bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estrogen alone and joint symptoms in the Women's Health Initiative randomized trial
Authors: Chlebowski Rowan T. , Cirillo Dominic J. , Eaton Charles B. , Stefanick Marcia L. , Pettinger Mary , Carbone Laura D. , Johnson Karen C. , Simon Michael S. , Woods Nancy F. , Wactawski-Wende Jean 
Published: October 2018

Abstract

Objective:
Although joint symptoms are commonly reported after menopause, observational studies examining exogenous estrogen's influence on joint symptoms provide mixed results. Against this background, estrogen-alone effects on joint symptoms were examined in post hoc analyses in the Women's Health Initiative randomized, placebo-controlled, clinical trial.

Methods:
A total of 10,739 postmenopausal women who have had a hysterectomy were randomized to receive daily oral conjugated equine estrogens (0.625 mg/d) or a matching placebo. The frequency and severity of joint pain and joint swelling were assessed by questionnaire in all participants at entry and on year 1, and in a 9.9% random subsample (n = 1,062) after years 3 and 6. Logistic regression models were used to compare the frequency and severity of symptoms by randomization group. Sensitivity analyses evaluated adherence influence on symptoms.

Results:
At baseline, joint pain and joint swelling were closely comparable in the randomization groups (about 77% with joint pain and 40% with joint swelling). After 1 year, joint pain frequency was significantly lower in the estrogen-alone group compared with the placebo group (76.3% vs 79.2%, P = 0.001), as was joint pain severity, and the difference in pain between randomization groups persisted through year 3. However, joint swelling frequency was higher in the estrogen-alone group (42.1% vs 39.7%, P = 0.02). Adherence-adjusted analyses strengthen estrogen's association with reduced joint pain but attenuate estrogen's association with increased joint swelling.

Conclusions:
The current findings suggest that estrogen-alone use in postmenopausal women results in a modest but sustained reduction in the frequency of joint pain.
Comparison of Home and Ambulatory Blood Pressure Measurements in Association With Preclinical Hypertensive Cardiovascular Damage
Authors: Lin Ting-Tse , Juang Jimmy Jyh-Ming , Lee Jen-Kuang , Tsai Chia-Ti , Chen Chen-Huan , Yu Wen-Chung , Cheng Hao-min , Wu Yen-Wen , Chiu Yu-Wei , Kuo Chi-Tai , Chen Jin-Jer , Chen Zhih-Cherng , Chang Wei-Ting , Liu Ping-Yen , Chen Po-wei , Yen Hsueh-Wei , Chen Ying-Chih , Tseng Wei-Kung , Chiang Fu-Tien , Wu Cho-Kai 
Published: October 2018

Objective:
To evaluate whether home or ambulatory blood pressure (BP) monitoring was associated with preclinical hypertensive cardiovascular target organ damage (TOD).

Methods:
We enrolled participants with prehypertension and stage 1 hypertension from 11 medical centers within the Taiwan hypertension-associated cardiac disease consortium. Recordings of clinical BP measurement, ambulatory BP monitoring for 24 hours, and home BP monitoring during morning and evening were made. The measured parameters of target organ damage included left ventricular mass index (LVMI), left atrial volume index (LAVI), and carotid-femoral pulse wave velocity (PWV).

Results:
Data were collected from 561 study participants (mean age, 65.0 ± 10.8 years; men, 61.3%). Morning and evening home BP values were slightly higher than the daytime and nighttime ABP values (difference for systolic morning-daytime/evening-nighttime, 7.3 ± 14.2/11.3 ± 18.5 mm Hg, P < .001; for diastolic, 5.4 ± 9.4/7.3 ± 12.1, P < .001). Daytime ambulatory (r = 0.114), nighttime ambulatory (r = 0.130), morning home (r = 0.310), and evening home (r = 0.220) systolic BPs (SBPs) were all associated with LVMI (all P < .05). The correlation coefficient was significantly greater for the relationship between daytime home SBP and LVMI than for the relationship between ambulatory SBP and LVMI (P < .01). The goodness of fit of the association between SBP and LVMI improved by adding home daytime SBP to the other SBPs (P < .001). Similar findings were observed for LAVI, but not for PWV.

