Search

Objective To date, no biomarkers have been established to predict haematological complications and outcomes of extracorporeal membrane oxygenation (ECMO). The aim of this study was to investigate the expression of a panel of microRNAs (miRNAs), which are promising biomarkers in many clinical fields, in patients before and after initiating ECMO. Methods Serum miRNA levels from 14 patients hospitalized for acute respiratory failure and supported with ECMO in our medical intensive care unit were analysed before and 24 hours after ECMO. In total, 179 serum-enriched miRNAs were profiled by using a real-time PCR panel. For validation, differentially expressed miRNAs were individually quantified with conventional real-time quantitative PCR at 0, 24, and 72 hours. Results Under ECMO support, platelet count significantly decreased by 65 × 103/µL (25th percentile = 154.3 × 103/µL; 75th percentile = 33 × 103/µL). Expression of the 179 miRNAs investigated in this study did not change significantly throughout the observational period. Conclusions According to our data, the expression of serum miRNAs was not altered by ECMO therapy itself. We conclude that ECMO does not limit the application of miRNAs as specific clinical biomarkers for the patients’ underlying disease.

Background The factors that influence cognitive function in patients with atrial fibrillation (AF) remain unclear. Methods This study involved an AF group and control group (normal sinus rhythm) of 150 patients each. Cognitive function was assessed with the adjusted Mini-Mental State Examination (MMSEadj) score and Memory and Executive Screening (MES) score. The relationship between cognitive function and the CHA2DS2VASc score was analyzed. Subgroup analysis was performed according to stroke history. Clinical factors affecting the MMSE score were screened by logistic regression analysis. Results Baseline data were similar between the two groups. The MMSEadj and MES scores were significantly lower in the AF than control group; the mean MMSEadj score in the AF non-stroke subgroup and control non-stroke subgroup was 26.2 ± 2.7 and 27.9 ± 2.0, respectively. In non-stroke patients with AF, the MMSEadj and MES scores were negatively correlated with the CHA2DS2VASc score. Factors significantly influencing the MMSE score in these patients were age, education, smoking history, NT-proB-type natriuretic peptide, hemoglobin, and anticoagulation. Conclusion AF is associated with cognitive dysfunction regardless of stroke history. High CHA2DS2VASc scores are associated with impaired cognitive function. Factors influencing cognitive function in non-stroke patients with AF are age, education, smoking history, NT-proB-type natriuretic peptide, hemoglobin, and anticoagulation.

Objective Deep neck infection (DNI) associated with descending necrotizing mediastinitis (DNM) is a highly lethal condition. This retrospective review was performed to share our experience performing multidisciplinary management of DNI associated with DNM during a 7-year period. Methods We reviewed 16 patients who had been surgically treated for DNM at Peking Union Medical College Hospital from April 2010 to July 2017. The clinical outcomes were analysed to determine the most appropriate therapeutic strategy. Results Five women and 11 men were included in this study. Their mean age was 54.9 ± 14.3 years. DNM-associated infections most commonly occurred secondary to odontogenic infections (n = 10). Thirteen patients required tracheotomy because of tracheal compression. All patients underwent unilateral or bilateral cervicotomy. Six patients with DNM localized in the upper mediastinal space underwent transcervical mediastinal drainage, while 10 patients with DNM extending to the lower mediastinum were treated by cervicotomy and video-assisted thoracoscopic surgery. Three patients died of multiple organ failure. Conclusion Multidisciplinary treatment can achieve favourable outcomes in >80% of patients with DNM. Early diagnosis, proper airway management, and adequate surgical drainage are crucial for reducing mortality in patients with DNM, and minimally invasive procedures also play an important role.

Purpose To analyze the impact of a 12-week extended International Normalized Ratio (INR) follow-up interval on healthcare use. Methods A prospective cohort study of the use of an extended INR follow-up interval of up to 12 weeks was conducted over 2 years in a pharmacist-managed anticoagulation clinic. A detailed protocol was used to extend the INR follow-up interval to 5–6 weeks and then 7–8 weeks and 11–12 weeks. The number of planned and unplanned anticoagulation encounters, procedures requiring warfarin interruption, telephone triage phone calls, emergency department visits, and hospitalizations were collected. A post hoc subanalysis was also completed on participants who were scheduled for 4 consecutive 12-week intervals. Results Compared to baseline, at 12 months there was a mean decrease in planned anticoagulation encounters of 2.24 visits (p < 0.001) among 44 participants. From 12 to 24 months compared to baseline, there was a mean decrease in planned anticoagulation encounters of 3.13 visits (p < 0.001) and an increase of 0.54 unplanned anticoagulation encounters (p = 0.04) among 39 participants. The remainder of healthcare use variables were not statistically significantly different from baseline at any time point. Of the 15 participants scheduled for 4 consecutive 12-week intervals, there was a decrease from baseline of approximately 5 visits over the course of a year (p < 0.001). Conclusion An extended INR follow-up interval appears to decrease anticoagulation healthcare use without an increase in acute healthcare use. While this intervention could be cost-effective, institutions need to consider safety, efficacy, and feasibility prior to implementation.

Objective This study focused on carbapenem resistance in Pseudomonas aeruginosa and examined potential ecological correlations with carbapenem use in Japan. Methods The proportion of carbapenem-resistant P. aeruginosa isolates from 2015 and 2016 by prefecture was obtained from the Japan Nosocomial Infections Surveillance system. Data on carbapenem use was obtained from the National Database of Health Insurance Claims. The correlation between the proportion of carbapenem-resistant isolates and carbapenem consumption was assessed in a cross-sectional manner. The study also collected information on other variables including the numbers of physicians, nurses and medical facilities per 100 000 individuals by prefecture. Results Both the proportion of carbapenem-resistant P. aeruginosa isolates and levels of carbapenem use were higher in western Japan. Using a multivariate model, only carbapenem use remained significantly associated with the proportion of carbapenem-resistant isolates. Conclusions Carbapenem use and the proportion of carbapenem-resistant P. aeruginosa isolates were positively correlated. By longitudinal data collection, this approach offers an avenue to establish causal links as the frequency of carbapenem-resistant P. aeruginosa isolates starts to change in the future.

Objective We aimed to investigate the symptoms of inpatients with bipolar disorder (BD) in different types of families, and to explore the correlations between family coherence, family adaptability, and family functioning among inpatients with BD. Methods Inpatients with BD in Hebei, China (n = 61; mean age = 33.85±10.54; 39 males) participated in this study. Participants’ symptoms were evaluated using the Bech–Rafaelsen Mania Scale (BRMS) and Hamilton Depression Rating Scale (HDRS) at weeks 1, 4, and 8 after their admission to the hospital. Participants’ family type was assessed using the Family Adaptability and Cohesion Scale II–Chinese Version. Family functioning was assessed using Family Assessment Device. Results Participants were classified into three family types: balanced (n = 13), mid-range (n = 28), and extreme (n = 20). BRMS scores improved over time in patients from all three family types. Improvement was slightly better with the balanced than the extreme family type. HDRS scores showed an improving trend over time, although this was not significant. Family coherence, adaptability, and functioning were mutually correlated. Conclusion The family system and family functioning are important factors that clinicians should keep in mind when treating people with BD.

