bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vertical Expandable Rib-based Distraction Device for Correction of Congenital Scoliosis in Children of 3 Years of Age or Younger: A Preliminary Report
Authors: Berger-Groch Josephine , Weiser Lukas , Kunkel Philip O.S. , Stuecker Ralf , Jungesblut Oliver D. 
Published: May 2020

Background:
This study was designed to evaluate the treatment outcome of very young children with congenital scoliosis aged 3 years or under after surgery with a vertical expandable prosthetic titanium rib (VEPTR)-based distraction device.

Methods:
A retrospective study of 13 children undergoing implantation of a vertical expandable rib-based distraction device. From September 2007 to June 2018, 13 children (7 male and 6 female patients) with congenital scoliosis were followed after treatment with a VEPTR. The outcome parameters were complications, thoracic height, kyphosis, lordosis, and coronal major scoliosis curve. In addition, the American Society of Anaesthesiologists (ASA) score, assisted ventilation rating, and hemoglobin and body mass index were analyzed. Data were examined separately by 2 investigators.

Results:
The mean age at initial surgical treatment was 24.4±10.6 months, follow-up was 91.5±23.1 months. The mean number of surgical procedures per patient was 14±3.9 (total 182 operations). Apart from planned operations every 6 months, 5 unplanned operations (2.7%) were performed. The major scoliosis curve improved significantly from 55.2±21.9 degrees to 40.5±18.7 degrees, thoracic spine height T1-T12 significantly from 111±12 mm to 137±23 mm, T1-S1 height significantly from 211±13 mm to 252±36 mm and space available for the lung from 80.9%±11.3% to 84.4%±8.8% (preoperatively and at 5-y follow-up, respectively). Kyphosis increased significantly from 30±21.4 degrees to 42.6±23.5 degrees and lordosis from 32.4±20.9 degrees to 37.6±10.4 degrees. Hemoglobin levels were virtually unchanged. Weight increased from 10.6±2.8 kg to 20.2±5.0 kg at final follow-up, but body mass index decreased from 16.6±3.7 kg/m² to 15.7±2.9 kg/m².

Conclusions:
The expandable rib-based distraction device is an effective method to treat severe congenital scoliosis in very young children. It can control the deformity and promotes spinal and thoracic growth.

Level of Evidence:
Level IV.
A case report of recurrent acute pancreatitis associated with life threatening atypical hemolytic uremic syndrome
Authors: Jean-Marie Elizabeth M. , Cho Jonathan J. , Trevino Jose G. 
Published: May 2020

Abstract

Introduction:
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy defined by the sudden onset of hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). HUS is categorized as either typical, caused by Shiga toxin-producing Escherichia coli infection, or atypical HUS (aHUS), usually complement mediated or secondary to systemic disease. We describe a rare case of aHUS in an adult male patient with recurrent acute pancreatitis.

Patient clinical findings:
A 32-year-old Caucasian male presented to our institution for his third episode of alcohol-induced pancreatitis. He presented with abdominal pain, elevated lipase and pancreatic inflammation on computed tomography consistent with acute pancreatitis. While admitted, he developed sudden onset severe thrombocytopenia, AKI and hemolytic anemia.

Diagnosis, therapeutic interventions, outcomes:
Peripheral blood smear, haptoglobin and hemoglobin level confirmed microangiopathic hemolytic anemia. Worsening anemia, thrombocytopenia and AKI were consistent with the diagnosis of aHUS. The patient's pancreatitis resolved with supportive measures, but resolution of significant thrombocytopenia and AKI was not achieved until administration of eculizumab, a complement inhibiting therapy. Eculizumab therapy provided dramatic improvement in this patient, with platelet count increasing from a low of 11,000 to >100,000 within 48 hours of therapy. Creatinine and hemoglobin levels returned to baseline within 3 weeks.

