bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hybrid ablation versus transcatheter ablation for atrial fibrillation
Authors: Zhang Junjie , Sun Haoliang , He Keshuai , Gu Jiaxi , Zheng Rui , Shao Yongfeng 
Published: January 2019

Abstract

Background:
Despite the successful creation of complex lesion sets during hybrid ablation (HA), reoccurrence of atrial fibrillation (AF), and/or atrial arrhythmia and procedural complications still occur. The main objective of this study was to compare the efficacy and safety between HA and transcatheter ablation (TA).

Methods:
We searched Pubmed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) database up to October 2017. Studies that satisfied our predefined inclusion criteria were included. Of the 894 records, 4 studies encompassing 331 patients were included in our study. We assessed pooled data using random-effect or fixed-effect model. The main endpoint was freedom of atrial arrhythmia after follow-up duration, secondary results were procedure time and intraoperative and postoperative adverse events. Similarly, tertiary outcomes were endocardial time, fluoroscopy time, and postoperative hospitalization.

Results:
Compared with TA, HA treatment through mini-thoracotomy access improved superiority in freedom of atrial arrhythmia after follow-up duration (odds ratio [OR] = 6.67, 95% confidence interval [CI]: 2.63–16.90), but HA increased the incidence of intraoperative and postoperative adverse events for AF patients (OR = 2.98, 95% CI: 1.30–6.83). HA through either mini-thoracotomy or transdiaphragmatic/subxiphoid access had longer procedure time and postoperative hospitalization than TA. However, endocardial time was shorter than TA.

Conclusions:
For AF patients, HA possessed of an overall superior outcome using mini-thoracotomy way to TA. Although HA had longer procedure time, it yielded a reduction in endocardial time. Meanwhile, we should pay attention to the significantly high risk of intraoperative and postoperative adverse events that the HA generated.
Increased HMGB1 expression correlates with higher expression of c-IAP2 and pERK in colorectal cancer
Authors: Zhang Wenjia , An Fangmei , Xia Min , Zhan Qiang , Tian Wenying , Jiao Yang 
Published: January 2019

Abstract
The aim of this study was to investigate the relationship between high-mobility group box 1 (HMGB1) and colorectal cancer (CRC).
In this prospective study, patients with CRC undergoing primary surgery and healthy subjects (control group) were enrolled from July 2013 to December 2014. The serum HMGB1 concentration and HMGB1 mRNA expression were determined using enzyme-linked immunosorbent assay reverse transcription-polymerase chain reaction, respectively. Immunohistochemical analysis was performed to determine HMGB1, pERK, and c-inhibitor of apoptosis protein 2 (c-IAP2) protein expression levels in the cancer tissues.
A total 144 patients with CRC and 50 healthy subjects underwent serum HMGB1 testing. Resected specimens of 50 patients were used for HMGB1 mRNA and protein expression analyses. Mean serum HMGB1 level in the patients with CRC was higher than that of the control group (8.42 μg/L vs 1.79 μg/L, P < .05). Mean serum HMGB1 level in the patients with CRC with distant metastasis was significantly higher than that of the controls (13.32 μg/L vs 7.37 μg/L, P < .05). The HMGB1 mRNA and protein expression levels in the CRC tissues were significantly higher than those in the adjacent normal mucosa. HMGB1 protein expression positively correlated with the lymph node metastasis. There were positive correlations between HMGB1 and c-IAP2 (r = 0.457, P < .05), HMGB1 and pERK (r = 0.461, P < .05), as well as pERK and c-IAP2 (r = 0.399, P < .05).
HMGB1 expression in CRC correlates with distant and lymph node metastasis. It may inhibit apoptosis by inducing activation of pERK and c-IAP2.
Clinical efficacy of low-level laser therapy in plantar fasciitis
Authors: Wang Wei , Jiang Weifeng , Tang Chuanxi , Zhang Xiao , Xiang Jie 
Published: January 2019

Abstract

Background:
Emerging evidence suggests that low-level laser therapy (LLLT) for plantar fasciitis (PF) may be beneficial. However, the convincing study investigating its effectiveness for treatment of PF was scarce. Therefore, a systematic review and meta-analysis was conducted to assess whether LLLT significantly relieve pain of patients with PF.

Methods:
PubMed, EMBASE, EBSCO, Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, Chinese Wan fang, and Cochrane CENTRAL were searched systematically up to March 2018.

