bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Surgery Using the FACE-Q Skin Cancer Module
Authors: Vaidya Toral S. , Mori Shoko , Khoshab Nima , Dusza Stephen W. , Bander Thomas , Matros Evan , Rossi Anthony M. , Nehal Kishwer S. , Lee Erica H.
Published: October 2019

Background:

Over 5 million basal and squamous cell skin cancers are diagnosed each year. Seventy to 80% of these cancers occur in the head and neck region, for which surgical excision is the standard treatment. As patient satisfaction and quality of life are among the most important outcomes in plastic and reconstructive surgery, understanding patient perception of aesthetic postoperative outcome is critical. The objective of this study was to assess aesthetic satisfaction following facial skin cancer surgery using the FACE-Q Skin Cancer Module in the context of sociodemographic and clinical factors.

Methods:

This is a single-center, cross-sectional study in a tertiary care cancer setting of patients who underwent facial skin cancer surgery from March 1, 2016, to March 31, 2018. Patients completed the FACE-Q Skin Cancer Satisfaction with Facial Appearance and Appraisal of Scar scales postoperatively, between May 21, 2018, and October 1, 2018.

Results:

Patients completed the Satisfaction with Facial Appearance (n = 405) and Appraisal of Scar scales (n = 408) postoperatively (response rate 39%). Lower postoperative facial appearance and scar satisfaction scores were associated with female gender, younger age (<65 years), surgery location on the lip or nose, repair by flap or graft, and greater defect size. Linear regression models established that younger age, female gender, nose location, and flap repair were independently predictive of lower aesthetic satisfaction.

Conclusions:

Sociodemographic factors, central facial location, and repair type strongly contribute to aesthetic satisfaction following facial skin cancer surgery. This patient-reported data may guide counseling regarding postoperative aesthetic outcome and inform patient expectations.
Combined Breast Implant Explantation and Multilevel Mastopexy Technique
Authors: Borenstein Amiram , Friedman Or
Published: October 2019

Patients dissatisfied with their breast implants are faced with 2 options: secondary augmentation or removal of the implants. Simple removal of breast implants often leads to wide, deflated, and laterally displaced breasts which are notoriously difficult to reconstruct. We present a surgical technique that was specifically developed to recreate the breast mound using the wide laterally displaced breast tissue left after breast implant removal.
Improving Cost-efficiency in Bilateral Direct-to-Implant Reconstructions with Acellular Dermal Matrix
Authors: Buendía Javier , Olivas-Menayo Jesus
Published: October 2019

The use of acellular dermal matrix (ADM) for bilateral breast reconstruction has increased in recent years. Detection of BCRA mutation and therefore bilateral risk-reduction mastectomy is one of the main reasons for this increase. High cost of ADM is considered a major drawback for its use. The authors present a new technique which allows the use of only one unit of ADM for both breasts. After assessing the viability of the skin of mastectomy flaps, a musculofascial pocket formed superiorly by pectoralis major, laterally by serratus fascia and inferiorly by rectus fascia, is performed. Then, the ADM is divided in two halves. We propose two different ways to divide the matrix, cutting it vertically or diagonally in two. The way in which the matrix should be cut depends on the distensibility of the pocket. Afterwards, the implant is inserted and the exposed area of the implant is covered by the ADM sutured to the edges of the musculofascial pocket. Using only one ADM unit for bilateral reconstruction, the procedure becomes not only more cost-effective but also can reduce complications such as seroma, rippling, wrinkling, and visibility by means of a better coverage with lesser foreign body load. Furthermore, the lesser the matrix used, the faster the integration is achieved.
SUDDEN VISION LOSS FROM CENTRAL RETINAL ARTERY OCCLUSION AS A PRESENTING SYMPTOM OF MITRAL VALVE PAPILLARY FIBROELASTOMA
Authors: Henao Martha , Chamchikh Joud , Chalam Kakarla V.
Published: October 2019

Purpose:

We describe a central retinal artery occlusion with cilioretinal sparing in a young male patient who was found to have mitral valve papillary fibroelastoma

Methods:

At the initial examination, a 33-year-old Hispanic man had visual acuity of 20/200 in his left eye, and 2 weeks later, visual acuity improved to 20/20. Diagnosis required transesophageal echocardiography to localize the lesion.

Results:

Mitral valve papillary fibroelastoma involving the mitral valve was successfully treated with tumor resection.

Conclusion:

Routine echocardiography should be performed in all patients presenting with central retinal artery occlusion as it may diagnose treatable cardiogenic etiologies and present further potentially life-threatening embolic events.
Interaction between eNOS gene polymorphism and current smoking on susceptibility to coronary heart disease in Chinese people
Authors: Yang Ping , Wu Peng , Liu Xing , Feng Jian , Zheng Shuzhan , Wang Yan , Fan Zhongcai
Published: October 2019

Objective

This study aims to explore the relation between endothelial nitric oxide synthase (eNOS) single-nucleotide polymorphisms (SNPs) and the risk of coronary heart disease (CHD).

Methods

SNPstats (online software: http://bioinfo.iconcologia.net/SNPstats) was performed to test Hardy–Weinberg equilibrium in controls. Generalized multifactor dimensionality reduction (GMDR) was adopted to screen the preferable interaction between eNOS SNPs and smoking.

