bluuebunny/crossref_metadata_2025 huggingface dataset:
Analyzing maternal mortality rate in rural China by Grey-Markov model
Authors: Wang Yawen , Shen Zhongzhou , Jiang Yu
Published: February 2019

Maternal mortality rate (MMR) in China has reduced during a decade but still higher than many countries around the world. Rural China is the key region which affects over all maternal death. This study aims to develop a suitable model in forecasting rural MMR and offer some suggestions for rural MMR intervention. Data in this study were collected through the Health Statistical Yearbook (2017) which included the overall MMR in China and urban and rural mortality rate. A basic grey model (GM(1,1)), 3 metabolic grey models (MGM), and a hybrid GM(1,1)–Markov model were presented to estimate rural MMR tendency. Average relative error (ARE), the post-test ratio (C), and small error probability (P) were adopted to evaluate models’ fitting performance while forecasting effectiveness was compared by relative error.

The MMR in rural China reduced obviously from 63.0 per 100,000 live births in 2005 to 21.1 per 100,000 live births in 2017. One basic GM(1,1) model was built to fit the rural MMR and the expression was X^((1)) (k + 1) = 553.80e^0.0947k – 550.00 (C = 0.0456, P > .99). Three MGM models expressions were X^((1)) (k + 1)  = 548.67e^0.0923k – 503.17 (C = 0.0540, P > .99), X^((1)) (k + 1) = 449.39e^0.0887k – 408.09 (C = 0.0560, P > .99), X^((1)) (k + 1) = 461.33e^0.0893k – 425.23(C = 0.0660, P > .99). Hybrid GM(1,1)–Markov model showed the best fitting performance (C = 0.0804, P > .99). The relative errors of basic GM(1,1) model and hybrid model in fitting part were 2.42% and 2.03%, respectively, while 5.35% and 2.08%, respectively, in forecasting part. The average relative errors of MGM were 2.07% in fitting part and 17.37% in forecasting part.

Data update was crucial in maintain model's effectiveness. The hybrid GM(1,1)–Markov model was better than basic GM(1,1) model in rural MMR prediction. It could be considered as a decision-making tool in rural MMR intervention.
Assessment of cholestasis in drug-induced liver injury by different methods
Authors: Xing Mindan , Zhai Lu , Li Jia , Li Qian , Gao Min , Wen Jun , Xu Zengli
Published: February 2019

Cholestasis in drug-induced liver injury (DILI) can be assessed by biochemical and pathologic methods, but the agreement between the 2 methods remains unclear.

The aim of this study was to identify the accurate method for assessment of cholestasis in DILI.

The DILI standard established and revised by the Council for International Organizations of Medical Sciences (CIOMS) (R values were calculated by liver function at different time points), cholestatic liver disease guideline (European Association for the Study of the Liver, EASL), and liver pathology were used to assess, compare, and analyze the cholestasis in 133 patients with DILI.

The R values at different time points in CIOMS standard had no statistical difference for the assessment of cholestatic DILI (a = 0.05, χ2 = 1.51, P = .679). There were statistical differences among the results of CIOMS, EASL, and pathology (a = 0.05, χ2 = 99.97, P < .001). EASL standard had no statistical difference with pathology (a = 0.003, χ2 = 8.00, P = .005).

CIOMS and EASL standards based on biochemical parameters underestimated cholestatic DILI, as compared to liver pathology.
Comparative efficacy and safety of lipid-lowering agents in patients with hypercholesterolemia
Authors: Zhao Zonglei , Du Song , Shen Shuxin , Luo Ping , Ding Shoukun , Wang Guanggong , Wang Lixia
Published: February 2019

Background:

The comparative efficacy and safety of PCSK9 inhibitors, statins, and ezetimibe to lower lipid levels in patients with hypercholesterolemia remain unknown. We aimed to investigate the benefits and harms of the lipid-lowering agents in these patients.

Methods:

PubMed, Embase, and the Cochrane Library were searched from January 1, 2000 to June 1, 2018 for relevant randomized controlled trials (RCTs). Frequentist network meta-analysis was used to pool all estimates. Ranking probabilities were used to rank the comparative effects of all drugs against placebo.

Results:

Eighty-four RCTs enrolled 246,706 patients were included. Most of the included were assessed as low risk of bias. The probabilities of PCSK9 inhibitors that ranked first in improving lipid outcomes were all 100%. The probability of statins that ranked first in reducing the risk of cardiovascular (CV) events was 60.6%, and the probability of PCSK9 inhibitor was 37.1%, while no significant difference of efficacy in reducing CV events was observed between the 2 agents (odds ratios [OR] 0.98, 95% CI 0.87–1.11). Statin ranked first in reducing all-cause and CV death. Compared with placebo, statins were associated with reduced risks of all-cause (OR 0.90, 95% CI 0.85–0.96) and CV death (OR 0.83, 95% CI 0.75–0.91) while PCSK9 inhibitors and ezetimibe were not. No agents caused adverse events (including neurocognitive events), except that statins therapy significantly increases the levels of alanine aminotransferase (ALT) (OR 1.89, 95% CI 1.42–2.51) and creatine kinase (CK) (OR 1.45, 95% CI 1.09–1.93) and the incidence of diabetes (OR 1.13, 95% CI 1.02–1.26).

