bluuebunny/crossref_metadata_2025 huggingface dataset:
Rushdie and the Art of Modernism
Authors: Begam Richard
Published: December 2018

This chapter positions The Moor’s Last Sigh (1995)—the first full-fledged novel Salman Rushdie wrote following the 1989 fatwa—in relation to criticisms of modernism advanced not only by Ayatollah Khomeini but also by scholars such as Fredric Jameson and Edward Said. It is significant that the novel’s subject is modernism itself, represented by Aurora Zogoiby, whose work synthesizes virtually every avant-garde movement, from fauvism, surrealism, and Dadaism to cubism, expressionism, and abstractionism. In offering a history of twentieth-century art, Rushdie explores how modernism can retain its aesthetic autonomy while giving voice to its social and political commitments. The chapter concludes by examining two aspects of the novel that are usually considered postmodern: the figure of the palimpsest and Moraes’s accelerated aging. The former is associated with James Joyce and T. S. Eliot’s mythic method, while the latter—with its sense of accelerated temporality—functions as a metaphor for modernism itself.
Interior History, Tempered Selves
Authors: Rooney Brigid
Published: December 2018

Focusing on Johnno (1975), An Imaginary Life (1978), and Remembering Babylon (1993), this chapter argues that David Malouf’s redeployment of the formal devices of the modernist novel enables a distinctively Australian representation of postcolonial modernity. It explores Malouf’s public and literary advocacy of “imaginative possession” as a means to achieve settler belonging and effect true reconciliation between Indigenous and non-Indigenous Australians. Postcolonial critics, however, have accused Malouf of appropriating Aboriginal history and identity. This chapter argues that modernist investments within Malouf’s fiction enable imaginative possession but also yield enigma. Malouf’s use of Woolf and Faulkner’s shifts in narrative perspective, Proust’s manipulation of time and memory, Proust and Joyce’s reworking of the Bildungsroman, and the modernist intensification of lyrical subjectivity enables the tempering and attuning of settler selves to place. Yet in Johnno modernist resources unravel fixed truths, pointing instead to creative error and the fabrications of the self.
Can Blockchain technologies help tackle the opioid epidemic: A Narrative Review
Authors: Raghavendra Meda
Published: December 2018

Objective

To introduce the basic concepts of blockchain technologies in tackling the opioid epidemic.

Design

A narrative review.

Setting/Background

The opioid epidemic is taking a big toll in terms of lives and livelihood in America. Various public and private sector agencies are actively implementing different strategies to contain the epidemic. Development of robust real-time databases that are secure and easily accessible to the stakeholders in the opioid/paincare ecosystem is essential. Blockchain technologies, with their inherent features of decentralization, immutability, and easy access are well suited to achieving these goals. Some practical applications of blockchain technologies include data collection/aggregation/analysis, patient/provider identification, traceability/monitoring of opioids, supply chain provenance, prescription monitoring, licensure and credentialing, interoperability, seamless integration/communication, development of opioid alternatives, and research incentivization.

Conclusions

Blockchain technologies may help support the efforts of different agencies in curtailing the opioid epidemic.
Starting Points: Divergent Trajectories of Labor Market Integration among U.S. Lawful Permanent Residents
Authors: Kreisberg A Nicole
Published: December 2018

Legal status is a growing dimension of inequality among immigrants in the U.S. Scholars have suggested that the legal status with which immigrants enter the country stratifies their short- and long-term opportunities for labor market integration. However, much quantitative immigration scholarship modeling the relationship between legal status and labor market integration treats legal status as static. In reality, immigrants change statuses dynamically throughout their lives. This article uses a dynamic conceptualization of legal status, as well as nationally representative data and regression and propensity score weighting techniques, to examine whether five initial legal statuses are associated with divergent labor market trajectories even after those statuses change. I find that initial legal statuses—which I refer to as starting points—are associated with ordered differences in immigrants’ occupational positions immediately after immigrants change status to lawful permanent residence. These differences persist over time. Five years after all immigrants share lawful permanent residence, employment visa holders maintain more prestigious jobs; immigrants with family reunification and diversity status are in the middle; and immigrants with refugee status and undocumented experience have less prestigious jobs. This article demonstrates aggregate, longitudinal patterns of stratification among a nationally representative sample of permanent residents. The findings suggest the importance of modeling legal status as a dynamic rather than static category to reflect the continued influence of legal status starting points on immigrants’ labor market integration.
How UK Scientists Legitimize Religion and Science Through Boundary Work
Authors: Sorrell Katherine , Ecklund Elaine Howard
Published: December 2018

Research on the religious lives of scientists focuses mainly on U.S. scientists. Drawing on 115 interviews with UK biologists and physicists collected between 2011 and 2014, we move beyond to examine how UK scientists understand religion, a context that is seemingly more secular than the United States. Findings show that scientists maintain the legitimacy of science through boundary work with religion, and under certain conditions religion may actually gain legitimacy from these tight boundaries. When religion violates this tight boundary by making claims that conflict with science, particularly in the form of creationist claims, scientists consider religion illegitimate and irrational, engaging in critical boundary work. Yet, when they see religion as adaptable to science, flexible rather than dogmatic, scientists believe religion may be beneficial and engage in more conciliatory boundary work. This article shows how scientists react to religion and use it in ways that protect science’s epistemological and institutional authority.
The effect of precipitation received during gestation on progeny performance in Bos indicus influenced beef cattle
Authors: Beard Joslyn K , Silver Gail A , Scholljegerdes Eric J , Summers Adam F
Published: December 2018

