bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of frailty in China
Authors: Wang Qi , Lai Honghao , Wang Yunhua , Qi Jing , Pan Bei , Wang Jiancheng
Published: May 2020

Introduction:

China is facing more and more enormous challenges including aging, the increase of social security costs and health care cost, decrease of labors, and how to keep elders’ capacity to function well and live independently. Healthy aging has become an extremely challenging issue. Frailty, a geriatric syndrome resulted from the declines of multiple physiological systems, characterized by malnutrition, exercise intolerance, dependence, longer bed rest, lower gaits peed, weakness, weight loss, anorexia, hip fracture, risk of falling, delirium, dementia, and keep indoors, has become one of the biggest challenges in facilitating healthy aging. Because the research of frailty just had started in recent years in China, the evidence regarding the prevalence of frailty among the Chinese population is scarce and just limited in certain area.

Method:

We will systematically search 7 electronic database including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of science, MEDLINE, CNKI (Chinese National Knowledge Infrastructure), and CBM (Chinese Biological Medical Database) to identify studies that provide or potential available of data regarding to prevalence of frailty. Risk of bias of individual study will be assessed using 8-iterm critical appraisal criteria for prevalence or incidence studies. Data will be analyzed using STATA V.12.0 software.

Conclusions:

Our systematic review and meta-analysis will firstly pool the results from available studies to provide a comprehensive evidence for the prevalence of frailty. The results of this study will be submitted to a peer-reviewed journal for publication.
Intractable or persistent hiccups treated with extracranial acupuncture
Authors: Zhang Zong-wang , Gong Chang-xiang
Published: May 2020

Rationale:

Hiccups are a common clinical symptom, and persistent hiccups and intractable hiccups severely impair the individual's quality of life. To date, there has been no effective treatment specifically for hiccups. Herein, we report 2 cases with intractable or persistent hiccups that were successfully treated with extracranial acupuncture.

Patient concerns:

The first case is a 46-year-old woman who presented with a 7-year history of intractable hiccups that had worsened over the past 3 years. She also complained of chest tightness, dyspnea, palpitations, dreaminess, dysphoria, intolerance of cold, and hypohidrosis. The second case is a 75-year-old man who presented with a 7-day history of persistent hiccups and hematemesis for 3 hours. The patient's persistent hiccups were treated using traditional Chinese acupuncture, but the patient reported no remarkable benefit.

Diagnoses:

They were diagnosed as intractable or persistent hiccups.

Interventions:

They were treated with extracranial acupuncture.

Outcomes:

The hiccups completely disappeared. During the follow-up period, the hiccups did not reappear.

Lessons:

According to neural balance theory, an episode of the hiccups is caused by an imbalance of the nervous system. Extracranial acupuncture in the area adjacent to the external occipital protuberance affects the intracranial nervous system, which can effectively control the hiccups. Our study provides a new approach to the treatment of hiccups.
Can high-frequency ultrasound combined computed tomography accurately diagnose thyroid tumor?
Authors: Zhang Lin-hua , Chen Gang , Tao Wei
Published: May 2020

Background:

Previous clinical studies have reported that clinical value of high-frequency ultrasound combined computed tomography (HFUCT) is used for diagnosis of thyroid tumor (TT). However, no study has investigated this topic systematically. Therefore, this study will evaluate the clinical value of HFUCT for the diagnosis of TT.

Methods:

We will search the databases of Cochrane Library, EMBASE, PUBMED, SCOPUS, Web of Science, OpenGrey, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from any time period published to the present. We will consider all case-controlled studies that assessed the clinical value of HFUCT for diagnosis of TT. Two authors will independently scan titles and abstracts to check eligible studies, followed by full-text read. We will extract data and assess study quality using Quality Assessment of Diagnostic Accuracy Studies tool. RevMan 5.3 software will be utilized for data pooling and statistical analysis.

Results:

This study will be performed to assess the clinical value of HFUCT for the diagnosis of TT, and will provide an evidence-based synthesis for clinical application and further study.

Conclusion:

Summary of this study will provide the latest evidence to determine whether HFUCT can be used for TT diagnosis accurately.

Study registration:

INPLASY202040022.
Study on the correlation between anti-ribosomal P protein antibody and systemic lupus erythematosus
Authors: Wang Yanping , Luo Peng , Guo Ting , Zou Lin , Shi Jing , Chen Pu
Published: May 2020

The aims of this study were to compare diagnostic value of anti-ribosomal P protein antibody (anti-P), anti-Smith antibody (anti-Sm), anti-double-stranded DNA antibody (anti-dsDNA), anti-nucleosome antibody (ANuA), and anti-histone antibody (AHA) for systemic lupus erythematosus (SLE) as well as explore the correlation between anti-P and SLE.

A retrospective study was performed with 487 SLE patients, 235 non-SLE rheumatic diseases, and 124 healthy subjects from January 2015 to December 2018. Clinical manifestations, laboratory results and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2000 scores were analyzed between anti-P/+/ and anti-P/−/ patients. SPSS19.0 statistical software was used for data analysis.

