bluuebunny/crossref_metadata_2025_split huggingface dataset:
Curative-intent radiotherapy in patients with oligometastatic lesions from colorectal cancer
Authors: He Xiaofeng , Zhang Pengfei , Li Zhiping , Bi Feng , Xu Feng , Wang Xin , Shen Yali , Li Qiu , Qiu Meng 
Published: October 2018

AbstractThe purpose of the present study was to investigate the efficacy and safety of radiotherapy for patients with oligometastases from colorectal cancer (CRC).This was a retrospective cross-sectional study. Patients with liver and/or lung oligometastatic lesions from CRC treated with curative-intent radiotherapy in West China Hospital, Sichuan University, between 2009 and 2013 were included. Radiotherapy modality included 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and stereotactic body radiation therapy (SBRT); simultaneous chemotherapies along with radiotherapy of metastasis were allowed. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan–Meier method. Local control (LC) rates, toxicities, and factors of prognostic significance were also assessed.A total of 40 CRC patients with 57 liver and/or lung oligometastatic lesions were included. Most of the patients (95%) had received at least 1 line of previous systemic chemotherapy. Among them, 19 patients with 26 lesions received 3D-CRT with a median dose of 51.5 Gy in 16.1 fractions, 7 patients with 11 lesions received IMRT with a median dose of 49.3 Gy in 10.4 fractions, and 14 patients with 20 lesions received SBRT with a median dose of 56.4 Gy in 6.7 fractions, respectively. The median follow-up time was 34 months (range, 9–86 months). Median OS and PFS for patients were 30.0 months [95% confidence interval (95% CI), 21.3–38.7] and 11.0 months (95% CI, 9–13), respectively. One, 3, and 5 years’ LC rates for metastasis were 63.2%, 24.6%, and 16.9%, respectively. In subgroup analysis, patients with metachronous metastases had longer OS (median, 41.0 months; 95% CI, 33.3–48.7) than patients with synchronous lesions (median, 17.0 months; 95% CI, 7.4–26.6,P = .001). All patients tolerated the radiation treatment well, and there was no treatment-related death. Multivariate analysis showed that number of metastasis lesions and simultaneous liver and lung metastases were potential survival predictors.The study demonstrated that curative radiotherapy might be a tolerable and potential alternative for the treatment of patients with liver and/or lung oligometastases from CRC, and patients with metachronous lesions might have better survival than those with synchronous lesions when treated with curative-intent radiotherapy.
Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome
Authors: Liu Jianlin , Quan Jianjun , Li Yanzi , Wu Yue , Yang Lin 
Published: October 2018

Abstract
The Global Registry of Acute Coronary Events (GRACE) risk score independently predicts major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). This study aims to evaluate whether the level of plasma homocysteine in addition to the GRACE score enhances the predictive value for MACEs in patients with acute coronary syndrome.
A total of 361 patients with ACS evaluated at our hospital were included in the study and tested for blood homocysteine levels. We recorded 40 (11.1%) instances of MACE during a median follow-up of 43.3 months (quartile 40.6–44.4 months), including 29 cases (8.0%) of all-cause death and 11 cases (3.1%) of nonfatal myocardial infarction.
The GRACE score was significantly associated with homocysteine levels, and multivariate Cox regression analysis showed that both the GRACE risk score and homocysteine content were independent predictors of MACEs (HR 2.63; 95% confidence interval (CI) 1.54 to 4.49; P < .001 and 2.27; 1.06 to 4.86; P = .035, respectively). Moreover, meta-analysis showed that as the homocysteine level increased, the incidence of MACEs also increased (log-rank 8.41; P = .015). GRACE scores adjusted by homocysteine level increased the area under the curve (AUC) from 0.78 to 0.83 (P = 0.006).
Blood homocysteine levels are significantly associated with the GRACE risk score, and using both parameters can further improve risk stratification in patients with acute coronary syndrome.
Role of qSOFA in predicting mortality of pneumonia
Authors: Jiang Jianjun , Yang Jin , Jin Yongmei , Cao Jiyu , Lu Youjin 
Published: October 2018

Abstract

Background:
The concept of sepsis was redefined recently, and a new screening system termed the quick Sequential Organ Failure Assessment (qSOFA) was recommended for identifying infected patients at high risk for death. However, the predictive value of qSOFA for mortality in patients with pneumonia remains unclear. Thus, we performed a meta-analysis with the aim of determining the prognostic value of qSOFA in predicting mortality in patients with pneumonia.

