bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance and immune infiltration of microenvironment-related signatures in pancreatic cancer
Authors: Lu Qian , Zhang Yu , Chen Xiaojian , Gu Weihong , Ji Xinrong , Chen Zhong 
Published: March 2021

Abstract
Pancreatic ductal adenocarcinoma (PDAC) is 1 of the highly fatal and most aggressive types of malignancies and accounts for the vast majority of Pancreatic Cancer. Numerous studies have reported that the tumor microenvironment (TME) was significantly correlated with the oncogenesis, progress, and prognosis of various malignancies. Therefore, mining of TME-related genes is reasonably important to improve the overall survival of patients with PDAC.
The Estimation of STromal and Immune cells in MAlignant Tumor tissues using Expression data algorithm was applied to identify differential expressed genes. Functional and pathway enrichment analyses, protein–protein interaction network construction and module analysis, overall survival analysis and tumor immune estimation resource database analysis were then performed on differential expressed genes.
Data analysis indicated that higher immune scores were correlated with better overall survival (P = 0.033). Differential expression analysis obtained 90 intersection genes influencing both stromal and immune scores. Among these intersection genes, CA9, EBI3, SPOCK2, WDFY4, CD1D, and CCL22 were significantly correlated with overall survival in PDAC patients. Moreover, multivariate Cox analysis revealed that CA9, SPOCK2, and CD1D were the most significant prognostic genes, and were closely correlated with immune infiltration in TCGA cohort. Further analysis indicated that CD1D were significantly related with immune cell biomarkers for PDAC patients.
In summary, our findings provide a more comprehensive insight into TME and show a list of prognostic immune associated genes in PDAC. However, further studies on these genes need to be performed to gain additional understanding of the association between TME and prognosis in PDAC.
Comorbidities’ potential impacts on severe and non-severe patients with COVID-19
Authors: Cheng Sixiang , Zhao Yuxin , Wang Fenxiao , Chen Yan , Kaminga Atipatsa Chiwanda , Xu Huilan 
Published: March 2021

Abstract

Background:
An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus (SARS-CoV-2) emerged in December 2019 in Wuhan, China. Epidemiologic evidence suggests that patients with comorbidities and novel coronavirus disease 2019 (COVID-19) infection may have poor survival outcomes. However, the risk of these coexisting medical conditions in severe and non-severe cases has not been systematically reported.

Purpose:
The present study aimed to estimate the association of chronic comorbidities in severe and non-severe cases.

Methods:
A literature search was conducted using the databases PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database, Chinese Scientific Journals Full-text Database (CQVIP) from the inception dates to April 1, 2020, to identify cohort studies assessing comorbidity and risk of adverse outcome. Either a fixed- or random-effects model was used to calculate the overall combined risk estimates.

Results:
A total of 22 studies involving 3286 patients with laboratory-confirmed COVID-19 were included in the analysis. Overall, compared with the patients with non-severe cases, the pooled odds ratios (ORs) of hypertension, diabetes mellitus, and cardiovascular, cerebrovascular, and respiratory diseases in patients with severe cases were 2.79 (95% confidence intervals [95% CI]: 1.66–4.69), 1.64 (95% CI: 2.30–1.08), 1.79 (95% CI: 1.08–2.96), 3.92 (95% CI: 2.45–6.28), and 1.98 (95% CI: 1.26–3.12), respectively.

Conclusions:
This meta-analysis supports the finding that chronic comorbidities may contribute to severe outcome in patients with COVID-19. According to the findings of the present study, old age and 2 or more comorbidities are significantly impactful to COVID-19 outcomes in hospitalized patients in China.
Efficacy and safety of fire acupuncture for psoriasis vulgaris
Authors: Cheng Xueli , Lai Jiawen , Zhang Yuelin , Lin Liyun , Xu Donghan , Zhong Zhenghong , Wu Qibiao , Liu Jing 
Published: March 2021

Abstract

Introduction:
Fire acupuncture is commonly used for the treatment of psoriasis vulgaris, but the efficacy and safety of fire acupuncture for psoriasis vulgaris remain unclear.

Methods:
This systematic review and meta-analysis will be conducted and reported strictly according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese biomedical literature, and Pubmed will be retrieved for potentially eligible studies from their inception to Jan. 2021. All randomized clinical trials comparing fire acupuncture versus no fire acupuncture in the treatment of psoriasis vulgaris will be retrieved and assessed for inclusion. RevMan5.3 software provided by Cochrane collaboration will be used for the analysis. Randomized Clinical Trials Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. The primary endpoint is the total effective rate, the secondary outcomes are the Psoriasis Area Severity Index (PASI) score, the recurrence rate and the adverse reactions.

