bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical relevance of alpha-fetoprotein in determining resection margin for hepatocellular carcinoma
Authors: Lee Jin-Chiao , Cheng Chih-Hsien , Wang Yu-Chao , Wu Tsung-Han , Lee Chen-Fang , Wu Ting-Jung , Chou Hong-Shiue , Chan Kun-Ming , Lee Wei-Chen 
Published: March 2019

Abstract
Liver resection for hepatocellular carcinoma (HCC) is associated with high recurrence rates. Adequate resection margin which is carried out by surgeons may reduce tumor recurrence. Nevertheless, the margin width remains controversial particularly in cirrhotic patients where optimal parenchymal preservation is necessary. This study aims to find a reference for proposing the resection margin when liver resection is planning.
Totally, 534 patients who received liver resection for HCC were included. The clinical profiles of the patients, tumor characteristics and patients’ survival were all collected. The patients were classified according to resection margin (<0.5 cm, 0.5–0.99 cm, and ≥1 cm) and preoperative α-fetoprotein (AFP) levels (<15 ng/ml, 15–200 ng/ml, and >200 ng/ml), then survival was calculated.
Most of the patients had hepatitis B (52.4%) and hepatitis C (24.0%) infection. Multivariate analysis showed that narrow resection margin (<0.5 cm) (hazard ratio [HR]: 1.323, P = .024), high AFP level (≥15 ng/ml) (HR: 1.305, P = .039), major extent of resection (≥3 segments) (HR: 1.507, P = .034), and underlying cirrhosis (HR: 1.404, P = .009) were independent risk factors for disease-free survival. In further survival analysis, resection margin was not significant for disease-free survival if serum AFP levels were <15ng/ml. However, for the patients with AFP level between 15 and 200 ng/ml, resection margin ≥0.5 cm was significant to improve 5-year disease-free survival from 24.6 months to 38.7 months (P = .040). For the patients with AFP >200 ng/ml, resection margin had to be extended to ≥1 cm to improve 5-year disease-free survival from 33.9 months to 48.8 months (P = .012). When the patients meeting AFP <15 ng/ml with tumor-free margin, AFP between 15 and 200 ng/ml with margin ≥0.5 cm, and AFP level >200 ng/ml with margin ≥1 cm were compared, their survival rates were not different.
Adequate resection margin can be guided by pre-operative AFP levels. Tumor-free margin is enough for patients with normal AFP level. A resection margin ≥0.5 cm is advised for the patients with AFP between 15 and 200 ng/ml, and ≥1 cm for the patients with AFP over 200 ng/ml.
Dynamic changes of pulmonary arterial pressure in perinatal neonates with pulmonary and extrapulmonary acute lung injury/respiratory distress syndrome
Authors: Yin Tong-jin , Hu Yu-Sheng , Cheng Sheng , Yong Qi-Jun 
Published: March 2019

Abstract
This study aims to explore the dynamic changes of pulmonary arterial pressure (PAP) and its clinical significance in prenatal neonates with pulmonary and extra-pulmonary acute lung injury/respiratory distress syndrome (ALI/ARDS).
A prospective study was conducted in the Neonate Intensive Care Unit (NICU) between May 2015 and April 2017. A total of 78 prenatal neonates with ALI/ARDS were selected and divided into 2 groups: pulmonary group (n = 37) and extra-pulmonary group (n = 41). These neonates were further divided into 3 groups according to the OSI index: mild, moderate, and severe groups. The dynamic changes of PAP were observed in these neonates. In the moderate and severe groups, PAP was significantly higher in neonates with pulmonary ALI/ADDS (ALI/ARDSp) than in neonates with extrapulmonary ALI/ARDS(ALI/ARDSexp) (62.5 ± 5.4 vs 68.0 ± 6.5, 54.7 ± 5.9 vs 64.2 ± 4.9; t = 3.264, 3.123; P = .004,.039). Furthermore, PAP was higher in neonates with ALI/ADDSp in the severe group, compared with those in the moderate group (t = 2.420, P < .05). There was significant difference among the 3 subgroups of neonates with ALI/ADDSexp (F = 60.100, P = .000). PAP was positively correlated with the OSI index (r = 0.823). The overall dynamic PAP monitoring results revealed that PAP was higher in the pulmonary group than that in the extrapulmonary group, and this exhibited a gradually decreasing trend as the condition of the subject improved.
PAP in perinatal neonates with ALI/ARDS increases in varying degrees, and its extent was related to the severity of the illness. PAP was significantly higher in neonates with ALI/ADDSp than in neonates with ALI/ADDSexp. This can be used as a monitoring indicator for the severity of illness.
Electromagnetic navigation bronchoscopic dye marking for localization of small subsolid nodules
Authors: Hyun Kwanyong , Park In Kyu , Song Jae Won , Park Samina , Kang Chang Hyun , Kim Young Tae 
Published: March 2019