Conclusion:
Recurrent pancreatitis is suggested as the etiology of atypical HUS in this patient and this condition should be recognized and treated in a timely manner for optimal clinical outcomes.
Spontaneous bacterial peritonitis caused by Campylobacter Coli in cirrhotic patient
Authors: Wang Cheng-Hui , Tai Ting-Han , Weng Shih-Yen , Yeh Shin-Wen , Shiue Sheng-Jie , Jargalsaikhan Ganbolor , Wu Ming-Shun 
Published: May 2020

Abstract

Introduction:
Spontaneous bacterial peritonitis (SBP) is a fatal infection in patients. It often happens in patients with cirrhosis, cancer or diabetes, and is caused mostly by Enterobacteriaceae. Here we report a rare case of SBP caused by Campylobacter Coli (C coli) infection, which was identified promptly by the matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and received adequate therapy sooner after.

Patient concerns:
In the present study, we reported a 46-year-old male with alcoholic liver cirrhosis (Child-Pugh class C) and type 2 diabetes mellitus presented with a 1-day history of fever and abdominal pain.

Diagnosis:
Based on the clinical examinations, the patient was diagnosed with SBP and the pathogen was quickly identified as C coli by the matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), a rare causative pathogen of SBP.

Interventions:
The patient received a 10-day antibiotic treatment with Ciprofloxacin 400 mg every 12 hours, and recovered successfully.

Outcomes:
The patient had a successful treatment outcome.

Conclusion:
The study demonstrated a new possible infectious cause of SBP by C Coli, which was rarely seen in liver cirrhosis but mostly found in immunocompromised patients. Thus, it might raise an idea of microorganism screening of broader types that might also induce SBP for immunocompromised patients.
Cutaneous metastasis of ascending colon cancer harboring a BRAF V600E mutation
Authors: Liao Lianggong , Cheng Qian , Zhu Guangsheng , Pei Feng , Ye Shengwei 
Published: May 2020

Abstract

Rationale:
Cutaneous metastases from colorectal cancer are extremely rare and generally appear several years after diagnosis or resection of the primary colorectal tumor. Although cutaneous metastasis is unusual, it often indicates a poor prognosis.

Patient concerns:
We treated a 62-year-old woman with multiple cutaneous metastatic nodules on the chest, back, and armpit 7 months after resection of ascending colon cancer.

Diagnoses:
The patient was diagnosed with cutaneous metastasis of ascending colon cancer with BRAF V600E mutation.

Interventions:
After 6 cycles of fluorouracil, leucovorin, oxaliplatin, cetuximab, and emurafenib, most of the metastatic lesions had begun to shrink, and no new metastases were observed. Serum tests showed that the levels of several tumor markers were decreased.

Outcomes:
The patient responded well to treatment and survived for 6.5 months after presentation with skin metastasis.

Lessons:
Cutaneous metastasis of colorectal cancer with BRAF V600E mutation is a rare but important phenomenon that should not be ignored. Cutaneous metastasis of colorectal cancer frequently indicates advanced disease and poor prognosis. The SWOG 1406 program is one of the treatment options, but this needs further exploration.
Association between ALDH2 rs671 polymorphism and risk of ischemic stroke
Authors: Jiang Yan , He Jinting , Liu Hongyu , Xu Zhongxin 
Published: May 2020

Abstract
In last decades, many scholars have studied the relationship between aldehyde dehydrogenase 2 (ALDH2) rs671 and ischemic stroke (IS), however, the results obtained from these studies were inconclusive. The purpose of this study was to investigate the association between rs671 and the risk of IS by systematically review.
Two researchers independently screened relevant published literatures, derived data and estimated the risk of bias of the research in Pubmed, Embase, Ovid, China National Knowledge Infrastructure (CNKI), Cochrane Library and China Biomedical Literature Database throughout March 29, 2020. All statistical analyses were performed with the Stata 12.0 software. The data of the study was analyzed using fixed and random effects models. The results were expressed by odds ratio (OR) and 95% confidence interval (95%CI).
A total of 10 articles were included this study. The total number of samples for all studies was 5265, including 2762 cases and 2503 controls. Statistical results indicated statistical differences between ALDH2 rs671 polymorphism and IS under dominant model (AA vs. AG + GG) and allelic model (A vs G), ORs (95% CI) were 1.66 (1.27–2.17) (P = .00) and 1.34 (1.05–1.71) (P = .02), respectively. But there was no statistical difference under recessive model (AA + AG vs GG), OR (95% CI) was 1.40 (0.99–1.97), P = .06.