Results:
This study will systematically evaluate the efficacy and safety of fire acupuncture for psoriasis vulgaris. The results will be published in a peer-reviewed journal.

Conclusion:
This systematic review will evaluate the effects of fire acupuncture in patients with psoriasis vulgaris, thus providing evidence to the clinical application of this therapy.
Hemophagocytic lymphohistiocytosis in COVID-19
Authors: Schnaubelt Sebastian , Tihanyi Daniel , Strassl Robert , Schmidt Ralf , Anders Sonja , Laggner Anton N. , Agis Hermine , Domanovits Hans 
Published: March 2021

Abstract

Rationale:
The immunologic syndrome induced by severe acute coronavirus disease 2019 (COVID-19) is yet not fully understood. Typical patterns of clinical and laboratory features match secondary hemophagocytic lymphohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear.

Patient concerns:
Three patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation.

Diagnosis:
Secondary hemophagocytic lymphohistiocytosis due to severe COVID-19; diagnosed via HScore.

Interventions:
A treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered.

Outcomes:
One patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased.

Lessons:
A routine screening of COVID-19 patients for secondary HLH by using the HScore is feasible; especially those patients deteriorating clinically with no sufficient response to shock management might be at particular high risk. A stepwise therapeutic approach comprising corticosteroids, immunoglobulins and anakinra, accompanied by immunoadsorption, may dampen cytokine storm effects, and potentially reduce mortality.
A delayed diagnosis of atypical immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome
Authors: Zhang Ying , Liu Hanmin , Ai Tao , Xia Wanmin , Chen Tingting , Zhang Lei , Luo Xiulan , Duan Yaping 
Published: March 2021

Abstract

Introduction:
Immune dysregulation, polyendocrinopathy, enteropathy, and X-linked (IPEX) syndrome is a rare monogenic autoimmune disease, which is caused by mutations in the forkhead box protein 3 gene, can affect various systems. The typical clinical manifestations of IPEX are enteropathy, type 1 diabetes mellitus, and skin diseases. However, some atypical phenotypes can easily be misdiagnosed clinically.

Patient concerns:
A 9-year-and-7-month old patient suffered from recurrent wheezing, hematochezia, and eczematous dermatitis at the age of six months, but did not have any manifestations of autoimmune endocrinopathy. The patient was treated with glucocorticoids for more than six years, and he developed bronchiectasis.

Diagnosis:
Whole exome sequencing revealed a hemizygous pathogenic mutation c.1010G>A, p. (Arg337Gln) in Forkhead box protein 3 gene (NM_014009.3).

Interventions:
The patient was treated with oral mycophenolate mofetil combined with inhaled budesonide formoterol for six months after diagnosis.

Outcomes:
The respiratory symptoms of the patient seemed to be controlled but eczematous dermatitis progressed, which led the patient to give up the treatment.

Conclusion:
Early diagnosis and treatment of IPEX are crucial. Lung injury may be a major problem in the later stages of atypical IPEX, and mycophenolate mofetil seems to control the respiratory symptoms, but could induce significant skin side effects.
Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey
Authors: Stephens Andrew R. , Presson Angela P. , Chen Danli , Tyser Andrew R. , Kazmers Nikolas H. 
Published: March 2021

Abstract
Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.
New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.
Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.
Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.
Utility of lung ultrasound to identify interstitial lung disease
Authors: Yan Jun-Hong , Pan Lei , Gao Yan-Bing , Cui Guang-He , Wang Yue-Heng 
Published: March 2021