Results

The frequency for the rs1799983-T allele was 31.1% in CHD patients, which was significantly higher than that of 19.8% in controls (P < 0.05). The frequency for the rs891512-A allele was 28.8% in cases, which was also significantly higher than that of 20.1% in controls (P < 0.05). Logistic regression analysis showed that both rs1799983-T and rs891512-A alleles were related with increased risk of CHD, and the odds ratios (ORs) [95% confidence interval (CI)] were 1.71 (1.31–2.15) and 1.57 (1.14–2.07), respectively. High-order interactions were investigated among SNPs and environmental factors using the GMDR method. The data showed that a two-locus model (rs1799983 × smoking) had a testing accuracy of 0.60 (P = 0.001). We found that current smokers with rs1799983-GT or TT within eNOS gene have the highest CHD risk, compared to never smokers with rs1799983-GG genotype, OR (95% CI) = 2.74 (1.78–3.85), after covariates adjustment for age, gender, BMI, and alcohol drinking.

Conclusion

The rs1799983-T and rs891512-A alleles and interaction between rs1799983 and smoking were all risk factors of CHD.
Caring for the surgical patient with limited ICU resources
Authors: Ribeiro Marcelo A.F. , Fonseca Alexandre Z. , Santin Stephanie
Published: October 2019

Purpose of review

The current review aims to discuss the management of surgical patients in an ICU in countries where resources are limited.

Recent findings

ICU beds in low-income and middle-income countries (LMICs) are limited and also have limited human and structural resources. The working force has been described to be the costliest factor. Nevertheless, costs for intensive care in LMICs are one third from the cost reported from high-income countries. Alternative options have been described, so intensive care can be delivered outside ICU. Examples are Rapid-Response Systems and Medical Emergency Teams.

The care of the surgical patients in an intensive care setting in countries with resource limitations should be optimized, protocols for standardized care implemented and Better research and resource allocation, as well as investment in healthcare training are essential for the development of intensive care in LMICs is necessary.
Prevalence of and risk factors for anxiety after coronary heart disease
Authors: Chen Ying-Ying , Xu Ping , Wang Yuan , Song Tian-Jiao , Luo Nan , Zhao Li-Jing
Published: October 2019

Background:

As the most important component of cardiovascular disease, coronary heart disease (CHD) is closely related to psychological factors such as anxiety. Anxiety, whether present before or after the onset of illness, can lead to many serious consequences. The aim of this systematic review and meta-analysis was to assess the prevalence of and potential risk factors for anxiety after coronary heart disease (post-CHD anxiety).

Method:

Systematic searches were performed in electronic databases including China National Knowledge Infrastructure (CNKI), Wanfang, Technology Journal database (VIP), PubMed, Web of Science, Embase and Medline.

Result:

Thirteen studies were included. With regard to cross-sectional studies, the prevalence of post-CHD anxiety was P = .37, 95% CI (0.26–0.49). The overall analysis among cohort studies revealed that the prevalence of post-CHD anxiety was P = .50, 95% CI (0.05–0.95). Among the 11 potential risk factors, low education level [OR = 1.46, 95% CI (1.05–2.02)] and long duration of disease [OR = 2.05, 95% CI (1.05–4.00)] were statistically significant.

Conclusion:

There is high heterogeneity between studies and many defects; thus, further research is required to support these results. Attention should be paid to post-CHD anxiety, and clinical caring should include psychological counselling and imparting disease-related knowledge to patients with a long disease duration and low educational background.
Treatment of varicocele with Fu's subcutaneous needling
Authors: Yu Xiaojiang , Li Ting , Zhuang Zhenjie , Li Yingxian , Xie Dongming , Li Zikang , Yuan Xueya , Yang Chaojie
Published: October 2019

Rationale:

Fu's subcutaneous needling (FSN) is an innovative therapy of traditional acupuncture. FSN has been widely applied for the treatment of pain symptoms by relieving local muscle tension and promoting local blood circulation. Varicocele (VCL) is a disease that commonly occurs in male adolescents. Patients with VCL can suffer from pain in the scrotum, inguinal area, or unilateral testis, which could be an indication for FSN. In this study, we present a unique case, in which a 30-year-old male patient with VCL benefitted from FSN.

Patient concerns:

A 30-year-old male complained of dull pain and swelling in the testicular area for 4 months. No significant abnormalities were identified in his genitalia by physical examination.

Diagnoses:

The patient was diagnosed with VCL, with his symptoms and signs of dull pain and swelling in the testicular area, and ultrasound also demonstrated the left-side VCL.

Interventions:

FSN was performed successfully twice a week on a different day without postoperative complications. The total course lasted 8 weeks.

Outcomes:

The patient experienced obvious relief of his testicular pain and swelling after each treatment course. All his symptoms resolved and disappeared after 4 treatment courses. After the 8-week treatment course, the color ultrasound after treatment demonstrated improved anastomotic blood flow rates in his left spermatic vein. No narrow or thrombotic parts were observed post-treatment compared to the color ultrasound before treatment. The patient was followed up at 1, 3, and 6 months after treatment. During the follow-up period, his previous symptoms disappeared without recurrence.

