bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Lung Adenocarcinoma Microenvironment Mining and Its Prognostic Merit
Authors: Zhao Rongchang , Ding Dan , Yu Wenyan , Zhu Chunrong , Ding Yan 
Published: December 2020

Background: As a common pathological type of lung cancer, lung adenocarcinoma (LUAD) is mainly treated by surgery, chemotherapy, targeted therapy and radiotherapy. Although a relatively mature treatment system has been established, there are few studies on the microenvironment of LUAD. Material and Methods: The immune and stromal scores of patients from the LUAD cohort in the TCGA database were obtained by using ESTIMATE. The relationship of immune and stromal scores with the clinicopathological characteristics and overall survival of LUAD patients was assessed by R. GO, KEGG and Cox regression analyses were employed to analyze intersecting genes and to identify reliable prognostic markers. The identified genes were also analyzed in the GEPIA database to assess their correlations with survival, and these relationships were verified with the Kaplan-Meier Plotter database. Results: The immune score was related to the survival time and tumor topography of LUAD patients. There was a significant correlation between stromal score and tumor metastasis. Through multivariate analysis, stage (HR = 1.640, 95% CI = 1.019-2.642, P = 0.042) and risk score (HR = 1.036, 95% CI = 1.026-1.046, P < 0.001). The genes (ARHGAP15, BTLA, CASS4, CLECL1, FAM129C, STAP1, TESPA1, and S100P) showed credible prognostic value in LUAD patients in TCGA through GEPIA database online analysis and verification in the Kaplan-Meier plotter database. Conclusions: In the microenvironment of lung adenocarcinoma, the differentially expressed genes screened by immune score and stromal score have certain value in evaluating the survival/prognosis of patients, as well as the invasion and progression of tumors.
microRNA-214 Prevents Traits of Cutaneous Squamous Cell Carcinoma via VEGFA and Bcl-2
Authors: Ma Xianpeng , Wu Di , Zhang Xiaodong , Shao Xiao , Hu Guangyao 
Published: December 2020

Background: Dysregulation of microRNA-214 (miR-214) has been indicated in different tumors. The function of miR-214 in cutaneous squamous cell carcinoma (CSCC) is yet to be deciphered. The current study aimed to investigate the specific mechanism underpinning CSCC development with the involvement of miR-214 and its putative targets. Methods: Microarray analysis of CSCC and adjacent tissues was carried out to filter the most significant downregulated miRNA. Survival analysis of patients was subsequently implemented, followed by miRNA expression determination in CSCC cells. Gain-of-function assays were performed to evaluate its function on cellular level. The targets of the determined miRNA were predicted and their expression in CSCC and adjacent tissues was evaluated. The targeting relationship was analyzed by dual-luciferase assays. Finally, rescue experiments were conducted. Results: miR-214 was reduced in CSCC tissues and cells, and the survival of patients harboring overexpression of miR-214 was higher. miR-214 restoration increased CSCC cell apoptosis, while decreased proliferative, invasive and migratory activities. miR-214 interacted with vascular endothelial growth factor A (VEGFA) and B-cell CLL/lymphoma 2 (Bcl-2). VEGFA and Bcl-2, overexpressed in CSCC tissues and cells, were negatively correlated with miR-214. Moreover, VEGFA and Bcl-2 overexpression reversed the anti-tumor phenotypes of miR-214 on CSCC cells. miR-214 disrupted the Wnt/β-catenin pathway through VEGFA and Bcl-2 in the CSCC cells. Conclusion: Our data demonstrates that miR-214 exerts a suppressing role in CSCC. The discovery of novel targets such as miR-214 and VEGFA/Bcl-2 may facilitate the development of therapeutic options.
Aneurysm Excision With Arteriovenous Anastomosis Proximalization for Dialysis Fistula Aneurysm Treatment
Authors: Góra Rafał , Bojakowski Krzysztof , Piasecki Antoni , Kasprzak Dominika , Kaźmierczak Stanisław , Andziak Piotr 
Published: December 2020