Conclusion:
These findings indicate that morning SBP assessed by home monitoring appears to be a better predictor than other BP measures to determine preclinical hypertensive cardiovascular damage in patients with early-stage hypertension.
Readmission of High-Risk Discharged Patients at a Tertiary Hospital in Korea
Authors: Kim Young Man , Lee Taehee , Lee Hyun Joo , Yang You Lee , Oh Eui Geum 
Published: October 2018

ABSTRACT
This study aims to investigate the readmission rates of major disease groups as stated by the Centers for Medicare and Medicaid Services and to identify risk factors related to readmission in Korea. We studied 2,973 patients discharged from a 2,200-bed tertiary referral hospital in South Korea, from April 1, 2016, to March 31, 2017. Using electronic medical records, we calculated the 30-day readmission rates of seven diseases: acute myocardial infarction, chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, stroke, coronary artery bypass graft (CABG), and total hip arthroplasty/total knee arthroplasty. We used Cox proportional hazards regression analysis to identify risk factors affecting readmission in this retrospective, observational study. For 2,973 consecutively discharged patients, the 30-day unplanned readmission rate was 10.3%. The readmission rate of HF (19.0%) was the highest, followed by pneumonia (13.7%), CABG (12.0%), and COPD (10.5%). Factors associated with readmission were polypharmacy (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.60–2.64), hospitalization history in the previous 6 months (HR: 1.81; 95% CI: 1.41–2.32), and comorbidity (HR: 1.16; 95% CI: 1.11–1.23). Therefore, the discharge intervention program for high-risk discharge patients with polypharmacy, admission history, and comorbidity should include medication reconciliation.
Correlation of tumor uptake on breast-specific gamma imaging and fluorodeoxyglucose PET/CT with molecular subtypes of breast cancer
Authors: Lee Soo Jin , Chung Min Sung , Shin Su-Jin , Choi Yun Young 
Published: October 2018

Abstract
Mechanisms of technetium-99m sesta-methoxyisobutylisonitrile (sestamibi) and 18F-fluorodeoxyglucose (FDG) uptake by tumor are different. The purpose of this study was to investigate the association between the tumor uptake of these 2 tracers in invasive ductal carcinoma and to examine thecorrelation of uptake of each tracer with prognostic factors and tumor molecular subtypes.
A total of 96 patients with invasive ductal carcinoma who underwent preoperative breast-specific gamma imaging and FDG positron-emission tomography/computed tomography were retrospectively enrolled. Tumor-to-background ratio (TBR) of sestamibi and maximum standardized uptake value (SUVmax) of FDG were correlated with each other. Each of them was then compared with prognostic factors and molecular subtypes.
In all tumors, there was a moderate positive correlation between TBR and SUVmax (r = 0.520, P < .001). Both TBR and SUVmax were significantly correlated with tumor size, incidence of axillary lymph node metastasis, histologic grade, estrogen receptor, progesterone receptor status, and Ki-67.
There is a moderate degree of association between TBR of sestamibi and SUVmax of FDG in the invasive breast cancer. Two imaging indexes showed the similar tendency related with prognostic factors and molecular subtypes. While both TBR and SUVmax were significantly different between luminal A and nonluminal A tumors, neither of them had high enough sensitivity or specificity to obviate pathologic and molecular diagnosis.
Efficacy and safety of empagliflozin for type 2 diabetes mellitus
Authors: Zhang Yun-Jing , Han Shi-Liang , Sun Xi-Feng , Wang Shu-Xiang , Wang Hong-Yun , Liu Xiao , Chen Li , Xia Ling 
Published: October 2018

Abstract

Background:
This study was designed to evaluate the efficiency and tolerability of empagliflozin (EMPA) as monotherapy or add-on to existing therapy in patients with type 2 diabetes mellitus (T2DM).

Methods:
Randomized controlled trials (RCTs) comparing efficacy and safety of EMPA vs placebo or EMPA plus other antidiabetes drugs vs placebo plus other oral antidiabetes drugs (OADs) in T2DM were recruited from electronic database Pubmed, Web of Knowledge, and Cochrane Central Register of Controlled Trials (CENTRAL), supplemented by a hand search of the reference lists of selected articles. Main effect sizes were change from baseline on glycemia control, body weight, blood pressure, and complications (i.e., incidence of urinary and genital tract infections, and morbidity of hypoglycemia and hyperglycemia). Random-effects model was used to account for clinical or methodologic heterogeneity across studies.