Conclusions:

PCSK9 inhibitors were the most effective lipid-lowering agents in improving lipid levels. Furthermore, PCSK9 inhibitors achieved similar CV benefits like statins, while PCSK9 inhibitors were not associated with any increased risk of statin-related side-effects. Thus, PCSK9 inhibitors may also be recommended as promisingly first-line lipid-lowering treatment for patients with hypercholesterolemia, especially for these with statins intolerance or resistance.
Association of rs2910164 polymorphism in MiR-146a gene with psoriasis susceptibility
Authors: Gong Hai-bo , Zhang Shi-lei , Wu Xiu-juan , Pu Xiong-ming , Kang Xiao-jing
Published: February 2019

The rs2910164 single nucleotide polymorphism (SNP) in miR-146a has been implicated in the etiology of psoriasis in different relevant studies with contradictory conclusions and limited sample size. Therefore, the aim of this study was to undertake a systematic review and meta-analysis to estimate the association between rs2910164 SNP and psoriasis. We searched the databases of PubMed, EMBASE, Web of Science, WanFang, and Chinese National Knowledge Infrastructure (CNKI) to identify relevant literatures published before July 15, 2018. Four case–control studies including 2212 cases and 2274 healthy controls from 4 different countries met the predetermined criteria. The effect size was pooled by odds ratios (ORs) and 95% confidence intervals (95%CIs). Recessive model (CC vs CG+GG) was confirmed to be the optimal model. The results indicated that rs2910164 SNP was significantly associated with psoriasis (OR = 0.74, 95%CI 0.60–0.91, P = .004), and individuals with CC-genotype were predisposed to have decreased risk of psoriasis.
The influence of preterm birth on expressive vocabulary at the age of 36 to 41 months
Authors: Brósch-Fohraheim Nina , Fuiko Renate , Marschik Peter B. , Resch Bernhard
Published: February 2019

Children born preterm (PT) have a higher risk of language delays than children born full-term (FT). Expressive vocabulary plays a central role in language development, as later grammar ability can be predicted from earlier vocabulary size.

To determine the effects of preterm birth on expressive vocabulary at the age of 36 to 41 months.

Cross-sectional study of 27 PT (children with a gestational age of ≤ 32 + 0 weeks and/or a birth weight ≤ 1500 g) and 26 FT children (from several kindergartens in Vienna, Austria). The groups were matched regarding age, sex, and monolingual Austrian German speech. They were all examined using the active vocabulary test (AWST-R) and the development test, Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).

The AWST-R revealed significantly lower scores (46% vs 52%, P 
= .027) for PT children. The Bayley-III revealed significantly lower scores in language development (mean 96.3 ± 11.81 vs 105.1 ± 6.24, P 
= .002) and the expressive communication subscale (8.78 ± 2.01 vs 10.69 ± 1.49, P 
< .001) for PT children, but no differences in cognitive development (98.5 ± 11.08 vs 100.8 ± 6.43, P = .369) or on the receptive communication subscale (10.15 ± 2.23 vs 11.08 ± 1.09, P = .060).

Preterm children tested had less expressive vocabulary (AWST-R and Bayley-III) than those born full-term, while test results in their cognitive development and receptive communication (Bayley-III) did not differ.
An inadvertent subarachnoid injection reversed by cerebrospinal fluid lavage for the treatment of chronic low back pain
Authors: Sun Xiaodi , Liu Shijiang , Liu Cunming , Xu Jijun , Sun Jie , Pan Yinbing
Published: February 2019

Rationale:

We present a case of high spinal anesthesia after inadvertent injection of local anesthetics and corticosteroids into the subarachnoid space during attempted epidural injection. Cerebrospinal fluid (CSF) lavage is a suitable method for treatment.

Patient concerns:

A 45-year-old woman presented with posterior thigh, leg, and ankle pain for >6 months and was treated with epidural injection. Five minutes after the third time of epidural injection, the patient complained loss of sensation and muscle strength in the lower extremities and abdominal area.

Diagnoses:

A high spinal anesthesia was confirmed by the patient loss of sensation and muscle strength in the lower extremities and abdominal area.

Interventions:

CSF lavage was performed for treatment.

Outcomes:

After CSF lavage, the patient gradually returns to normal sensory and motor functions of lower limbs. On the fourth day, the patient sensed her physical function restoring gradually and was discharged uneventfully. At 4-month follow-up, the patient could have normal activities without obvious subsequent complications and any pain.

Lessons:

We conclude that CSF lavage could be a helpful maneuver to clear lidocaine and betamethasone and avoid potential nerve damage caused by an unintentional intrathecal injection during an epidural injection for the treatment of chronic low back pain.
PICC insertion in the sitting position for a patient with congestive heart failure
Authors: Mitsuda Shingo , Tokumine Joho , Matsuda Rena , Yorozu Tomoko , Asao Takayuki
Published: February 2019

Rationale:

A peripherally inserted central catheter (PICC) is typically inserted with the patient in the supine position. Here, we placed a PICC in a patient in the sitting position, in order to treat congestive heart failure.

Patient concerns:

A 65-year-old man was diagnosed with end-stage lung cancer. He had experienced septic shock and was medicated with continuous infusion of noradrenaline through a peripheral vein, in order to maintain sufficient blood pressure. However, indwelling peripheral venous catheters were difficult to place and maintain.

Diagnosis:

The patient experienced orthopnea due to congestive heart failure and could not assume any other position.

Interventions:

An anesthesiologist performed PICC placement while the patient was in the sitting position, using ultrasound guidance.

Outcomes:

The patient's orthopnea was slightly ameliorated, and he was able to sleep at night.