The objective of this retrospective study was to determine the effect of precipitation level during key fetal development periods on beef progeny performance. The hypothesis that was precipitation level during different periods of gestation would program subsequent calves for an environment similar to that experienced in utero resulting in altered growth and reproductive performance. Data were collected on Brangus cows (n = 2,429) over a 46-yr span at the Chihuahuan Desert Rangeland Research Center. Recorded precipitation values were used to calculate average precipitation associated with total gestation (April–March), early gestation, (July–September), and late gestation (December–February). These values were used to classify treatments: low (z value ≤ –1.00), average (z value –0.99 to +0.99), and high (z value ≥ +1.00) for each time period. Calves experiencing high precipitation throughout gestation had heavier body weight (BW) at birth (P = 0.02), weaning (P = 0.05), and adjusted 205-d BW (P = 0.04) than those experiencing low precipitation . Female progeny gestated during low precipitation throughout gestation were more likely to remain (P < 0.0001) in the herd and calve after the age of 8 yr when compared to heifers experiencing high precipitation levels in utero (38% vs. 16% ± 5%, respectively). In addition, a greater percentage (P < 0.0001) of heifers experiencing low precipitation levels during the early gestation period produced a calf within the herd after 8 yr of age. Similarly, calves experiencing low precipitation during those same time points also had a greater number of calves while in production (P < 0.0001) when compared to the average and high precipitation groups. These results indicate that selection of heifers exposed to lower than average precipitation levels in utero may result in increased herd retention and productivity.
Correlation of the tamoxifen use with the increased risk of deep vein thrombosis and pulmonary embolism in elderly women with breast cancer
Authors: Lin Hsien-Feng , Liao Kuan-Fu , Chang Ching-Mei , Lin Cheng-Li , Lai Shih-Wei , Hsu Chung-Y.
Published: December 2018

The association between tamoxifen use and risk of deep vein thrombosis or pulmonary embolism in women with breast cancer has been reported in the Western population. The study aimed to evaluate the association between tamoxifen use and deep vein thrombosis or pulmonary embolism in older women with breast cancer in Taiwan.

We conducted a retrospective case–control study using the database of the Taiwan National Health Insurance Program. A total of 281 women subjects with breast cancer aged ≥65 years with newly diagnosed deep vein thrombosis/or pulmonary embolism from 2000 to 2011 were identified as the cases. Additionally, 907 women subjects with breast cancer aged ≥65 years without deep vein thrombosis or pulmonary embolism were randomly selected as the controls. The cases and the controls were matched with age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before index date. Never use of tamoxifen was defined as subjects who never had a prescription for tamoxifen before index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and the 95% confidence interval (CI) of deep vein thrombosis or pulmonary embolism associated with tamoxifen use.

After adjustment for confounding variables, the adjusted OR of deep vein thrombosis or pulmonary embolism was 1.95 for subjects with ever use of tamoxifen (95% CI 1.45, 2.62), as compared with never use of tamoxifen. In addition, atrial fibrillation (adjusted OR 3.73, 95% CI 1.89, 7.35) and chronic kidney disease (adjusted OR 1.72, 95% CI 1.06, 2.80) were also associated with deep vein thrombosis or pulmonary embolism.

Tamoxifen use is associated with 1.95-fold increased odds of deep vein thrombosis or pulmonary embolism among older women with breast cancer in Taiwan.
Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders
Authors: Song Hyun Jin , Seo Hyun-Ju , Lee Youngjin , Kim Sung Kyu
Published: December 2018

Background:

Although high-intensity laser therapy (HILT) has been used for the management of musculoskeletal disorders (MSD), studies examining the effectiveness of HILT have been limited. We investigated the effectiveness of HILT in MSD using a systematic review and meta-analysis.

Methods:

We searched the ovid MEDLINE, ovid Embase, Cochrane CENTRAL library, and Web of Science until January, 2018. Relevant studies concerning the effectiveness of HILT in patients with MSD were included. Both placebo and active controls were considered as comparators and only randomized controlled trial (RCT) design studies were included. Risk of bias (ROB) was used for the quality assessment of the RCT. For continuous variables, a meta-analysis was conducted using an inverse variance random effects model. The mean difference (MD) for visual analog scale pain and standardized mean difference (SMD) for disability were applied.

Results:

Twelve studies were selected for this systematic review. In 11 studies, comprising 736 patients, pain was significantly improved by HILT compared with a control group (MD: −1.01; 95% confidence interval [CI]: −1.28 to −0.74). From the analysis of 688 patients from 10 studies, the pooled standardized mean difference (SMD) of HILT showed a significant improvement in disability scores compared with those in the control group (SMD, −1.09; 95% CI −1.77, −0.41). In subgroup analysis by treatment regions, the mean difference (MD) in neck pain was the highest at −1.02 (95% CI: −1.45, −0.58) than in controls, followed by back pain (MD, −0.91; 95% CI: −1.24, −0.59).

