bluuebunny/crossref_metadata_2025_split huggingface dataset:
An immune scores-based nomogram for predicting overall survival in patients with clear cell renal cell carcinoma
Authors: Wu Zhulin , Ouyang Chensheng , Peng Lisheng 
Published: August 2020

Abstract
The role of immune cell infiltration in the prognosis of clear cell renal cell carcinoma (ccRCC) has received increasing attention. However, immune scores have not yet been introduced into routine clinical practice of ccRCC patients. The principal objective of our research was to study the correlation between immune scores and overall survival (OS) of ccRCC.
In this study, Cox regression analyses were used to identify risk factors associated with OS of ccRCC based on the Cancer Genome Atlas datasets. Furthermore, an integrated nomogram combining immune scores and clinicopathologic factors was built for predicting 3- and 5-year OS of ccRCC patients. The receiver operating characteristic curve, concordance index, and calibration curves were used for the evaluation of our nomogram. Also, Kaplan–Meier (KM) survival analysis of immune scores, stromal scores, and different clinicopathological factors was performed.
A total of 514 patients were divided into the low- or high-immune scores group. KM and multivariate Cox regression analyses demonstrated that ccRCC patients with high-immune scores had significantly poor OS compared with those with low-immune scores. Calibration curves showed good consistency between the predicted OS and the actual OS probability. Areas under the receiver operating characteristic curves for 3- and 5-year OS were 0.816 and 0.769, and the concordance index was 0.775, indicating that our nomogram had good accuracy for predicting OS of ccRCC patients. Additionally, KM analysis showed that older age, later T stage, distant metastasis, advanced tumor lymph node metastasis stage, higher tumor grade, left site, and low stromal scores were associated with worse OS in ccRCC patients.
High-immune scores show a significant correlation with unsatisfactory prognosis in ccRCC patients. Furthermore, the immune scores-based nomogram may be helpful in predicting ccRCC prognosis.
Litholytic agents as an alternative treatment modality in patients with biliary dyspepsia
Authors: Kim Young Min , Jang Sung Ill , Cho Jae Hee , Koh Dong Hee , Kwon Chang-Il , Lee Tae Hoon , Jeong Seok , Lee Dong Ki 
Published: August 2020

Abstract
Biliary dyspepsia presents as biliary colic in the absence of explanatory structural abnormalities. Causes include gallbladder dyskinesia, sphincter of Oddi dysfunction, biliary tract sensitivity, microscopic sludges, and duodenal hypersensitivity. However, no consensus treatment guideline exists for biliary dyspepsia. We investigated the effects of medical treatments on biliary dyspepsia.
We retrospectively reviewed the electronic medical records of 414 patients who had biliary pain and underwent cholescintigraphy from 2008 to 2018. We enrolled patients who received litholytic agents and underwent follow-up scans after medical treatment. We divided the patients into the GD group (biliary dyspepsia with reduced gallbladder ejection fraction [GBEF]) and the NGD group (biliary dyspepsia with normal GBEF). We compared pre- and post-treatment GBEF and symptoms.
Among 57 patients enrolled, 40 (70.2%) patients had significant GBEF improvement post-treatment, ranging from 34.4 ± 22.6% to 53.8 ± 26.8% (P < .001). In GD group (n = 35), 28 patients had GBEF improvement after medical treatment, and value of GBEF significantly improved from 19.5 ± 11.0 to 47.9 ± 27.3% (P < .001). In NGD group (n = 22), 12 patients had GBEF improvement after medical treatment, but value of GBEF did not have significant change. Most patients (97.1% in GD group and 81.8% in NGD group) had improved symptoms after medical treatment. No severe complication was reported during treatment period.
Litholytic agents improved biliary colic in patients with biliary dyspepsia. Therefore, these agents present an alternative treatment modality for biliary dyspepsia with or without gallbladder dyskinesia. Notably, biliary colic in patients with gallbladder dyskinesia resolved after normalization of the GBEF. Further prospective and large-scale mechanistic studies are warranted.
The prediction potential of neutrophil-to-lymphocyte ratio for the therapeutic outcomes of programmed death receptor-1/programmed death ligand 1 inhibitors in non-small cell lung cancer patients
Authors: Huang Ying , Shen Aizong 
Published: August 2020

Abstract

Background:
Programmed death receptor-1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have been demonstrated to improve the prognosis of patients with advanced non-small cell lung cancer (NSCLC) compared with chemotherapy. However, there were still some non-responders. Thus, how to effectively screen the responder may be an important issue. Recent studies revealed the immune-related indicator, neutrophil-lymphocyte ratio (NLR), may predict the therapeutic effects of anti-PD1/PD-L1 antibodies; however, the results were controversial. This study was to re-evaluate the prognostic potential of NLR for NSCLC patients receiving PD1/PD-L1 inhibitors by performing a meta-analysis.

