bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atypical and delayed de Winter electrocardiograph pattern
Authors: Yang Yingchao , Ma Yeshuo , Yin Da , Zhang Ying , Song Wei , Cheng Yunpeng , Fu Tingting , Zhang Ri , Liu Yue , Kang Kai , Wang Lixin , Jiang Yinong , Lu Yan 
Published: May 2019

Abstract

Rationale:
de Winter electrocardiograph (ECG) pattern signifies proximal left anterior descending coronary artery (LAD) occlusion and extensive anterior myocardial infarction, and it is found in about 2% of patients with proximal LAD occlusion. However, it is often unrecognized by physicians. In this case report, we present a patient with chest pain but showing an atypical and delayed de Winter ECG pattern.

Patient concerns:
A previously healthy 61-year-old man attended our emergency department with chest pain radiating to the left arm and back for 4 hours, who was without serious cardiovascular risk factors. ECG at emergency department showed no significant changes. High-sensitivity cardiac troponin I (hs-cTnI) was within normal limit.

Diagnosis:
At 5 hours after onset, ECG showed significant upsloping ST depression at J point in precordial leads V3 to V6, slight ST elevation in aVR and depression in inferior leads, and hs-cTnI peaked at 2.610 μg/L. The diagnosis of de Winter ECG pattern was confirmed by coronary angiography with an occlusion of the proximal LAD.

Interventions:
A stent was implanted through percutaneous coronary intervention.

Outcomes:
The patient's chest pain was relieved without further increase of hs-cTnI. ECG after procedure showed ST segment back to baseline in leads V4 to V6, but persistent ST elevation in V1 to V3 with QS or Q wave.

Lessons:
Timely diagnosis of de Winter ECG pattern is very important, especially the atypical and delayed ECG changes. It should be treated as ST elevation myocardial infarction equivalent and deserves emergent revascularization therapy.
Does postoperative morphine consumption for acute surgical pain impact oncologic outcomes after colorectal cancer resection?
Authors: Wu Hsiang-Ling , Tai Ying-Hsuan , Chang Wen-Kuei , Chang Kuang-Yi , Tsou Mei-Yung , Cherng Yih-Giun , Lin Shih-Pin 
Published: May 2019

Abstract
Whether morphine used in human cancer surgery would exert tumor-promoting effects is unclear. This study aimed to investigate the effects of morphine dose on cancer prognosis after colorectal cancer (CRC) resection.
In a retrospective study, 1248 patients with stage I through IV CRC undergoing primary tumor resections and using intravenous patient-controlled analgesia for acute surgical pain at a tertiary center between October 2005 and December 2014 were evaluated through August 2016. Progression-free survival (PFS) and overall survival (OS) were analyzed using proportional hazards regression models.
Multivariable analysis demonstrated no dose-dependent association between the amount of morphine dose and PFS (adjusted hazard ratio, HR = 1.31, 95% confidence interval, CI = 0.85–2.03) or OS (adjusted HR = 0.86, 95% CI = 0.47–1.55). Patients were further classified into the high-dose and low-dose groups by the median of morphine consumption (49.7 mg), and the morphine doses were mean 75.5 ± standard deviation 28.8 mg and 30.1 ± 12.4 mg in high-dose and low-dose groups, respectively. Multivariable models showed no significant difference in PFS or OS between groups, either (adjusted HR = 1.24, 95% CI = 0.97–1.58 for PFS; adjusted HR = 1.01, 95% CI = 0.71–1.43 for OS).
Our results did not support a definite association between postoperative morphine consumption and cancer progression or all-cause mortality in patients following CRC resection.
Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?
Authors: Kang Taewook , Park Si Young , Kang Chun Hyung , Lee Soon Hyuck , Park Jong Hoon , Suh Seung Woo 
Published: May 2019

Abstract

Background:
Lumbar decompressive surgery is a standard surgical technique for lumbar spinal stenosis. Many new surgical techniques have been introduced, ranging from open surgery to minimally invasive procedures. Minimally invasive surgical techniques are preferred because patients experience less postoperative pain and shorter hospital stays. However, the success rate of minimally invasive techniques have been controversial. The object of this study was to assess the feasibility of spinal decompression using biportal technique/endoscopic surgery compared with microscopic surgery.

