bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer
Authors: Marks John H. , Salem Jean F. , Valsdottir Elsa B. , Yarandi Shadi S. , Marks Gerald J.
Published: September 2019

BACKGROUND:

Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant.

OBJECTIVE:

The purpose of this study was to evaluate the quality of life and functional outcomes of patients after transanal abdominal transanal proctectomy.

DESIGN:

This is a cross-sectional study.

SETTINGS:

The study was conducted at a tertiary referral colorectal center.

PATIENTS:

Patients who underwent transanal abdominal transanal proctectomy were included and surveyed using the Fecal Incontinence Quality of Life Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, the Quality of Life Questionnaire CR38 module, and a questionnaire designed by the authors to assess satisfaction with quality of life.

MAIN OUTCOME MEASURES:

Quality of life, functional outcomes, and patient satisfaction were measured and compared by age, tumor level, and stage of the disease.

RESULTS:

A total of 133 surveys were mailed, and 90 patients responded and were included in the study. Patient quality of life was not significantly different after surgery. Patients with more proximal tumors had better lifestyle, physical, and emotional scores. Older patients performed better on multiple levels, including coping, emotional, body image, future perspective, and digestive. Stage of disease had no impact on quality of life. Compared with reference values, patients who underwent transanal abdominal transanal proctectomy performed better on most of the components. All of patients preferred transanal abdominal transanal proctectomy over having a stoma based on their current anal sphincter function, and >97% of patients preferred transanal abdominal transanal proctectomy based on their current quality of life, sexual function, and level of activities.

LIMITATIONS:

This study is limited by the lack of a comparison group and a potential selection bias.

CONCLUSIONS:

Satisfaction with quality of life and functional outcomes is high after transanal abdominal transanal proctectomy. Older patients and those with more proximal tumors performed better. This patient population clearly preferred a sphincter-preserving option for treatment of their rectal cancer.
Effect of Topical Garlic on Wound Healing and Scarring: A Clinical Trial
Authors: Alhashim Minhal , Lombardo Jamie
Published: September 2019

BACKGROUND

Historically, garlic containing compounds have been used on wounds to improve healing and ward off infection. Researchers have tested many of these ancient ointments, discovering that garlic is a common ingredient in those that are effective.

OBJECTIVE

To determine the efficacy of topical garlic on surgical wounds compared with Vaseline by analysis of visual analog scales and digital photograph analysis.

MATERIALS AND METHODS

Seventeen patients with 2 skin excisions applied a 30% garlic ointment to one surgical wound and Vaseline to the other surgical wound twice daily. They were followed up at 2 weeks and 4 weeks post-op. Digital photographs were taken of the sites, and wound visual analog scales were filled out by the patient and the physician.

RESULTS

Patients and the onsite physician stated the garlic site healed better in 59% and 65% of the wounds, respectively, at 2 weeks. At 4 weeks, the patients and the onsite physician stated the garlic site healed better in 76% and 88% of wounds, respectively. Digital photograph analysis revealed less erythema at the garlic sites (p-value = .02).

CONCLUSION

Surgical wounds treated with 30% garlic ointment healed with more cosmetically appealing scars than the Vaseline-treated sites.
Urinary Incontinence: Evaluation and Management
Authors: HANDLER STEPHANIE J. , ROSENMAN AMY E.
Published: September 2019

Urinary incontinence is a major public health issue in the United States with physical, mental, social, and economic repercussions. History and in-office evaluation are paramount to diagnosis and formation of an appropriate treatment plan. Lifestyle modifications, which include pelvic floor muscle training and behavioral changes, are appropriate for initial management. Patients with overactive bladder syndrome whose symptoms are not adequately controlled with conservative treatment can be offered medical or procedural management. Stress urinary incontinence refractory to first-line treatment can be treated with surgical options such as mesh midurethral slings.
The use of adjuvants in assisted reproduction treatment
Authors: Kennedy Richard
Published: September 2019

The basic process of in vitro fertilization and related techniques has been overtime expanded by a group of interventions known collectively as “add-ons” or adjuvants. These additional processes vary from simple medications through complex laboratory procedures through to surgical procedures. Almost without exception they have been applied without thorough evaluation by adequately powered clinical trials and universally they add cost to the process. We examine the most commonly used adjuvants under the headings periconceptual medication, laboratory procedures and interventions to enhance implantation.
Sperm cryopreservation for fertility preservation in male patients with cancer at a single-center in Japan
Authors: Takeshima Teppei , Ueno Hiroe , Yamamoto Mizuki , Usui Kimitsugu , Mori Kohei , Asai Takuo , Yasuda Kengo , Kuroda Shinnosuke , Kawahara Takashi , Miyoshi Yasuhide , Uemura Hiroji , Yumura Yasushi
Published: September 2019