Lessons:

FSN significantly improved the patent's symptoms of testicular pain and abnormal dilatation and tortuosity of the spermatic veins. FSN might exert its therapeutic effect by improving the relaxation of muscle oppression and increasing the local blood reperfusion to resume blood stream. Due to the limitation of a single clinical observation case, a randomized clinical trial with a sufficient follow-up time is needed.
Papillary thyroid carcinoma with tracheal invasion
Authors: Zhang Jiateng , Fu Chao , Cui Kefei , Ma Xiao
Published: October 2019

Rationale:

Compared with most malignant tumors, papillary thyroid carcinoma (PTC) is usually associated with favorable survival and low recurrence rate. The prognostic factors of PTC include age, sex, tumor size, enlarged lymph nodes, and extrathyroidal extension. Among the extrathyroidal extension, upper aerodigestive tract (ADT) invasion by PTC is a marker of more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death.

Patient concerns:

A 61-year-old woman had a cervical mass that was slowly growing for three years. Additionally, she had haemoptysis of 1-year duration. During the month prior to her visit, she had difficulty breathing.

Diagnosis:

Neck ultrasonography (US) and thyroid computed tomography (CT) images both showed a well-defined calcified mass on the left lobe of the thyroid gland. Additionally, the thyroid CT revealed that part of the mass protruded into the lumen which resulted in the thickening on the left side of the trachea. Accordingly, her diagnoses were as follows: firstly, a solid mass on the left lobe of the thyroid gland with tracheal compression; and finally, the space-occupying airway lesion.

Interventions:

She underwent a bronchoscopic examination, which revealed a mass blocking most of the upper endoluminal trachea. Thus, the mass was resected at the upper tracheal segment, followed by electrotome and argon plasma coagulation treatment. She was then transferred to the Thyroid Surgery Department. Thyroid surgeons took the surgical type of bilateral subtotal thyroidectomy + exploration of bilateral recurrent laryngeal nerve + dissection of the lymph node in neck central area + circumferential sleeve resection + end-to-end anastomosis + tracheotomy in the patient.

Outcomes:

After surgery, she recovered well without any local recurrence or distant metastasis.

Lessons:

When patients with PTC have haemoptysis, hoarseness, dyspnea, or any other symptoms, and the imaging examinations reveal a space-occupying lesion in the thyroid and airway, clinicians should focus on PTC with tracheal invasion, a bronchoscopic examination must be immediately performed because the subsequent surgical management depends on the degree of tracheal invasion.
Spleen-preserving distal pancreatectomy and lymphadenectomy for glucagonoma syndrome
Authors: Cao Xuefeng , Wang Xixiu , Lu Yanmin , Zhao Baolei , Shi Jian , Guan Qinghai , Zhang Xingyuan
Published: October 2019

Rationale:

Glucagonoma is a rare type of functional pancreatic neuroendocrine tumor that is characterized by distinctive clinical manifestations; among these, necrolytic migratory erythema represents the hallmark clinical sign of glucagonoma syndrome and is usually presented as the initial complaint of patients.

Patient concerns:

A 30-year-old male patient was admitted to our hospital with a complaint of diffuse erythematous ulcerating skin rash for more than 10 months. He also complained of hyperglycemia and a weight loss of 15 kg in those months.

Diagnosis:

This patient underwent a contrast-enhanced computed tomography scan which showed a pancreatic body mass measuring approximately 6 cm with low density accompanied by partial calcification in plain scanning images and uneven enhancement in strengthening periods. In addition, laboratory tests indicated elevated fasting blood glucagon (1109 pg/mL, normal range: 50–150 pg/mL) levels. Glucagonoma syndrome was ultimately diagnosed in clinical.

Intervention:

Spleen-preserving distal pancreatectomy was conducted and postoperative pathology revealed the presence of glucagonoma.

Outcomes:

The patient recovered uneventfully with the glucagonoma syndrome disappeared soon after surgery, and the postoperative plasma glucagon decreased to a normal level. Follow-up showed no recurrence for 5 years since the surgery.

Lessons:

The treatment of glucagonoma should be directed according to the stage at which the disease is diagnosed. Surgery is currently the only method available to cure the tumor, although medications are given to patients who present with advanced glucagonoma and who are not candidates for operation. Multidisciplinary therapy and multimodality treatment are advised, although these have been systematically evaluated to a lesser degree.
Efficacy and safety of high-dose tigecycline for the treatment of infectious diseases
Authors: Gong Jinhong , Su Dan , Shang Jingjing , Yu Hai , Du Guantao , Lin Ying , Sun Zhiqiang , Liu Guangjun
Published: October 2019

Background:

High-dose (HD) tigecycline regimen is increasingly used in infectious diseases, however its efficacy and safety versus low-dose (LD) is still unclear.

Methods:

A systematic review and meta-analysis was performed; PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, clinicalTrials.gov, Wanfang, VIP, and China National Knowledge Infrastructure (CNKI), were searched using terms “tigecycline” AND “dose” up to October 31, 2018. Eligible studies were randomized trials or cohort studies comparing mortality, clinical response, microbiological eradication and safety of different tigecycline dose regimens for any bacterial infection. The primary outcome was mortality, and the secondary outcomes were clinical response rate, microbiological eradiation rate and adverse events (AEs). Meta-analysis was done with random-effects model, with risk ratios (RR) and 95% confidence intervals (CI) calculated for all outcomes.

