bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tibial tubercle avulsion fracture according to different mechanisms of injury in adolescents
Authors: Shin Yong-Woon , Kim Dae-Wook , Park Kun-Bo 
Published: August 2019

Abstract
Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.
Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.
There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients’ BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.
Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.
Expression of CD133 is associated with poor prognosis in stage II colorectal carcinoma
Authors: Park Youn Young , An Chang Hyeok , Oh Seong Taek , Chang Eun Deock , Lee Jaeim 
Published: August 2019

AbstractCD133 is currently believed to be one of the best colorectal cancer stem cell markers. This study aimed to evaluate prognostic significance of CD133 expression in colorectal cancer patients.A total of 303 patients with stage I to III colorectal cancer who underwent curative surgical resection from 2003 to 2008 at a single institution were included. CD133 expression was evaluated using immunohistochemical staining, and clinicopathological data were retrospectively reviewed. The patients were dichotomized after scoring CD133 expression (0 to 2+: low CD133 expression vs 3+ to 4+: high CD133 expression) according to the extent of area of CD133 positive tumor cells (<50% vs ≥50%) and pattern of staining (membranous staining of the luminal surface and/or staining of cellular debris in the tumor glands and cytoplasm).The 5-year overall survival (OS) (61.9% vs 80.2%,P = .001) and disease-free survival (64.8% vs 75.8%,P = .026) were poorer in the high CD133 expression group than the low CD133 expression group. In the multivariate analysis for risk factors of OS in the whole population, higher nodal stage (N2 compared to N0: hazard ratio [HR] 3.141; 95% confidence interval [CI] 1.718–5.744,P < .001), perineural invasion (HR 2.262; 95% CI 1.347–3.798,P = .002) and high CD133 expression (HR 1.929; 95% CI 1.221–3.048,P = .005) were independent poor prognostic factors of OS. Subgroup analyses according to each TNM stage revealed that CD133 expression was associated with OS only within the stage II patients (HR 3.167 95% CI 1.221–8.216,P = .018). Furthermore, the stage II patients demonstrating the high CD133 expression showed survival benefit of adjuvant chemotherapy, regardless of high-risk feature positivity (HR 0.201 95% CI 0.054–0.750,P = .017).High CD133 expression is correlated with poor prognosis in colorectal cancer patients after radical resection. The CD133 expression may serve as a more potent and informative biomarker for prognosis than conventional high-risk features in the stage II colorectal cancer patients.
Diagnostic accuracy of serum dickkopf-1 protein in diagnosis hepatocellular carcinoma
Authors: Li Zhenjie , Mou Lisha , Gao Haibin , Zeng Yi , Tang Xueyi , Deng Xuesong , Pu Zuhui , Ni Yong , Zhan Yongqiang 
Published: August 2019

Abstract

Background:
To verify the accuracy of serum dickkopf-1 protein (DKK-1) in the diagnosis of hepatocellular carcinoma (HCC) by an updated meta-analysis.

Methods:
We searched potential eligible studies in PubMed and Embase before July 8, 2018. Sensitivity (SN), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), summary receiver operating characteristics curve (sROC), and diagnostic odds ratio (DOR) were pooled with their 95% confidence intervals CIs) using a bivariate random-effects model.

Results:
A total of 8 articles contained 10 studies on diagnosis of HCC with DKK-1 alone,7 articles contained 9 studies on diagnosis of HCC with a-fetoprotein (AFP) alone and 5 articles contained 7 studies on diagnosis of HCC with DKK-1 + AFP were identified. The pooled SN, SP, PLR, NLR, and DOR of DKK-1 alone, AFP alone and DKK-1 + AFP were 0.72 (95% CI: 0.70–0.75), 0.62 (95% CI:0.59–0.64) and 0.80 (95% CI:0.78–0.83), 0.86 (95% CI: 0.84–0.87), 0.82 (95% CI:0.80–0.84) and 0.87 (95% CI: 0.85–0.88), 4.91 (95% CI: 2.73–8.83), 3.60 (95% CI:2.01–6.44) and 6.18 (95% CI: 4.68–8.16), 0.32 (95% CI: 0.22–0.47), 0.49 (95% CI:0.40–0.60) and 0.20 (95% CI: 0.15–0.26), and 17.21 (95% CI: 9.10–32.57), 7.45 (95% CI:3.69–15.01) and 31.39 (95% CI: 23.59–43.20), respectively. The area under the sROC was 0.88, 0.70, and 0.92 for the 3 diagnostic methods.