Advanced treatment modalities for cancer have led to improved prognosis in patients with cancer. However, these treatments may adversely affect the fertility of these patients. Therefore, peritreatment preservation of fertility in adolescent and young adult populations is very important. For male patients, sperm cryopreservation before the initiation of treatment for cancer is currently the most effective method for the preservation of fertility. We performed a retrospective cohort analysis of a sperm cryopreservation protocol at the Yokohama City University Medical Center between 2012 and 2017. A total of 235 men were referred and attempted sperm cryopreservation during this period. The most prevalent diseases were hematological malignancies (38.7%; leukemia, malignant lymphoma, and multiple myeloma), testicular cancer (32.3%, including extragonadal germ cell tumor), bone and soft tissue sarcoma (8.5%), lung cancer (4.7%), prostate cancer (4.3%), and brain tumor (2.6%) in descending order. The median age of patients was 31 (range: 13–65) years, mean sperm density and motility were 28.54±30.25 106/mL, and 20.38±20.62%, respectively. Sperm cryopreservation was successfully performed in 195 patients (83.0%). In those with cryopreservation failure (36 patients; 15.3%), the primary causes were azoospermia or poor semen quality. In the remaining 4 patients (1.7%), testicular spermatozoa were successfully cryopreserved through surgical extraction. In the cryopreservation failure group (n=36), 23 patients (63.9%) were referred after initiation of treatment. Of those, 17 patients were referred from the departments of hematology and oncology. Moreover, sperm density was significantly lower in patients who under gone treatment than in those of the pretreatment group (P=0.003). Cryopreserved sperm from 18 patients was used in 23 in vitro fertilization cycles, resulting in a clinical pregnancy rate of 56.5% per cycle. It is important to inform other departments regarding the option for sperm cryopreservation before initiating treatment in patients with cancer.
Quarter-Descemet Membrane Endothelial Keratoplasty: One- to Two-Year Clinical Outcomes
Authors: Birbal Rénuka S. , Ni Dhubhghaill Sorcha , Baydoun Lamis , Ham Lisanne , Bourgonje Vincent J.A. , Dapena Isabel , Oellerich Silke , Melles Gerrit R. J.
Published: September 2019

Purpose:

To report clinical outcomes of the first Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) case series performed for central Fuchs endothelial corneal dystrophy.

Methods:

This is a prospective, interventional case series analyzing the clinical outcomes of 19 eyes of 19 patients with central Fuchs endothelial corneal dystrophy, that is, with guttae predominantly in the 6- to 7-mm optical zone, who underwent unilateral Quarter-DMEK at a tertiary referral center. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative complications. Included eyes had up to 2 years of postoperative follow-up.

Results:

At 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5): 18 of 19 eyes (95%) with ≥20/25 (≥0.8) and 9 of 19 eyes (42%) with ≥20/20 (≥1.0). Thereafter, BCVA remained stable up to 2 years postoperatively. The mean donor ECD decreased from 2842 ± 139 cells/mm2 (n = 19) before implantation to 913 ± 434 cells/mm2 (−68%) at 6 months (n = 19), 869 ± 313 cells/mm2 (−70%) at 12 months (n = 18), and 758 ± 225 cells/mm2 (−74%) at 24 months (n = 13) after Quarter-DMEK. Visually significant graft detachment requiring rebubbling occurred in 8 of 19 eyes (42%).

Conclusions:

Quarter-DMEK surgery yields visual outcomes similar to those of conventional DMEK and may potentially quadruple the availability of endothelial grafts. Further modifications of the graft preparation and the surgical technique may improve clinical outcomes in terms of lower ECD decrease and fewer graft detachments.
Modified Sutureless and Glue-Free Method Versus Conventional Sutures for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Randomized Controlled Trial
Authors: Yan Bin , Peng Li , Peng Hanhan , Zhou Shu , Chen Baihua
Published: September 2019

Purpose:

To compare the advantages and disadvantages of a modified sutureless and glue-free method with those of conventional sutures for conjunctival autograft fixation in pterygium surgery.

Methods:

A prospective randomized controlled study was performed on 73 eyes with primary nasal pterygium. After pterygium excision, the bare sclera was covered with a limbal conjunctival autograft, which was fixed using a modified sutureless and glue-free method in group 1 (39 eyes) and sutures in group 2 (34 eyes). The main outcome measures were operative time, autograft stability, postoperative discomfort, autograft thickness, pterygium recurrence, and complications.

Results:

The mean operative time was significantly shorter in group 1 (11.9 ± 1.3 minutes) than in group 2 (24.3 ± 6.1 minutes, P < 0.0001). On day 2 postsurgery, the average conjunctival autograft thickness was significantly higher in group 1 (861 ± 340 μm) than in group 2 (577 ± 287 μm, P = 0.034). Subsequently, conjunctival autograft thickness gradually decreased, with no significant difference between groups after 1 week. There were no significant differences in postoperative discomfort between groups, except for a greater foreign body sensation on day 2 and an itching sensation in 1 week in group 2 compared with group 1. Autograft side displacement occurred in 4 patients (10.3%) in group 1; 2 of these 4 developed a granuloma. There was 1 recurrence (2.9%) in group 2.

Conclusions:

The modified sutureless and glue-free limbal conjunctival autograft fixation method might be effective and efficient for primary pterygium surgery, with potentially decreased recurrence and postoperative discomfort.
Effect of age at first use of oral contraceptives on breast cancer risk
Authors: Ji Li-Wei , Jing Chun-Xia , Zhuang Su-Lian , Pan Wei-Cheng , Hu Xing-Po
Published: September 2019

Background:

We evaluated the relationship between the age at first use of oral contraceptives (OC) and breast cancer (BC) risk.

Methods:

We searched PubMed, Embase, and related reviews published through June 28, 2018, and used summary relative risk (RR) and 95% confidence intervals (CIs) to evaluate the cancer risks, and fixed-effects dose–response meta-analysis to assess potential linear and non-linear dose–response relationships.