Results:

Of 951 publications retrieved, 17 studies (n = 1041) were pooled in our meta-analysis. The primary outcome was available in 11 studies, and the RR for mortality was 0.67 (95% CI 0.53–0.84, P < .001). Clinical response (RR 1.46, 95% CI 1.30–1.65, P < .001) and microbiological eradication rate (RR 1.61, 95% CI 1.35–1.93, P < .001) were both higher in HD than in LD tigecycline regimen. However, non-Chinese study subgroup presented no statistical significance between HD and LD regimen, RR for mortality, clinical response and microbiological eradication were 0.79 (95% CI 0.56–1.14, P = .21), 1.35 (95% CI 0.96–1.92, P = .26), 1.00 (95% CI 0.22–4.43, P = 1.00), respectively. AEs did not differ between HD and LD tigecycline (RR 1.00, 95% CI 0.80–1.26, P = .97).

Conclusion:

HD tigecycline regimen reduced mortality meanwhile improved clinical efficacy and should be considered in serious infections caused by multidrug-resistant and extensively drug-resistant (MDR/XDR) bacteria.
Combined hepatocellular-cholangiocarcinoma
Authors: Zhang Hao , Yu Xiaojiong , Xu Jian , Li Juan , Zhou Yao
Published: October 2019

Combined hepatocellular-cholangiocarcinoma (CHCC) is a rare type of primary liver cancer (PLC). The aim of this study was to investigate the disease characteristics in CHCC patients and compare them with those in hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC).

The perioperative and follow-up data of CHCC patients (n = 15), HCC patients (n = 577), and ICC patients (n = 61) were retrospectively analyzed, and the clinicopathological characteristics were compared among these 3 groups.

In the CHCC group, the serum level of AFP was significantly higher than that of the ICC group (P = .002), and the CA19-9 level was higher than that of the HCC group (P = .011). The positive rates of CK7 and CK19 expression were higher in CHCC group than in HCC group (both P < .001), while the positive rates of Glypican–3 and Hepatocyte expression were higher in CHCC group than in ICC group (both P < .001). Meanwhile, the CHCC patients were likely to have undergone more MJH/LT than the HCC patients (P = .037) and the ICC patients (P = .011). Macrovascular invasion and lymph node metastasis in the CHCC group were significantly higher but satellite lesions were similar, compared to the HCC group. Both the 1-year disease-free survival (DFS) and the 1-year overall survival (OS) for the CHCC patients were worse than those for the HCC patients. AFP ≥ 400 ng/ml, tumor size ≥5 cm, tumor number ≥2, macro- and microvascular invasion, distant metastasis and positive margin were risk factors for both DFS and OS for the PLC patients. Multivariate analysis also confirmed that ICC and lymph node metastasis were risk factors for DFS and MJH/LT was risk factor for OS.

CHCC patients appear to have intermediate clinical characteristics in comparison with the HCC and ICC patients, and the 1-year DFS and OS for the CHCC patients was worse than the HCC patients, but similar to the ICC patients.
Epidemiological evaluation of traumatic lower limb fractures in children
Authors: Liu Huan , Wang Hongwei , Shao Bing , Lu Han , Zhang Song , Ou Lan , Chen Yu , Xiang Liangbi
Published: October 2019

To investigate the age, gender, time, and etiology differences of traumatic lower limb fractures (TLLFs) in a population of children (≤18 years old), we retrospectively reviewed 936 children who had TLLFs and who came to our university-affiliated hospitals from 2001 to 2010. This study enrolled 657 males (70.2%) and 279 females (29.8%) aged (11.6 ± 4.9) years old. The most common etiologies and fracture sites were motor vehicle collisions (MVCs, 440, 47.0%) and tibias (376, 40.2%). A total of 126 (13.5%) patients suffered neurological deficits (NDs), 127 (13.6%) patients sustained associated injuries (ASOIs), and 78 (8.3%) patients sustained complications. During all periods the occurrence increased with increasing age group and a male preponderance was observed in all age groups. With increasing age, the proportion of injuries due to different etiologies increased and the proportion of femur fracture decreased from 65.2% to 34.5%. With increasing year of admission, the proportion of injuries due to MVCs decreased. The most common fracture sites were tibias in MVCs, femurs in low fall, high fall, and struck by object, feet in sprain. Male patients presented with significantly higher proportions of injuries due to struck by object and sprain, significantly lower proportions of pelvis fracture than the female patients. MVCs and tibias were the most common etiologies and fracture sites. Prevention and treatment should be taken according to the pattern of TLLFs which have specific annual, gender, and age characteristics.
Impact of ultrasound-guided fine needle aspiration cytology for diagnosis of thyroid nodules
Authors: Wang Jing , Liu Jing , Liu Zhe
Published: October 2019

Background:

Previous clinical studies have reported that ultrasound-guided fine needle aspiration cytology (UGFNAC) can be used for the diagnosis of thyroid nodules (TN) effectively. However, no study has systematically explored its diagnosis accuracy in patients with TN. Thus, this study will assess its diagnosis accuracy for TN.

Methods:

We will perform a comprehensive literature search from the following databases from their inceptions to the present without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will consider all case-controlled studies investigating the impacts of UGFNAC diagnosis for patients with TN for inclusion. Two authors will independently carry out study selection, data collection, and methodological quality assessment. Quality Assessment of Diagnostic Accuracy Studies tool will be used for methodological quality evaluation. We will use RevMan V.5.3 and Stata V.12.0 software to perform statistical analysis.

Results:

We will apply sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio to judge the diagnostic accuracy of UGFNAC for TN.

Conclusion:

The results of this study will provide latest evidence for the diagnostic accuracy of UGFNAC for TN.

