bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upregulated delta-like protein 3 expression is a diagnostic and prognostic marker in endometrial cancer
Authors: Wang Juan , Zhang Kaishuo , Liu Zi , Wang Tao , Shi Fan , Zhang Yingbing , Su Jin , Jia Yina 
Published: December 2018

Abstract
Upregulated delta-like protein 3 (DLL3) functions as a Notch ligand and has been a target for cancer therapy. The present study assessed DLL3 expression as a tumor marker for endometrial cancer.
RNA-Seq expression data and clinicopathologic records from 545 patients with endometrial cancer were downloaded from The Cancer Genome Atlas database. Mann–Whitney U and logistic regression tests were applied to associate the level of DLL3 expression with clinical variables from the patients. Kaplan–Meier curves and log-rank tests were performed to compare overall survival of patients stratified by different levels of DLL3 expression. Multivariate Cox regression tests were used to analyze independent predictors for endometrial cancer. DLL3 expression was upregulated in endometrial cancer tissues compared to para-carcinoma tissues (P = .0003). High DLL3 expression was associated with the age of patients (odds ratio [OR] = 1.74), advanced stages of the International Federation of Gynecology and Obstetrics system (OR = 2.9), grade III/IV (OR = 5.1), myometrial invasion (OR = 2.2), pelvic involvement (OR = 12.9), and para-aortic lymph node metastasis (OR = 9.9) (all P ≤ .001). Furthermore, upregulated DLL3 expression was also associated with a median overall survival of 112 months (HR = 1.85, confidence internal 1.202–2.846, P = .005). The multivariate analysis showed that DLL3 overexpression and advanced tumor stages, grades, and lymph node metastases were all independent prognostic predictors for endometrial cancer.
The DLL3 expression could be a potential and novel tumor marker for early diagnosis and an independent predictor of poor survival for patients with endometrial cancer.
The impact of preoperative frailty status on outcomes after transcatheter aortic valve replacement
Authors: Huang LiLi , Zhou XiaoShuang , Yang XiaoYun , Yu Hai 
Published: December 2018

Abstract

Background:
Frailty is a syndrome of impaired physiologic reserve and decreased resistance to stressors and can often be seen in high-risk patients undergoing transcatheter aortic valve replacement (TAVR). Preoperative frailty status is thought to be related to adverse outcomes after TAVR. We conducted this systematic review and meta-analysis to determine the impact of preoperative frailty status on outcomes among patients after TAVR.

Methods:
PubMed, Embase, and the Cochrane Library were searched for relevant studies through January 2018. Fourteen articles (n = 7489) meeting the inclusion criteria were finally included. Possible effects were calculated using meta-analysis.

Results:
The pooled risk ratios (RRs) of late mortality (>6 months) and acute kidney injury after TAVR in frail group were 2.81 (95% confidence interval (CI) 1.90–4.15, P < .001, I2 = 84%) and 1.41 (95% CI 1.02–1.94, P = .04, I2 = 24%), respectively. Compared with non-frail group, significantly higher incidence of 30-day mortality (RR 2.03, 95% CI 1.63–2.54, P < .001, I2 = 0%) and life threatening or major bleeding after TAVR (RR 1.48, 95% CI 1.20–1.82, P < .001, I2 = 14%) was found in frail group. There was no significant association between frailty and incidence of stroke after TAVR (RR 0.93, 95% CI 0.53–1.63, P = .80, I2 = 0%).

Conclusion:
Preoperative frailty status is proved to be significantly associated with poor outcomes after TAVR. Our findings may remind doctors in the field of a more comprehensive preoperative evaluation for TAVR candidates. More well-designed and large-sample sized prospective studies are further needed to figure out the best frailty assessment tool for patients undergoing TAVR.
Insulin autoimmune syndrome
Authors: Chen Fangyuan , Yang Jianming , Liu Yanqun , Wang Wen , Zhu Li , Wang Wei , Yang Jun , You Wei 
Published: December 2018

Abstract

Rationale:
Insulin autoimmune syndrome (IAS) is a rare endocrine disease characterized by repeated fasting hypoglycemia or episodes of hypoglycemia late after meals, elevated serum insulin, and positivity for insulin autoantibody (IAA) or insulin receptor antibody (IRA). We summarize the clinical manifestations and treatment experiences of 3 patients with IAS.