Conclusions:
Serum DKK-1 + AFP showed a high accuracy for diagnosis of HCC, and serum DKK-1 alone had moderate accuracy as compared to a previous meta-analysis, while AFP alone owned an unsatisfied diagnostic behavior for HCC. Due to the limitations of the current analysis, further well-designed studies are needed to confirm the diagnostic value of DKK-1 and DKK-1 + AFP in HCC diagnosis.
Minimally invasive pancreatoduodenectomy is associated with lower morbidity compared to open pancreatoduodenectomy
Authors: Yan Jia-fei , Pan Yu , Chen Ke , Zhu He-pan , Chen Qi-long 
Published: August 2019

Abstract

Background:
Minimally invasive pancreatoduodenectomy (MIPD) is being increasingly performed as an alternative to open pancreatoduodenectomy (OPD) in selected patients. Our study aimed to present a meta-analysis of the high-quality studies conducted that compared MIPD to OPD performed for pancreatic head and periampullary diseases.

Methods:
A systematic review of the available literature was performed to identify those studies conducted that compared MIPD to OPD. Here, all randomized controlled trials identified were included, while the selection of high-quality, nonrandomized comparative studies were based on a validated tool (i.e., Methodological Index for Nonrandomized Studies). Intraoperative outcomes, postoperative recovery, oncologic clearance, and postoperative complications were also evaluated.

Results:
Sixteen studies matched the selection criteria, including a total of 3168 patients (32.1% MIPD, 67.9% OPD). The pooled data showed that MIPD was associated with a longer operative time (weighted mean difference [WMD] = 80.89 minutes, 95% confidence interval [CI]: 39.74–122.05, P < .01), less blood loss (WMD = −227.62 mL, 95% CI: −305.48 to −149.75, P < .01), shorter hospital stay (WMD = −4.68 days, 95% CI: −5.52 to −3.84, P < .01), and an increase in retrieved lymph nodes (WMD = 1.85, 95% CI: 1.33–2.37, P < .01). Furthermore, the overall morbidity was significantly lower in the MIPD group (OR = 0.67, 95% CI: 0.54–0.82, P < .01), as were total postoperative pancreatic fistula (POPF) (OR = 0.79, 95% CI: 0.63–0.99, P = .04), delayed gastric emptying (DGE) (OR = 0.71, 95% CI: 0.52–0.96, P = .02), and wound infection (OR = 0.56, 95% CI: 0.39–0.79, P < .01). However, there were no statistically significant differences observed in major complications, clinically significant POPFs, reoperation rate, and mortality.

Conclusion:
Our study suggests that MIPD is a safe alternative to OPD, as it is associated with less blood loss and better postoperative recovery in terms of the overall postoperative complications as well as POPF, DGE, and wound infection. Methodologic high-quality comparative studies are required for further evaluation.
Clinical manifestation of pediatric mediastinal tumors, a single center experience
Authors: Chen Chieh-Ho , Wu Kang-Hsi , Chao Yu-Hua , Weng De-Fu , Chang Jeng-Sheng , Lin Chien-Heng 
Published: August 2019

