bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of programmed cell death ligand 1 expression in patients with ovarian carcinoma
Authors: Huang Li-Jun , Deng Xiao-Feng , Chang Fan , Wu Xian-Lan , Wu Yang , Diao Qi-Zhi 
Published: October 2018

Abstract

Background:
Programmed cell death ligand 1 (PD-L1) overexpression has been reported to be associated with poor prognosis in several human cancers. However, studies on the prognostic value of PD-L1 expression in ovarian carcinoma (OC) remain controversial. This meta-analysis aimed to evaluate comprehensively the prognostic value of PD-L1 in OC.

Methods:
Electronic databases, including PubMed, EMBASE, and the Cochrane Library, were searched up until March 28, 2018. Hazard ratio (HR), along with 95% confidence interval (CI), was used to analyze the included outcomes.

Results:
A total of 10 studies with 1179 OC patients were included in this meta-analysis. There was no significant correlation between PD-L1 expression and overall survival (OS) (HR 1.23, 95% CI 0.85–1.79) and progression-free survival (PFS) (HR 0.88, 95% CI 0.52–1.47) of OC patients. However, the subgroup analysis suggested that positive PD-L1 expression was significantly associated with poor OS (HR 1.66, 95% CI 1.08–2.55) and PFS (HR 2.17, 95% CI 1.31–3.61) among OC patients from Asian countries. Increased PD-L1 expression was also a favorable factor for OS (HR 0.73, 95% CI 0.53–0.99) and PFS (HR 0.58, 95% CI 0.45–0.75) in OC patients from non-Asian regions. No evidence of publication bias was detected by the Egger linear regression test and Begg funnel plot. Sensitivity analyses suggested that the results of this meta-analysis were robust.

Conclusions:
The results indicated that PD-L1 expression may be a negative predictor for prognosis of OC patients from Asian countries, and a good predictor for favorable prognosis of OC patients from non-Asian countries. PD-L1 expression has potential to be a prognostic biomarker to guide clinicians for the selection of individuals who may get clinical benefit from anti-PD-1/PD-L1 immunotherapy. Prospective clinical studies are needed to support these findings.
A special superior cortex compressive fracture of femoral neck
Authors: Xian Hang , Zhang Hang , Lian Kejian , Lin Dasheng 
Published: October 2018

Abstract

Rationale:
Garden type I femoral neck fractures are incomplete stable fractures with impaction in valgus fractures that the question of whether there exists Garden type I femoral neck fracture is currently uncertain. There is still disagreement on the existence of the Garden type I fractures.

Patient concerns:
Herein we report 2 cases with the Garden type I femoral neck fractures. Both of them had a history of simple fall.

Diagnoses:
The X-ray showed incomplete fractures of the femoral neck and the Garden classification is type I. Further computed tomography and magnetic resonance imaging were used to confirm the diagnosis of this type fracture, which showed that the superior cortex of femoral neck was discontinuous and the inferior cortex remains intact.

Interventions:
The conservative treatment schedule including immobilization of the affected lower limb, strict bed rest, bed-to-wheelchair transfer training, and half-to-full weight bearing mobilization were chosen to treat the patients.

Outcomes:
Both of them achieved fracture union with conservative treatment at 3-month follow-up. No secondary displacement, signal of osteonecrosis of the femoral head or other complications occurred during 24-month follow-up in 2 cases.

Lessons:
Although the Garden type I femoral neck fractures are rare, our report is in line with the real existence of it.
The pretreatment platelet-to-lymphocyte ratio predicts clinical outcomes in patients with cervical cancer
Authors: Ma Jian-ying , Ke Li-chi , Liu Qin 
Published: October 2018

Abstract

Introduction:
The platelet-to-lymphocyte ratio (PLR) has been reported to possess significant prognostic value in multiple types of cancer. However, its prognostic value in patients with cervical remains controversial. We conducted a meta-analysis to evaluate the prognostic value of pretreatment PLR in cervical cancer.

Methods:
We searched the MEDLINE, EMBASE, and Cochrane databases to identify studies evaluating the prognostic significance of the pretreatment PLR in patients with cervical cancer. The end points were overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and clinicopathological parameters. All statistical analyses were conducted with Stata 13.0.