Conclusions:

The results of this study show that HILT treatment for back and neck pain significantly improved pain and disability scores compared with controls. The ROB of the included studies was moderate; however, significant heterogeneity existed. Thus, additional well-designed studies involving larger samples with long-term follow-up are needed to further assess each laser application, treatment region, and comparator.
Application of dynamic monitoring of genomic profiles in non-small cell lung cancer
Authors: Kuang Bo-Hua , Wang Bi-Cheng , Tong Fan , Yang Jin-Song , Zeng Yu-Lan , Cao Ru-Bo , Liu Li
Published: December 2018

Rationale:

Although lung cancer is the leading cause of cancer-related death in the world, targeted therapy plays an essential role in improving the survival of lung cancer. Next-generation sequencing (NGS) technology can dynamically monitor the genomic profiles of tumors and assist cancer diagnosis and treatment.

Patient concerns:

We reported on a 55-year-old man who presented with chest tightness and wheezing for 1 month.

Diagnoses:

The patient was diagnosed with stage cT4N2M1a non-small cell lung cancer (NSCLC) and was found to have wild-type EGFR by pleural effusion cytology.

Interventions:

The patient received systemic treatments, including chemotherapy, targeted therapy, and radiotherapy. During the cancer development, sequential DNA sequencing data that used circulating cell-free tumor DNA, and NGS revealed EGFR L858R and T790M mutations, MYC amplification, and other gene variations.

Outcomes

: The patient died of brain and lung metastases, and had an overall survival as long as 37 months.

Lessons:

The dynamic monitoring of tumor genomic profiles has important implications for NSCLC diagnosis, treatment, and prognosis.
Transcutaneous electric nerve stimulation over acupoints for patients with diarrhea-predominant irritable bowel syndrome
Authors: Han Bo-yu , Shao Qian-Feng , Cong Yu , Guo Song , Mao Xin-Yong , Wei Ru-Han , Wei Wei
Published: December 2018

Background:

At present, drug therapy for diarrhea-predominant irritable bowel syndrome (IBS-D) has made great progress; however, it does not often produce a satisfying curative effect. Transcutaneous electric nerve stimulation over acupoints (Acu-TENS) might be more effective in improving patient's symptoms and producing fewer side-effects as a result.

Although with a great progress of the drug therapy for IBS-D, it is often hard to achieve its satisfactory curative effect. Acu-TENS that may be effective to improve patients’ symptoms and fewer side-effects will be sought. There is no systematic review concerning the efficacy of Acu-TENS for IBS-D published. Therefore, this review aims to systematically evaluate the efficacy of Acu-TENS on IBS-D.

Methods:

Four English (PubMed, EMBASE, The Cochrane Library, Web of Science) and 4 Chinese electronic databases (Biomedical Literature Database, CNKI, VIP, Wanfang Database) will be searched from their inception to November 26, 2018. Randomized controlled trials that evaluated the effect of Acu-TENS on patients with IBS-D will be included. The primary outcome measures will include average weekly stool frequency, visual analog scale (VAS), and the Bristol scale. The secondary outcome measures will include the MOS 36-item short-form health survey (SF-36), IBS Quality of Life Questionnaire (IBS-QOL), severity of IBS symptoms (IBS-SSS), and rectal perception. Quality evaluation and data extraction will be independently undertaken, respectively. The data from the eligible trials will be analyzed by RevMan5.3.

Results:

For patients with IBS-D, this systematic review will provide evidences related to the efficacy of Acu-TENS in these evaluation aspects, stool frequency, VAS and the Bristol scale, SF-36, IBS-QOL, IBS-SSS, and rectal perception.

Conclusion:

This evidence may be useful to medical workers with regard to the use of Acu-TENS in the treatment of IBS-D.

PROSPERO registration number: PROSPERO CRD442018109294.
Prognostic value of pre-dialysis blood pressure and risk threshold on clinical outcomes in hemodialysis patients
Authors: Hara Masatoshi , Tanaka Shigeru , Taniguchi Masatomo , Fujisaki Kiichiro , Torisu Kumiko , Masutani Kosuke , Hirakata Hideki , Nakano Toshiaki , Tsuruya Kazuhiko , Kitazono Takanari
Published: December 2018

The influence of pre-dialysis blood pressure (BP) on the prognosis of hemodialysis (HD) patients is still inconclusive.

A total of 3436 HD patients were prospectively followed up for 4 years. The patients were divided into quintiles of pre-dialysis systolic BP (SBP) and diastolic BP (DBP) levels [mm Hg]: Quintile 1 (Q1), SBP <134, DBP <66; Q2, SBP 134 to 147, DBP 66 to 72; Q3, SBP 148 to 158, DBP 73 to 79; Q4, SBP 159 to 171, DBP 80 to 85; Q5, SBP ≥172, DBP ≥86. The association between the pre-dialysis BP and outcomes were examined using a Cox proportional hazards model.

During a 4-year follow-up period, 564 (16.4%) patients died of any cause and 590 (17.2%) developed cardiovascular (CV) events. The lowest level of pre-dialysis SBP group (Q1) showed a significantly increased risk of all-cause mortality (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.40–2.39) and the highest group (Q5) significantly increased risk of CV events (HR 1.31, 95% CI 1.02–1.68) compared with the reference group (Q3), respectively. The highest level of pre-dialysis DBP group was significantly associated with increased risk for both all-cause mortality and CV events. Restricted cubic spline analysis for BP and outcomes suggested the optimal pre-dialysis BP value associated with the lowest risk of outcomes was SBP 152 mm Hg for all-cause mortality, SBP 143 mm Hg for CV events, and DBP 68 mm Hg for all-cause mortality.

