bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of dual-time point 18F-FDG PET/CT tumor-to-background ratio, intraoperative 5-aminolevulinic acid fluorescence scale, and Ki-67 index in high-grade glioma
Authors: Kim Yong-il , Cho Kyung Gi , Jang Su Jin
Published: February 2019

The aim of this study was to compare preoperative dual-time point 18F-fluorodeoxyglucose (FDG) uptake pattern with intraoperative 5-aminolevulinic acid (5-ALA) fluorescence in high-grade gliomas. In addition, we assessed for possible associations with a pathologic parameter (Ki-67 index).

Thirty-one patients with high-grade glioma (M:F = 19:12, mean age = 60.6 ± 11.2 years) who underwent dual-time point 18F-FDG positron emission tomography (PET)/computed tomography (CT) scan before surgery were retrospectively enrolled; 5-ALA was applied to the surgical field of all these patients and its fluorescence intensity was evaluated during surgery. Measured 18F-FDG PET/CT parameters were maximum and peak tumor-to-background ratio (maxTBR and peakTBR) at base (-base) and delayed (-delay) scan. The intensity of 5-ALA fluorescence was graded on a scale of three (grade I as no or mild intensity, grade II as moderate intensity, and grade III as strong intensity).

Seven of the patients had WHO grade III brain tumors and 24 had WHO grade IV tumors (mean tumor size = 4.8 ± 1.8 cm). MaxTBR-delay and peakTBR-delay showed significantly higher values than maxTBR-base and peakTBR-base, respectively (all P < .001). Among the 18F-FDG PET/CT parameters, only maxTBR-delay demonstrated significance according to grade of 5-ALA (P = .030), and maxTBR-delay gradually decreased as the fluorescence intensity increased. Also, maxTBR-delay and peakTBR-delay showed significant positive correlation with Ki-67 index (P = .011 and .009, respectively).

Delayed 18F-FDG uptake on PET/CT images could reflect proliferation in high-grade glioma, and it has a complementary role with 5-ALA fluorescence.
Imatinib-induced irreversible interstitial lung disease
Authors: Zhang Ping , Huang Jingfeng , Jin Fangfang , Pan Jiaohai , Ouyang Guifang
Published: February 2019

Rationale:

Imatinib mesylate (imatinib) is a classic tyrosine kinase inhibitor used to treat chronic myeloid leukemia. Although it is well tolerated by most patients and helps in the achievement of complete remission, a few rare imatinib-associated adverse effects such as pulmonary interstitial fibrosis have been reported. Because of its rareity, the clinical features of imatinib-induced interstitial lung disease (ILD) remain unclear.

Patient concerns:

A 49-year-old Chinese man with chronic myeloid leukemia received oral treatment with imatinib and initially exhibited a good response. However, he presented with cough and fever 9 months after treatment initiation.

Diagnoses:

Pulmonary computed tomography indicated diffuse interstitial fibrosis in both lungs. All tests for possible infectious pathologies provided negative results.

Interventions:

The patient was diagnosed with interstitial pneumonia and treated with antibiotics; however, there was no improvement. On the basis of a suspicion of imatinib-induced ILD, imatinib was discontinued and prednisone treatment was initiated.

Outcomes:

The patient's symptoms ameliorated with treatment, and imatinib was reintroduced. However, he developed cough and dyspnea again, and his treatment was switched to nilotinib as a second-line regimen. He was regularly monitored, and although his clinical symptoms ameliorated, computed tomography performed 29 months after he was diagnosed with ILD showed irreversible pulmonary interstitial fibrosis without progression.

Lessons:

Clinicians should consider the possibility of severe irreversible ILD and carefully monitor patients receiving imatinib treatment.
Role of oral calcium supplementation alone or with vitamin D in preventing post-thyroidectomy hypocalcaemia
Authors: Xing Tengfei , Hu Yiyi , Wang Bin , Zhu Jingqiang
Published: February 2019

Background:

Thyroidectomy is the main intervention for thyroid malignancies and some benign thyroid diseases. Its most common complication is hypocalcaemia, which requires oral or intravenous calcium therapy. The aim of this meta-analysis was to assess the efficacy of routine calcium supplementation with or without vitamin D in preventing hypocalcaemia post-thyroidectomy.

Methods:

Systematic searches of the PubMed, EMBASE, and Cochrane Library databases were performed. The qualities of the included articles were assessed using the Cochrane risk of bias tool. The studies’ qualities of outcomes and strengths of evidence were evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Review Manager 5.3, and odds ratio (ORs) with their 95% confidence intervals (CIs) were computed for dichotomous data.

Results:

Ten randomized controlled trials (RCTs) were included. The combined study recruited 1620 patients (343 men and 1277 women) who underwent total thyroidectomy alone or with neck dissection. Calcium supplementation decreased the risk of transient postoperative hypocalcaemia (OR 0.48 [95% CI, 0.31–0.74];P < .001) but did not decrease the demand for intravenous supplementation or the rate of permanent hypocalcaemia compared to no treatment. Calcium and vitamin D supplementation significantly reduced the rate of transient hypocalcaemia and the demand for intravenous supplementation compared to either no treatment (OR 0.21 [95% CI, 0.11–0.40];P < .001 and OR 0.26 [95% CI, 0.10–0.69];P = .007, respectively) or calcium alone (OR 0.39 [95% CI, 0.18–0.84];P = .02 and OR 0.18 [95% CI, 0.07–0.47];P < .001, respectively), but did not decrease the rate of permanent hypocalcaemia. GRADE-based confidence was moderate.

