bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the diagnostic performance of a decision tree model in suspected acute appendicitis with equivocal preoperative computed tomography findings compared with Alvarado, Eskelinen, and adult appendicitis scores
Authors: Kang Hyo Jung , Kang Hyuncheol , Kim Bohyun , Chae Min Seok , Ha Young Rock , Oh Seong Beom , Ahn Jung Hwan 
Published: October 2019

Abstract
This study evaluated the diagnostic performance of a new clinical approach based on decision tree (DT) analysis in adult patients with equivocal computed tomography (CT) findings of acute appendicitis (AA) compared with previous scoring systems.
This retrospective study of 244 adult patients with equivocal CT findings included appendicitis (AG, n = 80) and non-appendicitis (NAG, n = 164) groups. The chi-squared automatic interaction detection algorithm was for AA prediction. A receiver operating characteristic curve analysis and area under the curve (AUC) were used to compare the DT analysis with Alvarado, Eskelinen score, and adult appendicitis scores (AAS).
The following factors were selected for AA prediction: rebound tenderness severity, migration, urinalysis, symptom duration, leukocytosis, neutrophil count, and C-reactive protein levels. The DT comprised 11 final nodes with the following AA probabilities: node 1, 100% (16/16); node 2, 90% (9/10); node 3, 80% (8/10); node 4, 60.9% (14/23); node 5, 50% (3/6); node 6, 43.8% (7/16); node 7, 22.6% (12/53); node 8, 13% (10/77); node 9, 5.6% (1/18); node 10, 0% (0/12); and node 11, 0% (0/3). The AUC of the DT was higher (0.850 [95% confidence interval {CI}; 0.799–0.893]) than the Alvarado score (0.695 [95% CI; 0.633–0.752]), AAS (0.749 [95% CI; 0.690–0.802]), and the Eskelinen score (0.715 [95% CI; 0.654–0.770]). The results were statistically significant when compared with the AUCs of the Alvarado score, Eskelinen score, and AAS (P < .001, P < .001, P = .003, respectively).
The DT-based approach facilitated AA diagnosis and determination of clinical status in patients with equivocal preoperative CT findings and ambiguous results.
Correlation between right ventricular–pulmonary artery coupling and the prognosis of patients with pulmonary arterial hypertension
Authors: Nie Lin , Li Jun , Zhang Sanping , Dong Yaling , Xu Ming , Yan Menghuan , Zhang Gangcheng , Song Laichun 
Published: October 2019

Abstract
This study aimed to analyze the correlation between the efficiency coefficient of right ventricular–pulmonary artery coupling (η
vv) and the prognosis of patients with pulmonary arterial hypertension (PAH).
A total of 64 patients who underwent right heart catheterization (RHC) were enrolled and divided into PAH and control groups depending on the RHC results. Pressure and volumetric methods were adopted to analyze the results of RHC and cardiac magnetic resonance imaging examination. The η
vv of patients in 2 groups were calculated, and the relationship between η
vv calculated by the 2 methods and the 2-year prognosis of patients with PAH was evaluated.
The hemodynamic index and right ventricular–pulmonary artery coupling parameter of patients with PAH were significantly higher than those in the control group (P < .05). The right ventricular volume parameter in the PAH group was significantly different from that in the control group (P < .05). For patients with PAH, the end-systolic elastance/effective arterial elastance (Ees/Ea) calculated by the volumetric method was significantly related to the prognosis of patients (odds ratio = 0.192, 95% confidence interval: 0.042–0.868, P = .032). When Ees/Ea <0.67 was calculated by the volumetric method, the adverse prognosis of patients with PAH increased significantly (P < .05).
The Ees/Ea calculated by the volumetric method may be better an independent factor for the prognosis of patients with PAH.
Prediction of postoperative survival of triple-negative breast cancer based on nomogram model combined with expression of HIF-1α and c-myc
Authors: Cui Jianxiu , Jiang Hongchuan 
Published: October 2019

