bluuebunny/crossref_metadata_2025_split huggingface dataset:
A study of radiomics parameters from dual-energy computed tomography images for lymph node metastasis evaluation in colorectal mucinous adenocarcinoma
Authors: Liu Yingying , Dou Yafang , Lu Fang , Liu Lei 
Published: March 2020

Abstract
Lymph nodes (LN) metastasis differentiation from computed tomography (CT) images is a challenging problem. This study aims to investigate the association between radiomics image parameters and LN metastasis in colorectal mucinous adenocarcinoma (MAC).
Clinical records and CT images of 15 patients were included in this study. Among them, 1 patient was confirmed with all metastatic LNs, the other 14 were confirmed with all non-metastatic LNs. The regions of the LNs were manually labeled on each slice by experienced radiologists. A total of 1054 LN regions were obtained. Among them, 164 were from metastatic LNs. One hundred nine image parameters were computed and analyzed using 2-sample t test method and logistic regression classifier.
Based on 2 sample t test, image parameters between the metastatic group and the non-metastatic group were compared. A total of 73 parameters were found to be significant (P < .01). The selected shape parameters demonstrate that non-metastatic LNs tend to have smaller sizes and more circle-like shapes than metastatic LNs, which validates the common agreement of LN diagnosis using computational method. Besides, several high order parameters were selected as well, which indicates that the textures vary between non-metastatic LNs and metastatic LNs. The selected parameters of significance were further used to train logistic regression classifier with L1 penalty. Based on receiver operating characteristic (ROC) analysis, large area under curve (AUC) values were achieved over 5-fold cross validation (0.88 ± 0.06). Moreover, high accuracy, specificity, and sensitivity values were observed as well.
The results of the study demonstrate that some quantitative image parameters are of significance in differentiating LN metastasis. Logistic regression classifiers showed that the parameters are with predictive values in LN metastasis, which may be used to assist preoperative diagnosis.
Removal of intracardiac bone cement embolism after percutaneous kyphoplasty
Authors: Song Yu , Huang Xiaofan , Wu Long 
Published: March 2020

Abstract

Rationale:
Leakage of bone cement is a common complication after percutaneous kyphoplasty. In rare cases, bone cement can leak into the venous system, which can be life threatening, especially when it causes an embolism in the heart.

Patient concerns:
A 79-year-old female patient developed chest pain with chest tightness 3 weeks after the percutaneous kyphoplasty.

Diagnoses:
Initially, negative fluoroscopy results and elevated myocardial enzymes suggested that the patient's chest pain and chest tightness symptoms were manifestations of coronary heart disease. However, in the subsequent computed tomography (CT) examination, foreign bodies in the heart and pulmonary vessels were found.

Interventions:
The patient underwent emergency surgery to remove the bone cement and repair the tricuspid valve.

Outcomes:
The postoperative course was uneventful and the patient was discharged on the 13th day after surgery.

Lessons:
If a patient develops chest pain with chest tightness after percutaneous kyphoplasty, the clinicians must be vigilant and take into account the limited sensitivity of fluoroscopy and use chest computer tomography and echocardiogram as the first choice and thereby prevent serious consequences.
Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis
Authors: Chen Zehan , Wang Chang , You Di , Zhao Shishun , Zhu Zhe , Xu Meng 
Published: March 2020

Abstract

Background:
This meta-analysis focuses on the controversial efficacy and safety of platelet-rich plasma (PRP) as compared with hyaluronic acid (HA) in the clinical treatment of knee osteoarthritis. We have attempted to provide an evidence-based medicine protocol for the conservative treatment of knee osteoarthritis. In addition, we included the latest relevant literature in this meta-analysis, and a staging study was conducted to compare the therapeutic effects of PRP and HA for knee osteoarthritis over different time periods.

Methods:
An online computer search with “platelet-rich plasma” and “knee osteoarthritis” as search terms was conducted in the PubMed, EMBASE, and Cochrane Library databases. We conducted a quality assessment of the retrieved literature and extracted the following indicators: visual analog scale (VAS) score, subjective International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and adverse events. RevMan5.3 software was used to determine the effect sizes, and indicators were compared across studies at three different time points from the administration of treatment.

