bluuebunny/crossref_metadata_2025 huggingface dataset:
Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs*
Authors: Ashana Deepshikha Charan , Umscheid Craig A. , Stephens-Shields Alisa J. , Kohn Rachel , Madden Vanessa , Harhay Michael O. , Chen Yong , Kerlin Meeta Prasad
Published: August 2019

Objectives:

As ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients.

Design:

Retrospective cohort study.

Setting:

Pennsylvania ICUs.

Patients:

Medicare fee-for-service beneficiaries.

Interventions:

Availability of any of one hospital-based resource (palliative care consultants) or four ICU-based resources (protocol for withdrawal of life-sustaining therapy, triggers for automated palliative care consultation, protocol for family meetings, and palliative care clinicians embedded in ICU rounds).

Measurements and Main Results:

In mixed-effects regression analyses, admission to a hospital with end-of-life resources was not associated with mortality, length of stay, or treatment intensity (mechanical ventilation, hemodialysis, tracheostomy, gastrostomy, artificial nutrition, or cardiopulmonary resuscitation); however, it was associated with a higher likelihood of discharge to hospice (odds ratio, 1.58; 95% CI, 1.11–2.24), an effect that was driven by ICU-based resources (odds ratio, 1.37; 95% CI, 1.04–1.81) rather than hospital-based resources (odds ratio, 1.19; 95% CI, 0.83–1.71). Instrumental variable analysis using differential distance (defined as the additional travel distance beyond the hospital closest to a patient’s home needed to reach a hospital with end-of-life resources) demonstrated that among those for whom differential distance would influence receipt of end-of-life resources, admission to a hospital with such resources was not associated with any outcome.

Conclusions:

ICU-based end-of-life care resources do not appear to change mortality but are associated with increased hospice utilization. Given that this finding was not confirmed by the instrumental variable analysis, future studies should attempt to verify this finding, and identify specific resources or processes of care that impact the care of ICU patients at the end of life.
Strategies for Reducing Final Surgical Defect Sizes in the Treatment of Lentigo Maligna
Authors: Sampson Blake P. , Bowen Glen M.
Published: August 2019

BACKGROUND

Lentigo maligna (LM) is associated with disproportionately high surgical morbidity.

OBJECTIVE

The authors report on 2 strategies to reduce the surgical morbidity associated with LM.

METHODS

Forty LM lesions were removed with excisional biopsies without margins and closed with purse-string sutures. Invasive cases underwent staged excisions with 10-mm margins. Cases without invasion were treated with neoadjuvant topical imiquimod 5% cream (5 d/wk × 8 weeks) followed by conservative staged excisions with 2-mm margins using radial sections stained with hematoxylin and eosin and immunostaining with Mart-1, with or without SOX10.

RESULTS

Invasion was detected in 12/40 (30%) of the excisional biopsy specimens (average depth 0.45 mm). No invasion was detected in 28/40 (70%). All 24 patients who completed neoadjuvant topical imiquimod 5% cream before staged excisions had negative first-stage margins at 2 mm. Compared with average published margins for LM, this represents a 71.4% reduction in the required margin and an average reduction in the final surgical defect by 74%.

CONCLUSION

LM treatment by excisional biopsies with a purse-string closure enables accurate tumor staging and contracts the tumor footprint to its minimal size. Subsequent neoadjuvant imiquimod followed by a conservative staged excision with 2-mm margins allows for removal of LM with decreased surgical morbidity.
Long Noncoding RNA NEAT1 Promotes Myocardiocyte Apoptosis and Suppresses Proliferation Through Regulation of miR-129-5p
Authors: Wei Qi , Zhou Huan-Yu , Shi Xiao-Dong , Cao Hong-Yan , Qin Ling
Published: August 2019

Recent studies have revealed the important role of long noncoding RNAs (lncRNAs) in heart development and pathogenesis. This study was aimed to investigate the role of NEAT1 in hypoxia-induced cardiac injury and explore its possible molecular mechanism. Real-time PCR (RT-PCR) was used to determine the relative RNA expression of NEAT1 and its potential target microRNA, miR-129-5p, in the plasma of patients with acute myocardial infarction, heart failure, and angina, as well as in H2O2-treated H9c2 cells. The role of NEAT1 overexpression or inhibition in H9c2 cell migration and proliferation was assessed by transwell assay and Edu staining, respectively. Collagen deposition and apoptosis were evaluated by Western blot detection of collagen and apoptotic proteins, including Capase3, Bax, and Bcl2. We showed that H2O2 treatment significantly decreased H9c2 cell migration and proliferation while increasing H9c2 cell apoptosis. Inhibition of NEAT1 attenuated the cell apoptosis and alleviated proliferation inhibition induced by hypoxia. Bioinformatics analysis showed that miR-129-5p was the direct target of NEAT1, which was confirmed by luciferase assay. NEAT1 upregulation aggravated apoptosis by downregulating miR-129-5p. In conclusion, we uncovered a novel NEAT1-miR-129 axis and its implication in H2O2-induced heart failure.
Dietary Apigenin Reduces Induction of LOX-1 and NLRP3 Expression, Leukocyte Adhesion, and Acetylated Low-Density Lipoprotein Uptake in Human Endothelial Cells Exposed to Trimethylamine-N-Oxide
Authors: Yamagata Kazuo , Hashiguchi Kazuki , Yamamoto Hiroaki , Tagami Motoki
Published: August 2019