Results:
Fifteen RCTs with a total number of 7891 individuals (5374 in EMPA group and 2517 in control group) were suitable for this meta-analysis. The results demonstrated that significant improvements in glycemia control, body weight, and blood pressure were associated with EMPA application (i.e., monotherapy and add-on therapy) in patient with T2DM when compared with placebo. Meanwhile, EMPA 10 and 20 mg improved glycemia, body weight, and blood pressure control for patients with T2DM. There was no significant difference in incidence of hypoglycemia and urinary tract infections across EMPA and placebo group. Significant reduced risk of hyperglycemia was revealed in EMPA group vs placebo (risk ratio: 0.34, 95%confidence interval: 0.23–0.49, P < .00001), except in patients on background insulin therapy. However, increased risk of genital infection was noted across EMPA vs placebo (risk ratio: 2.59, 95% confidence interval: 1.80–3.71, P < .00001).

Conclusion:
Our evidence supports the application of EMPA in treatment of patients with T2DM who are obesity or at risk of weight gain.
The value of magnetic resonance imaging to diagnose pathological complete response of rectal cancer after therapy
Authors: Zhang Mei , Li Jipin , Ma Xueni , Wang Bo , Wu Jiarui , Gao Ya , Tian Jinhui , Wang Jiancheng 
Published: October 2018

Abstract

Background:
Although the trends of colorectal incidence rate and mortality have decreased during the past 20 years, however, they are still high. Neoadjuvant chemoradiotherapy is recommended as the standard treatment strategy of local advanced rectal cancer followed by surgery and adjuvant therapy. Predicting pathological complete response (pCR) accurately is relative to the next treatment strategy to avoid extensive therapy. And there are more and more physicians who would like to choose pelvic MRI imaging to evaluate the state of rectal cancer. Therefore, our analysis will aim to assess the value of MRI to predict pCR of rectal cancer after therapy and distinguish which sequence and magnetic strength is the best one to diagnose pCR.

Methods:
Comprehensive computer-based search will be performed using the PubMed, EMBASE, Cochrane Library, and CBM database (last updated in April 2018), 2 reviewers will extract the related information respectively. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and the area under the hierarchical summary receiver-operating characteristic curves will be calculated to estimate the diagnostic accuracy of different sequences and intensities of magnetic resonance imaging. Methodological quality will be assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.

Results:
The results of this analysis will be submitted to a peer-reviewed journal for publication.

Conclusion:
The ability of different MRI sequences and magnetic intensities to identify pCR will be evaluated and the best one to diagnose pCR of rectal cancer after therapy will be recommended.

Ethics and dissemination:
Ethics approval and patient consent are not required, as this study is a meta-analysis based on published studies.

PROSPERO registration number:
CRD42018105672.
Relationship between the IADPSG-criteria-defined abnormal glucose values and adverse pregnancy outcomes among women having gestational diabetes mellitus
Authors: Ding Ting-ting , Xiang Jie , Luo Bi-ru , Hu Juan 
Published: October 2018

AbstractTo explore the influence of the 75 g oral glucose tolerance test (OGTT) on pregnancy outcomes and to determine the risk factors for adverse outcomes among women with gestational diabetes mellitus (GDM).This retrospective cohort study was conducted among women who had GDM and were treated between January 1, 2015 and December 31, 2017. The diagnostic criteria for GDM were proposed by the International Diabetes and Pregnancy Research Organization (IADPSG) in 2010. Women with GDM were stratified according to the number of abnormal OGTT values or the presence/absence of adverse pregnancy outcomes. Maternal characteristics, OGTT values, pregnancy outcomes, and the relationship between the latter 2 were analyzed.In total, 3221 pregnant women with GDM were included. The incidence of adverse outcomes was affected by maternal age (28–37 years, in particular; odds ratio [OR], 1.403; 95% confidence interval [CI], 1.037–1.899;P = .028), days of pregnancy (OR, 0.904; 95% CI, 0.894–0.914;P < .001), gestational weight gain (OR, 1.018; 95% CI, 1.000–1.036;,P = .048), and age of menarche (OR, 0.925; 95% CI, 0.863–0.992;P = .029). Both fasting plasma glucose (FPG) and 2-h OGTT were positively correlated with adverse outcomes, of which FPG was more predictive (FPG: OR, 1.143; 95% CI, 1.007–1.297;P = .038; 2-h OGTT: OR, 1.074; 95% CI, 1.018–1.133;P = .009). Meanwhile, higher abnormal OGTT values were associated with significantly increased risks of antenatal insulin treatment, cesarean delivery, premature delivery, gestational hypertension, premature rupture of membranes, preeclampsia, macrosomia, neonatal asphyxia, and full term low weight infants.OGTT values and the number of abnormal glucose are associated with various adverse pregnancy outcomes. Stratified management is recommended for pregnant women with GDM, especially those with fasting hyperglycemia and/or 3 abnormal OGTT values.
Urinary β2-microglobulin as an early marker of infantile enterovirus and human parechovirus infections
Authors: Azuma Junji , Yamamoto Takehisa , Sakurai Mihoko , Amou Ryuko , Yamada Chieko , Hashimoto Kazuhisa , Kajita Satomi , Yamamoto Kyoko , Kijima Eri , Mizoguchi Yoshimi , Nakata Keiko , Shimotsuji Tunesuke , Ozono Keiichi 
Published: October 2018