Introduction: Dialysis fistula aneurysms are common complications, which require surgical revision in selective cases. The results of aneurysm excision with arteriovenous anastomosis proximalization for the treatment of dialysis fistula aneurysms have been described below. Methods: Patients qualified for the reconstruction of a dialysis fistula aneurysm underwent a duplex ultrasound examination. The diameter, length of the aneurysm, relations with the artery, thrombus presence and blood flow were determined. In the case of favorable anatomical conditions, we performed aneurysm excision with arteriovenous anastomosis proximalization as the procedure of choice. Patients, dialysis access, operative data and the results obtained during a median follow-up of 41 months were then analyzed. Findings: Since 2012, we have performed 20 aneurysm excision combined with primary anastomosis as dialysis fistula aneurysm treatment. In 18 patients, aneurysm excision was combined with simple re-anastomosis in the more proximal arterial segment. In 2 autogenous radio-cephalic forearm direct fistulas the aneurysm excision was combined with switching anastomosis type from side-to-end to end-to-end. The 12- and 24-month primary patency rates of corrected fistulas in the observed group were 94.7% and 82.4%, respectively. No early complications were noted. In 7 patients (35%) we observed late complications, which required reintervention or led to access failure. Dialysis fistula thrombosis as an indication for treatment was a significant risk factor for late re-occlusion. Discussion: A simple primary reconstruction by arteriovenous anastomosis proximalization and aneurysm excision for the surgical correction of dialysis fistula aneurysms has potential benefits compared to established methods—aneurysmorraphy and aneurysm excision with a vascular prosthesis bypass. The obtained data showed the efficiency, safety and excellent long-term results of this procedure.
Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting
Authors: Quispe-Orozco Darko , Limaye Kaustubh , Zevallos Cynthia B , Farooqui Mudassir , Mendez-Ruiz Alan , Ansari Sameer , Dajles Andres , Samaniego Edgar A , Derdeyn Colin , Ortega-Gutierrez Santiago 
Published: December 2020

Introduction Carotid artery stenting (CAS) has increasingly emerged as an alternative strategy to carotid endarterectomy in the treatment of patients with symptomatic carotid stenosis. Optimal timing for CAS after symptoms onset remains unclear. We aimed to evaluate the safety and efficacy of CAS when performed in an emergency setting. Patients and methods We performed a retrospective analysis of CAS patients admitted to our CSC with symptomatic extracranial carotid occlusion or significant stenosis from January 2014-September 2019. Emergency CAS was defined as CAS performed during the same hospitalization from TIA/stroke onset, whereas elective CAS as CAS performed on a subsequent admission. The primary outcome was defined as the occurrence of any stroke, myocardial infarction, or death related to the procedure at 3 months of follow-up. Secondary outcomes included periprocedural complications and the rate of restenosis/occlusion at follow-up. Logistic regression and survival analyses were used to compare outcomes and restenosis at follow-up. Results We identified 75 emergency and 104 elective CAS patients. Emergency CAS patients had significantly higher rates of ipsilateral carotid occlusion (17% vs. 2%, p < 0.001) and use of general anesthesia (19% vs. 4%, p = 0.001) than elective CAS. There were no significant differences between emergency and elective CAS in the primary (5.7% vs. 1%, p = 0.161) and secondary (9% vs. 4.8%, p = 0.232) outcomes. We did not find differences in the rate of restenosis/occlusion (7% vs. 11.6%; log-rank test p = 0.3) at a median of 13 months follow-up. Conclusion In our study, emergency CAS in symptomatic patients might have a similar safety and efficacy profile to elective CAS at 3 months and long-term follow-up.
Chronic total occlusion and spontaneous recanalization of the internal carotid artery: Natural history and management strategy
Authors: Lall Alex , Yavagal Dileep R , Bornak Arash 
Published: December 2020

