bluuebunny/crossref_metadata_2025_split huggingface dataset:
Homocysteine as a potential predictive factor for high major adverse cardiovascular events risk in female patients with premature acute coronary syndrome
Authors: Wei Mei , Wang Le , Liu Yongsheng , Zheng Mingqi , Ma Fangfang , Qi Yanchao , Liu Gang 
Published: August 2019

Abstract
Background We aimed to investigate correlation of homocysteine (Hcy) level with clinical characteristics, and explore its predictive value for major adverse cardiovascular events (MACE) risk in female patients with premature acute coronary syndrome (ACS).Methods Serum Hcy level was detected from 1,299 female patients with premature ACS. According to the tertile of Hcy level, patients were divided into three groups: lowest tertile group (≤9.1 µmol/L), middle tertile group (9.2~11.6 µmol/L) and highest tertile group (>11.6 µmol/L). MACE incidence was recorded and MACE-free survival was caculated with the median follow-up duration of 28.3 months.Results Increased Hcy correlated with older age ( P <0.001), higher creatinine level ( P <0.001) and enhanced uric acid level ( P =0.001), while reduced fasting glucose concentration ( P <0.001). MACE incidence was 10.7% and it was highest in highest tertile group (22.1%), followed by middle tertile group (7.7%) and lowest tertile group (2.4%) ( P <0.001). Receiver operating characteristic curve showed that Hcy distinguished MACE patients from non-MACE patients with the area under the curve of 0.789 (95% CI: 0.742-0.835). Kaplan-Meier curves revealed that MACE-free survival was shortest in Hcy highest tertile group, followed by middle tertile group and lowest tertile group ( P <0.001). Multivariate Cox’s analyses further showed that higher Hcy level was an independently predictive factor for poor MACE-free survival (middle tertile vs. lowest tertile ( P =0.001, HR: 3.615, 95% CI: 1.661-7.864); highest tertile vs. lowest tertile ( P <0.001, HR: 11.023, 95% CI: 5.356-22.684)).Conclusion Hcy serves as a potential predictive factor for increased MACE risk in female patients with premature ACS.
Clinical characteristics and outcomes for HIV-associated Diffuse Large B-cell Lymphoma in China: A retrospective single-center study
Authors: Wu Jiazhu , Miao Yi , Li Xia , Lou Jincheng , Qian Chuan , Tao Pengfei , Wang Xicheng , Dong Xingqi , Guo JingJing , Liang Jinhua , Xu Wei , Li Jianyong , Min Haiyan 
Published: August 2019

Abstract
Background: Human immunodeficiency virus (HIV) infection is associated with an increased risk of aggressive lymphoma, especially diffuse B cell lymphoma (DLBCL). We aimed to analyze characteristics and outcomes of DLBCL in HIV-associated patients.
Methods: We retrospectively studied HIV-infected patients with DLBCL since 2011. Data on HIV infection and lymphoma characteristics, treatment and outcome were retrieved and analyzed.
Results: In 53 patients with HIV-associated DLBCL, most patients had frequent bad performance status (PS) (74%), elevated LDH level (94%), B symptoms (69%), advanced Ann Arbor (75%), bulky tumor (72%) and extra-nodal involvement (68%) at diagnosis. The median CD4 T cell count was 175/μl, and 17 patients were already on cART treatment. Plasma EBV DNA was detectable in 18 patients (53%, 18/34). Of the patients evaluated at the end of treatment, 21 (64%) achieved CR, 1 (3%) achieved PR and 6 (18%) experienced progressive disease. The 2-year progression free survival (PFS) was 50% and overall survival (OS) rate was 60%. Factors associated with poor PFS in univariate analysis were unfavorable PS, high IPI score and detectable plasma EBV load. High IPI and detectable EBV load correlated with worse OS. However, only detectable plasma EBV load was the independent factor of poor prognosis for PFS (HR: 14.46, 95% CI [2.57-81.50]) and OS (HR: 7.47, 95% CI [1.48-37.59]) in a multivariate Cox regression model.
Conclusions: In our population, HIV-associated DLBCL still presented aggressive characteristics and poor survival outcomes. Plasma EBV DNA could be used as a prognostic factor in HIV-infected DLBCL.
High antimicrobial resistance and plasmid-carrying resistance genes in swine-origin mcr-1-positive Escherichia coli in Guangxi, South China
Authors: Yuan Jingzhi , Wang Xiaoye , Shi Dali , Ge Qiang , Song Xingxing , Hu Wen , Wei Deyuan , Ge Chenling , Li Xun , Hu Chuanhuo 
Published: August 2019