Methods:
Embase, Google Scholar, and PubMed (up to March 2018) were searched for related articles. We constructed a 2 × 2 contingency table according to mortality and qSOFA scores (<2 and ≥2) in patients with pneumonia. Two investigators independently extracted data and assessed study eligibility. A bivariate meta-analysis model was used to determine the prognostic value of qSOFA in predicting mortality. I
2 index and Q-test were used to assess heterogeneity.

Results:
Six studies with 17,868 patients were included. A qSOFA score ≥2 was related to a higher risk for death in patients with pneumonia, with a pooled risk ratio (RR) was 3.35 (95% CI, 2.24–5.01) using a random-effects model (I
2 = 89.4%). The pooled sensitivity and specificity of a qSOFA score ≥2 to predict mortality in patients with pneumonia were 0.43 (95% CI, 0.33–0.53) and 0.86 (95% CI, 0.76–0.92), respectively. The diagnostic OR was 4 (95% CI, 3–6). The area under the summary receiver operator characteristic (SROC) curve was 0.67 (95% CI, 0.63–0.71). When we calculated the community-acquired pneumonia (CAP) subgroup, the pooled sensitivity and specificity were 0.36 (95% CI, 0.26–0.48) and 0.91 (95% CI, 0.84–0.95), respectively. The area under the SROC curve was 0.70 (95% CI, 0.66–0.74).

Conclusions:
A qSOFA score ≥2 is strongly associated with mortality in patients with pneumonia, but the poor sensitivity of qSOFA may have limitations in the early identification of mortality in patients with pneumonia.
Quantitative evaluation of retinal artery occlusion using optical coherence tomography angiography
Authors: Wang Xiaogang , Sun Bin , Wang Jie , Jia Yali , Huang David , Dong Jing 
Published: October 2018

Abstract

Rationale:
Retinal artery occlusion (RAO) results in painless, catastrophic vision loss in a period of seconds. Optical coherence tomography angiography (OCTA) can image retinal microcirculation, which is helpful to evaluate treatment response during the follow-up period. Using a single case with central RAO, we report its retinal perfusion changes before and after treatment using OCTA.

Patient concerns:
A 36-year-old Chinese man came to our clinic with a sudden, painless loss of vision (hand motion) in his left eye. A vasodilator (nicotinic acid) was used as the primary treatment. OCTA imaging and a visual field examination were performed to assess the retinal perfusion changes before and after treatment.

Diagnosis:
Retinal artery occlusion was considered.

Interventions:
This patient was treated with an inhaled oxygen-carbon dioxide mixture, nicotinic acid tablets (100 mg) taken orally twice a day, and intravenous infusion of nicotinic acid injections (60 mg) combined with 0.9% sodium chloride injections (100 ml) once a day for vasodilation.

Outcomes:
After treatment and 9 months of follow-up, the vessel density of the left eye at the 9-month follow-up appointment was improved in all quadrants.

Lessons:
Retinal edema and retinal atrophy were observed at the RAO onset and several months later, respectively. However, macular perfusion gradually increased after treatment. The timely administration of a vasodilator and the presence of the cilioretinal artery play important roles in the prevention of profound vision loss.
Th17 cells over 5.9% at admission indicate poor prognosis in patients with HBV-related acute-on-chronic liver failure
Authors: Zhang Geng-lin , Zhang Ting , Zhao Qi-yi , Lin Chao-shuang , Gao Zhi-liang 
Published: October 2018

