bluuebunny/crossref_metadata_2025 huggingface dataset:
Awake Neonatal Extracorporeal Membrane Oxygenation
Authors: Costa Joanna , Dirnberger Daniel R. , Froehlich Curtis D. , Beaty Christopher D. , Priest Marc A. , Ogino Mark T.
Published: July 2019

Extracorporeal membrane oxygenation (ECMO) is used in patients with acute respiratory failure that is not responsive to conventional management. The practice of awake ECMO has become an area of interest but with limited data and experience. Most reported experience comes from adult and pediatric populations. Traditional management of these patients still includes mechanical ventilator support and often requires the use of sedatives for provision of safe care. We present a series of eight neonates who were electively extubated while on ECMO, with expanded discussion of two representative cases. We discuss the rationale for extubation and outcomes. The greatest benefit of this management was seen in patients with significant air leak, and in no reported case did we experience any adverse effects or complications as a direct result of extubation while on ECMO. In conclusion, in our experience, awake neonatal ECMO appears safe and effective and may offer significant advantages over traditional management in certain clinical scenarios. Prospective comparison trials are warranted to further investigate the clinical benefits and risks of awake neonatal ECMO.
Blood Recirculation Enhances Oxygenation Efficiency of Artificial Lungs
Authors: Madhani Shalv P. , May Alexandra G. , Frankowski Brian J. , Burgreen Greg W. , Federspiel William J.
Published: July 2019

Ambulating patients on extracorporeal membrane oxygenation (ECMO) or extracorporeal CO2 removal (ECCO2R) improves outcomes. These systems would further simplify ambulation if made more compact. This study investigates blood recirculation to decrease device size by increasing efficiency. The required hollow fiber membrane (HFM) area was determined by numerically modeling gas transfer. An oxygenation device with recirculating blood flow was designed using computational fluid dynamics (CFD). Hydrodynamic performance and shear stresses of the device were analyzed using CFD at 2,000, 2,250 and 2,500 RPM. A prototype (0.38 m2) was manufactured for in-vitro oxygenation testing. Oxygenation was measured at a constant 3.5 L/min blood flow while recirculation flow rate varied up to 6.5 L/min. Hemolysis was measured at 3.5 L/min blood flow and 6.5 L/min recirculation flow. A 0.3 m2 prototype device was used to test in-vitro ECCO2R recirculation at a constant 500 ml/min blood flow rate and recirculation flow rates up to 5.5 L/min. Computational fluid dynamics analysis showed that the oxygenation device could produce over 250 mm Hg while maintaining 3.5 L/min blood flow and 6.5 L/min recirculation flow. The model predicted oxygenation within 8% and overestimated ECCO2R by up to 32%. Measured gas transfer was 180 ml O2/min and 62 ml CO2/min. Normalized index of hemolysis contribution of the HFM was 0.012 gm/100 L.
Neurodevelopmental Outcomes in Extracorporeal Membrane Oxygenation Patients: A Pilot Study
Authors: Dhar Archana V. , Scott Stacey , Anton-Martin Pilar , Tweed Jefferson , Morris Mary Ann , Modem Vinai , Raman Lakshmi , Golla Sailaja
Published: July 2019

In this pilot study, we evaluated the long-term neurodevelopmental outcomes in neonatal and pediatric patients supported by extracorporeal membrane oxygenation (ECMO) and aimed to identify the role of post-ECMO magnetic resonance imaging (MRI) in predicting neurodevelopmental outcomes. Twenty-nine patients were evaluated using the Ages and Stages Questionnaire, Third Edition (ASQ-3) screening tool. Thirteen were evaluated during their visit at the neurodevelopmental clinic and 16 were interviewed via phone. We also reviewed the post-ECMO MRI brain of these patients and scored the severity of their injury based on the neuroimaging findings. In our cohort of 29 patients, 10 patients (34%) had developmental delay. Of those with developmental delay, 80% were newborns. Sixty-seven percent of patients with developmental delay had moderate to severe MRI abnormalities as compared with only 18% with no developmental deficits (p = 0.03). The younger the age at the time of placement on ECMO, the higher the chances of impaired neurodevelopmental outcome. Long-term follow-up of patients who have survived ECMO, with standardized neuropsychologic testing and post-ECMO imaging, should become the standard of care to improve long-term outcomes. Significant abnormalities on brain MRIs done before discharge correlated with developmental delay on follow-up.
Venoarterial Extracorporeal Membrane Oxygenation With Concomitant Impella Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock
Authors: Vallabhajosyula Saraschandra , O’Horo John C. , Antharam Phanindra , Ananthaneni Sindhura , Vallabhajosyula Saarwaani , Stulak John M. , Dunlay Shannon M. , Holmes David R. , Barsness Gregory W.
Published: July 2019