Objective To evaluate changes in knee articular cartilage of novice half-marathon runners using magnetic resonance imaging T2 relaxation time mapping. Methods Healthy subjects were recruited from local running clubs who met the following inclusion criteria: (i) age 18–45 years; (ii) body mass index less than 30 kg/m2; (iii) had participated in one half-marathon or less (none within the previous 6 months); (iv) run less than 20 km/week; (v) no previous knee injury or surgery; (vi) no knee pain. T2 signals were measured pre- and post-race to evaluate the biochemical changes in articular cartilage after the subjects run a half-marathon. Results A significant increase in the mean ± SD T2 relaxation time was seen in the outer region of the medial tibial plateau (50.1 ± 2.4 versus 54.7 ± 2.6) and there was a significant decrease in T2 relaxation time in the lateral femoral condyle central region (50.2 ± 4.5 versus 45.4 ± 2.9). There were no significant changes in the patella, medial femoral condyle and lateral tibia articular surfaces. Conclusion An increase in T2 relaxation time occurs in the medial tibial plateau of novice half-marathon runners. This limited region of increased T2 values, when compared with complete medial compartment involvement seen in studies of marathon runners, may represent an association between distance run and changes seen in articular cartilage T2 values.

Objective Vitiligo is a common pigmentation disorder of the skin, and its pathogenesis remains unclear. We evaluated the effectiveness of compound glycyrrhizin combined with fractional carbon dioxide (CO2) laser and triamcinolone acetonide solution in patients with vitiligo. Methods Patients with stable vitiligo treated at our hospital between May 2016 and August 2017 were randomized to a control group or an observation group. Both groups were treated with fractional CO2 laser and triamcinolone acetonide solution, while the observation group also received compound glycyrrhizin. Clinical effectiveness, serum IL-17 and TGF-β levels, and adverse drug reactions were compared between the groups. Results Following treatment, the clinical effective rate was significantly higher in the observation group than in the control group (75.00% vs. 52.50%). Furthermore, IL-17 decreased in both groups but was significantly lower in the observation group, while TGF-β increased in both groups but was significantly higher in the observation group. The incidence of adverse drug reactions was not significantly different between the groups. Conclusion Compound glycyrrhizin in combination with fractional CO2 laser and triamcinolone acetonide solution can be used to treat vitiligo and appears to modulate cytokine levels. Trial registration: Hebei Provincial Administration of Traditional Chinese Medicine (no. 2019366; http://www.hebwst.gov.cn/index.do?templet=cs_zyj )

ObjectiveMetabolic syndrome (MS) is a common clinical condition associated with cardiovascular disease in patients undergoing peritoneal dialysis (PD); however, its prognostic implication among patients receiving PD remains controversial.MethodsIn a prospective study from January 2013 and June 2016, we enrolled 190 patients undergoing PD and followed them for 46.4 ± 30.7 months. We assessed the associations of clinical characteristics and measurements with diabetes mellitus (DM) status, MS, and prognostic outcomes among the included patients.ResultsWe found that DM was associated with shortened duration of dialysis and poor survival. The prevalence of MS was 58.9% among all patients. We found significant differences in age, body weight, body mass index, triglycerides, high-density lipoprotein cholesterol, fasting plasma glucose, leukocytes, platelets, neutrophil percentage, and pre-albumin between patients with and without MS. We found a negative correlation trend between serum intact parathyroid hormone and MS among our patients. The arteriosclerosis index was significantly elevated in the MS group compared with the non-MS group. Serum calcium concentration and frequency of hospital admissions were significantly associated with mortality and technique failure.ConclusionsMS was positively associated with cardiovascular disease. DM, and hypocalcemia. Frequent hospital admissions can predict poor prognosis in patients undergoing PD.

Objective The study objective was to enhance clinical skills among undergraduate students majoring in clinical medicine in performing physical examination by establishing a novel platform for peer assessment of clinical skills. Methods A total 126 Year 2012 students majoring in medicine and receiving traditional training were assigned to the control group, and 126 Year 2013 students receiving instruction via the peer assessment platform of clinical skills were allocated to the study group. Scores of the physical examination, paper exam, and peer assessment were compared using a t-test, and we performed linear correlation analysis of the data. Results Scores of the physical examination and peer assessment among Year 2013 students (the study group) were significantly higher than those in the control group. Paper exam scores in the study group were also significantly higher than those in the controls. The three assessment scores did not differ significantly according to sex. Conclusions The peer assessment platform can not only improve medical students’ skills and capabilities in physical examination, it can also enhance their theoretical knowledge of basic clinical principles. We determined that sex was not related to the assessment scores obtained by medical students.

Objective Volume load in patients undergoing hemodialysis correlates with renal anemia, with reductions in volume load significantly improving hemoglobin levels. We performed a prospective controlled study to assess the effect of post-dialysis dry weight reduction, resulting from the gradual enhancement of ultrafiltration, on renal anemia in this patient population. Methods Sixty-four patients with renal anemia on maintenance hemodialysis were randomized to an ultrafiltration group, in which dry weight was gradually reduced by slightly increasing the ultrafiltration volume while maintaining routine hemodialysis, and a control group, in which patients underwent conventional dialysis while routine ultrafiltration was maintained. After 28 weeks, post-dialysis weight and levels of hematocrit, hemoglobin, C-reactive protein, serum albumin, serum ferritin, and transferrin saturation were compared. Results All parameters were similar at baseline between the two groups and remained unchanged at week 28 in the control group compared with baseline. In contrast, the ultrafiltration group showed a significant reduction in post-dialysis weight and C-reactive protein concentration and a significant increase in hematocrit, hemoglobin, albumin, serum ferritin, and transferrin saturation. Conclusions Dry weight reduction resulting from enhanced ultrafiltration may improve renal anemia in patients undergoing hemodialysis.

ObjectivesAlzheimer’s disease (AD) and behavioral variant frontotemporal dementia (bvFTD) are among the leading causes of early-onset dementia. This study aimed to assess the rate of whole brain atrophy by comparing bvFTD and AD.MethodsTwo patients (one man with AD, and one woman with bvFTD) had neuropsychological and neuroimaging assessment by using automated techniques for cross-sectional and longitudinal atrophy measurements.ResultsIn the patient with AD, magnetic resonance imaging (MRI) showed decreased bilateral hippocampal and mesial-temporal volume. However, conventional images showed no difference between baseline (T0) and after 1 year (T1). In the patient with bvFTD, MRI showed bilateral frontotemporal lobe atrophy and a moderate increase in atrophy between T0 and T1, particularly in the temporal lobes. A cross-sectional cerebral volume examination showed a considerable reduction in brain volume in the patient with bvFDT and a moderate reduction in the patient with AD. A longitudinal cerebral volume examination showed a lower percentage brain volume change in the patient with bvFTS compared with the patient with AD.ConclusionsOur results suggest that bvFTD has more neurodegenerative progression. MRI findings should be considered as a reliable marker of disease progression in the brain. Our findings offer potential for monitoring treatment outcomes.

