bluuebunny/crossref_metadata_2025 huggingface dataset:
Biology, strategies, and fresh meat consequences of manipulating the fatty acid composition of meat
Authors: Burnett Derris D , Legako Jerrad F , Phelps Kelsey J , Gonzalez John M
Published: January 2020

The utility and attractiveness of adipose tissue within meat products vary based on species, cut, and consumer preference. In beef, producers are rewarded for producing carcasses with greater visual marbling at the 12th and 13th rib juncture, while pork producers are either not rewarded or penalized for producing carcasses with too much adipose tissue. Some consumers prefer to purchase leaner meat cuts, while other consumers pay premiums to consume products with elevated fat content. While no clear consumer adipose tissue preference standard exists, advances in beef and swine nutrition have enabled producers to target markets that enable them to maximize profits. One niche market that has increased in popularity over the last decade is manipulating the fatty acid profile, specifically increasing omega-3 fatty acid content, of beef and pork products to increase their appeal in a healthy diet. While much research has documented the ability of preharvest diet to alter the fatty acid profile of beef and pork, the same studies have indicated both the color and palatability of these products were negatively affected if preharvest diets were not managed properly. The following review discusses the biology of adipose tissue and lipid accumulation, altering the omega-3 fatty acid profile of beef and pork, negative fresh meat color and palatability associated with these studies, and strategies to mitigate the negative effects of increased omega-3 fatty acid content.
Superstition, Misconceptions, and Magical Beliefs in Burns Patients—A Cross-Sectional Study of 100 Patients
Authors: Dash Suvashis , Muthukumar Vamseedharan , Sharma Shardendu
Published: January 2020

Superstitious beliefs have been frequently encountered in our day-to-day practices among patients and caretakers. Though this is a common phenomenon, there is a paucity of data pertaining to these beliefs due to various reasons. Many of these beliefs are deep engraved into the culture and mindsets of the population. This is an observational study performed in Tertiary burn care center in India during period October 1, 2018 to January 31, 2019. Data from 100 patient units were collected through a set of questionnaires given to each of patient and their caregivers/family members and responses were collected and analyzed. In the food category of superstitions, there was a thought that white colored foods had to be avoided to avoid pus discharge and wound healing in 60% of the response; eating pomegranate or drinking the juice of pomegranate improves the hemoglobin in 80% of the response. Wearing various colored strings in various parts of the body seemed to be a dominant practice in 85% of the responses, wearing the hair with origin from human, donkeys, horses, and various animals was practiced in 45% of people and wearing peacock feathers was seen in 40% of patients. About 95% of the patients thought adversely to the idea of bathing or even contact of the water with the wounds. This study is an attempt to analyze the different parameters of superstition, misconception, and magical beliefs.
MUC5AC enhances tumor heterogeneity in lung adenocarcinoma with mucin production and is associated with poor prognosis
Authors: Dong Yujie , Zhou Lijuan , Zhao Dan , Li Kun , Liu Zichen , Che Nanying , Liu Honggang
Published: January 2020

Objective

The clinicopathological significance of Mucin5AC (MUC5AC) in lung adenocarcinoma with mucin production is still unclear. This study aimed to explore MUC5AC expression in lung adenocarcinoma with mucin production and its correlation with histological subtypes, common driver mutations and its impact on prognosis.

Methods

MUC5AC and thyroid transcription factor 1 immunohistochemistry was performed on surgical samples from 90 patients with lung adenocarcinoma with mucin production. Common driver mutations including EGFR and KRAS mutations and ALK rearrangement were detected by established methods.

Results

MUC5AC was significantly associated with lymphovascular invasion (P = 0.023) and tumors with intra-cytoplasmic mucin (P < 0.001). Moreover, MUC5AC was more significant in invasive mucinous adenocarcinoma (P < 0.001), as well as in tumors with KRAS mutations (P = 0.005) and a lack of thyroid transcription factor 1 expression (P < 0.001). Conversely, MUC5AC was less significantly detected in acinar predominant adenocarcinoma (P = 0.036) and tumors with EGFR mutations (P = 0.001). Notably, MUC5AC in non-pure mucinous subtype of lung adenocarcinoma with mucin production showed more aggressive behavior, distinct expression pattern and a lack of significant correlation with thyroid transcription factor 1 (P = 0.113) when compared with pure mucinous subtype. MUC5AC-positive tumors were significantly associated with a worse prognosis compared to MUC5AC-negative tumors (P < 0.001). A multivariate survival analysis showed that MUC5AC was an independent prognosis factor for poor prognosis (P = 0.006).