There are contrasting data on concomitant Impella device in cardiogenic shock patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO) (ECPELLA). This study sought to compare early mortality in patients with cardiogenic shock treated with ECPELLA in comparison to VA ECMO alone. We reviewed the published literature from 2000 to 2018 for randomized, cohort, case-control, and case series studies evaluating adult patients requiring VA ECMO for cardiogenic shock. Five retrospective observational studies, representing 425 patients, were included. Venoarterial extracorporeal membrane oxygenation with concomitant Impella strategy was used in 27% of the patients. Median age across studies varied between 51 and 63 years with 59–88% patients being male. Use of ECPELLA was associated with higher weaning from VA ECMO and bridging to permanent ventricular assist device or cardiac transplant in three and four studies, respectively. The studies showed moderate heterogeneity with possible publication bias. The two studies that accounted for differences in baseline characteristics between treatment groups reported lower 30 day mortality with ECPELLA versus VA ECMO. The remaining three studies did not adjust for potential confounding and were at high risk for selection bias. In conclusion, ECPELLA is being increasingly used as a strategy in patients with cardiogenic shock. Additional large, high-quality studies are needed to evaluate clinical outcomes with ECPELLA.
Hemodynamic Performance and Outcomes of Mosaic Valve for Aortic Stenosis with Decreased Left Ventricular Function: Results from J-MOVE Study
Authors: Fukunaga Naoto , Okita Yutaka , Yaku Hitoshi , Kobayashi Junjiro , Uesugi Hideyuki , Takanashi Shuichiro , Ito Toshiaki , Nakao Tatsuya , Sakaguchi Taichi , Yamamoto Kouji , Yoshikawa Yasushi , Sawa Yoshiki , Koyama Tadaaki
Published: July 2019

We evaluated impact of a small-sized Mosaic porcine bioprosthesis on hemodynamic performance and outcomes in patients with aortic stenosis (AS) and low left ventricular ejection fraction (LVEF) in a Japan multicenter cohort. Of 1,202 patients enrolled, 105 (8.7%) who had LVEF < 50% and AS underwent aortic valve replacement (AVR). Fifty-two patients received Mosaic porcine bioprosthesis ≤ 21 mm (S-AVR), and 53 received a bioprosthesis ≥ 23 mm (L-AVR). The median follow-up period was 3.1 [1.2, 5.1] years. At 5 years, LVEF significantly improved from median 41.2 [33.8, 45.9]% to 64.2 [49.8, 72.5]% in S-AVR (p < 0.001) and from median 43.2 [37.3, 46.8]% to 61.2 [47.2, 68.0]% in L-AVR (p < 0.001). The left ventricular mass index significantly decreased from median 158.4 [122.2, 194.9] to 110.0 [83.6, 129.4] gm/m2 in S-AVR (p < 0.001) and from median 169.8 [132.2, 203.6] to 109.6 [101.8, 132.4] gm/m2 in L-AVR (p < 0.001). There were no significant differences between S-AVR and L-AVR groups regarding freedom from cardiac death (93.1 ± 3.9% vs. 96.2 ± 3.8%; p = 0.119) and valve-related death (97.6 ± 2.4% vs. 100.0 ± 0.0%; p = 0.953). Clinical outcomes and improved hemodynamic performance were similar in both groups.
Impact of Durable Ventricular Assist Device Support on Outcomes of Patients with Congenital Heart Disease Waiting for Heart Transplant
Authors: Cedars Ari , Tecson Kristen M. , Zaidi Ali N. , Lorts Angela , McCullough Peter A.
Published: July 2019

The number of congenital heart disease (CHD) patients with heart failure is expanding. These patients have a high probability of dying while awaiting heart transplant. The potential for durable ventricular assist devices (VAD) to improve waiting list survival in CHD is unknown. We conducted an analysis of the Scientific Registry of Transplant Recipients database for the primary outcome of death or delisting due to clinical worsening while listed for heart transplant. We compared CHD patients with non-CHD patients matched for listing status. Multivariable models were constructed to account for confounding variables. Congenital heart disease patients were less likely to have a VAD and were more likely to experience the primary outcome of death or delisting due to clinical worsening compared to non-CHD patients. Ventricular assist devices decreased the probability of experiencing the primary outcome for non-CHD but not for CHD patients with a final listing status of 1A. Ventricular assist devices increased the probability of experiencing the primary outcome among CHD patients for those with a final listing status of 1B with no impact in non-CHD patients. Among non-CHD patients who died or were delisted, the time to the primary outcome was delayed by VAD, with a similar trend in CHD. Except for patients with a final listing status of 1B, VAD does not adversely affect waiting list outcomes in CHD patients listed for heart transplant. Ventricular assist devices may prolong waiting list survival among high-risk CHD patients.
Preoperative Risk Stratification of Right Ventricular Function Utilizing Cardiac Magnetic Resonance Imaging Compared With Echocardiographic and Hemodynamic Parameters
Authors: Avery Ryan , Ebong Imo , Skaria Rinku , Day Kevin , Miller Christopher , Juneman Elizabeth , Oliva Isabel , Friedman Mark , Maltais Simon , Khalpey Zain
Published: July 2019