By inducing vascular inflammation, trimethylamine-N-oxide (TMAO) is associated with endothelial dysfunction, atherosclerosis, and enhanced risk of cardiovascular diseases in humans. However, the underlying mechanisms are unknown. Expression of several genes related to arteriosclerosis, inflammasomes, and endothelial dysfunction was quantified by polymerase chain reaction after exposure to TMAO. LOX-1, ICAM-1, and NLRP3 were also quantified by Western blot, whereas leukocytic adhesion was examined using fluorescently labeled U937 cells. Scavenger receptors, adhesion molecules, and other genes associated with atherosclerosis were induced in endothelial cells exposed to TMAO. On the other hand, apigenin, a flavonoid that is abundant in parsley and celery, prevents initial arteriosclerosis events in endothelial cells. Apigenin reversed the effects of TMAO on mRNA expression of LOX-1, SREC, SR-PSOX, NLRP3, ASC, TXNIP, VCAM-1, ICAM-1, and MCP-1, as well as protein expression of LOX-1, the adhesion molecule ICAM-1, and the inflammasome protein NLRP3. Apigenin also suppressed leukocyte adhesion and uptake of acetylated low-density lipoprotein. The data indicate that expression of scavenger receptors and adhesion molecules in response to TMAO, along with formation of NLRP3 inflammasomes, may drive endothelial dysfunction through uptake of acetylated low-density lipoprotein and lymphocyte adhesion. Apigenin reverses these effects, implying that it may also prevent arteriosclerosis.
Monitoring of Adalimumab Concentrations at Home in Patients with Inflammatory Bowel Disease Using Dried Blood Samples
Authors: Berends Sophie E. , Bloem Karien , de Vries Annick , Schaap Tiny , Rispens Theo , Strik Anne S. , Talwar Rawina , Löwenberg Mark , D'Haens Geert R. , Mathôt Ron A.
Published: August 2019

Background:

Adalimumab (ADL) is a subcutaneously administered anti–tumor necrosis factor (TNF) agent used in the treatment of patients with inflammatory bowel disease. Higher ADL trough concentrations are associated with improved clinical and endoscopic outcomes. Therapeutic drug monitoring (TDM) of ADL might be facilitated by using dried blood samples (DBSs) from capillary blood obtained at home. The study aimed to compare serum ADL concentrations obtained through venipuncture to ADL concentrations in DBSs.

Methods:

Patients with Crohn's disease and ulcerative colitis receiving induction or maintenance ADL therapy were enrolled in this prospective cohort study. Blood was obtained through venipuncture and through DBSs during a regular outpatient visit (time point 1). Just before the next ADL administration, patients performed DBSs at home (time point 2). For this time point, serum ADL concentrations were estimated by Bayesian analysis.

Results:

Thirty-three patients with inflammatory bowel disease were enrolled. During the outpatient visit, samples were obtained after a median (interquartile range) of 6 (4–10) days after the last ADL dose. A high correlation was found between DBSs and venipuncture results (Pearson correlation: ≥0.96), without any clinically relevant bias. For DBSs performed by patients at home, initial comparison showed a moderate correlation between DBS results and predicted ADL serum concentrations (Pearson correlation: 0.51), although no bias was present. In addition, DBS eluate results compared with predicted ADL serum concentrations showed a mean absolute percentage error (ie, accuracy) of 45%.

Conclusions:

High correlations were found between ADL serum concentrations obtained through conventional venipuncture and DBSs, which indicates that this home-based test can facilitate therapeutic drug monitoring–based ADL dose adjustments in daily practice.
ICSI from the beginning to where we are today: are we abusing ICSI?
Authors: Keating Derek , Cheung Stephanie , Parrella Alessandra , Xie Philip , Rosenwaks Zev , Palermo Gianpiero D.
Published: August 2019

Intracytoplasmic sperm injection (ICSI) was first described in 1992 providing couples, struggling with male factor infertility resulting in complete and unexpected fertilization failure with standard in vitro insemination, the chance to conceive a child of their own. In the 2 and a half decades since, ICSI has gained popularity worldwide and has become the most utilized insemination method at our center due to its versatility and abundance of indications. In this brief report, we examine the achievements and accomplishments of ICSI while we also question whether ICSI may be suffering abuse from overuse.
COMPARISON OF MULTICOLOR IMAGING AND COLOR FUNDUS PHOTOGRAPHY IN THE DETECTION OF PATHOLOGICAL FINDINGS IN EYES WITH POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Tan Anna C. S. , Yanagi Yasuo , Cheung Gemmy Chui Ming
Published: August 2019

Purpose:

To compare the appearance and frequency of detection of common features in eyes with polypoidal choroidal vasculopathy using multicolor imaging (MC) or color fundus photography (CFP).

Methods:

Thirty-eight eyes with indocyanine green angiography–proven polypoidal choroidal vasculopathy, imaged with both MC and CFP, were graded by three independent retinal specialists. The presence of five prespecified pathological features (blood, exudation, polypoidal lesions, pigment epithelial detachments, and atrophy) was graded on each modality independently. Multimodal imaging including optical coherence tomography, fluorescein, and indocyanine green angiography was used as the gold standard.