Our results suggested that pre-dialysis BP was independently associated with all-cause mortality and CV events among Japanese HD patients.
Persistent HPV-16 infection leads to recurrence of high-grade cervical intraepithelial neoplasia
Authors: Byun Jung Mi , Jeong Dae Hoon , Kim Young Nam , Jung Eun Jung , Lee Kyung Bok , Sung Moon Su , Kim Ki Tae
Published: December 2018

High-grade cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer. The aims of this study were to evaluate the risk factors for recurrence of high-grade CIN and to determine if the specific genotype of human papillomavirus (HPV) is a predictor of recurrent high-grade CIN. Between January 2010 and December 2014, 172 patients with CIN 2+ underwent cold knife conization or a loop electrosurgical excision. The HPV DNA chip was used to detect HPV. Recurrent lesions were histologically confirmed and considered to be recurrence of CIN2+. We compared the recurrence rate in patients who did and did not have HPV infection after treatment. One hundred forty-eight (86%) patients had HPV infection before treatment. The first follow-up HPV test was performed on average 4.6 months after treatment and the recurrence rate for high-grade CIN was 3.5%. Fifty-eight patients (33.7%) were found to have HPV infection after treatment; of these, 14 (24.1%) had HPV genotype 16 and/or 18. Eleven patients had persistent HPV16 and/or 18 infection and 3 had new HPV 16 infection after treatment (78.6% and 21.4%, P = .001); the HPV 16 genotype was significantly correlated with recurrent disease and persistent infection after treatment (P = .013 and P = .054, respectively, [OR], 19.4; 95% [CI], 1.89–198.79). Recurrence of high-grade CIN was related to HPV infection after treatment, and persistent HPV16 infection was the most important factor for recurrence. Therefore, HPV vaccination for the HPV16 genotype and regular follow-up with HPV testing after treatment may be useful for preventing recurrent high-grade CIN.
Use of statins and the risk of delirium in critically ill and surgical patients
Authors: Zeng Hai , Li Zunjiang , He Guoxin , Han Yanhong , Fu Wenbin , Wen Junru
Published: December 2018

Background:

The critically ill and surgical patients are at significant risk of delirium, which is associated with a high morbidity and mortality. The association between statin use and the incidence of delirium is still controversial. In this article, we will perform a systematic review and meta-analysis of published studies to evaluate the effectiveness of statins for the prophylaxis of delirium among critically ill and surgical patients.

Methods:

We will conduct a systematic literature search in EMBASE, PubMed, and the Cochrane Library from inception date to October 2018 for randomized controlled trials (RCTs) and observational studies (either cohort or case-control studies) investigating the association between use of statins and delirium risk. The Cochrane Collaboration's tool for evaluating the risk of bias and Newcastle-Ottawa scale (NOS) will be used to assess the methodological quality of RCTs and observational studies, separately. The primary outcome will be the risk of incident delirium associated with statin use. Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) will be calculated by a random-effects or fixed-effects model according to heterogeneity among included studies. Subgroup analyses, meta-regression method, and assessment of publication bias will be also performed. Statistical analyses will be conducted with RevMan (version 5.3.5) and Stata (version 14.0) software. In addition, the grading of recommendations assessment, development and evaluation (GRADE) approach will be applied to evaluate the quality of evidence.

Results:

The study will provide a high-quality synthesis and evaluate the effectiveness of statins for delirium prevention among critically ill and surgical patients.

Conclusions:

The systematic review and meta-analysis will provide convincing evidence concerning the effect of statins against delirium in critically ill and surgical patients.
Efficacy of mineralocorticoid receptor antagonists in postmyocardial infarction patients with or without left ventricular dysfunction
Authors: Xu Yan , Qiu Zhiqiang , Yang Renqiang , Wu Yanqing , Cheng Xiaoshu
Published: December 2018

Background:

There is heated debate about the benefits of using mineralocorticoid receptor antagonists (MRAs) in addition to standard therapy in patients admitted for myocardial infarction (MI) with or without left ventricular dysfunction (LVD).

Methods:

Randomized controlled trials (RCTs) were scanned by a formal search of electronic databases (PubMed, EMBASE, Cochrane Library, Ovid, and clinical trials) from their inception to April 2018. A meta-analysis was conducted using Review Manager 5.3 to identify studies reporting the efficacy of MRAs use in post-MI patients with or without LVD.

Results:

Thirteen RCTs involving 11,365 individuals were eligible for this study. MRAs treatment reduced all-cause mortality by 16%, cardiovascular death by 16%, and death from heart failure (HF) by 22% in post-MI patients. MRAs use reduced all-cause mortality by 13% and cardiovascular death by 15% in post-MI patients with LVD, but there was no significant difference in all-cause mortality and cardiovascular death in post-MI patients without LVD (relative ratios [RR] 0.83, 95% confidence interval [CI] 0.26–2.69, P = .76, I2 = 0%; RR 1.01, 95% CI 0.33–3.09, P = .99, I2 = 0%). In 6 RCTs involving post-MI patients, MRAs treatment had a significant effect on improving left ventricular ejection fraction (LVEF) (mean difference 3.33, 95% CI 0.91–5.75, P = .007, I2 = 94%). Patients treated with MRAs did not show a decrease in recurrent MI or repeat revascularization compared with patients treated without MRAs (RR 0.95, 95% CI [0.80–1.12], P = .54, I2 = 0%; RR 1.09, 95% CI [0.79–1.50], P = .61, I2 = 0%). However, MRAs treatment significantly increased the incidence of hyperkalemia compared with patients treated without MRAs (RR 2.05, 95% CI [1.60, 2.61], P < .00001, I2 = 49%).