Patient concerns:
One patient with >20-year history of type 2 diabetes mellitus had irregular episodes of hypoglycemia 2 years of after treatment with insulin. Another patient with a 6-year history of type 2 diabetes mellitus presented irregular episodes of hypoglycemia after 6 months of treatment with insulin. One patient with a history of Graves’ disease showed hypoglycemia after administration of thiamazole.

Diagnosis:
Serum islet cell antibody (ICA) and glutamic acid decarboxylase antibody (GADA) were negative, while antibody insulin autoantibodies were positive in all the 3 patients. Two patients demonstrated diabetes mellitus after an oral glucose tolerance test, while one had normal glucose tolerance. Furthermore, serum insulin levels significantly elevated and did not matched C peptide levels. No abnormalities were found on enhanced MRI of the pancreas, and all 3 patients were clinically diagnosed with IAS.

Interventions:
In case one, insulin aspart 30 injection was withdrawn after admission. In addition, the patient was prescribed sublingual acarbose 3 times daily. Two weeks after admission, prednisone acetate was administered orally once daily at night. In case 2, insulin aspart 30 injection was withdrawn after admission, the patient was prescribed sublingual acarbose 3 times daily with a meal. Five days after admission, oral prednisone acetate was administered once daily at night. In case 3, oral propylthiouracil was prescribed and thiamazole withdrawn after admission, and the patient consumed an extra meal before sleeping.

Outcomes:
At the 3-month follow-up visit, the hypoglycemic episodes had disappeared, serum insulin levels were significantly decreased, and insulin antibody (IA) levels were no longer detectable in all 3 patients.

Lessons:
For those patients with high-insulin hypoglycemia, IAA should be evaluated if serum insulin concentrations are inconsistent with C peptide levels. Therapeutically, a lower dose of glucocorticoids with more appropriate medication timing can be used to achieve good results.
Comparison of effective teaching methods to achieve skill acquisition using a robotic virtual reality simulator
Authors: Shim Ji Sung , Kim Jae Yoon , Pyun Jong Hyun , Cho Seok , Oh Mi Mi , Kang Seok Ho , Lee Jeong Gu , Kim Je Jong , Cheon Jun , Kang Sung Gu 
Published: December 2018

Abstract

Background:
To compare the superiority of teaching methods for acquiring a proficient level of surgical skill in a robotic surgery-naïve individual using a robotic virtual reality simulator.

Methods:
This study employed a prospective, randomized study design to assess student's learning curve. We divided 45 subjects into 3 groups: those with expert proctoring (group I), those who watched only an educational video (group II), and those with independent training (group III; n = 15 per group). The task used in this study was the Tube 2 and it imitates a vesicourethral anastomosis in robotic prostatectomy. The effects were analyzed by the time to end the task after overcoming the learning curve which is determined by several performance parameters.

Results:
The number of task repetitions required to reach the learning curve plateau was 45, 42, and 37 repetitions in groups I, II, and III, which means that there was continuous improvement in performing the task after 40 repetitions only in groups I and II. The mean time for completing the task during the stabilization period was significantly different between group I and group III and group II and group III, which means that the independent training method was inferior to the other methods (group I vs. group II vs. group III: 187.38 vs. 187.07 vs. 253.47 seconds, P < .001).

Conclusions:
This study's findings showed that an educational video can be as beneficial as expert proctoring, which implies that the development of a standardized educational video would be worthwhile.
Effect of nerve electrical stimulation for treating chemotherapy-induced nausea and vomiting in patients with advanced gastric cancer
Authors: Guo Wen-cheng , Wang Fang 
Published: December 2018

Abstract

Background:
This randomized controlled trial evaluated the effectiveness of nerve electrical stimulation (NES) for the treatment of chemotherapy-induced nausea and vomiting (CINV) in patients with advanced gastric cancer (AGC).