Results:
A total of 14 randomized controlled trials (RCTs) involving 1350 patients were included. Long-term VAS, IKDC, WOMAC-Pain, WOMAC-Stiffness, WOMAC-Physical Function, and WOMAC-Total scores at each time point were higher in the PRP group than in the HA group. There were no significant differences in the remaining indicators between the two groups.

Conclusion:
Compared with HA, PRP offers obvious advantages in the conservative treatment of knee osteoarthritis. Treatment with PRP can reduce long-term pain and improve knee joint function with no additional risks. Therefore, PRP can be widely used for the conservative treatment of knee osteoarthritis.
Rapid disease progression after discontinuation of lenvatinib in thyroid cancer
Authors: Yamazaki Haruhiko , Sugino Kiminori , Matsuzu Kenichi , Masaki Chie , Akaishi Junko , Hames Kiyomi , Tomoda Chisato , Suzuki Akifumi , Uruno Takashi , Ohkuwa Keiko , Kitagawa Wataru , Nagahama Mitsuji , Masuda Munetaka , Ito Koichi 
Published: March 2020

Abstract
Some thyroid cancer patients experience a rapid disease progression after the discontinuation of tyrosine kinase inhibitors (TKIs), which is called flare phenomenon. The incidence of the flare phenomenon of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) ranged from 4% to 11.1% and the median time to occurrence of the flare phenomenon ranged from 7 to 12 days in previous reports. In this study, we investigate the timing and incidence of the flare phenomenon in thyroid cancer patients treated with lenvatinib.
The records of patients treated with lenvatinib were retrospectively reviewed. The primary outcomes were the incidence rate and timing of the flare phenomenon after the discontinuation of lenvatinib. The flare phenomenon was defined as death, hospitalization attributable to tumor progression, or unexpected event (e.g., pleural drainage) within 1 month of lenvatinib cessation. We excluded patients with progression of underlying diseases other than thyroid cancer or infection, those in whom the disease progressed, or those who died without achieving a clinical response (stable disease, partial response, or complete response).
In total, 8 (14.3%) of the 56 patients experienced the flare phenomenon. The median time from lenvatinib cessation to the flare phenomenon was 9 (range, 4–30) days. Three patients in the flare group died within 1 month of lenvatinib cessation without an imaging evaluation. The remaining 5 patients had dyspnea and pleural effusion, and pleural drainage was performed in 3 of the 5 patients. Lenvatinib was resumed in 4 of the 8 patients in the flare group. Median overall survival (OS) was 15.1 months in the flare group and 41.9 months in the non-flare group. The OS tended to be poor in the flare group than in the non-flare group; however, this difference was not statistically significant (P = .051).
In lenvatinib treatment for thyroid cancer, the incidence and timing of the flare phenomenon were similar to those observed with other TKIs. OS tended to be poor in the flare group than in the non-flare group. Further studies are needed to determine the mechanism of the flare phenomenon and establish measures and treatment policies.
CTLA-4 rs5742909 polymorphism and cervical cancer risk
Authors: Hu ShiWan , Pu Dan , Xia XueYi , Guo BeiXi , Zhang ChuanLi 
Published: March 2020

Abstract

Background:
Number of studies have been performed to evaluate the relationship between the cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) gene variant rs5742909 polymorphism and cervical cancer risk, but the sample size was small and the results were conflicting. This meta-analysis was conducted to comprehensively evaluate the overall association.

Methods:
PubMed, Web of Science, Embase, China Biology Medical Literature database, China National Knowledge Infrastructure, WanFang, and Weipu databases were searched before July 31, 2018. The strength of associations was assessed using odds ratios (ORs) and 95% confidence intervals (CIs). All of the statistical analyses were conducted using Review Manager 5.3 and Stata 14.0.

Results:
Eleven studies involved 3899 cases and 4608 controls. Overall, significant association was observed between the CTLA-4 gene variant rs5742909 polymorphism and cervical cancer (T vs C: OR = 1.40, 95% CI = 1.12–1.76; TT vs CC: OR = 2.22, 95% CI = 1.13–4.37; TT vs CT+CC: OR = 1.96, 95% CI = 1.03–3.74; TT+CT vs CC: OR = 1.47, 95% CI = 1.14–1.90). In subgroup analysis by ethnic group, a statistically significant association was observed in Asians (T vs C: OR = 1.56, 95% CI = 1.22–1.99), but not in Caucasians (T vs C: OR = 1.19, 95% CI = 0.87–1.62). The sensitivity analysis confirmed the reliability and stability of the meta-analysis.