Conclusion:

Postoperative calcium supplementation is effective for preventing post-thyroidectomy hypocalcaemia. Calcium plus vitamin D was more effective than calcium alone in preventing postoperative hypocalcaemia and decreasing the demand for intravenous calcium supplementation. Further, well-designed RCTs with larger sample sizes are required to validate our findings.
Echocardiographical findings of giant cardiac lipoma
Authors: Liu Liu , Zuo Yangping , Huang Yuwen , Cao Liting
Published: February 2019

Rationale:

Cardiac lipoma is a kind of extremely rare benign tumor. Lipomas can be located in various parts of the pericardium and heart, among which the pericardial lipoma is relatively rare.

Patient concerns:

We report the case of a 59-year-old male with extremely rare cardiac lipoma. The patient was admitted to the hospital because of palpitation and dyspnea for more than one month. Echocardiography examination and the pathological results indicated lipoma.

Diagnoses:

Diagnosed with lipoma.

Interventions:

The patient underwent cardiac lipoma resection successfully.

Outcomes:

There was no obvious cardiac abnormality in the follow-up three months after the surgery.

Lessons:

Echocardiography is of great significance for preoperative evaluation and postoperative follow-up.
Molecular epidemiology and antibiotic resistance of Burkholderia pseudomallei isolates from Hainan, China
Authors: Rao Chenglong , Hu Zhiqiang , Chen Jiangao , Tang Mengling , Chen Hai , Lu Xiaoxue , Cao Liusu , Deng Ling , Mao Xuhu , Li Qian
Published: February 2019

Burkholderia pseudomallei is the causative agent of meliodosis, and the cases in China are gradually increasing. The present retrospective study aimed to surveil the molecular epidemiological characteristics and antibiotic resistance of B pseudomallei isolates. B pseudomallei strains were isolated and verified from meliodosis patients with relevant epidemiological information from 2004 to 2016 in Hainan, China. Pulsed-field gel electrophoresis based on Spe I digestion was carried out, and antimicrobial resistance of B pseudomallei strains was observed against 9 frequently-used antimicrobials. A total of 164 B pseudomallei isolates were successfully divided into 60 pulsed-field gel electrophoresis (PFGE) patterns, including 33 clusters and 27 single types, at an 85% similarity level. The isolates also exhibited a high level of ceftazidime resistance rate (12.8%, 21/164). B pseudomallei strains were mainly heterogenous with no predominant type, but there were some clonal populations, dominate clusters prevalent and the resistance rates of cephems antimicrobial increased significantly between 2004 and 2016 along with the number of melioidosis cases collected in Hainan (cefoperazone-sulbactam [SCF], r
s = 0.96, P = .04; ceftazidime [CAZ], r
s = 0.98, P = .01). In conclusion, this study will help to enhance our understanding of molecular characteristics and antibiotic resistance of B pseudomallei.
Pretransplant C-reactive protein as a prognostic marker in allogeneic stem cell transplantation
Authors: Wu Peilin , Liang Wei , Chen Xianying , Chen Lihong , Yang Xuerong , Yan Zhengwei , Wang Wei
Published: February 2019

Background:

Numerous reports have explored the prognostic value of pretransplant serum C-reactive protein (CRP) in patients receiving allogeneic stem cell transplant (ASCT), but the results remain conflicting. Therefore, we performed a meta-analysis to comprehensively assess the prognostic value of pretransplant serum CRP in patients receiving ASCT.

Methods:

We systematically searched eligible studies in PubMed, Embase, and Web of Science from 1999 to September 2018. The pooled hazard ratios (HRs) and their corresponding 95% CIs were used to synthetically assess the prognostic value of pre-ASCT CRP in terms of overall survival (OS), non-relapse mortality (NRM), and acute graft versus host disease (aGVHD).

Results:

A total of 14 articles with 15 studies containing 3458 patients were included in this meta-analysis. The pooled results showed that high pre-ASCT CRP level was significantly related to worse OS (HR = 1.63; 95% CI: 1.34–1.98; P < .05), to an increased risk of NRM (HR = 2.06; 95% CI: 1.62–2.62; P < .05), and aGVHD (HR = 1.35; 95% CI: 1.07–1.71; P < .05). Additionally, sensitivity and subgroup analyses demonstrated that our pooled results were stable and reliable.

Conclusions:

High pre-ASCT serum CRP was significantly associated with worse OS, as well as higher risk of NRM and aGVHD. CRP may be a candidate factor of updating the existing risk scoring systems or establishing a novel risk scoring systems, which has the potential of guiding patient selection for ASCT and proceeding with risk-adapted therapeutic strategies. However, more high-quality clinical studies and basic research are required to further validate our findings in view of several limitations in our meta-analysis.
Subacute stroke physical rehabilitation evidence in activities of daily living outcomes
Authors: García-Rudolph Alejandro , Sánchez-Pinsach David , Salleras Eloy Opisso , Tormos Josep María
Published: February 2019

Background:

Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability.

Objectives:

To systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation interventions in (ADLs) for stroke patients.

Methods:

Umbrella review on meta-analyses of RCTs ADLs in MEDLINE, Web of Science, Scopus, Cochrane, and Google Scholar up to April 2018. Two reviewers independently applied inclusion criteria to select potential systematic reviews of meta-analyses of randomized controlled trials (RCTs) of physical rehabilitation interventions (during subacute phase) reporting results in ADLs. Two reviewers independently extracted name of the 1st author, year of publication, physical intervention, outcome(s), total number of participants, and number of studies from each eligible meta-analysis. The number of subjects (intervention and control), ADL outcome, and effect sizes were extracted from each study.