Methods:
Seventy lumbar spinal stenosis patients undergoing laminectomy were included in this study. A number table was used to randomize the patients into two groups: a biportal technique/endoscopic surgery group (BG-36) and a microscopic surgery group (OG-34). One surgeon performed either biportal technique/endoscopic decompression or microscopic decompression using a tubular retractor, depending on the group to which the patient was randomized. Perioperative data and clinical outcomes at postoperative 6 months were collected and analyzed.

Results:
The demographic data and level of surgery were comparable between the two groups. A shorter operation time (36 ± 11 vs 54 ± 9 min), less hemovac drain output (25.5 ± 15.8 vs 53.2 ± 32.1 ml), less opioid usage (2.3 ± 0.6 vs 6.5 ± 2.5 T) and shorter hospital stay (1.2 ± 0.3 vs 3.5 ± 0.8 days) were shown in BG. The BG experienced no significant differences in clinical outcomes compared with OG. Favorable clinical outcomes were shown at 6 months after surgery in both groups.

Conclusion:
Lumbar decompressive surgery using biportal technique/endoscopy showed favorable clinical outcomes, less pain and a shorter hospital stay compared to microscopic surgery in patients with lumbar spinal stenosis.
Good hemostatic effect of platelets stored at 4°C in an in vitro model of massive blood loss and thrombocytopenia
Authors: Yang Jiang-Cun , Liu Feng-Hua , Sun Yang , Ma Ting , Xu Cui-Xiang , Wang Wen-Hua , Chen Ping , Xie Xin-Xin , Song Yao-Jun , Yin Wen 
Published: May 2019

Abstract
This study compared the corrective effects of storage of platelets at 4°C and at 22°C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications.
In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4°C (1, 3, 5, 7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices.
①Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 × 109/L to greater than 120 × 109/L for 4°C storage, and 20 to 27 × 109/L to greater than 120 × 109/L for 22°C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4 mm to greater than 43 mm for 4°C storage, and 12.2 to 14.4 mm to greater than 44.8 mm for 22°C storage. Thromboelastography reaction time values decreased from 9.9–24.9 minutes to 3.8–5.5 minutes for 4°C storage, and 9.9–22.7 minutes to 4.3–4.5 minutes for 22°C storage. ②Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 × 109/L to greater than 99 × 109/L for 4°C storage, and 12 to 34 × 109/L to greater than 120 × 109/L for 22°C storage. TEG-MA results improved from 21.4 to 32.1 mm to greater than 49.1 mm for 4°C storage, and 21.4 to 31.6 mm to greater than 50.5 mm for 22°C storage.
Platelets stored at 4°C and 22°C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4°C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.
Diagnostic performance of biomarkers for ovarian cancer
Authors: Hua Jinyong , Liu Jing , Hua Mengge , Cai Runjin , Li Muyang , Wang Jing , Wang Jiancheng 
Published: May 2019

Abstract

Background:
Ovarian cancer is one of the deadliest gynecological diseases and the annual mortality of ovarian cancer continues to rise. The prognosis of ovarian cancer is poor because it is prone to early metastasis during progression. Therefore, early diagnosis of ovarian cancer is very important. Some systematic reviews have evaluated the diagnostic value of different biomarkers for ovarian cancer. However, there is no consensus in the conclusions, and some are even contradictory. This study aims to assess the methodological and reporting quality of available systematic reviews and to find an optimal biomarker for diagnosing ovarian cancer.

Methods:
The PubMed, Embase.com, the Cochrane Library of Systematic Reviews, and Web of Science were searched to identify relevant systematic reviews from inception to February 2019. We included systematic reviews that include randomized controlled trials, cross-sectional studies, case-control studies, or cohort studies as long as the systematic reviews evaluated the diagnostic performance of biomarkers for ovarian cancer. The methodological quality will be assessed using assessment of multiple systematic reviews-2 checklist, and the reporting quality will be assessed using preferred reporting items for systematic reviews and meta-analysis diagnostic test accuracy (PRISMA-DTA) checklist. The pairwise meta-analysis and indirect comparisons will be performed using STATA (13.0; Stata Corporation, College Station, TX).