Lessons:

The technique of inserting a PICC in the sitting position is simple and feasible. This approach may be useful for patients in whom central venous access is needed, but the supine position cannot be achieved.
The efficacy of the traditional Chinese medicine Jia Wei Niu Bang Zi granule combined with methotrexate in treating active rheumatoid arthritis
Authors: Wang Yi-Ru , Liu Li , Wang Xiao-Yun , Wang Qiong , Yao Min , Cui Xue-jun , Mao Jian-Chun , Liu Jian , Gu Xiao-Hua , Chen Yong-Li , Yu Xiang , Shi Qi , Liang Qian-Qian , Wang Yong-Jun
Published: February 2019

Background:

Rheumatoid arthritis (RA) is a chronic systemic and autoimmune inflammatory disease ending with the destruction of joints. Current therapies can relieve RA symptoms, but some also bring severe adverse events. Therefore, an effective and safe therapeutic strategy remains to be created to benefit patients with RA by large. Jia Wei Niu Bang Zi granule (NBZG) consisting of RA-fighting Chinese herbals has been used in Longhua Hospital in the last several decades. NBZG has potential therapeutic effect on RA, which should be evaluated by larger sample clinical trial.

Methods:

A multicenter, randomized, double-blind, placebo-controlled clinical trials will be conducted to determine the efficiency of NBZG in pain relief and joint protection. A total of 120 patients with active RA will be enrolled, and treated with NBZG or placebo for 12 weeks. The primary outcome measurements include rate of American College of Rheumatology (ACR) 50 at 12 weeks’ treatment. The 2nd outcome measurements include rate change of ACR20, ACR70, the disease activity score (DAS) 28, 36-item Short-Form Health Survey Questionnaire, Health Assessment Questionnaire - Disability Index, score changes of Patient Assessment of Arthritis Pain, Patient Global Assessment of Arthritis, and the Athens insomnia scale at the same time points.

Discussion:

Although NBZG has shown efficacy in treating RA in Longhua Hospital for decades, the universality of this efficacy needs evaluated. The results of this trial will provide a convincing evidence about NBZG's efficacy in treating active RA in a large population.

Trial registration:

ClinicalTrials.gov ID: NCT03173040 (registered on May 30, 2017)
Clinical utility of miniprobe endoscopic ultrasonography for prediction of invasion depth of early gastric cancer
Authors: Luo Mingchi , Li Lifeng
Published: February 2019

Background:

Recently, some studies assessed the clinical utility of miniprobe endoscopic ultrasonography for prediction of invasion depth of early gastric cancer (GC). However, the results remain inconsistent.

Objectives:

We conducted a meta-analysis to assess the clinical utility of miniprobe endoscopic ultrasonography for diagnostic of invasion depth of early GC.

Methods:

We systematically searched several online electronic databases including PubMed, China National Knowledge Infrastructure, Web of Science, Embase, and Wanfang from initial library to July 20, 2018, identifying the study about miniprobe endoscopic ultrasonography for diagnostic of invasion depth of early GC. Bivariate mixed effects models were used to calculate the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) with theirs 95% confidence intervals (CIs).

Results:

Nineteen studies with 3401 patients were included in the meta-analysis. The bivariate mixed effect model indicated that the overall diagnostic sensitivity was 0.86 (95%CI: 0.79–0.91) and the specificity was 0.73 (95%CI: 0.66–0.78). The area under the curve was 0.84 (95%CI: 0.81–0.87). We also estimated the other pooled parameters as follows: the pooled PLR was 3.13 (95%CI: 2.55–3.84), the pooled NLR was 0.19 (95%CI: 0.13–0.28), the diagnostic score was 2.78 (95%CI: 2.33–3.23), and the diagnostic odds ratio was 16.1 (95%CI: 10.23–25.36). Subgroup analysis indicated that ethnicity may be the decisive factor on heterogeneity.

Conclusions:

The present study indicated that the miniprobe endoscopic ultrasonography had a moderate diagnostic ability for invasion depth of early GC. The diagnostic utility was influenced by ethnicity. Further research is required to confirm the present findings and explore the potential factors of heterogeneity.
Current Status of helicopter emergency medical services in China
Authors: Xu Ding , Luo Peng , Li Sheng , Pfeifer Roman , Hildebrand Frank , Pape Hans-Christoph
Published: February 2019

Background:

After nearly 20 years of development, China has realized some achievements in helicopter emergency medical services (HEMS). The purpose of this article is to introduce and evaluate the development and characteristics of HEMS in China by collecting and analyzing relevant literature and, in so doing, help this vital service to further develop.

Method:

We conducted a Pubmed, Medline, Embase, ScienceDirect, Wanfang, CNKI, and VIP search of the literature on HEMS of China published between January 1950 and April 2017. The title, author name, number of authors, publishing date, country or region of origin, institution, type of article, study topic, funding source, and level of evidence of each article were recorded and analyzed.

Results:

There were 41 papers included in the analysis. All articles were published in Chinese. The selected articles were published between 2002 and 2017. The 41 articles originated from China, but 7 different regions were represented: East China (n = 14), followed by North China (n = 12), Central China (n = 8), Southwest China (n = 3), South China (n = 2), and Northwest China (n = 2). The articles included 18 clinical studies, 12 reviews, and 11 clinical guidelines. Among these, 22 articles were from public hospitals; 18 were from military units and 1 came from a private hospital. One article from the public hospitals was funded by public foundations (4.5%); 11 articles from the army units received support from Army funding (61.1%). Compared with the public and private hospitals, articles from military units were more likely to receive financial support (χ2 = 15.7 P <.01). All the articles were assigned a level of evidence from 1 to 5. Level 5 (78.0%) was the most frequent level of evidence. There were 7 studies at level 4. Only 2 articles were assigned to level 3. There were no articles at levels 1 or 2.