ALDH2 rs671 polymorphism was related to IS risk for Chinese population and the A allele of rs671 may be a risk factor of IS.
Colorectal cancer with invasive micropapillary components (IMPCs) shows high lymph node metastasis and a poor prognosis
Authors: Guo Zeying , Yang Ziru , Li Dan , Tang Jinlong , Xu Jinghong , Shen Hong , Yuan Ying 
Published: May 2020

Abstract

Objects:
The present study aimed to identify the clinicopathological characteristics of colorectal cancer (CRC) with invasive micropapillary components (IMPCs) and the relationship between different amounts of micropapillary components and lymph node metastasis.

Methods:
A cohort of 363 patients with CRC who underwent surgical treatment in the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2013 and December 2016 were retrospectively reviewed. We compared the clinicopathological characteristics, including survival outcomes and immunohistochemical profiles (EMA, MUC1, MLH1, MSH2, MSH6, and PMS2), between CRC with IMPCs and those with conventional adenocarcinoma (named non-IMPCs in this study). Logistic regression was used to identify the association between IMPCs and lymph node invasion. A multivariate analysis was performed using the Cox proportional hazard model to evaluate significant survival predictors.

Results:
Among 363 patients, 76 cases had IMPCs, including 22 cases with a lower proportion of IMPCs (≤5%, IMPCs-L) and 54 cases with a higher proportion (>5%, IMPCs-H). Compared to the non-IMPC group, the IMPC group (including both IMPC-L and IMPC-H) had a lower degree of tumor differentiation (P = .000), a higher N-classification (P = .000), more venous invasion (P = .019), more perineural invasion (P = .025) and a later tumor node metastasis (TNM) stage (P = .000). Only tumor differentiation (P = .031) and tumor size (P = .022) were different between IMPCs-L and IMPCs-H. EMA/MUC1 enhanced the characteristic inside-out staining pattern of IMPCs, whereas non-IMPCs showed luminal staining patterns. The percentage of mismatch repair deficiency (dMMR) in the non-IMPC group was much higher than that in the IMPC group (14.7% vs 4.7%). The overall survival time of patients with IMPCs was significantly less than that of patients with non-IMPCs (P = .002), then that of IMPCs-H was lower than that of IMPCs-L (P = .030). Logistic regression revealed that patients with IMPCs were associated with lymph metastasis, regardless of the proportion of IMPCs. Multivariate analysis demonstrated both IMPCs-L and IMPCs-H as negative prognostic factors.

Conclusions:
IMPCs are significantly associated with lymph node metastasis and poor outcome, and even a minor component (≤5%) may render significant information and should therefore be part of the pathology report.
The application of quality control circle to improve the quality of samples
Authors: Liu Kangsheng , Xu Zhirong , Wang Xiangdong , Chen Yajun , Mao Xiao-Dong 
Published: May 2020

Abstract
Since its application in medical institutions in China, quality control circle (QCC) has gained achievements in medical care and thus earned more attention from the administrative department of health.
In order to improve the quality of laboratory specimens, we launched a QCC activity to solve the problems and evaluate the effect of it. The data of 30,105 unqualified specimens in our hospital were collected from February to June 2017. After the QCC activity, the data of 43,125 specimens taken from July to December 2017 were collected.
The defect rate of the specimens before the QCC activity was 0.98% (297/30105), and after the QCC activity, it was 0.45% (193/43125), showing a significant statistical difference (P < .05). The achievement rate and improvement rate were 108.2% and 54.1%, respectively.
After the implementation of QCC, the defect rate of specimens in clinical laboratories was significantly decreased, and the intangible factors were also improved, which demonstrated the positive effects of QCC on the quality control of specimens.
In silico analysis of the molecular regulatory networks in peripheral arterial occlusive disease
Authors: Guan Xuwen , Yang Xiaoyan , Wang Chunming , Bi Renbing 
Published: May 2020

Abstract

Background:
Peripheral arterial occlusive disease (PAOD) is a global public health concern that decreases the quality of life of the patients and can lead to disabilities and death. The aim of this study was to identify the genes and pathways associated with PAOD pathogenesis, and the potential therapeutic targets.