Results:

We included 10 studies, with 8585 BC cases among 686,305 participants. The pooled RR for BC was 1.24 (95% CI: 1.10–1.41), with moderate heterogeneities (I2 = 66.5%,P < .001). No significant publication bias was found (P = .584 for Begg test,P = .597 for Egger test). A linear dose–response relationship between the age at first OC use and BC risk was detected (P = .518 for non-linearity). Subgroup analyses were restricted to studies done by BC subtypes, region, sample size, follow-up time and study quality. Inconsistent consequences with no statistical significance were explored when limited to studies from Western countries, study quality <7, sample size <10,000, follow-up time <5 years, and BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2) expression status in tumor tissue. Sensitivity analyses indicated that our results were stable and reliable after removing each study in turn and omitting studies of adjusted unreported variables.

Conclusion:

A significant linear relationship between the age at first OC use and BC risk was confirmed. No further consistent differences are noted in multiple aspects of BC subtypes defined by progesterone or ER status.
Effects of adductor canal block versus femoral nerve block in patients with anterior cruciate ligament reconstruction
Authors: Liu Xuwen , Zhou Jiawen , Mao Guping , Yu Qiao , Wu Xin , Sun Hong , Yang Hua
Published: September 2019

Objective:

It is reported that both adductor canal block (ACB) and femoral nerve block (FNB) are commonly used methods for postoperative analgesia in anterior cruciate ligament (ACL) reconstruction. Currently, no record has compared the efficacy of postoperative pain relief and the influence to quadriceps strength between them. This study aims to provide a protocol to compare the efficacy and safety between ACB and FNB for the postoperative analgesia of ACL reconstruction.

Methods:

This study will be performed in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. Online databases including PubMed, Embase, Web of Science, Cochrane Library, Wanfang database, and the Chinese National Knowledge Infrastructure database will be systematically searched from their inception up May 31, 2019. All randomized controlled trials will be included in present meta-analysis. The quality of enrolled literatures will be evaluated by using the Cochrane Collaboration Risk of bias Tool. Statistical analysis will be calculated by the Review Manager 5.3.

Results:

This review will investigate the efficacy and safety of ACB compared with FNB in patients undergoing ACL reconstruction. The primary outcomes are visual analog scale, cumulative opioid consumption during 24 hours after surgery, numerical rating scale, and the time to first straight-leg raise. The secondary outcomes include maximal voluntary isometric contraction, stretching torque at 3, 6 months’ follow-up, and adverse effects.

Conclusion:

Findings of this systematic review and meta-analysis will summarize the current evidence in postoperative analgesia for ACL reconstruction and also provide implications for clinical practice.
Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta
Authors: Lin Jinxiao , Lin Fengning , Zhang Yulong
Published: September 2019

To investigate the influence of uterine artery ligation before placental delivery during cesarean section on postpartum hemorrhage (PPH) and related complications in patients with placenta previa accreta.

A retrospective study was conducted of data from 78 patients with pernicious placenta previa, treated at Fujian Provincial Maternal and Child Health Hospital (Fuzhou, China) between January 2014 and June 2018. Twenty-nine patients underwent uterine arterial ligation before placental delivery (UALBPD), and the other 49 patients in the control group did not undergo peri-paracentesis before the delivery of the placenta. The statistical analysis and data management were performed with SPSS 19.0.

The intraoperative and postoperative complications after uterine artery ligation were compared between the 2 groups: in the UALBPD group, no woman (0.0%) underwent a subtotal cesarean hysterectomy, whereas four (8.2%) did so in the control group (P = .24). The mean number of packed red blood cell (RBC) units transfused was 3.7 ± 1.2 in the UALBPD group and 5.7 ± 3.4 units in the control group (P = .0002). The estimated blood loss was 734.2 ± 317.5 mL in the UALBPD group and 1101.6 ± 442.7 mL in the control group (P < .0001). Nine (31.0%) women in the UALBPD group underwent transfusion compared with 38 (77.6%) in the control group (P = .003). The reduction in hemoglobin was 2.63 ± 1.85 g/L in the UALBPD group and 5.41 ± 2.38 g/L in the control group (P < .0001). The reduction in hematocrit was 2.96 ± 4.07 in the UALBPD group and 6.77 ± 8.74 (%) in the control group (P = .009).

Bilateral uterine artery ligation before the delivery of the placenta in women with placenta accreta can effectively reduce the amount of intraoperative blood loss, the incidence of PPH, and the risk of complications, such as hysterectomy.
Definitive BCG immunotherapy versus radical cystectomy in intermediate or high-risk nonmuscle invasive bladder cancer patients
Authors: Jian Xiaoming , Shen Mingkang , Liao Guodong
Published: September 2019

At present, intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is recommended for prophylaxis purposes after transurethral resection of bladder tumor, but has chances of recurrence. Radical cystectomy reduces the risk of recurrence in bladder cancer patients, but may have chances of postoperative complications. The objective of the study was to test the hypothesis that radical cystectomy has overtreatment and definitive BCG immunotherapy has undertreatment in intermediate or high-risk nonmuscle invasive bladder cancer patients. Data regarding biopsies, ultrasound, the computed tomography scan, adopted treatment strategy, treatment-emergent adverse effect, and a follow-up period of 312 patients with confirmed nonmuscle invasive bladder cancer (pTa, pTis, or pT1 stage; intermediate or high-risk cancer) were reviewed. Patients who had received definitive intravesical BCG immunotherapy were included in BCG group (n = 210) and those who underwent radical cystectomy were included in RXC group (n = 87). Clinical decision-making for treatment strategies was evaluated for both groups. Cystitis was frequently observed in all patients who received BCG immunotherapy. In RXC group, ileus was frequently observed in all patients in early days after the operation. During 2 years of the follow-up period, biopsies, ultrasound, and the computed tomography scan reported that BCG group had fewer numbers of negative cancer patients after treatment than the RXC group after surgery (P < .0001). Total expenditure for BCG immunotherapy was higher than radical cystectomy (22,945 ± 945 ¥/patient vs 17,985 ± 545 ¥/patient; P < .0001). Definitive BCG immunotherapy had undertreatment and radical cystectomy had overtreatment for intermediate or high-risk invasive bladder cancer patients (level of evidence III).
Decreased capillary density in renal cell carcinoma
Authors: Lin Tzu-Chun , Chen Huey-Yi , Yang You-Rong , Liu Po-Len , Chen Yung-Hsiang , Chen Wen-Chi
Published: September 2019