Objectives Spontaneous recanalization of a chronic total occlusion of the extra-cranial internal carotid artery is an under-reported clinical entity. This paper reviews the different etiologies of internal carotid artery occlusion, its natural course, as well as the significance and our recommendations for the management of spontaneous internal carotid artery recanalization. Methods A review of literature on etiology, diagnosis, and treatment of internal carotid artery occlusion and recanalization was conducted. PubMed database was searched using the terms “internal carotid occlusion” and “recanalization”. Articles were reviewed and studies involving the management of internal carotid artery occlusion and spontaneous recanalization were included. We subsequently developed a management algorithm for chronic total occlusion of the internal carotid artery and spontaneous recanalization of such lesions based on the available evidence. Results Common etiologies of chronic total occlusion of the internal carotid artery include carotid atherosclerotic disease, cardioembolic, and carotid dissection. Progression of an asymptomatic to symptomatic occlusion is estimated at 2–8% annually. Well-compensated patients can be asymptomatic. In others, clinical symptoms range from ipsilateral or global hypoperfusion to embolic stroke in some cases of spontaneous recanalization. Spontaneous recanalization occurs in 2.3–10.3% of patients but rarely results in a cerebrovascular event. Conclusions Progression of an asymptomatic chronic total occlusion of the internal carotid artery to symptomatic is infrequent. The management algorithm of chronic total occlusion of the internal carotid artery and spontaneous recanalization of the internal carotid artery must be tailored to the patient based on symptoms, etiology of the lesion, imaging findings, surgical risk, and reliability for follow-up.
The multiarm optimization of stroke thrombolysis phase 3 acute stroke randomized clinical trial: Rationale and methods
Authors: Deeds S Iris , Barreto Andrew , Elm Jordan , Derdeyn Colin P , Berry Scott , Khatri Pooja , Moy Claudia , Janis Scott , Broderick Joseph , Grotta James , Adeoye Opeolu 
Published: December 2020

Background Intravenous recombinant tissue plasminogen activator is the only proven effective medication for the treatment of acute ischemic stroke. Two approaches that may augment recombinant tissue plasminogen activator thrombolysis and prevent arterial reocclusion are direct thrombin inhibition with argatroban and inhibition of the glycoprotein 2b/3a receptor with eptifibatide. Aim The multi-arm optimization of stroke thrombolysis trial aims to determine the safety and efficacy of intravenous therapy with argatroban or eptifibatide as compared with placebo in acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator within 3 h of symptom onset. Sample size estimate A maximum of 1200 randomized subjects to test the superiority of argatroban or eptifibatide to placebo in improving 90-day modified Rankin scores. Methods and design Multiarm optimization of stroke thrombolysis is a multicenter, multiarm, adaptive, single blind, randomized controlled phase 3 clinical trial conducted within the National Institutes of Health StrokeNet clinical trial network. Patients treated with 0.9 mg/kg intravenous recombinant tissue plasminogen activator within 3 h of stroke symptom onset are randomized to receive intravenous argatroban (100 µg/kg bolus followed by 3 µg/kg/min for 12 h), intravenous eptifibatide (135 µg/kg bolus followed by 0.75 µg/kg/min infusion for 2 h) or IV placebo. Patients may receive endovascular thrombectomy per usual care. Study outcomes The primary efficacy outcome is improved modified Rankin score assessed at 90 days post-randomization. Discussion Multiarm optimization of stroke thrombolysis is an innovative and collaborative project that is the culmination of many years of dedicated efforts to improve outcomes for stroke patients.
Moderate to severe leukocytosis with vasopressor use is associated with increased mortality in trauma patients
Authors: Hasjim Bima J , Grigorian Areg , Stopenski Stephen , Swentek Lourdes , Sun Beatrice , Livingston Joshua K , Williams Barbara , Nastanski Frank , Nahmias Jeffry 
Published: December 2020

Background Leukocytosis is a rise in white blood cell (WBC) count and clinical outcomes of moderate to severe leukocytosis in trauma patients have not been described. We hypothesized that trauma patients with severe leukocytosis (SL; ≥40.0 × 109 leukocytes/L) have higher rates of in-hospital complications and mortality than those with moderate leukocytosis (ML; 25.0–39 × 109 leukocytes/L). Methods We performed a retrospective analysis (2010-2017) on trauma patients developing ML or SL at a single Level-I trauma center. A multivariable logistic regression analysis for risk factors were performed. Results From 15,807 trauma admissions, 332 (2.1%) had ML or SL. Of these, 308 (92.8%) were ML and 24 (7.2%) were SL. Patients with ML and SL reached their peak WBC count in 1 and 10 days after admission respectively (p < 0.001). SL patients suffered higher rates of in-hospital complications (p < 0.05) and mortality compared to those without ML or SL (14.5% vs. 3.3%, p < 0.001). Between ML and SL, mortality rates rose with leukocytosis severity (13.3% vs. 29.2%, p = 0.03). Among all patients with ML or SL, vasopressor use was the strongest independent risk factor for mortality (OR 12.61, p < 0.001). Conclusion Clinicians should be weary of the increased mortality rates and in-hospital complications in SL patients. Among patients with ML or SL, vasopressor use, rather than SL, was the strongest predictor of mortality. Patients with ML had a quicker time course to peak leukocytosis compared to SL, suggesting these two entities to be distinct in etiology and outcome, warranting future research.
Covering surgical instruments with single- or double-layer drape pending surgery: an experimental study in a perioperative setting
Authors: Qvistgaard Maria , Almerud-Österberg Sofia , Lovebo Jenny 
Published: December 2020