The sensitivities of anti-P, anti-Sm, anti-dsDNA, ANuA, and AHA in SLE were 31.6%, 20.7%, 45.0%, 27.9%, and 14.6%, and the specificities were 99.2%, 99.4%, 98.9%, 98.3%, and 96.7%, respectively. Only 27.9% of SLE had a single positive anti-P while the other 4 antibodies were all negative. There were significant differences in the age of onset, skin erythema, urinary protein, creatinine and serum IgG, IgM, C3, C4 between anti-P/+/ and anti-P/−/ patients (P < .05). When anti-Sjogren syndrome A antibody, anti-P were positive and anti-dsDNA was negative, the incidence of skin erythema was the highest (35.1%). Compared with anti-P/−/ patients, anti-P/+/ patients had higher SLEDAI scores (P < .001).

Anti-P, anti-Sm, anti-dsDNA, ANuA, and AHA have high specificity but poor sensitivity in the diagnosis of SLE; combined detection can greatly improve the detection rate. Anti-P is more valuable in the diagnosis of SLE when other specific autoantibodies are negative. SLE patients with positive anti-P have an earlier onset age and are more prone to skin erythema, lupus nephritis as well as higher disease activity.
Pilot study of a longitudinal integrated disaster and military medicine education program for undergraduate medical students
Authors: Tsai Yi-Da , Tsai Shih-Hung , Chen Sy-Jou , Chen Yin-Chung , Wang Jen-Chun , Hsu Chia-Ching , Chen Ying-Hsin , Yang Tse-Chun , Li Chih-Wei , Cheng Cheng-Yi
Published: May 2020

Disaster medicine education in medical curricula is scarce and frequently nonexistent. It is reasonable to initiate educational approaches for physicians in this field at the medical school level. An understanding of disaster medicine and the health care system during massive casualty incidents has been recommended as an integral part of the medical curriculum in the United States and Germany.

The goal of the reformed curriculum was to develop a longitudinal integrated disaster and military medicine education program extending from the first year to the sixth year based on previously separated clinical and military medicine topics. Emergency medicine physicians, military emergency medical technicians, and Tactical Combat Casualty Care instructors formed an interprofessional faculty group and designed a learning curriculum.

A total of 230 medical students participated in the revised disaster preparedness curriculum. Satisfaction survey response rates were high (201/230, 87.4%). Most of the free-text comments on the program were highly appreciative. The students considered the number of teaching hours for the whole program to be adequate. The students showed significant improvements in knowledge and judgment regarding disaster medicine after the program.

We found that medical students were highly interested, were appreciative of, and actively participated in this longitudinal integrated disaster and military medicine education program, but gaps existed between the students’ scores and the educators’ expectations. The educators believed that the students needed more disaster preparedness knowledge and skills.
Impact of cuff-assisted colonoscopy for adenoma detection
Authors: Li Qi , Gao Hai-de , Liu Chun-Cheng , Zhang Hao , Li Xun-Hai , Wu Jia , Zhang Xian-Kai
Published: May 2020

Background:

Previous studies have reported that cuff-assisted colonoscopy (CAC) can be used for detection of adenoma (DA). However, there are inconsistent results regarding the CAC for DA. Thus, this study will systematically explore the impact of CAC for DA.

Methods:

In order to retrieve potential eligible articles, this study will identify the following electronic databases from their inceptions to present: MEDLINE, EMBASE, Cochrane Library, PSYCINFO, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched without any language limitation. We will consider case-controlled studies that focused on exploring the impacts of CAC for DA. Two authors will perform study selection, information collection and risk of bias assessment, respectively. Any discrepancies between 2 authors will be resolved through discussion with a third author.

Results:

This study will summarize the most recent evidence to assess the impact of CAC for DA.

Conclusion:

The findings of this study will provide evidence of CAC for DA in clinical practice.

Systematic review registration:

INPLASY202040042.
Association between microRNA 25 expression in serum and lung cancer
Authors: Luo Peng , Qiao Feng , Dou Peng-Hui , Li Shu-Min , Zhang Tian-Lu , Xing Yu-Tong , Zhou Gang , Xu Su-Kun , Sun Jia-Bin
Published: May 2020

Background:

This study aims to identify the association between microRNA 25 (mRNA 25) expression in serum and lung cancer (LC).

Methods:

This planned study will cover all eligible case-controlled studies that report association between mRNA 25 expression in serum and LC. It will include published studies from inception to the present in Cochrane Library, PUBMED, EMBASE, Web of Science, Allied and Complementary Medicine Database, VIP database, and China National Knowledge Infrastructure regardless language and geographical location. We will also search other sources, such as conference abstracts and reference lists of related known studies and experts in the domain consulted to avoid missing potential studies. Two contributors will independently examine and select studies, collect all necessary data, and judge study quality for all included studies. We will perform statistical analysis using RevMan V.5.3 software and Stata V.12.0 software.

Results:

This study will summarize current evidence to present first systematic review of research on the association between mRNA 25 expression in serum and LC.

Conclusion:

This study will present comprehensive evidence to determine whether mRNA 25 expression in serum is associated with LC, and will provide helpful evidence for the future studies.

Systematic review registration:

INPLASY202040056.
Anesthetic efficacy of propofol combined butorphanol in laparoscopic surgery for ectopic pregnancy
Authors: Chang Wang-yan , Li Hai-ying
Published: May 2020

Background:

Recent studies have suggested that propofol combined butorphanol (PB) has anesthetic effect in laparoscopic surgery (LS) for ectopic pregnancy (EP). But investigations of its potential effects are inconsistent. We will explore the current literature examining PB in LS for EP.