Results:

Fifty-five meta-analyses on 21 subacute rehabilitation interventions presented in 30 different publications involving a total of 314 RCTs for 13,787 subjects were identified. Standardized mean differences (SMDs), 95% confidence intervals (fixed and random effects models), 95% prediction intervals, and statistical heterogeneity (I
2 and Q test) were calculated. Virtual reality, constraint-induced movement, augmented exercises therapy, and transcranial direct current stimulation interventions resulted statistically significant (P < .05) with moderate improvements (0.5 ≤ SMD ≤ 0.8) and no heterogeneity (I
2 = 0%). Moxibustion, Tai Chi, and acupuncture presented best improvements (SMD > 0.8) but with considerable heterogeneity (I2 > 75%). Only acupuncture reached “suggestive” level of evidence.

Conclusion:

Despite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes.
Multiple risks analysis for aplastic anemia in Zhejiang, China
Authors: Wu Li-qiang , Shen Ying-ying , Zhang Ying , Kuang Yue-min , Fang Bing-mu , Wang Zhou-zheng , Fu Li-juan , Shao Ke-ding , Shen Jian-ping , Zhou Yu-hong , Shen Yi-ping , Ye Bao-dong , Zheng Zhi-yin , Chen Jun-fa , Lin Sheng-yun
Published: February 2019

To understand the risks associated with aplastic anemia (AA) in 4 cities of Zhejiang Province, China, with special focus on the joint contributions of multiple risks.

Based on an Electronic Data Capture (EDC), a case control study was carried out. Data regarding socio-demographic, diseases history, living habits, and exposures to toxic substances, etc., were collected through survey questionnaires. t Test, chi-square test, or non-parametric rank sum test, and univariate and multivariate Logistic regression analysis were conducted to analyze data.

The univariate logistic regression analysis results indicated that among all study participants (n = 1802), AA was associated with over 30 risks, in terms of their individual behaviors, daily and environmental exposures, diseases history, and family history. Multivariate logistic regression analysis further confirmed that the independent risks related to AA included presence of chemical factory within 3 km of living residence (odds ratio [OR] = 8.73, 95% CI: 1.42–53.74, P = .019), living in a newly decorated house/apartment (OR = 25.37, 95% CI: 4.44–144.81, P < .001), vegetarian diet (OR = 131.60, 95% CI: 3.45–5020.16, P = .009), preference of sugar (OR = 89.38, 95% CI: 7.22–1106.44, P < .001), preference of oily food (OR = 55.68, 95% CI: 5.12–605.26, P = .001), drinking lake water or pond water (OR = 58.05, 95% CI: 3.21–1049.81, P < .001), habit of staying up late (OR = 11.87, 95% CI: 3.43–41.02, P < .001), infection history (OR = 10.08, 95% CI: 2.75–36.93, P < .001). Result of receiver operating characteristic curve (ROC) analysis on the joint contribution of multiple risks indicated that AA was 13.835 times likely to occur when exposed to ≥1 risks than those exposed to 0 risks (95% CI: 9.995–19.149).

Our study results demonstrated a comprehensive epidemiological pattern, in which the joint contributions of individual inherited health status, environment exposure, and individual behaviors lead to the occurrence of AA.
Prognostic value of serum uric acid in patients with acute heart failure
Authors: Huang Gang , Qin Juan , Deng Xuejun , Luo Guiquan , Yu Dongmei , Zhang Mei , Zhou Shiheng , Wang Lei
Published: February 2019

Background:

Conflicting results have been reported on the prognostic significance of serum uric acid (SUA) in patients with acute heart failure (AHF). This meta-analysis aimed to determine the prognostic significance of SUA level in patients with AHF.

Methods:

We made a comprehensive literature search in Pubmed and Embase databases from inception to April 6, 2018. All available observational studies or post hoc analysis of randomized controlled trial that evaluated the prognostic value of SUA level in patients with AHF were eligible. Outcome of interests were all-cause mortality and the combined endpoint of death or readmission. Prognostic values of SUA level were summarized as higher vs lower SUA category or per 1 mg/ml SUA rise.

Results:

Ten studies involving 12,854 AHF patients were identified and analyzed. AHF patients with the highest SUA level had an increased risk of all-cause mortality (risk ratio [RR] 1.43; 95% confidence intervals [CI] 1.31–1.56) and combined endpoint of death or readmission (RR 1.68; 95% CI 1.33–2.13) after adjusting potential variables. In addition, per 1 mg/ml SUA rise significantly increased by 11% and 12% higher risk all-cause mortality and combined endpoint of death or readmission, respectively. A leave out 1 study sensitivity analysis confirmed the reliability of the pooling effect sizes.

Conclusion:

This meta-analysis indicates that elevated SUA level independently predicts all-cause mortality and the combined endpoint of death or readmission in AHF patients. Measurement of SUA level may improve risk stratification of adverse outcomes in these patients.
Prolonged stabilization of platinum-refractory ovarian cancer in a single patient undergoing long-term Mistletoe extract treatment
Authors: Hwang Woo Yeon , Kang Mi Hyun , Lee Seul Ki , Yeom Ji Su , Jung Min Hyung
Published: February 2019

Rationale:

Advanced ovarian malignancies are associated with poor overall survival; thus, patients often turn to alternative treatments, despite the controversy surrounding their use. Mistletoe extract has been commonly used as complementary medicine to treat patients with cancer for several decades, and has proven benefits in integrative oncology.