ObjectiveThis study aimed to determine the most appropriate cognitive and cerebrospinal fluid (CSF) biomarker setting to distinguish frontotemporal dementia (FTD) from Alzheimer’s disease (AD).MethodPatients with FTD, those with AD, and those without dementia were enrolled in this study. CSF amyloid-ß 42 (Aß42), total (t)-tau, and phosphorylated (p)-tau concentrations were determined by enzyme-linked immunosorbent assays. Cognition was evaluated by the Mini-Mental State Examination (MMSE) and its domain scores. The associations of CSF biomarkers with cognitive measures were examined using regression models and the diagnostic value of CSF biomarkers was determined by receiver operating characteristics curves.ResultsCSF Aß42 levels were lower, whereas t-tau/Aß42 and p-tau/Aß42 ratios were higher in patients with AD compared with those with FTD. Some MMSE domain scores were different in FTD and AD, but they did not improve the ability to distinguish between the two pathologies. Poor temporal orientation scores were associated with low Aß42 levels only in patients with FTD. The p-tau/Aß42 ratio reached sufficient levels of sensitivity and specificity to discriminate FTD with primary progressive aphasia from AD.ConclusionsThe ratio of CSF p-tau/Aß42 is a sensitive and specific biomarker for discriminating patients with primary progressive aphasia from those with AD.

Objective To present and discuss the clinical course, management, recurrence and survival of patients with thymoma at a single centre. Methods This prospective observational study included patients with confirmed thymoma who were diagnosed and managed over a 10-year period. Results The study included 89 patients (mean ± SD age, 48.53 ± 11.60 years). There were 46 (51.7%) males and 43 (48.3%) females. The mean duration of follow-up was 60 months (range, 2 months to 8 years). Stage II was the most common stage (37 [41.6%]), followed by stage I with 30 (33.7%) patients, stage IIIA with 11 (12.4%) patients, stage IVA with six (6.7%) patients and stage IIIB with five (5.6%) patients. Overall (actuarial) 5-year survival was achieved by 84 of 89 patients (94.4%). Stage-specific survival was as follows: 100% in stage I (30 of 30 patients), 100% in stage II (37 of 37 patients), 54.5% in stage IIIA (six of 11 patients), 80.0% in stage IIIB (four of five patients) and 50.0% in stage IVA (three of six patients). Conclusion Complete surgical resection is the main modality used for the definitive diagnosis, staging and surgical cure of thymoma.

Objectives We aimed to compare the effects of general anesthesia with combined epidural and general anesthesia in patients with early-stage non-small cell lung carcinoma (NSCLC). Methods Patients scheduled to undergo tumor resection with adjuvant chemoradiotherapy were eligible. Patients in the control group received general anesthesia during surgery, and those in the observation group received combined epidural and general anesthesia. The hemodynamic factors mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, and oxygen saturation were measured. Serum levels of pro-inflammatory cytokines interleukin (IL)-1, IL-8, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor (TNF)-α as well as β-endorphin were measured by enzyme-linked immunosorbent assay. Serum malondialdehyde (MDA) was measured using the thiobarbituric acid method. Results The incidence of specific adverse events was reduced and overall and disease-free survival were improved in the observation group compared with the control group. MAP was generally lower in the observation group compared with the control group, as were the serum levels of IL-1, IL-8, hs-CRP, TNF-α, and MDA. Conclusions Compared with general anesthesia, combined epidural and general anesthesia may inhibit the occurrence of short-term adverse events and improve long-term outcomes by inhibiting inflammatory responses in patients with early-stage NSCLC after tumor resection.

ObjectiveThis study aimed to investigate the clinicopathological factors of the false negative rate (FNR) and accuracy of sentinel lymph node biopsy (SLNB) mapping with 1% methylene blue dye (MBD) alone, and to examine how to reduce the FNR in patients with breast cancer.MethodsA total of 365 patients with invasive breast carcinoma who received axillary lymph node dissection after SLNB were retrospectively analyzed. SLNB was performed with 2 to 5 mL of 1% MBD. We studied the clinicopathological factors that could affect the FNR of SLNB.ResultsThe identification rate of sentinel lymph nodes (SLNs) was 98.3% (359/365) and the FNR of SLNB was 10.4% (16/154). Multivariate analysis showed that the number of dissected SLNs and metastatic lymph nodes were independent predictive factors for the FNR of SLNB. The FNR in patients with 1, 2, 3, and ≥4 SLNs was 23.53%, 15.79%, 3.85%, and 1.79%, respectively.ConclusionsSLNB mapping with MBD alone in patients with breast cancer can produce favorable identification rates. The FNR of SLNB decreases as the number of SLNs rises. Because of side effects of searching for additional SLNs and the FNR, removal of three or four SLNs may be appropriate.

Objective No studies to date have focused on the safety of coloanal/ileoanal anastomosis (CAIAA) in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC), which is associated with severe morbidity and mortality. We herein present the outcomes of patients with peritoneal carcinomatosis (PC) who underwent CAIAA. Methods We evaluated the prospectively collected data from 20 patients with PC who underwent CRS + HIPEC with respect to the primary disease, synchronous resections, intraoperative chemotherapy regimen, timing of protective ileostomy closure, and overall postoperative complications. Results Most patients underwent CRS + HIPEC and CAIAA for PC due to colorectal cancer. Coloanal anastomosis was performed in 15 (75%) patients, and J-pouch ileoanal anastomosis was performed in 5 (25%) patients. No anastomosis-related complications occurred in any patients who underwent CAIAA; however, one patient died of pulmonary embolism on postoperative day 7. Conclusions CAIAA is associated with serious complications even after performing benign colorectal surgery. However, it may be challenging for surgeons to simultaneously perform CAIAA in patients with PC who undergo CRS + HIPEC. We emphasize that this procedure can be safely performed with experienced surgical teams by using a multidisciplinary approach.

Objective Nonalcoholic Wernicke’s encephalopathy (WE) is a devastating neuropsychiatric syndrome caused by thiamine deficiency. Although many case reports on WE have been published, more studies are required to guide the diagnosis and treatment of nonalcoholic WE. Methods We retrospectively studied patients who were diagnosed with WE in our hospital. Data on demographics, possible causes, phenomenology, and diagnostic and treatment delays were abstracted from medical records by chart reviews. Results Seventeen patients were diagnosed with nonalcoholic WE. Nonalcoholic WE had many causes, such as gastrointestinal surgery, gastrointestinal tract diseases, vomiting, and psychiatric diseases. Most patients presented with abnormal mental symptoms, including those in a coma. Conclusion In summary, we recommend using operational criteria to diagnose and treat nonalcoholic WE as early as possible to avoid misdiagnosis and treatment delays. Nonalcoholic WE remains a clinical diagnosis, and certain examinations are helpful for this diagnosis, such as measuring serum thiamine concentrations. We should focus on patients who present with abnormal mental symptoms, even those in a coma, and administer parenteral thiamine before any carbohydrate to reduce the high frequency of residual morbidity.