Abstract
Medical decisions should be well-planned to improve prognosis and reduce complications of mediastinal tumors. In this study, we analyzed the clinical presentations of pediatric mediastinal tumors and their correlation with long-term clinical outcome.
Forty patients under 18 years of age diagnosed with mediastinal tumors at China Medical University Children's Hospital between 2001 and 2016 were enrolled. The patients’ sex, age of onset, initial clinical symptoms, and treatment outcomes were analyzed.
75% of the patients with mediastinal tumors in this study were men, and the median age of onset was 13 years old (age range: 0–17 years). The overall mortality rate was 40%. The most common tumors were lymphoma (47.5%), followed by germ cell tumors (12.5%), neuroblastoma (12.5%), and thymoma (7.5%). Neuroblastoma was more prevalent in girls younger than 5 years old. The initial presentations of these patients included breathing difficulty (65%), productive cough (47.5%), pleural effusion (54.5%), superior vena cava (SVC) syndrome (35%), neck mass (35%), airway compression (32.5%), fever (30%), chest pain (27.5%), and pericardial effusion (25%). Lymphomas were more likely to be accompanied by neck mass (52.6% vs19.0%, P = .04) and SVC syndrome (52.6% vs 19.0%, P = .026), yet also had a better 1-year-survival rate (68.4% vs 52.4%, P = .02).
Overall, lymphoma should be suspected when children present with neck mass and SVC syndrome. Neuroblastoma with a posterior mediastinal origin should be suspected among children younger than 5 years old. Tumor-related airway obstruction, pleural effusion, and pericardial effusion were leading cause of cardiopulmonary instability during sedation for invasive procedures, which should be managed cautiously.
The incidence and risk factors for surgical site infection in older adults after gastric cancer surgery
Authors: Kim Jung Ho , Kim Jinnam , Lee Woon Ji , Seong Hye , Choi Heun , Ahn Jin Young , Jeong Su Jin , Ku Nam Su , Son Taeil , Kim Hyoung-Il , Han Sang Hoon , Choi Jun Yong , Kim Chang Oh , Yeom Joon-Sup , Hyung Woo Jin , Song Young Goo , Noh Sung Hoon , Kim June Myung 
Published: August 2019

Abstract
Surgical site infection (SSI) is a well-known complication in older adults. However, there have been no studies on SSI after gastrectomy in older adults. Therefore, we aimed to investigate the incidence, risk factors, and outcomes of SSIs after gastrectomy in older adults.
We performed a retrospective cohort study of older adults, aged 65 years or older, who underwent gastrectomy between January 2015 and December 2015 at the Severance Hospital in Seoul, Korea. The incidence and outcomes of SSIs after gastrectomy were evaluated, and the risk factors for SSI were identified using multivariate analyses.
We identified 353 older adults who underwent gastrectomy. Of these, 25 patients (7.1%) developed an SSI. Multivariate analysis indicated that open surgery (odds ratio, 2.71; 95% confidence interval, 1.13–6.51; P = .03) and a longer operation time (odds ratio, 1.01; 95% confidence interval, 1.00–1.01; P = .04) were independent risk factors for SSI after gastrectomy. In the SSI group, the incidence of postoperative fever (84.0% vs 51.8%; P < .001), length of postoperative hospital stay (13 days vs 6 days; P < .001), and re-admission rates within 30 days postoperatively (32.0% vs 3.4%; P < .001) were significantly higher than those in the non-SSI group.
The risk factors for SSI in older adults after gastrectomy were open surgery and a longer operation time. When an SSI occurred, the postoperative hospital stay was prolonged and the chances of having a postoperative fever and being re-admitted within 30 days increased.
Mapping the knowledge structure and trends of epilepsy genetics over the past decade
Authors: Gan Jing , Cai Qianyun , Galer Peter , Ma Dan , Chen Xiaolu , Huang Jichong , Bao Shan , Luo Rong 
Published: August 2019

Abstract

Introduction:
Over the past 10 years, epilepsy genetics has made dramatic progress. This study aimed to analyze the knowledge structure and the advancement of epilepsy genetics over the past decade based on co-word analysis of medical subject headings (MeSH) terms.