Patient concerns:

A 47-year-old woman with stage IVB ovarian cancer who underwent optimal surgical cytoreduction, but whose disease persisted after adjuvant platinum-based combination chemotherapy and 2nd-line chemotherapy.

Diagnosis and interventions:

The patient discontinued chemotherapy due to her septic condition and acute kidney injury accompanied by acute pyelonephritis, and opted for adjuvant treatment with mistletoe extract.

Outcomes:

The patient has achieved good health without progression of cancer or ascites over the 42 months since the 1st diagnosis and 24 months since the last relapse.

Lessions:

Our case suggests that mistletoe extract can produce favorable outcomes in patients with platinum-refractory ovarian cancer.
Pancreatic progenitor cell differentiation and proliferation factor predicts poor prognosis in heptaocellular carcinoma
Authors: Mao Zhengfa , Li Xi , Ma Xiaoyan , Wang Xuqing , Zhang Jiangxin , Fan Xin
Published: February 2019

The aim of this study is to investigate the expression of pancreatic progenitor cell differentiation and proliferation factor (PPDPF) and its relationship with clinicopathological factors in hepatocellular carcinoma (HCC).

A total of 135 patients diagnosed with HCC who underwent curative surgery were enrolled in this study. The expression of PPDPF was examined by real time-polymerase chain reaction (RT-PCR), western blot, and immunohistochemistry. The prognostic value for each sample was explored.

Both RT-PCR and western blot revealed PPDPF expression was upregulated in HCC. Higher PPDPF expression was also observed in HCC (54.07%) detected by immunohistochemistry (IHC), which was significantly associated with tumors size (P = .003), Edmondson-Steiner Grading (P = .021), recurrence (P = .010), and Diolame complete (P = .023). Patients with higher PPDPF expression had increased cancer progression and poorer prognosis than those with lower expression (P = .043). Multivariate analysis indicated PPDPF as an independent prognostic factor (P = .014).

Aberrance PPDPF expression might be a useful predictor and could serve as a potential therapeutic target for HCC.
Prognostic factors in patients with advanced extrahepatic cholangiocarcinoma
Authors: Aktas Gokmen , Kus Tulay , Balkan Ayhan , Metin Taylan , Gulsen Murat Taner , Abali Huseyin
Published: February 2019

Extrahepatic cholangiocarcinoma (ECC) is an aggressive malignancy causing a lot of fatalities and comorbidities. Endoscopic biliary stenting (EBS) is mostly needed for ECC. In this study, we aimed to investigate the prognostic factors for the overall survival (OS) and the factors predicting the patients eligible for chemotherapy after EBS in ECC.

We retrospectively screened 153 advanced ECC patients who underwent EBS for jaundice to make the patients eligible for chemotherapy. Patient's clinical and laboratory parameters were recorded. OS was estimated by the Kaplan–Meier method. All parameters were assessed by binary logistic regression analysis to predict which patients are eligible for chemotherapy.

The median OS of all patients was 12.0 months (10.1–13.8). The median OS of the patients treated with chemotherapy was 13.0 months (12.0–14.0), while it was 4.0 months (2.3–5.7) for patients unable for chemotherapy after EBS. Albumin, aspartate aminotransferase (ALT) and carbohydrate antigen 19-9 (CA 19-9) values were independent prognostic factors for OS. Higher albumin and lower prothrombin time (PT) levels were independent parameters to predict the patients eligible for chemotherapy after EBS.

Being suitable for chemotherapy was the main determinant for prolonged survival and albumin and PT levels were independent predictors for chemotherapy eligibility after EBS. Albumin, ALT, and CA 19-9 values were independent prognostic factors for OS in ECC.
Doughnut sign of hepatic alveolar echinococcosis on FDG PET/CT
Authors: Shen Guohua , Kou Ying , Kuang Anren
Published: February 2019

Rationale:

A characteristic metabolic finding of hepatic alveolar echinococcosis (HAE) on positron emission tomography/computed tomography (PET/CT) correlates with morphologic features on CT and magnetic resonance imaging (MRI).

Patient concerns:

A young man from an endemic area was admitted to our hospital due to right upper quadrant pain for 2 months.

Diagnosis:

CT and MRI revealed a heterogeneous mass with calcification, consisting of central necrosis and peripheral solid inflammatory tissues. Accordingly, FDG PET/CT demonstrated a characteristic metabolic finding of doughnut sign. Combining the above characteristic imaging features with positive serologic findings, the patient was diagnosed as HAE.

Interventions:

He then underwent extracorporeal hepatectomy and liver autotransplantation followed by medical treatment of benzimidazoles.

Outcomes:

He remained asymptomatic without evidence of recurrence at 2-year follow-up.

Lessons:

The characteristic metabolic appearance of HAE on FDG PET/CT, correlated with its morphologic features of CT and MRI, may allow to make accurate diagnoses.
Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer
Authors: Zhou Yaodong , Zhang Yixin
Published: February 2019

Radiation therapy can have adverse effects on normal tissue and cause chronic ulcers. The purpose of this study was to compare breast cancer patients who underwent single-stage reconstruction with patients who underwent 2-stage reconstruction for chronic radiation-induced necrotic ulcers of the chest wall.