Conclusions:

China's HEMS is a relatively new service. Its level of development is low, interregional development is uneven, and cooperation has been insufficient. We need to strengthen capital investment and develop a unified guideline to further enhance the development of HEMS in China.
Comparison of the effectiveness of different umbilical cord care in infants
Authors: Shang Yi , Sun Yue
Published: February 2019

Background:

More and more studies were performed to explore the effectiveness of umbilical cord care practices. However, the results remain controversial. Hence, the aim of the review was to evaluate and compare the effectiveness of different umbilical cord care in infants through network meta-analysis.

Methods:

A systematic literature search for relevant articles published in the English language will be conducted in PubMed, EMBASE, the Cochrane library, and Chinese Biomedical Literature Database from their inception to December 2018. Randomized controlled trials (RCTs) that compared the effectiveness of different types of umbilical cord care practices will be included. Cord infection, illness, and death will be used to assess the clinical effect. Risk of bias assessment of the included RCTs will be conducted by the Cochrane risk of bias tool. The WinBUGS 1.4.3 software will be used to perform the network meta-analysis and the result figures will be generated by STATA V.15.0 software. Grading of recommendations assessment, development, and evaluation will be used to assess the quality of evidence.

Results:

The results will be published in a peer-reviewed journal.

Conclusion:

This will be the first network meta-analysis to evaluate and compare the effectiveness of different umbilical cord care in infants. Our study will generate evidence of cord care for infants and provide suggestions for clinical practice or guideline.

PROSPERO registration number:

CRD42018118052.
Somatosensory stimulation treatments for postoperative analgesia of mixed hemorrhoids
Authors: Zhang An-Mei , Chen Min , Tang Tai-Chun , Qin Di , Yue Ling , Zheng Hui
Published: February 2019

Background:

Pain after hemorrhoidal surgery bothers both clinicians and patients. Somatosensory stimulation treatments have shown promising effect on the pain after hemorrhoidal surgery, but the comparative effectiveness between them has not been studied. We aim to determine the relative effectiveness among these treatments on pain relief after hemorrhoidal surgery by using network meta-analysis.

Method:

We will search the following electronic databases: MEDLINE, EMBASE, the Cochrane library, Chinese Biomedicine database (CBM), China National Knowledge Infrastructure (CNKI). We will include randomized controlled trials (RCTs) that examine the effect of somatosensory stimulation treatments on pain after hemorrhoidal surgery. The primary outcome will be the responder rate after treatment. The secondary outcomes will include the assessments with pain intensity scales (visual analog scale, numeric rating scale, or other scales) on day 1 to 7 after surgery. Two independent reviewers will extract needed information from eligible trials using standardized electronic forms. Network meta-analysis will be performed using a frequentist framework based on electrical network theory. The relative effectiveness of the treatments will be ranked by using P score, which is the mean probability of a treatment ranking the best in all treatments. Meta-regression will be performed to assess the impact of surgery type, anesthesia methods, and funding source on the treatment ranking. The quality of the eligible RCTs will be evaluated by the Cochrane risk of bias tool.

Ethics and dissemination:

The result of this network meta-analysis will clarify which is the relatively best somatosensory-stimulation treatment in relieving postoperative pain caused by hemorrhoidal surgery, and the review will, therefore, guide the management of postoperative pain after hemorrhoidal surgery for clinicians and patients. This review does not require ethical approval and will be reported in a peer-reviewed journal.

Trial registration number:

PROSPERO CRD42018115558.
Review: Acute superior mesenteric artery embolism
Authors: Liao Guanyi , Chen Siyang , Cao Haoyang , Wang Wuwan , Gao Qing
Published: February 2019

Background:

Acute mesenteric ischemia (AMI) is a life-threatening medical condition that occurs when a sudden decreased perfusion to the intestines which leads to bowel infarction, and acute superior mesenteric artery embolism (ASMAE) is the main cause of AMI. Unfortunately, with the improvement of diagnosis and treatment technology, the mortality remains high due to less frequent clinical suspicion resulted from the unclear clinical manifestation and non-specific laboratory findings.

Methods:

Relevant studies published were identified by searching the PubMed, Embase and Cochrane Library databases. This review presented the literatures to introduce the research progress of ASMAE in recent years.

Results:

Patients with the history of atrial fibrillation, heart valve disease and atherosclerosis should be considered as ASMAE. Laboratory findings are insensitive and unspecific, however, angiography and Computed tomography angiography (CTA) can provide a clear diagnosis sensitively and specifically. Endovascular approaches have been increasingly reported in multiple case series. The key to successful treatment of AMI involves early clinical recognition and early intervention to move the embolus, which can reduce the rate of misdiagnosis and save the precious time and lives of patients.

Conclusions:

Loss of time eventually leads to progression of ischemia to transmural bowel necrosis with peritonitis and septicemia, which may further worsen patients’ outcomes. It is important for physicians to make a timely and accurate diagnosis, which can save precious time and reduce the mortality.
Long-term adjuvant imatinib treatment for a patient who underwent complete resection of a localized recurrent gastrointestinal stromal tumor after preoperative imatinib treatment
Authors: Tjhoi Welda E.H. , Li Kai , Shou Chun-hui , Yang Wei-li , Yu Ji-ren
Published: February 2019

Rationale:

The efficiency and tolerance of long-term adjuvant imatinib treatment for patient who underwent complete resection of a localized recurrent gastrointestinal stromal tumor (GIST) was unknown.