Objectives To assess the efficacy and tolerability of cabazitaxel in relapsed penile cancer. Methods This Phase II single-arm trial was designed to recruit 17 patients with relapsed penile cancer. The primary endpoint was objective (complete + partial) response rate (ORR; Response Evaluation Criteria in Solid Tumours [RECIST] v1.1). Treatment comprised six 21-day cycles of cabazitaxel with restaging after cycles 2 and 4. The planned interim analysis was based upon the premise that if none of the first nine patients achieved ORR, trial would be stopped (α = 0.05, Simon’s 2-stage design). Results Nine patients were recruited from four UK centres between December 2014 and August 2016. The median age was 61 (range, 27–73.6) years, and seven patients had metastases. Patients received a median of two chemotherapy cycles (range, 2–5). None of the nine patients achieved ORR and the trial was stopped. Cabazitaxel was well tolerated with no dose reductions or delays. Three patients had grade 3/4 adverse events (anaemia, vomiting, or neutropenic sepsis). The median progression-free and overall survival were 1.3 and 5.6 months, respectively. Conclusions The trial did not reach the threshold for further continuation of single-agent cabazitaxel. However, the observed tolerability profile supports its further investigation in combination with other agents to improve patient outcomes.

Objective The aim of this study was to identify clinicopathological factors that affect the number of lymph nodes (LNs) (12 or more) retrieved from patients with colorectal cancer (CRC), particularly those with pathologic T1 (pT1) disease. Methods From 429 CRC patients, 75 pT1 cancers were identified and digitally scanned. Binary logistic regression analysis was performed to identify the clinicopathological factors affecting the number of LNs retrieved from all 429 patients and from the subset of patients with pT1 CRC. Results For the 429 patients, the mean number of harvested LNs per specimen was 20 (median, 19). The number of retrieved LNs was independently associated with maximum tumor diameter > 2.3 cm and right-sided tumor location. The mean number of LNs retrieved from the 75 patients with pT1 CRC was 14 (median, 15); retrieval of 12 or more LNs from this group was independently associated with maximum tumor diameter > 14.1 mm. Conclusion The number of LNs retrieved from patients with CRC was associated with maximum tumor diameter and right-sided tumor location. For patients with pT1 CRC, maximum tumor diameter was independently associated with the harvesting of 12 or more LNs.

Objective This study aimed to assess the safety and efficacy of left liver anatomical resection via the left vertical groove following intraoperative antegrade cholangioscopy (biliary exploration through the left hepatic duct orifice) in patients with left-sided hepatolithiasis (LSH) and previous biliary tract surgery. Methods Between January 2012 and January 2016, eligible patients with LSH (n = 28) who underwent left liver anatomical resection via the left vertical groove followed by intraoperative antegrade cholangioscopy, were referred to our hospital. Clinical results, such as the overall operative time, length of hospital stay, intraoperative complications, residual stones and postoperative bile leaks, were recorded and analyzed. Results No residual stones and bile leakage occurred in the patients. No patients experienced intraoperative complications or T-tube placement. The mean operative time was 135.1 ± 18.9 minutes. The mean postoperative duration of hospitalization was 7.8 ± 1.8 days. Conclusions Left liver anatomical resection via the left vertical groove combined with intraoperative antegrade cholangioscopy is a safe and useful method for patients with LSH and previous biliary tract surgery. This technique simplifies the operative procedure by avoiding dissection of the porta hepatis and subsequent choledochotomy.

Objective This study aimed to validate new staging of Japanese patients with human papillomavirus-mediated oropharyngeal cancer (HPV+-OPC) and the effectiveness of transoral surgery. Methods Fifty-three patients with HPV+-OPC were classified according to the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging, along with assessment of prognosis, smoking and alcohol status, and treatment outcome. Transoral videolaryngoscopic surgery (TOVS) was performed as transoral surgery. Results The 5-year overall survival (OS) rate was 77.3% in all patients. Five-year OS rates of seventh edition staging were as follows: II, 100%; III, 100%; IVa, 75.9%; and IVb and IVc, 0%. Five-year OS rates of the eighth edition clinical staging were as follows: I, 89.3%; II, 88.9%; III, 46.3%; and IV, 0%. In non-smoking and smoking patients with HPV+-OPC, the 5-year OS rates were 90.9% and 70.7%, respectively. TOVS was used for treating 20 smokers with HPV+-OPC (5-year OS: 85.7%), while 12 were treated with chemoradiotherapy (5-year OS: 75.0%). Conclusions The eighth edition of the AJCC determines the prognosis of HPV+-OPC more accurately than the seventh edition in clinical staging. Smokers with HPV+-OPC have a poor prognosis, but TOVS might improve the prognosis.

Objective This study compared the incidence of cerebrospinal fluid (CSF) leakage and residual tumors between functional and nonfunctional pituitary adenomas treated with the endoscopic endonasal transsphenoidal approach (EETA). Methods All patients underwent endocrine examinations and brain magnetic resonance imaging before and after surgery. The length of admission, incidence of central diabetes insipidus, incidence of CSF leakage, symptom relief, and presence of residual tumors were compared between patients with functional and nonfunctional pituitary adenomas. Results Thirty-eight patients were enrolled, among whom 12 and 26 had functional and nonfunctional pituitary adenomas, respectively. The incidence of CSF leakage was significantly higher in patients with nonfunctional adenomas; a hard or elastic tumor character accounted for the difference. A large tumor size and cavernous sinus invasion were risk factors for residual tumors. No significant differences were found in sex, length of admission, operative times, incidence of diabetes insipidus, or number of residual tumors between the two groups. The hormone levels were lower postoperatively than preoperatively in patients with nonfunctional adenomas. Conclusion Nonfunctional pituitary macroadenomas resulted in more CSF leakage. Use of the rescue nasoseptal flap reduced unnecessary nasal destruction. Cooperation between a neurosurgeon and otolaryngologist was safer and more effective when using the EETA.

ObjectiveThis study aimed to examine the effects of ultrasonic debridement plus a wet dressing of Shenghong (SH) on chronic ulcer healing of the lower extremities in patients with diabetes.MethodsSixty cases of diabetes combined with chronic lower limb ulcers were randomly divided into control (n = 30) and experimental (n = 30) groups. The control group was treated with ultrasonic debridement plus recombinant human fibroblast growth factor (FGF) gel. The experimental group was treated with ultrasonic debridement plus SH wet dressing.ResultsThe mean clinical efficacy in the experimental group was significantly higher than that in the control group (93.33% ± 6.32% versus 60.0% ± 5.87%). The mean ulcer area was significantly smaller and the mean ulcer healing rate was significantly shorter in the first 3 months, and the mean overall pain intensity score was significantly lower in the experimental group than in the control group. Moreover, the positive rates of bacterial culture on the 7thand 15thdays were significantly lower in the experimental group than in the control group.ConclusionThe use of ultrasonic debridement plus SH wet dressing for treating ulcers can significantly improve clinical efficacy and promote healing.