Methods:
One hundred twenty-four eligible patients with AGC were included in this randomized controlled trial. They were equally divided the NES group and the sham group. The patients in the NES group received NES intervention, while the subjects in the sham group underwent sham NES. The primary outcome included symptoms severity and appetite. The secondary outcomes included quality of life, as measured by the MD Anderson Symptom Inventory (MDASI) score, and functional impairment, as evaluated by the Karnofsky score. Additionally, adverse events were also documented during the period of the treatment.

Results:
After treatment, NES showed greater effectiveness in reducing the severity of nausea (P = .02), and vomiting (P = .04), as well as the appetite improvement (P = .02), compared with the sham NES. Furthermore, no adverse events related to NES treatment were detected.

Conclusion:
The results of this study demonstrated that NES may help to relieve CINV in patients with AGC. Future studies are still needed to warrant these results.
A feasibility study using cadaver
Authors: Kang Seok , Yoon Joon Shik , Lee Chung Ho , Kim Guk-Han , Choi Hyuk , Kim Jae Do , Park Hong Seok 
Published: December 2018

Abstract
Intermittent catheterization is an effective bladder management strategy for patients with incomplete bladder emptying. For self-catheterization, sufficient hand function in both hands is necessary. We have developed a novel automatic urinary catheterization device to induce self-IC for patients with bladder dysfunction and upper extremity disability. The aim of this study was to investigate the feasibility of this novel automatic catheterization device.
This study was performed using 4 fresh cadavers. First, 400 mL of normal saline was filled into the cadaver bladder. Then, the catheter was inserted using the newly developed device. The catheter insertion was performed 3 times for each cadaver, with the penis positioned at 45°, 90°, and 135°, respectively. A transrectal ultrasonography was performed during the catheterization. We evaluated whether the catheter was successfully inserted into the bladder at each position of penis and whether the urethrovesical junction was injured when inserting the catheter. We also measured the volume of normal saline evacuated from the bladder after successful catheterization.
With the penis positioned at 45° and 90°, catheter insertion was successful without any damage to the urethrovesical junction. However, when the penis was at 135°, the catheter could not be inserted into the bladder. When the automatic catheter insertion was successful, the bladder was successfully emptied. On average, 81.56 ± 3.26% of normal saline was discharged from the bladder and 11.13 ± 2.09% was remained.
The newly developed automatic urinary catheterization device could insert the catheter effectively and safely. This device would be a useful tool for the urinary catheterization of bladder dysfunction patients with upper extremity disability.
Genetic polymorphisms of methylenetetrahydrofolate reductase C677T and risk of ischemic stroke in a southern Chinese Hakka population
Authors: Hou Jingyuan , Zeng Xing , Xie Yunquan , Wu Hesen , Zhao Pingsen 
Published: December 2018

AbstractPrevious studies have shown that methylenetetrahydrofolate reductase (MTHFR) gene to be a genetic risk factor for the susceptibility to ischemic stroke. The aim of this case-control study was to investigate whether the polymorphisms ofMTHFRC677T were associated with the susceptibility to ischemic stroke in a southern Chinese Hakka population. In this study, a total of 1967 ischemic stroke patients and 2565 controls of Chinese Hakka ethnicity were recruited. TheMTHFRC677T polymorphisms were genotyped by polymerase chain reaction (PCR) amplification and microarray method. The risk of ischemic stroke was estimated by logistic regression analysis. The frequencies of CC, CT, and TT genotypes were 52.67% versus 55.63%, 40.31% versus 38.52%, and 7.02% versus 5.85% in patients with ischemic stroke versus controls, respectively. The frequency of T allele was significantly higher in ischemic stroke patients (27.17%) than in controls (25.11%) (P = .026, odds ratio [OR] 1.113, 95% confidence interval [CI] 1.013–1.223). The homozygous TT genotype in the ischemic stroke patients was associated with increased risk (P = .049, OR 1.132, 95% CI 1.001–1.281) when compared with the controls after adjustment for age and sex. The positive association was only found in dominant model without adjustment for age and sex (P = .047, OR 1.127, 95% CI 1.002–1.268). Also, the carrier status of theMTHFRT allele was identified as an independent risk factor for the development ischemic stroke even after the adjustment for conventional risk factors (P = 0.047, OR 1.109, 95% CI 0.964–1.225). Our results provide evidence that variants ofMTHFRC677T gene may influence the risk of developing ischemic stroke in a southern Chinese Hakka population. Further studies are needed to confirm this association, which will promote the development of strategies for prevention and treatment of ischemic stroke in our study population.
Pleomorphic rhabdomyosarcoma metastasis to small intestine causing intussusception
Authors: Xi Shiwen , Tong Weihua 
Published: December 2018