Rationale:

Conventional computerized tomography (CT) examination can differentiate renal cortical tumor from urothelial carcinoma on the basis of the highly contrast-enhanced vessels in renal cortical tumors. However, the capillary distribution of renal cell carcinoma (RCC) has been under-investigated. Here, we present a micro-CT image of tumor tissue in a patient with RCC.

Patient concerns:

The patient was a 72-year-old woman with a past history of diabetes mellitus and hypertension. She did not have tumor-related symptoms.

Diagnosis and interventions:

The tumor was diagnosed using abdominal CT during her yearly routine health check. After radical nephrectomy, the tumor was subjected to pathological examination and micro-CT imaging. Pathological analysis confirmed a clear cell renal carcinoma. The capillary distribution of the tumor was significantly lesser than that of the normal cortex on micro-CT image.

Lessons:

Microvessels of RCC can be detected by micro-CT. We also found that the distribution of microvessels was uneven and lower than that in the normal cortex in this case. For a more general diagnosis, more micro-CT images of RCC tumors are needed.
Clinical feasibility of imaging with indocyanine green combined with carbon nanoparticles for sentinel lymph node identification in papillary thyroid microcarcinoma
Authors: Zhang Xing , Shen Yan-Ping , Li Jia-Gen , Chen Gun
Published: September 2019

Background:

Although several previous studies demonstrated the feasibility and efficacy of indocyanine green (ICG) for thyroid cancer surgery, ICG was administered through venous injection and focused on parathyroid gland protection. We thus aimed to study the feasibility of imaging using ICG combined with carbon nanoparticles (CNs) in the identification of sentinel lymph nodes (SLNs) in patients diagnosed with papillary thyroid microcarcinoma (PTMC).

Methods:

Two approaches were applied to detect lymph nodes in PTMC surgery. Patients were randomized into 2 groups. ICG and CNs were injected into the thyroid in Group A. In Group B, only CNs was injected. Black-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs. SLN and central lymph node (CLN) dissection was completed in both groups. The pathological and postoperative outcomes were compared between 2 groups.

Results:

There were 40 patients in Group A and 60 in Group B. A total of 138 SLNs were identified; 72 and 66 SLNs were detected and dissected in Groups A and B, respectively. The number of SLNs identified (per patient) in Group A was higher than that in Group B (P = .027). The number of harvested CLNs was 161 and 192 in Groups A and B, respectively, out of which 45 and 48 lymph nodes with metastasis were confirmed by permanent pathology. The CLN metastatic rate in Group A was higher than that in Group B (P = .048).

Conclusion:

Imaging using ICG combined CNs is feasible and safe for SLN identification in PTMC patients. Compared with using only CNs, more SLNs can be removed and more metastatic lymph nodes can be confirmed when using the combined method. Although the combined method appears to accurately stage tumors, further research is needed.
Tacrolimus-induced diabetic ketoacidosis with subsequent rapid recovery of endogenous insulin secretion after cessation of tacrolimus
Authors: Maruyama Koji , Chujo Daisuke
Published: September 2019

Rationale:

Immunosuppressive agents such as tacrolimus (TAC) and cyclosporin might cause glycemic disorders by suppressing insulin production. However, only a few cases of diabetic ketoacidosis (DKA) with longitudinal evaluation of endogenous insulin secretion related to TAC administration have been reported.

Patient concerns:

A 59-year-old Asian woman, who received prednisolone and TAC 4.0 mg for the treatment of anti-aminoacyl-tRNA synthetase antibody-positive interstitial pneumonia, was admitted to our hospital due to impaired consciousness and general malaise.

Diagnoses:

She had metabolic acidosis; her plasma glucose, fasting serum C-peptide immunoreactivity (CPR), and urinary CPR levels were 989 mg/dL (54.9 mmol/L), 0.62 ng/mL, and 13.4 μg/d, respectively. No islet-related autoantibodies were detected. Therefore, she was diagnosed with TAC-induced DKA.

Intervention:

Intravenous continuous insulin infusion and rapid saline infusion were administered. TAC was discontinued because of its diabetogenic potential.

Outcomes:

Sixteen weeks after cessation of TAC administration, she showed good glycemic control without administration of insulin or any oral hypoglycemic agents; her serum CPR level also improved dramatically. These findings suggested that TAC-induced pancreatic beta cell toxicity is reversible.