Background: Surgical site infections (SSI) constitute a severe threat to surgery patients. The surgical environment must be as free of contaminating microorganisms as possible. Using sterile surgical instruments while performing surgery is an absolute necessity for ensuring quality of care in perioperative settings. Aim: To compare bacterial contamination of agar plates after 15 h on set surgical instrument tables covered with a single- or double-layer drape. Methods: An experimental design was used consisting of set instrument tables with six agar plates on each table: four instrument tables were covered with a single-layer drape and four instrument tables were covered with a double-layer drape. This set-up was repeated on nine occasions during the period of data collection, making 76 set instrument tables in total. As a control, one instrument table was uncovered on four of those occasions. Results: The double-layer drape cover showed a significantly ( P = 0.03) lower number of colony forming units (CFU) per agar plate than the single-layer drape covering. As expected, the uncovered instrument tables were highly contaminated. Discussion: Our results indicate that it is good practice to cover instruments properly with at least a single-layer drape before a surgical procedure. If there is difficulty achieving optimal conditions while setting the instrument tables (e.g. positioning the patient for general anaesthesia), it is a better option to set the instrument tables earlier and cover them with a double-layer drape. These precautions will help protect the patient from harm and unnecessary SSI by lowering microbiological burden, a key factor in developing SSI.
Shoulder hydrodilatation for primary, post-traumatic and post-operative adhesive capsulitis
Authors: Makki Daoud , Al-Yaseen Mustafa , Almari Fayez , Monga Puneet , Funk Lennard , Basu Subhasis , Walton Michael 
Published: December 2020

Background Adhesive capsulitis (frozen shoulder) is characterised by pain and loss of range of motion of the glenohumeral joint. It can be present as primary (idiopathic) or secondary to surgery, trauma or other conditions that restrict the use of the shoulder joint. Various treatment options have been adopted including physiotherapy, manipulation under anaesthetic, hydrodilatation and arthroscopic or open capsular release but the optimal form of management remains uncertain. Objectives The purpose of the study was to assess the clinical outcome of glenohumeral hydrodilatation in three cohorts of patients with different aetiologies with adhesive capsulitis. Study design & methods We carried out a retrospective study of patient who underwent hydrodilatation for adhesive capsulitis between 2013 and 2015. The procedure was performed by a specialist musculoskeletal radiologist under radiological guidance. The injection consisted of steroids, local anaesthetics and NaCl solution with a target volume around 35 mL. Our outcome measures were range of motion, and pre- and post-operative pain. Patients were divided into three groups based on the presumed cause of their stiffness: idiopathic, post-traumatic and post-surgical. Results Two hundred fifty patients were included, with a mean age of 59 years (range: 20–79). Of these, 180 had idiopathic primary adhesive capsulitis (27 were diabetic), 23 were post-traumatic, and 20 following surgical procedures. Thirty-four required further intervention following initial hydrodilatation with 8 undergoing repeat hydrodilatation, and 26 requiring arthroscopic capsular release. The diabetic group accounted for 16 capsular releases and 4 repeat procedures, while the idiopathic group accounted for 9 and 4, respectively. One patient required capsular release in the surgical group. An improvement was recorded in ROM in all groups with mean abduction improving from 59° to 110°, flexion from 50° to 120° and external rotation from 20° to 50°. With regards to pain, the majority showed an improvement from severe or moderate pain to no or mild pain. Conclusions Results show that hydrodilatation resulted in an improvement in all outcome measures, with only a small number of patients, especially those with diabetes, needing further procedures or showing no improvement in range of motion and pain. There was no difference between the post-traumatic and post-surgical groups.
Comparative efficacy and safety of radiotherapy/cetuximab versus radiotherapy/chemotherapy for locally advanced head and neck squamous cell carcinoma patients: a systematic review of published, primarily non-randomized, data
Authors: Mei Mei , Chen Yu-Huan , Meng Tian , Qu Ling-Han , Zhang Zhi-Yong , Zhang Xiao 
Published: December 2020