Results:

Overall, there was no statistically significant difference in the ability of MC imaging compared with CFP in detecting the pathological features. Polypoidal lesions appear as small, dark green, round lesions which have higher contrast on MC compared with a nodular orange appearance seen on CFP. Polypoidal lesions can be identified noninvasively using both MC and CFP in about half of the cases.

Conclusion:

There are differences in the appearance of polypoidal choroidal vasculopathy–associated features on MC compared with CFP. Both modalities are comparable for the detection of pathological features in eyes with polypoidal choroidal vasculopathy. MC imaging may be considered as an alternative to CFP.
UNUSUAL CAUSE OF BRANCH RETINAL ARTERY OCCLUSION: POLYCYTHEMIA IN A TRANSGENDER MAN FROM UNREGULATED TESTOSTERONE USE
Authors: Choy Darren Mun Yoong , Voon Li-Wern , Teoh Stephen C. B.
Published: August 2019

Purpose:

We report a transgender patient with branch retinal artery occlusion who had secondary polycythemia from unregulated testosterone injections and review the literature on the mechanisms of supraphysiologic and standard doses of testosterone causing a hypercoagulable state.

Methods:

Case report.

Results:

A 45-year-old Chinese transgender man with no medical history presented with a 1-week history of a scotoma in his left eye vision. Ophthalmologic examination revealed retinal pallor and edema along the superotemporal arteriole in the left eye. Optical coherence tomography showed increased thickness of the inner retinal layers of the superotemporal retina. Fluorescein angiography demonstrated an arm–retina time of 1 minute and 43 seconds, with no vascular sheathing and capillary fallout. A diagnosis of left superotemporal branch retinal artery occlusion was made. Initial blood tests revealed a hemoglobin level of 19.3 g/dL (11.8-14.6 g/dL), hematocrit of 62% (34.3–43.0%), and erythrocytes of 6.56 × 1012/L (3.7–4.8 × 1012/L). He revealed later that he had been on weekly testosterone injections (testosterone enanthate 250-mg depot injection) since 2011. He was also exposed to a moderately high altitude, when his symptoms occurred, raising the possibility of worsening hypercoagulability resulting in his thrombotic event.

Conclusion:

To the best of our knowledge, this is the first documented case of a trans man who developed branch retinal artery occlusion after self-administering supraphysiological doses of testosterone. In a young patient with no history of cardiovascular risk factors who develops retinal arterial occlusion, other causes such as hypercoagulable syndromes must be excluded. This case warns of the dangers of unregulated testosterone use, especially at supraphysiologic doses, and the risks of thrombotic events from secondary polycythemia.
Depression in Nonhospitalized Jordanian Patients With Coronary Artery Disease
Authors: AL-ZARU Ibtisam M. , ALHALAIQA Fadwa , DALKY Heyam Fawaz , ARRAMADAN Kholoud Ali , BATIHA Abdul-Monim
Published: August 2019

Background:

Patients with coronary artery disease (CAD) are likely to experience depression, which contributes to the burden of disease and is a risk factor for mortality. Patients in outpatient clinics in Jordan are not routinely screened for depression. Significant relationships among patient characteristics must be determined to ascertain the predictors of depression.

Purpose:

The aims of this research were to assess the level of depression symptoms in nonhospitalized patients with CAD; to examine the relationships between depression and relevant sociodemographic, self-reported health history, and patient health perception variables; and to identify possible predictors of depression in Jordan.

Methods:

This cross-sectional study recruited a convenience sample (N = 174) of nonhospitalized outpatients who had been diagnosed with CAD. Self-reported demographic, health history, and health perception information (independent variables) were provided by the participants. The depression scores (dependent variable) for the participants were assessed using the Cardiac Depression Scale. Data were analyzed using descriptive statistics, the chi-square test, Pearson's correlations, and multiple linear regressions.

Results:

Half of the participants reported mild to moderate depression, with 37% reporting severe depression. Predictors of depression included gender (being female), having a concomitant chronic disease, prior surgery, irregular exercise, impaired sexual activity, and self-perceived poor psychological health.

Conclusions/Implications for Practice:

To improve patient outcomes, clinical personnel should screen patients with CAD for depression and offer a combined pharmaceutical and therapeutic treatment intervention. An easy-to-administer instrument to detect depression may be included in the standard patient checkup routine used in clinics. Several patient characteristics were found to significantly affect depression and health outcomes.
The Process of Developing Resilience in Patients With Burn Injuries
Authors: HAN Jing , ZHOU Xue-Ping , LIU Jun-E , YUE Peng , GAO Li
Published: August 2019

Background

Patients with burn injuries resulting in visible disabilities may face negative emotional experiences during rehabilitation. Understanding the development of resilience in these patients may help those who are seeking methods to better adapt to their new situation.

Purpose

This study aimed to explore the development of resilience in patients with burns during their convalescence.

Methods

Ten patients with burn injuries who were convalescing in a general hospital in China were recruited and enrolled as participants. Data were collected using recorded, semistructured in-depth interviews and analyzed following the principles of grounded theory.