Methods:

We will perform a comprehensive search from MEDLINE, Embase, Cochrane Library, PsycINFO, Global Health, Web of Science, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the present. Other literatures, such as conference abstracts, references to the relevant reviews will also be checked. Two authors will check the titles, abstracts, and full texts independently. They will also independently carry out data collection and study quality assessment. We will conduct statistical analysis using RevMan 5.3 software.

Results:

This study will provide accurate results on the anesthetic effect and safety of PB in LS for EP.

Conclusion:

This study will establish high-quality evidence of the anesthetic effect and safety of PB in LS for EP to facilitate the clinical practice and guideline development.

Study registration number:

INPLASY202040044.
Bioinformatics analysis of key biomarkers and potential molecular mechanisms in hepatocellular carcinoma induced by hepatitis B virus
Authors: Li Zhe , Xu Jingyong , Cui Hongyuan , Song Jinghai , Chen Jian , Wei Junmin
Published: May 2020

Background:

Hepatocellular carcinoma (HCC) accounts for up to 90% of all primary hepatic malignancies; it is the sixth most common cancer and the second most common cause of cancer mortality worldwide. Numerous studies have shown that hepatitis B virus and its products, HBV integration, and mutation can induce HCC. However, the molecular mechanisms underpinning the regulation of HCC induced by HBV remain unclear.

Methods:

We downloaded 2 gene expression profiling datasets, of HBV and of HCC induced by HBV, from the gene expression omnibus (GEO) database. Differentially expressed genes (DEGs) between HCC and HBV were identified to explore any predisposing changes in gene expression associated with HCC. DEGs between HCC and adjacent healthy tissues were investigated to identify genes that may play a key role in HCC. Any overlapping genes among these DEGs were included in our bioinformatics analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of overlapping genes were performed using the Metascape online database; the protein–protein interaction (PPI) network was analyzed using the STRING online database; and we obtained the hub genes of the PPI network using Cytoscape software. An overall survival (OS) analysis of hub genes was performed using km-plotter and the gene expression profiling interactive analysis (GEPIA) online database. The expression levels of hub genes were determined using the TCGA and GEPIA databases. Finally, the relationships between hub genes and tumors were analyzed using the comparative toxicogenomics database (CTD).

Results:

We identified 113 overlapping genes from the 2 datasets. Using functional and pathway analyses, we found that the overlapping genes were mainly related to the AMPK signaling pathway and cellular responses to cadmium ions. C8A, SPP2, KLKB1, PROZ, C6, FETUB, MBL2, HGFAC, C8B, and ANGPTL3 were identified as hub genes and C8A, SPP2, PROZ, C6, HGFAC, and C8B were found to be significant for survival.

Conclusion:

The DEGs re-analyzed between HCC and hepatitis B enable a systematic understanding of the molecular mechanisms of HCC reliant on hepatitis B virus.
Is continuous catheter adductor canal block better than single-shot canal adductor canal block in primary total knee arthroplasty?
Authors: Sun Changjiao , Zhang Xiaofei , Song Fei , Zhao Zhe , Du Ruiyong , Wu Sha , Ma Qi , Cai Xu
Published: May 2020

Background:

The adductor canal block (ACB) has emerged as an alternative to the femoral nerve block (FNB) after total knee arthroplasty. This meta-analysis was conducted to investigate which ACB method provides better pain relief and functional recovery after total knee arthroplasty

Methods:

We conducted a meta-analysis to identify randomized controlled trials involving single-shot adductor canal block (SACB) and continuous catheter ACB (CACB) after TKA up to December 2019 by searching databases including the PubMed, Web of Science, Embase, Cochrane Controlled Trials Register, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases. Finally, we included 8 randomized controlled trials involving 702 knees in our study. We used Review Manager Software and Grading of Recommendations Assessment, Development, and Evaluation profiler to perform the meta-analysis.

Results:

Compared with SACB, CACB can achieve better postoperative pain relief at 24 and 48 h both at rest and after mobilization, lower amount of opioid consumption at 72 h, a shorter length of hospital stay (LOH) and larger range of motion (ROM). In addition, the Timed Up and Go (TUG) test results; quadriceps strength; and incidence of complications, including postoperative nausea and vomiting, DVT, catheter-related infections, catheter dislodgement and neurologic deficits, showed no significant difference between the two ACB methods.

Conclusion:

The results of this study demonstrate that CACB is an effective alternative to SACB and can provide better pain relief, a shorter LOH, more degrees of maximum flexion and a lower amount of opioid consumption over time, but it provides a comparable level of recovery of quadriceps strength and mobility with a similar risk of catheter-related complications. Thus, CACB may be a better analgesia strategy than SACB after TKA at present.
Identification of crucial genes correlated with esophageal cancer by integrated high-throughput data analysis
Authors: Zhou Wei , Wu Jiarui , Liu Xinkui , Ni Mengwei , Meng Ziqi , Liu Shuyu , Jia Shanshan , Zhang Jingyuan , Guo Siyu , Zhang Xiaomeng
Published: May 2020

Background:

Esophageal cancer (ESCA) is one of the most deadly malignancies in the world. Although the management and treatment of patients with ESCA have improved, the overall 5-year survival rate is still very poor.