Patient concerns:

A 45-year-old man underwent complete resection of an intestinal GIST in August 2001. Four years later, a giant (11 × 8 × 6 cm) recurrent GIST located in the retroperitoneum was detected.

Diagnosis:

The recurrent tumor was positive for CD117 by immunohistochemistry.

Interventions:

The recurrent tumor was completely resected after 4 months of effective imatinib treatment (400 mg/day), and the patient continued imatinib treatment postoperatively. In June 2011, imatinib treatment was stopped for 3 weeks because of hepatitis B infection, and resumed with a reduced dose level of 300 mg/day when liver function recovered. In March 2017, imatinib treatment was interrupted again for 12 days because the patient underwent cholecystectomy.

Outcomes:

In December 2017, a computed tomography scan showed no signs of tumor recurrence. To date, the patient has been under adjuvant imatinib treatment for >12 years without severe side effects. The plasma concentration of imatinib (detected in February 2018) was trough concentration (Cmin) 1015.7 ng/mL and peak concentration (Cmax) 1550.5 ng/mL.

Lessons:

This case report highlights the active role of long-term (>12 years) imatinib treatment after complete resection of localized recurrent GIST.
Combination of S100B and procalcitonin improves prognostic performance compared to either alone in patients with cardiac arrest
Authors: Jang Jae Ho , Park Won Bin , Lim Yong Su , Choi Jea Yeon , Cho Jin Seong , Woo Jae-Hyug , Choi Woo Sung , Yang Hyuk Jun , Hyun Sung Youl
Published: February 2019

This study aimed to determine whether the combination of procalcitonin (PCT) and S100B improves prognostic performance compared to either alone in cardiac arrest (CA) patients treated with targeted temperature management (TTM).

We performed a prospective cohort study of CA patients treated with TTM. PCT and S100B levels were obtained at 0, 24, 48, and 72 hours after return of spontaneous circulation. The prognostic performance was analyzed using each marker and the combination of the 2 markers for predicting poor neurological outcome at 3 months and mortality at 14 days and 3 months.

A total of 97 patients were enrolled, of which 67 (69.1%) had poor neurological outcome. S100B showed a better prognostic performance (area under the curve [AUC], 0.934; sensitivity, 77.6%; and specificity, 100%) than PCT (AUC, 0.861; sensitivity, 70.2%; and specificity, 83.3%) with the highest prognostic value at 24 hours. The combination of 24-hour PCT and S100B values (S100B ≥0.2 μg/L or PCT ≥6.6 ng/mL) improved sensitivity (85.07%) compared with S100B alone. In multivariate analysis, PCT was associated with mortality at 14 days (odds ratio [OR]: 1.064, 95% confidence interval [CI]: 1.014–1.118), whereas S100B was associated with neurological outcomes at 3 months (OR: 9.849, 95% CI: 2.089–46.431).

The combination of PCT and S100B improved prognostic performance compared to the use of either biomarker alone in CA patient treated with TTM. Further studies that will identify the optimal cutoff values for these biomarkers must be conducted.
Effect of Gabapentin on Sexual Function in Vulvodynia: A Randomized, Placebo-controlled Trial
Authors: Bachmann Gloria A. , Brown Candace S. , Phillips Nancy A. , Rawlinson Leslie A. , Yu Xinhua , Wood Ronald , Foster David C.
Published: February 2019

(Abstracted from Am J Obstet Gynecol 2019;220:89.e1–89.e8)

Vulvodynia is a chronic pain syndrome characterized by symptoms such as stinging, burning, irritation, or itching of the vulva. Women with vulvodynia experience deficits across all aspects of sexual function.
Surgery Is Not Superior to Dilation for the Management of Vaginal Agenesis in Mayer-Rokitansky-Küster-Hauser Syndrome: A Multicenter Comparative Observational Study in 131 Patients
Authors: Cheikhelard Alaa , Bidet Maud , Baptiste Amandine , Viaud Magali , Fagot Christine , Khen-Dunlop Naziha , Louis-Sylvestre Christine , Sarnacki Sabine , Touraine Philippe , Elie Caroline , Aigrain Yves , Polak Michel
Published: February 2019

(Abstracted from Am J Obstet Gynecol 2018;219:281.e1–281.e9)

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital condition characterized by vaginal agenesis, which impairs sexuality and has a negative impact on quality of life (QOL). Classic management of this condition is to create a cavity allowing satisfying painless penetrative intercourse.
Proteomics and Metabolomics in Pregnancy—An Overview
Authors: Vora Niraj , Kalagiri Ram , Mallett Lea H. , Oh Jin Ho , Wajid Umaima , Munir Saef , Colon Natalie , Raju Venkata Nakta , Beeram Madhava R. , Nasir Uddin M.
Published: February 2019

Importance

Pregnancy is getting more and more complex due to increasing number of complications that may affect fetal outcomes. The introduction of newer “proteomics and metabolomics” technologies in the field of obstetrics and gynecology may allow physicians to identify possible associated etiologies that affect the mother during pregnancy and lead to associated complications affecting the offspring.

Objective

The principal objective of this review article is to provide a comprehensive evaluation of the use of proteomics and metabolomics in complicated pregnancies. Future studies that incorporate data from multiple technologies may allow the development of an integrated biological system approach to maternal genomes, proteomes, and metabolomes in pregnancy.