Methods:
Scientific publications focusing on epilepsy genetics from the PubMed database (January 2009–December 2018) were retrieved. Bibliometric information was analyzed quantitatively using Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) software. A knowledge social network analysis and publication trend based on the high-frequency MeSH terms was built using VOSviewer.

Results:
According to the search strategy, a total of 5185 papers were included. Among all the extracted MeSH terms, 86 high-frequency MeSH terms were identified. Hot spots were clustered into 5 categories including: “ion channel diseases,” “beyond ion channel diseases,” “experimental research & epigenetics,” “single nucleotide polymorphism & pharmacogenetics,” and “genetic techniques”. “Epilepsy,” “mutation,” and “seizures,” were located at the center of the knowledge network. “Ion channel diseases” are typically in the most prominent position of epilepsy genetics research. “Beyond ion channel diseases” and “genetic techniques,” however, have gradually grown into research cores and trends, such as “intellectual disability,” “infantile spasms,” “phenotype,” “exome,” “ deoxyribonucleic acid (DNA) copy number variations,” and “application of next-generation sequencing.” While ion channel genes such as “SCN1A,” “KCNQ2,” “SCN2A,” “SCN8A” accounted for nearly half of epilepsy genes in MeSH terms, a number of additional beyond ion channel genes like “CDKL5,” “STXBP1,” “PCDH19,” “PRRT2,” “LGI1,” “ALDH7A1,” “MECP2,” “EPM2A,” “ARX,” “SLC2A1,” and more were becoming increasingly popular. In contrast, gene therapies, treatment outcome, and genotype-phenotype correlations were still in their early stages of research.

Conclusion:
This co-word analysis provides an overview of epilepsy genetics research over the past decade. The 5 research categories display publication hot spots and trends in epilepsy genetics research which could consequently supply some direction for geneticists and epileptologists when launching new projects.
Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients
Authors: Zhu Chao , Yin Jian , Wang Bin , Xue Qingmei , Gao Shan , Xing Linyu , Wang Hua , Liu Wei , Liu Xinhui 
Published: August 2019

AbstractBackground:Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery.Methods:Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I2test. Both Begg and Egger tests were used to assess potential publication bias.Results:We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion (P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome (P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents (P <.05).Conclusion:In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.
Similar effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on depressive disorder in heart failure patients
Authors: Abdelbasset Walid Kamal , Alqahtani Bader A. , Alrawaili Saud M. , Ahmed Ahmed S. , Elnegamy Tamer E. , Ibrahim Ahmed A. , Soliman Gaber S. 
Published: August 2019

Abstract

Background:
Heart failure related depression is recently increased worldwide. Heart failure (HF) disease is identified as a critical cause of increasing morbidity, hospital readmission, and mortality. The most important purpose of treatment of HF disease is to relief disease problems, improve functional performance, and achieve better quality of life.

Objectives:
This study was proposed to evaluate the effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on the level of depressive disorder in heart failure patients.

Study design:
12-week randomized controlled trial.

Methods:
Sixty nine HF patients with mild to moderate level of depression and ejection fraction <40% were examined before and after 12-week intervention. Their age was ranged from 40 to 60 years. Patients were randomly classified into 3 groups. Group I (n = 23) received low to moderate intensity exercise program (LMIEP), group II (n = 23) received moderate-intensity exercise program (MICEP), and group III (n = 23) did not receive any exercise program (Non-exercised group). All patients were instructed to conduct home-based exercise with their pharmacological therapy. The level of depression was evaluated before and after 12 weeks of the intervention program.

Results:
The 3 study groups were associated with significant decrease of depression level (P < .05). Significant differences were exhibited between the 3 groups in favor to both exercise programs (P < .05) with non-significant differences between the 2 exercise programs (P > .05).