Abstract

Rationale:
Pleomorphic rhabdomyosarcoma (PRMS) is a rare soft tissue malignancy which is frequently misdiagnosed and associated with metastasis to the lungs, lymph nodes, and bone marrow. Case studies are needed to improve the awareness of the disease and our understanding of it.

Patient concerns:
In this study, we present a case of a 36-year-old man with a lesion on the right back shoulder. Lesion was confirmed by magnetic resonance imaging (MRI) around the right armpit, subscapularis, deltoid, and infraspinatus muscle, with oozing surrounding soft tissues.

Diagnosis:
The tumor was diagnosed as PRMS which metastasized to the intestine, where it caused intussusception.

Interventions:
The patient was treated by complete surgery in combination with neo-adjuvant chemotherapy including ifosfamide and epirubicin.

Outcome:
The patient remained alive 6 months after the treatment with no recurrence and metastasis.

Lesson:
PRMS can be aggressive, and surgical treatment in combination with multidrug chemotherapy can be used in the management.
The effect of Baduanjin qigong combined with CBT on physical fitness and psychological health of elderly housebound
Authors: Jing Liwei , Jin Yanpeng , Zhang Xiaoli , Wang Fenglan , Song Yuyu , Xing Fengmei 
Published: December 2018

Abstract

Background:
To investigate the effectiveness of Baduanjin qigong combined with cognitive-behavior therapy (CBT) on the physical fitness and psychological health of elderly housebound.

Materials and methods:
The 120 elderly housebound were randomly divided into 3 intervention groups: Baduanjin training, Baduanjin training combined with CBT, and CBT. The interventions were conducted by means of home visits over 6 months. Spirometry, SF-36 health survey of quality of life, and Lawton and Brody Instrumental Activities of Daily Living Scale (IADL) were used to collect physical health data, and self-evaluation of overall health status, self-evaluation of loneliness, and short-form geriatric depression scale (GDS-15) were used to collect mental health data at baseline, 3 months, and 6 months after intervention. Data was analyzed by repeated measures analysis of variance (rANOVA) and chi-squared test (χ2 test).

Results:
Forced vital capacity (FVC), maximum voluntary ventilation (MVV), quality of life (QOL), and self-reported health status were significantly increased (P < .05) in the group receiving joint Baduanjin and CBT intervention at 3 months and 6 months, as compared to the Baduanjin only group or the CBT only group. Activities of daily living (ADL), self-evaluated loneliness, and level of depression were significantly lowered (P < .05) in the group receiving joint Baduanjin and CBT intervention at 3 months and 6 months, as compared to the Baduanjin only group or the CBT only group.

Conclusions:
Physical and psychological statuses of elderly housebound were significantly improved by Baduanjin training combined with CBT. The effect of the combined intervention exceeded that of CBT or Baduanjin alone.
A quality improvement pilot assessment of the safety and associated outcomes of a viable cryopreserved umbilical tissue allograft as an adjunct surgical wrap in peroneus brevis tendon repair
Authors: Sundblad Kyle W. , Tassis Elisabet K. 
Published: December 2018