Methods:

The study aimed to identify potential key genes associated with the pathogenesis and prognosis of ESCA. In the study, integrated bioinformatics methods were used to screen differentially expressed genes (DEGs) between ESCA and normal tissue in the data set of gene expression profiles. The hub gene in DEGs was further analyzed by protein–protein interaction (PPI) network and survival analysis to explore its relationship with the pathogenesis and poor prognosis of ESCA.

Results:

134 up-regulated genes and 183 down-regulated genes were obtained in ESCA compared with normal tissues. Moreover, the PPI network was established with 176 nodes and 800 interactions. Ten hub genes (AURKA, CDC20, BUB1, TOP2A, ASPM, DLGAP5, TPX2, CENPF, UBE2C, and NEK2) were filtered out based on the degree value. Functional enrichment analysis indicated that a variety of extracellular related items and ECM–receptor interaction pathway were all correlated with the ESCA.

Conclusions:

The results of this study would provide some guidance for further study of diagnostic and prognostic biomarkers to promote ESCA treatment.
Efficacy and Safety of Omalizumab for Chronic Spontaneous Urticaria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Jia Hong-Xia , He Yan-Ling
Published: May 2020

Background:

Omalizumab has been proposed as a possible effective treatment of chronic spontaneous urticaria (CSU).

Study Question:

We aimed to access the efficacy and safety of omalizumab in the treatment of CSU based on qualified, randomized controlled trials (RCTs).

Data Sources:

PubMed, the Cochrane library, and Embase databases.

Study Design:

Computerized search by index words was performed to identify qualified RCTs, and relevant literature sources were also searched.

Result:

Nine RCTs were included in the meta-analysis with 1612 patients in the omalizumab group and 1251 patients in the placebo group. Compared with the placebo group, omalizumab significantly decreased the weekly itch score after therapy [Weighted Mean Difference (WMD), −3.94; 95% confidence interval (CI), −4.64 to −3.24], the weekly hive score (WMD, −5.27; 95% CI, −6.17 to −4.38), the dermatology life quality index (DLQI; WMD, −3.58; 95% CI, −4.66 to −2.50), and the urticaria activity score over 7 days (UAS7; WMD, −9.51; 95% CI, −10.94 to −8.08). There was no significant difference in the incidence of adverse events (AE) [relative risk (RR), 1.01; 95% CI, 0.91–1.12], serious AE (RR, 0.85; 95% CI, 0.57–1.27), and severe AE (RR, 0.83; 95% CI, 0.60–1.14) between the 2 groups. Compared with the placebo, omalizumab significantly decreased the weekly itch score and weekly hive score after therapy in patients receiving 75, 150, and 300 mg omalizumab, respectively. DLQI was significantly reduced in patients receiving 150 and 300 mg of omalizumab, respectively. In all the subgroup of UAS7, omalizumab significantly decreased the score compared with the placebo. Only patients receiving 600-mg omalizumab had a significantly higher AE incidence versus placebo. There was no significant difference in serious and severe AE between the 2 groups.

Conclusion:

Omalizumab caused a significantly greater reduction in weekly itch score, weekly hive score, DLQI, and UAS7 in CSU patients than the placebo. However, high-quality, multicenter RCTs with a larger sample size are needed to confirm the safety of omalizumab, and whether AEs are caused by omalizumab or other factors.
The role of PPARα in autosomal dominant polycystic kidney disease
Authors: Lakhia Ronak
Published: May 2020

Purpose of review

Metabolic reprogramming is a prominent feature of cyst epithelial cells in autosomal dominant polycystic kidney disease (ADPKD). Peroxisome proliferator activated receptor alpha (PPARα) is a transcription factor that regulates many aspects of cellular metabolism. The purpose of this review is to understand the role of PPARα in ADPKD.

Recent findings

PPARα expression is reduced in ADPKD kidneys of mice and humans. This downregulation is in part secondary to microRNA mediated translational repression and leads to impairment of fatty acid metabolism. Genetic studies demonstrate that deletion of Pparα aggravates cyst growth in a slowly progressive mouse model of ADPKD. Recent studies also show that administration of Pparα agonists ameliorates cyst burden in mice.

Abnormal reduction of PPARα affects cellular metabolism in ADPKD. Pparα is a modulator of cyst progression in mouse models of ADPKD. These studies establish PPARα as an exciting new drug target for the treatment of individuals with ADPKD.
Molecular subtypes of invasive breast cancer: correlation between PET/computed tomography and MRI findings
Authors: Akin Meliha , Orguc Sebnem , Aras Feray , Kandiloglu Ali Riza
Published: May 2020

Objective

The aim of the study was to investigate the diagnostic value of fluorodeoxyglucose-18 (FDG)-PET/computed tomography (CT) and MRI parameters in determining the molecular subtypes of invasive breast cancer.

Methods

Data from 55 primary invasive breast cancer masses in 51 female patients who underwent pre-treatment PET/CT and MRI scans, and histopathological diagnosis at the authors’ center were retrospectively reviewed. The relationship between FDG-PET/CT and MRI parameters, including maximum and mean standard uptake values (SUVmax and SUVmean, respectively), mean metabolic index (MImean) and metabolic tumor volume (MTV) values obtained from FDG-PET, and shape, margin, internal contrast-enhancement characteristics, kinetic curve types, functional tumor volume (FTV), apparent diffusion coefficient (ADC) values obtained from MRI was evaluated. Subsequently, differences among molecular subtypes (i.e. luminal A, luminal B, c-erbB-2 positive, and triple-negative) in terms of PET/CT and MRI parameters were evaluated.