Methods:
Differentially expressed genes (DEGs) and miRNAs related to PAOD were extracted from the GSE57691 dataset and through text mining. Additionally, bioinformatics analysis was applied to explore gene ontology, pathways and protein–protein interaction of those DEGs. The potential miRNAs targeting the DEGs and the transcription factors (TFs) regulating miRNAs were predicted by multiple different databases.

Results:
A total of 59 DEGs were identified, which were significantly enriched in the inflammatory response, immune response, chemokine-mediated signaling pathway and JAK-STAT signaling pathway. Thirteen genes including IL6, CXCL12, IL1B, and STAT3 were hub genes in protein–protein interaction network. In addition, 513 miRNA-target gene pairs were identified, of which CXCL12 and PTPN11 were the potential targets of miRNA-143, and IL1B of miRNA-21. STAT3 was differentially expressed and regulated 27 potential target miRNAs including miRNA-143 and miRNA-21 in TF-miRNA regulatory network.

Conclusion:
In summary, inflammation, immune response and STAT3-mediated miRNA-target genes axis play an important role in PAOD development and progression.
Evaluation of predictive role of carcinoembryonic antigen and salivary mRNA biomarkers in gastric cancer detection
Authors: Xu Fei , Jiang Meiquan 
Published: May 2020

AbstractWe explored the potential of combining carcinoembryonic antigen (CEA) and salivary mRNAs for gastric cancer (GC) detection.This study included 2 phases of study: a biomarker discovery phase and an independent validation phase. In the discovery phase, we measured CEA levels in blood samples and expression level of messenger RNAs (SPINK7, PPL, SEMA4B, SMAD4) in saliva samples of 140 GC patients and 140 healthy controls. We evaluated the clinical performance of each biomarker and developed a predictive model using machine-learning algorithm to differentiate GC patients and healthy controls.Our biomarker panel successfully discriminated GC patients from healthy controls with both high sensitivity (0.94) and high specificity (0.91). We next applied our biomarker panel in the independent validation phase, in which we recruited a new patient cohort of 60 GC patients and 60 healthy controls. Using our biomarker panel, the GC patients were discriminated from healthy controls in the validation phase, with sensitivity of 0.92 and specificity of 0.87.A combination of blood CEA and salivary messenger RNA could be a promising approach to detect GC.
Combat thoracic surgery in Iraq and Afghanistan: 2002–2016
Authors: Stern Caryn A. , Stockinger Zsolt T. , Gurney Jennifer M. 
Published: May 2020

BACKGROUND
Thoracic surgery constitutes 2.5% of surgical procedures performed in theater, but the skills required are increasingly foreign to military surgeons. This study examines thoracic surgical workload in Iraq and Afghanistan to help define surgical training gaps.

METHODS
Retrospective analysis of Department of Defense Trauma Registry for all role 2 (R2) (forward surgical) and role 3 (R3) (theater) military facilities, from January 2002 to May 2016. The 95 thoracic surgical International Classification of Diseases—9th Rev.—Clinical Modification procedure codes were grouped into 10 categories based on anatomy or endoscopy. Select groups were further stratified by type of definitive procedure. Procedure groupings were determined and adjudicated by surgeon subject matter experts. Data analysis used Stata Version 15 (College Station, TX).

RESULTS
Of the total procedures, 5,301 were classified as thoracic surgical procedures and were included in the present study. The majority of thoracic surgical procedures (4,645 [87.6%]) were recorded as being performed at R3 medical treatment facilities (MTFs). The thoracic surgical procedures groups with the largest proportions were: bronchoscopy (39.1%), thoracotomy (16.9%), diaphragm (15.6%), and lung (11.4%). The most common lung procedure subgroup, aside from not otherwise specified, was segmentectomy (28.8%). The R3 MTFs recorded nearly five times the number of lung procedures compared with R2 MTFs; with R3 MTFs recording more than eight times the number of lobectomies compared with R2 MTFs. Thoracic workload was variable over the 15-year study period.