Background: Cetuximab (CTX) has been approved to be administered concurrently with radiotherapy (RT) to treat locally advanced head and neck squamous cell carcinoma (HNSCC). The aim of this study was to assess the efficacy and safety of concurrent CTX with RT (ExRT). Method: The PubMed, Cochrane Library, EMBASE databases were systematically searched to find relevant articles. The combined hazard ratio (HR), risk ratio (RR) and 95% confidence interval were calculated to assess the efficacy and safety of ExRT in contrast to concurrent platinum-based chemotherapy with RT (ChRT). Results: In total, 32 articles with 4556 patients were included. The pooled HRs indicated that ExRT achieved an unfavorable overall survival (HR: 1.86, p < 0.0001), disease-specific survival (HR: 2.58, p = 0.002), locoregional control (HR: 1.94, p < 0.00001), and progression-free survival (HR: 2.04, p = 0.003) compared with ChRT for locally advanced HNSCC patients. In human papillomavirus-positive patient subgroups, ExRT showed inferior disease-specific survival (HR: 2.55, p = 0.009) and locoregional control (HR: 2.27, p < 0.0001) in contrast to ChRT. Additionally, ExRT increased the occurrence of mucositis (RR: 1.17, p < 0.005), skin toxicity (RR: 6.26, p < 0.00001), and infection (RR: 2.27, p = 0.04) compared with non-CTX groups (ChRT and RT), and was associated with lower incidence of anemia (RR: 0.35, p = 0.009), leukocytopenia (RR: 0.17, p < 0.0001), neutropenia (RR: 0.06, p < 0.0001), nausea/vomiting (RR: 0.23, p < 0.0001), and renal toxicity (RR: 0.14, p = 0.007). Conclusion: ChRT should remain the standard treatment for locally advanced HNSCC patients. ExRT was recognized as an effective alternative treatment for locally advanced HNSCC patients who experienced unbearable toxicities caused by non-CTX treatments.
Are educational materials on medicinal products reaching out and useful to physicians? A survey of Singapore prescribers’ experiences and preferences
Authors: Han Phey-Yen , Limenta Michael , Tan Liesbet Li-Bei , Ho Christine Su-Ching , Poh Jalene Wang-Woon 
Published: December 2020

Background: Effective benefit–risk communication to healthcare professionals plays a vital role in promoting the rational use of medicinal products. The Health Sciences Authority (HSA) of Singapore has implemented Physician Educational Materials (PEMs) and Patient Medication Guides (PMGs) as educational materials to support informed decision-making. To evaluate their effectiveness as a safety communication tool, we sought to understand prescribers’ experiences and preferences with these materials. Methods: Invitations to an online survey were emailed to 387 healthcare professionals who had recently purchased the 22 medicinal products with requirements for educational materials in Singapore (“Purchasers”). The survey scope included their experiences with the receipt and usage of the materials, and their preferences towards the types of content and distribution channels for these materials. Results: The survey invitation reached 367 purchasers, of which 89 (24%) responded, including 66 who indicated that they had prescribed the surveyed products (“Prescribers”). Although only 47% of prescribers recalled receiving the educational materials, the majority who had used them found them useful in their clinical practice. However, the PMG was used less frequently than the PEM (59% vs 96%), and there was a mismatch between current and preferred distribution methods (mostly hard copies vs electronic copies). Conclusions: Prescribers who had received educational materials generally perceived them as being useful in raising awareness on treatment-associated safety concerns. The publication of educational materials on the HSA website and encouraging more routine distribution of PMGs by prescribers may improve their accessibility and facilitate safety communication on medicinal products to healthcare professionals and patients.