This retrospective study comprised of 50 patients with chronic radiation-induced chest wall ulcers who underwent chest wall reconstruction in our hospital between January 2002 and January 2016. All patients developed ulcers after undergoing breast cancer surgery, followed by radiation therapy. These patients were divided into 2 groups: group A, patients who underwent debridement and reconstruction with tissue flaps simultaneously in a single-stage procedure; group B, patients who underwent debridement and omentum majus tamping in the 1st stage, followed by surgical reconstruction with skin grafting or flap transfer 2 weeks later. The postoperative complications and outcomes were evaluated and compared.

These patients were followed up for 48 to 55 months (mean: 50 months), and overall survival was 98%. One patient in group A died of septicemia 5 days after the operation. Six patients in group A developed flap infection, among which 4 patients progressed to flap necrosis (group A: 6/25 vs group B: 0/25; P = .000).

Compared to single-stage reconstruction, surgical reconstruction in 2 stages was safer and more effective in treating chronic radiation-induced ulcers of the chest wall, and is associated with fewer postoperative complications. The omentum majus flap was the most ideal tissue for the repair of these defects.
Peritoneal lymphoma with ascites mimicking portal hypertensive ascites
Authors: Liu En-Shao , Wang Jyh-Seng , Yang Wen-Chi
Published: February 2019

Rationale:

Lymphoma with an initial manifestation of ascites and peritoneal invasion is rare.

Patient concerns:

A 65-year-old woman presented to the emergency department with a 3-week history of abdominal distention, anorexia, and night sweating, and a 2-week history of melena. She was a silent hepatitis B virus carrier. Abdominal ultrasound showed massive ascites without cirrhosis. Abdominal computed tomography revealed ascites, infiltrative peritoneal lesions with omental cake appearance, and lymphadenopathies.

Diagnosis:

We performed paracentesis and the ascites cytology was obtained. The patient also underwent esophagogastroduodenoscopy, which showed ulcerative tumors in the stomach. Both ascites cytology and pathology of the gastric tumors confirmed the diagnosis of B-cell lymphoma.

Interventions:

This patient received 7 cycles of chemotherapy.

Outcomes:

Follow-up imaging studies revealed partial remission of lymphoma, but an enlargement of residual tumors in omentum and mesentery, which resulted in intractable ascites and rapid deterioration of performance status. Despite a change of regimen of chemotherapy, this patient expired 10 months after diagnosis.

Lessons:

Lymphoma should be one of the differential diagnoses in patients with intractable ascites not attributable to other comorbidities.
Temporal trends and black–white disparity in mortality among hospitalized persons living with HIV in the United States
Authors: Salihu Hamisu M. , Henshaw Chelsea , Salemi Jason L. , Dongarwar Deepa , Wudil Usman J. , Olaleye Omonike , Godbole Nupur , Aggarwal Anjali , Aliyu Muktar H.
Published: February 2019

We sought to determine whether black–white gap in mortality exists among hospitalized HIV-positive patients in the United States (US). We hypothesized that in-hospital mortality (IHM) would be similar between black and white HIV-positive patients due to the nationwide availability of HIV services.

Our analysis was restricted to hospitalized HIV-positive patients (15–49 years). We used the National Inpatient Sample (NIS) that covered the period from January 1, 2002 to December 31, 2014. We employed joinpoint regression to construct temporal trends in IHM overall and within subgroups over the study period. We applied multivariable survey logistic regression to generate adjusted odds ratios (OR) and 95% confidence intervals (CI).

The total number of HIV-related hospitalizations and IHM decreased over time, with 6914 (3.9%) HIV-related in-hospital deaths in 2002 versus 2070 HIV-related in-hospital deaths (1.9%) in 2014, (relative reduction: 51.2%). HIV-related IHM among blacks declined at a slightly faster rate than in the general population (by 56.8%, from 4.4% to 1.9%). Among whites, the drop was similar to that of the general population (51.2%, from 3.9% to 1.9%). Although IHM rates did not differ between blacks and whites, being black with HIV was independently associated with a 17% elevated odds for IHM (OR = 1.17; 95% CI = 1.11–1.25).

In-hospital HIV-related deaths continue to decline among both blacks and whites in the US. Among hospitalized HIV-positive patients black–white disparity still persists, but to a lesser extent than in the general HIV population. Improved access to HIV care is a key to eliminating black–white disparity in HIV-related mortality.
A critical review to traumatic brain injury clinical practice guidelines
Authors: Di Bao-shan , Wei Min , Ma Wen-juan , Zhang Qi , Lu An-qing , Wang Hu , Niu Yang , Cao Nong , Guo Tian-kang
Published: February 2019

The aim of this study was to assess the quality of clinical practice guidelines of traumatic brain injury (TBI) and investigate the evidence grading systems.

A systematic search of relevant guideline websites and literature databases (including PubMed, NGC, SIGN, NICE, GIN, and Google) was undertaken from inception to May 2018 to identify and select TBI guidelines. Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. The degree of agreement was evaluated with intraclass correlation coefficient (ICC).

From 1802 records retrieved, 12 TBI guidelines were included. The mean scores for each AGREE II domain were as follows: scope and purpose (mean ± SD= 74.2 ± 9.09); stakeholder involvement (mean± SD= 54.6 ± 11.6); rigor of development (mean ± SD=70.1 ± 13.6); clarity and presentation (mean ± SD=78.4 ± 11.5); applicability (mean ± SD= 60.5 ± 13.6); and editorial independence (mean ± SD=61.7 ± 14.8). Ten guidelines were rated as “recommended.” The ICC values ranged from 0.73 to 0.95. Seven grading systems were used by TBI guidelines to rate the level of evidence and the strength of recommendation.