Evidence Acquisition and Results

We conducted a substantial MEDLINE, EBSCOhost, and Cochrane database search for all the relevant articles containing use of “omics” technologies in pregnancy. We identified 197 relevant articles, following standardized systematic review process along with grading systems; 69 eligible articles were identified.

Conclusion/Relevance

We sought to provide a comprehensive review in this emerging field of “omics” in pregnancy and associated complications. This article focuses mainly on use of proteomics and metabolomics identification techniques and possible interventions for early pregnancy complications to improve neonatal outcomes.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After completing this activity, the learner should be better able to describe the various complications of pregnancy and their outcomes; assess current available techniques and modalities involving proteomics and metabolomics; and evaluate and provide a comprehensive review of the use of proteomics and metabolomic techniques in various complications of pregnancy.
Evaluation of Comprehensive Chromosome Screening Platforms for the Detection of Mosaic Segmental Aneuploidy
Authors: Goodrich David , Xing Tongji , Tao Xin , Lonczak Agnieszka , Zhan Yiping , Landis Jessica , Zimmerman Rebekah , Scott Richard T. , Treff Nathan R.
Published: February 2019

(Abstracted from J Assist Reprod Genet 2017;34:975–981)

Advancements in the efficacy of comprehensive chromosomal screening (CCS), namely, the ability to detect aneuploidy in all 24 human chromosomes, have established it as a cornerstone of infertility care. Recently, the development of high-throughput, massively parallel sequencing for use with CCS has led to highly accurate, simultaneous screening of multiple samples.
Effect of Oxygen vs Room Air on Intrauterine Fetal Resuscitation: A Randomized Noninferiority Clinical Trial
Authors: Raghuraman Nandini , Wan Leping , Temming Lorene A. , Woolfolk Candice , Macones George A. , Tuuli Methodius G. , Cahill Alison G.
Published: February 2019

(Abstracted from JAMA Pediatr 2018;172(9):818–823)

Category II fetal heart tracings are defined by the National Institute of Child Health and Human Development as a broad class of electronic fetal monitoring observed in more than 80% of laboring patients. This categorization does not necessarily predict neonatal acidemia, but the presence of category II fetal heart tracings often results in intrauterine resuscitation efforts aimed at improving fetal oxygenation.
Smooth Muscle Tumors of the Visceral Adnexal and Uterine Ligaments and Adnexal Connective Tissue: A Clinicopathologic Study of 67 Cases
Authors: Patel Vatsal , Xing Deyin , Feely Michael , Schoolmeester John Kenneth
Published: February 2019

The endopelvic fascia is a biomechanical network of supportive tissue that suspends and secures the female reproductive organs to the pelvic sidewall. Several visceral adnexal and uterine ligaments are part of this framework, and we have observed that smooth muscle tumors (SMTs) arising from these structures morphologically resemble gynecologic smooth muscle neoplasms. To determine whether gynecologic smooth muscle tumor criteria for malignancy are valid in these tumors, we evaluated the morphologic features of 67 tumors from 67 patients and correlated our findings with patient outcome. Using current uterine SMT WHO definitions, 57 tumors (85%) were classified as leiomyoma, 2 (3%) as smooth muscle tumor of uncertain malignant potential (STUMP), and 8 (12%) as leiomyosarcoma. Clinical follow-up was available for 88% of patients (range: 1–296 mo, mean: 174 mo, median: 79 mo). Only 1 case of leiomyosarcoma had metastasis at time of presentation, but 6 of 8 (75%) patients eventually died of disease. The other 2 cases of leiomyosarcoma that have not recurred are 11 and 16 mo from initial diagnosis. No cases of STUMP or leiomyoma recurred. On the basis of morphologic features and patient outcome, we believe these tumors distribute into similar categories of leiomyoma, STUMP and leiomyosarcoma, paralleling the biologic potential of uterine SMTs as well as SMTs of other gynecologic sites. We propose use of uterine WHO SMT criteria to classify spindled SMTs that arise in the visceral adnexal and uterine ligaments and adnexal connective tissue.
Pathologic Changes in Uterine Leiomyomas After Extended Treatment With Ulipristal Acetate
Authors: Chang Martin C. , Latta Eleanor
Published: February 2019

Ulipristal acetate is a selective progesterone receptor modulator that acts on progesterone receptors in uterine muscle and endometrium. It is effective in reducing the size of uterine leiomyomas (fibroids) and in managing associated menorrhagia. Although ulipristal acetate–associated pathologic changes have been previously documented in the endometrium, it is unclear what morphology can be expected in posttreatment fibroids. We herein report 2 cases in which patients underwent hysterectomy, after at least two 3-mo courses of ulipristal acetate. The fibroids demonstrated some pathologic changes that have previously been described associated with gonadotropin-releasing hormone agonist treatment and other progestogens. In addition, both cases demonstrated plexiform/“patchwork” fibrosis and vascular medial myxoid degeneration. Mitotic activity was absent; however, the presence of ischemic necrosis and mild nuclear atypia may mimic a more aggressive neoplasm in some areas. Awareness of these histopathologic patterns is important in the setting of ulipristal acetate treatment, to avoid over-diagnosis of “uncertain malignant potential” or malignant smooth muscle tumors.
Long-term Comparison of Recurrence Rates Between Different Lightweight and Heavyweight Meshes in Open Anterior Mesh Inguinal Hernia Repair
Authors: Melkemichel Maria , Bringman Sven Anders Wilhelm , Widhe Björn Otto Ola
Published: February 2019

Objective:

To compare the reoperation rate for recurrence of different lightweight to heavyweight meshes after an open anterior mesh (OAM) inguinal hernia repair.