Accurate right ventricle functional analysis prior to mechanical circulatory support continues to be valuable for preoperative stratification of patients at risk for developing right ventricular (RV) failure. While cardiac magnetic resonance imaging (CMR) remains the gold standard, CMR is limited by availability and patient-specific contraindications. Further investigation of other imaging modalities would be beneficial as it may serve as a surrogate to identifying RV systolic dysfunction. A single-center, retrospective study including 29 patients with advanced heart failure was performed. All patients underwent ventricular functional analysis with both CMR and echocardiography, and 19 patients underwent right heart catheterization. Predictability with multimodal assessment of RV function was determined using logistic regression methods. Of the 29 participants, 10 had severe RV dysfunction. Tricuspid annular plane of systolic excursion was a modest predictor of RV dysfunction with odd ratio (OR) of 0.07 (0.01–0.72) and c-statistic of 0.79. Invasive hemodynamic measurement of cardiac index by thermodilution method was also predictive of RV dysfunction but failed to reach statistical significance (OR of 0.03, <0.001–1.28) with c-statistic of 0.83. The role of invasive hemodynamic data in predicting RV function compared with CMR should be further explored among patients with advanced heart failure.
The Effects of Nitric Oxide in Oxygenator Sweep Gas During Extracorporeal Circulation in a Neonatal Ovine Model
Authors: Rossidis Avery C. , Lawrence Kendall M. , Mejaddam Ali Y. , Kim Aimee G. , Baumgarten Heron D. , Coons Barbara E. , Young Kathleen , Monos Stylianos , Hwang Grace , Flake Alan W. , Davey Marcus G.
Published: July 2019

Extracorporeal membrane oxygenation is a life-saving intervention, but bleeding complications are frequent. Given that the combination of platelet loss and dysfunction is a major contributor to this acquired bleeding diathesis, efforts to combat these phenomena are of great clinical importance. In this study, we investigated the effects of nitric oxide (NO) added to the sweep gas of an extracorporeal circuit in a neonatal ovine model. Eight lambs (age 9.6 ± 1.9 days) were cannulated via the neck vessels and maintained on a pumpless arteriovenous extracorporeal membrane oxygenation circuit with blood flow restricted to 100 ml/min for 72 hours. All animals were heparinized, and a subset (n = 4) also received NO in the sweep gas at a concentration of 200 ppm. We observed no adverse effects from NO administration, and methemoglobin levels remained unchanged. Platelet counts significantly declined in all animals over the course of the study; however, mean counts were higher in the NO-treated group, and this difference was statistically significant at 24 hours (62 ± 3% vs. 32 ± 7% of baseline, P < 0.01). Likewise, mean plasma levels of beta-thromboglobulin, a marker of platelet activation, were lower in the NO-treated group, and this difference was also significant at the 24 hour time point (9.5 ± 2.2 vs. 19.7 ± 6.5 pg/mL/103 platelets, P < 0.05). We conclude that 200 ppm NO can be safely blended into the oxygenator sweep gas of a low-flow extracorporeal circuit and that it may transiently attenuate platelet consumption and activation.
Time-Course of Physiologic Variables During Extracorporeal Membrane Oxygenation and Outcome of Severe Acute Respiratory Distress Syndrome
Authors: Spinelli Elena , Mauri Tommaso , Carlesso Eleonora , Crotti Stefania , Tubiolo Daniela , Lissoni Alfredo , Bottino Nicola , Panigada Mauro , Tagliabue Paola , Rossi Nicola , Scotti Eleonora , Conigliaro Federica , Gattinoni Luciano , Grasselli Giacomo , Pesenti Antonio
Published: July 2019

In patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS), it is unknown which clinical physiologic variables should be monitored to follow the evolution of lung injury and extrapulmonary organ dysfunction and to differentiate patients according to their course. We analyzed the time-course of prospectively collected clinical physiologic variables in 83 consecutive ARDS patients undergoing ECMO at a single referral center. Selected variables—including ventilator settings, respiratory system compliance, intrapulmonary shunt, arterial blood gases, central hemodynamics, and sequential organ failure assessment (SOFA) score—were compared according to outcome at time-points corresponding to 0%, 25%, 50%, 75%, and 100% of the entire ECMO duration and daily during the first 7 days. A logistic regression analysis was performed to identify changes between ECMO start and end that independently predicted hospital mortality. Tidal volume, intrapulmonary shunt, arterial lactate, and SOFA score differentiated survivors and nonsurvivors early during the first 7 days and over the entire ECMO duration. Respiratory system compliance, PaO2/FiO2 ratio, arterial pH, and mean pulmonary arterial pressure showed distinct temporal course according to outcome over the entire ECMO duration. Lack of improvement of SOFA score independently predicted hospital mortality. In ARDS patients on ECMO, temporal trends of specific physiologic parameters differentiate survivors from non-survivors and could be used to monitor the evolution of lung injury. Progressive worsening of extrapulmonary organ dysfunction is associated with worse outcome.
Population enrichment for critical care trials: phenotypes and differential outcomes
Authors: Shankar-Hari Manu , Rubenfeld Gordon D.
Published: July 2019

Purpose of review

Sepsis and acute respiratory distress syndrome (ARDS) are two heterogenous acute illnesses where numerous RCTs have indeterminate results. We present a narrative review on the recent developments in enriching patient populations for future sepsis and ARDS trials.

Recent findings

Many researchers are actively pursuing enrichment strategies to reduce heterogeneity to increase the sensitivity of future trials. Enrichment refers to the use of measurable patient characteristics, known before randomisation, to refine trial populations. Biomarkers could increase the diagnostic certainty of sepsis, whereas chest radiology training to enhance reliability of interpretation and stabilisation period of mechanical ventilation have been considered to increase the diagnostic certainty of ARDS. Clinical and biomarker data analyses identifies four to six sepsis clinical phenotypes and two ARDS clinical phenotypes. Similarly, leukocyte gene expression data identifies two to four sepsis molecular phenotypes. Use of a test-dose identifies ARDS subpopulations who are likely to benefit from higher PEEP. Early-phase trials report how a biomarker that is altered by the intervention, such as lymphocyte count for recombinant interleukin-7 therapy and higher check point inhibitor expression for anti-check point treatments in sepsis, could identify a higher treatment effect population for future trials.