Most TBI guidelines got a high-quality rating, whereas a standardized grading system should be adopted to provide clear information about the level of evidence and strength of recommendation in TBI guidelines.
A study on spleen transient elastography in predicting the degree of esophageal varices and bleeding
Authors: Wang Xie-Kui , Wang Ping , Zhang Yong , Qi Sheng-Lin , Chi Kun , Wang Gong-Chen
Published: February 2019

This study aims to investigate the value and determine the accuracy of spleen stiffness in predicting the degree of esophageal varices and bleeding in patients with liver cirrhosis.

The age, gender, liver stiffness, spleen stiffness, and gastroscopy results of 124 inpatients or outpatients with liver cirrhosis and healthy volunteers, who underwent both gastroscopy and FibroScan testing in the fasting state, were retrospectively analyzed. According to the gastroscopy results, the patients and healthy volunteers were divided into six groups: varicose bleeding, severe varices, moderate varices, mild varices, no varices, and healthy control group. Then, the receiver operating characteristic curves were drawn, and the corresponding area under each curve was calculated and evaluated to predict the severity of varices based on the relevance of the area and its parameters.

The area under the receiver operating characteristic curve of liver stiffness and spleen stiffness for predicting severe and moderate varices in the bleeding group was 0.955 and 0.989, respectively. The cut-off values were 29.6 kPa and 45.5 kPa, respectively. The area under the receiver operating characteristic curve of liver stiffness for predicting varicose bleeding was 0.860 (95% CI: 0.789–0.931). The liver stiffness cut-off value for predicting varicose bleeding was 33.2 kPa, with a specificity and sensitivity of 66.02% and 95.24%, respectively. The area under the receiver operating characteristic curve of spleen stiffness for predicting varicose bleeding was 0.923 (95% CI: 0.875–0.971). A spleen stiffness cut-off value of 55.2 kPa had a sensitivity and specificity of 90.48% and 86.41%, respectively.

Spleen stiffness can predict the degree of esophageal varices and bleeding in liver cirrhosis patients, and has good predictive accuracy.
Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab
Authors: Yan Zhe , Cui Bei-Bei , Yu Yong-Yang , Yin Geng , Cen Xiao-Min , Xie Qi-Bing
Published: February 2019

Rationale:

Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult.

Patient Concerns:

A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation.

Diagnosis:

Intestinal BD with severe post-operative complication.

Interventions:

A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy.

Outcomes:

In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation.

Lessons:

This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.
Compound salvia pellet might be more effective and safer for chronic stable angina pectoris compared with nitrates
Authors: Huiping Wei , Yu Wang , Pei Jin , Jiao Li , Shian Zhang , Hugang Jiang , Zheng Wang , Yingdong Li
Published: February 2019

Background:

Chronic stable angina (CSA) resulted in a considerable burden for both individuals and the society. In this study we aimed to critically evaluate the effectiveness and safety of Compound salvia pellet compared with nitrates in the treatment of Chronic Stable Angina (CSA) pectoris, and to provide more credible evidence for clinical practice.

Methods:

A comprehensive and exhaustive search strategy was formulated to identify potential RCTs of compound salvia pellet for CSA in international and Chinese databases from their inception to July 4th, 2018. We also searched the bibliographies of relevant studies. Two reviewers independently assessed the quality of included trials by using Cochrane Risk of Bias Tool.

Results:

The literature search yielded 1849 citations and 51 RCTs (n = 4732) were included for meta-analysis after titles, abstracts and full text selection according to eligibility criteria. The pooled results suggested that compound salvia pellet was much more effective than nitrates in the improvement of angina symptoms (therapy = 4 weeks, RR = 1.23, 95%CI = [1.17, 1.30], P < .001, I
2 = 0%; therapy = 4 weeks, RR = 1.13, 95%CI = [1.08, 1.17], P < .001, I
2 = 45.6%), and ECG test (therapy = 4 weeks, RR = 1.24, 95%CI [1.14, 1.35], P < .001, I
2 = 51.5%; and therapy > 4 weeks, RR = 1.30, 95%CI[1.20, 1.42], P < .001, I
2 = 36.4%) in CSA. Compared with nitrates, the percentage of patients with adverse events significantly decreased when prescribed with compound salvia pellet (3.2% vs 17.0%).

Conclusion:

Compound salvia pellet might be more effective on the improvement of angina symptoms, ECG test and with few adverse events compared with nitrates. While there are some limitations in this study, which may weaken the results, we believe the findings could provide useful information for stakeholders concerned with outcomes in patients with CSA. More rigorous RCTs with high quality are needed to confirm these findings.
Characteristics of dry eye in patients with pre-existing Sjögren's syndrome according to the revised 2016 ACR-EULAR classification criteria
Authors: Yoon Hyeon Jeong , Choi Won , Yang Jee Myung , Ji Yong Sok , Lee Shin-Seok , Yoon Kyung Chul
Published: February 2019

To compare the characteristics of dry eye (DE) patients who did and did not satisfy the 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (SS) among patients with pre-existing SS diagnosed according to the 2012 ACR criteria

This cross-sectional study evaluated 91 patients with pre-existing SS and 55 with non-SS DE. Patients with SS were divided into 2 groups according to whether they met the revised 2016 ACR-EULAR classification criteria for primary SS. Group 1 (n = 71) was comprised of patients who satisfied the revised 2016 criteria and group 2 (n = 20) was comprised of patients who did not satisfy the newly revised criteria. Group 3 consisted of 55 patients with non-SS DE. The ocular surface disease index (OSDI) score, tear break-up time (TBUT), Schirmer score, tear clearance rate (TCR), and corneal and conjunctival staining scores were evaluated and compared between the groups. Laboratory profiles, including antinuclear antibodies, rheumatoid factor levels, erythrocyte sedimentation rate, and C-reactive protein levels, and focus scores were analyzed.