Abstract
Background The discovery of mcr-1-positive Escherichia coli (MCRPEC), a notable superbug, attracted great attention worldwide. Swine-origin multi-drug resistance MCRPEC is a potential threat to public health and safety. To date, few detailed studies regarding swine-origin MCRPEC in Guangxi, South China, have been reported. Results In this study, thirty-three MCRPEC harbored mcr-1 genes were identified from 142 E. coli strains isolated from swine droppings and entrails in Guangxi in 2018. All MCRPEC isolates were assigned to 8 unique STs, including ST10, ST224 and ST410, which overlapped with the human-origin MCRPEC. Additionally, a total of six plasmid replicon types (IncFI, IncHI1, IncY, IncN, IncI1 and IncX1) were found. Moreover, the drug susceptibility of the MCRPEC isolates was tested with 27 antimicrobial agents belonging to 17 antimicrobial categories that are usually used in hospitals. There were 19 extended spectrum beta lactamase (ESBL) E. coli and 12 carbapenem resistant E. coli among the 33 MCRPEC strains. Importantly, the MCRPEC showed a high rate of resistance against two broad-spectrum carbapenem antibiotics, imipenem and meropenem, which are forbidden in livestock production use. Three MCRPEC strains were further identified to be extensively drug-resistant (XDR), and other isolates were recognized as multi-drug-resistant (MDR). Meanwhile, to detect whether plasmid-carrying antimicrobial resistance genes coexisted with the mcr-1 gene in the MCRPEC isolates, a total of 22 plasmid-carrying antimicrobial resistance genes were tested for. The results showed that four ESBL genes and one pAmpC gene were identified. Eight of the MCRPEC isolates also contained the carbapenem gene blaNDM-5, which could cause untreatable infections. Moreover, ten non-lactamase genes were also detected. Conclusion This study indicated that swine-origin MCRPEC isolated in Guangxi seemed to have a high rate of resistance to both regular and final line of defense drugs as well as drug resistance genes, which pose a great threat to human public safety and health.
Installation or exchange of double-J ureteral stent is a risk factor of febrile urinary tract infection in a compromised host
Authors: Kitano Hiroyuki , Teishima Jun , Ohge Hiroki , Matsubara Akio 
Published: August 2019

Abstract
Background : To study the predictors of febrile urinary tract infections (febrile UTI) after the placement of Indwelling double-J ureteral stent (DJS), and effective prophylactic antimicrobial agent.

Methods : Installation or exchange of 298 double-J stents (DJS) ( 66 men and 232 women, median age 67 years, range 42～86) were examined. 258 patients had been given prophylactic antibiotic therapy after the placement of stents, 40 patients with no prophylactic antibiotic therapy.

Results : 14 patients (4.2%) had febrile UTI after the placement of the stent. The pathogens was identified from the pelvic urine culture of 9 patients with febrile UTI. Enterococcus faecalis was the most common pathogen, it accounted for 25.0% of all pathogens. Compromised host was potential risk factors for the febrile UTI in patients with DJS. 1.1% of patients who received with fluoroquinolones or 4.7% of patients with cephalosporin developed a febrile UTI.