Systematic review registration:

PROSPERO CRD42019138805.
Efficacy of laser therapy for exercise-induced fatigue
Authors: Wang Dongmei , Wang Xingtong
Published: October 2019

Background:

Laser therapy is widely used for exercise-induced fatigue, while the effect among different studies remains controversial. The present study was to summary available randomized controlled trials (RCTs) to evaluate the effect of laser therapy in subjects with exercise-induced fatigue.

Methods:

PubMed, Embase, and Cochrane Library were searched to identify the potential RCTs from inception to October 2017. The weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated using a random-effects model.

Results:

Twenty RCTs involving a total of 394 individuals were included in final analysis. No significant differences were observed between the laser therapy and control for the outcomes of lactate (WMD: −0.19; 95%CI: −0.52 to 0.13; P = .244), repetitions (WMD: 4.44; 95%CI: −1.43 to 10.32; P = .138), work load (WMD: 3.38; 95%CI: −1.15 to 7.91; P = .144), time taken to perform the exercise tests (WMD: 4.42; 95%CI: −2.33 to 11.17; P = .199), creatine kinase (WMD: −41.80; 95%CI: −168.78 to 85.17; P = .519), maximum voluntary contraction (WMD: 23.83; 95%CI: −7.41 to 55.07; P = .135), mean peak forces (WMD: 2.87; 95%CI: −1.01 to 6.76; P = = .147), and visual analog scale (VAS) (WMD: −1.91; 95%CI: −42.89 to 39.08; P = = .927). The results of sensitivity analysis suggested that laser therapy might play an important role on the levels of lactate (WMD: −0.30; 95%CI: −0.59 to −0.01; P = = .040), maximum voluntary contraction (WMD: 33.54; 95%CI: 1.95 to 65.12; P = = .037), and VAS (WMD: −21.00; 95%CI: −40.78 to −1.22; P = = .037). The results of subgroup analyses indicated no significant differences between the laser therapy and placebo for lactate and repetitions when stratified by study design, mean age, gender, and study quality.

Conclusions:

The findings of this meta-analysis did not indicate any significant differences between the laser therapy and placebo.
Tumor-suppressor gene SOX1 is a methylation-specific expression gene in cervical adenocarcinoma
Authors: Yuan Min , Yao Lili , Abulizi Guzhalinuer
Published: October 2019

The present study is to analyze the difference of gene methylation in early cervical adenocarcinoma and to find molecular markers for predicting the occurrence and development of cervical adenocarcinoma.

A total of 15 cases of primary cervical adenocarcinoma and 10 cases of primary cervical squamous cell carcinoma at stages IB1 or IIA1 were included in the study. Infinium MethylationEPIC BeadChip (850K) was used to screen specifically expressed genes in cervical adenocarcinoma tissues. Bisulfite sequencing polymerase chain reaction (BSP) and quantitative real-time polymerase chain reaction (qRT-PCR) were used to verify the methylation levels in cervical adenocarcinoma, cervical squamous cell carcinoma, and normal cervical tissues.

Sex determining region Y-box 1 (SOX1) and cyclin D1 (CCND1) genes participated in multiple signaling pathways, being the central nodes of gene regulatory networks. SOX1 gene, but not CCND1 gene, was a specifically methylated gene in cervical adenocarcinoma according to BSP. According to qRT-PCR, methylation level of SOX1 in cervical adenocarcinoma tissues is significantly different from that in cervical squamous cell carcinoma tissues or normal cervical tissues, and the methylation level of CCND1 in cervical adenocarcinoma tissues or cervical squamous cell carcinoma tissues is significantly different from that in normal cervical tissues.

The present study demonstrates that tumor-suppressor gene SOX1 is a methylation-specific expression gene of cervical adenocarcinoma and is expected to become a specific molecular marker for the diagnosis of cervical adenocarcinoma. However, CCND1 gene was not proven to be a specific methylation expression gene in cervical adenocarcinoma in the present study.
Magnetic resonance imaging volumetric analysis for diabetic striatopathy with two episodes of hemichorea-hemiballism syndrome
Authors: Lin Yi-Te , Chen Shih-Chung , Yip Ping-Keung , Wang Vinchi
Published: October 2019

Rationale:

Diabetic striatopathy (DS) is an uncommon movement disorder among diabetic patients characterized by clinical hemichorea-hemiballism with neuroimage change of the striatum. Here, we report a case of DS with relapsed hemichorea-hemiballism attacks even during euglycemic period, and the MRI changes by volumetric analysis.

Patient concerns:

A 69-year-old diabetic female suffered from a relapsed episode of hemichorea-hemiballism during her euglycemic period after the treatment of hyperglycemia.

Diagnoses:

To investigate the serial MRI changes in a case with diabetic striatopathy who had clinical hemichorea-hemiballism syndrome.

Interventions:

Semi-quantitative volumetric analyses from T1 images of these brain MRIs were obtained during the disease course.

Outcomes:

Besides, the negative finding of the first brain MRI during her first hospital admission, three afterward MRI examinations disclosed a waxing-and-waning mode of volume change from high-signal T1 images in left striatum. The clinical symptoms paralleled with the neuroimage changes in striatum. The MR signal volume changes were valuable for the clinical course of the hemichorea-hemiballism caused by diabetic striatopathy

Lessons:

Serial MR images for the diabetic striatopathy presented as a key pathognomonic relationship with the clinical hemichorea-hemiballism syndrome, assessed by our simplied volumetric analysis. Clinical involuntary movements may relapse and persist even with euglycemic condition as our case.
The association between vitamin D deficiency and community-acquired pneumonia
Authors: Zhou Yun-Fang , Luo Bang-An , Qin Lu-Lu
Published: October 2019

Emerging evidence has shown that vitamin D deficiency may be related with community-acquired pneumonia (CAP), but individually published studies showed inconclusive results. The aim of this study was to quantitatively summarize the association between vitamin D and the CAP.