Conclusion:
our meta-analysis supports that the CTLA-4 gene variant rs5742909 polymorphism might contribute to individual susceptibility to cervical cancer in Asians.
Is it necessary to remove syndesmotic screw before weight-bearing ambulation?
Authors: Moon Young Jae , Kim Dong Hee , Lee Kwang-Bok 
Published: March 2020

Abstract
In syndesmosis injury, whether the syndesmosis screw should be removed prior to weight-bearing remains controversial. The aim of this study was to compare the functional outcome between removed screw and retained groups and between recurrence of diastasis and no diastasis groups.
Fifty-six patients who had undergone open reduction and internal fixation due to syndesmosis injury were retrospectively evaluated and divided into four groups: (A) removed syndesmotic screw before weight-bearing (postoperative 3 months, n = 28), (B)retained (n = 28), (C) recurrence of diastasis (n = 9), and (D) no diastasis (n = 47). Radiological diastasis, American Orthopedic Foot Ankle Society Score (AOFAS), Short Form Health Survey-12 (SF-12), and complications (screw loosening and breakage) were evaluated between groups.
AOFAS ankle-hindfoot score was 75.10 ± 10.40 in group A, 77.07 ± 10.60 in group B. SF-12 was 45.78 ± 5.68 in group A and 47.33 ± 5.83 in group B, showing no significant difference in AOFAS ankle-hindfoot score or SF-12 (P = .487, P = .319, respectively) between groups A and B. Radiological diastasis developed significantly (P = .025) more in group A (8/28) compared to that in group B (1/28). However, screw loosening or breakage developed significantly (P = .001) more in group B (4/28) compared to that in group A (0/28). AOFAS ankle-hindfoot score was 70.33 ± 6.22 in group C and 76.50 ± 10.26 in group D. SF-12 was 49.85 ± 3.83 in group C and 47.40 ± 8.01 in group D, showing no significant difference between groups C and D in AOFAS ankle-hindfoot score or SF-12 (P = .808, P = .948, respectively).
Removal of syndesmotic screw before weight-bearing does not influence clinical outcomes. Although unrelated to clinical progress, recurrence of diastasis significantly increased in screw removed group. Therefore, removal of syndesmotic screw is unnecessary before weight-bearing.
The association between pretreatment serum alkaline phosphatase and prognosis in hepatocellular carcinoma
Authors: Sun Ping , Chen Shihai , Li Yanlong 
Published: March 2020

Abstract

Background:
Numerous studies have investigated the association between pretreatment serum alkaline phosphatase (ALP) and prognosis in hepatocellular carcinoma (HCC), but conclusions remain controversial. Thus, we performed a meta-analysis to assess systematically the relationship between ALP and prognosis in HCC.

Methods:
We searched the PubMed, EMBASE, and Web of Science databases for eligible studies up to October. A combined hazard ratio (HR) was determined to describe the correlation between pretreatment serum ALP level and prognosis in HCC patients. Overall survival (OS) was calculated from the date of treatment either to the end point of the follow-up period or to the date of death by any cause. Disease-free survival (DFS) and recurrence-free survival (RFS) were defined as the period from the date of treatment to the date of last follow-up or to the date of recurrence. OS was regarded as the major outcome.

Results:
Altogether, 21 studies about OS and 6 studies about DFS/RFS were included in this meta-analysis. Our combined results showed that there was an inverse association of pretreatment serum ALP level with OS (HR=1.15, 95% CI: 1.12–1.19) and RFS (HR=1.78, 95% CI: 1.37–2.31).

Conclusion:
There was a close association between high pretreatment ALP level and poor survival in HCC patients, indicating that ALP may be used as a biomarker for prognosis. More high-quality studies are required to validate our findings further, considering the limitations of our meta-analysis.
Extrapyramidal side effect of donepezil hydrochloride in an elderly patient
Authors: Li Hong-Chun , Luo Ke-Xue , Wang Jie-Sheng , Wang Qin-Xian 
Published: March 2020

Abstract

Introduction:
Alzheimer disease (AD) is a neurodegenerative disease characterized by progressive cognitive dysfunction, which is mainly manifested as memory impairment and a reduced ability to self-care, often accompanied by neuropsychiatric and behavioral disorders. Donepezil is the second drug to be approved by the US FDA for the treatment of AD. Of the five FDA-approved drugs for AD treatment, donepezil is currently the most widely used. Here, we report an extrapyramidal adverse reaction to donepezil in an elderly patient with AD.