Abstract
Thoracoscopic resection of small subsolid nodules is challenging and requires preoperative localization. We investigated the efficacy, safety, and factors affecting accuracy in localizing pulmonary nodules with electromagnetic navigation bronchoscopy (ENB)-guided dye marking.
Patients with small subsolid nodule(s) who underwent thoracoscopic resection after ENB-guided dye marking were retrospectively reviewed. Dye marking was performed at the nearest pleura and the localized nodule(s) was resected thoracoscopically. Efficacy was evaluated by success rates of dye marking and resection of nodules. Navigation accuracy was represented by target distance, which was the closest distance between target and the tip of locatable guide. Factors affecting target distance were evaluated by linear regression analyses.
Twenty-nine ENB-guided dye markings were done for 24 nodules in 20 patients. The success rate of the dye marking and nodule localization were 93.1% (27/29) and 95.8% (23/24), respectively. Twenty-three nodules were completely resected thoracoscopically without conversion. There were no ENB-related complications: pneumothorax or bronchopulmonary hemorrhage. Nine targets were in the upper, 14 in the middle, and 6 in the lower zone. Even though navigation time was longer in the upper zone, target distance showed no significant inter-zone difference. Approach angle was the only significant predictor for target distance (0–45°, estimate = −1.24, P = .01; 45–90°, estimate = −1.26, P = .006; reference = ≥90°).
Localization with ENB-guided dye marking is effective and safe for thoracoscopic resection of small subsolid nodules. For better performance, a pathway with smaller approach angle (<90°) should be selected to increase the navigation accuracy.
Comparison of 1-year clinical outcomes between prasugrel and ticagrelor versus clopidogrel in type 2 diabetes patients with acute myocardial infarction underwent successful percutaneous coronary intervention
Authors: Ahn Kye Taek , Seong Seok-Woo , Choi Ung Lim , Jin Seon-Ah , Kim Jun Hyung , Lee Jae-Hwan , Choi Si Wan , Jeong Myung Ho , Chae Shung Chull , Kim Young Jo , Kim Chong Jin , Kim Hyo-Soo , Cho Myeong-Chan , Gwon Hyeon-Cheol , Jeong Jin-Ok , Seong In-Whan 
Published: March 2019

Abstract
Although the new oral P2Y12 inhibitors, prasugrel/ticagrelor have shown greater efficacy than clopidogrel in patients with the acute coronary syndrome, but they have not shown better efficacy in Korean patients. So we evaluated the efficacy of the prasugrel/ticagrelor in patients with myocardial infarction (MI) and diabetes, a more high-risk patients group.
From the Korea Acute Myocardial Infarction Registry-National Institute of Health, 3985 patients with MI and diabetes who underwent PCI were enrolled between November 2011 and December 2015. The patients were divided into 2 groups: clopidogrel (n = 2985) and prasugrel/ticagrelor (n = 1000).
After propensity score matching, prasugrel/ticagrelor group showed a no significant difference in risk of the composite of cardiac death (CD), recurrent MI or stroke (hazard ratio [HR], 0.705; 95% confidence interval [CI], 0.474–1.048; P = .084). However, the risk of major bleeding was significantly higher in the prasugrel/ticagrelor group. (HR; 2.114, 95% CI; [1.027–4.353], P = .042). In subgroup analysis, major bleeding was significantly increased in the subgroup of creatinine clearance <60 ml/min/1.73 m2, hypertension, underwent a trans-femoral approach and diagnosed as NSTEMI among the prasugrel/ticagrelor group.
The use of prasugrel/ticagrelor did not improve the composite of CD, recurrent MI or stroke, however, significantly increased major bleeding events in Korean patients with MI and diabetes undergoing PCI.
Risk factors of obstetric admissions to the intensive care unit
Authors: Lin Lin , Chen Yan-Hong , Sun Wen , Gong Jing-Jin , Li Pu , Chen Juan-Juan , Yan Hao , Ren Lu-Wen , Chen Dun-Jin 
Published: March 2019