Introduction Hepatocellular carcinoma (HCC) is a common gastrointestinal cancer that occurs worldwide, and conventional transarterial chemoembolization (cTACE) is one of the first treatment choices for advanced HCC. However, biochemical factors and comorbidity have seldom been reported in the long-term outcomes. Methods This retrospective cohort study included 444 HCC patients who underwent cTACE-based therapy in 2010 to 2012. Survival outcomes were analyzed using a Kaplan–Meier curve and Cox regression analysis. Results The mean age was 62.1 ± 12.5 years, and 74.3% were men. Analysis of the mean biochemical values indicated that the presence of portal vein thrombosis, α-fetoprotein (AFP) >200 ng/mL, AJCC 7th stage III, diabetes, albumin Discussion The presence of venous thrombus and elevation of AFP levels are the most important factors in cTACE treatment. The host factors, including metabolic status and liver damage, should be evaluated in these patients.

Objective Both obstructive sleep apnea–hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM) are closely related to the renin-angiotensin-aldosterone system. We investigated whether hyperaldosteronemia is found in patients with OSAHS complicated by T2DM and whether continuous positive airway pressure (CPAP) treatment can significantly reduce the aldosterone level. Methods Patients with T2DM were classified into an OSAHS group [apnea–hypopnea index (AHI) of ≥15] and a control group (without OSAHS; AHI of Results The plasma aldosterone, plasma renin, and urinary aldosterone levels were higher in the OSAHS than control group. The plasma aldosterone and renin levels were significantly lower after than before treatment in the OSAHS group, but they were still higher than the baseline levels in the control group. The post-treatment urinary aldosterone level was significantly higher in the OSAHS than control group. No correlation was found between the AHI and plasma renin, plasma aldosterone, and 24-hour urinary aldosterone levels. The blood glucose level in the OSAHS group did not significantly change after treatment. Conclusions The plasma and urine aldosterone levels are increased in patients with concurrent T2DM and OSAHS and are significantly reduced by CPAP. Trial registration: ChiCTR-ION-16009837

Objective We sought to investigate somatic symptoms detected by the Somatic Self-rating Scale and to evaluate whether they were associated with the psychological symptoms of anxiety and depression in patients with cardiac neurosis. Methods A total of 180 patients with cardiac neurosis at the Third Xiangya Hospital, Changsha, China, were surveyed from January 2017 to July 2018. Participants completed a general information questionnaire, the Somatic Self-rating Scale, the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Scale-7. Results The mean (±standard deviation) somatic symptom score in patients with cardiac neurosis was 40.83 ± 7.12. The most severe symptoms were cardiovascular symptoms, fatigue and muscle soreness. A total of 90 patients (46.4%) had anxiety and 80 (50.0%) had depression. Multiple stepwise regression analysis showed that somatic symptoms in patients with cardiac neurosis were associated with both anxiety and depression. Conclusion Somatic symptoms in patients with cardiac neurosis were associated with both anxiety and depression. Therefore, it is important to provide effective emotional interventions to promote patient rehabilitation.

Objective Helicobacter pylori commonly occurs in the stomach, but localizations outside the stomach and related diseases have also been investigated. However, the relationship between H. pylori and gallstones remains controversial. We aimed to investigate the relationships between H. pylori in the stomach and the gallbladder and gallstones. Methods This prospective case-control study included patients who underwent cholecystectomy because of gallstones, pancreatic head cancer, or hepatic resection. The patients were separated into two groups according to the detection of H. pylori in gallbladder samples using Giemsa staining. Stomach H. pylori status was based on previous gastroscopy. Results The study enrolled 60 patients, comprising 27 patients with gallstones and 33 without. There was no significant difference in the incidence of gallstones between patients with or without H. pylori in the stomach or gallbladder. Furthermore, the presence of H. pylori in the stomach was measured in 14 patients and was significantly correlated with H. pylori in the gallbladder. Conclusion The current study showed no relationship between the occurrence of gallstones and the presence of H. pylori in either the gallbladder or the stomach. In contrast to previous reports, this suggests that H. pylori does not play a role in the development of gallstones.

Objective To evaluate the efficiency and incremental value of chromosomal microarray analysis as compared with standard karyotyping for the identification of genomic abnormalities in fetal DNA. Methods This retrospective study enrolled female patients with ultrasonographically diagnosed fetal ventriculomegaly. The prevalence, associated anomalies and clinical outcomes of ventriculomegaly were evaluated based on data from a single maternal and child health hospital in southwest China. Results A total of 943 cases of ventriculomegaly were analysed in this study, which were diagnosed at a mean ± SD gestational age of 23.8 ± 8.2 weeks. Non-isolated ventriculomegaly cases had a significantly higher maternal age than isolated cases (29.6 ± 5.5 versus 27.9 ± 4.2 years, respectively) and were also associated with a larger proportion of bilateral (56.1% versus 46.7%, respectively) and severe (12.8% versus 3.7%, respectively) ventriculomegaly. There were 97 cases detected by both karyotyping and microarray analysis. All apparent chromosome abnormalities identified upon karyotyping were detected with the use of microarray analysis. Microarray analysis also reported genetic abnormalities in 20 additional cases not detected by karyotyping. Of these additional 20 cases, 9.3% of pregnancies reported standard genetic variants for clinically relevant information, whereas 11.3% reported uncertain genetic abnormalities. Conclusion Chromosomal microarray analysis is an efficient tool, significantly increasing the diagnostic power for prenatal diagnosis.

Objective This study was performed to assess the feasibility of conservative treatment for stage II or III serous borderline ovarian tumors (BOTs). Methods Twenty-one patients were treated conservatively for advanced serous BOTs from 2006 to 2017. Two patients were lost to follow-up. The patients’ clinical status, surgical results, fertility results, and oncological outcomes were collected. Results The patients’ median age at surgery was 28 years (range, 22–37 years). The median follow-up interval was 74 months (range, 16–214 months). Among the 19 patients who were followed up, 8 had stage II tumors and 11 had stage III tumors. Sixteen patients had noninvasive peritoneal implants. Two patients developed tumor metastasis to the fallopian tubes and one developed metastasis to the pelvic lymph nodes and omentum. The total recurrence rate was 26.3%. Seventeen (89.5%) patients were nulliparous. Four of 10 patients who wished to preserve their fertility obtained natural pregnancy. No patients died of their disease. Conclusions This study supports the efficacy of conservative treatment for advanced BOTs with respect to its favorable fertility result. The overall prognosis is not changed by conservative treatment.

Objective Breast cancer (BC) is a common malignancy among women worldwide. Fibroblast growth factor receptor 2 (FGFR2) rs2981582 is reported to play a vital role in BC development. However, the relationship between them remains unclear. Methods Ninety-five patients and 140 healthy controls were enrolled in the study. Plasma DNA was genotyped by the MassARRAY method. A meta-analysis was conducted to clarify the effect of FGFR2 polymorphism on BC risk. Results Our case-control study results revealed a significant difference in CC, TC, and TT genotypes between patients and controls. Logistic regression analysis showed that TT and TC genotype and the dominant mode were significantly correlated with BC development [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.050–2.27; OR = 1.81, 95% CI: 1.24–2.73; OR = 2.15, 95% CI: 1.25–5.31, respectively], even after adjusting for age, body weight, drinking, smoking, and estrogen receptor status. A meta-analysis of 15 studies showed significant differences among the dominant, recessive, heterozygote, and homozygote models between patients and controls. Conclusions Our results showed an association of FGFR2 rs2981582 polymorphism with BC in an Asian population. However, a more comprehensive study of the relationship between the polymorphism and BC is still needed.