Results:
A total of 12 studies comprising 3668 patients with cervical cancer were included. Elevated PLR was significantly correlated with poor OS [hazard ratio (HR): 1.56, 95% confidence interval (CI): 1.32–1.85, P < .001] and DFS/PFS (HR = 1.56; 95% CI = 1.26–1.94; P < .001). In addition, elevated PLR was highly correlated with lymphovascular space invasion (+), lymph node metastasis (+), tumor size (>4 cm), grade (G3).

Conclusion:
The pretreatment PLR could serve as a predicative biomarker of poor prognosis for patients with cervical cancer.
Diagnostic accuracy of endoscopic ultrasound, computed tomography, magnetic resonance imaging, and endorectal ultrasonography for detecting lymph node involvement in patients with rectal cancer
Authors: Wang Xin , Gao Ya , Li Jipin , Wu Jiarui , Wang Bo , Ma Xueni , Tian Jinhui , Shen Minghui , Wang Jiancheng 
Published: October 2018

Abstract

Background:
Rectal cancer is one of the most common tumors and is the leading cause of cancer-related deaths in developed countries. Lymph node involvement remains the strongest prognostic factor associated with a worse prognosis in patients with rectal cancer. Several systematic reviews have investigated the accuracy of endoscopic ultrasound, computed tomography, magnetic resonance imaging, and endorectal ultrasonography for lymph node involvement of rectal cancer and compared the diagnostic accuracy of different imaging techniques, but there are considerable differences in conclusions. This study aims to assess the methodological quality and reporting quality of systematic reviews and to determine which diagnostic imaging techniques is the optimal modality for the diagnosis of lymph node involvement in patients with rectal cancer.

Methods:
We will search PubMed, EMBASE, Cochrane Library, and Chinese Biomedicine Literature to identify relevant studies from inception to June 2018. We will include systematic reviews that evaluated the accuracy of diagnostic imaging techniques for lymph node involvement. The methodological quality will be assessed using AMASAR checklist, and the reporting quality will be assessed using PRISMA-DTA checklist. The pairwise meta-analysis and indirect comparisons will be performed using STATA V.12.0.

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

Conclusion:
This overview will provide comprehensive evidence of different diagnostic imaging techniques for detecting lymph node involvement in patients with rectal cancer.

Ethics and dissemination:
Ethics approval and patient consent are not required as this study is an overview based on published systematic reviews.

PROSPERO registration number:
CRD42018104906.
The prognostic impact of tumor length in esophageal cancer
Authors: Zhang Xiangwei , Wang Yang , Jiang Yuanzhu , Wang Zhaoyang , Zhao Linping , Xue Xianbiao , Sang Shaowei , Zhang Lin 
Published: October 2018

Abstract

Background:
More and more studies were performed to explore the prognostic role of tumor length in esophageal cancer (EC). However, the results remain controversial. Hence, the aim of the review was to evaluate the association between tumor length and oncologic outcome in EC patients through meta-analysis.

Methods:
A systematic literature search for relevant articles published in English language will be conducted in the PubMed, Web of Science, and Embase. Hazard ratio and 95% confidence intervals (CIs) will be employed as effect measures to estimate the correlation between tumor length and the oncologic outcomes including overall survival, disease-free survival, progression-free survival, relapse-free survival, and cancer-specific survival. We will use the software STATA 14.0 to perform the meta-analysis to calculate the data synthesis.

Results:
The review will provide a high-quality synthesis of current evidence of the prognostic role of tumor length in ECs. The results will be published in a peer-reviewed journal.

Conclusion:
This will be the first systematic review and meta-analysis to evaluate the prognostic role of tumor length in EC patients. The results will better predict EC survival and identify higher-risk patients for postoperative therapy.

PROSPERO registration number:
This systematic review protocol has been registered in the PROSPERO network (No. CRD42018106851).
Association of 18F-FDG PET or PET/CT results with spontaneous remission in classic fever of unknown origin
Authors: Takeuchi Motoki , Nihashi Takashi , Gafter-Gvili Anat , García-Gómez Francisco Javier , Andres Emmanuel , Blockmans Daniel , Iwata Mitsunaga , Terasawa Teruhiko 
Published: October 2018

Abstract

Background:
Spontaneous remission is common in patients with undiagnosed classic fever of unknown origin (FUO). Although identifying reliable predictors of spontaneous remission in such diagnostically challenging cases could improve their management strategies, few studies have assessed such clinical factors. Recently, studies have reported that 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) alone and integrated with computed tomography (PET/CT) were useful in localizing the source of FUO. In this systematic review and meta-analysis, we assessed the association of results of these imaging modalities with spontaneous remission in patients with classic FUO.