Conclusions : Indwelling DJS is a risk factor of febrile UTI in a compromised host, fluoroquinolones may be effective for preventing febrile UTI after placement of DJS.
Validation of EORTC, CUETO and EAU risk stratification in prediction of recurrence, progression and death of patients with initially non-muscle invasive bladder cancer (NMIBC): a cohort analysis with systematic review.
Authors: Jobczyk Mateusz , Stawiski Konrad , Fendler Wojciech , Różański Waldemar 
Published: August 2019

Abstract
Purpose: To validate and summarize current evidence about the reliability of EORTC, CUETO and EAU risk stratification in prediction of recurrence, progression and death of patients with initially non-muscle-invasive bladder cancer (NMIBC).Methods: Retrospective cohort analysis of 322 patients with newly diagnosed NMIBC. We assessed the concordance (Harrell's c-index) of our results with calculated risk scores in Cox proportional hazard regression models and utilized receiver operating characteristic curve analysis (area under curve; AUCROC). Lastly, to further confirm our observations we conducted a systematic reviewResults: 1-year and 5-year c-indices ranged from 0.55 to 0.66 for recurrence and from 0.72 to 0.82 for progression. AUCROC of predictions ranged from 0.46 for 1-year recurrence risk based on CUETO groups to 0.82 for 1-year progression risk based on EAU risk groups. The accuracy of prediction was lower for patients treated with BCG maintenance immunotherapy. EORTC model (overall c-index c=0.64; 95%CI:0.61-0.68) was superior to EAU (p=0.035; 0.62; 95%CI: 0.59-0.66) and CUETO (p<0.001; c=0.53; 95%CI:0.50-0.56) model in recurrence prediction. EORTC model (c=0.82; 95%CI:0.77-0.86) also performed better than CUETO (p=0.008; c=0.73; 95%CI:0.66-0.81) but there was no sufficient evidence that it performed better than EAU (p=0.572; c=0.81; 95%CI:0.77-0.84) for predicting progression. EORTC and CUETO comparably predicted progression in BCG-treated EAU high-risk patients (p=0.48).Conclusions: The division into risk groups by EORTC, CUETO and EAU offered moderately accurate predictions about recurrence and progression of NMIBC, which emphasizes the urgent need for the development of more personalized and accurate predictive tool. EORTC provided the best recurrence and progression prediction.
Treatment of Complex Ureteral Strictures or Defects with Autologous Urinary Tract Muscle Flaps
Authors: Wu Jianchen , LI Xuesong , Pang Dong , Song Zhiqiang , Li Shihai , Chen Biao , Wang Wenjia , Li Shengwen 
Published: August 2019

Abstract
Background The surgical alternatives are complicated for complex ureteral strictures or long defects such as nearly full-length ureteral avulsion and recurrent ureteral strictures after pyeloplasty or ureteroplasty with severe local adhesion. This study was performed to summarize our clinical experience in the treatment of complex ureteral strictures or defects with autologous urinary tract muscle flaps. Methods We retrospectively analyzed seven patients with complex ureteral strictures or defects. The seven patients comprised three men and four women ranging in age from 37 to 61 years (average age, 46 years). The causes of ureteral lesions were nearly full-length ureteral avulsion (n = 2), postoperative ureteral stricture after sigmoid augmentation cystoplasty (n = 1), and postoperative recurrent ureteral stricture due to local inflammation and local adhesion (n = 4). The lengths of the defects in the patients with ureteral avulsion were 22 and 24 cm, and the average length of the recurrent ureteral strictures was 5.2 cm (range, 4–8 cm). The patients underwent ureteroplasty using spiral bladder muscle flaps (n = 4), muscle flaps from the dilated ureter or pelvis segment proximal to the strictures (n = 2), or a bowel segment (sigmoid) (n = 1). Six-French double-J stents were placed in the repaired ureters. Results All operations were successful, and the ureteral double-J stents were safely removed under cystoscopy 8 weeks postoperatively. All of the patients had improvement of hydronephrosis, and none had ureteral strictures on intravenous urography or contrast CT. The patient with failed pyeloplasty was found to have enlarged kidney and dilated calyx postoperatively, but the degree was less severe than preoperatively and three-dimensional CT reconstruction showed renal pelvis reduction and a patent ureter with no stenosis at the reconstruction site. Renal function was normal in all patients. Conclusions Treatment of ureteral strictures or defects with autologous urinary tract muscle flaps can be performed in some complicated cases with good results.
Treatment of Chronic Active Antibody-mediated Rejection in Renal Transplant Recipients – A single center retrospective study
Authors: Chiu Hsien-Fu , Wen Mei-Chin , Wu Ming-Ju , Chen Cheng-Hsu , Yu Tung-Min , Chuang Ya-Wen , Huang Shih-Ting , Tsai Shang-Feng , Lo Ying-Chih , Ho Hao-Chung , Shu Kuo-Hsiung 
Published: August 2019