Enrichment reduces heterogeneity and will enhance the sensitivity of future trials. However, enrichment, even when it identifies more homogenous populations, may not be efficient to deploy in trials or clinical practice.
Defining standard of practice: pros and cons of the usual care arm
Authors: Angriman Federico , Masse Marie-Hélène , Adhikari Neill K.J.
Published: July 2019

Purpose of review

The aim of this review is to describe the use of usual care arms in randomized trials.

Recent findings

Randomization of patients to an experimental or a control arm remains paramount for the estimation of average causal effects. Selection of the control arm is as important as the definition of the intervention, and it might include a placebo control, specific standards of care, protocolized usual care, or unrestricted clinical practice. Usual care control arms may enhance generalizability, clinician acceptability of the protocol, patient recruitment, and ensure community equipoise, while at the same time introducing significant variability in the care delivered in the control group. This effect may reduce the difference in treatments delivered between the two groups and lead to a negative result or the requirement for a larger sample size. Moreover, usual care control groups can be subject to changes in clinician behavior induced by the trial itself, or by secular trends in time.

Usual care control arms may enhance generalizability while introducing significant limitations. Potential solutions include the use of pretrial surveys to evaluate the extent to which a protocolized control arm reflects the current standard of care and the implementation of adaptive trials.
How should we treat acinetobacter pneumonia?
Authors: Amaya-Villar Rosario , Garnacho-Montero José
Published: July 2019

Purpose of review

To describe recent data about Acinetobacter baumannii pneumonia epidemiology and the therapeutic options including adjunctive nebulized therapy.

Recent findings

A. baumannii is a major cause of nosocomial pneumonia in certain geographic areas affecting mainly debilitated patients, with prolonged hospitalization and broad-spectrum antimicrobials. Inappropriate empirical treatment has clearly been associated with increased mortality in A. baumannii pneumonia. Carbapenems may not be considered the treatment of choice in areas with high rates of carbapenem-resistant A. baumannii. Nowadays, polymyxins are the antimicrobials with the greatest level of in-vitro activity. Colistin is the antimicrobial most widely used although polymyxin B is associated with less renal toxicity. It is clear that lung concentrations of polymyxins are suboptimal in a substantial proportion of patients. This issue has justified the use of combination therapy or adjunctive nebulized antibiotics. Current evidence does not allow us to recommend combination therapy for A. baumannii pneumonia. Regarding nebulized antibiotics, it seems reasonable to use in patients who are nonresponsive to systemic antibiotics or A. baumannii isolates with colistin minimum inhibitory concentrations close to the susceptibility breakpoints. Cefiderocol, a novel cephalosporin active against A. baumannii, may represent an attractive therapeutic option if ongoing clinical trials confirm preliminary results.

The optimal treatment for multidrug-resistant A. baumannii pneumonia has not been established. New therapeutic options are urgently needed. Well designed, randomized controlled trials must been conducted to comprehensively evaluate the effectiveness and safety of nebulized antibiotics for the treatment of A. baumannii pneumonia.
Therapeutic effect of lutein supplement on non-proliferative diabetic retinopathy
Authors: Ren Yong-bo , Qi Yan-xiu , Su Xing-jie , Luan He-qun , Sun Qi
Published: July 2019

This study retrospectively evaluated the effect of lutein supplement (LS) on patients with non-proliferative diabetic retinopathy (NPDR).

A total of 72 patients with NPDR were included in this study. All patients received Zeaxanthin during the study period. In addition, 36 patients also received LS and were assigned to the treatment group, while the other 36 patients did not receive LS and were assigned to the control group. All patients were treated for a total of 4 months. The endpoints included visual acuity (VA), contrast sensitivity (CS), and glare sensitivity (GS). In addition, any adverse events were also assessed. All endpoints were measured before and after 4-month treatment.

Before treatment, there were no significant differences in VA (P = .75), CS (P = .71), and GS (P = .73) between two groups. After 4-month treatment, there were still no significant differences in all endpoints of VA (P = .66), CS (P = .58), and GS (P = .61) between two groups. No adverse events were recorded in either group.

The results of this retrospective study showed that LS may not benefit for patients with NPDR after 4-month treatment. More high quality randomized controlled trials should still be needed to warrant the results of this study.
Prognostic role of C-reactive protein to albumin ratio in colorectal cancer
Authors: Wang Fan , Li Pei , Li Feng-sen
Published: July 2019

Objective:

This meta-analysis evaluates the prognosis value of C-reactive protein to albumin ratio (CAR) in colorectal cancer.

Methods:

Embase, PubMed, and Web of Science were searched. Pooled hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were used as effective values.

Results:

A total of 6 studies with 1942 patients were included in this study. Pooled results revealed that elevated pretreatment CAR was related with poorer overall survival (OS) (HR: 2.09, 95%CI: 1.78–2.45, P < .001) in colorectal cancer.

