bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease
Authors: Ye Zengpanpan , Ai Xiaolin , Liao Zenglin , You Chao , Cheng Yongzhong 
Published: July 2019

Abstract

Objective:
Neutrophil to lymphocyte ratio (NLR) is considered as an inflammatory biomarker for clinical outcomes in patients with chronic obstructive pulmonary disease (COPD). We aimed to conduct a meta-analysis to evaluate the prognostic values of NLR for the exacerbation and mortality in patients with COPD.

Methods:
We searched the database of Cochrane Central Register of Controlled Trials, EMBASE, and PubMed, before September 2017. The eligible studies were retrieved by 2 authors independently following the criteria. The pooled odds ratios (ORs) of included studies were used to evaluate the prognostic values of NLR. Subgroup analyses were conducted to make the results more accurate.

Results:
Nine studies with 5140 patients were enrolled in this analysis. The high NLR was associated with higher risk of exacerbation (OR: 3.81, 95% confidence interval [CI]: 1.20–12.13, P = .02) and mortality (OR: 2.60, 95% CI: 1.48–4.57, P < .01). By subgroup analysis, high NLR could predict the mortality in patients >70 years (OR: 2.16, 95% CI: 1.17–3.98, P = .01) but not in patients <70 years (OR: 4.08, 95% CI: 0.91–18.24, P = .07), and had a higher predictive ability in Asian group (OR: 3.64, 95% CI: 1.87–7.08, P < .01) than Eurasia group (OR: 1.82, 95% CI: 1.43–2.32, P < .01). In addition, high NLR could predict the short-term mortality (OR: 2.70, 95% CI: 1.10–6.63, P = .03) and the long-term mortality (OR: 2.61, 95% CI: 1.20–5.65, P = .02).

Conclusions:
The NLR may be an independent predictor for incidence of exacerbation in patients with COPD. In addition, high NLR may be associated with higher mortality in patients with COPD, especially for Asian and the patients with higher mean NLR.
Umbilical cord blood-based gene signatures related to prenatal major depressive disorder: Retracted
Authors: Liu Wenhua , Zhang Lan , Zheng Donglin , Zhang Yijie 
Published: July 2019

Abstract

Background:
Prenatal exposure to depression has been considered as a risk factor for adverse childhood, while it is accompanied by unknown molecular mechanisms. The aim of this study was to identify differentially expressed genes (DEGs) and associated biological processes between cord blood samples from neonates born to mothers who exposed to major depressive disorder (MDD) and healthy mothers.

Methods:
The microarray data GSE114852 were downloaded to analyze the mRNA expression profiles of umbilical cord blood with 31 samples exposed to prenatal MDD and 62 samples with healthy mothers. Kyoto Encyclopedia of Genes and Genomes pathway and Gene ontology enrichment analyses were conducted to identify associated biochemical pathways and functional categories of the DEGs. The protein–protein interaction network was constructed and the top 10 hub genes in the network were predicted.

Results:
The results showed several immunity related processes, such as “phagosome”, “Epstein-Barr virus infection”, “proteasome”, “positive regulation of I-kappaB kinase/NF-kappaB signaling”, “interferon-gamma-mediated signaling pathway”, and “tumor necrosis factor” presented significant differences between two groups. Most of the hub genes (for example PSMD2, PSMD6, PSMB8, PSMB9) were also associated with immune pathways.

Conclusion:
This bioinformatic analysis demonstrated immune-mediated mechanisms might play a fatal role in abnormalities in fetal gene expression profiles caused by prenatal MDD.
Asymptomatic left posterior mediastinal functional paraganglioma
Authors: Yue Yang , Xin Hua , Li Fu-Qiang , Wu Jun-Duo , Liu Jun-Zhi , Zhang Le-Ning 
Published: July 2019

Abstract

Rationale:
Paraganglioma refers to a set of neuroendocrine tumors derived from the chromaffin cells of the adrenal diplomatic ganglion. Paragangliomas can be classified as functional or nonfunctional based on the ability to synthesize and release catecholamines.

Patient concerns:
We report a 47-year-old man with a functional paraganglioma in the left posterior mediastinum and highlight the key elements of management of mediastinal paragangliomas.

Diagnoses:
A left posterior mediastinal mass was found by computed tomography (CT) scan and Chest-enhanced CT. Preoperative ultrasound-guided biopsy suggested the possibility of a paraganglioma. A diagnosis of paraganglioma was established by immunohistochemistry.