Results

The development of resilience in patients with burns included five stages of “black hole,” “introspection,” “integration,” “practice,” and “growth.” Both internal and external protective factors were identified. The internal protective factors included hope, sincerity, will, belief, and curiosity, and the external protective factor was mutual relationships that reflected the qualities of caring, support, sharing, commitment, and intimacy.

Conclusions

Resilience was achieved gradually over several progressive steps through the five stages (black hole, introspection, integration, practice, and growth). The results of this research may provide insights and support to patients who seek to improve their adaptation to new situations.
Clinical characteristics and management of primary granulocytic sarcoma of the breast
Authors: Wu Heng-yu , Liu Lei , Gu Lei , Luo Yong-hui
Published: August 2019

Rationale:

Primary granulocytic sarcoma of the breast is a rare and poor-prognosis malignancy. Clinicians do not have sufficient knowledge of this disease and often misdirect it as other soft tissue sarcomas or inflammation.

Patient concerns:

A 42-year-old female presented with a self-discovered asymptomatic growing and palpable right breast mass that had been present for 4 months.

Diagnoses:

The patient was diagnosed as primary myeloid sarcoma.

Interventions:

The patient received modified radical mastectomy in the right breast and sentinel lymph node biopsy. Pathological diagnosis is primary granulocytic sarcoma. Then the patient accepted acute myeloid leukemia-induction chemotherapy.

Outcomes:

The follow-up of this patient has no evidence of disease progression or spread during 1 year.

Lessons:

Granulocytic sarcoma in the breast tissue is rare. But it still should be considered in the differential diagnosis of any tumor in the breast. The present study discusses comprehensively the clinical and pathological characteristics to improve the understanding of myeloid sarcoma.
Vitamin D concentration and risk of Alzheimer disease
Authors: Yang Kui , Chen Jun , Li Xiaoguang , Zhou Yongning
Published: August 2019

Background:

Considerable controversy exists on the association between serum vitamin D concentrations and Alzheimer disease (AD) risk. This study aimed to synthesize the association of serum vitamin D concentrations with AD in adults.

Methods:

PubMed, Embase, and Cochrane library databases were searched for prospective cohort studies with data on serum vitamin D concentrations and AD risk.

Result:

The studies that reported the adjusted relative risks (RRs) with 95% confidence intervals (CIs) of AD associated with serum vitamin D concentrations were included and subjected to subgroup analyses. Six prospective cohort studies with 1607 AD cases and 21,692 individuals were included in the meta-analysis. In 4 cohort studies with information about serum vitamin D concentrations <25 and 25 to 50 nmol/L, the random effects summary estimate did not show an increased risk of AD after adjustment for the established risk factors, while 3 cohort studies reported the RRs for incident AD per standard deviation (SD) decrease in serum vitamin D concentration and the random effects summary estimate did not show an increased risk of AD after adjustment for the established risk factors.

Conclusions:

The current meta-analysis indicated that serum vitamin D deficiency (<25 nmol/L) or insufficiency (25–50 nmol/L) was not statistically significant and associated with the risk of AD.
Multifocal head and neck amyloidosis as a diagnostic clue of systemic lupus erythematosus (SLE)
Authors: Chen Chih-Hao , Sun Chuan-Hung
Published: August 2019

Rationale:

Amyloidosis accounts for 2% of head and neck tumors. Amyloidosis that develops in the head and neck region is localized amyloidosis. Multifocal amyloidosis in the head and neck region is extremely rare.

Patient concerns:

The patient presented to the clinic of otolaryngology with nasal obstruction, anosmia and left neck mass for several months.

Diagnosis:

A left nasopharynx tumor was revealed under nasopharyngeal scope. Eosinophilic, proteinaceous material was revealed under a pathology scope in the nasopharynx tissue and neck tumor. Congo red staining demonstrated pale congophilic amorphous material with apple-green birefringence under cross-polarized light, and multifocal amyloidosis was diagnosed. Amyloidosis secondary to systemic lupus erythematosus (SLE) was confirmed after a series of investigations.

Interventions:

The patient underwent local excision for multifocal amyloidosis without following management. To control underlying SLE, the patient accepted steroid pulse therapy and immunosuppressants. The patient eventually achieved disease remission.

Outcomes:

During the 6 months of follow-up in the outpatient department of otolaryngology and rheumatology, complications, recurrence of nasopharyngeal amyloidosis, and SLE flare-up were not observed.

Lessons:

Head and neck amyloidosis involving the nasopharynx is a rare presentation of this disease. Head and neck multifocal amyloidosis should be taken as a hint of systemic disease. In head and neck amyloidosis, a comprehensive survey should be performed to clarify the underlying disease predisposing to amyloidosis and organ involvement.
Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines
Authors: Pérez-Panero Alberto J. , Ruiz-Muñoz María , Cuesta-Vargas Antonio I. , Gónzalez-Sánchez Manuel
Published: August 2019

Aim:

Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines.

Methods:

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were “NICE”, “Cinahl”, “Health Guide”, “RNAO”, “Sign”, “PubMed”, “Scopus” and “NCG”. The search terms included were “diabetic foot”, “guideline(s)”, “practice guideline(s)” and “diabetes.”

Results:

Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed.