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

Conclusion:
This overview will provide comprehensive evidence of different biomarkers for diagnosing ovarian cancer.

PROSPERO registration number:
CRD42019125880.
The level of Krüppel-like factor 8 expression predicts prognosis and metastasis in various carcinomas
Authors: Liu Jun , Zheng Huimin , Ding Yangyang , Li Manman , Li Jingrong , Guo Jiaojiao , Hu Linhui , Pu Lianfang , Xiong Shudao 
Published: May 2019

AbstractBackground and objective:Krüppel-like factor 8 (KLF8), a transcription factor, belongs to the KLF8 family. Currently, studies have shown that KLF8 is highly expressed in some tumors. However, the prognostic value and metastasis of KLF8 in cancers remain unclear. For the first time, we conducted meta-analysis to explore the relationship between KLF8 expression with prognosis and metastasis in various carcinomas patients.Methods:Web of Science, PubMed, Embase, and Cochrane Library were systematically searched for eligible articles. Pooled hazard ratios (HRs) and their 95% confidence intervals (95% CIs) were calculated to evaluate the prognostic value and metastasis of KLF8 expression in human cancer patients.Results:The result revealed that highly expression level of KLF8 was significantly associated with poor overall survival (OS) (HR = 1.56, 95% CI: 1.26–1.87). Meanwhile, this significant correlation was also observed in subgroup analysis stratified by cancer types, source of HR, sample size, follow-up (months). In addition, highly expression of KLF8 was also closely associated with metastasis (HR = 1.37, 95% CI: 0.57–2.17) and tumor node metastasis stage (HR = 1.58, 95% CI: 0.90–2.25) in carcinomas.Conclusion:In summary, our meta-analysis indicates that overexpression of KLF8 may be associated with poor prognosis and higher incidence of metastasis in various carcinomas, and KLF8 may be used as a prognostic and metastatic indicator in human cancers.
Mitochondrial metabolism and the maintenance of hematopoietic stem cell quiescence
Authors: Hu Mengjia , Wang Junping 
Published: May 2019

Purpose of review
Hematopoietic stem cells (HSCs) are characterized by a potent multilineage regenerative capability that is dependent on their quiescence property. In the past few decades, researchers have found many intrinsic and niche-derived factors that can regulate HSCs, whereas how to precisely control HSC behaviors remains elusive. Recently, mitochondrial metabolism has been shown to be involved in the regulation of HSC biology. The purpose of this review is to overview recent advances in the relationship between mitochondrial metabolism and maintenance of HSC quiescence.

Recent findings
On the basis of fact that HSCs are heterogeneous populations that have their unique metabolic characteristics, increasing studies have demonstrated that the quiescence and function of HSCs are closely correlated with the mitochondrial mass and activity, as well as the levels of mitochondria-derived reactive oxygen species and metabolites. Apart from that, mitochondria have been reported to undergo internal protective programs, including mitochondrial unfolded protein response, autophagy and mitochondrial dynamics, which are beneficial to maintaining HSC homeostasis.

Summary
The maintenance of HSC quiescence needs a metabolic balance in mitochondria, and unraveling the metabolic complexity may provide deep understanding of the functional heterogeneity of HSCs.
Addressing Health Disparities in America: Analysis of Community Health Improvement Plans
Authors: Inderstrodt Jill , Perrault Evan K. , Hintz Elizabeth A. , Hildenbrand Grace M. 
Published: May 2019

Background
Healthy People 2020 has made achieving health equity one of its overarching goals; another goal is increasing the number of accredited local agencies that have Community Health Improvement Plans (CHIPs). Community Health Improvement Plans are meant to serve agencies as guiding documents for multiple years.

Objectives
This study investigates the prevalence with which health disparities are addressed within CHIPs and the specific health disparities targeted by these objectives.