Abstract
Surgical tendon repairs of the lower extremity are frequently associated with post-operative (post-op) risks that result in poor patient outcomes. Initially, increased pain levels may contribute to extended post-op rehabilitation while the development of tissue adhesions and fibrosis limit long-term functionality through reduced range of motion. Several surgical methods describing incorporation of various augmentative graft materials in tendon repair exist. However, reports demonstrating technique and both short- and long-term patient outcomes are lacking. Recently, advances in tissue preservation technology have led to the commercialization of human placental allografts. Of these available allogeneic biomaterials, the components found in human placental membranes may provide anti-inflammatory, antimicrobial, anti-adhesive, and antifibrotic properties to benefit surgical outcomes.
Here, the authors introduce and technically describe the use of a viable cryopreserved umbilical tissue (vCUT) (Stravix, Osiris Therapeutics, Inc., Columbia, MD) as a complementary surgical wrap in primary tendon repair, with particular focus on the peroneus brevis. A pilot study was undertaken to assess the safety and potential for secondary rehabilitative outcomes associated with the use of vCUT in 5 tendon repair cases. The use of vCUT as a surgical tendon wrap was evaluated via the following primary endpoints at post-op day 7:
Secondary investigative endpoints included clinical and rehabilitative outcome measures for comparative pain reduction and transition times to both controlled ankle movement (CAM) boot and normal shoe ambulation.
All patients were followed for an average of 24.15 months (range 16.75–26.5 months) after surgery. For primary safety measures, erythema, tenderness, drainage, heat, and swelling was absent in all 5 surgical sites. None of the patients required post-op use of narcotics past day 7. The potential for long-term rehabilitative improvement with adjunct use of vCUT was also demonstrated through reduced pain and reduced transition times to functional and non-assisted ambulation in normal shoewear as compared to historical controls managed without vCUT.
This surgical technique is simple and safe for patients and preliminary findings have demonstrated favorable clinical and rehabilitative outcomes over historically observed controls.
Facial paralysis as a presenting symptom of infant leukemia
Authors: Wang Liyuan , Wang Zhiling , Wan Chaomin , Cai Xiaotang , Zhang Ge , Lai Chunqi 
Published: December 2018

Abstract

Rationale:
Facial paralysis as the initial clinical presentation of infant leukemia (IL) is rare, and the rate of its misdiagnosis is high. Identifying the clinical characteristics of IL with facial paralysis as the initial symptom is necessary to improve the understanding of the causes of facial paralysis and IL.

Patient concerns:
A 10-month-old infant had facial paralysis and recurrent fever. He was misdiagnosed as having bacterial meningitis for >2 months.

Diagnoses:
The infant was diagnosed as having acute monocytic leukemia (M5) with central infiltration based on examinations of the bone marrow and cerebrospinal fluid by flow cytometry.

Interventions:
Before the diagnosis of leukemia, the patient was given meropenem, ceftriaxone, vancomycin, and ampicillin successively for anti-infective treatment for 2 months, and dexamethasone for several days. But he gave up further treatment after confirmed diagnosis.

Outcomes:
Our patient discontinued treatment and discharged. From literature review, there were 6 cases (including this case) of IL with facial paralysis as the initial symptom. 80% of patients were misdiagnosis and treated with a corticosteroid in the early stage, and the mortality was 33.3%.

Lessons:
The clinical symptoms of IL with facial paralysis are not typical, with a high rate of misdiagnosis. When the cause of facial paralysis is unknown or the advance treatment effect is poor, tumor diseases should be considered. Corticosteroids should be carefully administered to children with facial paralysis.
Balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients
Authors: Ma Peifen , Wang Bo , Zhang Jun , Shen Xiping , Yu Liping , Dou Xinman 
Published: December 2018

Abstract

Background:
The balanced crystalloids have become a substitute for saline for fluid resuscitation. Some studies have investigated the clinical effect and adverse event of differently balanced crystalloids, but they have no consistent conclusions. This study aims to assess and compare the effect of differently balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients using network meta-analysis (NMA).

Methods:
Electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, Clinical Trials.gov, and the International Clinical Trials Registry Platform (ICTRP) will be searched from inception to April 2018. We will include randomized controlled trials (RCTs) that reported the effect and adverse event of balanced crystalloids. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed using R software. GRADE will be used to explore the quality of evidence.

Results:
The results of this NMA will be published in a peer-reviewed journal.

Conclusion:
This NMA will summarize the direct and indirect evidence to assess the effect of differently balanced crystalloids.

Ethics and dissemination:
Ethics approval and patient consent are not required as this study is an NMA based on published studies.

PROSPERO registration number:
CRD42018093818.