Objectives To investigate the periapical bone thicknesses of maxillary posterior teeth at the preferred level for root resection (3 mm apical to the root end) and to determine vertical distances from apex to maxillary sinus floor (MSF) using cone beam computed tomography (CBCT) scans. Methods CBCT scans were collected from 341 subjects (2389 teeth). Associations of bone thicknesses and vertical distances with age and sex were determined by one-way analysis of variance. Results At the level of root-end resection, buccal bone was the thickest over the mesiobuccal roots of second molars (mean, 2.99 mm) and thinnest over the double-root first premolars (mean, 0.29 mm). In maxillary posterior teeth, thicker buccal bone was found in men than in women. The mesiobuccal roots of second molars were nearest to the MSF (mean, 1.33 mm), and were also most frequently extended into the sinus cavity (15.81%). Subjects more than 40 years of age had larger vertical distances from root apices to MSF in the molar region, compared with younger subjects. Conclusions Generally, periapical bone was thicker in men, and root apices were located nearer to the MSF in younger subjects. Age and sex should be considered before endodontic microsurgery.

Objective This study aimed to determine the effect of repeated antivenom therapy compared with that of single antivenom therapy for treating snakebite-related systemic complications. Methods A retrospective medical record review from January 2008 to September 2016 was performed. Patients with snakebite injury who visited the Emergency Department in one tertiary center of Korea were included. The primary outcome was the survival rate. The secondary outcome was the effect of repeated antivenom therapy for treating snakebite-related systemic complications compared with that of single antivenom therapy on hospital length of stay. Results A total of 110 patients with snakebites were included. All patients survived to discharge. Twenty-nine (26.4%) patients had snakebite-related systemic complications. Of these, nine patients received repeated antivenom therapy and 20 patients received single antivenom therapy. The length of stay was significantly longer in those who received repeated antivenom therapy compared with those who received single antivenom therapy (10.0 [4.0–11.0] vs. 3.5 [0–7.0] days). Conclusion We were unable to demonstrate any superiority of repeated versus single antivenom therapy. However, repeated antivenom therapy is associated with a longer hospital stay. The reason for this finding is unknown.

Objective Acute decompensation (AD) in liver cirrhosis has high mortality. We assessed prognostic scoring models and established prediction models for different etiologies of AD. Methods This retrospective analysis included 732 patients hospitalized with acute decompensated cirrhosis without acute-on-chronic liver failure. We performed logistic regression analysis of risk factors for mortality associated with different etiologies, to establish predictive models. Results Patients with different etiologies, scored using different scoring systems and various impact factors, exhibited differences with respect to mortality. MELD, CLIF-C-AD, MELD-Na, and AARC-ACLF scores exhibited adequate predictive ability for mortality. Area under the receiver operating characteristic curve for 28-day mortality for MELD, CLIF-C-AD, MELD-Na, AARC-ACLF, and the newly developed AD scores was 0.663, 0.673, 0.657, 0.662, and 0.773, respectively, in the hepatitis B virus group (HBV-AD score =−5.51 + 0.07*WBC count (109/L) +0.7*AD sum+0.4*AARC-ACLF score); 0.731, 0.737, 0.735, 0.689, and 0.778, respectively, in the alcoholic liver disease group (ALD-AD score =−4.55 +0.08* WBC count (109/L) +1.34* AD sum); and 0.765, 0.767, 0.814, 0.720, and 0.814, respectively, in the Others group (OTHERS-AD score =−2.14 + 1.24*MELD-Na score +4.49*AD sum). Conclusions The newly developed scoring models for short-term mortality were superior to the other scoring systems in predicting prognosis of acute decompensated cirrhosis in hospitalized patients.

Objective To investigate what is the most appropriate strategy for patients with ST-segment elevation myocardial infarction (STEMI) aged ≥80 years in China. Methods This cohort study retrospectively enrolled patients with STEMI aged ≥80 years old and grouped them according to the treatment strategy that was used: a conservative treatment strategy or an invasive treatment strategy. Factors associated with whether to perform an invasive intervention, in-hospital death and a good prognosis were investigated using logistic regression analyses. Results A total of 232 patients were enrolled: conservative treatment group ( n = 93) and invasive treatment group ( n = 139). Patients in the invasive treatment group had a better prognosis and lower incidence of adverse events compared with the conservative treatment group. Advanced age, creatinine level and a higher Killip class were inversely correlated with whether to perform an invasive intervention, while the use of beta-receptor-blocking agents was a favourable factor for invasive treatment. Hypertension and a higher Killip class were risk factors for in-hospital death, while the use of beta-receptor-blocking agents and diuretics decreased the risk of in-hospital death. Conclusions An invasive treatment strategy was superior to a conservative treatment strategy in patients with STEMI aged ≥80 years.

Objective This study aimed to analyze the effects of maternal weight on adverse pregnancy outcomes. Methods Data were retrospectively collected from a hospital in Wuhan, China. A total of 1593 pregnant women with singletons were included. Adverse outcomes during pregnancy, such as small for gestational age (SGA), large for gestational age (LGA), and hypertensive disorders in pregnancy (HDP) were analyzed. Results The risks of low birth weight, SGA, and preterm birth were significantly higher in the inadequate gestational weight gain (GWG) group compared with the adequate GWG group. GWG over the guidelines was related to a higher risk of macrosomia, LGA, cesarean section, and HDP than GWG within the guidelines. The risks of low birth weight (OR = 5.082), SGA (OR = 3.959), preterm birth (OR = 3.422), and gestational diabetes mellitus (OR = 1.784) were significantly higher in women with a normal pre-pregnancy body mass index (BMI) and inadequate GWG compared with women with a normal pre-pregnancy BMI and adequate GWG. The risks of macrosomia (OR = 3.654) and HDP (OR = 1.992) were increased in women with normal pre-pregnancy BMI and excessive GWG. Conclusion Women with an abnormal BMI and inappropriate GWG have an increased risk of adverse maternal and infant outcomes. Weight management during the perinatal period is required.

Objective The second messenger inositol triphosphate (IP3) is involved in signal transduction in multiple cell types. We evaluated the effects of high-dose levocetirizine on chronic spontaneous urticaria (CSU) and examined the significance of serum IP3 level in the pathogenesis of CSU. Methods Fifteen patients with refractory CSU were given oral levocetirizine at a dose of 15 mg once daily for 7 days, and treatment efficacy was determined using the Urticaria Activity Score and by evaluating wheal-and-erythema reactions and itching. The serum concentration of IP3 at specific time points was determined by enzyme-linked immunosorbent assay. Results The mean serum concentration of IP3 was 43.54 ± 41.97 pg/mL prior to treatment, 18.40 ± 17.53 pg/mL after treatment, and 1.31 ± 0.92 pg/mL in a healthy control group. The mean concentration of IP3 was significantly higher before treatment than after treatment, and the level of IP3 in the patient group before and after treatment was significantly higher than that in the control group. Conclusion High-dose levocetirizine was shown to be effective in the treatment of CSU. The level of serum IP3 was positively correlated with CSU activity, indicating that IP3 may play an important role in the pathogenesis of this condition.