Conclusion:

Elevated CAR was associated with poor prognosis in colorectal cancer. Thus CAR might be used as a prognostic system and classification of colorectal patients in clinical potential.
Efficacy of prison-based cognitive behavioral rehabilitation intervention on violent sexual behaviors among sex offenders in Nigerian prisons
Authors: Nwokeoma Bonaventure N. , Ede Moses O. , Ugwuanyi Christian , Mezieobi Daniel , Ugwoezuonu Amanda U. , Amoke Chijioke , Egenti Nkechi T. , Nwosu Nneka , Oforka Theresa O. , Victor-Aigbodion Vera , Offordile Edmund E. , Ezeh Ngozi E. , Eze Celestine O. , Eluu Patrick E. , Ugwuanyi Benedict E. , Uzoagba Ngozi C. , Ugwonna Grace O. , Chukwu Chinyere Loveth , Amadi Kingley C. , Eseadi Chiedu
Published: July 2019

Background/Objective:

Evidence showed that reoffending habits are increasing among offenders with violent sexual behaviors. Given the recidivism rates, a psychotherapeutic intervention becomes imperative. This study examined the efficacy of prison-based cognitive behavioral rehabilitation intervention (PCBRI) on violent sexual behaviors among sex offenders in Nigerian prisons.

Method:

A total of45 participants were the sample size. Compulsive Sexual Behavior Inventory and Hypersexual Behavior Inventory were employed in assessing the participants at 3 points. Using a simple random allocation sequence, 23 participants were exposed to PCBRI programme and 22 participants allocated to control condition. The data obtained were analyzed using repeated measures 2-way analysis of variance.

Results:

Results indicated a significant effect of the treatment on violent sexual behaviors among sex offenders in Nigerian prisons exposed to the PCBRI programme when compared to the no-intervention group. Result also showed a significant interaction effect of time and group on sex offenders with violent sexual behaviors. Follow-up tests showed significant decrease in violent sexual behaviors after 6 months for the PCBRI group in comparison to the control group.

Conclusion:

This study concluded that PCBRI approach is a type of psychotherapy that reduces violent sexual behaviors among sex offenders in Southeast Nigeria.
Correction of labial tubercle defect in repaired bilateral cleft lips using bilateral vermilion musculomucosal sliding flaps
Authors: Liang Yun , Yang Yusheng , Wu Yilai
Published: July 2019

Rationale:

Insignifificant, asymmetrical or lack of labial tubercle often occurs after cleft lip surgery due to improper treatment of vermilion tissue. Especially in the cases of bilateral cleft lip, because of short front lip and insuffificient vermilion tissue, the median vermilion depression often occurs after surgery, forming a “whistling” deformity. The object of this study is to verify the outcomes of patients with median labial tubercle detects after treatment with bilateral vermilion musculomucosal sliding flflaps (VMSF).

Patient concerns:

Six patients with median labial tubercle defect after bilateral cleft lip repair from March 2015 to May 2017 were enrolled in our department and subjected to bilateral lip deformity correction under general anesthesia.

Diagnoses:

Secondary deformity of bilateral cleft lip forming a “whistling” deformity were diagnosed in all the patients.

Interventions:

Bilateral VMSF were designed and used to reconstruct the median labial tubercles by sliding downward so as to eliminate the whistling deformity.

Outcomes:

During the 10 to 37 months of follow-up, the reconstructed vermilion tubercles had stable morphology showing no whistling deformity and the overall lip shapes were satisfactory.

Lessons:

Reconstructing MVTD and eliminating whistling deformity using the scar tissues that need to be removed previously on the vermilion musculomucosa has achieved stable and satisfactory results and is worthy of clinical application.
Upregulation of microRNA-191 can serve as an independent prognostic marker for poor survival in prostate cancer
Authors: Liu Jing-bo , Yan Yong-ji , Shi Jing , Wu Ya-bing , Li Yan-feng , Dai Lin-feng , Ma Xue-tao
Published: July 2019

MicroRNA-191 (miR-191) has been identified as being upregulated in several types of cancers, and plays the role of oncogene. The expression of miR-191 has been found to be upregulated in prostate cancer tissues as well as cell lines. In this study, we analyzed the correlation of miR-191 expression with clinicopathologic factors and prognosis in prostate cancer.

Prostate cancer tissue samples and adjacent normal prostate tissue samples were collected from 146 patients who underwent laparoscopic radical prostatectomy between April 2013 and March 2018. Student two-tailed t-test was used for comparisons of 2 independent groups. The relationships between miR-191 expression and different clinicopathological characteristics were evaluated using the Chi-squared test. Kaplan–Meier survival plots and log-rank tests were used to assess the differences in overall survival of the different subgroups of prostate cancer patients.

miR-191 expression was significantly higher in prostate cancer tissues compared with normal adjacent prostate tissues (P < .001). miR-191 expression was observed to be significantly correlated with Gleason score (P < .001), pelvic lymph node metastasis (P = .006), bone metastases (P < .001), and T stage (P = .005). Kaplan–Meier analysis showed that patients with higher levels of miR-191 had significantly poorer survival than those with lower expression of this miRNA in prostate cancer patients (log rank test, P = .011). Multivariate analysis revealed that miR-191 expression (hazard ratio [HR] = 2.311, 95% confidence interval, [CI]: 1.666–9.006; P = .027) was independently associated with the overall survival of prostate cancer patients.