Results:
A total of 6 randomized controlled trials were included. The meta-analysis indicated that compared with control group, visual analogue scale (VAS) score significantly decreased at the end point of the treatment in LLLT group. In addition, this improvement is continued for up to 3 months. However, no significant difference was observed according to the Foot Function Index-pain subscale (FFI-p).

Conclusion:
This meta-analysis indicates that the LLLT in patients with PF significantly relieves the heel pain and the excellent efficacy lasts for 3 months after treatment.
Growth hormone replacement therapy improves hypopituitarism-associated hypoxemia in a patient after craniopharyngioma surgery
Authors: Qi Wenting , Gu Feng , Wu Chuyue 
Published: January 2019

Abstract

Rationale:
There are some reports about hypoxemia related to hypopituitarism. However, little is known about the relationship between growth hormone deficiency (GHD) and hypoxemia.

Patients concerns:
A 23-year-old female presented with severe hypoxemia after the operations of craniopharyngioma. Laboratory tests found that serum growth hormone (GH) levels were extremely low.

Diagnosis:
She was diagnosed with growth hormone deficiency-related hypoxemia.

Interventions:
In addition to oxygenation, low doses of GH replacement therapy was conducted for 3-month.

Outcomes:
After 3-month r-hGH replacement therapy, hypoxemia was improved significantly and the level of serum GH was elevated.

Lessons:
We’ve already known that hypopituitarism may induce hypoxemia owing to multiple possible mechanisms according to previous literature. But little is known about growth hormone deficiency-related hypoxemia. Our case shows that GH replacement therapy is an effective treatment, and it's significant to examination the level of GH in serum for hypoxemia patients especially when the cause of hypoxemia is unknown.
Effect of pemetrexed on brain metastases from nonsmall cell lung cancer with wild-type and unknown EGFR status
Authors: Yu Xiaoqing , Fan Yun 
Published: January 2019

Abstract
We aimed to evaluate the effectiveness of pemetrexed-based chemotherapy in wild-type nonsmall-cell lung cancer (NSCLC) patients with brain metastases (BM). Brain metastases are a common cause of mortality in NSCLC patients. For epidermal growth factor receptor (EGFR) wild-type patients, therapeutic options for BM are even limited. Pemetrexed-based therapy is a standard care for patients with EGFR-negative, nonsquamous NSCLC. Besides local therapy, pemetrexed is the preferred chemotherapy for wild-type BM patients, but the efficacy is uncertain.
We retrospectively studied 138 NSCLC patients with BM whose EGFR status were unknown or wild-type. All patients received first-line pemetrexed-based chemotherapy from 2010 to 2015. Forty-six of 89 patients with unknown EGFR status were treated with EGFR TKIs after progression.
Among the 138 patients, 49 (35.5%) were EGFR wild-type and 89 (64.5%) were unknown EGFR status. The median overall survival (OS), and the median intracranial progression-free survival (iPFS) was 21.0 months, 9.5 months, respectively. Patients who received more than 4 cycles of chemotherapy had significantly longer OS than those who received 3 to 4 cycles (Mantel-Byar X-squared = 6.65, P = .001). In the EGFR wild-type group, the median OS, and the median iPFS was 17.7 months, 7.6 months, respectively. And patients treated with pemetrexed plus platinum tended to have a longer OS than those who were treated with pemetrexed alone (P = .078). In the subgroup with unknown EGFR status, we noted a statistically significant improvement in OS for the patients who received EGFR tyrosine kinase inhibitors (TKIs) after progression of 29 months compared to 20.3 months of the EGFR TKIs naïve arm (P = .027).
Pemetrexed shows an ideal effectiveness in EGFR wild-type and unknown status NSCLC patients with BM, and has a favorable control on brain localizations. EGFR wild-type patients can significantly benefit from pemetrexed continuation maintenance.
Nonthrombotic pulmonary embolism caused by intravenous leiomyomatosis
Authors: Wu Yi-Hsiao , Lee Yung-Tsai , Lee Chuin-I , Tzeng Yun-Hsuan , Wei Jeng 
Published: January 2019

Abstract

Rationale:
Pulmonary embolism is a potentially devastating medical condition. Although deep-vein thrombosis is the most common etiology, a nonthrombotic pulmonary embolism is not uncommon.

Patient concerns:
A 45-year-old woman was admitted to our hospital for progressive effort dyspnea for 3 weeks.

Diagnosis:
Echocardiography revealed a mobile mass extending from the right atrium to the bilateral proximal pulmonary artery. As the mass was no response to thrombotic therapy, intravenous leiomyomatosis was suspected. Computed tomography (CT) revealed a hypo-attenuated tumor extending from the ovarian vein to the pulmonary artery.