Abstract
Enterovirus and human parechovirus (HPeV) are RNA viruses belonging to the family Picornaviridae that frequently infect infants. These infections show a wide variety of clinical manifestations, from mild to severe. However, there are no known early clinical markers for diagnosis and prediction of disease severity. The aim of this study was to examine the clinical utility of urinary beta 2-microglobulin (β2MG) for the early detection and prognosis of infantile enterovirus and HPeV infections.
This retrospective study included 108 full-term infants younger than 60 days of age, including 15 with enterovirus or HPeV-3 (enterovirus/HPeV-3), 22 with respiratory syncytial virus (RSV), and 24 with bacterial infections. Laboratory data and clinical characteristics were compared among these 3 groups. Of the 15 patients with enterovirus/HPeV-3, 6 were treated with intravenous immunoglobulin (IVIG subgroup) because of severe clinical conditions.
Urinary β2MG to creatinine ratio (β2MG/Cr) was significantly higher in the enterovirus/HPeV-3 group compared to bacterial and RSV infection groups (both P < .001). In the enterovirus/HPeV-3 group, mean peak urinary β2MG/Cr was observed on day 1 or 2. Urinary β2MG/Cr values were significantly higher in the IVIG subgroup than the non-IVIG subgroup (P < .001).
Increased urinary β2MG/Cr in early-stage infection may be a useful clinical marker for the detection and prediction of infantile enterovirus and HPeV infection severity.
Periclitoral accessory breast tissue in a lactating woman
Authors: Song Yanlin , Zhang Jing , Liu Zhiyong , Fan Yimeng , Luo Min , Wei Yuquan , Zhang Yange , Xu Xuewen 
Published: October 2018

Abstract

Rationale:
The accessory breast is residual mammal tissue which does not regress during the embryonic development. The accessory breast is so rare that it is easily ignored in diagnosis of disease.

Patient concerns:
We report a 29-year-old lactating woman presented with complaints of periclitoral lesions without any pain or discomfort.

Diagnoses:
Periclitoral accessory breast tissue.

Interventions:
We performed wide local resection of the lesions. Pathologic examination confirmed the lesions were ectopic breast tissues with secretory changes. The patient was followed up for 3 months and she was totally recovered.

Lessons:
Accessory breast tissue should be considered as a diagnosis when a mass grow fast on the milk line, especially the masses changes obviously with sex hormones according to the clinical findings.
Solitary thin-walled cystic lung cancer with extensive extrapulmonary metastasis
Authors: Wang Xiang , Tao Yun-Xia , Zhang Miao , Wu Wen-Bin , Yang Dun-Peng , Wang Min 
Published: October 2018

Abstract

Rationale:
Asymptomatic, isolated, and thin-walled cystic lung cancer with extensive extrapulmonary metastasis is rare, and the risk of pulmonary cyst developing into lung cancer is poorly understood. The efficacy of apatinib for end-stage pulmonary adenosquamous carcinoma has not been clarified yet.

Patient concerns:
We herein report a rare case of primary lung cancer that appeared as an isolated thin-walled cystic lesion on computed tomography (CT) image, who was initially misdiagnosed as having pulmonary cyst empirically.

Diagnoses:
Fluorine-18-fluorodeoxyglucose-positron emission tomography and CT-guided liver biopsy of the patient revealed extra-pulmonary metastasis of lung cancer.

Interventions:
Eight cycles of cisplatin-based chemotherapy were administered, followed by oral apatinib for 6 months. Thereafter, best supportive care was given for this patient.