We conducted this meta-analysis though a systematic literature search of PubMed, Medline, and EMBASE up to 31 September 2018 with the following keywords ‘vitamin D’ or ‘cholecalciferol’ or ‘25-hydroxyvitamin D’ or ‘25(OH)D’ in combination with ‘community-acquired pneumonia’ or ‘CAP’ or ‘pneumonia’ with no limitations. This meta-analysis was performed following the guidelines of Meta-analysis of Observational Studies in Epidemiology. The association between vitamin D levels and CAP were measured as odds ratio (OR) and weighted mean difference (WMD). Results were combined using a random-effect or a fix-effect meta-analysis, and sensitivity analyses were conducted to explore potential factors.

Eight observational studies involving 20,966 subjects were included. In this meta-analysis, CAP patients with vitamin D deficiency (serum 25(OH)D levels <20 ng/mL) experienced a significantly increased risk of CAP (odds ratio (OR) = 1.64, 95% confidence intervals (CI): 1.00, 2.67), and an obvious decrease of −5.63 ng/mL (95% CI: −9.11, −2.14) in serum vitamin D was demonstrated in CAP patients. Sensitivity analysis showed that exclusion of any single study did not materially alter the overall combined effect.

The evidence from this meta-analysis indicates an association between vitamin D deficiency and an increased risk of CAP patients. However, well-designed trails are required to determine the explicit effect of vitamin D supplementation.
High-throughput autoantibody analysis in malignant pleural effusion and tuberculosis pleural effusion
Authors: Yi Fengshuang , Zhang Xin
Published: October 2019

Background:

Malignant pleural effusion (MPE) and tuberculosis pleural effusion (TPE) are 2 kinds of common pleural diseases. Finding efficient and accurate biomarkers to distinguish the 2 is of benefit to basic and clinical research. In the present study, we carried out the first high-throughput autoantibody chip to screen the beneficial biomarker with samples of MPE and TPE and the corresponding serum.

Methods:

We collected pleural effusion and serum of patients with MPE (n = 10) and TPE (n = 10) who had been in Beijing Chao-Yang hospital from June 2013 to August 2014. Using RayBio Human Protein Array-G2 to measure the concentration of 487 defined autoantibodies.

Results:

Fold changes of Bcl-2-like protein 11 (BIM) autoantibody in MPE-serum/TPE-serum and MPE/TPE groups were 10 (P = .019) and 6 (P = .001); for decorin autoantibody, MPE-serum/TPE-serum ratio was 0.6 (P = .029), and MPE/TPE ratio was 0.3 (P < .001).

Conclusion:

BIM autoantibody is a promising MPE biomarker by high-throughput autoantibody analysis in MPE and TPE.
Impact of the modality of mechanical ventilation on bleeding during pituitary surgery
Authors: Le Guen Morgan , Paternot Alexis , Declerck Agnes , Feliot Elodie , Gayat Etienne , Gaillard Stephan , Fischler Marc
Published: October 2019

Background:

Bleeding modifies the surgeon's view of the field during transsphenoidal endoscopic pituitary surgery. Since ventilation can alter venous return, we compared the effect of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) on intraoperative bleeding.

Methods:

Eighty-six patients were randomized to VCV or PCV in this single blinded study; comparisons concerned 42 in the PCV group and 43 in the VCV group.

Results:

Intraoperative bleeding, the primary endpoint, did not differ between groups whether analysis focused on 7 levels of the score, from minimal bleeding to bleeding with significant change in the conduct of surgical procedure (P = .89) or on a stratification into 3 categories, mild, moderate, and major (P = .47). Median [interquartile range] peak airway pressure was lower in the PCV group (13.5 [12.5–15] vs 16.3 [14.4–19.1] cm H2O, P < .001) while mean airway pressures were similar (P = .08). Means ± SD of tidal volumes were lower in the VCV group when expressed as absolute values (470.6 ± 84 vs 434.7 ± 71.7 ml, P = .05) or as tidal volume/theoretical ideal weight ratio (6.7 [6.5–7] vs 7.2 [6.9–7.9], P < .001). The 2 groups were similar for postoperative complications and number of patients cured.

Conclusion:

In conclusion, ventilation mode does not influence intraoperative bleeding during transsphenoidal pituitary surgery.

Trial registration:

Clinicaltrials.gov identifier: NCT01891838; July 3, 2013
The role of echocardiography and 99mTc-HDP scintigraphy in non-invasive diagnosis of cardiac amyloidosis
Authors: Costache Irina Iuliana , Buburuz Ana Maria , Crisu Daniela , Statescu Ana Maria , Ungureanu Carmen , Aursulesei Viviana
Published: October 2019

Rationale:

Cardiac amyloidosis, considered for the last years to be a rare disease, is one of the determinants of HFpEF. The non-specific clinical presentation and the difficulties related to endomyocardial biopsy have made cardiac amyloidosis an underdiagnosed clinical entity. Improvement of non-invasive diagnostic techniques and the development of new therapies increased clinical awareness for this form of restrictive cardiomyopathy. We here summarize echocardiography and 99mTc-HDP scintigraphy findings in 6 cases of cardiac amyloidosis and review the literature data of this progressive and fatal cardiomyopathy.