TBUT, Schirmer, and corneal/conjunctival staining scores were significantly worse in both groups of patients with SS (groups 1 and 2) than in those with non-SS DE (group 3). However, there were no significant differences between groups 1 and 2 in laboratory findings as well as in ocular surface findings, including OSDI, TBUT, Schirmer score, TCR, and corneal/conjunctival staining scores. The focus score, which shows the level of lymphocytic infiltration in the salivary glands, was higher in group 1 than in group.

Of the patients with pre-existing SS who were diagnosed according to the 2012 ACR classification, patients who did not satisfy the 2016 ACR-EULAR classification criteria for primary SS showed similar ocular surface parameters and laboratory findings to patients who did meet the revised classification, except for focus score. There is no need to change the direction of treatment of DE in patients with pre-existing SS who did not meet the revised 2016 ACR-EULAR criteria.
Health utilities in cancer patients
Authors: Poder Thomas G. , Carrier Nathalie , McFadden Nathalie , Pavic Michel
Published: February 2019

Background:

Cost-utility analysis (CUA) is becoming more commonly used in healthcare decision-making. CUA uses the quality-adjusted life-years (QALY) metric, which combines the length of life with the health-related quality of life (HRQoL). Most QALY-measuring instruments were validated for general populations. For patients with cancer, the perception of their health state is different and may vary by the type of cancer considered. In Quebec, no preference weights for QALY have been developed, neither for the general population nor particular subpopulations.

Methods/design:

This survey is a prospective, longitudinal cohort study. The study objectives are: to assess the extent of difference in health utilities between the general population and patients with breast or colorectal cancer; to develop a QALY preference weights dataset for patients with cancer; and to perform “mapping” with different HRQoL questionnaires by correlating the SF-6Dv2 with the EQ-5D-5L, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, and functional assessment of cancer therapy - general questionnaires. Data will be collected via a self-administered online survey. Patients’ health utilities will be measured within 2 days before the beginning of a chemotherapy treatment cycle and about 8 days after the start of the chemotherapy. Health utilities will be measured by a hybrid method using the time-trade-off and discrete choice experiment methods.

Ethics and dissemination:

The proposed research was reviewed and approved by the Institutional Research Ethics Review Boards of the CHUS. We will disseminate our study findings through peer-reviewed publications and conference presentations.
Neuromuscular electrical stimulation on hearing loss caused by skull base fracture
Authors: Yang Lin-hong , Wang Wei-feng , Zhang Shu-hong , Fan Zong-xian , Xiao Jian-qi
Published: February 2019

Background:

This systematic review aims to investigate the effectiveness and safety of neuromuscular electrical stimulation (NMES) on hearing loss (HL) caused by skull base fracture (SBF).

Methods:

We will retrieve the following electronic databases of Cochrane Library, PUBMED, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database from the inception to January 1, 2019 for relevant RCTs of NMES for HL caused by SBF. Two experienced authors will independently perform the study selection, data extraction, and methodology quality assessment. A 3rd author will solve any disagreements between 2 authors through discussion.

Results:

This study will provide a high-quality synthesis of latest evidence of NMES for HL caused by SBF from comprehensive assessments, including hearing loss evaluation, hearing threshold, quality of life, and any relevant adverse events.

Conclusion:

The expected results of this systematic review will provide the up-to-date evidence to assess the effectiveness and safety of NEMS for patients with HL caused by SBF.

Ethics and dissemination:

The results of this study will be disseminated through publication in a peer-reviewed journal or will be presented at an associated conference meeting. This study will not use individual patient data, thus, the ethical approval is not needed.

PROSPERO registration number:

PROSPERO CRD42019120195.
Assessment of the left ventricular function in patients with uremia using layer-specific 2-dimensional speckle tracking echocardiography
Authors: Sun Mengyao , Dong Yu , Wang Ying , Li Guangsen , Huang Dongmei
Published: February 2019

The aim of this research is to evaluate the longitudinal and circumferential systolic function of the left ventricle with different configurations from endocardium, midmyocardium, and epicardium, respectively, in patients with uremia using layer-specific 2-dimensional speckle tracking echocardiography (2D-STE).

According to the different left ventricular (LV) configurations, 119 patients with uremia were divided into 2 groups: LV normal group (LVN group, n = 63) and LV hypertrophy group (LVH group, n = 56). In all, 66 healthy volunteers were selected as controls. High-frame rate 2-dimensional images were recorded from the apical 4-chamber view, apical 2-chamber view, parasternal LV long-axis view, and mitral annulus, papillary muscle, and apical levels of the parasternal LV short-axis view during 3 consecutive cardiac cycles. The peak systolic longitudinal strain (LS) and circumferential strain (CS) were measured in the endocardium, midmyocardium, and epicardium.