Abstract
The aims of this study were to explore the expression of hypoxia inducible factor-1α (HIF-1α) and c-myc protein in triple-negative breast cancer (TNBC) and its clinical prognostic significance, and to establish a prediction model for postoperative survival of TNBC based on nomogram.
A total of 87 patients with TNBC at the Department of Breast Surgery, Beijing Chaoyang Hospital, Capital Medical University from January 2012 to December 2015 were enrolled in this study. Immunohistochemistry was performed to detect the expression of HIF-1α and c-myc protein in breast cancer tissues. Cox regression analyses were performed to explore the correlation between HIF-1α/c-myc expression and clinical pathological parameters as well as prognosis. Receiver-operating characteristic curve was generated for cox multivariate analysis. A nomogram was generated based on the cox multivariate analysis, and a calibration curve was prepared for the nomogram to evaluate the consistency between the predicted probability of the nomogram and the actual observed probability. The stability of nomogram model was validated with an external cohort including 39 TNBC patients.
The positive expression rates of HIF-1α and c-myc protein in breast cancer tissues were 41.4% (36/87) and 55.2% (48/87), respectively. HIF-1α expression was significantly correlated with age, tumor diameter, histological grade, lymph node status, and tumor TNM stage; c-myc expression was significantly associated with tumor diameter, histological grade, lymph node status, and tumor TNM stage. Cox univariate and multivariate analyses showed that HIF-1α and c-myc protein expression, histological grade, lymph node status, and tumor TNM stage were the independent risk factors for postoperative survival in TNBC patients. The AUC of prediction model was 0.843 (0.809–0.887). The nomogram could predict the probability of 3-year disease-free survival according to each patient's condition. The calibration curve displayed good agreement of the predicted probability with the actual observed probability, indicating that the nomogram model had great value of prediction. The external validation indicated the prediction model had good stability.
HIF-1α-positive expression, c-myc positive expression, histological grade III, lymph node positive, and TNM stage III tumors suggested that TNBC patients had a poor prognosis. This prediction model can be used to predict postoperative survival of TNBC.
Idiopathic prepubertal unilateral gynecomastia
Authors: Wang Chenyu , Yu Nanze , Zhu Lin , Zeng Ang 
Published: October 2019

Abstract

Rationale:
Prepubertal unilateral gynecomastia is extremely rare, whose etiology and management strategy are not familiar. We would like to present a case and a literature review of unilateral prepubertal gynecomastia.

Patient concerns:
A 11-year old male patient with complaints of unilateral enlargement of breast tissue presented in our clinic, whose physical examination, biochemical, hormonal and oncologic findings were normal.

Diagnoses:
This patient was diagnosed as idiopathic unilateral prepubertal gynecomastia (IUPG) and self-abasement, social isolation and sensitive of interpersonal relationship.

Interventions:
The patient received subcutaneous mastectomy. Histopathological examinations showed idiopathic gynecomastia of ductal epithelial hyperplasia and active interstitial fibrous hyperplasia, with no evidence of any pathological finding. Immunohistochemical examination showed estrogen receptor (ER)-α positive (70%), epidermal growth factor receptor (EGFR) positive, Her-2 positive (1+), Progesterone Receptor (PR) positive (80%).

Outcomes:
A remarkable improvement was observed both in the physical and mental conditions at the post-surgical 6-month follow-up visit, showing no evidence of recurrence.

Lessons:
Further investigation is needed to clarify the pathogenesis of IUPG. All patients with IUPG should have a full endocrine and oncologic evaluation, and surgical excision may be the individually designed for each patient with the help of MRI of breast.
Does reduced E-cadherin expression correlate with poor prognosis in patients with upper tract urothelial cell carcinoma?
Authors: Tae Bum Sik , Jeong Chang Wook , Kwak Cheol , Kim Hyeon Hoe , Ku Ja Hyeon 
Published: October 2019

Abstract

Background:
E-cadherin has emerged as a prognostic factor of urothelial cell carcinoma. In the present work we investigate the relationship between expression of E-cadherin and clinical outcomes, following radical nephroureterectomy for upper tract urothelial cell carcinoma.

Methods:
We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify eligible studies published until July 2017.