Results

The luminal B subtype of invasive breast cancer had higher SUVmax and SUVmean (P = 0.002 and P = 0.017, respectively) values than the luminal A subtype. In addition, the triple-negative subtype had a higher SUVmax (P = 0.028) than the luminal A subtype. There was a statistically significant positive correlation between pathological tumor volume (PTV) and SUVmean (P = 0.019, r = 0.720). SUVmax and ADC were negatively correlated (P = 0.001; r = −0.384). A very strong positive correlation was detected between MTV and FTV (P = 0.000; r = 0.857), and between MTV and PTV (P = 0.006, r = 0.796), and between FTV and PTV (P = 0.006, r = 0.921).

Conclusion

Results of the present study suggest that SUVmax was superior to MRI findings in predicting molecular subtypes and that MRI was superior to PET/CT in predicting PTV.
Hematopoietic regeneration under the spell of epigenetic-epitranscriptomic factors and transposable elements
Authors: Clapes Thomas , Trompouki Eirini
Published: May 2020

Purpose of review

Since the discovery of master transcription factors that regulate hematopoietic regeneration following different stressors, many more layers of regulation have been discovered. The purpose of this review is to outline the recent discoveries of epigenetic and epitranscriptomic control of hematopoietic regeneration and highlight the novel involvement of transposable elements in this process.

Recent findings

Over the past 2 years, we have gained additional knowledge in the role of epigenetic regulators in hematopoietic regeneration. Histone modifiers, like SETD1A, JARID2, KDM6B, and classic DNA methylation regulators, like DNMT3A and TET2, govern hematopoietic regeneration. Concomitantly, the significance of RNA modifications and the expanding functions of transposable elements establish novel layers of regulation of hematopoietic regeneration. Capitalizing on this newly acquired knowledge may provide insights on new therapies or drug targets that will improve or accelerate hematopoietic regeneration.

The spectrum of epigenetic and epitranscriptomic modifications that affect hematopoietic regeneration is continually expanding. Transposable elements are also emerging as potent responders of stress stimuli that affect the self-renewal capacity of hematopoietic stem cells. The future challenge is to understand the hierarchy of these control mechanisms and how they integrate and consolidate information from transcription factors and external stimuli.
Systemic treatment options for metastatic hormone-sensitive prostate cancer: making sense of the data
Authors: Baston Catalin , Preda Adrian , Guler-Margaritis Silviu S. , Sinescu Ioanel , Gingu Constantin
Published: May 2020

Purpose of review

Systemic treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have recently shifted from the traditional androgen deprivation therapy (ADT) monotherapy to multidrug approaches incorporating drugs initially approved for castration-resistant state and ADT. However, clinicians have difficulties in choosing the adequate combination therapy for individualized patient care, because of the lack of consensus regarding disease risk factors, differences in study design of the major clinical trials and lack of direct comparisons between drugs. The aim of this review is to provide an update of the current treatment options for this heterogenous group of patients.

Recent findings

Current oncological guidelines strongly recommend that patients with newly diagnosed mHSPC and high-volume disease (CHAARTED criteria) should receive docetaxel and ADT, whereas those with high-risk disease (LATITUDE criteria) abiraterone and ADT. Recently, the Food and Drug Administration approved apalutamide and enzalutamide for mHSPC. Moreover, new data support the efficacy of docetaxel and abiraterone in patients with mHSPC, regardless of metastatic burden.

Today, the combination approach should be recommended for newly diagnosed mHSPC over ADT monotherapy, but treatment initiation must be personalized based on disease, drug and patient characteristics. Thanks to continuous efforts and progress in patient and disease-related outcomes, mHSPC could become a chronic disease.
An Unusual Presentation of Hemorrhagic Disease in an Infant: A Probable Case of Abetalipoproteinemia
Authors: Sivamurukan Palanisamy , Boddu Deepthi , Pulimood Anna , Agarwal Indira
Published: May 2020

We report a probable case of abetalipoproteinemia in an infant who presented with unusual symptoms of late-onset vitamin K deficiency. Abetalipoproteinemia is a rare autosomal recessive disease caused by mutation of the microsomal triglyceride transfer protein gene, resulting in the absence of microsomal triglyceride transfer protein function in the small bowel. It is characterized by the absence of plasma apolipoprotein B-containing lipoproteins, fat malabsorption, hypocholesterolemia, retinitis pigmentosa, progressive neuropathy, myopathy, and acanthocytosis. A biopsy of the small intestine characteristically shows marked lipid accumulation in the villi of enterocytes. Large supplements of fat-soluble vitamins A, D, E, and K have been shown to limit neurologic and ocular manifestations. Dietary fat intake is limited to medium-chain triglycerides.
Dedifferentiated Chordoma
Authors: Hung Yin P. , Diaz-Perez Julio A. , Cote Gregory M. , Wejde Johan , Schwab Joseph H. , Nardi Valentina , Chebib Ivan A. , Deshpande Vikram , Selig Martin K. , Bredella Miriam A. , Rosenberg Andrew E. , Nielsen G. Petur
Published: May 2020