Conclusion:

MRAs treatment reduced all-cause mortality, cardiovascular death, and death from HF in post-MI patients. MRAs treatment also demonstrated a significant improvement in LVEF. MRAs reduced cardiovascular death and all-cause mortality in patients with LVD. Eplerenone significantly reduced all-cause mortality and cardiovascular death in post-MI patients. However, MRAs failed to show any cardiovascular benefit in post-MI patients without LVD.
Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012
Authors: Kim Bongyoung , Kim Yeonjae , Hwang Hyeonjun , Kim Jieun , Kim Shin-Woo , Bae In-Gyu , Choi Won Suk , Jung Sook In , Jeong Hye Won , Pai Hyunjoo
Published: December 2018

The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption.

Data on total antibiotic prescriptions, patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad-spectrum antibiotics and carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin as antibiotics against multidrug-resistant (MDR) pathogens.

A 15.1% decrease in total antibiotic consumption was observed in 2012 compared to that observed in 2004. In contrast, a 10.2% and 70.7% increase in broad-spectrum antibiotics and antibiotics against MDR pathogens were observed, respectively, in the same period. The resistance rate of Escherichia coli to 3rd CEPs (17.6% in 2004, 21.7% in 2008, and 33.8% in 2012, P <.001) and ciprofloxacin (37.5% in 2004, 38.7% in 2008, and 46.6% in 2012, P = .001) demonstrated a significantly increasing trend. Similarly, the resistance rate of Klebsiella pneumoniae to 3rd CEPs (34.3% in 2004, 33.7% in 2008, and 44.5% in 2012, P <.001) gradually increased. Resistance of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem significantly increased throughout the study period (A baumanii: 8.9% in 2004, 40.8% in 2008, and 65.3% in 2012, P 
<.001; P aeruginosa: 25.1% in 2004, 31.5% in 2008, and 29.7% in 2008, P = .050).

The consumption of carbapenems and FQs demonstrated significant positive correlation for resistance of E coli or K pneumoniae to 3rd CEPs as well as E coli or K pneumoniae to ciprofloxacin. Increasing resistance of A baumanii to ciprofloxacin was significantly correlated with increasing consumption of FQs; increasing resistance of A baumanii to imipenem was significantly correlated with increasing consumption of carbapenems.

In conclusion, overall antimicrobial resistance increased and consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens subsequently increased in Korean hospitals.
Association of early menopause with angiographically-derived SYNTAX score
Authors: Yan Liqiu , Cao Xufen , Zeng Saitian , Yu Jing , Li Zhe , Lian Zheng , Lv Fengfeng , Wang Jiawang
Published: December 2018

Association of early menopause with increased risk of cardiovascular events has been confirmed in previous studies. SYNTAX score (SX-score) can comprehensively quantify severity of coronary artery disease (CAD) and predict the outcomes of patients with CAD. However, the association of early menopause with SX-score has never been reported.

We prospectively included 1875 consecutive postmenopausal patients who underwent coronary angiography (CAG) and were angiographically diagnosed with CAD from January 2011 to December 2013. SX-score was calculated using the SX-score algorithm based on diagnostic angiogram. Ordinal logistic regression analysis was used to investigate the association between early menopause and SX-score.

Patients with early menopause were more likely to have a history of hypertension, diabetes, hyperlipidemia, and less likely to smoking. Besides, they have higher fasting glucose, hemoglobin A1C (HbA1c), total cholesterol (TC), low-density lipoprotein (LDL), triglyceride (TG), and body mass index (BMI) compared with the patients without early menopause. Moreover, patients with early menopause have higher SX-score and multi-vessel diseases. Ordinal logistic regression analysis showed that age, hypertension, diabetes, and early menopause exerted independent influences on SX-score. The patients undergone oophorectomy, early menopause was highly associated with SX-score.

Early menopause was an independent predictor of SX-score in postmenopausal patients with CAD.
Pneumomediastinum caused by occult paraquat poisoning
Authors: Deng Peng , Chen Yao , Li Hong , Wan Zhi
Published: December 2018

Rationale:

Paraquat is a widely applied contact herbicide that is highly poisonous. About 20% of patients with paraquat poisoning develop pneumomediastinum as a complication with a mortality rate of almost 100%.

Patient concerns:

A 15-year-old boy presented with a 1-month history of retrosternal chest pain with no obvious cause. High-resolution computed tomography showed pneumomediastinum.

Diagnoses:

After all likely causes of pneumomediastinum were eliminated, the diagnosis of occult paraquat poisoning was made when serum paraquat concentration was revealed at 467.40 ng/mL, despite the patient's denial of ingestion or contact.

Interventions:

Hemoperfusion, intravenous glucocorticoid, and ulinastatin was administered for 3 days with other routine treatment against paraquat poisoning. The serum paraquat concentration decreased to zero.

Outcomes:

Despite the general high mortality and poor prognosis of paraquat poisoning, the patient recovered and was completely asymptomatic at his 3-month follow-up.