Abstract
Background: A plethora of evidences suggest that the most important cause of late graft loss in renal transplant recipients is chronic active antibody-mediated rejection. However, there are no consensus on treatment strategies.
Methods: We retrospectively analyzed clinical and pathological data of renal transplant recipients who received kidney graft biopsy with confirmed diagnosis of chronic active antibody-mediated rejection in the past 7 years. The patients were divided into two groups according to treatment strategy: Group 1: aggressive treatment (double filtration plasmapheresis and one of the followings: rituximab, intravenous immunoglobulin, antithymogycte globulin, bortezomib, or methylprednisolone pulse therapy); and group 2: supportive treatment.
Results: From February 2009 to December 2017, a total of 82 graft biopsies with diagnosis of chronic active antibody mediated rejection were identified. Kaplan-Meier analysis of death-censored graft survival showed a worse survival in group 2 (P = 0.015 by log-rank test). Adverse event-free survival was lower in group 1, whereas patient survival was no significant different. Proteinuria and supportive treatment were independent risk factors for graft loss in multivariate analysis.
Conclusions: Aggressive treatment was associated with better graft outcome. However, higher incidence of adverse events merit personalized treatment, especially for those with higher risk of infection. Appropriate prophylactic antibiotics are recommended for aggressive treatment patients.
Therapeutic Iloprost for the treatment of acute respiratory distress syndrome (ARDS) (the ThIlo-Trial): a prospective, randomized, multicenter phase II study
Authors: Haeberle Helene Anna , Prohaska Stefanie , Martus Peter , Straub Andreas , Zarbock Alexander , Marx Gernot , Zago Monica , Giera Martin , Koeppen Michael , Rosenberger Peter 
Published: August 2019

Abstract
Background

Acute respiratory distress syndrome (ARDS) is caused by rapid onset (within hours) acute inflammatory processes in lung tissue, and it is a life-threatening condition with high mortality. The treatment of ARDS to date is focused on the prevention of further iatrogenic damage of the lung rather than the treatment of the initial inflammatory process. Several preclinical studies have revealed a beneficial effect of iloprost on the control of pulmonary inflammation, and in a small number of ARDS patients, iloprost treatment resulted in improved oxygenation. Therefore, we plan to conduct a large multicenter trial to evaluate the effect of iloprost on ARDS.Methods

The Therapeutic Iloprost during ARDS ( ThIIo-Trial) is a multicenter, randomized, clinical phase II trial assessing the efficacy of inhaled Iloprost for the prevention of the development and progression of ARDS in critically ill patients. One hundred fifty critically ill patients suffering from acute ARDS will be treated either by nebulized iloprost or NaCl 0.9% for 5 days. Blood samples will be drawn at defined time points to elucidate the serum levels of iloprost and inflammatory markers during treatment. Mechanical ventilation will be standardized. In follow-up visits at days 28 and 90 as well as 6 months after enrollment, functional status according to the Barthel Index, a health care-related questionnaire and frailty (Vulnerable Elderly Survey) will be evaluated. The primary endpoint is the improvement of oxygenation, defined as the ratio of PaO 2 /FiO 2 . Secondary endpoints include 90-day all-cause mortality, SOFA scores during the study period up to day 90, the duration of mechanical ventilation, the length of ICU stay, ventilator-associated pneumonia, delirium, ICU-acquired weakness and discharge localization. The study will be conducted in three university ARDS centers in Germany.Discussion