Methods:
We searched PubMed and Scopus from inception until June 30, 2018, and studies that evaluated the PET or PET/CT results of ≥10 adult or adolescent patients with classic FUO who were followed up for at least 3 months were included. At least 2 investigators extracted data and rated quality using the QUIPS-2 tool. We used a random-effects meta-analysis to calculate summary risk ratios (RRs) with 95% confidence intervals (CIs).

Results:
Nine studies of PET/CT results (418 patients) and 4 studies of standalone PET results (128 patients) were eligible. None explicitly specified the incidence of spontaneous remission as the primary or secondary outcomes of interest. The risk of bias was considered high in all studies because patients received subsequent diagnostic workup based on imaging results. Patients with negative PET/CT results were significantly more likely to present with spontaneous regression than those with positive results (summary RR = 5.6; 95% CI: 3.4–9.2; P < .001; I

2
= 0%). In contrast, no significant association was found between standalone PET results and spontaneous remission. The random-effects study-level meta-regression found that PET/CT results [relative RR (rRR) = 7.4; 95% CI: 2.5–21.3; P = .002], compared with standalone PET results, and publication year (rRR = 1.2 per 1 year; 95% CI: 1.0–1.3; P = .013) were significantly associated with spontaneous remission.

Conclusion:
Limited data suggest that undiagnosed classic FUO patients with negative PET/CT results had a high likelihood of spontaneous remission after a series of unsuccessful investigations for fever workup. Prospective studies should validate these results.
An aortic intra mural hematoma in ventilation/perfusion SPECT/CT
Authors: Robin Philippe , Delcroix Olivier , Abgral Ronan , Le Roux Pierre-Yves , Salaun Pierre-Yves 
Published: October 2018

Abstract

Rationale:
Ventilation/perfusion (V/Q) single-photon-emission computed tomography (SPECT) has arisen as an alternative to computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) suspicion. The addition of low dose CT (ldCT) to V/Q SPECT improves the specificity of the test, allowing for potential alternative diagnosis.

Patient concerns and diagnosis:
Here we presented a case of an aortic intramural hematoma (IMH) diagnosed on the ldCT portion of V/Q SPECT combined with CT. A 74-year-old man suffering from sudden-onset chest pain was referred to our nuclear medicine department for PE suspicion.

Intervention and outcome:
A V/Q SPECT combined with nonenhanced ldCT ruled out PE diagnosis. Nevertheless, ldCT revealed high attenuation aortic wall thickening suggestive of aortic IMH. Chest CT angiography showed mild dilatation and circumferential thickening of aortic wall confirming Stanford type A IMH involving the entire ascending aorta.

Lesson:
This case illustrates the potential usefulness of combining ldCT to V/Q SPECT in providing alternative diagnosis in suspected PE patients.
Diabetes management in a Primary Care Network (PCN) of private general practitioners in Singapore
Authors: Luo Miyang , Poh Zhongxian , Koh Gerald , Tham Tat Yean , Lau Winifred , Toh Sue Anne , Chong Chin Kwang , Low Lian Leng , Venkataraman Kavita 
Published: October 2018

Abstract
A Primary Care Network (PCN) is a virtual network of general practitioners (GPs), sharing common resources and common clinical governance framework for effective chronic disease management. In this study, we analyzed the frequency of assessment as well as control of HbA1c, blood pressure (BP), and low-density lipoprotein (LDL) over time among adult patients with diabetes managed by a group of private GPs under PCN.
Data, including clinical measurements of HbA1c, BP, and LDL from 2012 to 2015, of 943 subjects at 9 GP clinics that piloted PCN in Singapore in 2012 was obtained from the chronic disease register for this analysis.
The total number of PCN patients increased from 371 in 2012 to 911 in 2015. The average HbA1c decreased from 7.5% in 2012 to 7.3% in 2015, with a significant yearly improving trend of −0.11% (P < .001). The trends in change for systolic BP and LDL were not statistically significant during the same follow-up period. Regular assessment of HbA1c decreased from 80% in 2012 to 55% in 2015. Such decreases were also found in BP and LDL assessments. We also found that receiving government subsidies under a national scheme was a major determinant for maintaining regular assessment, with patients so covered 3 to 20 times more likely to have regular assessments.
The PCN model can help improve care and clinical outcomes in adult patients with diabetes in the private primary care sector. Investing greater financial and human resources to augment service capacity and expanding subsidy coverage may be important to ensure the effectiveness, scalability, and sustainability of such a model of care.
Vitamin D and bisphosphonates therapies for osteoporosis are associated with different risks of atrial fibrillation in women
Authors: Yang Hung-Yu , Huang Jen-Hung , Chiu Hung-Wen , Lin Yung-Kuo , Hsu Chien-Yeh , Chen Yi-Jen 
Published: October 2018