Lessons:

Paraquat poisoning should be suspected as a differential diagnosis when patients present with pneumomediastinum without recognizable cause.
VEGF overexpression is associated with optic nerve involvement and differentiation of retinoblastoma
Authors: Wu Qizheng , Sun Xiao , Zheng Guangying
Published: December 2018

Background:

Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of cancer. Although numerous studies have investigated the association between VEGF expression and pathogenesis of retinoblastoma, the results remained inconsistent. To illuminate the association, we performed a meta-analysis study.

Methods:

According to the PRISMA guideline, eligible studies were searched in the Medicine, Embase, Web of Science, Chinese National Knowledge Infrastructure, and Wanfang databases. Stata 14.0 software was used to calculate the relevant statistical parameters.

Results:

Seventeen studies with 296 controls and 470 patients with retinoblastoma were included from 17 eligible literatures. Overall, significant association between VEGF overexpression and susceptibility of retinoblastoma was observed in Chinese population (odds ratio [OR] = 21.67, 95% confidence interval [CI] = 13.96–33.62). Subgroup analysis based on control sample type showed that VEGF overexpression was significantly associated with the risk of retinoblastoma (Normal retina tissue, OR = 23.97, 95% CI = 9.67–59.42; retinoblastoma adjacent tissue, OR = 20.85, 95% CI = 12.64–34.37). Significant associations of VEGF overexpression with optic nerve involvement and differentiation of retinoblastoma were found (Optic nerve involvement, OR = 6.90, 95% CI = 4.01–11.88; Differentiation, OR = 0.18, 95% CI = 0.12–0.28). In addition, only 1 study was included to analyze the role of VEGF protein expression in the prognosis of retinoblastoma, and the result showed that VEGF expression was significantly associated with the prognosis of retinoblastoma, which should be verified in the future studies.

Conclusions:

Our findings demonstrated that VEGF overexpression was significantly associated with the risk of retinoblastoma. Besides, the results suggested that VEGF overexpression might have a crucial effect on the optic nerve involvement and differentiation of retinoblastoma.
The efficacy of cervical spine phantoms for improving resident proficiency in performing ultrasound-guided cervical medial branch block
Authors: Kwon So Young , Kim Jong-Woan , Cho Min Ji , Al-Sinan Abdullah Hussain , Han Yun-Joung , Kim Young Hoon
Published: December 2018

Background:

Few studies have been conducted on the utility of cervical spine phantoms for practicing cervical procedures. Here, we describe a simple method for creating a cervical spine phantom and investigate whether the use of a gelatin-based phantom is associated with improved proficiency in performing ultrasound-guided cervical medial branch block.

Methods:

A cervical spine phantom was prepared using a cervical spine model immersed in a mixture of gelatin and psyllium husk. In total, 27 participants, inexperienced in spinal ultrasonography, were enrolled and allocated to 1 of 2 groups (training group, n = 18; control group, n = 9). All participants were tested (test-1) following an introductory course of basic ultrasonography. Participants in the control group were tested again after 1 week (test-2). Those in the training group received a further individual 3-hour training session, and were tested again after 1 week (test-2).

Results:

The mean performance score in test-1 was 62.5 ± 10.1 points in the training group and 62.3 ± 4.1 points in the control group [95% confidence interval (95% CI) −5.5 to 5.8; P = .954]. In test-2, the mean score was 86.8 ± 6.5 points and 59.9 ± 4.4 points in the training and control groups, respectively (95% CI 21.9–31.8; P < .001). The mean time required to complete test-1 was 84.6 ± 26.6 seconds in training group and 90.7 ± 43.9 seconds in the control group (95% CI −34.0 to 21.7; P = .653); in test-2, the time required was 56.6 ± 27.9 and 91.2 ± 43.8 seconds (95% CI −63.0 to −6.2; P = .019), respectively. Interobserver reliability showed excellent agreement based on the intraclass correlation coefficient, and moderate to almost perfect agreement by kappa statistics.

Conclusion:

Training using a gelatin-based cervical spine phantom helps novices acquire the skills necessary to perform ultrasound-guided cervical medial branch blocks.
Is the transdermal fentanyl patch an efficient way to achieve acute postoperative pain control?
Authors: Jang Ji Su , Hwang Sung Mi , Kwon Youngsuk , Tark Hyunjin , Kim Young Joon , Ryu Byoung Yoon , Lee Jae Jun
Published: December 2018

Backgroupd:

This study investigated the plasma fentanyl concentration and efficacy of transdermal fentanyl patch (TFP) (25 μg/h) in the management of acute postoperative pain.

Methods:

Patients undergoing laparoscopic cholecystectomy were randomly allocated to 2 groups. The TFP group (n = 30) received a single TFP 25 μg/ h to the anterior chest wall 14 h before operation. The IV group (n = 30) received a placebo patch. After the operation, intravenous fentanyl infusion (25 μg/h) was begun with loading dose 25 μg in the IV group and only normal saline in the TFP group. Plasma fentanyl levels were measured at admission, 1, 6, 12, 24, and 48 h postoperatively. Pain severity and adverse effects were evaluated too.

Results:

The fentanyl level peaked 1 h after operation in the TFP group (3.27 ± 0.34 ng/mL) and 24 h postoperatively in the IV group (2.9 ± 0.42 ng/mL). Pain scores and the use of rescue analgesics were not significantly different between 2 groups. Respiratory depression was not happened in both groups.