Dedifferentiated chordoma is a rare chordoma subtype characterized by a high-grade sarcoma juxtaposed to conventional chordoma. We identified a series of dedifferentiated chordomas, reviewed clinicopathologic features, performed next-generation sequencing in select cases, and analyzed all related English-language publications. Our series included 7 men and 3 women (age 15 to 80 y [median: 54 y]; <1% of >1000 chordomas surveyed). The tumor (2.8 to 24.5 cm [median: 5.8 cm] in size) presented de novo or as recurrence (including postradiotherapy) in sacrum (n=5), skull base (n=2), lumbar spine (n=1), thoracic/mediastinum (n=1), and lung (n=1; as metastasis). Histologically, the dedifferentiated component (3% to 95% [median: 60%]) was pleomorphic-to-fibrosarcomatous, juxtaposed to conventional (n=8) or chondroid (n=2) component. By immunohistochemistry, the conventional/chondroid component consistently expressed cytokeratin and brachyury, whereas the dedifferentiated component showed loss of both. We identified a sacral conventional chordoma with INI1 loss, with one of the lung metastases showing biphasic histology with loss of cytokeratin and brachyury in the dedifferentiated component. Sequencing identified tumor suppressor mutations in 4 tumors, including TP53 mutations in the dedifferentiated component in 3 tumors. Of 7 patients with follow-up, 6 developed metastases; 4 died at 15 to 99 months (median: 24 mo) after dedifferentiated chordoma diagnosis. Collectively, of 87 dedifferentiated chordoma patients described in 1913-2020 (including 10 herein), the median overall survival was 20 months. In summary, dedifferentiated chordoma involves diverse sites and presents de novo, postradiotherapy, or as recurrence/metastasis months-to-years after initial diagnosis. The dedifferentiated component shows loss of brachyury and cytokeratin staining and harbors recurrent TP53 mutations, implicating tumor suppressor dysregulation in chordoma dedifferentiation.
Standardized Perioperative Feeding Protocol Improves Outcomes in Patients With d-Transposition of the Great Arteries Undergoing Arterial Switch Operation
Authors: Clark Stephen T. , Law Mark A. , Alten Jeffrey A.
Published: May 2020

Objective:

To determine whether the presence of a standardized feeding protocol improves outcomes in a subset of neonates undergoing cardiac surgery.

Design:

Retrospective cohort study.

Setting:

Cardiovascular ICU at a freestanding academic children’s hospital.

Patients:

Neonates with a diagnosis of d-transposition of the great arteries undergoing arterial switch operation from January 2007 to June 2017.

Interventions:

Initiation of perioperative feeding protocols.

Measurements and Main Results:

Patients were evaluated before and after implementation of standardized perioperative feeding protocols in neonates with d-transposition of the great arteries undergoing arterial switch operation. Low-risk patients born after initiation of nurse-driven protocols were compared with a similar historical group. Data obtained included time to achievement of feeding goals, with primary outcome being weight gain at hospital discharge. Other measures analyzed included duration of mechanical ventilation and postoperative hospital length of stay. Overall, 33 patients in the protocol group were compared with 44 patients in the historical group. No significant baseline differences existed between the two cohorts. The protocol group achieved improved feeding outcomes in nearly all measured categories, including introduction to enteral feeds preoperatively (91% vs 59%; p < 0.01) and earlier attainment of postoperative full enteral feeds of 120 mL/kg/d (2 vs 5 d; p < 0.01). Protocol patients had significantly improved weight gain at the time of discharge (60 vs 1 g; p < 0.01), while achieving shorter postoperative length of stay (10.1 vs 12.6 d; p = 0.04).

Conclusions:

An aggressive, but safe, perioperative feeding protocol implemented in a homogenous low-risk neonatal cardiac surgical population improves feeding outcomes, including increased weight gain, as well as decreased postoperative length of stay. Consideration for perioperative feeding protocol implementation and further study should be given.
Which Ultrasound Parameter Is More Accurate in the Diagnosis of Carpal Tunnel Syndrome
Authors: Ciloglu Osman , Görgülü Feride Fatma
Published: May 2020

Objective

The aim of this study was to compare the accuracy of cross-sectional area (CSA), resistive index (RI), and strain ratio (SR) in carpal tunnel syndrome (CTS).

Design

This prospective and case-control study included patients with a diagnosis of CTS and a healthy control group. The participants were examined with an ultrasound Doppler system equipped with a high-resolution (5–18 MHz) linear probe (Philips L18-5). CSA, RI, and SR values were compared.

Results

CSA, RI, and SR were found to be effective tools to detect the presence of CTS (regardless of severity). The cut-off value of 11.25 mm2 for CSA had a sensitivity and specificity of 97.2% and 88.0%, respectively. The cut-off value of 0.740 for RI had a sensitivity and specificity of 94.4% and 94.0%, respectively. The cut-off value of 1.95 for SR had a sensitivity and specificity of 97.2% and 84.0%, respectively. In respect of the severity of CTS, ultrasound was found to be an effective method to classify severe CTS cases only.

Conclusion

The CSA, SR, and RI seem to have excellent accuracy in the diagnosis of CTS. When the grading of severity is considered, ultrasound seems to be sensitive and specific in differentiating severe CTS cases from mild or moderate CTS cases.
Establishment of a Novel Porcine Model to Study the Impact of Active Stretching on a Local Carrageenan-Induced Inflammation
Authors: Vergara Dennis Muñoz , Berrueta Lisbeth , Carmody Colleen , An Xingxing , Wayne Peter M. , Zavacki Ann Marie , Langevin Helene M.
Published: May 2020

Objective

Active stretching of the body is integral to complementary mind-body therapies such as yoga, as well as physical therapy, yet the biologic mechanisms underlying its therapeutic effects remain largely unknown. A previous study showed the impact of active stretching on inflammatory processes in rats. The present study tested the feasibility of using a porcine model, with a closer resemblance to human anatomy, to study the effects of active stretching in the resolution of localized inflammation.

