total, 2 screws were inserted into the bilateral pubic ramus and both were excellently positioned. It took 7.4 minutes to design the screws, 8.1 minutes to implant the guidewire, and 39.3 minutes to place the screws. Intraoperative blood loss amounted to 21 mL and the total fluoroscopic time was 3.8 minutes. No clinical complications, such as neurologic, vascular, or urologic injury, infection, screw loosening, or loss of reduction, were found after the operation. Follow-up lasted 28 months.

Lessons:

The outcome of our study suggests that the screw-view model of navigation maximizes the retrograde transpubic screw insertion accuracy in the treatment of a pubic ramus fracture, which is made efficient by pain relief and early out-of-bed mobilization. Our suggestion is, therefore, that the relative position between the pubic ramus and the patient tracker must be static to ensure the accuracy of the entire system throughout the operation.
Clinical evaluation of the loop-mediated isothermal amplification assay for the detection of common lower respiratory pathogens in patients with respiratory symptoms
Authors: Hou Jingyuan , Wu Heming , Zeng Xing , Rao Hui , Zhao Pingsen
Published: December 2018

Lower respiratory tract infections (LRTIs) are a substantial public health problem and a leading cause of significant morbidity and mortality worldwide. The aim of this study was to evaluate a commercially available loop-mediated isothermal amplification (LAMP) assay for the simultaneously detection of thirteen common lower respiratory pathogens in patients with respiratory symptoms. All participants age from 1 to 101 years old were recruited from inpatient or outpatient of Meizhou People's Hospital between October 2016 and March 2018. A total of 1767 sputum samples and 88 bronchoalveolar lavage fluid samples from patients with suspected LRTI were collected. For each sample, a parallel study using both routine bacterial culture-based and LAMP assays were carried out. In total, 810 (44.85%) out of the 1855 samples were found to be positive infected with respiratory pathogens by using the LAMP assays. Methicillin-resistant Staphylococcus aureus (MecA) was the most predominant bacterial pathogens, with proportions of 17.09% in sputum and 10.23% bronchoalveolar lavage fluid samples, respectively. The proportions of bacterial pathogen infection with Streptococcus pneumoniae (Spn) (24.24%) was relatively high in aged <15 group (P <.001) while the proportions of bacterial pathogen infection with MecA (22.89%) was relatively high in aged >60 group (P <.001). Bacterial pathogen infection with MecA having the highest prevalence with proportions of 17.81% and 13.94% in male and female, respectively. A statistically higher proportion of male group had bacterial pathogen infection with Pseudomonas aeruginosa (Pae) in this study (P = .035). Comparison of results between the LAMP assay and culture method was conducted and our results indicated that there was higher detection rate by the LAMP assay than the bacterial culture method. Comparison of the results obtained with the LAMP assay and those obtained by sequencing analysis, when the sequencing method was set to 100%, demonstrating that the LAMP assay is 100% specific and 95.50% sensitive. The technique of LAMP assay was proved to be a simple, sensitive, specific, convenient, and rapid method, which can be implemented for diagnosing pathogenic bacteria in patients with LRTIs in primary labs without any need for expensive equipment or specialized techniques in resource-limited areas of China.
Preoperative celecoxib analgesia is more efficient and equally tolerated compared to postoperative celecoxib analgesia in knee osteoarthritis patients undergoing total knee arthroplasty
Authors: Liu Jiangfeng , Wang Fei
Published: December 2018

The aim of the present study was to evaluate the efficacy and safety of preoperative celecoxib administration in alleviating postoperative pain in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA).

A total of 226 knee OA patients underwent TKA were consecutively recruited and randomized into preoperative analgesia group and postoperative analgesia group as 1:1 ratio. Preoperative analgesia group received celecoxib before and post operation; postoperative analgesia group received celecoxib post operation, all patients received TKA and intravenous patient-controlled analgesia (PCA) post operation. Pain visual analog scale (VAS), patient's global assessment (PGA), flexional angles, PCA consumption, percentage of patients receiving pethidine, pethidine consumption, and adverse events were assessed.