Patient concerns:
An 87-year-old woman presented with a 1-year history of forgetfulness that was aggravated since the past 2 months. She had a long-term history of multiple major conditions, including hypertension, diabetes, osteoporosis, and arterial plaques. Brain imaging showed age-related changes, and her Mini Mental State Examination score was 20. Other tests revealed no abnormalities apart from multiple thyroid nodules on ultrasonography.

Diagnosis:
She was diagnosed with AD, hypertension, type 2 diabetes mellitus, diabetic neuropathy, osteoporosis, carotid and lower-extremity arterial plaques, thyroid nodules.

Interventions:
She was treated with donepezil (5 mg/day), amlodipine besylate (5 mg/day), glimepiride (4 mg/day), methylcobalamin (1.5 mg/day), calcium carbonate D3 (600 mg/day), simvastatin (20 mg/day) and enteric-coated aspirin (100 mg/day).

Outcomes:
Four days later, she experienced fatigue, panic, sweating, and one episode of vomiting. On the 5th day, she developed increased muscle tension, speech difficulty, and involuntary tremors. Imaging and blood tests revealed no obvious abnormality, and the patient was not receiving psychotropic drugs. An extrapyramidal adverse reaction to donepezil was considered, and the drug was discontinued, after which the symptoms gradually disappeared.

Conclusion:
Serious adverse reactions to donepezil can occur in elderly patients, who typically require multiple medications for a variety of comorbidities. In particular, extrapyramidal reactions have occurred when donepezil is administered in combination with psychotropic drugs. However, in our patient, an extrapyramidal adverse reaction occurred in the absence of psychotropic drugs. Thus, clinicians must be aware of inter-individual differences in drug actions and possible serious adverse reactions, and carefully monitor these patients to ensure the timely detection of adverse events and their safe treatment.
The correlation between UDP-glucuronosyltransferase polymorphisms and environmental endocrine disruptors levels in polycystic ovary syndrome patients
Authors: Luo Yunyao , Nie Ying , Tang Lu , Xu Charles C. , Xu Liangzhi 
Published: March 2020

Abstract

Background:
In recent years, there has been an interest in whether environmental endocrine disruptors (EEDs) may contribute to the endocrine disorders in patients with polycystic ovary syndrome (PCOS). The clearance of EEDs from the human body is regulated by the glucuronidation of UDP-glucuronosyltransferases (UGT). This study aimed to analyze the relationship of UGT1A1, UGT2B7, and UGT2B15 polymorphisms with the metabolism of EEDs in patients with PCOS.

Methods:
A total of 357 Chinese women (119 PCOS cases and 238 controls) were genotyped for polymorphisms of UGT1A1

G71R
, UGT2B7

H268Y
, and UGT2B15

D85Y
. The plasma concentrations of EEDs were measured by the gas chromatography-mass spectrometry method. The association between UGT polymorphisms and the serum level of EEDs in patients with PCOS was analyzed.

Results:
The UGT2B7

H268Y
single nucleotide polymorphism was associated with an increased risk of PCOS. The homozygous polymorphism (TT) of UGT2B7

H268Y
showed higher bisphenol A and PAEs concentrations in serum. However, a single nucleotide polymorphism on UGT2B15

D85Y
expression was associated with a decreased risk of PCOS. Subjects homozygous for the T allele of UGT2B15

D85Y
had a significant effect on phthalates in the blood. In addition, our results also showed that the homozygous polymorphism (TT) of UGT2B7

H268Y
and UGT2B15

D85Y
was associated with the capacity of the excretion of androgen in patients with PCOS.

Conclusions:
Our study reported the novel associations between the UGT polymorphisms and EEDs concentrations in patients with PCOS, supporting the relevance of genetic differences in EEDs metabolism, which might be considered as an etiology of PCOS.
Bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation support for advanced cancer metastasis to the central airway
Authors: Yu Wei , Zhou Pengcheng , Chen Keling , Tang Wenjun , Xia Qianming , Ma Junmei 
Published: March 2020

Abstract

Introduction:
Dyspnea due to tracheal invasion by malignant tumors is a common oncological emergency that is difficult to manage, and a common cause of death among patients with advanced cancer. Bronchoscopy-guided intervention therapy under conventional ventilation is very risky for patients with severe central airway stenosis. Extracorporeal membrane oxygenation (ECMO) provides strong cardiopulmonary support, but is rarely used in bronchoscopy-guided interventional therapy.