Design

A total of 12 pigs were trained to stretch before subcutaneous bilateral Carrageenan injection in the back at the L3 vertebrae, 2 cm from the midline. Animals were randomized to no-stretch or stretch, twice a day for 5 mins over 48 hrs. Animals were euthanized for tissue collection 48 hrs postinjection.

Results

The procedure was well tolerated by the pigs. On average, lesion area was significantly smaller by 36% in the stretch group compared with the no-stretch group (P = 0.03).

Conclusion

This porcine model shows promise for studying the impact of active stretching on inflammation-resolution mechanisms. These results are relevant to understanding the stretching-related therapeutic mechanisms of mind-body therapies. Future studies with larger samples are warranted.
Computed Tomography Features of Coronavirus Disease 2019 (COVID-19)
Authors: Goyal Nikhil , Chung Michael , Bernheim Adam , Keir Graham , Mei Xueyan , Huang Mingqian , Li Shaolin , Kanne Jeffrey P.
Published: May 2020

Coronavirus Disease 2019 (COVID-19) pneumonia has become a global pandemic. Although the rate of new infections in China has decreased, currently, 169 countries report confirmed cases, with many nations showing increasing numbers daily. Testing for COVID-19 infection is performed via reverse transcriptase polymerase chain reaction, but availability is limited in many parts of the world. The role of chest computed tomography is yet to be determined and may vary depending on the local prevalence of disease and availability of laboratory testing. A common but nonspecific pattern of disease with a somewhat predictable progression is seen in patients with COVID-19. Specifically, patchy ground-glass opacities in the periphery of the lower lungs may be present initially, eventually undergoing coalescence, consolidation, and organization, and ultimately showing features of fibrosis. In this article, we review the computed tomography features of COVID-19 infection. Familiarity with these findings and their evolution will help radiologists recognize potential COVID-19 and recognize the significant overlap with other causes of acute lung injury.
Historical and Contemporary Management of Infantile Hepatic Hemangioma
Authors: Macdonald Alexander , Durkin Natalie , Deganello Annamaria , Sellars Maria E. , Makin Erica , Davenport Mark
Published: May 2020

Objective:

To describe outcome of infants with hemangioma(s) of the liver.

Summary of Background Data:

Infantile hepatic hemangiomas exhibit a diverse phenotype. We report our 30-year experience and describe optimal management based on precise radiological classification.

Methods:

Retrospective review of 124 infants (66 female) 1986–2016. Categorical analysis with Chi2 and nonparametric comparison. Data expressed as median (range) and P < 0.05 considered significant.

Results:

Lesions classified as focal (n = 70, 56%); multifocal (n = 47, 38%) or diffuse (n = 7, 6%) and of these 80(65%) were symptomatic (eg, cardiac failure n = 39, 31%; thrombocytopenia n = 12, 10%).

Increased hepatic artery velocity was seen in 63 (56%). Median hepatic artery velocity was greatest in diffuse lesions [245 (175–376) cm/s vs focal 120 (34–242) cm/s vs multifocal 93 (36–313) cm/s; P = 0.0001]. Expectant management alone was followed in 55 (44%). Medical therapy was utilised in 57(46%) and sufficient for symptom control in 29/57 (51%). Propranolol therapy (from 2008) was sufficient for symptom control in 22/28 (79%). Surgery (hepatic artery ligation n = 26; resection n = 13; embolization n = 1) was required in 40 (32%). Median maximal lesion diameter was 3 (0.5–17.1) cm and greater in those requiring surgery (7 cm vs 4.9 cm; P = 0.04). The proportion requiring surgery decreased markedly in the propranolol era [pre-propranolol 25/48 (52%) vs post-propranolol 16/76 (21%) (P = 0.0003)]. Systematic follow-up with ultrasound to a median of 2.6 (0.02–16) years.

Conclusions:

A proportion of infantile hepatic hemangiomas remain asymptomatic permitting observation until resolution but the majority require complex multi-modal therapy. First-line pharmacotherapy with propranolol has reduced but not abolished the need for surgery.
A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration
Authors: Funk Luke M. , Alagoz Esra , Jolles Sally A. , Shea Grace E. , Gunter Rebecca L. , Raffa Susan D. , Voils Corrine I.
Published: May 2020

Objective:

To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers.

Summary of Background Data:

Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration.

Methods:

We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or “contextual” barriers within Andersen Behavioral Model of Health Services Use.

Results:

Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time.

Conclusions:

Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.
Effectiveness of Laparoscopic Sleeve Gastrectomy in Super-obese and Non–Super-obese Patients
Authors: Hidalgo Marta , Vilallonga Ramon , Ruiz de Godejuela Amador García , Rodríguez-Luna María R. , Balibrea José M. , Roriz-Silva Renato , González Oscar , Caubet Enric , Ciudin Andrea , Armengol Manel , Fort José M.
Published: May 2020

Objectives:

The primary aim of this study was to assess the effectiveness of sleeve gastrectomy (SG) in super-obese patients. The secondary aim was to identify patient characteristics associated with worse SG outcomes in this group.