Abstract
The aim of this study was to identify risk factors among obstetric patients admitted to the intensive care unit (ICU).
The study was conducted in Third Affiliated Hospital of Guangzhou Medical University during January 1, 2009 and December 31, 2016. A total of 44,817 pregnant women ≥20 weeks of gestational age were scanned. Demographic characteristics, perinatal outcomes, and risk factors among participants were analyzed.
A number of factors (21) were more prevalent in the ICU admission group. The greatest for admission to the ICU occurred with amniotic fluid embolism, heart disease, acute fatty liver, and referral for care. The incidence of postpartum hemorrhage, hysterectomy, organ failure, and method of delivery differed significantly between groups (P < .05). Adverse neonatal outcome differed significantly between groups (P < .05).
Complications of pregnancy are risk factors for referral to the ICU and may increase risk for unexpected outcomes among mothers and neonates.
A case report of an extranodal NK/T-cell lymphoma nasal type, occurring primarily in eyes with masquerade syndrome
Authors: Zhang Feng , Duan Xuanchu , Liu Ke 
Published: March 2019

Abstract

Rationale:
Extranodal natural killer T-cell lymphoma nasal type (ENKL) is an extremely rare tumor with a very low survival rate. In recent decades, only a few ENKL cases have been published. Presenting a special ENKL case lead the authors to emphasize the primary features of ENKL in early diagnosis and therapy. Here we report an unusual ENKL case which was initially found in the eyes and presented as masqueraded uveitis

Patient concerns:
A 55 years old female, with vision loss in the right eye for approximately 6 months, and vision blurry, redness and pain in the left eye for 2 weeks, was referred to our hospital.

Diagnosis:
Clinical examinations and images demonstrated bilateral anterior uveitis, retinal and choroidal detachment, and secondary glaucoma. After 3 months, the patient began to present a sore throat, fever, and headaches. The computed tomography (CT) and magnetic resonance imaging (MRI) of her skull demonstrated nothing positive. One month later, a neoplasm was found in her nasopharynx and tonsil, which was confirmed, by histopathology, as ENKL

Interventions:
This patient was prescribed with steroid for 3 months because of the first diagnosis by the ophthalmologist. After the other symptoms like a sore throat, fever and headaches occurred, symptomatic treatment was given. Unfortunately, when the real cause was found, the patient could not tolerate the other treatment for ENKL.

Outcomes:
Since the patient was treated with steroid without improvement, she died due to the septic shock and multiple organ failure.

Lessons:
Clinicians should always be cautious to ENKL which can be easily be misdiagnosed in the early stage. Early diagnosis and appropriate treatment are keys to raise the survival rate of ENKL patients.
Does chronic obstructive pulmonary disease relate to poor prognosis in patients with lung cancer?
Authors: Lin Hefeng , Lu Yunlong , Lin Liya , Meng Ke , Fan Junqiang 
Published: March 2019

Abstract

Background:
Nowadays, there is growing recognition that chronic obstructive pulmonary disease (COPD) may have influence on lung cancer. However, coexisted COPD related to prognosis of lung cancer is still elusive. We conducted this meta-analysis to examine the association between COPD and 5-year overall survival (OS) and postoperative pulmonary complications of patients with lung cancer.

Methods:
A comprehensive computer-based online search was conducted using PubMed, Embase, Medline, and the Cochrane Library for articles published before September 30, 2017. We identified 29 eligible studies, which included 70,111 patients in the related literature.

Results:
Twenty-two of the 29 studies provided hazard ratio for OS (1.18, 95% confidence interval: 1.11–1.25; P < .001), it suggested that the presence of COPD indicated poor survival for the patients with lung cancer. In subgroup analysis, the relationship between COPD and OS occurrence remained statistically prominent in the subgroups stratified by study designs, COPD diagnosis timing, lung cancer surgery, cancer stage, and origins of patients. The presence of COPD increased the risk of bronchopleural fistula, pneumonia, prolonged air leakage, and prolonged mechanical ventilation.

Conclusions:
The present meta-analysis suggested that coexisting COPD is associated with poor survival outcomes in patients with lung cancer and higher rates of postoperative pulmonary complications.
Association between BDNF Val66Met polymorphism and generalized anxiety disorder and clinical characteristics in a Mexican population
Authors: González-Castro Thelma Beatriz , Pool-García Sherezada , Tovilla-Zárate Carlos Alfonso , Juárez-Rojop Isela Esther , López-Narváez María Lilia , Frésan Ana , Genis-Mendoza Alma Delia , Pérez-Hernández Nonanzit , Nicolini Humberto 
Published: March 2019