The results of the ThIlo-Trial will highlight the anti-inflammatory effect of iloprost on early inflammatory processes during ARDS, resulting in the improvement of outcome parameters in ARDS patients.
Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population
Authors: Subramaniam Mythily , Zhang Yunjue , Lau Jue Hua , Vaingankar Janhavi Ajit , Abdin Edimansyah , Chong Siow Ann , Lee Eng Sing 
Published: August 2019

Abstract
Background: The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the levels of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore. Methods: This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. HRQoL was measured using the EuroQol-5 Dimension (EQ-5D-3L). Data on clinical parameters like hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, five subscales of the EQ-5D and EQ-5D index, respectively. Results: In all, 932 respondents with multimorbidity were recruited for the study. Of them, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents with moderate and high physical activity had significantly lower odds of being overweight (OR: 0.57, 95% confidence interval [CI]: 0.41-0.81, p = 0.002), but had significantly higher odds of having high LDL-C levels (OR: 1.50, 95% CI: 1.02-2.22, p = 0.04), as compared to those with low physical activity. The multiple linear regression model revealed that moderate and high activity level was positively associated with higher EQ-5D index scores (β = 0.05, p < .001) as compared to low activity levels in respondents with multimorbidity. Conclusions: The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.
Oesophageal Cancer Magnitude and Presentation in Ethiopia
Authors: Wondimagegnehu Abigiya , Hirpa Selamawit , Abaya Samson Wakuma , Gizaw Muluken , Getachew Sefonias , Ayele Wondimu , Yirgu Robel , Demeke Tamiru , Dessalegn Berhe , Diribi Jilcha , Kaba Mirgissa , Assefa Mathewos , Jemal Ahmedin , Kantelhardt Eva J. , Addissie Adamu 
Published: August 2019

Abstract
Background Although oesophageal cancer is a public health problem in Ethiopia, there are limited data on the magnitude and distribution of the disease in the country. The aim of this study is to assess the magnitude, socio-demographic and clinical characteristics of oesophageal cancer patients in selected referral hospitals of Ethiopia.Methods A retrospective document review was employed in ten referral hospitals in different regions of Ethiopia. Data were extracted from clinical care records of all clinically and pathologically confirmed oesophageal cancer patients who were diagnosed and treated in those hospitals from 2012 - 2017. A structured data extraction tool was used to collect important variables. Descriptive statistics such as median, interquartile range (IQR) and percentages were computed to describe the regional and national distribution of the disease.Results Over the past six years, a total of 777 oesophageal cancer cases were identified and the median age of these patients was 55 years with IQR of 19. More than half 428 (55.1%) of the cases were males and majority of them were reported from Oromia and Somali regional states with 388 (49.9%) and 202 (25.9%) respectively. The highest number of oesophageal cancer cases were recorded in 2016 with a total number of 185 (23.8%) while the lowest 98 (12.6%) was in 2012. Eighty percent of oesophageal cancer cases were diagnosed at late stage of the disease. More than one-fourth 210 (27.0%) of patients were operated with the majority 156 (74.3%) to insert a feeding tube followed by trans-hiatal oesophagostomy 23 (10.9%). Of the 118 results analysed, squamous cell carcinoma and adeno carcinoma were the predominant histologic type with 67(56.7%), and 43(36.4%) respectively. One fourth 194 (25.0%) of the patients were alive and more than two third 557 (71.7%) patients’ current status were unknown at the time of the review.Conclusions In referral hospitals of Ethiopia, many oesophageal cancer patients came at late stage of the disease and needed palliative care measures. The number of patients seen in Oromia and Somali region hospitals by far exceeds hospitals of the other regions thus postulating possibly unique risk factors in those geographic areas.