Conclusions

The clinicopathological features of non-pure mucinous subtype of lung adenocarcinoma with mucin production were distinct and should be distinguished from pure mucinous subtype. MUC5AC was associated with poor prognosis and could be a potential therapeutic target for this distinct type of lung adenocarcinoma that has few effective treatments.
Sequential Bargaining in the Field: Evidence from Millions of Online Bargaining Interactions*
Authors: Backus Matthew , Blake Thomas , Larsen Brad , Tadelis Steven
Published: January 2020

We study patterns of behavior in bilateral bargaining situations using a rich new data set describing back-and-forth sequential bargaining occurring in over 25 million listings from eBay’s Best Offer platform. We compare observed behavior to predictions from the large theoretical bargaining literature. One-third of bargaining interactions end in immediate agreement, as predicted by complete-information models. The majority of sequences play out differently, ending in disagreement or delayed agreement, which have been rationalized by incomplete information models. We find that stronger bargaining power and better outside options improve agents’ outcomes. Robust empirical findings that existing models cannot rationalize include reciprocal (and gradual) concession behavior and delayed disagreement. Another robust pattern at odds with existing theory is that players exhibit a preference for making and accepting offers that split the difference between the two most recent offers. These observations suggest that behavioral norms, which are neither incorporated nor explained by existing theories, play an important role in the success of bargaining outcomes.
OCCUPATIONAL EXPOSURE CHARACTERISTICS AND FACTORS ASSOCIATED WITH RADIATION DOSES AMONG KOREAN RADIATION WORKERS
Authors: Kim Jiyeong , Seo Songwon , Lee Dal Nim , Park Soojin , Im Ki-Jung , Park Sunhoo , Jin Young Woo
Published: January 2020

This study identified occupational factors associated with radiation exposure in Korea. Survey data of 16 037 workers from 2016 to 2017, including lifestyle factors and occupational characteristics, were combined with the National Dose Registry. Higher average annual doses were observed in groups exhibiting health risk factors such as body mass index (BMI) and smoking. Average annual doses also differed according to occupational characteristics, including average daily working hours, use of radiation protection gear, calendar year of hiring and employment status. Moreover, the influence of different factors on radiation dose differed with occupations. In industrial radiography and nuclear power plants, average daily working hours were the most important factor determining worker radiation doses. In other occupations, such as education, industry and research, calendar year of hiring and duration of employment were the most important factors. This research indicates the need to consider the specific work procedures of occupations to determine exposure variations between or within facilities.
Exposure to money modulates neural responses to outcome evaluations involving social reward
Authors: Li Jin , Liu Lei , Sun Yu , Fan Wei , Li Mei , Zhong Yiping
Published: January 2020

Recent research suggests that exposure to monetary cues strengthens an individual’s motivation to pursue monetary rewards by inducing the ‘market mode’ (i.e. thinking and behaving in accordance with market principles). Here, we examined the effect of market mode on social reward processes by means of event-related potentials (ERPs). Participants primed with monetary images or neutral images acted as advisors who selected one of two options for a putative advisee. Subsequently, all participants passively observed the advisee accepting or rejecting their advice and receiving a gain or loss outcome. After money priming, the feedback-related negativity (FRN) to the advisee’s gain/loss outcome was larger following incorrect as compared to correct advice irrespective of whether the advice had been accepted or rejected. A smaller P3 following incorrect advice showed only when the advice was rejected. After neutral priming, the FRN was larger for incorrect relative to correct advice only when the advice had been rejected. However, the P3 was larger for correct relative to incorrect advice irrespective of the advisee’s final choice. These findings suggest that the market mode facilitates early and automatic feedback processing but reduces later and controlled responding to outcomes that had been accepted.
Bone Lesions of the Hand and Wrist: Systematic Approach to Imaging Evaluation
Authors: Cecava Nathan D. , Kephart David A. , Bui-Mansfield Liem T.
Published: January 2020

Hand and wrist bone lesions comprise a special subset of masses. When evaluating these lesions, relative tumor incidence always should be considered. For bone lesions occurring throughout the body, the incidence of primary bone tumors is much lower than that of nonneoplastic bone diseases, metastatic diseases, and hematolymphoid malignancies.1 In the hand, benign bone lesions greatly outnumber malignant lesions, as highlighted in a published case series on hand and foot bone lesions.1 Of 52 bone lesions of the hands and feet evaluated with histopathology, the relative incidence was pseudotumors (38%), benign primary tumors (38%), inflammatory/postinfectious lesions (17%), and malignant tumors (12%).1 A large percentage of benign bone lesions of the hand and wrist will have characteristic features on imaging and will not require histopathologic assessment. Appropriate management for indeterminate bone lesions of the hand and wrist will include imaging surveillance or biopsy. Comprehending relative incidence, relevant clinical features, and typical imaging characteristics of various bone lesions of the hand and wrist will assist in formulating a short and relevant differential diagnosis to guide management.
Sevoflurane Enhances Proliferation, Metastatic Potential of Cervical Cancer Cells via the Histone Deacetylase 6 Modulation In Vitro
Authors: Zhang Wenwen , Sheng Bo , Chen Sisi , Zhao Hailin , Wu Lingzhi , Sun Yibing , Cui Jiang , Zhu Xueqiong , Ma Daqing
Published: January 2020

Background

Sevoflurane is commonly used for cervical cancer surgery, but its effect on cervical cancer cell biology remains unclear. This mechanistic study explores how sevoflurane affects the proliferation and metastatic potential of immortalized cervical cancer cell lines.

Methods

Cultured cervical cancer Caski and HeLa lines were exposed to 1, 2, or 3% sevoflurane for 2 or 4 h. Cell proliferation was determined through the Kit-8 assay and Ki-67 immunofluorescent staining. Cell migration and invasion were evaluated with the Transwell assay. Immunofluorescent staining and Western blot analysis were used to identify sevoflurane-induced morphological and biochemical changes.