Result:
Six studies were included in the meta-analysis, with a total of 1014 patients. The pooled hazard ratio (HR) for recurrence-free survivor was 0.69 (95% confidence interval [CI], 0.44–1.09, I
2 = 63%, P = .04). Also, reduced E-cadherin was not significantly associated with poor cancer-specific survivor (pooled HR, 1.40; 95% CI, 0.66–1.43, I
2 = 54%, P = .11). The pooled HR for overall survivor was not statistically significant (pooled HR, 0.68; 95% CI, 0.32–1.46, I
2 = 80%, P = .007). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis.

Conclusions:
Reduced E-cadherin expression did not appear to be significantly associated with disease prognosis after nephroureterectomy in the meta-analysis. However, further high quality, prospective studies are warranted to better address this issue.
The usefulness of stereotactic radiosurgery for recursive partitioning analysis class II/III lung cancer patients with brain metastases in the modern treatment era
Authors: Ha In Bong , Song Jin Ho , Jeong Bae Kwon , Jeong Hojin , Lee Yun Hee , Choi Hoon Sik , Kang Ki Mun 
Published: October 2019

Abstract
Stereotactic radiosurgery (SRS) is considered the initial treatment for lung cancer patients with small-sized and limited number of brain metastases. The objective of this study was to assess clinical outcomes of SRS treatment using CyberKnife (CK) for recursive partitioning analysis (RPA) class II/III patients with 1 to 3 brain metastases from lung cancer and identify which patients in the high RPA class could benefit from SRS.
A total of 48 lung cancer patients who received CK-based SRS for their metastatic brain lesions from 2010 to 2017 were retrospectively analyzed. Radiographic response was evaluated during follow-up period. Overall survival (OS) and intracranial progression-free survival (IPFS) were calculated and prognostic variables associated with OS and IPFS were evaluated.
Median follow-up time was 6.6 months. Local control rates at 6 months and 1-year following SRS were 98% and 92%, respectively. The median OS of all patients was 8 months. One-year and 2-year OS rates were 40.8% and 20.9%, respectively. In multivariate analysis, uncontrolled primary disease (P = .01) and Eastern Cooperative Oncology Group performance status of 2 or 3 (P = .001) were independent prognostic factors for inferior OS. These 2 factors were also significantly associated with inferior IPFS. In subgroup analysis according to RPA class, primary disease status was the only prognostic factor, showing statistically significant OS differences in both RPA class II and III (controlled vs uncontrolled: 41.1 vs 12.3 months in RPA class II, P = .03; 26.9 vs 4.1 months in RPA class III, P = .01).
Our results indicated that SRS could be an effective treatment option for RPA class II/III patients with brain metastases from lung cancer in the modern treatment era. SRS might be particularly considered for patients with controlled primary disease.
Treatment experience of thoracic aortic aneurysm recurrence after multiple surgeries for Marfan syndrome
Authors: Chen Huai-Dong , He Fan , Qian Xi-Ming 
Published: October 2019

Abstract

Rationale:
Marfan syndrome (MFS), an autosomal dominant hereditary disease, often results in structural and functional abnormalities of the aortic wall. Because of residual aortic aneurysm or aortic dissection, patients with MFS usually need repeat operations after the first operation.

Patient concerns:
A patient diagnosed with MFS who had undergone 2 surgeries because of abdominal aortic dissection aneurysm and Stanford A type aortic dissection at different times.

Diagnoses:
MFS.

Interventions:
Due to aneurysmal dilatation of the residual descending aorta, we performed the third surgery for him through using 2 artificial stent grafts to fix and package the area of the remaining vessel in our hospital.

Outcomes:
The result was good, and the patient was discharged successfully.