Methods:

A retrospective analysis was carried out of our electronic prospective bariatric surgery patient database, including all patients who underwent SG between January 2007 and January 2017. The sample was divided according to the initial body mass index (BMI) (> or <50 kg/m2). The initial characteristics and results in terms of weight loss and comorbidity resolution between the groups were compared. A subanalysis of the variable distributions was carried out according to whether or not the final BMI in the super-obese group had reached <35 kg/m2. Data analysis was carried out using STATA 13.1, with a P-value <0.05 considered to be significant.

Results:

The mean initial BMI was 42.8 kg/m2 in group 1 (<50 kg/m2) and 55 kg/m2 in group 2 (>50 kg/m2). The median follow-up (FU) was 56.2 months. Maximum weight loss was attained at the 18-month FU in both groups (BMI: 28.8 and 34.7 kg/m2, respectively). At the 5-year FU, percentage of total weight loss was higher in group 2 and percentage of excess weight loss was statistically higher in group 1 (29.6% vs. 33.1% and 67% vs. 59%, respectively). Outcomes for type 2 diabetes mellitus, hypertension, and dyslipidemia were similar in both groups. The variables associated with attaining a final BMI <35 kg/m2 in the super-obese group were lower initial BMI, absence of baseline weight-related conditions (type 2 diabetes mellitus, obstructive sleep apnea syndrome, home continuous positive airway pressure, arthropathy, heart disease), and absence of gastroesophageal reflux disease.

Conclusions:

We observed a statistically significant increase in poor outcomes in patients with a higher initial BMI and with weight-related comorbidities. These parameters could be considered to be potentially good predictors of less satisfactory outcomes in the super-obese patients.
Perioperative Adverse Events for Stress Urinary Incontinence Surgery: A National Analysis
Authors: Sappenfield Elisabeth C. , O’Sullivan David M. , Tulikangas Paul K.
Published: May 2020

Objective

The aim of the study was to compare perioperative morbidity of stress urinary incontinence surgery using data from a nationwide cohort.

Methods

This is a retrospective cohort study of the American College of Surgeons’ National Surgical Quality Improvement Program database from 2005 to 2016. Stress urinary incontinence surgery was defined using current procedural terminology (CPT) for abdominal retropubic colposuspension (CPT 51840, 51841), laparoscopic retropubic colposuspension (CPT 51990, 51992), and suburethral sling (CPT 57288). Patients were excluded if they underwent any concomitant surgery except for cystoscopy (CPT 52000). Surgical approach and perioperative morbidity were examined using suburethral sling as the referent population. Patient characteristics, operative data, and 30-day postoperative events were collected.

Results

Overall, 19,093 women underwent a stress urinary incontinence surgery: 317 abdominal retropubic colposuspension, 357 laparoscopic retropubic colposuspension, and 18,419 suburethral sling. Patients undergoing abdominal retropubic suspension had more inpatient procedures compared with suburethral sling and laparoscopic retropubic colposuspension (65% vs 10.4% and 17.6%, P < 0.001) and longer length of stay (1.6 ± 2.9 vs 0.3 ± 2.7 and 0.3 ± 0.6, respectively, P < 0.001). Abdominal retropubic colposuspension had the longest odds ratio time compared with suburethral sling (72.0 ± 64.6 vs 38.1 ± 34.2 minutes, P < 0.001). Composite morbidity was significantly higher for abdominal retropubic colposuspension compared with suburethral sling and laparoscopic retropubic colposuspension (7.9% vs 3.4% and 2.0%, P < 0.001). After adjusting for comorbidities, composite morbidity was higher for abdominal retropubic suspension (P = 0.007) compared with suburethral sling.

Conclusions

Compared with suburethral sling, laparoscopic retropubic colposuspension had the lowest 30-day comorbidity and abdominal retropubic colposuspension had the highest 30-day comorbidity.
Rescue therapy for severe COVID-19–associated acute respiratory distress syndrome with tissue plasminogen activator: A case series
Authors: Barrett Christopher D. , Oren-Grinberg Achikam , Chao Edward , Moraco Andrew H. , Martin Matthew J. , Reddy Srinivas H. , Ilg Annette M. , Jhunjhunwala Rashi , Uribe Marco , Moore Hunter B. , Moore Ernest E. , Baedorf-Kassis Elias N. , Krajewski Megan L. , Talmor Daniel S. , Shaefi Shahzad , Yaffe Michael B.
Published: May 2020

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented stresses on modern medical systems, overwhelming the resource infrastructure in numerous countries while presenting a unique series of pathophysiologic clinical findings. Thrombotic coagulopathy is common in critically ill patients suffering from COVID-19, with associated high rates of respiratory failure requiring prolonged periods of mechanical ventilation. Here, we report a case series of five patients suffering from profound, medically refractory COVID-19–associated respiratory failure who were treated with fibrinolytic therapy using tissue plasminogen activator (tPA; alteplase). All five patients appeared to have an improved respiratory status following tPA administration: one patient had an initial marked improvement that partially regressed after several hours, one patient had transient improvements that were not sustained, and three patients had sustained clinical improvements following tPA administration.

LEVEL OF EVIDENCE

Therapeutic, Level V.