Abstract
Our previous study demonstrated that Th17 cells increased significantly in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). However, their prognostic role in HBV-ACLF patients remains unknown.
Sixty-eight consecutive HBV-ACLF patients were enrolled in this cohort study. Th17 cells were examined using flow cytometry. Disease severity scores were assessed. ROC curves were used to evaluate the value in predicting prognosis. Survival was analyzed using Kaplan–Meier curves. Predictors of mortality were determined by regression analysis.
Th17 cells were significantly higher in HBV-ACLF patients compared to patients with chronic hepatitis B and normal controls (both P < .001). Also, Th17 cells were higher in nonsurviving HBV-ACLF patients than in surviving patients (P = .014). Th17 cells were positively correlated with CLIF-Consortium ACLF (CLIF-C ACLF) score (r = 0.240, P = .048). ROC curves showed that the frequency of Th17 cells had accuracy in predicting 90-day prognosis equivalent to MELD, MELD-Na and CLIF-C ACLF scores in HBV-ACLF (P = .34, P = .26, and P = .15, respectively). More importantly, the area under the ROC curve (AUROC) increased when Th17 cells were combined with MELD, MELD-Na or CLIF-C ACLF score than using Th17 cells alone (P = .021, P = .006, and P = .023, respectively). Kaplan–Meier analysis revealed that higher Th17 cells (≥5.9%) were closely associated with poor overall survival in HBV-ACLF (P = .0086). Additionally, multivariate regression analysis showed that the frequency of Th17 cells over 5.9% was an independent predictor of mortality (OR = 0.154, P = .025).
Circulating Th17 cells positively correlated with disease severity in HBV-ACLF. The frequency of Th17 cells over 5.9% could serve as a prognostic biomarker for HBV-ACLF patients.
Inflammatory myofibroblastic lung tumor transforming into intracranial desmoplastic noninfantile ganglioglioma
Authors: Wei Fu , Richard Seidu A. , Tan Junya , Lan Zhigang , Ju Yan 
Published: October 2018

Abstract

Rationale:
Inflammatory myofibroblastic tumor (IMT) of the lung often arises from excessive inflammatory response. It is one of the rare benign tumors of the lung, while desmoplastic noninfant gangliogliomas (DNIG), on the contrary, are rare intracranial benign tumors often seen in children within the first one and a half years of life.

Patient concerns:
We present a 12-year-old girl with 2 months history of none productive cough and right-sided chest pain.

Diagnoses:
Computer tomography scan of the chest revealed a soft tissue mass at the right upper lobe which was consistent with IMT. Histopathologic examination confirmed the diagnosis of IMT.

Interventions:
Thoracic surgery was successfully carried out and she further received radiotherapy. The patient recovered initially.

Outcomes:
Two years later, she complained of seizures during follow-up. Magnetic resonance imaging of the head revealed DNIG. We achieved total resection of the major lesions and she was further treated with radiotherapy. She is currently well and in school. Histopathologic examination confirmed the diagnosis of DNIG.

Lesions:
We speculate that IMT might have transformed into intracranial DNIG through metastatic process or as a result of genetic mutations or chromosomal abrasions.
Prepregnancy obesity status and risks on pregnancy outcomes in Shanghai
Authors: Shen Jie , Zhang Zhiping , Chen Ke , Lu Mei , Qian Qiao , Liu Pengfei , Gao Qingyun , Zhang Chengfeng 
Published: October 2018

Abstract
Obesity in women of reproductive age is not only associated with numerous adverse maternal and fetal effects prenatally but also exerts a negative influence on female fertility. The aim of this study was to investigate the situation of prepregnant obesity in Shanghai and explore the impact of prepregnant obesity on gestational weight gain as well as other pregnancy outcomes. A prospective hospital-based pregnant women cohort was established in Shanghai since January 2015. All pregnant women who were registered and expected to deliver in this hospital were included in the cohort. Nearly one fourth of pregnant women in Shanghai were overweight/obese and the prevalence of overweight/obesity was more common among women with advancing age (P < .001). Women prepregnancy overweight/obesity was associated with 3.5-fold higher risk of excessive gestational weight gain (odds ratio, OR 3.58; 95% confidence interval, CI, 2.82–4.55; P < .001). Women prepregnancy BMI was statistically related to pregnancy outcomes as macrosomia (OR 2.24; 95% CI, 1.55–3.23; P < .001), cesarean delivery (OR 2.04; 95% CI, 1.60–2.62; P < .001), maternal complications (OR 1.53; 95% CI, 1.18–1.98; P < .001). Prepregnancy obesity is associated with a much higher risk of excessive gestational weight gain and pregnancy outcomes in Shanghai. Further interventions targeting maternal obesity, especially prepregnancy obesity are required.
The efficacy of accommodative versus monofocal intraocular lenses for cataract patients
Authors: Zhou Hongwei , Zhu Chongyan , Xu Wenya , Zhou Fang 
Published: October 2018

Abstract

Introduction:
We performed a systematic review and meta-analysis to evaluate whether accommodative intraocular lenses (AC-IOLs) are superior for cataract patients compared with monofocal IOLs (MF-IOLs).