Patient concerns:
The patient had advanced esophageal cancer with metastases to the trachea and left and right main bronchi. Despite several sessions of radiotherapy, chemotherapy, and bronchoscopy-guided intervention therapy, the tumor in the airway became enlarged, the lumen was severely narrow, and the patient experienced respiratory distress.

Diagnosis:
A thoracic computed tomography scan performed at our hospital revealed invasion of the trachea and opening of the left and right main bronchi by the esophageal cancer, blockage of the stent by the tumor, and severe luminal narrowing. An emergency bronchoscopy showed slit-like stenosis of the middle and lower part of the trachea and the left and right main bronchi, and the tumor was highly vascular.

Interventions:
To reduce the risk of major airway bleeding and asphyxia during bronchoscopy under conventional ventilation, we finally performed argon plasma coagulation with a high frequency electric knife and cryotherapy with ECMO support.

Outcomes:
We successfully cleared the tumor tissue in the airway under ECMO support. The trachea and left and right main bronchi recovered smoothly, and the patient was soon discharged.

Conclusion:
ECMO can meet the oxygenation needs during bronchoscopy-guided intervention therapy. For patients with severe central airway obstruction due to malignant tumors, ECMO should be considered if conventional respiratory support cannot guarantee the safety of surgery.
Giant fibrous hamartoma of infancy
Authors: Wang Sun , Ma Qichao , Ying Hao , Jiao Qin , Yang Dan , Zhang Bin , Zhao Lihua 
Published: March 2020

Abstract

Rationale:
Fibrous hamartoma of infancy (FHI) is a rare benign soft-tissue tumor in children with a triphasic organoid histologic appearance.

Patient concerns:
We here report a case with the largest FHI published so far. A 13-month-old boy with a rapidly growing tumor 45 cm in length and 69.3 cm in circumference of the left lower extremity was identified immediately at birth.

Diagnoses:
The diagnosis was uncertain before the operation, although biopsy was conducted. The postoperation histological examination showed arranged spindle cells, adipose tissue, and nests of immature small cells embedded in a myxoid background, which is the characteristic triphasic histology of FHI.

Interventions:
Under general anesthesia, hip and lower extremity amputation was performed.

Outcomes:
The patient was followed-up for 6 years and no signs of recurrence were found, suggesting a favorable prognosis, although a part of the residual tumor was present after the surgery.

Lessons:
FHI exhibits pathological and clinical characteristics. However, differential diagnosis of FHI from other soft-tissue tumors before operation remains a challenge. Thus, sometimes, aggressive therapy for the treatment of FHI might be a good choice to get a satisfactory.
Protocol for a prospective multicenter cross-sectional observational study to investigate the role of air pollution on allergic rhinitis prevalence
Authors: Liu Jianmin , Wang Yongkuan , Liu Sisi , Cao Shuwei , Xu Chunyan , Zhang Meng , Liu Shixi 
Published: March 2020

Abstract

Introduction:
Allergic rhinitis (AR) is a major chronic inflammatory disease of the respiratory tract. A large number of epidemiological investigations have shown that the prevalence of AR is increasing, resulting in a large social burden. Importantly, the impact of air pollution on health is a widespread concern. We aim to evaluate association of air pollution and AR risk.

Methods and analysis:
This prospective study includes patients undergoing AR. The exclusion criteria will be as follows: Patients with nasal infection, nasal polyps, nasal tumors, mental disorders, and immunodeficiency will be excluded. Air pollution levels of ambient air pollutants including PM2.5, PM10, sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon dioxide (CO), and O3, and patient data will be collected. The correlation analysis will be performed in air pollutants and AR risk.

Discussion:
This study will provide correlation of NO2, SO2, PM10, and PM2.5 for AR in several aspects, including symptom score, drug score, quality of life score, asthma control score, side effects, and laboratory examination such as nasal function test, serum total immunoglobulin E, and nasal secretion smear.