Conclusions:

The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).
“A contemporary description of staphylococcus aureus prosthetic valve endocarditis. Differences according to the time elapsed from surgery”
Authors: Sáez Carmen , Sarriá Cristina , Vilacosta Isidre , Olmos Carmen , López Javier , García-Granja Pablo Elpidio , Fernández Cristina , de las Cuevas Carmen , Reyes Guillermo , Domínguez Lourdes , San Román Jose Alberto
Published: August 2019

Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity.

This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016.

Fifty percent had a Charlson Index score >5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic stroke was not higher in anticoagulated patients. Twenty-seven percent were methicilin-resistant SA (MRSA). Fifteen of 31 had positive valve culture; it was related to surgery within first 24 hours. At diagnosis, 69% had vegetation (>10 mm in 75%), 21.8% perianular extension, and 20% prosthetic dehiscence. Forty-eight percent had persistent bacteremia, related to nonsurgical treatment. Perianular extension progressed in 18%. Surgery was performed in 35 episodes (12 with stroke). Eleven uncomplicated episodes were managed with medical therapy, 8 survived. In-hospital mortality was 55%, higher in episodes with hemorrhagic stroke (77.8% vs 52.2%, odds ratio 3.2 [0.62–16.55]). Early SAPVE was nosocomial (92%), presented as severe HF (54%), patients were diagnosed and operated on early, 38% died. In intermediate SAPVE (9 weeks–1 year) diagnosis was delayed (24%), patients presented with constitutional syndrome (18%), renal failure (41%), and underwent surgery >72 hours after indication; 53% died. Late SAPVE (>1 year) was related with health care, diagnosis delay, and 60% of deceases.

Left SAPVE frequently affected patients with comorbidity and health care contact. Complications at diagnosis and absence of fever were frequent. Presence of MRSA was high. Positive valve culture was related to early surgery. Paravalvular extension was frequent; vegetations were large, but its absence at diagnosis was common. Some uncomplicated SAPVE episodes were safety treated with medical therapy. Surgery was feasible in patients with stroke. Mortality was high. There were differences in some clinical characteristics and in evolution according to the time elapsed from valve replacement. Prognosis was better in early SAPVE.
Apatinib as an optional treatment in metastatic colorectal cancer
Authors: Li Aiyi , Wang Kong , Xu Aiguo , Wang Gang , Miao Yongchang , Sun Zhichao , Zhang Jingyu
Published: August 2019

Antiangiogenic therapy has shown clinical benefit in metastatic colorectal cancer (mCRC). We aimed to evaluate the efficacy and safety of apatinib in patients who failed standard treatment and to explore potential factors related to its efficacy.

A total of 47 patients were enrolled in this retrospective study. Patients who received apatinib therapy after failure of standard therapy from December 2014 and February 2018 were included. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and treatment-related adverse events were recorded and evaluated.

The median PFS was 3.717 months (95% confidence interval [CI], 3.198–4.235), and the median OS was 7.335 months (95% CI, 6.738–7.932). The disease control rate was 72.34%, and the ORR was 8.51%. The most common grade 3 to 4 adverse reactions were hypertension, proteinuria, hand-foot syndrome, and diarrhea. Multivariate analysis indicated previous antiangiogenic therapy and baseline elevated neutrophil-to-lymphocyte ratio (NLR) as independent prognostic factors.

Apatinib might be a reasonable treatment option with a controlled safety profile for patients with mCRC who have failed standard therapy. Patients who previously received antiangiogenic therapy and who have baseline elevated NLR are more likely to benefit from apatinib.
Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem
Authors: Liu Zeming , Hu Hongpeng , Liu Sikai , Huo Jia , Li Mengnan , Han Yongtai
Published: August 2019

The femoral neck-preserving ratio is crucial in arthroplasty with a collum femoris-preserving (CFP) stem. The aim of our study was to analyze the relationships between the neck-preserving ratio and the short-term radiologic and clinical outcomes of patients who underwent total-hip arthroplasty (THA) with a CFP stem.

The data of 325 hips from January 2015 to December 2016 were retrospectively reviewed. The demographic and radiologic data before and after surgery were obtained from patients. The neck-preserving ratio was defined as the ratio of the preserved femoral neck length to the preoperative femoral neck length. Correlations between the neck-preserving ratio and the radiologic and clinical outcomes of patients were analyzed.

The mean neck-preserving ratio was 66.38 ± 6.91% in the current study. We divided patients into 3 groups according to the neck-preserving ratio: group A (neck-preserving ratio ≤60.00%), group B (60.00% < neck-preserving ratio < 70.00%), group C (neck-preserving ratio ≥70.00%). Radiologic features, including the neck-shaft angle ratio (0.96 ± 0.05), canal fill ratio (0.64 ± 0.07), anterior-posterior offset ratio (1.04 ± 0.10), and lateral offset ratio (2.55 ± 1.56) (ratios of the postoperative values to the preoperative values), and the prevalence of complications was significantly different among the groups (χ
2 = 21.173, P < .001). In the correlation analysis, we found a moderate negative correlation between the neck-preserving ratio and neck-shaft angle ratio (r = −0.308, P < .001) and a slight positive correlation of the neck-preserving ratio with the anterior-posterior offset ratio (r = 0.415, P < .001) and the lateral offset ratio (r = 0.164, P = .003). In the linear regression analyses, the neck-preserving ratio was significantly linearly correlated with the neck-shaft angle ratio (B = −0.232, 95% confidence interval [CI] = −0.311 to −0.154, P < .001), anterior-posterior offset ratio (B = 0.589, 95% CI = 0.447–0.730, P < .001), and lateral offset ratio (B = 3.693, 95% CI = 1.256–6.131, P = .003). However, there was no significant linear correlation between the neck-preserving ratio and the canal fill ratio (B = 0.073, 95% CI = −0.033 to 0.180, P = .174). Logistic regression analyses also showed that a sufficient neck-preserving ratio was a protective factor for periprosthetic femoral fractures (odds ratio [OR] = 0.924, 95% CI = 0.859–0.994, P = .035), dislocations (OR = 0.892, 95% CI = 0.796–0.999, P = .048), and thigh pain (OR = 0.886, 95% CI = 0.818–0.960, P = .003).