Conclusions:
Both exercise programs had positive effects in reducing the severity of depression in HF patients. Low to moderate and moderate-intensity exercise programs should be proposed for depression illness specially patients with heart failure.
Childhood obesity leads to adult type 2 diabetes and coronary artery diseases
Authors: Fang Xuqian , Zuo Junli , Zhou Jingqi , Cai Jialin , Chen Changqiang , Xiang Enfei , Li Haibo , Cheng Xiaoyan , Chen Peizhan 
Published: August 2019

Abstract
Observational studies have reported that childhood obesity is positively associated with risks of type 2 diabetes (T2D) and coronary artery disease (CAD) in adults; however, whether this association is causal is still unclear. In the present study, we conducted the 2-sample Mendelian randomization (MR) studies to investigate whether childhood obesity is causally associated with T2D and CAD in adults.
Seven single-nucleotide polymorphisms (SNPs) that significantly associated with childhood obesity were used as instrumental variables. The 2-sample MR analyses were performed with the summary-level data of large-sample genome-wide association studies to evaluate the causal effects of childhood obesity on adult T2D and CAD and the levels of cardiometabolic traits.
The 2-sample MR analyses suggested that each 1-unit increase in the log-odds of having childhood obesity was causally associated with an increased risk of adult T2D (odds ratio [OR] = 1.16, 95% confidential interval [CI] = 1.06–1.28; P = 1.0 × 10–3) and CAD (OR = 1.07, 95% CI = 1.02–1.12; P = 4.0 × 10–3) based on the inverse-variance weighted method. The MR analyses also suggested that childhood obesity was positively associated with the levels of adult body mass index, waist circumference, hip circumference, waist and hip ratio, log-transformed fasting glucose, log-transformed homeostatic model assessment (HOMA) of insulin resistance (%), and triglycerides. The childhood obesity was negatively associated with the adult high-density lipoprotein cholesterol level; however, there was no evidence of a causal association between childhood obesity and the levels of fasting glucose, 2-hour glucose, HbA1c (%), log-transformed HOMA of ß-cell function (%), low-density lipoprotein cholesterol, or total cholesterol in adults.
In conclusion, a genetic predisposition to childhood obesity was associated with an increased risk of adult T2D and CAD, providing causal relations between childhood obesity and the risks of T2D and CAD in adults; however, the results need to be validated with larger-scale intervention studies.
Auxiliary living donor liver transplantation combined with two-stage hepatectomy for unresectable colorectal liver metastases
Authors: Nadalin Silvio , Königsrainer Alfred , Capobianco Ivan , Settmacher Utz , Rauchfuss Falk 
Published: August 2019

Purpose of review
To review the role of liver transplantation for unresectable colorectal liver metastases (u-CRLM) and to describe the intial experience with auxiliary living donor liver transplantation combined with two-stage hepatectomy for u-CRLM (i.e. living donor RAPID).

Recent findings
Patients affected with u-CRLM have a poor prognosis with 5 years overall survival (OS) rate less than 10% under standard modern chemotherapy.There is an actual international consensus that liver transplantation for u-CRLM represents a viable option in highly selected patients with OS rate at 5 years up to 80% notwithstanding high recurrence rates. Due to the scarcity of whole liver graft from deceased donors, the RAPID procedure (i.e. resection and partial liver segment 2–3 transplantation from deceased donors with delayed total hepatectomy) has been introduced as possible alternative. The RAPID procedure represents the most actual and modern fusion of the two most challenging procedures of modern hepatobiliary and liver transplant surgery: that is auxiliary partial orthotopic liver transplantation and associating liver partition and portal vein ligation for staged hepatectomy. Although the deceased donor-RAPID procedure may show promising results, the basic problem of scarcity of organs from deceased donors and mainly the lack of splittable organs still remains.

Summary
The living donor RAPID, based on transplantation of left lateral segments from living donor, may represent the way out to this problem. It is feasible and safe (for both donor and recipient), but characterized by a very challenging high-end transplantological procedure.