Objective This study aimed to evaluate the effects of moderate chronic kidney disease (CKD) and left atrial enlargement on the risks of thromboembolic events, and all-cause and cardiovascular mortalities in elderly patients with atrial fibrillation (AF). Methods We retrospectively studied 751 patients (82.16% men, mean age: 79.0±9.1 years) with AF who were followed up for an average of 34.5 months at a single center. Adjusted hazard ratios (HRs) of risk factors for adverse clinical events were calculated using the Cox proportional hazards model. Results The risks of thromboembolic events, and all-cause and cardiovascular deaths were higher in patients with moderate CKD compared with patients with normal renal function after adjusting for other traditional risk factors (HR: 1.63, 95% confidence interval (CI): 1.03–2.58; HR: 1.55, 95% CI: 1.08–2.23; HR: 3.49, 95% CI: 1.57–7.74; respectively). Left atrial volume index >28.0 mL/m2 was an independent risk factor associated with thromboembolic events and all-cause and cardiovascular deaths (HR: 1.62, 95% CI: 1.21–2.33; HR: 1.56, 95% CI: 1.16–2.10; HR: 1.87, 95% CI: 1.07–3.28; respectively). Conclusions Moderate CKD and left atrial enlargement may predict thromboembolic events, and all-cause and cardiovascular mortalities in elderly patients with AF without anticoagulation therapy.

Objective This study was performed to evaluate the diagnostic value of the neutrophil CD64 index in patients with sepsis in the intensive care unit (ICU). Methods Patients with sepsis who were treated at the ICU of the authors’ institution from December 2016 to June 2018 were retrospectively reviewed. The controls comprised age- and sex-matched patients who underwent coronary bypass and had no evidence of infection. The neutrophil CD64 index, C-reactive protein (CRP) level, and procalcitonin level were compared between the two groups. The diagnostic performance of these measures, including the sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve, was examined. Results In total, 35 patients with sepsis and 27 control patients were included in the data analysis. The sensitivity of the neutrophil CD64 index, CRP level, and procalcitonin level was 83%, 74%, and 77%, respectively. The specificity was 88%, 86%, and 81%, respectively. The area under the ROC curve was 0.923 [95% confidence interval (CI), 0.856–0.989], 0.904 (95% CI, 0.832–0.976), and 0.863 (95% CI, 0.776–0.950), respectively. Conclusion The neutrophil CD64 index is a valuable biomarker for diagnosing sepsis in patients in the ICU.

Objective To determine the awareness of stroke symptoms and risk factors in middle and high school students at a single institution. Methods An 11-question multiple-choice stroke awareness survey was administered to students in grades 7 to 12 at City High Middle School in Grand Rapids, Michigan, United States. Summary statistics were calculated. Results A total of 603/608 surveys were analyzed. Only 8% of respondents correctly identified stroke as the fifth leading cause of death in the United States. Half (50.1%) recognized that a stroke occurred in the brain. Sixty-seven students (11.1%) correctly identified all 11 stroke risk factors. Only 5.1% correctly selected all four correct stroke symptoms. Two-thirds (64.5%) recognized stroke as an immediate medical emergency. Slightly more than half (55.9%) knew the acronym FAST (face, arms, speech, time). Conclusions Most students in our study were unaware of all the risk factors and symptoms related to stroke. Although this study was limited because data were collected from only one school, the findings suggest a need to educate middle and high school students about stroke risk factors, symptoms and acute interventions.

Objective This study aimed to investigate how to stabilize the condition of critically ill neonates within the neonatal transport network. Methods A total of 243 critically ill newborns in four hospitals involved in the transport network were enrolled. The newborns were divided into the research and control groups. In the research group, medical staff underwent theoretical training, and neonatal intensive care unit (NICU) professionals participated and provided on-site guidance on delivery of high-risk infants. Delivery of high-risk neonates in the control group was conventionally managed in local hospitals, and neonates were transferred after a phone call to the NICU. Results Gestational age and body weight were lower, and dexamethasone use was higher in the research group than in the control group. The proportions of neonates who underwent mask pressure, endotracheal intubation, pulmonary surfactant application, and chest compressions were higher, and those with dyspnea and nervous system abnormalities were lower in the research group than in the control group. Blood gas and sugar levels were better in the research group than in the control group. Conclusion Strengthening professional training and participation of professional NICU staff in childbirth can improve the conditions of high-risk neonates and increase safety of their transportation.

ObjectiveAs in other health sciences, a career in dentistry is associated with numerous stressors in practitioners. The main objective of this research was to examine the prevalence of emotional exhaustion, burnout, and perceived stress among dental students in Mexico.MethodsA cross-sectional study was conducted among 73 dental students attending a private university in Northern Mexico. Three scales were administered to students to identify emotional exhaustion, burnout, and perceived stress, and parametric data analysis was performed.ResultsAmong participants (mean age 19.7 years), the proportion with emotional exhaustion, perceived high stress, and burnout was 52.0%, 42.3%, and 17.8%, respectively. All students with perceived stress also had burnout.ConclusionsWe found that emotional exhaustion and perceived stress are experienced by a large proportion of dentistry students enrolled in the third semester at this private university in Northern Mexico. The proportions were independent of age and sex.

Objective Cystoscopy is a common urologic procedure. Analgesics are often used to reduce any pain associated with this procedure. The aim of this study was to investigate the efficacy in reducing pain and the cost-effectiveness of two forms of lidocaine gel in patients undergoing cystoscopy. Methods In this double-blind, randomized clinical trial, 77 male patients who were referred for double J removal, urethral dilatation, or cystoscopy were enrolled. The patients were divided into two groups: Dispogel and Cathejell. All patients received 20 mL of intraurethral lidocaine gel 2% and cystoscopy was performed 5 minutes thereafter. The primary outcome was the pain score (visual analogue scale, VAS) during and 5 minutes after cystoscopy. Results There were no statistically significant differences between the VAS scores, blood pressure, and pulse rate in the groups in either observation period. No patient required additional anesthetic agents or sedatives for insufficient pain relief. Conclusion The results of this study show that the analgesic efficacy of Dispogel and Cathejell in the treatment of pain during and after elective cystoscopy was the same, but Dispogel was more cost-effective.

Objective We aimed to explore the relationship among the duration of constipation at 30 days after thoracolumbar fracture surgery, self-efficacy, and anxiety or depression in patients with constipation after thoracolumbar fracture surgery. Methods In this descriptive correlational study, 108 patients with thoracolumbar fracture undergoing pedicle screw fixation surgery were recruited from January 2015 to May 2017 in our hospital. From the day of surgery, we conducted a 1-month follow-up investigation. We evaluated the pattern of defecation, stool consistency, and incidence of defecation-related problems using a structured interview. Clinical data were obtained using a patient intake form, and we applied the Health Behavior Self-Efficacy Scale (HBSES), and Hospital Anxiety and Depression Scale (HADS). Results Approximately 83.3% of patients experienced postoperative constipation, and most exhibited normal defecation by postoperative day 13. Self-efficacy and anxiety and depression were graded at a medium level in most patients. The average HBSES score was 74.39 ± 11.08, and the mean HADS score was 7.97 ± 4.08. The duration of postoperative constipation was negatively correlated with self-efficacy and positively associated with anxiety or depression. Conclusions Self-efficacy, anxiety, and depression are important sociopsychological factors associated with the duration of postoperative constipation.