Interventions:
A 1-stage operation for the surgical removal of the tumor, right salpingo-oophorectomy and subtotal hysterectomy were performed. Surgical specimen was identified as uterine leiomyomatosis without malignant transformation.

Outcomes:
The patient was followed- up for 2 years and subsequent CT did not reveal any notable lesions.

Lessons:
Nonthrombotic pulmonary embolism is a potentially life-threatening complication. This case indicated intravenous leiomyomatosis should be considered in the differential diagnosis for certain cases. Complete surgical excision was the only curative treatment.
Cutaneous vasculitis in a patient with ankylosing spondylitis
Authors: Ye Chao , Li Wenyuan 
Published: January 2019

Abstract

Rationale:
Cutaneous vasculitis is usually found in patients with rheumatoid arthritis (RA) as an extra-articular manifestation, but rare in patients with ankylosing spondylitis (AS). In this case, we describe an AS patient who developed large skin lesions, of which the histological findings were consistent with cutaneous vasculitis.

Patient concerns:
A 22-year-old male who was diagnosed as HLA-27 positive AS for 5 years. However, in the last year, he suffered a recurrent skin lesion in both lower extremities especially the dorsum of feet, accompanying with intense pruritus.

Diagnosis:
The originally diagnosis of the skin lessons was dermatitis, and then a skin biopsy pathology showed it was consistent with cutaneous vasculitis.

Intervention:
At first he was treated with gentamycin and ethacridine for nearly 2 weeks, the symptoms were relieved. But then he suffered severe cutaneous lesions with swell at the ulcerous margin in his dorsum of right foot. The patient was treated with dexamethasone 10 mg intravenous drip daily for 2 weeks, and followed by methylprednisolone 160 mg oral administration daily after discharge. The skin lesions were gradually healed in several months

Outcomes:
This patient was followed up at 1-month, 5-month, and 10-month after discharged, the skin lessons was gradually healed and never occurred.

Lessons:
This case indicated that cutaneous vasculitis might be an extra-articular manifestation of AS in which IgA may plays a pathogenic part. All this may be associated with the damage of cytokines and autoantibodies to vascular endothelial wall caused by active inflammatory phase.
Correlation of CYP2C19 genotype with plasma voriconazole exposure in South-western Chinese Han patients with invasive fungal infections
Authors: Miao Qiang , Tang Jiang-Tao , van Gelder Teun , Li Ya-Mei , Bai Yang-Juan , Zou Yuan-Gao , Wang Lan-Lan , Shi Yun-Ying 
Published: January 2019

Abstract
The aim of this study was to investigate the correlation between CYP2C19 genotype and dose-adjusted voriconazole (VCZ) trough concentrations (C0/dose).
We analyzed the correlation between CYP2C19

∗

2(681G>A), CYP2C19

∗

3(636G>A), and CYP2C19

∗

17(-806C>T) genetic polymorphisms and the dose-corrected pre-dose concentration (C0/dose) in 106 South-western Chinese Han patients.
The frequencies of variant alleles of CYP2C19

∗

2,
∗

3, and
∗

17 were 29.7%, 4.25%, and 0.92%. For 49.3% of the VCZ samples, the therapeutic window between 1.5 and 5.5 μg/ml was reached. Following the first dose VCZ measurement, in subsequent samples the proportion of VCZ C0 within the therapeutic window increased, suggesting effective therapeutic drug monitoring (TDM) (P = .001). The VCZ C0 was significantly different (P = .010) between patients with normal metabolism (NMs), intermediate metabolism (IMs), and poor metabolism (PMs). The VZC C0/dose was 12.2 (interquartile range (IQR), 8.33–18.2 μg·ml−1/kg·day−1), and 7.68 (IQR, 4.07–16.3 μg·ml−1/kg·day−1) in PMs and IMs patients, respectively, which was significantly higher than in NMs phenotype patients (4.68; IQR, 2.51–8.87 μg·ml−1/kg·day−1, P = .008 and P = .014).
This study demonstrated that the VCZ C0/dose was significantly influenced by the CYP2C19 genotype in South-western Chinese Han patients. In this patient population, more over-exposure was observed in patients with a CYP2C19 genotype associated with poor or intermediate metabolism. CYP2C19 genotype-based dosing combined with TDM will support individualization of VCZ dosing, and potentially will minimize toxicity and maximize therapeutic efficacy.
Pre-administration of remifentanil in target-controlled propofol and remifentanil anesthesia prolongs anesthesia induction in neurosurgical patients
Authors: Ahn Jin Hee , Kim Doyeon , Chung Ik Soo , Lee Jeong Jin , Lee Eun Kyung , Jeong Ji Seon 
Published: January 2019

Abstract

Background:
Pre- and co-administration of remifentanil in target-controlled propofol and remifentanil anesthesia are the most common methods in clinical practice. However, anesthesia induction time by timing remifentanil administration was not identified. Therefore, we investigated the induction time of anesthesia based on type of remifentanil administration in target-controlled anesthesia.