Abstract
Lung ultrasound (LUS) has recently been used to identify interstitial lung disease (ILD). However, data on the role of LUS in the detection of ILD remain limited. The aim of this study was to investigate the diagnostic value of LUS compared with high-resolution computed tomography (HRCT) in patients with ILD.
The retrospective study was carried out by reviewing the medical records of patients with respiratory signs and symptoms discharged from the respiratory ward. Only patients with suspected ILD who underwent HRCT and LUS within a week were selected. ILD was identified with a semi-quantitative score of B-lines >5 and a Warrick score >0 points. The endpoints of LUS in diagnosing ILD (i.e., sensitivity, specificity, positive likelihood ratio [PLR], negative likelihood ratio [NLR], positive predictive value [PPV], and negative predictive value [NPV], and receiver operating characteristic [ROC] curve) was compared with that of HRCT. The reference standard used for the diagnosis of ILD was based on history, clinical findings and examination, and laboratory and instrumental tests, including pulmonary function tests, lung histopathology, and HRCT (without LUS findings).
The final clinical diagnosis of ILD was 55 in 66 patients with suspected ILD. HRCT was positive in 55 patients, whereas LUS detected ILD in 51 patients. Four patients with negative LUS findings were positive on HRCT. The results showed 93% sensitivity, 73% specificity, 3.40 PLR, 0.10 NLR, 94% PPV, and 67% NPV for LUS, whereas 100% sensitivity, 82% specificity, 5.49 PLR, 0.01 NLR, 97% PPV, and 100% NPV for HRCT. Comparison of the 2 ROC curves revealed significant difference in the diagnostic value of the 2 methods for the diagnosis of ILD (P = .048).
Our results indicated that LUS is a useful technique to identify ILD. Considering its non-radiation, portable and non-invasive advantages, LUS should be recommended as a valuable screening tool in patients with suspected ILD.
Do accountable care organizations differ according to physician-hospital integration?
Authors: Lin Meng-Yun , Hanchate Amresh D. , Frakt Austin B. , Burgess James F. , Carey Kathleen 
Published: March 2021

Abstract
Physician-hospital integration among accountable care organizations (ACOs) has raised concern over impacts on prices and spending. However, characteristics of ACOs with greater integration between physicians and hospitals are unknown. We examined whether ACOs systematically differ by physician-hospital integration among 16 commercial ACOs operating in Massachusetts.
Using claims data linked to information on physician affiliation, we measured hospital integration with primary care physicians for each ACO and categorized them into high-, medium-, and low-integrated ACOs. We conducted cross-sectional descriptive analysis to compare differences in patient population, organizational characteristics, and healthcare spending between the three groups. In addition, using multivariate generalized linear models, we compared ACO spending by integration level, adjusting for organization and patient characteristics. We identified non-elderly adults (aged 18–64) served by 16 Massachusetts ACOs over the period 2009 to 2013.
High- and medium-integrated ACOs were more likely to be an integrated delivery system or an organization with a large number of providers. Compared to low-integrated ACOs, higher-integrated ACOs had larger inpatient care capacity, smaller composition of primary care physicians, and were more likely to employ physicians directly or through an affiliated hospital or physician group. A greater proportion of high-/medium-integrated ACO patients lived in affluent neighborhoods or areas with a larger minority population. Healthcare spending per enrollee in high-integrated ACOs was higher, which was mainly driven by a higher spending on outpatient facility services.
This study shows that higher-integrated ACOs differ from their counterparts with low integration in many respects including higher healthcare spending, which persisted after adjusting for organizational characteristics and patient mix. Further investigation into the effects of integration on expenditures will inform the ongoing development of ACOs.
Comparison of endoscopic ultrasound-guided choledochoduodenostomy and endoscopic retrograde cholangiopancreatography in first-line biliary drainage for malignant distal bile duct obstruction
Authors: Itonaga Masahiro , Kitano Masayuki , Yoshikawa Takanori , Ashida Reiko , Yamashita Yasunobu , Hatamaru Kenichi , Takenaka Mamoru , Yamazaki Tomohiro , Ogura Takeshi , Nishioka Nobu , Sakai Arata , Masuda Atsuhiro , Shiomi Hideyuki , Shimokawa Toshio 
Published: March 2021

Abstract

Introduction:
In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction.

Methods/design:
This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time.

Discussion:
If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided.

Trial registration:
University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201

Version number: 1.2, December 7, 2020.
The clinical classification of patients with COVID-19 pneumonia was predicted by Radiomics using chest CT
Authors: Xiong Fei , Wang Ye , You Tao , Li Han han , Fu Ting ting , Tan Huibin , Huang Weicai , Jiang Yuanliang 
Published: March 2021