Lessons:

We reported a case of TAC-induced DKA with subsequent recovery of pancreatic beta cell function after cessation of TAC, resulting in good glycemic control. As TAC is widely used, we should pay attention to patients’ glucose levels even though the TAC concentrations used are within the target range. Furthermore, dose reduction or cessation of TAC should be considered if hyperglycemia is detected during administration of this agent.
Essential oil extracted from erythrina corallodendron L. leaves inhibits the proliferation, migration, and invasion of breast cancer cells
Authors: Xing Xiang , Ma Jia-Hui , Fu Yao , Zhao Hang , Ye Xiao-Xuan , Han Zhuo , Jia Fu-Juan , Li Xia
Published: September 2019

Erythrina corallodendron L., a kind of landscape tree, has long been used as a traditional medicine. In this study, the composition of essential oil extracted from the leaves was analysed by GC-MS (gas chromatograph-mass spectrometer), with linalool identified as the main compound. Its cytotoxicity against MDA-MB-231, MCF-7 and HMLE cells was examined by MTT and cloning assays. Transwell and wound-healing assays were used to examine the inhibition of migration and invasion. Western blot, qRT-PCR and immunofluorescence staining were used to measure the mRNA and protein expression of factors related to EMT (snail, slug, E-cadherin, N-cadherin and vimentin). The essential oil of Erythrina corallodendron leaves was found to inhibit the proliferation, migration and invasion of breast cancer cells in a dose-dependent manner. The findings of this study suggest that the essential oil of E. corallodendron leaves may merit further investigation as a potential clinical or adjuvant drug for treating breast cancer migration and invasion.
Total cholesterol and mortality from ischemic heart disease and overall cardiovascular disease in Korean adults
Authors: Kwon Daeho , Yi Jee-Jeon , Ohrr Heechoul , Yi Sang-Wook
Published: September 2019

It is not completely clear whether “the lower, the better” cholesterol hypothesis for cardiovascular disease (CVD) and ischemic heart disease (IHD) can be applied to general populations with a low risk of heart disease mortality.

We prospectively followed up 503,340 Koreans who participated in routine health checkups during 2002–2003 until 2013 via linkage to national mortality records.

Nonlinear associations with total cholesterol (TC) were found: U-curves for overall CVD (I00-I99; nadir at 180–200 mg/dL) and a reverse-L-curve for IHD (I20-I25). Assuming a linear association in the lower range (<200 mg/dL), TC was inversely associated with CVD mortality (HR per 39 mg/dL [1 mmol/L] increase = 0.90). In the upper range (200–349 mg/dL), TC was positively associated with CVD mortality, largely due to IHD (HR = 1.19), especially acute myocardial infarction (HR = 1.23). The associations were generally similar in men versus women and in middle-aged (40–64 years) versus elderly (≥65 years) adults.

TC levels of 180–200 mg/dL were associated with the lowest CVD mortality. Below 200 mg/dL, TC had no graded positive associations with IHD mortality. It remains unclear whether the lowest cholesterol levels are associated with the least mortality from CVD and IHD in Korean adults with a low risk of heart disease.
The role of free triiodothyronine in high-density lipoprotein cholesterol metabolism
Authors: Huang Fang , Wu Lili , Qiu Ye , Bu Kunpeng , Huang Hui , Li Bixun
Published: September 2019

The aim of this study was to analyze the correlation between free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and serum high-density lipoprotein cholesterol (HDL-C), and to explore the significance of FT3 in HDL-C metabolism in people with normal thyroid function.

A total of 461 Chinese, aged ≥28 years, from a college community in Nanning, Guangxi, were enrolled for a cross-sectional epidemiological investigation of metabolic syndrome from October 2016 to November 2016. Height, weight, blood pressure, total cholesterol, HDL-C, triglyceride (TG), fasting glucose (FPG), FT3, FT4, and TSH were measured for each individual. Multiple linear regression analysis was used to evaluate the correlation between FT3, FT4, TSH, and HDL-C.

After controlling for sex, age, body mass index (BMI), smoking, drinking, and other confounding factors, FT3 was negatively correlated with HDL-C levels, on average, when FT3 increased by 1 pmol/L, HDL-C decreased by 0.143 mmol /L with a statistically significant difference (P < .001). FT4 was positively correlated with HDL-C, and HDL-C increased by 0.016 mmol/L for every 1-pmol/L increase in FT4. TSH was negatively correlated with HDL-C, and HDL-C decreases by 0.010 mmol/L for every 1-μIU/mL increase in TSH, but the differences were not statistically significant (P > .05).

FT3 may be an important factor affecting HDL-C levels. The detection and regulation of thyroid hormone (especially FT3) in patients with low HDL-C, as well as the detection of HDL-C in patients with thyroid dysfunction, is important to prevent the occurrence of cardiovascular diseases.
Combination therapy based on pegylated interferon alfa improves the therapeutic response of patients with chronic hepatitis B who exhibit high levels of hepatitis B e-antigen at 24 weeks
Authors: Zhang Yafei , Li Wei , Liu Zhongping , Ye Jun , Zou Guizhou , Zhang Zhenhua , Li Jiabin
Published: September 2019

Pegylated interferon alpha (PEG-IFN-α) is a first-line treatment for patients with chronic hepatitis B (CHB), but its efficacy varies from individual to individual. Early discrimination between responder and non-responder patients is important for optimal clinical management. In addition, low therapeutic efficacy is still a major issue; thus, treatment timing should be optimized.

We reviewed our experience with hepatitis B e-antigen (HBeAg)-positive patients treated with PEG-IFN-α, alone or in combination with nucleoside analogues (NAs), from 2009 through 2014. Collected data included both general characteristics of 113 patients and laboratory data at baseline and at treatment weeks 12, 24, 52, and 76. The endpoint was HBeAg seroconversion at week 76.