In the 3 groups, the endocardium had the highest LS and CS, whereas the epicardium had the lowest LS and CS; the LS and CS of each group gradually decreased from the endocardium to the epicardium in all the 3 sections; the LS and CS of the myocardial layers were kept gradient features, namely, endocardium > midmyocardium > epicardium. The LS of the endocardium in the LVN and LVH groups was significantly lower than that in the control group (P < .05). The LS of the midmyocardium and epicardium in the LVH group were significantly lower than those in the control group (P < .05). The LS of the endocardium significantly decreased in the LVH group compared with that in the LVN group (P < .05). The CS of the endocardium and midmyocardium in the LVH group significantly decreased compared with those in the control and LVN groups (P < .05). There were no significant differences in the CS between the LVN and control groups (P > .05).

In patients with uremia, the longitudinal and circumferential systolic function in 3 myocardial layers of the LVH group, and the longitudinal systolic function in endocardium of the LVN group were found significantly impaired by layer-specific 2D-STE.
Impact of short-acting loop diuretic doses and cardiac sympathetic nerve abnormalities on outcomes of patients with reduced left ventricular function
Authors: Onitsuka Hisamitsu , Koyama Shouhei , Ideguchi Takeshi , Ishikawa Tetsunori , Kitamura Kazuo , Nagamachi Shigeki
Published: February 2019

Recent studies reported that high doses of short-acting loop diuretics are associated with poor outcomes in patients with heart failure (HF). Short-acting loop diuretics have been shown to activate the renin-angiotensin system (RAS) and have no favorable effects on cardiac sympathetic nervous system (SNS) activity. The goal of this study is to investigate the relationship between daily doses of furosemide and the outcomes of patients with left ventricular dysfunction (LVD) from the viewpoint of cardiac SNS abnormalities using iodine-123-labeled metaiodobenzylguanidine (123l-MIBG) myocardial scintigraphy.

We enrolled 137 hospitalized patients (62.5 ± 14.2 years old, 103 men) with LVEF < 45% who underwent 123l-MIBG myocardial scintigraphy. A delayed heart-to-mediastinum ratio (delayed HMR) was assessed using 123l-MIBG scintigraphy. Cardiac events were defined as cardiac death or re-hospitalization due to the deterioration of HF. Cox proportional hazard analysis was used to identify predictors of cardiac events.

Cardiac events occurred in 57 patients in a follow-up period of 33.1 ± 30 months. In a multivariate Cox proportional hazard analysis, delayed HMR and furosemide doses were identified as independent predictors of cardiac events (P = .0042, P = .033, respectively). Inverse probability of treatment weighting Cox modeling showed that the use of furosemide (≥40 mg /day) was associated with cardiac events with a hazard ratio of 1.96 (P = .003). In the Kaplan-Mayer analysis, the cardiac event-free survival rate was significantly lower in patients treated with high doses of furosemide (≥60 mg/day vs 40–60 mg/day vs <40 mg/day, the Log-rank test P < .0001). In a receiver-operating characteristic (ROC) analysis, the cut-off value for cardiac events was 40 mg/day of furosemide. The cardiac event-free rate was significantly lower in patients with delayed HMR <1.8 (median value) and receiving furosemide ≥40 mg/day than in other patients (the Log-rank test P < .0001). Significant differences in cardiac event rates according to furosemide doses among patients with delayed HMR <1.8 were observed among patients without β-blocker therapy (P = .001), but not among those with β-blocker therapy (P = .127).

The present results indicate that a relationship exists between higher doses of furosemide and poor outcomes. The prognosis of HF patients with severe cardiac SNS abnormalities receiving high-dose short-acting loop diuretics is poor.
Association of increased B7 protein expression by infiltrating immune cells with progression of gastric carcinogenesis
Authors: Guo Lingchuan , Liu Zhiju , Zhang Yun , Quan Qiuying , Huang Lili , Xu Yunyun , Cao Lei , Zhang Xueguang
Published: February 2019

B7 negative costimulatory molecules are a group of molecules associated with the occurrence, development, and therapy of cancers. Here, we aimed to determine the clinical significance of PD-L1, B7-H3, and B7-H4 and their expression in CD8 and CD68 positive cells at different stages of gastric carcinogenesis.

We detected PD-L1, B7-H3, B7-H4, CD8, and CD68 expression in samples by immunohistochemical staining of 62 chronic superficial gastritis (CSG) samples, 72 chronic atrophic gastritis (CAG) samples, 68 low-grade intraepithelial neoplasia (LIN) samples, 65 high-grade intraepithelial neoplasia (HIN) samples obtained from gastroscopic biopsies and 50 gastric adenocarcinoma (GA) samples obtained from surgical resections. Then we statistically analyzed the expression differences and correlations.

Our results indicated that B7 and CD68 expression on infiltrating immune cells was associated with disease progression. However, infiltration of CD8+ cells decreased with disease progression. B7-H3 expression was markedly enhanced at neoplasia and GA stages. B7-H3 in tumor cells was negatively correlated with CD8-expressing cells. Conversely, B7-H3 expression in tumor-infiltrating immune cells was positively correlated with CD68-expressing cells. B7-H4 expression was found in the cell membrane at the stages of gastritis and low-grade neoplasia and was gradually expressed in the cytoplasm at high-grade neoplasia and GA stages. High B7-H4 expression in infiltrating immune cells was also significantly associated with lower CD8-positive and higher CD68-positive cell densities.

Increased B7 protein expression by infiltrating immune cells was associated with disease progression, and specifically, the level of B7-H3 expression and localization of B7-H4 expression differed significantly among different stages of gastric carcinogenesis.