Abstract
In 2020, the new type of coronal pneumonitis became a pandemic in the world, and has firstly been reported in Wuhan, China. Chest CT is a vital component in the diagnostic algorithm for patients with suspected or confirmed COVID-19 infection. Therefore, it is necessary to conduct automatic and accurate detection of COVID-19 by chest CT.
The clinical classification of patients with COVID-19 pneumonia was predicted by Radiomics using chest CT.
From the COVID-19 cases in our institution, 136 moderate patients and 83 severe patients were screened, and their clinical and laboratory data on admission were collected for statistical analysis. Initial CT Radiomics were modeled by automatic machine learning, and diagnostic performance was evaluated according to AUC, TPR, TNR, PPV and NPV of the subjects. At the same time, the initial CT main features of the two groups were analyzed semi-quantitatively, and the results were statistically analyzed.
There was a statistical difference in age between the moderate group and the severe group. The model cohort showed TPR 96.9%, TNR 99.1%, PPV98.4%, NPV98.2%, and AUC 0.98. The test cohort showed TPR 94.4%, TNR100%, PPV100%, NPV96.2%, and AUC 0.97. There was statistical difference between the two groups with grade 1 score (P = .001), the AUC of grade 1 score, grade 2 score, grade 3 score and CT score were 0.619, 0.519, 0.478 and 0.548, respectively.
Radiomics’ Auto ML model was built by CT image of initial COVID -19 pneumonia, and it proved to be effectively used to predict the clinical classification of COVID-19 pneumonia. CT features have limited ability to predict the clinical typing of Covid-19 pneumonia.
High expression of MMP28 indicates unfavorable prognosis in pancreatic cancer
Authors: Chen Zhitao , Huang Jiacheng , Li Mengxia , Zhang Lele , Wan Dalong , Lin Shengzhang 
Published: March 2021

Abstract
To investigate the expression pattern and diagnostic performance of matrix metalloproteinase 28 (MMP28) in pancreatic cancer (PC).
The RNA-seq data of PC and normal pancreas tissue were acquired from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression. Clinical information of PC that included prognostic data was obtained from TCGA. Later, Fisher exact test was applied for comparison of different clinicopathological features between high and low expression of MMP28 in PC. Afterwards, Kaplan-Meier survival analysis and Cox analysis (univariate and multivariate analysis) were used to explore the prognostic performance of MMP28 in PC cohort. Finally, gene set enrichment analysis (GSEA) revealed the potential signaling pathways related to high expression of MMP28 in PC.
Upregulation of MMP28 was identified in PC tissue compared to normal pancreas tissue (P < .001). Overexpression of MMP28 was related to histological grade (P < .001), M classification (P = .014), and survival status (P = .028). Kaplan-Meier survival analysis revealed that high level of MMP28 implied unfavorable prognosis in PC (P = .002). Multivariate analysis confirmed that MMP28 was an independent risk factor in PC (hazard rate = 1.308, P = .018). Our GSEA analysis found that signaling pathways including glycolysis, p53 pathway, notch signaling, estrogen response late, cholesterol homeostasis, estrogen response early, mitotic spindle, and transforming growth factor beta signaling were enriched in the group with higher MMP28 expression.
High expression of MMP28 could be identified in PC, which also served as an independent risk element for PC.
Ghrelin, Obestatin and Their Receptors As Well As Metabotropic Glutamate Receptor Assessment in Chronic Functional Constipation in Children
Authors: Czkwianianc Elzbieta , Kolejwa Michal , Bossowski Artur , Wawrusiewicz‐Kurylonek Natalia , Glowacka Ewa , Makosiej Aleksandra , Goscik Joanna , Socha‐Banasiak Anna , Makosiej Ryszard 
Published: March 2021

ABSTRACTObjectives:The aim of this study was to examine the role of ghrelin, obestatin, and glutamate and their receptors in the pathogenesis of children functional constipation.Methods:Children ages 4–17 were the subject of the study: 121 children with constipation (55 boys and 66 girls), 36 patients of the same age (26 boys and 10 girls) were the controls. Expression of ghrelin, obestatin, and glutamate receptors on gastric and colon specimens taken by endoscopy were assessed. The concentration of the above agents was estimated in serum by the enzyme‐linked immunosorbent assay test.Results:The lower median serum concentrations of ghrelin, in the constipated children than in controls were confirmed (1.9 ng/mL vs 2.6 ng/mL, P < 0.05). The expression of the metabotropic receptor 7 for glutamate (mGlu7) RNA was higher in the stomach (32.49 vs 31.47, P < 0.05), and was lower in the rectum in constipated patients compared to the control group (31.76 vs 32.62, P < 0.05). A negative correlation between the concentration of ghrelin in serum and colonic transient time (P = 0.01, rho = −0.23) was shown in the study group.Higher median expression of obestatin receptor G protein‐coupled receptor39 in rectal mucosae was found in a constipated group than in the controls (29.9 vs 26.9, P < 0.05).Conclusion:Ghrelin, and receptors for ghrelin, obestatin, and glutamate in gastrointestinal mucosa play a role in the pathogenesis of functional constipation in children.