Methods:
Eligible studies were identified by searching online databases of PubMed, EMBASE and Cochrane Library. The predictive values of NLR for overall survival, (OS), progression free survival (PFS) and overall response rate (ORR) were estimated by hazard ratio (HR) with 95% confidence interval (CI).

Results:
Twenty-four studies involving 2196 patients were included. The pooled analysis demonstrated that elevated NLR before PD-1/PD-L1 inhibitor treatment was a predictor of poor OS (HR = 2.17; 95% CI: 1.64 – 2.87, P < .001), PFS (HR = 1.54; 95% CI: 1.34 – 1.78, P < .001) and low ORR (HR = 0.64; 95% CI: 0.44 – 0.95, P = .027) in NSCLC patients. Subgroup analysis revealed the predictive ability of NLR for OS and PFS was not changed by ethnicity, sample size, cut-off, HR source, study design or inhibitor type (except the combined anti-PD-L1 group); while its association with ORR was only significant when the cut-off value was less than 5 and the studies were prospectively designed.

Conclusion:
Our findings suggest patients with lower NLR may benefit from the use of PD-1/PD-L1 inhibitors to prolong their survival period.
Lymphatic imaging and intervention for chylothorax following thoracic aortic surgery
Authors: Chen Cheng Shi , Kim Jong Woo , Shin Ji Hoon , Koo Hyun Jung , Kim Joon Bum , Li Hai-Liang , Kwon Se Hwan , Ibrahim Alrashidi , Alhazemi Almoaiad A. , Chu Hee Ho 
Published: August 2020

Abstract
Reports on lymphatic intervention for chylothorax complicating thoracic aortic surgery are limited. We aimed to evaluate technical and clinical outcomes of lymphangiography and thoracic duct embolization (TDE) for chylothorax complicating thoracic aortic surgery.
Nine patients (mean age, 38.9 years) who underwent chylothorax interventions after thoracic aortic surgery (aorta replacement [n = 7] with [n = 2] or without [n = 5] lung resection, and vascular ring repair [n = 2]) were reviewed retrospectively. Magnetic resonance (MR) lymphangiograms were obtained in 5 patients. The median interval between surgery and conventional lymphangiography was 9 days (range, 4–28 days). TDE clinical success was defined as lymphatic leakage resolution with chest tube removal within 2 weeks.
MR lymphangiograms revealed contrast leakage from the thoracic duct (n = 4) or no definite leakage (n = 1), which correlated well with conventional lymphangiogram findings. The technical success rate of conventional lymphangiography was 88.9% (8/9); 8 patients showed contrast leakage, while the patient without definite leakage on MR lymphangiography had small inguinal lymph nodes, and thoracic duct visualization by conventional lymphangiography failed. The technical success rates of antegrade and retrograde TDE via pleural access were 75% (6/8) and 100% (3/3), respectively. Clinical outcomes after embolization, as judged by the tube-removal day, were similar between low- (<500 mL/day) and high-output (≥500 mL/day) chylothorax patients. The drainage amount decreased significantly after lymphangiography/TDE, from 710.0 mL/day to 109.7 mL/day (p < .05). The clinical success rate of TDE was 87.8% (7/8).
Conventional lymphangiography and TDE yielded high technical success rates and demonstrated encouraging clinical outcomes for chylothorax complicating thoracic aortic surgery.
Usefulness of an additional lead shielding device in reducing occupational radiation exposure during interventional endoscopic procedures
Authors: Yamada Reiko , Saimyo Yusuke , Tanaka Kyosuke , Hattori Aiji , Umeda Yuhei , Kuroda Naoki , Tsuboi Junya , Hamada Yasuhiko , Takei Yoshiyuki 
Published: August 2020

Abstract
Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation.
An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures.
The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations.
An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.
Ovarian microcystic stromal tumor with significant bizarre nuclei
Authors: He Ying , Xu Lian , Feng Min , Wang Wei 
Published: August 2020

Abstract

Rationale:
Ovarian microcystic stromal tumor is a relatively rare tumor type, which is characterized by morphology with microcyst structure, solid cellular areas, and hyalinized fibrous stroma. The most reported tumors were stage I with good prognosis.