Interventions:
The patient underwent single-stage resection of the lesion via left thoracotomy after preoperative oral α-adrenoceptor (phenoxybenzamine) therapy and intravenous fluid resuscitation for two weeks.

Outcomes:
The postoperative period was uneventful. The patient exhibited no abnormal blood pressure or recurrence during the 12-month follow-up period.

Lessons subsections as per style:
Pathological examination alone cannot determine whether it was a benign or malignant paraganglioma, which can be determined by pathological examination combined with distant metastasis. Long-term follow-up is required to assess the treatment effect.
The clinical significance of PYCR1 expression in renal cell carcinoma
Authors: Weijin Fu , Zhibin Xie , Shengfeng Zheng , Xiaoli Yang , Qijian Ding , Jiayi Liu , Qiumei Liang , Yilong Chen , Hua Mi , Deyun Liu , Jiwen Cheng 
Published: July 2019

Abstract
Pyrroline-5-carboxylate reductase 1 (PYCR1) is an enzyme involved in cell metabolism and is upregulated in cancer. However, the correlations of PYCR1 expression with the clinicopathological features and prognosis of renal cell carcinoma (RCC) remain unclear. The purpose of this study was to identify the expression of PYCR1 and its clinical relevance in RCC patients.
PYCR1 mRNA expression differences between RCC and the adjacent normal renal tissues were assessed using the Cancer Genome Atlas database (TCGA). Subsequently, the expression of PYCR1 mRNA and protein were evaluated by quantitative real-time polymerase chain reaction, Western blot, and immunochemistry using 30 paired frozen samples of RCC and the adjacent normal renal tissues. The protein expression of PYCR1 was evaluated by immunostaining formalin-fixed, paraffin-embedded sections of RCC samples from 96 patients who underwent radical nephrectomy, and its relationship with clinical features were analyzed. Nonpaired t tests were used to statistically analyze the differences between the 2 groups. Cox univariable and multivariable analyses of overall survival (OS) among RCC patients were performed.
The expression of PYCR1 mRNA was significantly upregulated in RCC tissues compared to adjacent normal renal tissues in the TCGA database (P < .01). The area under the receiver operating characteristic curve value was 0.748. The expression of PYCR1 mRNA and protein was significantly upregulated in RCC compared with that in paired normal renal tissues (P < .01). Higher PYCR1 levels were associated with metastasis (P < .01). Kaplan–Meier survival curves indicated that higher PYCR1 expression was correlated with poorer OS. Therefore, PYCR1 may act as a novel prognostic marker and therapeutic target in the diagnosis and treatment of RCC.
Fenestration deformity of the basilar artery trunk with an aneurysm
Authors: Zhang Donghuan , Wang Honglei , Feng Yingli , Xu Ning 
Published: July 2019

Abstract

Rationale:
Fenestration of the basilar artery is most common in the proximal portion near the vertebrobasilar artery junction. Conversely, fenestration of the middle and distal portions of the basilar artery is not common, and fenestration of the basilar artery with an aneurysm is even less common.

Patient concerns:
This study reports the case of a 37-year-old woman with basilar artery fenestration malformation and an aneurysm at the mid-distal junction; her symptoms included sudden headaches with nausea and vomiting.

Diagnoses:
Head digital subtraction angiography showed fenestration at the junction of the middle and upper portions of the basilar artery associated with an aneurysm, and spontaneous pseudoaneurysm formation could not be excluded.

Interventions:
The patient underwent stent-assisted fenestration and channel occlusion.

Outcomes:
Five months later, no abnormalities were found by head magnetic resonance imaging. The stents were well positioned, and no occluded branches or aneurysms were present.

Lessons:
For mid-distal basilar artery fenestration malformation with an aneurysm, occlusion of the lesion channel is relatively safe when there are no perforating vessels in the fenestration channel and the lesion channel is a nondominant channel. Overall, more attention should be paid to the possibility of pseudoaneurysm formation in the diagnosis and treatment of this type of aneurysm.
Scalp melanoma with rectus abdominis metastasis
Authors: Hsu Kuo-Feng , Chen Chun-Yu , Chu Tzi-Shiang , Liu Hung-Hui , Chang Chun-Kai , Wu Chien-Ju , Lin Chin-Ta , Wang Chih-Hsin , Tzeng Yuan-Sheng , Dai Niann-Tzyy , Chen Shyi-Gen 
Published: July 2019

Abstract

Rationale:
The main cause of death in melanoma patients is widespread metastases as it can metastasize to almost every organ. However, melanoma skeletal muscle metastases (MSMM) are exceptional, and only a few cases of MSMM to the rectus abdominis muscles have been previously described. And our case maybe the first reported case in Asia region.