A total of 113 patients with changed to or start of NAs therapy were included in this study. At the end of treatment, 44 (38.9%) patients exhibited HBeAg seroconversion. Patients with HBeAg seroconversion had lower baseline HBeAg (475.5 vs 751.7; P = .007). The incidence of HBeAg seroconversion was significantly higher among patients with HBeAg ≤ 500 signal-to-cutoff ratio (S/CO) (OR = 2.60, 95% CI: 1.16–5.83, P = .02) at baseline, HBeAg S/CO ≤ 20 (OR = 3.37, 95% CI: 1.47–7.73, P = .003), or a higher than 10-fold HBeAg drop (OR = 3.55, 95% CI: 1.50–8.37, P = .003) at week 12 or HBeAg ≤ 15 S/CO (OR = 10.35, 95% CI: 4.09–26.20, P < .001) at week 24. Subgroup analyses demonstrated that in patients with HBeAg >20 S/CO at 24 weeks, the addition of NAs treatment may increase HBeAg seroconversion (23.3% vs 0%, P = .03).

HBeAg levels had an impact on the rate of serological conversion in CHB patients receiving PEG-IFN-based treatment. Combination therapy with NAs should be considered in CHB patients maintaining a high HBeAg level after 24 weeks of PEG-IFN monotherapy.
Aberrant expression of vasculogenic mimicry, PRRX1, and CIP2A in clear cell renal cell carcinoma and its clinicopathological significance
Authors: Wang Xiaolin , Yang Ruixue , Wang Qi , Wang Yichao , Ci Hongfei , Wu Shiwu
Published: September 2019

Vasculogenic mimicry (VM) involves a tubular structure with a basement membrane that is similar to and communicates with vessels but functions independent of blood vessels to nourish tumor cells, promote tumor progression, invasion, and metastasis, with reduced 5-year survival rates. Tumor cell proliferation, invasion, and metastasis are promoted by the epithelial-mesenchymal transition (EMT). Paired-related homeobox 1 (PRRX1), a newly discovered EMT inducer, has been shown to correlate with metastasis and prognosis in diverse cancer types. Cancerous inhibitor of protein phosphatase 2A (CIP2A) was initially recognized as an oncoprotein. In this study, we aimed to investigate the expression and clinical significance of the EMT markers PRRX1, CIP2A and VM in clear cell renal cell carcinoma (CCRCC) and their respective associations with clinicopathological parameters and survival.

Expression of PRRX1, CIP2A and VM in whole CCRCC tissues from 110 patients was analyzed by immunohistochemical and histochemical staining. Fisher's exact test or the chi square test was used to assess associations with positive or negative staining of these markers and clinicopathological characteristics.

Positive expression of CIP2A and VM presence was significantly higher and that of PRRX1 was significantly lower in CCRCC tissues than in corresponding normal tissues. Furthermore, positive expression of CIP2A and VM was significantly associated with tumor grade, size, lymph node metastasis (LNM) stage, and tumor node metastasis (TNM) stage and inversely associated with overall survival time (OST). Moreover, levels of PRRX1 were negatively associated with tumor grade, size, LNM stage, and TNM stage. The PRRX1 subgroup had a significantly longer OST time than did the PRRX1 subgroup. In multivariate analysis, high VM and CIP2A, tumor grade, LNM stage, TNM stage, and low PRRX1 levels were identified as potential independent prognostic factors for OST in CCRCC patients.

VM and expression of CIP2A and PRRX1 represent promising biomarkers for metastasis and prognosis and potential therapeutic targets in CCRCC.
Predictors for improvement of xerostomia in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy
Authors: Pan Xin-Bin , Liu Yang , Huang Shi-Ting , Chen Kai-Hua , Jiang Yan-Ming , Zhu Xiao-Dong
Published: September 2019

To identify predictors for improvement of xerostomia in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).

Patients diagnosed with stage I-IVb NPC (according to the 7th edition of the American Joint Committee on Cancer) between September 2015 and March 2016 were retrospectively analyzed. All the patients received IMRT. Predictors for improvement of xerostomia were analyzed using logistic regression analysis. Receiver operating characteristic curve analysis was used to identify the most appropriate cut-off values for predicting factors.

This study included 195 patients: xerostomia improved in 109 patients and xerostomia remained unchanged in 86 patients. Volume of the parotid gland ≤52.2 cm3 was a risk factor for xerostomia improvement (odds ratio [OR] = 3.506, 95% confidence interval [CI]: 1.932–6.362, P = .001). The mean dose of <39 Gy to the ipsilateral parotid gland was a protective factor (OR = 0.417, 95% CI: 0.271–0.641, P = .001). V30 of the contralateral parotid gland ≤52% was a protective factor (OR = 0.593, 95% CI: 0.462–0.760, P = .001).

Volume of the parotid gland, the mean dose of the ipsilateral parotid gland, and V30 of the contralateral parotid gland were independent predictors for improvement of xerostomia.
Acupotomy versus nonsteroidal anti-inflammatory drugs for knee osteoarthritis
Authors: Zhang Renpan , Li Lixiang , Chen Bin , Liu Hong , Liu Jing , Zhang Liangzhi , Xiu Zhongbiao
Published: September 2019

Background:

Knee osteoarthritis (KOA), a common clinical chronic osteoarthropathy, has adverse effects on the working ability and life quality of patients. At present, acupotomy and nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely applied on KOA in China and has achieved satisfactory results. However, there is no systematic review comparing the effectiveness of these two therapies for KOA. Therefore, this study will assess the efficacy and safety of acupotomy in treating KOA.