Patient concerns:
We report a case of a 33-year-old woman with primary ovarian microcystic stromal tumor with significant bizarre nuclei. We describe the clinical, histopathological, and immunohistochemical findings and review the English literatures. So far, as we know, the patient presented here is a rare case of ovarian microcystic stromal tumor with prominent bizarre nuclei accounting for about 50% of the tumor cells.

Diagnoses:
She was diagnosed with ovarian microcystic stromal tumor with significant bizarre nuclei.

Interventions:
The right ovarian tumor was resected laparoscopically on October 19, 2018.

Outcomes:
Up to now, the patient is free of disease at 19 months of follow-up.

Lessons:
This is a rare case of ovarian microcystic stromal tumor with obvious bizarre nuclei. This report will contribute to expand the morphological spectrum of ovarian microcystic stromal tumor.
Ligation of patent ductus venosus in a child with pulmonary arterial hypertension and hypersplenism
Authors: Xiao Yunbin , Li Wenfeng , Deng Xicheng , Chen Zhi , Peng Yuming , Wang Yefeng , Zeng Yunhong , Xiao Zhenghui 
Published: August 2020

Abstract

Introduction:
Patent ductus venosus (PDV) is a rare and critical disease, and the majority of patients present with pulmonary arterial hypertension (PAH) or hepatopulmonary syndrome due to congenital portosystemic shunt. We reported that both PAH and hypersplenism were major complications of PDV in this case. This case report can assist the treatment and recovery of the patients with similar symptoms.

Patient concerns:
A 4-year-old male patient presented to our institution with a history of recurrent respiratory infections accompanied by leukocytopenia, thrombocytopenia and presented with tachypnoea. upon mild exertion.

Diagnosis:
A wide communication, 10 mm in diameter, between the portal vein and inferior vena cava was identified in the subcostal echocardiogram and computed tomography images. Echocardiography showed an estimated systolic pulmonary artery pressure of 106 mm Hg. Right-sided cardiac catheterization indicated a mean pulmonary arterial pressure of 30 mm Hg and a pulmonary vascular resistance of 3 Wood units. Chest X-ray revealed cardiomegaly with a prominent pulmonary segment.

Interventions:
The patient was treated with combination pharmacotherapy of bosentan and tadalafil and PDV ligation.

Outcomes:
A year later, the boy showed normal exercise tolerance and weight gain. Liver and spleen parameters, liver function, blood cells and the general condition of the boy improved.

Conclusion:
Initial combination therapy of bosentan and tadalafil is safe and effective in children with PAH associated with PDV. When PDV banding test shows normal portal pressure, PDV ligation is considered acceptable in children with PAH and hypersplenism associated with PDV.
Decreased expression of TNFRSF12A in thyroid gland cancer predicts poor prognosis
Authors: Wu Zeng-Hong , Niu Xun , Wu Gui-Hong , Cheng Qing 
Published: August 2020