Results

Sevoflurane exposure for either 2 or 4 h significantly increased HeLa cell proliferation in a time- and concentration-dependent manner to be 106 ± 2.7% and 107 ± 1.4% relative to the controls (n = 10; P = 0.036; P = 0.022) at 24 h after exposure and to be 106 ± 2.2% and 106 ± 1.7% relative to the controls (n = 10; P = 0.031; P = 0.023) at the highest concentration of 3% sevoflurane studied, respectively, but not Caski cells. Sevoflurane promoted invasion ability (1.63 ± 0.14 and 1.92 ± 0.12 relative to the controls) and increased cell size (1.69 ± 0.21 and 1.76 ± 0.13 relative to the controls) of Caski and HeLa cells (n = 6; all P < 0.001), respectively. Sevoflurane increased histone deacetylase 6 expression in both cells, and histone deacetylase 6 knockdown abolished the prometastatic effects of sevoflurane. Sevoflurane also induced deacetylation of α-tubulin in a histone deacetylase 6–dependent manner. The protein kinase B (AKT) or extracellular regulated protein kinase (ERK1/2) phosphorylation inhibition attenuated sevoflurane-induced histone deacetylase 6 expression.

Conclusions

Sevoflurane enhanced proliferation, migration, and invasion of immortalized cervical cancer cells, which was likely associated with increasing histone deacetylase 6 expression caused by phosphatidylinositide 3-kinase/AKT- and ERK1/2-signaling pathway activation.

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Mutant Calreticulin in the Myeloproliferative Neoplasms
Authors: Prins Daniel , González Arias Carlos , Klampfl Thorsten , Grinfeld Jacob , Green Anthony R.
Published: January 2020

Mutations in the gene for calreticulin (CALR) were identified in the myeloproliferative neoplasms (MPNs) essential thrombocythaemia (ET) and primary myelofibrosis (MF) in 2013; in combination with previously described mutations in JAK2 and MPL, driver mutations have now been described for the majority of MPN patients. In subsequent years, researchers have begun to unravel the mechanisms by which mutant CALR drives transformation and to understand their clinical implications. Mutant CALR activates the thrombopoietin receptor (MPL), causing constitutive activation of Janus kinase 2 (JAK2) signaling and cytokine independent growth in vitro. Mouse models show increased numbers of hematopoietic stem cells (HSCs) and overproduction of megakaryocytic lineage cells with associated thrombocytosis. In the clinic, detection of CALR mutations has been embedded in World Health Organization and other international diagnostic guidelines. Distinct clinical and laboratory associations of CALR mutations have been identified together with their prognostic significance, with CALR mutant patients showing increased overall survival. The discovery and subsequent study of CALR mutations have illuminated novel aspects of megakaryopoiesis and raised the possibility of new therapeutic approaches.
Descemet Membrane Endothelial Keratoplasty With a Pull-Through Insertion Device: Surgical Technique, Endothelial Cell Loss, and Early Clinical Results
Authors: Tan Tien-En , Devarajan Kavya , Seah Xin-Yi , Lin Shu-Jun , Peh Gary Swee Lim , Cajucom-Uy Howard Yu , Ang Marcus , Mehta Jodhbir Singh , Tan Donald Tiang Hwee
Published: January 2020

Purpose:

To describe a surgical technique for Descemet membrane endothelial keratoplasty (DMEK) using a pull-through, endothelium-in insertion device, the DMEK EndoGlide. We evaluated the endothelial cell loss (ECL) associated with the EndoGlide-DMEK (E-DMEK) technique in both ex vivo and prospective clinical studies.

Methods:

The ex vivo study involved calcein acetoxymethyl staining and preparation of DMEK grafts, which were trifolded endothelium-in, loaded into the EndoGlide, pulled through, and unfolded in imaging dishes. Inverted fluorescent microscopy was performed, and ECL was quantified using trainable segmentation software. The prospective clinical series describes the outcomes of consecutive surgeries using the E-DMEK technique. Grafts were pulled through the EndoGlide with forceps and unfolded in the anterior chamber endothelium-down. Our main outcome measure was ECL in both studies.

Results:

In the ex vivo study with 9 human donor corneas, mean ECL was 15.2% ± 5.4% (n = 9). In our clinical series of 69 eyes, leading indications for surgery were pseudophakic/aphakic bullous keratopathy (47.8%), previous failed grafts (23.2%), and Fuchs endothelial dystrophy (18.8%). Rebubbling and primary graft failure rates related to E-DMEK were 11.6% and 1.5%, respectively. Among eyes with at least 6 months of follow-up, mean preoperative endothelial cell density was 2772 (range 2457–3448) cells/mm2, and postoperative endothelial cell density was 1830 (range 541–2545) cells/mm2. Mean ECL was 33.6% (range 7.5–80.4; n = 32) at the 7.1 (range 6–11) months follow-up.