Patients concerns:

The main clinical manifestations were fatigue, low exercise tolerance and edemas. The right heart failure symptoms usually dominated the clinical picture.

Diagnoses:

All cases were evaluated by echocardiography; 3 cases were further examined by bone scintigraphy and 4 cases a peripheral biopsy was performed. Electrocardiography showed low-voltage QRS complexes and “pseudo-infarct” pattern in the precordial leads, contrary to the echocardiographic aspect, which revealed thickening of ventricle walls. Biatrial dilation and diastolic disfunction were observed. Impaired systolic function was detected in advanced stages of the disease. 99mTc-HDP scintigraphy revealed cardiac uptake of radiopharmaceutical and managed to confirm the diagnosis in 1 case of cardiac amyloidosis in which salivary gland biopsy was negative.

Interventions:

The treatment was based on managing fluid balance, with the mainstream therapy represented by diuretics. Neurohormonal agents, usually used in heart failure treatment were avoided, due to poor tolerance and worsening of disease course. The management of these 6 cases was challenging due to the refractory manifestation of congestive heart failure.

Outcomes:

During follow-up, 4 of the 6 patients from the current study died in the first year after the final diagnosis was established.

Lessons:

Nuclear imaging of cardiac amyloidosis has a revolutionary development nowadays. Bone scintigraphy presents promising results for identifying patients at early stages of disease and to differentiate between cardiac amyloidosis types. Further studies are necessary for the standardization of imaging protocol and development of non-invasive diagnostic tools, especially in assessing the response to treatment and disease progression, for which little is known.
Clinical efficacy of combination of pertuzumab, trastuzumab, and docetaxel for treatment of patients with HER2-positive breast cancer
Authors: Liu Yan-cui , Ma Ying , An Ning , Sun Ping , Wang Ying , Sun Cheng
Published: October 2019

Background:

This study will systematically investigate the efficacy and safety of the combination of pertuzumab, trastuzumab, and docetaxel (PTD) for treatment of patients with HER2-positive breast cancer (HER2-PBC).

Methods:

A comprehensive literature search for this study will consist of 2 parts: electronic database records and gray literature. The electronic database literatures are searched from PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All databases will be searched from inception up to the present. In addition, gray literatures, such as dissertations, ongoing trials, and so on, will also be searched. Two authors will independently read the records, extract data collection, and evaluate the risk of bias. RevMan V.5.3 software will be applied for statistical analysis.

Results:

This study will summarize up-to-date evidence of PTD for patients with HER2-PBC via overall survival, complete response, cancer-specific survival, recurrence-free survival, disease-free survival, quality of life, and toxicities.

Conclusion:

This study will provide efficacy and safety of PTD for HER2-PBC.
Efficacy and safety of acupoint autohemotherapy in treating stable chronic obstructive pulmonary disease
Authors: Hong Haidu , Huang Chushuan , Chen Chumin , Zhou Rui , Li Jieying , Liu Jianbo , Liu Xiaohong
Published: October 2019

Background:

Chronic Obstructive Pulmonary Disease (COPD) is a clinically common chronic disease with the characteristic of recurrent attacks, difficulty of cure and high morbidity, disability, death rates. COPD exerts a great burden on patients, families and society. Acupoint Autohemotherapy (AA) is a traditional Chinese medicine (TCM) treatment by taking the patient's own venous blood and injecting them at acupoints, combined with the continuous stimulation of blood and the specific efficacy of the acupoint itself. It has been proved to be useful in pulmonary treatment and rehabilitation of COPD patients. However, the efficacy of AA on COPD patients has not been fully statistically evaluated. In this study, we aim to systematically examine the efficacy and safety of AA for COPD patients.

Methods:

Data from all English and Chinese databases, including Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database and Chongqing VIP information, will be used to conduct a systematic and comprehensive literature search. The range of date is from inception to July 2019. Randomized controlled trials (RCTs) related to AA and western medicine in the treatment of COPD will be included. Quality of included trials will be assessed according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the certainty of the evidence of estimates derived from meta-analysis. RevMan 5.3 will be used for data synthesis, sensitivity analysis, meta-regression analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias, and Begg and Egger tests will be used to assess funnel plot symmetries. Grading of recommendations assessment, development and evaluation system will be utilized to assess the quality of evidence.

Results:

This systematic review and meta-analysis aims to summarize the direct and indirect outcomes for AA and western medicine on COPD patients and evaluate its efficacy and safety. The results will be submitted to a peer-reviewed journal once completed.

Conclusion:

The systematic review will provide evidence to assess the efficacy and safety of AA and western medicine in the treatment of COPD patients.