For CFP stems, an insufficient neck-preserving ratio is significantly correlated with poor radiologic and clinical outcomes. Therefore, surgeons should be cognizant to preserve a sufficient femoral neck length during surgery to improve the outcomes for patients undergoing THA with CFP stems.
Association between miRNA polymorphisms and susceptibility to brain tumors
Authors: Gao Fu’an , Zhu Yuntao
Published: August 2019

Background:

Previous studies have demonstrated that single-nucleotide polymorphisms (SNPs) in miRNAs are related to the susceptibility to brain tumors, but the conclusions remain controversial. This study was to perform a meta-analysis to re-assess the associations between miRNA SNPs and brain tumor risk.

Methods:

Relevant studies were identified in the databases of PubMed and the Cochrane Library databases. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated to assess the relationships between SNPs and the risk of brain tumors under various genetic models by the STATA software.

Results:

Five studies, containing 2275 cases, and 2323 controls, were included, 4 of which evaluated miR-196a2 (rs11614913), 3 for miR-146a (rs2910164) and 2 for miR-499 (rs3746444) and miR-149 (rs2292832), respectively. The meta-analysis indicated that the GG genotype carriers of miR-146a were more susceptible to brain tumors compared with GC genotype carriers (OR = 1.19, 95%CI = 1.01–1.41, P = .036). No significant associations were observed between the SNPs of other miRNAs and the risk of brain tumors. Furthermore, all miRNA polymorphisms did not show significant associations with the risk of glioma subgroup in any genetic models, while meta-analysis of non-glioma subgroup could not be performed due to low statistical power and analysis of only 1 study.

Conclusion:

Our study suggests that miR-146a polymorphism may modify the risk for brain tumors, but which type (glioma or benign non-glioma tumors) should be verified with large sample size.
Physical activity and the risk of frailty among community-dwelling healthy older adults
Authors: Pan Bei , Li Hongli , Wang Yunhua , Sun Min , Cai Hui , Wang Jiancheng
Published: August 2019

Background:

Frailty has become one of the biggest challenges in facilitating healthy aging. Our study aims to investigate the association between physical activity and the risk of frailty, meanwhile, conduct a dose–response to observe the relationship between physical activity volume and frailty.

Method:

We will systematically search six databases to identify cohort studies assessing the association between physical activity and risk of frailty. Risk of bias of individual study will be assessed using the Newcastle–Ottawa Scale. Data will be analyzed by using STATA V.12.0.

Results:

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

Conclusion:

We will first investigate whether specific-physical activity reduce the risk to onset frailty in healthy older adults. However, predictable heterogeneity may exist in our study because of the inconsistent definitions of frailty.
The effectiveness of exercise on cervical radiculopathy
Authors: Liang Long , Cui Xin , Feng Minshan , Zhou Shuaiqi , Yin Xunlu , He Feng , Sun Kai , Yin He , Xie Rong , Zhang Dian , Zhou You , Wu Yue , Tan Guihong , Wang Zhengdong , Wang Xingyu , Zhang Jianhua , Zhu Liguo , Yu Jie , Wei Xu
Published: August 2019

Background:

Significant functional limitations and disabilities are common presenting complaints for people suffering from cervical radiculopathy. Exercise is a common conservative treatment for this disease. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy of exercise in the treatment of cervical radiculopathy.

Methods:

A systematic literature search for studies will be performed in 7 databases, including PubMed, Web of Science, Embase, the Cochrane Library, the Chinese National Knowledge Infrastructure Database (CNKI), Wanfang database, and VIP database. The methodological quality of the included studies using the risk bias assessment tool of Cochrane and the level of evidence for results are assessed by the GRADE method. Statistical analysis is conducted with Revman 5.3.

Results:

This systematic review and meta-analysis will provide a synthesis of existed evidences for exercise on cervical radiculopathy.

Conclusion:

The conclusion of this study will provide evidence to assess effectiveness of exercise on cervical radiculopathy, which can further guide clinical decision-making.

PROSPERO registration number:

CRD42019121886
Bleeding with negative coagulation screening test as initial presentation of chronic myelogenous leukemia managed by fresh frozen plasma
Authors: Wang Yanzhi , Wang Lina , Xi Yaming , Li Zijian
Published: August 2019

Introduction:

Chronic myelogenous leukemia (CML), a clonal disorder of pluripotent stem cell, rarely presents with bleeding in chronic phase due to the function preservation of the platelets. Factor (F) XIII deficiency, an extremely rare hemorrhagic disease, can cause fatal bleeding, which has been previously described in autoimmune disorders and leukemias.