Conclusions:

The ex vivo and pilot clinical studies suggest that E-DMEK shows acceptable rates of ECL, with safe and promising early clinical outcomes.
Maternity Providers' Perspectives on Barriers to Utilization of Intermittent Fetal Monitoring
Authors: Chuey Meagan , De Vries Raymond , Dal Cin Sonya , Low Lisa Kane
Published: January 2020

There are 2 approaches to fetal assessment during labor: continuous electronic fetal monitoring (EFM) and intermittent auscultation (IA). The vast majority of healthy labors in the United States use EFM, despite professional organization recommendations against its use for low-risk pregnancies. This qualitative investigation explores maternity care team members' perspectives on why EFM is the dominant approach to fetal assessment instead of IA. Focus groups comprised of nurses, midwives, and physicians were conducted using a semistructured interview guide. Transcripts were analyzed using directed content analysis to identify themes related to clinical and nonclinical factors influencing the type of fetal assessment employed during labor. Seven focus groups with a total of 41 participants were completed. Seven themes were identified: clinical environment; technology; policies, procedures, and evidence-based protocols; patient-centered influences; fear of liability; providers as members of healthcare team; and deflection of responsibility. All maternity care team members had knowledge of the evidence base supporting IA use for low-risk care. Nurses identified unique challenges in having agency over monitoring decision making and executing best practices. Improved communication among team members can facilitate evidence-based approaches to IA use, facilitating increased utilization for low-risk labor care.
New pharmacological treatments for heart failure with reduced ejection fraction (HFrEF)
Authors: Li Heng , Duan Yuting , Chen Benfa , Zhao Yu , Su Weiping , Wang Shanhua , Wu Jiaming , Lu Liming
Published: January 2020

Background:

Heart failure with reduced ejection fraction (HFrEF) has contributed to an increasing number of deaths and readmissions over the past few decades. Despite the appearance of standard treatments, including diuretics, β-receptor blockers and angiotensin-converting enzyme inhibitor (ACEI), there are still a large number of patients who have progressive deterioration of heart function and, inevitably, end-stage heart failure. In recent years, new medications for treating chronic heart failure have been clinically applied, but there is controversy surrounding drug selection and whether patients with HFrEF benefit from these medications. Therefore, we aimed to compare and rank different new pharmacological treatments in patients with HFrEF.

Methods:

We performed a network meta-analysis to identify both direct and indirect evidence from relevant studies. We searched MEDLINE, EMBASE, and PsycINFO through the OVID database and CENTRAL through the Cochrane Library for clinical randomized controlled trials investigating new pharmacological treatments in patients with HFrEF published up to September 30, 2018. We included trials of ivabradine, levosimendan, omega-3, tolvaptan, recombinant human B-type natriuretic peptide (rhBNP), isosorbide dinitrate and hydralazine (ISDN/HYD) and angiotensin-neprilysin inhibition (LCZ696). We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool. Based on these items, more than half of the entries were judged as having an overall low to moderate risk of bias; the remaining studies had a high or unclear risk of bias. The outcomes investigated were left ventricle ejection fraction (LVEF %), heart rate (HR) and serum level of B-type natriuretic peptide (BNP). We performed a random-effects network meta-analysis within a Bayesian framework.

Results:

We deemed 32 trials to be eligible that included 3810 patients and 32 treatments. Overall, 32 (94.1%) trials had a low to moderate risk of bias, while 2 (5.9%) trials had a high risk of bias. The quality of the included studies was rated as low in regard to allocation concealment and blinding and high in regard to other domains according to the Cochrane tools. As for increasing LVEF%, levosimendan was better than placebo (–3.77 (–4.96, –2.43)) and was the best intervention for improving ventricle contraction. As for controlling HR, n3-PUFA was better than placebo (4.01 (–0.44, 8.48)) and was the best choice for regulating HR. As for decreasing BNP, omega-3 was better than placebo (941.99 (–47.48, 1952.89) and was the best therapy for improving ventricle wall tension.

Conclusions:

Our study confirmed the effectiveness of the included new pharmacological treatments for optimizing the structural performance and improving the cardiac function in the management of patients with HFrEF and recommended several interventions for clinical practice.
Quantifying the depth of anesthesia based on brain activity signal modeling
Authors: Huh Hyub , Park Sang-Hyun , Yu Joon Ho , Hong Jisu , Lee Mee Ju , Cho Jang Eun , Lim Choon Hak , Lee Hye Won , Kim Jun Beom , Yang Kyung-Sook , Yoon Seung Zhoo
Published: January 2020

Various methods of assessing the depth of anesthesia (DoA) and reducing intraoperative awareness during general anesthesia have been extensively studied in anesthesiology. However, most of the DoA monitors do not include brain activity signal modeling. Here, we propose a new algorithm termed the cortical activity index (CAI) based on the brain activity signals. In this study, we enrolled 32 patients who underwent laparoscopic cholecystectomy. Raw electroencephalography (EEG) signals were acquired at a sampling rate of 128 Hz using BIS-VISTATM with standard bispectral index (BIS) sensors. All data were stored on a computer for further analysis. The similarities and difference among spectral entropy, the BIS, and CAI were analyzed. Pearson correlation coefficient between the BIS and CAI was 0.825. The result of fitting the semiparametric regression models is the method CAI estimate (−0.00995; P = .0341). It is the estimated difference in the mean of the dependent variable between method BIS and CAI. The CAI algorithm, a simple and intuitive algorithm based on brain activity signal modeling, suggests an intrinsic relationship between the DoA and the EEG waveform. We suggest that the CAI algorithm might be used to quantify the DoA.
Non-specific chronic low back pain and physical activity: A comparison of postural control and hip muscle isometric strength
Authors: Alsufiany Muhsen B. , Lohman Everett B. , Daher Noha S. , Gang Gina R. , Shallan Amjad I. , Jaber Hatem M.
Published: January 2020

Most research on sedentary lifestyle has focused on pain and disability, while neuromuscular outcomes (postural control and strength) have received less attention. The objective of the study was to determine whether low level of physical activity is negatively associated with measures of lower body muscular strength and postural control in individuals with and without non-specific chronic low back pain (NSCLBP).