Outcomes:
The pulmonary cystic lesion indicated stable disease through the therapy, but the hepatic tumors were progressed gradually after anticancer treatment. The patient died 16 months after the correct diagnosis.

Lessons:
Solitary thin-walled cystic lung cancer should be kept in mind during the differential diagnosis of pulmonary cavitary lesions. Chest CT alone is insufficient for surveillance of these cystic diseases. Timely biopsy and resection are essential to avoid delayed management. Besides, apatinib may play a role in the treatment of end-stage pulmonary adenosquamous carcinoma.
Prognostic value of osteopontin in patients with hepatocellular carcinoma
Authors: Sun Tingting , Li Peng , Sun Diwen , Bu Qingao , Li Guoqiang 
Published: October 2018

Abstract

Purpose:
The prognostic value of tissue and serum osteopontin (OPN) in hepatocellular carcinoma (HCC) remain controversial. The aim of present meta-analysis was to evaluate the prognostic value of OPN in patients with HCC.

Methods:
Eligible studies were systematically searched by PubMed, EMBASE, and Google scholar. A meta-analysis of 12 studies included 2117 cases was performed to estimate the association between OPN level and overall survival (OS), disease-free survival (DFS) in HCC patients. Subgroup analyses were also performed in the meta-analysis.

Results:
The pooled data of studies showed that high OPN level was significantly associated with poor OS (hazard ratios [HR] 1.84; 95% confidence intervals [CI] 1.54–2.20; P
= .000) and DFS (HR 1.67; 95% CI 1.40–1.98; P
= .000) in HCC. Furthermore, in subgroup analysis, high tissue based OPN by immunohistochemistry detection and serum-based OPN by enzyme-linked immunosorbent assay (ELISA) detection were both significantly associated with OS (tissue: HR 1.88; 95% CI 1.53–2.31; P < .0001; serum: HR 2.38; 95% CI 1.58–3.59; P < .0001). Simultaneously, we also found that OPN expression was positively associated with stage (odds ratios [OR] 5.68; 95% CI 3.443–7.758), tumor size (Size≤5 cm vs >5 cm; OR 2.001; 95% CI1.036–3.867).

Conclusion:
The current evidence indicates that OPN could serve as a prognostic biomarker and a potential therapeutic target for HCC.
Changes in background parenchymal enhancement in HER2-positive breast cancer before and after neoadjuvant chemotherapy
Authors: Dong Jing-Min , Wang Hong-Xia , Zhong Xiao-Fei , Xu Kun , Bian Jia , Feng Yan , Chen Liang , Zhang Lin , Wang Xia , Ma De-Jing , Wang Bin 
Published: October 2018

Abstract
This study aimed to analyze the relationship between pathologic complete response (pCR) and changes in background parenchymal enhancement (BPE) levels in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and who received neoadjuvant chemotherapy (NAC).
The pre- and post-NAC magnetic resonance imaging results of 51 patients with confirmed unilateral HER2-positive breast cancer were retrospectively analyzed by 2 experienced radiologists. Pre- and post-NAC of contralateral BPE levels were classified into 4 categories (1 = minimal, 2 = mild, 3 = moderate, and 4 = marked). The 4 categories of BPE were defined by the visually estimated enhancement of fibroglandular tissue of the breast. Changes in BPE before and after NAC were compared between the premenopausal and postmenopausal groups and between the pCR and non-pCR groups. The associations between BPE and pCR and between BPE and tumor size were analyzed before and after NAC.
Twenty-three patients achieved pCR, and 28 patients achieved non-pCR. Premenopausal patients had significantly higher baseline BPE levels than postmenopausal women (P = .023). The post-NAC BPE levels of premenopausal patients significantly decreased relative to those of postmenopausal patients (P = .027). The baseline BPE levels of the pCR group were not significantly different from those of the non-pCR group (P = .892). However, the decrease in BPE levels in the pCR group was more drastic than that in the non-pCR group (P < .001). Decreased BPE levels were directly associated with pCR and tumor size reduction (P < .05). Women with hormone receptor (HR)-negative tumors were more likely to exhibit pCR than those with HR-positive tumors (P = .007).
Decreased BPE of patients with HER2-positive breast cancer may serve as an indicator of NAC effectiveness. Furthermore, women with HR-negative tumors were more likely to exhibit pCR than women with HR-positive tumors.