Conclusions:

The TFP (25 μg/h) affixed 14 h before surgery reached a higher constant concentration than the same dose setting of a constant IV infusion of fentanyl after surgery. Although the concentration of fentanyl was higher than those of previous researches, there was no respiratory depression. But, there was no advantage of reducing pain score and the use of rescue analgesics. Clinical trial registration: (available at: http://cris.nih.go.kr, KCT0002221).
Combined therapy and antivascular endothelial growth factor monotherapies for polypoidal choroidal vasculopathy
Authors: Zhang Yun , Li Xun , Chen Xiaoye , Cai Zhaolun , Zhang Zirong , Tang You , Chang Tiancong , Chen Misha , Zhang Meixia
Published: December 2018

Background:

Different antivascular endothelial growth factor (VEGF) monotherapy regimens and photodynamic therapy (PDT) combined with anti-VEGF therapy are available for patients with polypoidal choroidal vasculopathy (PCV). However, the comparative efficacy and safety of different anti-VEGF monotherapy regimens and combined therapy with PDT and anti-VEGF remains unknown. The aim of our study is to evaluate the efficacy and safety of anti-VEGF monotherapies and combined therapy in patients with PCV.

Methods:

We will systematically search PubMed, Embase, and the Cochrane library for eligible studies. The Cochrane Collaboration's tool for assessing the risk of bias in a randomized trial and the ROBINS-I tool will be used to assess the risk of bias in the included studies. The primary outcome is the mean change in best corrected visual acuity from baseline. The secondary outcomes are the mean change in central retinal thickness from baseline and the number of serious adverse events.

Results:

The result will generate a comprehensive suggestion for the treatment of PCV.

Conclusion:

The results of the network meta-analysis will be submitted in a peer-reviewed journal for publication.

Ethics and dissemination:

The study does not involve human subjects and requires no ethical approval or patient consent. The results of the network meta-analysis will be submitted in a peer-reviewed journal for publication and generate a comprehensive suggestion for the treatment of PCV.
Removal of an intraorbital metallic foreign body following double-penetrating ocular injury
Authors: Cui Yan , Li Ziwei , Wang Yuwei , Shi Long
Published: December 2018

Rationale:

Open eye injury is one of the commonest ophthalmic emergencies, and when accompanied by intraorbital foreign bodies, the condition carries a poor prognosis.

Patient concerns:

A 28-year-old man presented to the emergency department of our hospital complaining of sudden painful loss of vision in the left eye after he hammered an iron plate.

Diagnosis:

The ocular examination revealed a 4-mm full thickness scleral laceration with prolapsed uveal tissue, a traumatic cataract. Computed tomography (CT) demonstrated an orbital foreign body in the retrobulbar area.

Interventions:

The patient underwent emergency scleral suturing, severance of medial rectus muscle, and removal of the orbital foreign body. Twelve days after the emergency operation, pars plana lensectomy and pars plana vitrectomy were performed.

Outcomes:

After 3 months of follow-up, there was no immune response. Visual acuity in the left eye was the perception of hand motion. The retina remained mostly attached with normal intraocular pressure, and good cosmetic appearance. The globe anatomy was maintained, but the vision could not be restored due to the grave nature of the trauma.

Lessons:

Transconjunctival approach extraocular muscle severance may thus be a suitable approach to the removal of intraorbital metallic foreign body.
Prediction of novel target genes and pathways involved in tall cell variant papillary thyroid carcinoma
Authors: Xia Fada , Jiang Bo , Chen Yong , Du Xin , Peng Yao , Wang Wenlong , Wang Zhuolu , Li Xinying
Published: December 2018

Background:

Tall cell variant papillary thyroid carcinoma (TCPTC) is reportedly associated with aggressive clinicopathological parameters and poor outcomes; however, the molecular mechanisms underlying TCPTC remain poorly understood.

Methods:

The gene mutation types and mRNA expression profiles of patients with TCPTC were obtained from The Cancer Genome Atlas (TCGA) database. Differentially expressed genes (DEGs) were identified. Pathways in the interaction network and the diagnostic approaches of candidate markers for TCPTC were investigated.

Results:

BRAFmutation was particularly prevalent in TCPTC with a mutation frequency of 78%. TCPTC was associated with a patient age >45 years, tumor multifocality, extrathyroidal extension, a higher T stage, advanced AJCC TNM stages,BRAFV600E mutation, and poor disease-free survival. We identified 4138 TCPTC-related DEGs and 301 TCPTC-specific DEGs. Intriguingly, the gene expression pattern revealed that the dysregulated levels of both putative oncogenes and tumor suppressors in TCPTC were higher than those in classical/conventional variant PTC (cPTC). Functional enrichment analyses revealed that these DEGs were involved in several cancer-related pathways. A protein-protein interaction (PPI) network was constructed from the 301 TCPTC-specific DEGs, and 3 subnetworks, and 8 hub genes were verified. Receiver operating characteristic (ROC) analyses revealed that 6 hub genes, includingCOL5A1,COL1A1,COL10A1,COL11A1,CCL20, andCXCL5, could be used not only for the differential diagnosis of PTC from normal samples, but also for the differential diagnosis of TCPTC from cPTC samples.