Pain VAS scores at rest and at flexion were both lower in preoperative analgesia group compared to postoperative analgesia group at 2 hours, 6 hours, 12 hours, and 24 hours post operation. Preoperative analgesia group also exhibited decreased PGA score compared to postoperative analgesia group at 2 hours, 6 hours, 12 hours, 24 hours, and 48 hours post operation. Meanwhile, active flexional angle and passive flexional angle in preoperative analgesia group were larger than that in postoperative analgesia group at 72 hours post operation. More interestingly, preoperative analgesia group patients consumed less PCA compared to postoperative analgesia group patients at 72 hours post operation. No difference of adverse event incidences between 2 groups was observed.

Preoperative administration of celecoxib exhibits better efficacy and equal safety profiles compared to postoperative administration of celecoxib in knee OA patients undergoing TKA.
Successful treatment of genotype 3 hepatitis C infection in a noncirrhotic HIV infected patient on chronic dialysis with the combination of sofosbuvir and velpatasvir
Authors: Begovac Josip , Krznarić Juraj , Bogdanić Nikolina , Močibob Loris , Zekan Šime
Published: December 2018

Rationale:

Data on anti-HCV therapy in patients on dialysis is still evolving. Sofosbuvir is mainly eliminated through the renal route and there is controversy about its use in these patients.

Patient concerns:

We describe a 53-year-old male patient with HCV genotype 3 and human immunodeficiency type 1 (HIV) infection on chronic dialysis. HIV infection was diagnosed in 1987 and since July 2007 the patient was compliant with his antiretroviral therapy (ART) and had an undetectable plasma HIV viral load on all follow-up measurements. The patient was known to have HCV infection since 1997 but has never been treated for chronic hepatitis C. Because of progressive renal impairment dialysis started in 2005.

Diagnosis:

Before anti-HCV treatment commenced the patient liver transient elastography (FibroScan) indicated F3 fibrosis (stiffness, 11.6 kPa) and his HCV RNA viral load was 320,798 IU/mL (Abbott RealTime HCV assay).

Intervention:

Fixed dose combination of sofosbuvir/velpatasvir (400 mg/100 mg) for 11 weeks.

Outcomes:

Twelve weeks after treatment cessation HCV RNA was undetectable, hence the patient achieved a sustained virologic response. The drugs were well tolerated and the patient did not report any side effects.

Lessons:

Sofosbuvir/velpatasvir may be an option for HCV genotype 3 infection in patients coinfected with HIV on long-term dialysis.
Ventilator for the treatment of acute respiratory distress syndrome
Authors: Gao Yan , He Ya-long
Published: December 2018

Background:

Ventilator has been reported to treat acute respiratory distress syndrome (ARDS). However, its efficacy is still inconclusive. This systematic review and meta-analysis study aims to evaluate its efficacy and safety for the treatment of patients with ARDS.

Methods:

The electronic databases of Cochrane central register of controlled trials (CENTRAL), EMBASE, MEDILINE, CINAHL, allied and complementary medicine database (AMED) and 4 Chinese databases will be used to search relevant literature from their inception to the present to evaluate the efficacy and safety of ventilator for ARDS without the language restrictions. This study will only consider randomized controlled trials (RCTs) of ventilator for the treatment of ARDS. The Cochrane risk of bias tool will be utilized to assess the quality of the included RCTs studies. The primary outcomes include arterial blood gases values (recorded once a day) and ventilator settings. The secondary outcomes will include the Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score, quality of life, cost, death, and any other adverse events. The summary results will be performed by using the models of random-effects or fixed-effects based on the heterogeneity of the included RCTs.

Results:

The results will be disseminated to peer-reviewed journals for publication. This study does not need ethics approval, because of no individual data will be involved. The results of this study will help clinicians and health policy-makers to refer for the policy or guideline making.

Conclusion:

The results of this systematic review and meta-analysis study may provide helpful evidence for the efficacy and safety of ventilator for ARDS.

Systematic review registration:

PROSPERO CRD42018 115409.