Lessons:
Using artificial material to repair and wrap the area of the residual vessel during the first surgery can provide an anchor area for future endovascular stent implantation and also offer a possibility for stent implantation in patients with MFS.
Predicting weaning difficulty for planned extubation patients with an artificial neural network
Authors: Hsieh Meng Hsuen , Hsieh Meng Ju , Cheng Ai-Chin , Chen Chin-Ming , Hsieh Chia-Chang , Chao Chien-Ming , Lai Chih-Cheng , Cheng Kuo-Chen , Chou Willy 
Published: October 2019

Abstract
This study aims to construct a neural network to predict weaning difficulty among planned extubation patients in intensive care units.
This observational cohort study was conducted in eight adult ICUs in a medical center about adult patients experiencing planned extubation.
The data of 3602 patients with planned extubation in ICUs of Chi-Mei Medical Center (from Dec. 2009 through Dec. 2011) was used to train and test an artificial neural network (ANN) model. The input features contain 47 clinical risk factors and the outputs are classified into three categories: simple, difficult, and prolonged weaning. A deep ANN model with four hidden layers of 30 neurons each was developed. The accuracy is 0.769 and the area under receiver operating characteristic curve for simple weaning, prolonged weaning, and difficult weaning are 0.910, 0.849, and 0.942 respectively.
The results revealed that the ANN model achieved a good performance in prediction the weaning difficulty in planned extubation patients. Such a model will be helpful for predicting ICU patients’ successful planned extubation.
Epileptiform EEG discharges and sevoflurane in children
Authors: Miao Mengrong , Xu Yuehua , Cong Xuhui , Zhang Liyuan , Zhang Jiaqiang 
Published: October 2019

Abstract

Background:
Epileptiform discharges in electroencephalogram (EEG) have been frequently reported in children undergoing sevoflurane mask induction. However, the incidence, characteristics and risk factors of these epileptiform patterns during sevoflurane anesthesia in children are poorly understood. The aim of this study is to systematically review the epileptic potential of sevoflurane in children with the EEG monitoring.

Methods:
PubMed, EMBASE, Cochrane library (Central) will be systematically searched from inception to December 2018. The effect of sevoflurane on epileptic EEG patters in children will be studied. The primary outcome will be the incidence of epileptic discharges, the characteristics and risk factors of these epileptic discharges. Meta-analysis will be calculated using R software 3.5.1.

Results:
This study will offer new evidence of the incidence, characteristics and risk factors of EEG epileptic discharges during sevoflurane anesthesia.

Conclusion:
The conclusion drawn from this systematic review will benefit the children with or without epilepsy undergoing sevoflurane anesthesia.

Ethics and dissemination:
Ethics approval is unnecessary because data of individual patients will not be included and no privacy will be involved. The results of this review will be published in a peer-reviewed journal or a conference report. Amendments of the basic protocol will be documented in the comprehensive review.

PROSPERO registration number:
PROSPERO CRD 42019122008.
An investigation of lower urinary tract symptoms and its potential associated factors in adult Chinese women with zero-inflated negative binomial regression model
Authors: Xu Tao , Zhang Lei , Li Zhiyi , Zhu Lan , Han Shaomei 
Published: October 2019