Twenty-four subjects with NSCLBP (28.8 ± 5.9 years) and 24 age, gender, and body mass index matched healthy controls participated in the study. Subjects were sub-classified into 4 subgroups based on their physical activity level: Non-active NSCLBP; Active NSCLBP; Non-active healthy control; and Active healthy control. Each subgroup consisted of 12 subjects. Peak force of hip muscles strength was assessed using a handheld dynamometer. Postural control was assessed using computerized posturography and the Y Balance Test.

There was no significant group by physical activity interaction for strength and static and dynamic postural control, except for static control during left single leg stance with eyes closed (P = .029). However, there was a significant difference in strength and postural control by physical activity (P < .05). Postural control and peak force of hip muscles strength were significantly associated with physical activity (r ranged from 0.50 to 0.66, P < .001 and r ranged from 0.40 to 0.59, P < .05, respectively).

Postural control and hip strength were independently related to physical activity behavior. A sedentary behavior may be an important risk factor for impaired postural control and hip muscles strength, and that physical fitness is vital to neuromuscular outcomes.
Comparison between using INTEGRA and manual method in determining axis for intraocular lens implantation
Authors: Jaworski Marcin , Wyględowska-Promieńska Dorota , Jaworski Piotr , Jaskot Krzysztof , Bieda Robert , Packard Richard
Published: January 2020

The aim of this study was to explore the efficacy, repeatability, and efficiency of a new intraoperative contactless device (INTEGRA Optomed, Chorzów, Poland) for determining the axis for toric intraocular lens implantation and then to compare this with that determined using a manual method.

This study was conducted at the Ophthalmological Center for Children and Adults Optomed, Chorzów, Poland.

This nonrandomized, retrospective, observational study included 20 eyes of 12 patients (5 males and 7 females) who had toric intraocular lens implanted. A video recording of each surgery using the INTEGRA system was made showing the analysis. The surgeon and one of the researchers then independently assessed the location of the implant axes determined with both digital and manual slit-lamp methods, and compared them.

The implantation axes suggested for both the manual and INTEGRA methods were similar. The median axis disparities were 0.0 degree and 0.5 degree, and standard deviations were 0.61 and 0.81 for researcher 1 and 2, respectively. The dominant value was 0.0 in both groups. The INTEGRA axis designation was not statistically different from the manual method (level of significance: α < 0.01).

The INTEGRA system is a digital ink-free device for image tracking scleral vessels. It was helpful for determining the implantation axis in a precise and repeatable manner, and measurements were comparable with a manual technique.
Fertility-preserving local excision under a hysteroscope with combined chemotherapy in a 6-year-old child with clear cell adenocarcinoma of the cervix
Authors: Su Yuehui , Zhang Chunyan , Hou Wenjing , Liou Yuligh , Chen Yueyue , Xie Ya , Zhang Dongya , Ji Pengcheng , Chen Renyin , Jiang Guozhong , Zhang Mengzhen
Published: January 2020

Introduction:

Clear cell adenocarcinoma of the cervix (CCAC), a rare and more severe type of gynecological cancer, is especially rare in pediatric patients. Traditionally, surgery following chemotherapy (CT) and radiation therapy is the preferred treatment for CCAC; however, patients have poor 5-year survival rates than other types of cervical cancers.

Patient concerns:

A 6-year-old girl with a history of vaginal discharge for 18 months was diagnosed with CCAC by histological examination. Her parents refused the traditional treatment of radical hysterectomy and lymph node dissection because of her young age.

Diagnosis:

The patient's tests revealed negative human papilloma virus and negative methylated paired box 1 gene results. The tumor mass histopathology revealed stage IIA1 CCAC that originated from the cervix.

Interventions:

Tumor mass excision with preservation of the cervix by electrosurgical biopsy under hysteroscopy was performed. Four cycles of docetaxel and oxaliplatin CT were administered every 3 weeks.

Outcomes:

No signs of recurrence were observed in the 28 months after final treatment and diagnosis on magnetic resonance imaging, color ultrasonic imaging, and gynecological examination. Serologic tumor biomarkers were also within normal ranges.