Summary Background Data:

Lightweight meshes have shown benefits compared with heavyweight meshes in terms of accelerated recovery after surgery with less postoperative pain. The use of such meshes may, however, be associated with an increase in hernia recurrence. Studies of large cohorts with long-term follow-up regarding recurrence are lacking.

Methods:

All OAM groin hernia repairs registered in The Swedish Hernia Register between January 1, 2005 and December 31, 2013 were eligible. Follow-up time was until June 30, 2016. Four groups of meshes were included: polypropylene (PP) heavyweight meshes >50 g/m2 (HWM), regular lightweight PP meshes <50 g/m2 (regular LWM-PP), lightweight PP mesh with absorbable poliglecaprone-25(LWM-PP/PGC), or polyglactin-910(LWM-PP/PG). Primary endpoint was reoperation for recurrence.

Results:

76,495 OAM inguinal hernia repairs in male patients were included for statistical analysis. 1676 repairs were reoperated for recurrence. Multivariate analysis demonstrated no significant difference of risk for recurrence between HWM and regular LWM-PP (HR 1.12, P = 0.13). LWM-PP/PGC (HR 1.42, P < 0.001) and LWM-PP/PG (HR 2.05, P < 0.001) resulted in a significant increased risk compared with HWM. Larger hernia defects, direct hernias, and recurrent hernias were associated with an increased risk of reoperation for recurrence.

Conclusions:

Although lightweight meshes with partially absorbable component resulted in an increased risk of recurrence, there was no difference between regular LWM-PP and HWM. Considering that regular LWM-PP has less associated side effects there are no benefits of using HWM in OAM inguinal hernia repair.
Is understanding the structure-function of microbial community of sludge suitable using DNA-based molecular methods?
Authors: Wang Ping , Wang Zhen , Ma Jing
Published: February 2019

Analysis the similarities between total and active microbial community is crucial to evaluate whether understanding the structure-function of microbial community of different types sludge is suitable using DNA-based molecular methods. In this study, procaryotic communities in different types sludge samples (including primary sludge, excess sludge, mixed sludge, and digested sludge) were evaluated using DNA-based and RNA-based Illumina MiSeq. Results showed that the similarities between total and active procaryotic communities of all different types sludge were considerable high. Meanwhile, the similarity in running sludge higher than that in idle sludge, because of the Jarccard’s coefficient of digested sludge was the highest in all types sludge samples. This study indicates that the DNA-based molecular biology technology could be applicable to profile procaryotic community structure and function in sludge samples, and this study adds the understanding of total and active procaryotic communities of sludge samples.
MS.liverK: an R package for transcriptome-based computation of molecular subtypes and functional signatures in liver cancer
Authors: Petitprez Florent , Meunier Léa , Letouzé Eric , Hoshida Yujin , Villanueva Augusto , Llovet Josep , Thorgeirsson Snorri , Wang Xin Wei , Fridman Wolf H , Zucman-Rossi Jessica , de Reyniès Aurélien
Published: February 2019

Liver cancer is a highly heterogeneous disease in terms of etiology, tissue and cellular morphology, tumor molecular characteristics, microenvironment composition and prognosis. Several studies, based on tumor gene-expression profiling (GEP) data, have dissected the molecular heterogeneity of liver cancer. They resulted in various tools, either delineating homogeneous tumor subtypes or calculating molecular scores of prognostic or biological functions. Here, we present MS.liverK, an easy-to-use R package providing a comprehensive implementation of these tools, for research use.

Availability and implementation

The MS.liverK R package is available from GitHub (https://github.com/cit-bioinfo/MS.liverK).
A cross-species assessment of behavioral flexibility in compulsive disorders
Authors: Benzina Nabil , N’Diaye Karim , Pelissolo Antoine , Mallet Luc , Burguière Eric
Published: February 2019

Background

Compulsive behaviors, one of the core symptoms of Obsessive-Compulsive Disorder (OCD), are defined as repetitive behaviors performed through rigid rituals. The lack of behavioral flexibility has been as being one of the primary causes of compulsions, but studies exploring this dimension have shown inconsistencies in different tasks performed in human and animal models of compulsive behavior. The aim of this study was so to assess the involvement of behavioral flexibility in compulsion, with a similar approach across different species sharing a common symptom of compulsivity.

Methods

40 OCD patients, 40 healthy individually matched control subjects, 26 C57BL/6J Sapap3 KO mice and 26 matched wildtype littermates were included in this study. A similar reversal learning task was designed to assess behavioral flexibility in parallel in these two species.

Results

When considered as homogeneous groups, OCD patients and KO mice expressing compulsive behaviors did not significantly differ from their controls regarding behavioral flexibility. When clinical subtypes were considered, only patients exhibiting checking compulsions were impaired with more trials needed to reach the reversal criterion. In KO mice, a similarly impaired subgroup was identified. For both species, this impairment did not result in a greater perseveration after reversal, but in a greater lability in their responses in the reversal condition. Moreover, this impairment did not correlate with the severity of compulsive behaviors.