Methods:
A total of 60 patients were randomly assigned to 1 of 2 groups: Pre-administered with remifentanil before propofol infusion (Group R, n = 30) and co-administered with remifentanil with propofol (Group N, n = 30). The primary outcome was total induction time based on the order of remifentanil administration. Secondary outcomes were from start of the propofol infusion time to loss of consciousness (LOC), rocuronium onset time, time to Bispectral index (BIS) 60, and hemodynamic variables.

Results:
The mean ± SD of total induction time was 180.5 ± 49.0 s in Group N and 246.3 ± 64.7 s in Group R (mean difference: 65.8 seconds; 95% CI: 35.0–96.5 s, P < .01). Time to BIS 60 and rocuronium onset time were longer in the Group R (P < .01 and P < .01, respectively). The Δheart rate and Δcardiac output values were lower in the Group R (P = .02 and P = .04, respectively). Injection pain was reported by 11 of 28 (39%) in the Group N and in 2 of 28 (7%) in the Group R (difference in proportion: 32%, 95% CI: 10–51%, P = .01).

Conclusion:
Pre-administration of remifentanil in target-controlled propofol and remifentanil anesthesia prolongs total induction time about 35% compared to co-administration of remifentanil and propofol by decreased CO.
Ketoacidosis with euglycemia in a patient with type 2 diabetes mellitus taking dapagliflozin
Authors: Yeo Sang Mok , Park Hayeon , Paek Jin Hyuk , Park Woo Yeong , Han Seungyeup , Park Sung Bae , Jin Kyubok 
Published: January 2019

Abstract

Rationale:
Dapagliflozin (a sodium-glucose cotransporter-2 [SGLT2] inhibitor) represents the most recently approved class of oral medications for the treatment of type 2 diabetes. Dapagliflozin lowers plasma glucose concentration by inhibiting the renal reuptake of glucose in the proximal renal tubules. In 2015, the US Food and Drug Administration released a warning concerning a potential increased risk of ketoacidosis in patients taking this medication.

Patient concerns:
We present the case of a 23-year-old woman with type 2 diabetes treated with dapagliflozin (10 mg, once a day) for 2 years who presented to the emergency department with abdominal pain.

Diagnoses:
We diagnosed her with severe ketoacidosis with a normal glucose level (177 mg/dL) due to dapagliflozin, accompanying acute pancreatitis due to hypertriglyceridemia. We concluded that the precipitating factor for euglycemic ketoacidosis was pseudomembranous colitis.

Interventions:
She was treated with intravenous infusions of insulin, isotonic saline, and sodium bicarbonate as diabetic ketoacidosis treatment.

Outcomes:
She was in shock with severe metabolic acidosis. After continuous renal replacement therapy, the uncontrolled metabolic ketoacidosis was treated, and she is currently under follow-up while receiving metformin (500 mg, once a day) and short- and long-acting insulins (8 units 3 times and 20 units once a day).

Lessons:
We report an unusual case of SGLT2 inhibitor-induced euglycemic ketoacidosis recovered by continuous renal replacement therapy in a patient with type 2 diabetes and recurrent acute pancreatitis due to hypertriglyceridemia. We diagnosed a rare complication of the SGLT2 inhibitor in a patient with type 2 diabetes in whom uncontrolled metabolic ketoacidosis could be effectively managed via continuous renal replacement therapy.
Primary urothelial carcinoma of the prostate
Authors: Zhou Jun , Yang Cheng , Lu Zhaoxiang , Zhang Li , Yin Yu , Tai Sheng , Liang Chaozhao 
Published: January 2019

Abstract

Rationale:
Prostatic urothelial carcinoma is a rare disease. Medical misdiagnosis rates remain high because there are no specific clinical symptoms or imaging features, which decreases patient survival. We report a case of prostatic urethral cancer confirmed by transrectal ultrasound-guided prostate biopsy because of an abnormal digital rectal exam.