Conclusions:

This is the first reported CCAC case in which the primary treatment included electrosurgical biopsy of the polypoid mass under hysteroscopy, followed by CT without traditional treatment: radical surgery with pelvic and/or lymphadenectomy for fertility preservation. This is a new treatment approach for young CCAC patients without the use of surgery.
Zenker's diverticulum treated with submucosal tunneling endoscopic septum division surgery
Authors: Shen Baile , Jiang Haizhong , Li Zhuoya , Wang Zheng , Song Haojun , Ding Xiaoyun
Published: January 2020

Introduction:

Zenker's diverticulum (ZD) refers to a pouch-like structure similar to the esophageal lumen formed from the herniation of the esophageal mucosa; this structure makes it difficult for food to pass through the esophagus to the stomach. The development of endoscopic technology has made minimally invasive surgical treatments for ZD possible.

Patient concerns:

A female 72-year-old patient was admitted to our hospital due to recurrent dysphagia for more than 5 years. A 62-year-old female patient underwent a gastroscopic examination due to recurrent dysphagia for 10 years and aggravated dysphagia accompanied by bad breath for 1 year.

Diagnosis:

A significant diverticulum with food residue at the entrance of the esophagus was found on gastroscopy in both cases.

Interventions:

After completing a relevant examination and excluding surgical contraindications, both patients underwent submucosal tunneling endoscopic septum division.

Outcomes:

Both patients were discharged after symptoms alleviated on postoperative day 4. A 3-month follow-up gastroscopy showed the disappearance of the diverticulum and recovery of the esophageal anatomical structure. No symptom relapse was found at the 6-month follow-up assessment.

Conclusion:

Submucosal tunneling endoscopic septum division has become the most common minimally invasive treatment option. It is efficient and safe for relieving symptomatic ZD in the short term.
Cardiac adverse events of PD-1 and PD-L1 inhibitors in cancer protocol for a systematic review and network meta-analysis
Authors: Han Deting , Dong Jianyong , Li Honglin , Ma Tao , Yu Wenjun , Song Lucheng
Published: January 2020

Introduction:

Programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors have been increasingly used in the treatment of cancer. Immunosuppressive therapy can control the cancer well and is suitable for the moderate to severe diseases. However, according to clinical observation, immune-related cardiac adverse events against PD-1or/and PD-L1 are inevitable, but generally reversible. Understanding the cardiac adverse events of PD-1 or/and PD-L1 inhibitors is crucial to improve the anti-cancer efficacy and ensure the life safety of patients. The variability of cardiac adverse events between different immunosuppressants and different cancers is not clear.

Methods and analysis:

This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will search the following electronic bibliographic databases: PubMed, Cochrane Library, EMBASE databases and ClinicalTrials.gov from their inception to December 2019. We will use a combination of Medical Subject Heading, and free-text terms with various synonyms to search based on the Eligibility criteria. We will include RCTs on PD-1 or/and PD-L1 inhibitors therapy to analyze. In addition, our study will include some clinical trials. All relevant RCTs will be included, such as early phase I/II, phase III experimental trials, prospective and retrospective observational studies. According to the inclusion and exclusion criteria outlined above, the full texts of each eligible study will be retrieved for further identification by one reviewer. Two authors will screen the titles and abstracts of all records retrieved in above electronic databases independently to find potentially eligible reviews. Data will be extracted by 2 reviewers independently using a pre-designed data extraction form. The other reviewer will validate data. I-square (I2) test, substantial heterogeneity, sensitivity analysis and publication bias assessment will be performed accordingly. For our network meta-analysis, we will use Stata 15.0 and WinBUGS 1.4.3.

Ethics and dissemination:

Ethics approval and patient consent would be not required because the data of this network meta-analysis mainly are obtained from existing resources. This network meta-analysis will be published in a peer-reviewed journal.

PROSPERO number:

CRD42019142865
Detecting trisomy in products of conception from first-trimester spontaneous miscarriages by next-generation sequencing (NGS)
Authors: Xu Jing , Chen Min , Liu Qi Yun , Hu Shun Qin , Li Li Rui , Li Jia , Ma Run Mei
Published: January 2020

Miscarriage is the spontaneous loss of a clinically established intrauterine pregnancy before the fetus has reached viability. In order to compare the performance of traditional G banding karyotyping with next-generation sequencing (NGS) for detecting common trisomies in products of conception (POC). Chromosome abnormalities were detected by high-resolution G banding karyotyping and NGS. A total of 48 miscarriage samples, including 20 samples without karyotype result and 28 with karyotype results were selected and coded for analysis by NGS. The multiplex PCR analysis of maternal and miscarriage DNA for single nucleotide polymorphism (SNP) markers were used to simultaneously monitor maternal cell contamination (MCC), chromosomal status, and sex of the miscarriage tissue. NGS detection results of 21 chromosome abnormalities were consisted with that in karyotyping examination. These chromosome abnormalities samples included 9 chromosome 16 trisomies, 3 chromosome 22 trisomies, 2 chromosome 7 trisomies, 2 chromosome 18 trisomies, 1 chromosome 4 trisomies, one chromosome 10 trisomies, 1 chromosome 13 trisomies, 1 chromosome 15 trisomies and 1 sex chromosomal aneuploidies (45, X). Meanwhile, NGS analysis of seven chromosome normalities was adapted to the karyotyping examination. Therefore, NGS combined with multiplex PCR is an effective method to test trisomies in POC. The results mentioned above will contribute to a detailed understanding of the first-trimester spontaneous miscarriages.
Smoking and alcohol drinking and risk of non-union or delayed union after fractures
Authors: Xu Bin , Chen Lingxiao , Lee Jae Hyup
Published: January 2020

Introduction:

To the best of our knowledge, there is no consensus on dose–response between smoking, alcohol drinking, and bone healing. The aim of the present study is to conduct a comprehensive systematic review and dose–response meta-analysis of studies to estimate the influence of smoking and alcohol use on the success of non-pathologic bone fracture healing in adult patients.