Methods and analysis:

Several databases including CNKI, Wanfang Database, CBM, VIP, PubMed, Cochrane library, Web of Science, and Embase will be used by two independent researchers to search the related clinical RCTs about acupotomy therapy for KOA patients until May 2019. Subsequently, meta-analysis will be conducted by using Review Manager 5.3, and the related data will be analyzed by using the method for GRADE. The continuous data will be presented as the WMD or SMD with 95% CI, while dichotomous data will be shown as the RR with 95% CI.

Conclusion:

Our results review will provide evidence to determine whether acupotomy can achieve the effect of NSAIDs, or whether it has advantages and safety compared with NSAIDs for patients with KOA.

Ethics and dissemination:

This study will not involve personal information. The ethical approval will not be required. This systematic review will be disseminated electronically through a peer-reviewed journal or international conference presentations.

PROSPERO registration number:

CRD42019129089.
Effectiveness comparisons of traditional Chinese medicine for psoriasis
Authors: Wang Longjun , Tao Yun , Deng Sheng , Chu Liyuan , Li Linge
Published: September 2019

Background:

Psoriasis is an immune-mediated polygenic hereditary skin disease quality of the patients‘ life because of the great trouble it causes to patients. Whereas, there is variability when we regard the selection of traditional Chinese medicine treatments in practice and most choices are made based on personal experience or preference of clinician. This study uses network meta-analysis to compare the effectiveness of different forms of TCM for psoriasis and assesses the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Methods:

We will search for PubMed, Cochrane Library, AMED, EMbase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to April 2019. The quality of the included RCTs will be evaluated by the risk of bias (ROB) tool and the evidence will be evaluated by GRADE. STATA 13.0 and WinBUGS 1.4.3 through the GeMTC package will be used to perform a network meta-analysis to synthesize direct and indirect evidence.

Results:

The results of this network meta-analysis (NMA) will be submitted to a peer-reviewed journal for publication.

Trial registration number:

PROSPERO CRD42019137250.
Quantitative stiffness of the median nerve, flexor tendons, and flexor retinaculum in the carpal tunnel measured with acoustic radiation force impulse elastography in various wrist and finger positions
Authors: Lee Sungche , Kwak Jinmyong , Lee Sanghoon , Cho Hyuncheol , Oh Eunsun , Park Ji Woong
Published: September 2019

Despite the high prevalence and clinical importance of soft-tissue disorders, objective methods for evaluation of the biomechanical properties of soft tissues are lacking. This study aimed to quantitatively evaluate stiffness, an important biomechanical characteristic of soft tissue, using acoustic radiation force impulse (ARFI) elastography. The shear wave velocity (SWV, m/s) values of soft tissue structures within the carpal tunnel (CT) were measured in various combinations of wrist and finger positions.

Twenty-six healthy adults were enrolled in this study. We measured the cross-sectional area of the median nerve (MN) and the SWV values of several structures within the CT at the CT inlet level. Measurement of SWV of the MN, flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and transverse carpal ligament (TCL) were conducted in six wrist/finger motion combinations.

When the wrist and fingers were in neutral positions (position A), the mean SWV was lowest for the MN (mean ± standard deviation, 2.3 ± 0.5 m/s), followed by the FDS (2.9 ± 0.2), FDP (3.2 ± 0.3), and TCL (3.3 ± 0.4). The SWV was significantly different among the six different wrist/finger positions for all structures (P < .001). However, the MN cross-sectional area was not significantly different (P = .527). The SWV values for the MN, FDS, and FDP increased significantly as the wrist/finger positions the stress on the tendons increased (from position B to F) compared with a neutral position, while the SWV of the TCL was significantly higher for in all positions compared with neutral, except for wrist neutral, finger extension. The SWV values for the MN, FDS, and TCL gradually increased as stress increased.

The intra-CT structures are under increased stress during wrist and finger motions than when the hand is in a neutral position. We have used ARFI elastography to gain insight into the pathophysiology of CTS.
Clinical implications of fecal calprotectin and fecal immunochemical test on mucosal status in patients with ulcerative colitis
Authors: Ryu Dae Gon , Kim Hyung Wook , Park Su Bum , Kang Dae Hwan , Choi Cheol Woong , Kim Su Jin , Nam Hyeong Seok
Published: September 2019

Although fecal calprotectin (Fcal) and the fecal immunochemical test (FIT) have been associated with endoscopic activity in ulcerative colitis (UC), the clinical implications of each marker depending on the mucosal status are not well known.

A total of 174 results obtained from 128 patients with UC who simultaneously underwent colonoscopy and fecal tests were retrospectively evaluated from March 2015 to February 2018. The correlation and predictability of fecal markers as a surrogate marker of endoscopic activity, and the sensitivity, specificity, and predictive value of fecal tests for mucosal healing were statistically evaluated.

Both fecal tests showed a statistically significant correlation with Mayo Endoscopic Subscore (MES) (Fcal: r = 0.678, P < .001 and FIT: r = 0.635, P < .001) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) (Fcal: r = 0.711, P < .001 and FIT: r = 0.657, P < .001). Fcal was statistically superior to FIT in predictive accuracy for endoscopic activity (area under the curve [AUC]: 0.863 vs 0.765 with MES, P < .001 and AUC; 0.847 vs 0.757 with UCEIS, P < .001). FIT was superior to Fcal in sensitivity for mucosal healing (98.0% vs 78.4% with MES, 94.9% vs 74.6% with UCEIS).