Patient concerns:
A 45-year-old man with history of right scalp melanoma, pT3aN0M0, stage IIA status post wide excision with 2 cm safe margin and right neck lymph node dissection at 5 years before. He had an almost 5 years disease-free period but presented to our clinic due to intermittent abdominal sharp pain for 1 to 2 months, with a palpable soft tissue mass over his right abdomen. Metastatic melanoma to rectus abdominis muscles was highly suspected.

Interventions:
The patient subsequently underwent radical en-block extraperitoneal 15 cm segmental resection of the right rectus abdominis muscle including tumor mass. The resected tumor was a black-gray colored solid mass, and the final histologic study showed a metastasis of melanoma.

Outcomes:
Postoperative course of the patient was uneventful, and the right abdominal pain was improved. The patient was referred for further target therapy, but passed away half a year later due to multiple metastasis.

Lessons:
Scalp melanoma with isolated rectus muscle metastasis is extremely rare especially for a young aged patient who had an almost 5-year disease-free period. Surgery is a potentially curative therapy for patients with isolated metastatic melanoma. The goal is negative resection margins, in order to avoid local recurrences. Radical compartmental surgery should be considered for selected stage IV melanoma patients with sole rectus abdominis MSMM, whose disease could be amenable to complete resection, in preliminary procedure to prolong disease-free survival time. For oligometastatic disease, surgical resection is sometimes useful in carefully selected patients after systemic therapy; also, it could be performed as symptomatic treatment.
Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery
Authors: Tseng Wei-Cheng , Lin Wei-Lin , Lai Hou-Chuan , Huang Tsai-Wang , Chen Pin-Hsuan , Wu Zhi-Fu 
Published: July 2019

Abstract

Background:
Thoracic epidural analgesia is the preferred method for postoperative analgesia following thoracic surgery. However, intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. This study was conducted because few scientific reports exist comparing fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment of postoperative pain after video-assisted thoracic surgery (VATS).

Methods:
This prospective, and randomized study included 70 patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during movement, successful and unsuccessful triggers after pressing the PCA device button, the need for rescue analgesia, drug-related adverse events, and patient satisfaction were recorded for 48 hours postoperatively.

Results:
No significant differences in the intensity of pain at rest or during movement were observed between the 2 groups within 48 hours postoperatively. The number of unsuccessful PCA triggers in the t-PCEA group 0 to 4 hours after surgery was significantly higher than that in the fk-IVPCA group. However, the numbers of successful PCA triggers in the fk-IVPCA group at 4 to 12 and 0 to 24 hours after surgery were significantly higher than those in the t-PCEA group. The incidence of analgesic-related side effects and patient satisfaction were similar in both groups.

Conclusions:
Compared with t-PCEA, the addition of a subanesthetic dose of ketamine to fentanyl-based IVPCA resulted in similar pain control after VATS with no increase in the incidence of drug-related adverse effects. The results confirm that both multimodal intravenous analgesia and epidural analgesia can provide sufficient pain control and are safe strategies for treating acute post-thoracotomy pain.
“Left at right” liver transplantation with heterotopic implantation of left liver graft in the right subphrenic space
Authors: Chan Kun-Ming , Cheng Chih-Hsien , Wu Tsung-Han , Lee Chen-Fang , Wu Ting-Jung , Chou Hong-Shiue , Lee Wei-Chen 
Published: July 2019

Abstract
Conventional orthotopic implantation of left liver grafts is technically demanding and requires consideration of limited space and vascular complications. The study proposed a modified approach termed “left at right” liver transplantation (LAR-LT), wherein left liver grafts were rotated and implanted in right subphrenic spaces. The selection of recipients for this approach is based on the measurement of the right subphrenic space width and left liver graft length, in which a rotated left liver graft could be comfortably placed in the right subphrenic space. A total of 36 recipients who had undergone LAR-LT between July 2006 and December 2017 were retrospectively reviewed. None of recipients died of complications related to this approach immediately after operation. All grafts showed remarkable increment in liver volume and bi-directional regeneration to fit well within the right abdominal cavity. Meanwhile, the alignment of the biliary tree in LAR-LT is quite straight, making no difficulty in both anastomosis during operation and dealing with biliary stenosis afterward. As such, long-term outcome of LAR-LT is satisfactory. Keeping in mind certain technical concerns, a heterotopic LAR-LT might be safely applied as an alternative with an easier reconstruction procedure for select patients.
Impacts of the surgical safety checklist on postoperative clinical outcomes in gastrointestinal tumor patients
Authors: Wang Hao , Zheng Taohua , Chen Dong , Niu Zhaojian , Zhou Xiaobin , Li Shikuan , Zhou Yanbing , Cao Shougen 
Published: July 2019