Methods:

A systematic search will be performed using MEDLINE, EMBASE and Cochrane CENTRAL, CINAHL, and AMED databases to identify randomized controlled trials and observational studies which have assessed the effect of smoking or alcohol drinking on fracture healing. Primary outcomes include delayed union or nonunion rate and time to union. Secondary outcomes are common complications which occur during bone healing including malunion and wound infection. Risk of bias will be evaluated using the Quality In Prognosis Studies (QUIPS) tool for quality assessment of each study. Dose–response meta-analysis will be performed between smoking, alcohol drinking, and bone healing. Evaluation of the quality of evidence will be conducted using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results:

The present study will assess the effects of smoking and alcohol drinking on non-pathologic bone fracture healing in adult patients.

Conclusion:

We hope that this systematic review and dose–response meta-analysis will provide high quality evidence on dose–response between smoking, alcohol drinking, and bone fracture healing.

PROSPERO registration number:

CRD42019131454.
Association between C-reactive protein level and subsequent risk of ovarian cancer
Authors: Wang Yan , Zhang Zhiming , Wang Jing , Zhang Xiaowei
Published: January 2020

Background:

Though studies have shown association between C-reactive protein (CRP) level and the risk of ovarian cancer (OC), there have been some inconsistencies. The current metaanalysis was conducted to study the relationship between CRP and OC.

Patients and methods:

Three electronic databases of PubMed, Embase, and Cochrane Library were searched for prospective studies of OC from inception till May 2018. Relative risk (RR) was summarized using random-effects model, and the results of sensitivity, subgroup analyses, and publication biases were also calculated.

Results:

A total of 13 cohorts involving 1,852 OC patients were included for the final meta-analysis. The summary RRs indicated that high CRP was associated with an increased risk of all invasive OC (RR:1.36; 95% confidence interval [CI]:1.03–1.80; P = .032), while moderate CRP showed no significant impact on the risk of all invasive OC compared with low CRP (RR:1.17; 95% CI:0.97–1.41; P = .107). High (RR: 1.42; 95% CI: 0.85–2.37; P = .183) or moderate (RR: 1.29; 95% CI: 0.94–1.77; P = .119) CRP levels showed little or no effect on serous OC. Similarly, no significant differences for the comparisons of high versus low (RR: 1.82; 95% CI: 0.27–12.42; P = .540) or moderate versus low (RR: 0.72; 95% CI: 0.31–1.69; P = .455) CRP levels for the risk of mucinous OC were observed. Moreover, high (RR: 0.58; 95% CI: 0.13–2.54; P = .471) or moderate (RR: 0.81; 95% CI: 0.44–1.47; P = .484) CRP levels were not associated with the risk of endometrioid OC compared with low CRP levels.

Conclusion:

High CRP levels were associated with increased risk of invasive OC. The risk of other OC types with CRP levels showed no association.
Concurrent anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and IgG4-associated tubulointerstitial nephritis with C3 glomerulonephritis
Authors: Feng Jianan , Yu Jinyu , Wang Xueyao , Wang Yue , Liu Yang , Xu Zhonggao , Sun Weixia
Published: January 2020

Rationale:

IgG4-related disease (IgG4-RD) is a slowly progressing inflammatory disease that can involve multiple organ systems. There is considerable overlap between IgG4-RDs and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Herein, we present an unusual case of IgG4-associated tubulointerstitial nephritis (IgG4-TIN) and ANCA-associated glomerulonephritis (ANCA-GN) co-occurring with C3 glomerulonephritis (C3GN).

Patient concerns:

A 72-year-old male was admitted to hospital because of fever and fatigue. He was diagnosed with elevated serum creatinine and IgG4 levels, and was positive for ANCA.

Diagnosis:

Initially, the pathology supported a diagnosis of IgG4-TIN and ANCA-GN; however, further examination revealed he also had C3GN.

Interventions:

The patient was treated with methylprednisolone and cyclophosphamide and received regular follow-up care.

Outcomes:

After treatment, the patient no longer exhibited fever or fatigue and had no complications. The seven-month follow-up showed downward trends in IgG4 and MPO-ANCA levels and stable 24-hour urine protein, serum creatinine levels.

Lessons:

Anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and IgG4-associated tubulointerstitial nephritis with C3glomerulonephritis rarely occur simultaneously. Laboratory analysis and pathology are both needed to ensure diagnostic accuracy. However, in this case, the three diseases overlapped to such a large extent that achieving a definitive diagnosis was particularly challenging. Timely and accurate diagnosis is crucial for selecting the best treatment course and optimizing patient outcome.
Risk assessment of first upper gastrointestinal bleeding using computerized tomoscanning in esophageal varices patients with cirrhosis and portal hypertension
Authors: Xie Wei , Chen Fa-xiang , Zhu Li-Yao , Wen Cheng-Cai , Zhang Xin
Published: January 2020

To evaluate the risk of first upper gastrointestinal bleeding by computerized tomoscanning (CT) for esophageal varices patients with cirrhotic portal hypertension.