Methods
Researchers analyzed 4,094 objectives from CHIPs of 280 local Public Health Accreditation Board (PHAB)-accredited and nonaccredited public health agencies in the United States.

Results
Despite the PHAB's focus on addressing health equity, not all PHAB-accredited agencies addressed health disparities (85.4% of CHIPs analyzed). However, more accredited than nonaccredited agencies (73.9%) contained at least one objective focused on health disparities.

Discussion
Findings indicate that if health equity is truly a goal of national initiatives, agencies' planning documents (e.g., CHIPs) can do a better job addressing commonly ignored populations.
Late-onset Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like Episodes Presenting With Auditory Agnosia
Authors: Smith Kelsey , Chiu Shannon , Hunt Christopher , Chandregowda Adithya , Babovic-Vuksanovic Dusica , Keegan B. Mark 
Published: May 2019

Introduction:
Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a multisystemic mitochondrial disorder that usually presents in childhood. Patients can have a wide array of neurological symptoms when presenting with stroke-like episodes, and imaging characteristics during the episodes can overlap with different neurological disorders.

Case Report:
A 61-year-old woman presented with communication difficulties consistent with auditory agnosia and was found to have bitemporal abnormalities on imaging that first raised the concern for herpes simplex virus encephalitis. Further work-up, in conjunction with the patient’s past medical and family history, suggested a mitochondrial disorder. Mitochondrial full genome analysis revealed m.3243A>G variant in the MT-TL1 gene, with 6% heteroplasmy in blood leading to a diagnosis of MELAS.

Conclusions:
MELAS is a disorder with clinical variability. Neuroimaging studies during stroke-like episodes in MELAS can provide significant clues to the underlying disorder. Although patients typically present in childhood, the first stroke-like episode can occur later in life in some patients, potentially related to a lower heteroplasmy level.
Risk of Neurological Toxicities Following the Use of Different Immune Checkpoint Inhibitor Regimens in Solid Tumors
Authors: Xu Min , Nie Yan , Yang Ying , Lu, MD Yang-Tian , Su Qiang 
Published: May 2019

Objectives:
The objective of this study was to assess risk of neurological toxicities following the use of different immune checkpoint inhibitor (ICI) regimens in solid tumors.

Methods:
Pubmed, Embase, and ClinicalTrials.gov databases were searched for publications, and data were analyzed using Review Manager 5.3 software to compare the risk of immune-related and nonspecific neurological complications potentially triggered by ICIs to controls.

Results:
In total 23 randomized clinical trials comprising 11,687 patients were included in this meta-analysis. Patients with PD-L1 (OR, 0.29; 95% confidence interval [CI], 0.18-0.48; P<0.01) or programmed cell-death protein 1 (PD-1) inhibitor (OR, 0.21; 95% CI, 0.14-0.31; P<0.01) were less likely to develop any-grade peripheral neuropathy than chemotherapy, while the risk of grade 3-5 was also smaller for PD-1 inhibitor (OR, 0.16; 95% CI, 0.05-0.54; P=0.003). Combination therapy with CTLA4 and PD-1 inhibitor did not significantly increase the risk of any-grade (OR, 0.83; 95% CI, 0.21-3.32; P>0.05) or grade 3-5 (OR, 1.4; 95% CI, 0.2-9.61; P>0.05) peripheral neuropathy compared to monotherapy with CTLA4 or PD-1 inhibitor. However, difference in risk of immune-related adverse events (irAEs) involving central nervous system did not reach statistical significance in patients with different ICI regimens compared those under chemotherapy. Additionally, risk of experiencing paresthesia was in line with that of peripheral neuropathy (OR, 0.42; 95% CI, 0.28-0.62; P<0.01).