Abstract
A 19-item surgical safety checklist (SSC) was published by the World Health Organization in 2008 and was proved to reduce postoperative complications. To date, however, the impacts of SSC implementation in China have not been evaluated clearly. The study was performed to evaluate the impacts of the SSC on postoperative clinical outcomes in gastrointestinal tumor patients.
Between April 2007 and March 2013, 7209 patients with gastrointestinal tumor who underwent elective surgery at the Affiliated Hospital of Qingdao University were studied. Data on the clinical records and outcomes of 3238 consecutive surgeries prior to SSC implementation were retrospectively collected; data on another 3971 consecutive surgeries performed after SSC implementation were prospectively collected. The clinical outcomes (including mortality, morbidity, readmission, reoperation, unplanned intervention and postoperative hospital stay) within postoperative 30 days were compared between the two groups. Univariate and multivariate logistic regression analysis were performed to identify independent factors for postoperative complications.
The rates of morbidity and in-hospital mortality before and after SSC implementation were 16.43% vs 14.33% (P = .018), 0.46% vs 0.18% (P = .028), respectively. Median of postoperative hospital stay in post-implementation group was shorter than that in pre-implementation group (8 vs 9 days, P < .001). Multivariable analysis demonstrated that the SSC was an independent factor influencing postoperative complications (odds ratio = 0.860; 95% CI, 0.750–0.988).
Implementation of the SSC could improve the clinical outcomes in gastrointestinal tumor patients undergoing elective surgery in China.
The risk of end-stage renal disease in systemic lupus erythematosus
Authors: Choi Hong Sang , Han Kyung-Do , Jung Jin-Hyung , Kim Chang Seong , Bae Eun Hui , Ma Seong Kwon , Kim Soo Wan 
Published: July 2019

Abstract
Systemic lupus erythematosus (SLE) is known to be one of the leading causes of end-stage renal disease (ESRD). The aim of this study was to estimate the incidence rate of ESRD and the risk for progression to ESRD in SLE patients compared to the general population.
A total of 21,253 SLE patients were extracted from the Korean National Health Insurance Service database between 2008 and 2013. Age-and sex-matched controls (n = 106,265) were randomly sampled in a 5:1 ratio from non-SLE individuals. Both cohorts were followed up for development of ESRD until 2015.
During the median 7.53 years of follow-up, 533 (2.51%) cases of ESRD were newly developed in SLE patients and 145 (0.14%) cases in matched controls (incidence rate: 4.075 and 0.219 per 1000 person-year, respectively). SLE patients were at higher risk for ESRD development compared to matched controls (hazard ratio [HR], 9.84; 95% confidence interval [CI] 8.10–11.96) after multivariate adjustment. In subgroup analysis, the risk for ESRD was higher in male (HR, 7.76; 95% CI 5.07–11.90) and female patients with SLE (HR, 10.48; 95% CI 8.41–13.07) than in matched controls. When analyzed by age group, the younger the age, the higher the risk of ESRD versus non-SLE matched controls; this result was also significant after adjustment. In subgroup analysis according to comorbidities, the SLE group had a significantly higher risk of ESRD than the non-SLE group in almost all subgroups.
SLE was associated with an increased incidence of ESRD.
A simple algorithm for non-invasive diagnosis of significant liver histological changes in patients with CHB and normal or mildly elevated alanine transaminase levels
Authors: Li Qiang , Huang Chenlu , Xu Wei , Hu Qiankun , Chen Liang 
Published: July 2019