Abstract
Thyroid cancer (TC) is the most well-known endocrine neoplasia as well as a common malignant tumor in the head and neck. Our study was designed to assess the prognostic meaningful of TNFRSF12A expression in TC dependent on data acquired from TCGA and so as to increase further knowledge into the biological pathways involved in TC pathogenesis related TNFRSF12A.
Information on gene expression and comparing clinical data were identified and downloaded from TCGA. Gene set enrichment analysis (GSEA) created an arranged list of all genes indicated by their connection with TNFRSF12A expression.
Our study cohort included 370 (73.1%) female and 136 (26.9%) male patients. The scatter plot and paired plot showed the difference of TNFRSF12A expression between normal and tumor samples (P < .01). The univariate analysis suggested that TNFRSF12A-low associated essentially with age (HR: 1.15; 95%CI: 1.08–1.22; P < .01), stage (HR: 2.79; 95%CI: 1.43–5.46; I vs IV; P = .003) and tumor stage (HR: 2.39; 95%CI: 1.08–5.30; P = .031). The GSEA results show that type II diabetes mellitus, pantothenate and CoA biosynthesis, adipocytokine signaling pathway, PPAR signaling pathway, mTOR signaling pathway, insulin signaling pathway, are enriched in TNFRSF12A low expression phenotype.
TNFRSF12A expression may be a potential useful prognostic molecular biomarker of bad survival in thyroid cancer, in addition, PPAR signaling pathway, insulin signaling pathway, mTOR signaling pathway may be the key pathway controlled by TNFRSF12A in thyroid cancer. Further experimental ought to be performed to demonstrate the biologic effect of TNFRSF12A.
Reproducibility and reliability of performance indicators to evaluate the therapeutic effectiveness of biofeedback therapy after elbow surgery
Authors: Takahashi Rina , Sano Kazufumi , Kimura Kazumasa , Ishioka Toshiyuki , Suzuki Makoto , Nakaya Naoki , Ozeki Satoru , Hamaguchi Toyohiro 
Published: August 2020

Abstract
Electromyographic biofeedback (EMG-BF) therapy provides information on the state of contraction of the targeted muscles and relaxation of their antagonists, which can facilitate early active range of motion (RoM) after elbow surgery. Our aim in this study was to calculate the minimum detectable change (MDC) during EMG-BF therapy, initiated in the early postoperative period after elbow surgery.
This study is an observational case series. EMG-BF of muscle contraction and relaxation was provided during active elbow flexion and extension exercises. Patients completed 3 sets of 10 trials each of flexion and extension over 4 weeks. The total range of flexion-extension motion and scores on the Japanese Society for Surgery of the Hand version of the disability of the arm, shoulder, and hand questionnaire and the Japanese version of the Patient-Rated Elbow Evaluation were obtained at baseline and weekly during the 4-week intervention period. A prediction formula was developed from the time-series data obtained during the intervention period, using the least-squares method. The estimated value was calculated by removing the slope from the prediction formula and adding the initial scores to residuals between the measured scores and predicted scores individually. Systematic error, MDC at the 95th percentile cutoff (MDC95), repeatability of the measures, and the change from the baseline to each time-point of intervention were assessed.
The MDC95 was obtained for all 3 outcome measures and the range of values was as follows: RoM, 8.3° to 22.5°; Japanese version of the Patient-Rated Elbow Evaluation score, 17.6 to 30.6 points; and disability of the arm, shoulder, and hand questionnaire subscale: disability and symptoms score, 14.2 to 22.9 points.
The efficacy of EMG-BF after elbow surgery was reflected in earlier initiation of elbow RoM after surgery and improvement in patient-reported upper limb function scores. The calculated MDC95 cut-offs could be used as reference values to assess the therapeutic effects of EMG-BF in individuals.
Qizhijiangtang capsule for the treatment of diabetic kidney disease
Authors: Tan Yumeng , Hu Jun , Zhang Yueying , Wu Qian , Ni Qing 
Published: August 2020

Abstract

Backgrounds:
Diabetic kidney disease (DKD) is 1 of the common microvascular complications of diabetes, and the therapeutic effect of modern medicine on DKD is limited. At present, patented Chinese medicine Qizhijiangtang (QZJT) capsule has been widely used in the treatment of DKD. We aim to systematically assess the efficacy and safety of QZJT capsule for the treatment of diabetic kidney disease (DKD).

Methods:
Randomized controlled trials of QZJT capsule for DKD treatment will be searched until July 1, 2020, in 7 electronic databases: PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and Chinese Biomedical Literature. Furthermore, additional relevant publications will be manually searched according to reference lists from the resulting publications. The Cochrane risk test from the Cochrane Handbook will be used as a bias tool to evaluate the methodological quality. The clinical efficacy will be the primary outcome, which is based on the changes in symptoms and levels of proteinuria. Review Manager 5.3 will be used to analyze the results.

Results and conclusions:
Our meta-analysis will provide evidence to the clinical application of QZJT capsule in the treatment of DKD from the 4 aspects including the clinical efficacy, changes in proteinuria, the renal function and level of blood glucose. Meanwhile, the results can also reflect the role of traditional Chinese medicine in the treatment of DKD.