Conclusions:

Our study might provide further insights into the investigations of the tumorigenesis mechanism of TCPTC and assists in the discovery of novel candidate diagnostic markers for TCPTC.
Association between thermal threshold abnormalities and peripheral artery disease in patients with type 2 diabetes
Authors: Sheen Yi-Jing , Li Tsai-Chung , Lin Jiann-Liang , Tsai Wen-Chen , Kao Chuen-Der , Bau Cho-Tsan , Sheu Wayne H.-H.
Published: December 2018

Both diabetic peripheral neuropathy and peripheral arterial disease (PAD) cause foot ulcers and often result in non-traumatic amputations in patients with type 2 diabetes. This study aimed to evaluate the association between clinical variables, PAD, and subclinical diabetic small fiber peripheral neuropathy detected by abnormal thermal thresholds of the lower extremities in patients with type 2 diabetes.

We investigated 725 consecutive patients with type 2 diabetes (male/female: 372/353; mean age, 67 ± 11 years) who did not have apparent cardiovascular disease (including coronary artery disease, arrhythmia, and stroke) and who underwent the quantitative sensory test for thermal (warm and cold) thresholds of the lower limbs and ankle-brachial index (ABI)/toe-brachial index (TBI) examinations in 2015. The analyses included glycated hemoglobin, estimated glomerular filtration rate, and other characteristics.

In total, 539 (74.3%) patients showed an abnormality of at least 1 thermal threshold in their feet. All patients with an abnormal ABI (<0.9) had concurrent impaired thermal thresholds, and 93% (87/94) of patients with an abnormal TBI experienced abnormal thermal thresholds in the lower limbs. Age- and sex-adjusted TBI and estimated glomerular filtration rate were significantly correlated to abnormal thermal thresholds. In the multivariate analysis, fasting plasma glucose, and glycated hemoglobin were independently associated with abnormal thermal thresholds in the lower extremities.

Subclinical thermal threshold abnormalities of the feet are significantly associated with PAD and nephropathy in patients who have type 2 diabetes without cardiovascular disease.
Coagulation markers and echocardiography predict atrial fibrillation, malignancy or recurrent stroke after cryptogenic stroke
Authors: Ellis Deandrea , Rangaraju Srikant , Duncan Alexander , Hoskins Michael , Raza Syed Ali , Rahman Haseeb , Winningham Melanie , Belagaje Samir , Bianchi Nicolas , Mohamed Ghada A. , Obideen Mahmoud , Sharashidze Vera , Belair Trina , Henriquez Laura , Nahab Fadi
Published: December 2018

We evaluated the utility of left atrial volume index (LAVI) and markers of coagulation and hemostatic activation (MOCHA) in cryptogenic stroke (CS) patients to identify those more likely to have subsequent diagnosis of atrial fibrillation (AF), malignancy or recurrent stroke during follow-up.

Consecutive CS patients who met embolic stroke of undetermined source (ESUS) who underwent transthoracic echocardiography and outpatient cardiac monitoring following stroke were identified from the Emory cardiac registry. In a subset of consecutive patients, d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer (MOCHA panel) were obtained ≥2 weeks post-stroke and repeated ≥4 weeks later if abnormal; abnormal MOCHA panel was defined as ≥2 elevated markers which did not normalize when repeated. We assessed the predictive abilities of LAVI and the MOCHA panel to identify patients with subsequent diagnosis of AF, malignancy, recurrent stroke or the composite outcome during follow-up.

Of 94 CS patients (mean age 64 ± 15 years, 54% female, 63% non-white, mean follow-up 1.4 ± 0.8 years) who underwent prolonged cardiac monitoring, 15 (16%) had new AF. Severe LA enlargement (vs normal) was associated with AF (P < .06). In 42 CS patients with MOCHA panel testing (mean follow-up 1.1 ± 0.6 years), 14 (33%) had the composite outcome and all had abnormal MOCHA. ROC analysis showed LAVI and abnormal MOCHA together outperformed either test alone with good predictive ability for the composite outcome (AUC 0.84).

We report the novel use of the MOCHA panel in CS patients to identify a subgroup of patients more likely to have occult AF, occult malignancy or recurrent stroke during follow-up. A normal MOCHA panel identified a subgroup of CS patients at low risk for recurrent stroke on antiplatelet therapy. Further study is warranted to evaluate whether the combination of an elevated LAVI and abnormal MOCHA panel identifies a subgroup of CS patients who may benefit from early anticoagulation for secondary stroke prevention.
Expression and Activity of Matrix Metalloproteinases in Leukemia
Authors: Amin Asnafi Ali , Bagheri Marziye , Zibara Kazem , Maleki Behzad Masumeh , Shahrabi Saeid
Published: December 2018

Matrix metalloproteinases (MMPs) are responsible for the degradation of extracellular matrix components and hence play a crucial role in physiological and pathologic processes. The imbalance between the expression of MMPs and their inhibitors can be effective in leukemic cell processes such as migration, angiogenesis, survival, and apoptosis, playing a key role in the progression and prognosis of leukemia. In this review, we discuss the potential involvement of MMPs and their inhibitors in the pathogenesis and progression of leukemia by examining their role in the prognosis of leukemia. Inducing leukemic cell growth, migration, invasiveness, and angiogenesis are the main roles of MMPs in leukemia progression mediated by their degradative activity. Given the important role of MMPs in leukemia progression, further clinical trials are needed to confirm the link between MMPs’ expressions and leukemia prognosis. It is hoped to use MMPs as therapeutic targets to improve patients’ health by recognizing the prognostic value of MMPs in leukemia and their effect on the progression of these malignancies and their response to treatment.