Conclusions:
This meta-analysis shows that PD-L1/PD-1 and CTLA4 inhibitor have decreased risk of peripheral neuropathy compared to chemotherapy, while combination therapy with CTLA4 and PD-1 inhibitor have no difference in neurological toxicities compared to monotherapy with CTLA4 or PD-1 inhibitor.
Case Report: Optical Coherence Tomography Can Find Typical Features in Pregnancy-induced Hypertension with Retinopathy
Authors: Zhang Zhenzhen , Lu Jianmin , Qin Xiuhong 
Published: May 2019

SIGNIFICANCE
Pregnancy-induced hypertension is a unique yet common complication in pregnant women and may cause retinopathy. Optical coherence tomography (OCT) may help find the features of retinopathy that are difficult to observe through fundus examination. Not all patients can fully recover from retinopathy.

PURPOSE
This report describes a case of pregnancy-induced hypertension with retinopathy and represents the features of retinopathy in OCT and fundus fluorescein angiography.

CASE REPORT
A 29-year-old pregnant woman presented with bilateral blurred vision and xanthopsia 2 days before her induced labor; she was also diagnosed as pre-eclamptic in the obstetrics department. The vision in her right eye was 20/33, and that in her left eye was 20/20. Fundus fluorescein angiography showed scattered-dot hypofluorescence around the disc at an early stage, and needle-like hyperfluorescence gradually appeared near the disc with late-stage fluorescein leakage in both eyes. Optical coherence tomography revealed multiple shallow retinal detachments with hyperreflective bright spots in the outer retina and clumped hyperreflective materials on the retinal pigment epithelium (RPE).

CONCLUSIONS
Typical findings and some tiny changes in the outer retina and RPE can be observed through spectral-domain OCT. The clumped hyperreflective deposits in the outer retina may be by-products of RPE swelling and necrosis that lead to barrier dysfunctions and fluid leakage. These described features may help diagnose retinopathy from pregnancy-induced hypertension. Although it is a self-limited disease, the disruptions in the ellipsoid and interdigitation zones may not fully recover and result in reduced visual dysfunction. Therefore, control of hypertension is indicated.
Bifocal & Atropine in Myopia Study: Baseline Data and Methods
Authors: Huang Juan , Mutti Donald O. , Jones-Jordan Lisa A. , Walline Jeffrey J. 
Published: May 2019

SIGNIFICANCE
The Bifocal & Atropine in Myopia (BAM) study aims to determine whether combining 0.01% atropine and +2.50-diopter add center-distance soft bifocal contact lenses (SBCL) slows myopia progression more than SBCL alone. The results could provide significant information on the myopia control effect of combining optical and pharmacological treatments.

PURPOSE
This article describes the subject characteristics at baseline, the study methods, and the short-term effects of this combination treatment on visual acuity (VA) and vision-related outcomes.

METHODS
Subjects from the BAM study who met the baseline eligibility criteria were dispensed the combination treatment for 2 weeks to determine final eligibility. Outcome measures included VA at near and distance (Bailey-Lovie logMAR charts), near phoria (modified Thorington), accommodative lag (Grand Seiko WAM-5500), and pupil size (NeurOptics VIP-200 Pupillometer). Compliance was monitored using surveys. Two subgroups in the Bifocal Lenses In Nearsighted Kids study, single-vision contact lens wearers and those who wore +2.50-diopter add SBCL, will serve as the age-matched historical controls for BAM study.

RESULTS
Forty-nine BAM subjects (9.6 ± 1.4 years) were enrolled; mean spherical equivalent cycloplegic autorefraction was −2.33 ± 1.03 diopters. After 2 weeks of treatment, the best-corrected low-contrast (10% Michelson) distance VA was reduced (pre-treatment, +0.09 ± 0.07; post-treatment, +0.16 ± 0.08; P < .0001), but the high-contrast VA at near or distance was unaffected. Near phoria increased by approximately 2△ in the exo direction (P = .01), but the accommodative lag was unchanged. The pupil size was not significantly different between pre-treatment and post-treatment of either the photopic or mesopic condition. Surveys indicated that the subjects wore SBCL 77 ± 22% of waking hours and used atropine 6.4 ± 0.7 days per week.

CONCLUSIONS
Two weeks of combination treatment reduced low-contrast distance VA and increased near exophoria slightly, but the subjects were compliant and tolerated the treatment well.