Our results demonstrated that miR-191 might serve as an independent prognostic indicator for prostate cancer patients.
Autologous hematopoietic stem cell transplantation for human immunodeficiency virus associated gastric Burkitt lymphoma
Authors: Junfeng Lu , Lina Ma , Xinyue Chen
Published: July 2019

Rationale:

HIV-related lymphoma, especially non-Hodgkin lymphoma, is one of the most common malignant tumors in HIV/acquired immune deficiency syndrome (AIDS) patients. Autologous hematopoietic stem cell transplantation (AHSCT) for the patients with Burkitt lymphoma (BL) is needed to be further explored.

Patient concerns:

A 57-year-old man was hospitalized with intermittent pain on upper abdomen and melena for >1 month.

Diagnosis:

HIV antibody testing was positive. The upper gastrointestinal endoscopy was performed and histopathology and immunohistochemistry revealed BL.

Interventions:

Highly effective antiretroviral therapy and sixth cycles of chemotherapy were administered, followed by autologous hematopoietic stem cell transplantation.

Outcomes:

The patient has had tumor-free survival for >6 years with normal CD4+ T cell counts and HIV viral load below the lowest detection

Lessons:

The patient was treated with AHSCT followed complete remission after chemotherapy and achieved long-term disease-free survival. AHSCT may be a promising way for clinical cure of HIV-related BL.
Diagnostic accuracy of different computer-aided diagnostic systems for malignant and benign thyroid nodules classification in ultrasound images
Authors: Liu Ruisheng , Li Huijuan , Liang Fuxiang , Yao Liang , Liu Jieting , Li Meixuan , Cao Liujiao , Song Bing
Published: July 2019

Objective:

The aim of this study was to determine the diagnostic accuracy of different computer-aided diagnostic (CAD) systems for thyroid nodules classification.

Methods:

A systematic search of the literature was conducted from inception until March, 2019 using the PubMed, EMBASE, Web of science, and Cochrane library. Literature selection and data extraction were conducted by 2 independent reviewers. Numerical values for sensitivity and specificity were obtained from false negative (FN), false positive (FP), true negative (TN), and true positive (TP) rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals (CIs). Summary receiver operating characteristic (SROC) curves were applied to assess the performance of diagnostic tests. Data were processed using Review Manager 5.3 and Stata 15. The methodological quality of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Trial registration number:

PROSPERO CRD42019132540
The erector spinae plane block for effective analgesia after lung lobectomy
Authors: Bang Seunguk , Chung Kyudon , Chung Jihyun , Yoo Subin , Baek Sujin , Lee Sang Mook
Published: July 2019

Rationale:

The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique.

Patient concerns:

Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted.

Diagnoses:

They were diagnosed with primary adenocarcinoma requiring lobectomy of lung.

Interventions:

The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later.

Outcomes:

The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen.

Lessons:

Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.
Association of CTLA-4 tagging polymorphisms and haplotypes with hepatocellular carcinoma risk
Authors: Yang Jing , Liu Jiaochun , Chen Yu , Tang Weifeng , Liu Chao , Sun Yuling , Chen Jianping
Published: July 2019

It has been proposed that cytotoxic T-lymphocyte antigen 4 (CTLA-4) may attenuate the T-cell activation threshold, thereby decreasing the antitumor response and conferring susceptibility to hepatocellular carcinoma (HCC).

In the present study, we selected CTLA-4 tagging single nucleotide polymorphisms (SNPs) and explored the relationship between these polymorphisms and susceptibility to HCC. A hospital-based case-control study, comprising 584 cases with HCC and 923 controls, was performed in an eastern Chinese Han population. CTLA-4 SNPs were genotyped using a custom-by-design 48-Plex SNPscan Kit.

We found that the CTLA-4 rs3087243 G>A polymorphism might be associated with increased risk of HCC (GA vs GG: adjusted odds ratio [OR], 1.38; 95% confidence interval [CI], 1.04–1.85; P = .028 and AA/GA vs GG: adjusted OR, 1.43; 95% CI, 1.08–1.89; P = .012). After using Bonferroni correction, this association remained (P = .012 for the AA/GA vs GG genetic model). In addition, the power value was 0.904 in the AA/GA versus GG genetic model. Haplotype analysis showed that CTLA4 Crs16840252Ars231775Ars3087243Trs733618, Crs16840252Grs231775Ars3087243Trs733618, and other haplotypes might increase the risk of HCC risk (P = .018, <.001, and .017, respectively). However, we found that CTLA4 Trs16840252A rs231775Grs3087243Trs733618 decreased the risk of HCC (P = .020).

Our results suggest that the CTLA-4 rs3087243 G>A polymorphism increases susceptibility to HCC in an eastern Chinese Han population. CTLA-4 haplotypes may influence the development of HCC. In the future, a population-based fine-mapping study with functional assessment should be performed to further determine these potential correlations.
Effects of febuxostat on renal function in patients with chronic kidney disease
Authors: Lin Tsu-Chen , Hung Lie Yee , Chen Ying-Chun , Lo Wei-Cheng , Lin Chun Hung , Tam Ka-Wai , Wu Mei-Yi
Published: July 2019

Background/Objective:

Hyperuricemia has been proven to be an independent risk factor for chronic kidney disease (CKD). However, the role of hyperuricemia in the progression of CKD remains unclear. Thus, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of febuxostat, a first line urate-lowering agent, in CKD patients with hyperuricemia.