Abstract
The aim of the present case–control study was to explore the association between BDNF Val66Met (rs6265) polymorphism and generalized anxiety disorder in Mexican individuals, and whether this polymorphism plays a role in the symptomatology of anxiety.
A total of 212 subjects were included in the study. Around 75 patients with generalized anxiety disorder were diagnosed by psychiatrists based on the DSM-IV instrument and 137 unrelated subjects psychiatrically healthy were used as comparison group. The subclinical symptomatology in patients was assessed with the State-Trait Anxiety Inventory. BDNF rs6265 genotypes were analyzed using the polymerase chain reaction end-point method.
The association between BDNF Val66Met with the risk for generalized anxiety disorder was evaluated using 4 inheritance models. The present study showed that carrying the Met allele confers increased risk for the presence of generalized anxiety disorder (χ2 = 4.7, P = .03; OR (95%) 1.96 (1.05–3.56)) when patients with generalized anxiety disorder were compared with the comparison group.
Our results provide evidence of an association between the Val66Met polymorphism of the BDNF gene and generalized anxiety disorder in a Mexican population. However, no association was observed between this polymorphism and the symptomatology of anxiety.
Outcomes of unplanned extubation in ordinary ward are similar to those in intensive care unit
Authors: Lin Pi-Hua , Chen Chiu-Fan , Chiu Hsin-Wei , Tai Hsueh-Ping , Lee David Lin , Lai Ruay-Sheng 
Published: March 2019

Abstract
Unplanned extubation (UE) may cause considerable adverse effects in patients receiving mechanical ventilation (MV). Previous literature showed inconsistent prognosis in patients with UE. This study aimed to evaluate the clinical implications and outcomes of UE.
The intubated adult patients with MV support in our hospital were enrolled, and they were divided into the UE and non-UE groups. Demographic data, admission unit, MV duration, overall weaning rate, and mortality rates were compared. The outcomes of UE in ordinary ward and intensive care unit (ICU) were also assessed.
Totally 9245 intubated adult patients were included. UE occurred in 303 (3.5%) patients, and the UE events were 0.27 times/100 MV days. Old age, nonoperation related MV cause, and admission out of the ICU were significant factors associated with UE events. UE patients showed a trend of better overall weaning rate (71.9% vs 66.7%, P = .054) than non-UE. However, the in-hospital mortality rate (25.7% vs 24.8%, P = .713) were similar between the UE and non-UE patients. The reintubation rate of UE patients was 44.1% (142/322). Successful UEs were associated with patients in weaning process (52.8% vs 38.7%, P = .012), and patients received non-invasive positive pressure ventilation (NIPPV) support after UE (19.4% vs 3.5%, P < .001). Patients with successful UE had significantly shorter MV days, higher overall weaning rate, and lower mortality than those with unsuccessful UE. Outcomes of UE in ordinary ward and in ICU had similar MV duration, reintubation rate, overall weaning rate, and in-hospital mortality rate.
The overall weaning rate and in-hospital mortality rates of the UE and non-UE patients were similar. UE occurred in ordinary ward had similar outcomes to those in ICU. Patients receiving MV should be assessed daily for weaning indications to reduce delayed extubation, and therefore, may decrease UE occurrence. Once the UE happened, NIPPV support may reduce the reintubation rate.
Impact of gastric endoscopic submucosal dissection in elderly patients
Authors: Yamaguchi Hayato , Fukuzawa Masakatsu , Kawai Takashi , Matsumoto Taisuke , Suguro Maya , Uchida Kumiko , Koyama Yohei , Madarame Akira , Morise Takashi , Aoki Yuki , Sugimoto Akihiko , Yamauchi Yoshiya , Kono Shin , Tsuji Yuichiro , Yagi Kenji , Itoi Takao 
Published: March 2019

Abstract
With the increase in the elderly population, we are witnessing an increase in the rate of patients with underlying diseases and those under treatment with antithrombotic drugs.
In this study, we compared the treatment outcomes of endoscopic submucosal dissection (ESD) and other parameters in the following 3 groups: super-elderly, elderly, and nonelderly.
Compared with the other groups, the super-elderly group showed a significantly higher incidence of underlying diseases and the rate of antithrombotic treatment (P < .05). However, we observed no significant difference in the rate of curative resection or incidence of complications among the 3 groups. ESD is a relatively safe technique when performed on super-elderly patients. However, we have identified some cases in the super-elderly group, for which ESD was selected as a minimally invasive treatment for lesions that did not meet the inclusion criteria for open surgery as well as for which follow-up observations were selected rather than additional surgery for noncurative resections.
Further investigations concerning ESD are required, focusing on aspects such as indications, additional surgery, and informed consent of the patient or family, particularly when ESD is performed for super-elderly patients.
Vas deferens sonographic appearances of tuberculosis lesions of 19 cases of male genital systemic tuberculosis
Authors: Jing Jigang , Zhuang Hua , Luo Yan , Chen Huijiao , Rao Yaping 
Published: March 2019