Patient concerns:

A 38-year-old woman with a 20-day history of spontaneous subcutaneous hemorrhage visited our hospital, who presented with intracranial hemorrhage, hematuria, and delayed hematoma after a bone marrow puncture. Initial management included cytogenetics analysis, molecular analysis, and coagulation evaluation.

Diagnosis:

Bone marrow puncture, cytogenetics, and molecular analysis indicated the diagnosis of CML. With the normal results of clotting screening tests and platelet counting, as well as the relief of bleeding after infusion of fresh frozen plasma (FFP), acquired rare bleeding disorder probably associated with factor XIII (FXIII) deficiency.

Interventions:

Management with anti-hyperleukocytosis and chemotherapy, hydration, alkalization, diuresis, uric acid-lowering, molecular targeted drugs, and freshly frozen plasma transfusion therapy resolved the bleeding diathesis.

Outcomes:

The patient survived from the initial bleeding, however, she died. Twenty six months later due to the progression of CML.

Lessons:

CML can initially present as unusual bleeding, possibly related to FXIII defect. It is essential to screen coagulopathy including FXIII activity and to supplement plasma for CML patients who present initially as bleeding, which cannot be deciphered by the routine clotting screening test.
Fulminant bilateral acute retinal necrosis complicated with secondary herpes simplex type-1 viral encephalitis
Authors: Ye Lingqi , Ding Xiansan , Shen Shanshan , Wang Jing , Wu Jimin , Chen Yanxing
Published: August 2019

Rationale:

Acute retinal necrosis (ARN), which is characterized by peripheral necrotizing retinitis, severe retinal arteritis, and progressive inflammatory reaction in the vitreous and anterior chambers, has been reported in cases with herpes simplex encephalitis (HSE). It is a relatively rare complication secondary to HSE. However, cases presented with viral encephalitis following ARN were seldom reported.

Patient concerns:

A 43-year-old immunocompetent male patient manifested the aforesaid reverse situation. He developed HSE following 3-day systemic steroid therapy for abrupt ocular pain and rapidly decreased visual acuity, which was later diagnosed as ARN. Polymerase chain reaction (PCR) analysis of vitreous specimen verified herpes simplex virus-1 (HSV-1) infection.

Diagnosis:

HSE associated with ARN.

Interventions:

The patient was treated with intravenous acyclovir (500 mg every 8 h) for 21 days. A pulse of intravenous methylprednisolone, 500 mg/d for 5 days was given as an anti-inflammatory therapy, followed by prednisone taper.

Outcomes:

The patient's neurological symptoms got improved very soon after the therapy, but his vision acuity remained no perception of light in both eyes.

Lessons:

The present case indicates that ARN can also be a risk factor for HSE. Once ARN was suspected, corticosteroid should be applied with caution and in combination with antiviral treatment to avoid progressive duplication of virus and its spread to the brain.
Chinese Herbal Medicine Versus Placebo for the Treatment Of Chronic Obstructive Pulmonary Disease
Authors: Xiong Chan , Li Yu , Zeng Yan , Wei Hua , Zhuang Guang-tong , Li Lin , Zhao Li-hong , Li Chen-yi , Qin Er-qi , Fu Juan-juan
Published: August 2019

Background:

Chinese herbal medicine (CHM) has been shown to be effective in the treatment of stable chronic obstructive pulmonary disease (COPD) by published meta-analyses. However, disease outcomes were inconsistent and heterogeneity was observed attributed to placebo-controlled studies. We present a protocol for a systematic review aiming to evaluate the clinical efficacy and safety of CHM comparing to placebo in the treatment of stable COPD, to provide robust evidence for the use of CHM in COPD.

Methods:

We will comprehensively search the following 9 databases from inception to March 2019: Web of Science, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), WANFANG Database, Chinese Scientific and Technological Periodical Database (VIP) and Chinese Biomedical Database (CBM), and the Cochrane Library database. All clinical randomized controlled trials comparing CHM to placebo for the treatment of stable COPD in English or Chinese will be included. The primary outcome will be quality of life, symptom score and exacerbation frequency, and the secondary outcomes include traditional Chinese medicine syndrome score and effective rate, lung function, 6-minute walk distance, and adverse events. Data extraction and quality assessment will be performed independently by 2 reviewers. Data synthesis and risk of bias will be assessed using the Review Manager software. This protocol will be conducted according to the Preferred Reporting Item for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidance.

Results:

This systematic review and meta-analysis will provide a high-quality comprehensive evaluation of the efficacy and safety based on current literature evidence of CHM intervention for stable COPD.

Conclusion:

The conclusion of this study will present the evidence of whether CHM is an effective and safe intervention for stable COPD patients.
Efficacy and safety of acupuncture therapy for chronic atrophic gastritis
Authors: Li Yuan , Zhang Yili , Meng Han , Liao Mengting , Su Zeqi , Zhai Mengyin , Jiang Lingling , Li Ping , Ding Xia
Published: August 2019

Background:

The proportion of application of acupuncture for chronic atrophic gastritis (CAG) is increasing over time. We will conduct this study to explore the efficacy and safety of acupuncture as a treatment method for CAG.