Conclusions

In our cross-species study, we found no consistent link between compulsive behaviors and a lack of behavioral flexibility. However, we showed in both species that the compulsive group was heterogeneous in term of performance in our reversal learning task. Among the compulsive subjects, we identified a subgroup with impaired performance not due to perseverative and rigid behaviors as commonly hypothesized, but rather to an increase in response lability.
Recent adverse mortality trends in Scotland: comparison with other high-income countries
Authors: Fenton Lynda , Minton Jon , Ramsay Julie , Kaye-Bardgett Maria , Fischbacher Colin , Wyper Grant MA , McCartney Gerry
Published: February 2019

Objective

Gains in life expectancy have faltered in several high-income countries in recent years. We aim to compare life expectancy trends in Scotland to those seen internationally, and to assess the timing of any recent changes in mortality trends for Scotland.

Setting

Austria, Croatia, Czech Republic, Denmark, England & Wales, Estonia, France, Germany, Hungary, Iceland, Israel, Japan, Korea, Latvia, Lithuania, Netherlands, Northern Ireland, Poland, Scotland, Slovakia, Spain, Sweden, Switzerland, USA.

Methods

We used life expectancy data from the Human Mortality Database (HMD) to calculate the mean annual life expectancy change for 24 high-income countries over five-year periods from 1992 to 2016, and the change for Scotland for five-year periods from 1857 to 2016. One- and two-break segmented regression models were applied to mortality data from National Records of Scotland (NRS) to identify turning points in age-standardised mortality trends between 1990 and 2018.

Results

In 2012-2016 life expectancies in Scotland increased by 2.5 weeks/year for females and 4.5 weeks/year for males, the smallest gains of any period since the early 1970s. The improvements in life expectancy in 2012-2016 were smallest among females (<2.0 weeks/year) in Northern Ireland, Iceland, England & Wales and the USA and among males (<5.0 weeks/year) in Iceland, USA, England & Wales and Scotland. Japan, Korea, and countries of Eastern Europe have seen substantial gains in the same period. The best estimate of when mortality rates changed to a slower rate of improvement in Scotland was the year to 2012 Q4 for males and the year to 2014 Q2 for females.

Conclusion

Life expectancy improvement has stalled across many, but not all, high income countries. The recent change in the mortality trend in Scotland occurred within the period 2012-2014. Further research is required to understand these trends, but governments must also take timely action on plausible contributors.

Strengths and limitations of this study

The use of five-year time periods for comparison of life expectancy changes reduces the influence of year-to-year variation on observations.

Examining long-term trends addresses concerns that recent life expectancy stalling may be over-emphasised due to notably large gains in the immediately preceding period.

The international comparison was limited to the 24 high-income countries for which data were readily available for the relevant period.

Analysis of trend data will always be sensitive to the period selected, however segmented regression of the full period of mortality rates available offers an objective method of identifying the timing of a change in trend.
Cohesin-mediated genome architecture does not define DNA replication timing domains
Authors: Oldach Phoebe , Nieduszynski Conrad A
Published: February 2019

3D genome organization is strongly predictive of DNA replication timing in mammalian cells. This work tested the extent to which loop-based genome architecture acts as a regulatory unit of replication timing by using an auxin-inducible system for acute cohesin ablation. Cohesin ablation in a population of cells in asynchronous culture was shown not to disrupt patterns of replication timing as assayed by replication sequencing (RepliSeq) or BrdU-focus microscopy. Furthermore, cohesin ablation prior to S phase entry in synchronized cells was similarly shown to not impact replication timing patterns. These results suggest that cohesin-mediated genome architecture is not required for the execution of replication timing patterns in S phase, nor for the establishment of replication timing domains in G1.
Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana
Authors: Musah Yahaya , Ameade Evans P. K. , Attuquayefio Daniel Korley , Holbech Lars Haubye
Published: February 2019

Background
Worldwide, snakebite envenomations total ~2.7 million reported cases annually with ~100,000 fatalities. Since 2009, snakebite envenomation has been classified as a very important ‘neglected tropical disease’ by the World Health Organisation. Despite this emerging awareness, limited efforts have been geared towards addressing the serious public health implications of snakebites, particularly in sub-Saharan Africa, where baseline epidemiological data remain incomplete. Due to poverty as well as limited infrastructure and public health facilities, people in rural Africa, including Ghana, often have no other choice than to seek treatment from traditional medical practitioners (TMP). The African ‘snakebite crisis’ is highlighted here using extensive complementary data from a community-based epidemiological study conducted by snake ecologists in the savanna zone of northern Ghana.

Methodology and findings
Our cross-sectional study included 1,000 residents and 24 TMPs in the Savelugu-Nanton District in northern Ghana between December 2008 and May 2009, and a 10-year (1999-2008) retrospective snakebite data from the district hospital. Variables tested included demography, human activity patterns, seasonality, snake ecology and clinical reports. Complementary data showed higher snakebite prevalence during the rainy season, and a hump-shaped correlation between rainfall intensity and snakebite incidences. Almost 6% of respondents had experienced a personal snakebite, whereas ~60% of respondents had witnessed a total of 799 snakebite cases. Out of a total of 857 reported snakebite cases, 24 (~2.8%) died. Highest snakebite prevalence was recorded for males in the age group 15-44 years during farming activities, with most bites occurring in the leg/foot region. Highest snakebite rate was within farmlands, most frequently caused by the Carpet viper (Echis ocellatus).

Conclusion
The relatively high community-based prevalence rate of ~6%, and fatality rate of ~3%, indicate that snakebites represent an important public health risk in northern Ghana. Based on the high number of respondents and long recording period, we believe these data truly reflect the general situation in rural Ghana and West Africa at large. We recommend increased efforts from both local and international health authorities to address the current snakebite health crisis generally compromising livelihoods and productivity of rural farming communities in West Africa.