Methods:

We have systematically searched for randomized controlled trials assessing the efficacy and safety of febuxostat versus control in CKD patients with hyperuricemia through MEDLINE, PubMed, EMBASE, and Cochrane databases. All statistical analyses were conducted by using the statistical package Review Manager, version 5.3.5. Heterogeneity was assessed using the Cochrane Q and I2 tests and summary statistics were reported with 95% confidence interval. Two-tailed test was used for analysis and a P value of <.05 is considered statistically significant.

Results:

Eleven eligible trials with 1317 participants were included in the meta-analysis. A significant reduction in serum uric acid was found in the febuxostat treated group. Also, a significant higher eGFR was found in the febuxostat treated group among CKD stage 3 and 4 patients. No significant difference of major complication or death was identified between treatment and control groups.

Conclusions:

The meta-analysis showed that other than its urate-lowering effect, febuxostat presented a reno-protective effect in CKD patients. More studies with larger sample sizes and higher quality are required to clarify the role of febuxostat use in the progression of CKD.
Evaluating the tumor biology of lung adenocarcinoma: A multimodal analysis
Authors: Kim Ki Hwan , Ryu Seong-Yoon , Lee Ho Yun , Choi Joon Young , Kwon O. Jung , Kim Hong Kwan , Shim Young Mog
Published: July 2019

We evaluated the relationships among functional imaging modality such as PET-CT and DW-MRI and lung adenocarcinoma pathologic heterogeneity, extent of invasion depth, and tumor cellularity as a marker of tumor microenvironment.

In total, 74 lung adenocarcinomas were prospectively included. All patients underwent 18F-fluorodeoxyglucose (FDG) PET-CT and MRI before curative surgery. Pathology revealed 68 stage I tumors, 3 stage II tumors, and 3 stage IIIA tumors. Comprehensive histologic subtyping was performed for all surgically resected tumors. Maximum standardized uptake value (SUVmax) and ADC values were correlated with pathologic grade, extent of invasion, solid tumor size, and tumor cellularity.

Mean solid tumor size (low: 1.7 ± 3.0 mm, indeterminate: 13.9 ± 14.2 mm, and high grade: 30.3 ± 13.5 mm) and SUVmax (low: 1.5 ± 0.2, indeterminate: 3.5 ± 2.5, and high grade: 15.3 ± 0) had a significant relationship with pathologic grade based on 95% confidence intervals (P = .01 and P < .01, respectively). SUVmax showed a strong correlation with tumor cellularity (R = 0.713, P < .001), but was not correlated with extent of invasion (R = 0.387, P = .148). A significant and strong positive correlation was observed among SUVmax values and higher cellularity and pathologic grade. ADC did not exhibit a significant relationship with tumor cellularity.

Intratumor heterogeneity quantification using a multimodal-multiparametric approach might be effective when tumor volume consists of a real tumor component as well as a non-tumorous stromal component.
Surgical versus nonsurgical treatment of primary acute patellar dislocation
Authors: Yang Fan , Guo Wenlai , Wang Qian , Zhu Zhe , Guan Congying , Zhao Shishun , Yuan Baoming
Published: July 2019

Background:

To systematically review the efficacy of surgical versus nonsurgical treatment for acute patellar dislocation.

Materials and Methods:

PubMed, Cochrane, and Embase were searched up to February 12, 2019. After removing duplicates, preliminary screening, and reading the full texts, we finally selected 16 articles, including 11 randomized controlled trials and 5 cohort studies. The quality of the enrolled studies was evaluated by Jadad score or Newcastle–Ottawa scale. Meta-analyses were performed using odds ratio (OR) and standardized mean difference (SMD) as effect variables. The clinical parameters assessed included mean Kujala score, rate of redislocation, incidence of patellar subluxation, patient satisfaction, and visual analog scale (VAS) for pain. Evidence levels were determined using GRADE profile.

Results:

The 16 included studies involved 918 cases, 418 in the surgical group and 500 in the nonsurgical group. The results of the meta-analysis showed higher mean Kujala score (SMD = 0.79, 95% confidence interval [CI] [0.3, 1.28], P = .002) and lower rate of redislocation (OR = 0.44, 95% CI [0.3, 0.63], P < .00001) in the surgical group than the nonsurgical group, but showed insignificant differences in the incidence of patellar subluxation (OR = 0.61, 95% CI [0.36, 1.03], P = .06), satisfaction of patients (OR = 1.44, 95% CI [0.64, 3.25], P = .38), and VAS (SMD = 0.84, 95% CI [−0.36, 9.03], P = .84).

Conclusion:

For patients with primary acute patellar dislocation, surgical treatment produces a higher mean Kujala score and a lower rate of redislocation than nonsurgical treatment.
Gastrointestinal motility should be emphasized after laparotomy treatment for complete small intestinal volvulus in older adults
Authors: Song Jianning , Ge Zhicheng , Liu Yuan , Yin Jie , Yao Hongwei , Zhang Zhongtao
Published: July 2019

Rationale:

Complete small intestinal volvulus is a rare entity in adults, unlike partial intestinal volvulus. Although prompt surgical intervention is the mainstay of treatment, attention should also be paid to recovery of intestinal function postoperatively. Ignoring this issue during the postoperative recovery process can have serious consequences. We report the case of an 82-year-old woman with complete small intestinal volvulus at the root of the superior mesenteric vessel.

Patients concerns:

The patient was admitted for acute onset (22 hours) of abdominal pain and distention. Nausea and vomiting also developed during this period.