Abstract
Osteoporosis and atrial fibrillation (AF) are common in post-menopausal women. Vitamin D and bisphosphonates are widely used to treat osteoporosis, and these may have different effects on the risk of AF.
The goal of this study was to evaluate whether different agents for treating osteoporosis modulate the risk of AF in a population-based database.
We identified 20,788 female patients suffering from osteoporosis who were or were not treated with vitamin D or bisphosphonates using the Taiwan National Health Insurance nationwide database from 2000 to 2008 and followed them up for 5 consecutive years to determine if they had a new diagnosis of AF after the diagnosis of osteoporosis.
There were 14 (2.67%) new AF diagnoses in osteoporosis patients treated with bisphosphonates, one (0.28%) new AF diagnosis in patients treated with vitamin D, and 279 (1.40%) new AF diagnoses in patients who were not treated with vitamin D or bisphosphonates (neither group). Osteoporosis patients who received bisphosphonates showed a higher incidence of AF occurrence than those that were not treated with bisphosphonates (P = .015). In contrast, 1 patient who received vitamin D had a new diagnosis of AF during the study period; thus, the incidence was significantly lower than that in the patients treated with bisphosphonates (P = .007). In addition, the patients who were treated with vitamin D had a lower incidence of AF than did those who were not treated with either vitamin D or bisphosphonates (P = .074). Kaplan–Meier analysis also showed a significant difference in AF occurrence in different groups during the 5-year follow-up (P = .010).
Different treatment for osteoporosis may carry diverse risks of AF occurrence. Vitamin D may have potential beneficial effects of reducing AF occurrence in osteoporosis patients.
Evaluation of the clinical outcomes of telehealth for managing diabetes
Authors: Wu Cong , Wu Zixiang , Yang Lingfei , Zhu Wenjun , Zhang Meng , Zhu Qian , Chen Xiaoying , Pan Yongmiao 
Published: October 2018

Abstract

Introduction:
The objective of this study was to systematically review the literature and perform a meta-analysis comparing the clinical outcomes of telehealth and usual care in the management of diabetes.

Methods:
Multiple strategies, including database searches (MEDLINE, PsycINFO, PubMed, EMBASE, and CINAHL), searches of related journals and reference tracking, were employed to widely search publications from January 2005 to December 2017. The change in hemoglobin A1c (HbA1c) levels was assessed as the primary outcome, and changes in blood pressure, blood lipids, body mass index (BMI), and quality of life were examined as secondary outcomes.

Results:
Nineteen randomized controlled trials (n = 6294 participants) were selected. Telehealth was more effective than usual care in controlling the glycemic index in diabetes patients (weighted mean difference = −0.22%; 95% confidence intervals, −0.28 to −0.15; P < .001). This intervention showed promise in reducing systolic blood pressure levels (P < .001) and diastolic blood pressure levels (P < .001), while no benefits were observed in the control of BMI (P = .79). For total cholesterol and quality of life, telehealth was similar or superior to usual care.