Fcal and FIT were well correlated with endoscopic activity in UC and can be surrogate markers of mucosal inflammation. Depending on mucosal status, Fcal was more accurate in predicting the endoscopic activity in active inflammation, whereas FIT was more sensitive in predicting the achievement of mucosal healing.
Risk of liver fibrosis progression in patients with suboptimal diagnosis of hepatitis C virus infection
Authors: Morales-Arraez Dalia , Nieto Bujalance Yolanda , Diaz-Flores Felicitas , de Vera Antonia , Jiménez Alejandro , Garcia Dopico Jose Antonio , Quintero Enrique , Hernández-Guerra Manuel
Published: September 2019

Objective

Many hepatitis C virus (HCV)-infected patients have a suboptimal diagnosis. Particularly, the characteristics and risk of fibrosis progression of HCV antibody-positive patients without RNA testing are unknown.

Methods

Patients with a positive HCV antibody performed during 2005–2007 were classified based on RNA request and result until January 2017. Fibrosis was estimated with serologic scores.

Results

Of the 38 246 HCV tests performed, 791 (2.01%) patients tested positive. At the end of the follow-up (median 128.6 months, range 109.8–145.9), 49.43% (n = 391) of the subjects did not have RNA testing, 13.02% (n = 103) had undetectable RNA, and 37.55% (n = 297) had detectable RNA. After excluding patients without data for AST to platelet ratio index calculation (n = 334), patients without RNA testing (n = 122) compared with RNA undetectable (n = 92) were more frequently men (68.9 versus 46.7%), alcohol (52.6 versus 38.2%) and drug (53.0 versus 39.1%) users, lacking social support (50.4 versus 29.3%), and showed higher basal fibrosis. Patients without RNA testing had a significantly higher increase in the percentage of patients with ≥F2 (P = 0.035) and cirrhosis (P = 0.022). The relative risk for ≥F2 and cirrhosis in patients without RNA testing was 3.03 [95% confidence interval (CI): 1.54–5.98] and 4.31 (95% CI: 1.42–13.10), respectively. Non-RNA request was an independent predictor factor for progression to cirrhosis.

Conclusion

In our cohort, patients with positive HCV antibody without RNA testing were more likely to be people at risk of social exclusion with an increased risk of fibrosis progression, because non-RNA request was a predictor for cirrhosis. Therefore, we urge support measures and strategies to link to care these difficult-to-treat populations.
Interobserver Agreement in Vascular Invasion Scoring and the Added Value of Immunohistochemistry for Vascular Markers to Predict Disease Relapse in Stage I Testicular Nonseminomas
Authors: Lobo João , Stoop Hans , Gillis Ad J.M. , Looijenga Leendert H.J. , Oosterhuis Wolter
Published: September 2019

Vascular invasion has been identified as an informative risk factor for relapse in stage I testicular nonseminomas, used to tailor treatment. We investigated interobserver agreement in vascular invasion reporting and studied the potential additional value of immunohistochemistry for vascular markers for predicting relapse. Patients (n=52) with stage I testicular nonseminomas undergoing surveillance (1993-2006) were included (median follow-up of 66 mo). Two formalin-fixed paraffin-embedded blocks with >1 cm2 tissue and tumor/normal parenchyma interface were stained with hematoxylin and eosin and CD31, FVIII, and D2-40. Slides were assessed by 3 independent testicular germ cell tumor-dedicated pathologists, and agreement was assessed using Cohen κ statistic. Sensitivity, specificity, and accuracy of vascular invasion scoring in predicting relapse were calculated. Agreement among testicular germ cell tumor-dedicated pathologists was moderate (κ=0.49 to 0.54), as was performance in predicting disease relapse (particularly, specificity of 86%). Immunohistochemistry increased overall sensitivity (71%), but decreased specificity (71%) in predicting relapse. All patients (n=8) with both blood and lymphatic vascular invasion developed a relapse. In multivariable analysis (including age, tumor size, rete testis invasion, and serum tumor markers), only vascular invasion had an independent impact in predicting relapse. Assessment of vascular invasion by testicular germ cell tumor-dedicated pathologists is good and is clinically meaningful, predicting disease relapse. Immunohistochemistry for vascular markers improves sensitivity of detecting disease relapse and allows for the identification of high-risk patients with both blood and lymphatic vascular invasion simultaneously, potentially of interest for tailored chemotherapy.
A New Surgical Method to Reconstruct the Fingertip
Authors: Yang Jianyun , Yu Cong , Jia Xiaotian
Published: September 2019

Background

In our previous study, we used cross finger fascial flap combined with split-thickness toe nail bed graft to reconstruct large area defect of the nail bed with distal phalanx exposure. Fingertip avulsions are common injuries to the upper extremity and cause a great deal of distress for patients. Replantation, amputation and flap coverage are considered. However, all these methods have their limitations.

Methods

Five patients with fingertip avulsions were enrolled. We used the methods mentioned above combined with the reversed pedicled island flap to covered the defects of both the dorsal and volar sides and reconstruct the fingertip.

Results

All the 5 patients were followed for at least 3 months. The blood supply of the flaps and nail bed is good. All the patients were satisfied with their new fingertips.

Conclusions

The method we introduced in this study is proved to be an effective surgical method for fingertip avulsions.