Diagnoses:

Abdominal physical examination was suspicious for peritoneal irritation. Computed tomography scan showed anticlockwise swirl of the mesenteric vessels at the lower margin of the pancreas with distension of the entire small intestine. A complete small intestinal volvulus was diagnosed.

Interventions:

Laparotomy and detorsion of the volvulus were performed after early diagnosis.

Outcomes:

The patient developed intestinal wall edema because of ischemic–reperfusion damage. She exhibited severe abdominal distention and absent intestinal motility. Two days later, she went into septic shock; she died 19 days after surgical intervention.

Lessons:

Because complete small intestinal volvulus involves the entire intestine, ischemic–reperfusion intestinal damage after detorsion may be severe and can predict prognosis.
Conservative tibiotalocalcaneal fusion for partial talar avascular necrosis in conjunction with ankle and subtalar joint osteoarthritis in Kashin–Beck disease
Authors: Li Liubing , Wang Ying , Zhu Zhenhua , Zhou Jupu , Li Shuyuan , Qin Jianzhong
Published: July 2019

Rationale:

Kashin–Beck disease (KBD) is known for some typical characters like finger joint enlargement, shortened fingers, and dwarfism. However, Avascular necrosis (AVN) of the talus in KBD has rarely been reported in the literature. Here, we reported on a KBD patient presented with partial AVN of the talus in conjunction with ankle and subtalar arthritis.

Patient concerns:

A 50-year-old woman presented with severe pain and limited range of motion in her left ankle and subtalar joint while walking for 2 years. She had been walking with the aid of crutches for many years. Conservative treatment with rigid orthosis and activity restriction could not help reduce the pain in the left foot.

Diagnoses:

Radiographs demonstrated that partial AVN was developed in the body of the talus and arthritis was viewed in the left ankle and subtalar joint. Hence, we established the diagnosis of partial talar AVN in conjunction with ankle and subtalar arthritis.

Interventions:

A conservative tibiotalocalcaneal fusion attempting to preserve as much viable talar body as possible was performed using a humeral locking plate and 2 cannulated compression screws.

Outcomes:

Bone union proved by CT scan and a good alignment of the left limb were achieved at 4-month follow-up postoperatively.

Lessons:

Partial AVN of the talus along with ankle and subtalar arthritis in KBD patients has rarely been reported as it is not a common characteristic of KBD in clinical practice. Conservative tibiotalocalcaneal fusion could help preserving much more viable talar body, maintaining most structural integrity of the ankle joint, and achieving a stable and plantigrade foot postoperatively.
Acupoint herbal patching for bronchitis
Authors: Jun Ji Hee , Kim Kyeong Han , Song Eunhye , Anga Lin , Park Sunju
Published: July 2019

Background:

Acupoint herbal patching (AHP) is widely used for symptom management in patients with acute and chronic bronchitis. The purpose of this protocol review is to evaluate the safety and efficacy of AHP for the treatment of bronchitis.

Methods and analysis:

This protocol of systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). The databases searched will include PubMed, Embase, CENTRAL, Web of Science, 3 Korean medical databases (OASIS, Korea Med, and KMBASE), and the Chinese database China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCTs) or quasi-RCTs using AHP for bronchitis will be considered. The selection of the studies, data abstraction, and validations will be performed independently by 3 researchers.

Conclusion:

The conclusion of the review will provide evidence that AHP is an effective intervention in patients with bronchitis.

Ethics and dissemination:

As individuals were not involved, ethical approval is not required. Findings will be published in a peer-reviewed journal. This systematic review may inform the treatment of bronchitis patients in clinical practice.

Registration:

This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO). The reference number is CRD42018110380.
External validation of a prediction tool to estimate the risk of human immunodeficiency virus infection amongst men who have sex with men
Authors: Luo Qianqian , Huang Xiaojie , Li Lingling , Ding Yingying , Mi Guodong , Scott Sarah Robbins , Zhao Yan , Rou Keming , He Na , Wu Hao , Wu Zunyou
Published: July 2019

A human immunodeficiency virus (HIV) risk assessment tool was previously developed for predicting HIV infection among men who have sex with men (MSM), but was not externally validated. We evaluated the tool's validity for predicting HIV infection in an independent cohort.

The tool was assessed using data from a retrospective cohort study of HIV-negative adult MSM who were recruited in Beijing, China between January 2009 and December 2016.

High-risk behaviors occurring within 6 months before the survey were evaluated. Area under curve (AUC) of the receiver operating character curve (ROC) was used to quantify discrimination performance; calibration curve and Hosmer–Lemeshow statistic were used for calibration performance valuation; and decision curve analysis (DCA) was used to evaluate clinical usage.

One thousand four hundred forty two participants from the cohort were included in the analysis; 246 (17.1%) sero-converted during follow-up. External validation of the tool showed good calibration, the Hosmer–Lemeshow test showed no statistical difference between observed probability and tool-based predictive probability of HIV infection (X

2
 = 4.55, P = .80). The tool had modest discrimination ability (AUC = 0.63, 95% confidence interval [CI]: 0.61–0.66). The decision curve analysis indicated that implementing treatment measures based on the tool's predicative risk thresholds ranging from 10% to 30% might increase the net benefit of treatment when compared with treating all or no MSM.

The HIV risk assessment tool can predict the actual risk of HIV infection well amongst MSM in China, but it has a moderate ability to discriminate those at high risk of HIV infection.