PROSPERO registration number:

PROSPERO CRD42019137189
Incidence patterns of traumatic upper limb fractures in children and adolescents
Authors: Yang Hua , Wang Hongwei , Cao Can , Lu Han , Zhao Yirong , Zeng Guofei , Li Changqing , Zhou Yue , Ou Lan , Liu Jun , Xiang Liangbi
Published: October 2019

China's child population ranked second in the world. However, data on the overall patterns and epidemiologic trends of TULFs among children and adolescents in Chongqing, China are scarce. With development of urbanization, motorization, building industry, the incidence patterns of traumatic upper limb fractures in children and adolescents might be about to change. To investigate the incidence patterns of traumatic upper limb fractures in children and adolescents (≤18 years old) according to age (≤3 years old, 3–6 years old, 6–12 years old, and 12–18 years old), gender, time, and etiology groups in Chongqing, China, we retrospectively reviewed 1078 children and adolescents who had traumatic upper limb fractures and who came to our university-affiliated hospitals from 2001 to 2010. The patients were grouped into different age groups, genders, year of admission range groups, and aetiologies. We used Pearson chi-square tests and independent samples t tests to assess differences of the grouped data and continuous variables, respectively. This study enrolled 1078 patients (849 males, 229 females) aged 11.0 ± 4.7 years old. The most common aetiologies and fracture sites of patients were low falls (705, 65.4%) and humerus (492, 45.6%). A total of 146 (13.5%) patients suffered a nerve injury, 94 (8.7%) patients sustained associated injuries, and 106 (9.8%) patients sustained complications. The proportion of injuries due to motor vehicle collisions increased with increasing age and year of admission. Female patients presented with significantly higher proportion of injuries due to motor vehicle collisions and significantly lower proportion of injuries due to hit by others. The proportion decreased from 63.2% to 33.3% in humeral fracture, increased from 8.8% to 35.5% in radius fracture, increased from 7.4% to 28.9% in ulna fracture with increasing age. Female patients presented with significantly higher proportion of humeral fracture, clavicle fracture and significantly lower proportion of radius fracture, ulna fracture, and hand fracture. Low falls and humerus fractures were the most common aetiologies and fracture sites. The pattern of traumatic upper limb fractures has specific age, gender, time, and etiology differences.
The risk of venous thromboembolism in women with inflammatory bowel disease during pregnancy and the postpartum period
Authors: Kim Yeon Hee , Pfaller Birgit , Marson Alanna , Yim Hyeon Woo , Huang Vivian , Ito Shinya
Published: October 2019

Pregnancy and inflammatory bowel disease (IBD) are independent risk factors for venous thromboembolism (VTE). Nevertheless, the optimal VTE prevention strategy for women with IBD in pregnancy and postpartum period has not been established yet. We assessed VTE risks during pregnancy and the postpartum period in women with IBD through systematic review and meta-analysis.

Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Ovid), and Web of Science (Tomson Reuters) from the database inception till May 2017 to identify relevant studies reporting the risk of VTE during pregnancy and/or the postpartum period in women with IBD. Random effect meta-analyses were performed to compare VTE-related outcomes between women with IBD and without IBD. Our protocol was registered: CRD 42017060199 in the PROSPERO International prospective register of systematic reviews.

In the analysis of 5 studies reviewed, IBD population (n = 17,636) had a significantly increased risk of VTE during pregnancy (pooled risk ratio (RR) 2.13, 95% confidence interval (CI) 1.66–2.73) and postpartum (RR 2.61, 95% CI 1.84–3.69), comparing to the non-IBD population (n = 11,251,778). According to the location of VTE, the risk of deep vein thrombosis increased significantly by RR of 2.74 (95% CI 1.73–4.36) during pregnancy, whilst risk increase of pulmonary embolism was not statistically significant. In the subgroup analysis, the degree of VTE risk was higher in both periods in the UC group than in the CD group, as compared to that in the non-IBD population (UC group, during pregnancy: RR 2.24, 95% CI 1.6–3.11; postpartum period: RR 2.85, 95% CI 1.79–4.52).

Significantly increased risks of VTE during pregnancy were found in the women with IBD, according to the periods and type of IBD, which might support a detailed strategy regarding administration of prophylactic anticoagulants to women with IBD.
Risk factors and etiology of repeat infection in kidney transplant recipients
Authors: Chen Yun-Xia , Li Ran , Gu Li , Xu Kai-Yi , Liu Yong-Zhe , Zhang Ren-Wen
Published: October 2019

Kidney transplantation (KT) is the best therapy available for patients with end-stage renal disease, but postoperative infections are a significant cause of mortality.

In this retrospective study the frequency, risk factors, causative pathogens, and clinical manifestations of infection in KT recipients from Beijing Chao-Yang Hospital, Capital Medical University were investigated. Ninety-seven KT recipients who were hospitalized with infection between January 2010 and December 2016 were included. Clinical characteristics, surgery details, laboratory results, and etiology were compared in patients who developed single infection and patients who developed repeated infection (2 or more) after KT.

A total of 161 infections were adequately documented in a total of 97 patients, of which 57 patients (58.8%) had 1 infection, 24 (24.7%) had 2, 11 (11.3%) had 3; 3 (3.1%) had 4, and 2 (2.1%) had 5 or more. The most common infection site was the urinary tract (90 infections; 56%), both overall and in the repeated infection group. The most frequently isolated pathogen was Pseudomonas aeruginosa. In the repeated infection patients, in most cases of P. aeruginosa infection (54%) it was cultured from urine. For first infections, a time between KT and infection of ≤ 21 days (area under receiver operating characteristic curve [AUC] 0.636) and a tacrolimus level ≥ 8 ng/mL (AUC 0.663) independently predicted repeat infection. The combination of these two predictive factors yielded an AUC of 0.716, which did not differ statistically significantly from either predictor alone.

With regard to first infections after KT, a time between KT and infection of ≤ 21 days, and a tacrolimus level ≥ 8 ng/mL each independently predicted repeated infection in KT recipients.