Patient concerns:
A 55-year-old man was referred to our hospital due to lower urinary tract symptoms that lasted for 5 years.

Diagnoses and Interventions:
On digital rectal examination, a hard and enlarged prostate was detected. Computed tomography, bone scintigraphy, and magnetic resonance imaging indicated benign prostatic hyperplasia. The patient underwent transrectal ultrasound-guided prostate biopsy. From the histopathological examination and immunohistochemical markers, a diagnosis of high-grade prostatic urothelial carcinoma was made. We excluded the possibility of urothelial cancer originating in the bladder lining after transurethral resection of the bladder. Radical cystoprostatectomy was performed, followed by 6 cycles of cisplatin and gemcitabine chemotherapy. Postoperative pathology showed primary urothelial carcinoma of the prostate.

Outcomes:
The patient recovered smoothly after surgery. After a 6-month follow-up, no evidence of local recurrence or metastatic disease was found.

Lessons:
This case reminds clinicians that, for middle-aged men with suspicious digital rectal examinations, a diagnosis of prostatic urothelial carcinoma should be considered. Initial radical surgery followed by combination chemotherapy is suggested for therapeutic management.
Wendan decoction for dyslipidemia
Authors: Feng Wenwei , Ye Xiaohan , Lv Hongxue , Hou Chijun , Chen Yingjun 
Published: January 2019

Abstract

Background:
Dyslipidemia is one of the most popular metabolic diseases and an important risk factor for arteriosclerotic cardiovascular diseases. In China, Wendan decoction (WDD) has been widely used to treat hyperlipidemia. However, no systematic review has been found. In order to evaluate the efficacy and safety of WDD in the treatment of dyslipidemia, a meta-analysis and systematic evaluation are conducted.

Methods:
The randomized controlled trials (RCTs) evaluating the effectiveness and safety of WDD in the treatment of dyslipidemia will be enrolled. Data are mainly from 4 English databases (Pubmed, Embase, Cochrane Library, and Web of science) and 4 Chinese databases (Wanfang, CBM, CNKI, and VIP Database). The enrollment of RCTs is from the starting date of database establishment till December 15, 2018. Low density lipoprotein cholesterol is considered as the main outcome, while the serum concentrations of total cholesterol, triglyceride, high density lipoprotein cholesterol, apolipoprotein A, and apolipoprotein B are regarded as the secondary outcome. Safety indicators include liver enzyme, fasting blood glucose, and kidney function. The work such as selection of literature, data collection, quality evaluation of included literature, and assessment of publication bias will be conducted by 2 independent researchers. Meta-analysis will be performed by RevMan 5.0 software.

Results:
This study will provide high-quality evidence for the treatment of dyslipidemia with WDD in terms of effectiveness and safety.

Conclusion:
The results of the study will help us determine whether WDD can effectively treat hyperlipidemia.

PROSPERO registration number:
PROSPERO CRD 42018114957.
What is the appropriate duration of adjuvant imatinib mesylate treatment for primary gastrointestinal stromal tumors classified according to the strict definition of tumor rupture?
Authors: Lu Jun , Dai Yun , Zheng Hua-Long , Xie Jian-Wei , Wang Jia-Bin , Lin Jian-Xian , Chen Qi-Yue , Cao Long-Long , Lin Mi , Tu Ru-Hong , Huang Ze-Ning , Lin Ju-Li , Li Ping , Huang Chang-Ming , Zheng Chao-Hui 
Published: January 2019

Abstract
In gastrointestinal stromal tumors (GISTs), rupture is a high-risk feature; however, “tumor rupture” is inconsistently defined, and its prognostic value remains controversial.
Six hundred ninety-one patients undergoing surgery for primary nonmetastatic GISTs from 2003 to 2015 at our institution were enrolled. The strict definitions of “tumor rupture” according to the Kinki GIST Study Group (KGSG) were used.
The median follow-up time was 64 months. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in the entire group were 79.3% and 84.1%, respectively. According to the KGSG's definition, tumor rupture occurred only in 24 (3.5%) of 691 patients. For all 691 patients, multivariable analysis showed that tumor rupture, according to KGSG's definition, is one of the independently prognostic factors for both RFS and OS. Twenty-four patients with tumor rupture were further analyzed. Receiving IM for more than 3 years was significantly associated with improved RFS and OS in GISTs patients with tumor rupture.
Tumor rupture according to KGSG's definition was an independent predictive factor associated with GIST patient prognosis. More importantly, for GISTs with tumor rupture according to the KGSG's strict definition, receiving IM treatment for ≥3 years should be considered.