Conclusion:
Telehealth holds promise for improving the clinical effectiveness of diabetes management. Targeting patients with higher HbA1c (≥9%) levels and delivering more frequent intervention (at least 6 times 1 year) may achieve greater improvement.
Role of Xingnaojing combined with naloxone in treating intracerebral haemorrhage
Authors: Xu Yu-Min , Wang Xin-Chen , Zhang Shi-Jie , Xu Ting-Ting , Li Hong-Ying , Hei Shang-Yan , Wen Ze-Huai , Ma Yun-Zhi , Wang Qi , Liang Wei-Xiong 
Published: October 2018

Abstract

Background:
Xingnaojing injection (XNJ) sharpen the mind and induce consciousness and are widely used in acute phases of intracerebral hemorrhage (ICH). Naloxone hydrochloride injection (NX) performs equally well and replace the effects of morphine-like substances to promote conscious awareness. The applications of XNJ combined with NX for ICH show some advantages compared with NX applied individually. The aim of this systematic review is to evaluate the effectiveness and safety of XNJ combined with NX for ICH.

Methods:
Comprehensive searches were conducted in 8 medical databases (PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, CBM and Wanfang database) from inceptions to October 2017 for randomized controlled trials (RCTs) that compared the applications of XNJ and NX with NX applied individually in ICH. Literature screening, assessing risk of bias and data extraction were conducted by 2 reviewers independently. According to the Cochrane Collaboration's RevMan5.3 software to perform the data analysis.

Results:
32 RCTs (3068 cases) were selected and the quality of studies were low. All trials compared XNJ and NX with NX applied individually. The overall meta-analysis results showed that XNJ combined with NX have significant effect on clinical efficacy (OR 3.78, 95% CI: 3.03–4.73; P < .00001), GCS score (MD 3.86, 95% CI: 3.46–4.25; P < .00001), coma duration (MD −5.59, 95% CI: −6.96 to −4.22; P < .00001), NIHSS score (MD −6.24, 95% CI: -8.05 to −4.42; P < .00001), Barthel Index score (MD 14.12, 95% CI: 6.7–21.54; P < .0002), cerebral hematoma volume (MD -6.05, 95% CI: −6.85 to −5.24; P < .00001) than NX applied individually. Adverse events reported in 4 studies and included mild discomfort symptoms.

Conclusion:
The effectiveness and safety of XNJ combined with NX for ICH cannot be determined due to the low quality of literature, publication bias and heterogeneity. More rigorous RCTs are necessary to verify the role of XNJ combined with NX in the treatment of ICH.
Clinicopathologic features of endometrial cancer in Chinese patients younger than 50 years with a family history of cancer
Authors: He Yuan , Tao Xiang , Huang Feifei , Jia Nan , Du Yan , Yu Jinming , Feng Weiwei 
Published: October 2018

Abstract
Genetic factors play an important role in shaping the biologic characteristics of malignant tumors, especially in young patients. We aimed to determine the clinicopathologic features of endometrial cancer (EC) in patients younger than 50 years with a family history of cancer.
Overall, 229 patients with EC, including 40 with a positive family history of cancer (PFH) and 189 with a negative family history of cancer (NFH), were enrolled in this case–control study. The family history of cancer in a 2-generation pedigree was recorded for the PFH group. Clinicopathologic features such as menarche age, body mass index, personal cancer history, grade, and histologic type were compared between the 2 groups. Mismatch repair (MMR) proteins including MLH1, PMS2, MSH2, and MSH6 were assessed by immunohistochemistry (IHC) in surgical samples. Univariate (Pearson Chi-squared test, Fisher exact test, T test, Wilcoxon rank sum test, logistic regression) statistics and stepwise multivariate logistic regression were used to identify factors associated with PFH in the analysis.
Among young patients with EC, the PFH group had younger age-of-onset age of endometrial cancer (≤40 years) (odds ratio [OR] = 2.21, 95% confidence interval [95% CI]: 1.01–4.82) than the NFH group. The proportion of overweight/obese patients was high in both the NFH (58.7%) and PFH (80%) groups. Colorectal, lung, endometrial, breast, and hepatocellular carcinoma accounted for 58.6% of all cancer types among 1st- and 2nd-degree relatives. Additionally, 19.2% of patients displayed deficiency in at least 1 MMR protein, with a significantly higher proportion of MMR protein deficiency in the PFH group than in the NFH group (adjusted OR = 4.81, 95% CI: 2.14–8.83).
Clinicopathologic features differ for young patients with EC with and without a family history of cancer. Surveillance of age-of-onset and family history of endometrial cancer, reduction of barriers to healthy lifestyles, and development of risk-appropriate Lynch syndrome screening tools, such as IHC, are needed for these women in Shanghai and other developing cities in China.