Abstract
Lower urinary tract symptoms (LUTS) have detrimental impact on health-related quality of life. This study has 2 aims: first to identify the optimum model for LUTS study and then to explore the potential associated factors of LUTS and bother LUTS with the optimum model among adult women in China.
The survey was conducted in 6 regions of China between February and July 2006. A modified Chinese Bristol Female LUTS questionnaire was administered. The number of LUTS was the main outcome measure. The fitting goodness was compared to identify the optimum model with likelihood ratio test statistics. Zero-inflated negative binomial (ZINB) model was used to explore the potential associated factors of LUTS and bother LUTS.
Of all 18,992 respondents, 55.5% of respondents reported one (any LUTS) or more LUTS (mixed LUTS) and 36.5% of respondents reported one or more bother LUTS. With the largest log likelihood and smallest AIC and BIC, ZINB model showed the best goodness of fit. In the ZINB model, we identified multiple associated factors for any LUTS and mixed LUTS; older age (β≥0.2), overweight [β = 0.059, 95%CI (0.016∼0.102)], obese [β = 0.143, 95%CI (0.087∼0.198)], postmenopausal status [β = 0.099, 95%CI (0.023∼0.175)], prolonged labor [β = 0.188, 95%CI (0.104∼0.272)], constipation [β = 0.309, 95%CI (0.262∼0.357)], coexisting pelvic organ prolapse (POP) [β = 0.348, 95%CI (0.224∼0.473)], diabetes (β = 0.178, 95%CI (0.100∼0.257), hypertension [β = 0.092, 95%CI (0.041∼0.143)], smoking (β = 0.192, 95%CI (0.127∼0.258) and alcohol consumption [β = 0.063, 95%CI (0.001∼0.126)] increased the odds of mixed LUTS. We identified multiple associated factors for bother LUTS and mixed LUTS; older age (β ≥ 0.1), prolonged labor [β = 0.153, 95%CI (0.031∼0.275)], constipation [β = 0.359, 95%CI (0.292∼0.426)] coexisting POP (β = 0.212, [95%CI (0.031∼0.393)], diabetes [β = 0.154, 95%CI (0.030∼0.278)], and smoking [β = 0.169, 95%CI (0.076∼0.262)] increased the odds of bother mixed LUTS.
ZINB model was the optimum model to explore the potential associated factors of LUTS. Older age, coexisting POP and constipation were both closely related to any and bother LUTS, also the severity of LUTS. Compared to nulliparity, single or multiple deliveries and women who had perineal laceration had nothing to do with the severity of LUTS.
Autologous platelet-rich plasma separation technology used in the same patient receiving 2 complicated aortic surgeries within a short time period
Authors: Chang Yi , Zhang Rongwei , Tian Ayong 
Published: October 2019

Abstract

Rationale:
Autologous platelet-rich plasma (PRP) separation technology has been widely used in various clinical therapies, and has achieved good results, especially in aortic surgeries.

Patient concerns:
A 50-year-old man who was diagnosed with aortic dissection (Stanford B type), a thoracoabdominal aortic aneurysm, and grade 2 hypertension underwent 2 complicated aortic surgeries within 4 months.

Diagnoses:
aortic dissection (Stanford B type).

Interventions:
PRP separation used as a blood protection measure was employed in both 2 surgeries.

Outcomes:
The patient's coagulation function recovered well after the surgeries. The amount of allogeneic blood products used in the perioperation was small.

Lessons:
PRP separation technology combined with blood salvage and warming of blood and fluid transfusion in the aortic surgery has been proved to be feasible and beneficial.
Comparison of 3-dimensional laparoscopy and conventional laparoscopy in the treatment of complex renal tumor with partial nephrectomy
Authors: Hu Mingqiu , Guan Chao , Xu Haibin , Gu Mingli , Fang Wenge , Yang Xuezhen 
Published: October 2019

Abstract
To compare the efficacies of 3-dimensional laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy for complex renal tumors. The complex renal tumors was defined as Preoperative Aspects and Dimensions Used for an anatomical (PADAU) ≥10, including some cT1b tumors.
This was a retrospective analysis of patients with local complex renal tumors who presented to our hospital from January 2014 to January 2018. All patients were managed with laparoscopic partial nephrectomy (LPN) or 3-dimensional partial nephrectomy (3DLPN).
There were 48 patients in the LPN group and 60 in the 3DLPN group. In the matched groups, demographic and tumor characteristics including Charlson Comorbidity Index, PADUA, based on the preoperative images, were similar. By contrast, 3DLPN achieved better results in terms of warm ischemia time (19 vs 27 minutes), operation time (105 vs 128 minutes), postoperative complications (14.9% vs 23.4%), and marginal width (0.6 cm vs 0.4 cm). We found statistically significant differences in terms of length of stay, estimated blood loss (EBL), positive surgical margin (PSM), and conversion to open or radical nephrectomy (RN). Median follow-up time was 17 and 18.5 months for the LPN and 3DLPN groups, respectively. The recovery of renal function (% change eGFR, 0 vs −8.7) was significantly different between the 3DLPN and LPN groups, whereas 12-month recurrence-free survival did not differ.
Both 3-dimensional laparoscopic nephron-sparing nephrectomy and conventional laparoscopic partial nephrectomy are safe, effective, and acceptable approaches to treating complex renal tumors, while the former may facilitate tumor resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.