Methods:
Pubmed, Embase, Cochrane library, CNKI, and Wanfang databases were searched through in August 2018 for AC-IOLs versus MF-IOLs in cataract patients. Studies were pooled under either fixed-effects model or random-effects model to calculate the relative risk (RR), weighted mean difference (WMD), or standard mean difference (SMD) and their corresponding 95% confidence interval (CI). Distance-corrected near visual acuity (DCNVA) was chosen as the primary outcome. The secondary outcomes were corrected distant visual acuity (CDVA), pilocarpine-induced IOL shift, contrast sensitivity, and spectacle independence.

Results:
Seventeen studies, involving a total of 1764 eyes, were included. Our results revealed that AC-IOLs improved DCNVA (SMD = −1.84, 95% CI = −2.56 to −1.11) and were associated with significantly greater anterior lens shift than MF-IOLs (WMD = −0.30, 95% CI = −0.37 to −0.23). Furthermore, spectacle independence was significantly better with AC-IOLs than with MF-IOLs (RR = 3.07, 95% CI = 1.06–8.89). However, there was no significant difference in CDVA and contrast sensitivity between the 2 groups.

Conclusion:
Our study confirmed that AC-IOLs can provide cataract patients with DCNVA and result in more high levels of spectacle independence than MF-IOLs. Further studies with larger data set and well-designed models are required to validate our findings.
Targeted high-throughput sequencing technique for the molecular diagnosis of primary immunodeficiency disorders
Authors: Chi Zuo Hua , Wei Wei , Bu Ding Fang , Li Huan Huan , Ding Fei , Zhu Ping 
Published: October 2018

Abstract
The aim of this study was to investigate the usefulness of targeted high-throughput sequencing (HTS) for the molecular diagnosis of primary immunodeficiency diseases (PID).
A total of 56 clinically diagnosed or suspected PID patients were divided into 4 groups according to the International Union of Immunological Societies Expert Committee for Primary Immunodeficiency 2015 and their chief clinical presentations. Patients and their biological family members were examined by targeted HTS, which sequenced the exons and ±10 bp flanking introns of 171 PID-related genes panel. All significant variants were confirmed by PCR-Sanger sequencing. Pathogenicity of the variants was evaluated by using bioinformatics.
A total of 117 variants in 73 genes were found in 56 patients. Accurate molecular diagnosis of PID was made in 13 (23.2%) patients, and 12 novel mutations were detected in these patients. Twenty-seven patients carried heterozygous variants that are probably pathogenic in ≥2 genes; 16 patients had only 1 missense variant, or had several variants but not >1 variant was deleterious as evaluated by bioinformatics. The meaning of the targeted HTS results of these patients remains to be studied.
Targeted HTS can make a precise molecular diagnosis of PID and detect more novel pathogenic mutations. More and more variations with ambiguous significance are discovered and explanation of these variations is a challenge to the clinicians.
No associations exists between red blood cell distribution width and serum uric acid in both sexes
Authors: Zhang Chunmei , Meng Zhaowei , Li Xue , Liu Ming , Ren Xiaojun , Zhu Mei , He Qing , Zhang Qing , Song Kun , Jia Qiyu , Chen Qian 
Published: October 2018

Abstract
The aim of this study was to determine whether there was a significant association between red blood cell distribution width (RDW) and uric acid (UA) in a large Chinese population.
This was a cross-sectional study with an enrollment of 80,298 ostensibly healthy participants (48,971 males, 31,327 females) during the period from 2011 to 2015. In the study, database was grouped by sex and the association between RDW and UA was analyzed by quartiles of RDW.
UA values between different sexes and RDW subgroups were analyzed by 2-way analysis of variance and Bonferroni t tests. Prevalence of hyperuricemia in different sexes was calculated. The relationship between risks of hyperuricemia and RDW level was analyzed by binary logistic regression with or without adjustment for age and body mass index.
UA values were not all the same between different sexes and RDW subgroups. Males had significantly higher hyperuricemia prevalence than females (20.00% vs 6.48%, P < .01). In addition, hyperuricemia prevalence in males decreased slightly across RDW quartiles, but was stable in females. No significant association between hyperuricemia risk and RDW was found in both sexes according to the results of multivariate logistic regression analysis. Similarly, negative results were also observed in multivariate linear analysis when both RDW and UA were considered as continuous variable.
We could not find any significant relationship between RDW and UA in both sexes.
Curative resolution of chronic thromboembolic pulmonary hypertension with pulmonary thromboendarterectomy in primary antiphospholipid syndrome
Authors: Li Can , Zhao Jiuliang , He Kun , Wu Yan , Liu Sheng , Wang Qian , Zhao Yan 
Published: October 2018

Abstract

Rationale:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of antiphospholipid syndrome (APS). Once diagnosed, the recommendation for the treatment of CTEPH is long-term anticoagulation and pulmonary thromboendarterectomy (PTE). However, cardiac surgeons apply PTE cautiously for these patients, as there is an increased risk of perioperative complications. Here, we present the curative case of a patient with severe APS-associated CTEPH treated with PTE.