Methods:

We will go through domestic and foreign databases until July 2019 to identify related randomized controlled trials that explored the effectiveness of acupuncture for CAG. RevMan (V.5.3) and test sequential analysis (V.0.9) will be used for mata-analysis and trial sequential analysis.

Results:

This study will update previous evidence summaries of acupuncture and determine the efficacy and safety of acupuncture for CAG based on clinical effectiveness rate, clearance of Helicobacter pylori (H pylori) infection, and quality of life and symptom scores.

Conclusion:

This study will determine the evidence for judging whether acupuncture provides benefits in the treatment of CAG, and will support the application of acupuncture in the recovery of patients with CAG.

Registration number:

CRD42019127916.
Impact of bedside percutaneous dilational and open surgical tracheostomy on intracranial pressure, pulmonary gas exchange, and hemodynamics in neurocritical care patients
Authors: Kieninger Martin , Windorfer Martin , Eissnert Christoph , Zech Nina , Bele Sylvia , Zeman Florian , Bründl Elisabeth , Graf Bernhard , Künzig Holger
Published: August 2019

Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.

We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).

Peak ICP levels were higher during PDT (22 [17–38] mm Hg vs 19 [13–27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.

Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.
Febrile convulsions during recovery after anesthesia in an infant with history of MMR vaccination
Authors: Lee Hyung Gon , Bae Hong-Beom , Choi Jeong Il , Pyeon Taehee , Kim Sungmin , Kim Joungmin
Published: August 2019

Rationale:

Seizures are rare during the perioperative period; in most cases, there is a previous history of epilepsy or surgery-associated seizures. Febrile convulsions may occur when the body temperature rises above 38°C; this is the most common cause of seizures in children. Febrile convulsions after general anesthesia in the postanesthetic care unit (PACU) without a past or family history are rare. Some reviews suggest that since anesthesia changes immunity, elective surgery should be postponed three weeks after live vaccination.

Patient:

A 12-month-old female with bilateral hearing loss underwent cochlear implantation under general anesthesia. She did not have any history of convulsions or developmental disorders. However, 1 week before surgery, measles-mumps-rubella (MMR) vaccination was given as a regular immunization.

Diagnoses:

Forty minutes after arrival at the PACU, sudden generalized tonic-clonic movement occurred during recovery and the patient's measured body temperature exceeded 38.0°C.

Interventions:

Thiopental sodium was administered intravenously as an anticonvulsant, and the tonic-clonic movement stopped immediately. Endotracheal intubation was performed to secure the airway, and tepid massage and diclofenac β-dimethylaminoethanol administration were performed to lower the patient's body temperature.

Outcomes:

There was no further fever and no seizures, and no other neurological deficits were observed until discharge.

Lessons:

The anesthesiologist should check the recent vaccination history even if the patient has not developed particular symptoms after vaccination. It is important to know that febrile convulsions may occur in patients who have recently received MMR vaccination.
The performance of M and XL probes of FibroScan for the diagnosis of steatosis and fibrosis on a Brazilian nonalcoholic fatty liver disease cohort
Authors: Cardoso Ana Carolina , Cravo Claudia , Calçado Fernanda Luiza , Rezende Guilherme , Campos Carlos Frederico F. , Neto João Marcello A. , Luz Rodrigo P. , Soares Jorge André S. , Moraes-Coelho Henrique Sergio , Leite Nathalie C. , Perez Renata M. , Villela-Nogueira Cristiane A.
Published: August 2019

Objectives

Recently, controlled attenuation parameter (CAP) was incorporated for XL probe. However, its performance through M and XL probes has been scarcely evaluated in nonalcoholic fatty liver disease (NAFLD). The performance of probes regarding transient elastography by Fibroscan is still under debate.

Aim

Compare the performance of CAP and transient elastography in NAFLD patients obtained through XL with M probes using histological analysis as gold standard.

Methods

NAFLD patients underwent liver biopsy and FibroScan/CAP with M and XL probes the same day. C-statistic evaluated CAP performance in the identification of moderate/severe (≥33%) and severe (≥66%) steatosis by both probes and transient elastography performance for identification of significant fibrosis (≥F2).

Results

Eighty-one patients (74% female; age 54.2 ± 9.9 years; BMI 32.8 ± 5.2/ BMI ≥ 25 92.6%; 96% metabolic syndrome; 60% diabetes mellitus) were included. Mean CAP with M and XL probes was 314 ± 39 and 325 ± 47 dB/m, respectively. The areas under receiver operating characteristic curves (AUROCs) of the M and XL probes for steatosis detection ≥33% were 0.75 (0.64–0.84) and 0.76 (0.65–0.84) (P = 0.95) and for steatosis ≥66% 0.83 (0.73–0.90) and 0.82 (0.71–0.89) (P = 0.73), respectively, with similar performances for both degrees of steatosis. Regarding transient elastography, AUROCs of M and XL probes for ≥F2 were 0.82 (0.71–0.93) and 0.80 (0.69–0.92) (P = 0.66).

Conclusion

Performance of M and XL probes is similar for the diagnosis of moderate and severe steatosis and significant fibrosis even on a overweight population with NAFLD.