Objective To investigate the involvement of microRNAs (miRNAs) in the pathogenesis of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods In this study, we investigated miRNA profiles in the upper airway (UA) skeletal muscles of four patients with OSAHS and four matched controls using the miRCURY miRNA array. In another cohort of 12 OSAHS cases and 7 controls, the mRNA expression levels of interleukin (IL)-6 and Lin-28 homolog A (Lin28A), targets of the downregulated let-7 family members, were measured by real-time quantitative-PCR. The potential targets of the miRNAs were predicted by miRNA target prediction databases miRanda, Microcosm, and Targetscan. Results The array identified 370 differentially expressed miRNAs, of which 181 were upregulated and 189 were downregulated in OSAHS patients (based on a fold-change >2.0 and p Conclusion This study demonstrated profoundly altered miRNA expression profiles in upper airway muscular tissues of patients with OSAHS, which might contribute to the formation and development of OSAHS.

Objective This study was performed to summarize our experience in applying choledochofiberscopy to the treatment of anastomotic stricture after cholangiojejunostomy. Methods We retrospectively analyzed patients who underwent choledochofiberscopy for the treatment of anastomotic stricture via balloon dilatation and were followed up for at least 6 to 12 months. Results A 6- to 12-month follow-up was performed in the above-mentioned 30 patients after trans-choledochofiberscopic balloon dilation and stone removal. Among these patients, 19 did not develop recurrent fever or abdominal pain, and the serum levels of direct bilirubin, aspartate aminotransferase, γ-glutamyl transpeptidase, and alkaline phosphatase returned to normal or near normal, with a total success rate of 63%. Eleven patients developed restenosis and recurrence of intrahepatic stones, with a stenosis rate of 37%. Among these 11 patients, 6 underwent trans-choledochofiberscopic balloon dilatation for stone removal, and they recovered uneventfully; the remaining 5 patients were transferred for surgical reoperations for treatment of stenosis following repeated dilatation, with a failure rate of 17%. Conclusion Choledochofiberscopy for the treatment of anastomotic stricture after cholangiojejunostomy has the following advantages: minimal trauma, minimal pain, rapid effect, low risk, repeatable treatment procedures, and no serious complications. This is a safe and effective method of treatment.

Objective We aimed to compare the survival and perioperative outcomes of patients with stage II endometrial cancer (EC) undergoing simple hysterectomy (SH) or radical hysterectomy (RH), to validate the various guidelines. Methods A total of 155 consecutive patients diagnosed with stage II EC from 2000 to 2014 were reviewed. We identified 40 pairs of patients (40 SH and 40 RH) who were matched in terms of age, pathological type, and lymphovascular space invasion status using matched-pair analysis. Patient data were collected from medical records and outcomes were determined by telephone follow-up. Results Among the 80 patients in the two groups, seven died from tumor recurrence. However, cancer-related survival rates were not significantly different between the SH and RH groups. The 3-year cancer-related survival rates in the SH and RH groups were 94.97% and 92.53%, and the 5-year survival rates were 92.40% and 90.03%, respectively. Regarding perioperative outcomes, the SH group had significantly less intraoperative bleeding and a significantly shorter catheter-indwelling time than the RH group. Conclusions SH provides similar survival outcomes and a superior perioperative quality of life compared with RH in patients with stage II EC.

Objective To determine whether 3% w/w levomenthol added to ibuprofen gel (5% w/w) improves its efficacy compared with ibuprofen gel alone or diclofenac gel (1.16%) for the treatment of soft-tissue injuries. Methods A total of 182 patients with acute soft-tissue injuries participated in a randomised, single-blind, single-dose study to assess the efficacy and safety of three topical analgesic gels. Efficacy was assessed as the score change in a numeric rating scale for pain. Results The median time to significant pain relief was 20 minutes for the ibuprofen/levomenthol and diclofenac gels but 25 minutes for ibuprofen gel. At 2 hours, significantly more patients treated with ibuprofen/levomenthol gel reported a cooling sensation (45.8%) compared with diclofenac (16.4%) or ibuprofen (14.7%) gels, and both ibuprofen/levomenthol and diclofenac gels provided significantly more effective global pain relief compared with ibuprofen gel. Few adverse events and no serious adverse events related to study medication were recorded. Conclusions Although all gels effectively relieved pain, both ibuprofen/levomenthol and diclofenac gels provided superior global pain relief compared with ibuprofen gel, with a shorter median time to significant pain relief. Only ibuprofen/levomenthol gel provided cooling for up to 2 hours. None of the gels were associated with serious safety concerns. EudraCT No 2015-005240-33 EU Clinical Trials Register URL: https://www.clinicaltrialsregister.eu/ctr-search/search

Objective Knee osteoarthritis (KOA) is a chronic inflammatory disease. The monocyte–lymphocyte ratio (MLR) was reported to be a non-invasive, cost-effective marker in various systemic diseases, but it has not yet been investigated in KOA. This cross-sectional study evaluated the diagnostic value of MLR in KOA. Methods Two hundred and five KOA patients and 120 healthy control subjects were enrolled. Patient data, including age, sex, blood cell counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, red blood cell distribution width, and the Kellgren–Lawrence (KL) score were recorded. Results One hundred nineteen patients (55 men, 64 women) were included, with a mean age of 55.47 ± 9.23 years. KOA patients showed a significantly higher MLR, neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) than controls. The MLR area under the curve was 0.81, which was higher than that of NLR and PLR. Multiple logistic regression analysis revealed blood MLR as an independent predictor of KOA. Correlation analysis showed that MLR was positively correlated with ESR and CRP levels. MLR and NLR were significantly higher in KL4 patients than in KL1–3 patients. Conclusions MLR has a high diagnostic value for KOA, so could be a reliable disease marker.

ObjectiveThis study was performed to compare the clinical outcomes, advantages, and disadvantages of laparoscopic myomectomy (LM) and transcervical resection of myoma (TCRM) in the treatment of type II submucous myoma.MethodsIn total, 136 patients with type II submucous myoma with a tumour diameter of 4 to 5 cm were randomly assigned to the hysteroscopy group or laparoscopy group.ResultsThe operative duration was shorter and the intraoperative bleeding volume was lower in the hysteroscopy than laparoscopy group. The success rate of the single-stage operation was obviously higher in the laparoscopy than hysteroscopy group. The duration of postoperative antibiotic use and the length of hospital stay were shorter in the hysteroscopy than laparoscopy group. The time to complete healing of the muscle layer was shorter in the hysteroscopy than laparoscopy group. The rate of intraoperative complications was lower in the hysteroscopy than laparoscopy group.ConclusionBoth hysteroscopic and laparoscopic surgery have beneficial effects in the treatment of type II submucous myoma. Hysteroscopic surgery has the advantages of a short operative duration, low intraoperative bleeding volume, fast postoperative recovery, and high quality of life. Laparoscopic surgery involves many intraoperative complications and slow recovery of ovarian function.