Patient concerns:
A 29-year-old man presented with chest pain, decreased exercise capacity, dyspnoea, and haemoptysis.

Diagnoses:
He was triple positive for antiphospholipid antibodies. Computed tomography pulmonary angiography revealed multiple, recurrent pulmonary embolisms and complete obstruction of the left pulmonary artery. He was diagnosed with APS and CTEPH.

Interventions:
After balancing the risk of thrombosis and haemorrhage, the patient underwent PTE.

Outcomes:
The patient experienced symptom relief after PTE, and electrocardiography at a six-month follow-up showed a recovery of cardiac structure and pulmonary arterial pressure.

Lessons:
After evaluating the thrombosis risk at an experienced treatment centre and the application of standard anticoagulation treatment, PTE may be a curative resolution for APS-associated CTEPH.
Case report of mixed-type autoimmune hemolytic anemia in a patient with relapsing polychondritis
Authors: Xu Qianyun , Luo Hui , Zuo Xiaoxia , Liu Sijia 
Published: October 2018

Abstract

Rationale:
Relapsing polychondritis (RP) is a rare autoimmune-related disease and may be associated with other autoimmune diseases.

Patient concerns
: Here we reported a case of RP patients with mixed-type AIHA. The patient was diagnosed with RP in March 2008 which was treated and the patient was in stable condition. Laboratory data revealed progressive decrease in hemoglobin during her hospitalization due to pulmonary infection in 2016. Positive Coombs’ test and moderate titer of anti-cold agglutinin was detected.

Diagnosis:
Mixed-type AIHA was diagnosed as a comorbidity in this case given the circumstance that her RP was stable and low-dose oral corticosteroids was enough to maintain remission.

Interventions:
The patient was treated with intravenous immunoglobulin and steroids.

Outcomes:
The patient's body temperature dropped and hemoglobin levels rose in 2 weeks.

Lessons:
Reports of RP patients with autoimmune hemolytic anemia (AIHA) are extremely rare and cases with the mixed-type AIHA has not been reported. Here we describe a case of RP with mixed-type AIHA which was considered as a comorbidity rather than a complication.
Infliximab as an alternative therapy for refractory adult onset Kawasaki disease
Authors: Kawaguchi Takeshi , Rikitake Yuki , Tsuruda Toshihiro , Kawata Chihiro , Rikitake Mao , Iwao Kosho , Aizawa Ayako , Kariya Yumi , Matsuda Motohiro , Miyauchi Syunichi , Umekita Kunihiko , Takajo Ichiro , Okayama Akihiko 
Published: October 2018

Abstract

Rationale:
Kawasaki disease (KD) is an acute febrile illness predominantly affecting children less than 5 years of age and characterized by systemic inflammation in all medium-sized arteries. Adult-onset KD (AKD) is rare with only 105 case reports published. Recently, the efficacy of infliximab (IFX) for patients with refractory KD has been demonstrated.

Patient concerns:
A previously healthy 24-year-old man was admitted because of a persistent fever, and elevated serum level of AST, ALT, LDH, and CRP.

Diagnosis:
The patients met the diagnostic criteria for KD based on the findings of persistent fever, polymorphous exanthema, unilateral cervical lymphadenopathy, non-purulent palpebral conjunctivitis and membranous desquamation. Echocardiogram revealed the dilatation at the proximal sites of the right coronary artery (7.9 mm) and left anterior descending artery (5 mm). The patient was treated with high-dose intravenous immunoglobulin (1 g/kg/day for 2 days) and ASA (100 mg daily). However, his fever and arthralgia persisted.

Interventions:
He was administered single 5 mg/kg doses of IFX.

Outcomes:
He became afebrile the next day and his arthralgia improved.

Lessons:
We report the first case of administration of IFX in a patient with AKD refractory to intravenous immunoglobulin (IVIG), and successful reduction of systemic inflammation. However, the effectiveness of IFX in the regression of coronary artery aneurysm remains to be determined.