One hundred thirty two esophageal varices patients with cirrhotic portal hypertension who are also complicated with gastrointestinal bleeding were recruited as bleeding group, while another 132 patients without bleeding as non-bleeding group. The diameter of esophageal varices, number of vascular sections, and total area of blood vessels were measured by CT scanning. The sensitivity and specificity of these indicators were calculated, and Youden index was adjusted with the critical point.

The diameter of esophageal varices was 7.83 ± 2.76 mm in bleeding group, and 6.57 ± 3.42 mm in non-bleeding group. The Youden index was 0.32 with the critical point 5.55 mm. The area under the receiver operating characteristics (AUROC) was 0.72. The number of venous vessels was 4.5 ± 2 in bleeding group, whereas being 4 ± 2 in non-bleeding group. The Youden index was 0.35 with a critical point 4, and the area under the curve (AUC) was 0.68. The blood vessel area was 1.73 ± 1.15 cm2 in bleeding group, and 1.12 ± 0.89 cm2 in non-bleeding group. The Youden index was 0.48 with the critical point being 1.03 cm2, and corresponding AUC was 0.82.

Among all 3 indicators of the total area, diameter, and number of sections of the esophageal varices, the total area of esophageal varices showed more accuracy as a potential and novel indicator for bleeding prediction.
Clinical characteristics of cytomegalovirus gastritis
Authors: Chen Dan , Zhao Ruijie , Cao Wei , Zhou Weixun , Jiang Ying , Zhang Shangzhu , Chen Yang , Fei Guijun , Li Ji , Qian Jiaming
Published: January 2020

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.

Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.

Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4+) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.

CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.
Soluble ST2 is associated with increased carotid intima-media thickness in patients with type 2 diabetes mellitus
Authors: Hu Xiaolei , Zhang Hengyan , Song Yuan , Yang Qingqing , Zhuang Langen , Jin Guoxi , Zhang Shirong , Sun Weihua , Shi Zhaoming
Published: January 2020

Soluble suppression of tumorigenicity 2 (sST2) is a free form of membrane-bound ST2, which is a member of the interleukin-1 receptor family. Previous research has shown that sST2 is associated with diabetes, but cardiovascular risk factors have not been established.

To analyze the relationship between sST2 and carotid intima-media thickness (CIMT) in patients with type 2 diabetes mellitus (T2DM).

After screening, a total of 118 subjects with T2DM were divided into 2 groups according to the measurement of CIMT (normal CIMT (NCIMT), n = 58; abnormal CIMT (ACIMT), n = 60), and 60 healthy subjects (normal control (NC), n = 60) were recruited in this study. CIMT was measured by a color Doppler ultrasound, and sST2 and other metabolic parameters were measured as well.

The median concentration of sST2 was elevated in the ACIMT group (31.30 ng/ml) compared with the NCIMT group (28.29 ng/ml, P < .01) and the NC group (20.15 ng/ml, P < .01). After adjustment for age and sex, log sST2 was strongly associated with smoking history (β = 0.197, 95% CI, 0.084–0.311, P < .01), FPG level (β = 0.302, 95% CI, 0.162–0.442, P < .01) and HbA1c level (β = 0.296, 95% CI, 0.165–0.426, P < .01) and negatively correlated with HDL level (β = −0.153, 95% CI, −0.259 to −0.046, P < .01). Furthermore, sST2 level was a risk factor for increased CIMT in patients with T2DM.

Increased sST2 level not only was associated with indicators of glucose and lipid metabolism but also was a risk factor for increased CIMT in patients with T2DM. Thus, sST2 may be a potential novel marker to assess the progression of diabetic macrovascular complications.
Inter-segmental coordination of the spine is altered during lifting in patients with ankylosing spondylitis
Authors: Lin Huijie , Seerden Stefan , Zhang Xianyi , Fu Weijie , Vanwanseele Benedicte
Published: January 2020

The abnormal inter-segmental coordination of the spine during lifting could be used to monitor disease progression and rehabilitation efficacy in patients with ankylosing spondylitis (AS). This study aimed to compare the inter-segmental coordination patterns and variability of the spine during lifting between patients with AS (n = 9) and control (n = 15) groups.

Continuous relative (CRP) and deviation (DP) phases between each segment of the spine (two lumbar and three thorax segments) and lumbosacral joint were calculated. The CRP and DP curves among participants were decomposed into few functional principal components (FPC) via functional principal component analysis (FPCA). The FPC score of CRP or DP of the two groups were compared, and its relationship with the indexes of spinal mobility was investigated.

Compared with the control group, the AS patients showed more anti-phase coordination patterns in each relative upper spine segment and lumbosacral joint. In addition, either less or more variation was found in the coordination of each relative lower spine segment and lumbosacral joint during different time periods of lifting for these patients. Some cases were considerably related to spinal mobility.

the inter-segmental coordination of the spine was altered during lifting in AS patients to enable movement, albeit inefficient and might cause spinal mobility impairment.