PROSPERO registration number:
CRD42020153949.
Primary metabolic tumor volume from 18F-FDG PET/CT associated with epidermal growth factor receptor mutation in lung adenocarcinoma patients
Authors: Liao Xuhe , Cui Yonggang , Chen Xueqi , Di Lijuan , Tong Zhenghao , Liu Meng , Wang Rongfu 
Published: August 2020

PurposeTo explore the potential parameters from18F-FDG PET/CT that might be associated with the epidermal growth factor receptor (EGFR) gene mutation status in lung adenocarcinoma (ADC) patients.MethodsData of the test cohort of 191 patients and the validation cohort of 55 patients with newly diagnosed ADC were retrospectively reviewed. All patients underwent18F-FDG PET/CT scans and EGFR mutation tests prior to treatment. The metabolic parameters obtained from18F-FDG PET/CT combining with clinical characteristics were analyzed by using univariate and multivariate logistic regression analyses. Then two cohorts were enrolled to validate the predictive model by area under the receiver-operating characteristic curve (AUC), respectively.ResultsEGFR mutation-positive was seen of 33.0% (63/191) and 32.7% (18/55) in two cohorts, respectively. In univariate analysis, female, nonsmokers, metabolic parameters of primary tumor [mean standardized uptake value, metabolic tumor volume (pMTV), and total lesion glycolysis], non-necrosis of primary tumor, and serum tumor markers [carbohydrate antigen 19-9, squamous cell carcinoma antigen, and precursor of gastrin releasing peptide (proGRP)] were significantly relevant with EGFR mutation. In multivariate analysis with adjustment of age and TNM stage, pMTV (<8.13 cm3), proGRP (≥38.44 pg/ml) and women were independent significant predictors for EGFR mutation. The AUC for the predictive value of these factors was 0.739 [95% confidence interval (CI) 0.665–0.813] in the cohort of 191 patients and 0.716 (95% CI 0.567–0.865) in the cohort of 55 patients, respectively.ConclusionLow pMTV (<8.13 cm3) was an independent predictor and could be integrated with women and high proGRP (≥38.44 pg/ml) to enhance the discriminability on the EGFR mutation status in ADC patients.
Improvement in gait function after carotid endarterectomy is associated with postoperative recovery in perfusion and neurotransmitter receptor function in the motor-related cerebral cortex: a 123I-iomazenil SPECT study
Authors: Sato Shinpei , Fujiwara Shunrou , Miyoshi Kenya , Chida Kohei , Kobayashi Masakazu , Kubo Yoshitaka , Yoshida Kenji , Terasaki Kazunori , Ogasawara Kuniaki 
Published: August 2020

Objective
Carotid endarterectomy (CEA) often restores cerebral perfusion and neurotransmitter receptor function, which is seen on early and late images, respectively, on brain 123I-iomazenil single-photon emission computed tomography (SPECT). The reliability of gait-related parameters obtained using a triaxial accelerometer, a portable device for gait assessment, has been confirmed with test-retest measurements. The purpose of the present prospective cohort study was to determine whether improvement in gait function after CEA is associated with postoperative recovery in perfusion and neurotransmitter receptor function in the motor-related cerebral cortex.

Methods
Gait testing using a triaxial accelerometer was performed preoperatively and 6 months postoperatively in 64 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≥70%). 123I-iomazenil SPECT was also performed with scanning within 30 min (early images) and at 180 min (late images) after tracer administration before and after surgery. SPECT data were analyzed using a three-dimensional stereotactic surface projection, and motor (Brodmann 4) and premotor (Brodmann 6) cortexes in each hemisphere were combined and defined as the motor-related cortex.

Results
Based on preoperative and postoperative gait testing, seven patients (11%) showed postoperative improved gait. Logistic regression analysis revealed that postoperative increase in 123I-iomazenil uptake in the motor-related cortex ipsilateral to surgery on early [95% confidence interval (CI), 4.32–365.21; P = 0.0477) or late (95% CI, 9.45–1572.57; P = 0.0173) images was an independent predictor of postoperative improved gait.

Conclusions
Improvement in gait function after CEA is associated with postoperative recovery in perfusion and neurotransmitter receptor function in the motor-related cerebral cortex.