Abstract
To investigate the sonographic findings of the vas deferens in male genital tuberculosis.
The ultrasonographic findings of the vas deferens of 19 cases of genital tuberculosis were retrospectively analyzed.
According to the pathological and ultrasound findings, the ultrasonographic appearances of the vas deferens tuberculosis could be divided into 4 groups, 1 of normal sonograms, 3 of abnormal sonograms. The abnormal ultrasonographic appearances of the vas deferens tuberculosis were considered 3 categories as follows: diffusely thickening of vas deferens, nodular thickening of vas deferens, and space-occupying lesions adjacent to the vas deferens.
The ultrasound manifestations of vas deferens in tuberculosis of the male genital system have certain characteristics. Combination of clinical manifestations, history of tuberculosis, experimental antituberculosis treatment, and ultrasound examination of vas deferens can suggest tuberculosis of vas deferens. Furthermore, it can provide objective basis for the comprehensive and noninvasive evaluation of the impact of genital tuberculosis on the reproductive ability for further treatments.
Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure
Authors: Qian Hao , Tang Chengchun , Yan Gaoliang 
Published: March 2019

Abstract
At present, the long-term prognosis of patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention is the focus of attention, and relevant research is actively investigating the risk factors associated with prognosis. Poor prognosis often exists in Patients with AMI complicated with acute heart failure (AHF). In recent years, some studies have found that blood urea nitrogen/creatinine ratio (BUN/Cr) can better predict the prognosis of patients with AHF than single BUN or Cr. The relationship between long-prognosis of patients with AMI, as one of the common causes of AHF, and BUN/Cr is unknown. The main purpose of this study was to determine whether BUN/Cr has a predictive value for long-term prognosis in patients with AMI complicated with AHF.
In this study, 389 consecutive patients with AMI were enrolled. According to AHF and a median BUN/Cr at admission of 15.32, the patients were divided into four groups (non-AHF + low BUN/Cr, non-AHF + high BUN/Cr, AHF + low BUN/Cr, and AHF + high BUN/Cr groups). A 1-year follow-up was implemented, and the study endpoint was defined as all-cause mortality. Predictors associated with 1-year mortality were evaluated using the Cox proportional hazard analysis, and the Kaplan–Meier analysis was used to estimate the survival rates.
AHF occurred in 163 patients (41.9%) during hospital admission and 29 patients died during the 1-year follow-up. The Cox proportional hazard analysis proved an association between the combination of AHF and high BUN/Cr and mortality; however, the association with AHF + low BUN/Cr was not statistically significant.
AHF combined with elevated BUN/Cr is linked with an increased risk of mortality in patients with AMI, which suggests that BNU/Cr has a predictive value for prognosis in patients with AMI complicated with AHF.
Comparison of surgical treatments of tumor-induced osteomalacia in different locations in the lower limbs
Authors: Li Ye , Li Yatong , Hui Min , Liu Yong , Liu Xiaoding , Jin Jin , Gao Peng 
Published: March 2019

Abstract
Tumor-induced osteomalacia (TIO) is a rare disease that behaves benignly. Very few reports about the features of the responsible tumors according to anatomical locations have been presented.
In this retrospective study of 53 patients with TIO-associated tumors in the foot/ankle, tibia and femur, we compared preoperative, postoperative, and follow-up courses, including alkaline phosphatase, phosphorus, and fibroblast growth factor 23, to compare the characteristics of TIO-associated tumors in these 3 locations (level of evidence: therapeutic level III).
Patients in the foot/ankle group had longer disease courses and therefore a significantly higher complication rate (P < .001). All TIO-associated tumors in the foot/ankle group involved soft tissue (P = .021), whereas most lesions in the tibia group involved bone, and therefore had much higher concentrations of alkaline phosphatase (P = .020). Additionally, serum phosphorus took much longer to normalize after surgery in the foot/ankle group than that in the other 2 groups (P = .004). Consequently, symptom remission was much better in the tibia and femur groups (P = .008). Moreover, the Ki 67 index in TIO-associated tumors was significantly higher in the foot/ankle group (P < .001) and the recurrence rate in this group was markedly higher (P = .002).
The TIO-associated tumors in the foot/ankle are characteristically of occult onset, more soft-tissue involvement, and more readily recurrence. More knowledge and examinations are necessary to enable early diagnosis, radical treatments, and minimize recurrence. New therapies are welcomed and needed.