Abstract
Significant liver histological changes (SLHC) were defined as moderate to severe liver inflammation (A2 or higher) and/or fibrosis (F2 or higher) using the METAVIR scoring system. This study aimed to develop an algorithm for the non-invasive detection of SLHC in patients with chronic hepatitis B (CHB) and normal or mildly elevated alanine transaminase (ALT) levels.
Using liver histology as gold standard, we developed a simple algorithm for the diagnosis of SLHC in a training set (504 patients), and then validated the diagnostic accuracy in a validation set (166 patients).
A new algorithm (AAG) attributed to age, ALT, and gamma-glutamyl transpeptidase (GGT) was developed. In the training set, the area under ROC curve (AUROC) of AAG was significantly higher than that of ALT, aspartate transaminase (AST), GPR, and APRI for the diagnosis of SLHC (0.74, 0.68, 0.65, 0.56, and 0.53, respectively; all P < .05). In the validation set, the AUROC of AAG was also higher than that of ALT, AST, GPR, and APRI (0.73, 0.65, 0.62, 0.62, and 0.61, respectively; all P < .05). Using AAG ≥ 2, the sensitivity and negative predictive value was 84% to 98% and 75% to 94%, respectively, for the diagnosis of SLHC. Using AAG ≥ 6, the specificity and positive predictive value was 93% to 97% and 67% to 79%, respectively, for the diagnosis of SLHC.
The AAG algorithm represents a novel noninvasive method for the diagnosis of SLHC in CHB patients with normal or mildly elevated ALT levels.
A pancreatic mucinous cystic neoplasm undergoing intriguing morphological changes over time and associated with recurrent pancreatitis
Authors: Shioyama Erika , Mitoro Akira , Ogawa Hiroyuki , Kubo Takuya , Ozutsumi Takahiro , Kitagawa Koh , Yoshikawa Masaaki , Ueda Shigehiko , Akahori Takahiro , Marugami Naga-aki , Hatakeyama Kinta , Yamao Junichi , Sho Masayuki , Ohbayashi Chiho , Yoshiji Hitoshi 
Published: July 2019

Abstract

Rationale:
Mucinous cystic neoplasms (MCNs) are pancreatic mucin-producing cystic lesions with a distinctive ovarian-type stroma. The diagnosis is generally easy in typical cases; however, differential diagnosis is difficult in others such as in the case we report herein.

Patient concerns:
A 27-year-old woman with sudden onset of epigastric pain was referred to our hospital for suspected acute pancreatitis. Contrast-enhanced computed tomography revealed a 25-mm cystic lesion in the pancreas and a low density area with delayed enhancement at the right upper side of the cystic lesion.

Diagnoses:
During its clinical course, the cystic lesion underwent various morphological changes. Eventually, it presented typical findings of MCNs, and could be accurately diagnosed.

Interventions:
Laparoscopic distal pancreatectomy was performed on the patient by preserving the spleen.

Outcomes:
The patient revealed no symptoms till 1 year after the operation.

Lessons:
This case of MCN with intriguing short-term morphological changes was associated with recurrent pancreatitis. A combination of imaging modalities is essential for accurate diagnosis of MCNs, and follow-up with serial imaging might be useful for certain unusual lesions.
Grade-lymph node ratio predicts the survival of breast cancer in different molecular types
Authors: Liu Chaoqun , Li Huiyao , Zhuo Ran , Wang Lijun , He Lihua , Ruan Qiqi , Luan Xiaoyi , Mo Xiujuan , Sun Yi 
Published: July 2019

Abstract
The prognostic value and conflicting results of metastatic lymph node ratio (mLNR) on breast cancer have aroused an increasing concern. We aimed to evaluate the imperative of mLNR classification and prognostic factors in breast cancer with molecular subtypes.
This study uses the database of surveillance, epidemiology, and end results (SEER) to investigate the imperative for reliable mLNR classification and critical prognostic factors in breast cancer with different molecular subtypes.
The prognostic characteristics for disease-specific survival (DSS) of breast cancer were investigated in the SEER cohort (n = 3651). mLNR (P = .017) and histology grade (P < .001) were independent factors. A novel grade-lymph node ratio (G-R) staging system was proposed for breast cancer prognosis. The receiver operating characteristic curves revealed that the G-R staging system had an accurate 1-, 3-, and 5-year DSS prediction. Further stratification analysis with molecular subtypes of breast cancer (Luminal and TNBC) first proved robust prognostic values of the G-R staging system among molecular subtypes.
The current population-based cohort demonstrated the capacity of mLNR serving as a critical prognostic factor. Also, G-R staging system has the potential to be regarded as reliable classification for breast cancer patients with different molecular subtypes.