CONCLUSION
Thoracic surgical skills are necessary in the deployed environment to manage combat-related injuries. Given the current trends in training and specialization, development and sustainment of thoracic surgical skills is challenging in the deployed US trauma system and likely for other nations, and humanitarian surgical care as well. Current training and practice paradigms pose both training and sustainment challenges for surgeons who deploy to a combat zone.

LEVEL OF EVIDENCE
Therapeutic/Care Management IV.
Bowled over or over bowled? Age-related changes in the performance of bowlers in Test match cricket
Authors: Thorley Jack 
Published: May 2020

ABSTRACTData from elite professional sports players provide a valuable source of information on human performance and ageing. Functional declines in performance have been investigated across a wide range of sporting disciplines that vary in their need for physical strength, endurance, cognitive ability and motor skills, but rarely have researchers considered other sources of heterogeneity that can exist among individuals. Using information on all male bowlers to have played Test match cricket since the early 1970s, I separated age-dependent variation in bowling performance at the population-level into within-individual and between-individual (cohort) changes. I found no evidence for senescence in bowling performance as measured via economy rate or wicket-taking ability, irrespective of the style of the bowler (fast or slow). Instead, analyses detected strong between-individual contributions to bowling performance as higher quality bowlers were able to compete at the elite level for longer, and were therefore over-represented in older age classes. Bowlers also experienced a deterioration in the last year of their Test careers. These results highlight that the very best Test match bowlers have been able to maintain and often improve their skill level well into their thirties, but how they accomplish this alongside the physical demands of Test cricket remains unresolved. Further multivariate models also identified a negative relationship among slow bowlers between their economy rate and their wicket-taking ability, suggesting that in general, the most economical slow bowlers in the modern era of Test match cricket have also taken wickets at the fastest rate. The same is not true for fast bowlers, which is perhaps partly because bowling at high speed compromises accuracy and thus increases scoring opportunities for batsman.
Data quantity is more important than its spatial bias for predictive species distribution modelling
Authors: Gaul Willson , Sadykova Dinara , White Hannah J. , León-Sánchez Lupe , Caplat Paul , Emmerson Mark C. , Yearsley Jon M. 
Published: May 2020

ABSTRACTBiological records are often the data of choice for training predictive species distribution models (SDMs), but spatial sampling bias is pervasive in biological records data at multiple spatial scales and is thought to impair the performance of SDMs. We simulated presences and absences of virtual species as well as the process of recording these species to evaluate the effect on species distribution model prediction performance of 1) spatial bias in training data, 2) sample size (the average number of observations per species), and 3) the choice of species distribution modelling method. Our approach is novel in quantifying and applying real-world spatial sampling biases to simulated data. Spatial bias in training data decreased species distribution model prediction performance, but only when the bias was relatively strong. Sample size and the choice of modelling method were more important than spatial bias in determining the prediction performance of species distribution models.
Comparing diversification rates in lakes, rivers, and the sea
Authors: Miller Elizabeth Christina 
Published: May 2020

AbstractThe diversity of species inhabiting freshwater relative to marine habitats is striking, given that freshwater habitats encompass <1% of Earth’s water. The most commonly proposed explanation for this pattern is that freshwater habitats are more fragmented than marine habitats, allowing more opportunities for allopatric speciation and thus increased diversification rates in freshwater. However, speciation may be generally faster in sympatry than in allopatry, as illustrated by lacustrine radiations such as African cichlids. Differences between rivers and lakes may be important to consider when comparing diversification broadly among freshwater and marine lineages. Here I compared diversification rates of teleost fishes in marine, riverine and lacustrine habitats. I found that lakes had faster speciation and net diversification rates than other aquatic habitats. However, most freshwater diversity arose in rivers. Surprisingly, riverine and marine habitats had similar rates of net diversification. Biogeographic models suggest that lacustrine habitats are evolutionary unstable, explaining the dearth of lacustrine species in spite of their rapid diversification. Collectively, these results suggest that diversification rate differences are unlikely to explain the freshwater paradox. Instead, this pattern may be attributable to the comparable amount of time spent in riverine and marine habitats over the 200-million-year history of teleosts.