Publications by authors named "Chao Tu"

140 Publications

Gastroparesis with concomitant gastrointestinal dysmotility is not a contraindication for per-oral pyloromyotomy (POP).

Surg Endosc 2021 Oct 12. Epub 2021 Oct 12.

Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Per-oral pyloromyotomy (POP or G-POEM) provides significant short-term improvements in symptoms and objective emptying for patients with medically refractory gastroparesis, but it is unclear if patients with gastroparesis and co-existing dysmotility (small bowel or colonic delay) also benefit. In this study, we used wireless motility capsule (WMC) data to measure outcomes in patients with isolated gastroparesis (GP) and gastroparesis with co-existing dysmotility (GP + Dys) who underwent POP.

Methods: We retrospectively analyzed patients who had POP and completed WMC data during their evaluation of intestinal dysmotility. WMC data were reviewed to identify patients who demonstrated isolated GP or GP + Dys. Each patient's pre-op and post-op Gastroparesis Cardinal Symptom Index (GCSI) and 4-h solid-phase scintigraphy gastric emptying studies (GES) scores were compared to evaluate improvement.

Results: Of the entire cohort (n = 73), 89% were female with a mean age of 47.0 ± 15.0 years old. Gastroparesis etiologies were divided among idiopathic (54.8%), diabetic (26%), postsurgical (8.2%), autoimmune (5.5%), and multifactorial (5.5%). Forty-one patients (56%) had GP and 32 patients (44%) had GP + Dys. GCSI improved after POP whether the patient had isolated GP (- 12.31, p < 0.001) or GP + Dys (- 9.58, p < 0.001); however, there was no significant difference in total GCSI improvement between the two groups. A subset of patients had postoperative GES available (n = 47). In the isolated GP and GP + Dys cohorts, 15/28 (54%) and 12/19 (63%) patients had normal post-op 4-h GES, respectively, but no statistical difference between the two groups.

Conclusion: Patients with medically refractory gastroparesis with and without concomitant gastrointestinal dysmotility show short-term subjective and objective improvement after POP. Concomitant small bowel or colonic dysmotility should not deter physicians from offering POP in carefully selected patients with gastroparesis.
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http://dx.doi.org/10.1007/s00464-021-08756-9DOI Listing
October 2021

Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies.

BMC Musculoskelet Disord 2021 Sep 12;22(1):776. Epub 2021 Sep 12.

Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.

Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA.

Methods: Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results.

Results: Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01-2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25-2.21)], AVN [1.65 (1.07-2.56)], femoral neck fracture [1.75 (1.39-2.20)], RA [1.37 (1.23-1.54)], CVD [1.34 (1.03-1.74)], chronic pulmonary disease (CPD) [1.22 (1.08-1.37)], neurological disease [1.19 (1.05-1.35)], opioid use [1.53 (1.35-1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13-1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45-0.93)], and OA [0.70 (0.62-0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk.

Conclusion: Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.
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http://dx.doi.org/10.1186/s12891-021-04647-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436433PMC
September 2021

Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve Gastrectomy, and Usual Care.

Diabetes Care 2021 Nov 9;44(11):2552-2563. Epub 2021 Sep 9.

Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.

Objective: To determine which one of the two most common metabolic surgical procedures is associated with greater reduction in risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and obesity.

Research Design And Methods: A total of 13,490 patients including 1,362 Roux-en-Y gastric bypass (RYGB), 693 sleeve gastrectomy (SG), and 11,435 matched nonsurgical patients with T2DM and obesity who received their care at the Cleveland Clinic (1998-2017) were analyzed, with follow-up through December 2018. With multivariable Cox regression analysis we estimated time to incident extended MACE, defined as first occurrence of coronary artery events, cerebrovascular events, heart failure, nephropathy, atrial fibrillation, and all-cause mortality.

Results: The cumulative incidence of the primary end point at 5 years was 13.7% (95% CI 11.4-15.9) in the RYGB groups and 24.7% (95% CI 19.0-30.0) in the SG group, with an adjusted hazard ratio (HR) of 0.77 (95% CI 0.60-0.98, = 0.04). Of the six individual end points, RYGB was associated with a significantly lower cumulative incidence of nephropathy at 5 years compared with SG (2.8% vs. 8.3%, respectively; HR 0.47 [95% CI 0.28-0.79], = 0.005). Furthermore, RYGB was associated with a greater reduction in body weight, glycated hemoglobin, and use of medications to treat diabetes and cardiovascular diseases. Five years after RYGB, patients required more upper endoscopy (45.8% vs. 35.6%, < 0.001) and abdominal surgical procedures (10.8% vs. 5.4%, = 0.001) compared with SG.

Conclusions: In patients with obesity and T2DM, RYGB may be associated with greater weight loss, better diabetes control, and lower risk of MACE and nephropathy compared with SG.
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http://dx.doi.org/10.2337/dc20-3023DOI Listing
November 2021

Relation-aware Shared Representation Learning for Cancer Prognosis Analysis with Auxiliary Clinical Variables and Incomplete Multi-modality Data.

IEEE Trans Med Imaging 2021 Aug 30;PP. Epub 2021 Aug 30.

The integrative analysis of complementary phenotype information contained in multi-modality data (e.g., histopathological images and genomic data) has advanced the prognostic evaluation of cancers. However, multi-modality based prognosis analysis confronts two challenges: (1) how to explore underlying relations inherent in different modalities data for learning compact and discriminative multi-modality representations; (2) how to take full consideration of incomplete multi-modality data for constructing accurate and robust prognostic model, since a host of complete multi-modality data are not always available. Additionally, many existing multi-modality based prognostic methods commonly ignore relevant clinical variables (e.g., grade and stage), which, however, may provide supplemental information to promote the performance of model. In this paper, we propose a relation-aware shared representation learning method for prognosis analysis of cancers, which makes full use of clinical information and incomplete multi-modality data. The proposed method learns multi-modal shared space tailored for prognostic model via a dual mapping. Within the shared space, it equips with relational regularizers to explore the potential relations (i.e., feature-label and feature-feature relations) among multi-modality data for inducing discriminatory representations and simultaneously obtaining extra sparsity for alleviating overfitting. Moreover, it regresses and incorporates multiple auxiliary clinical attributes with dynamic coefficients to meliorate performance. Furthermore, in training stage, a partial mapping strategy is employed to extend and train a more reliable model with incomplete multi-modality data. We have evaluated our method on three public datasets derived from The Cancer Genome Atlas (TCGA) project, and the experimental results demonstrate the superior performance of the proposed method.
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http://dx.doi.org/10.1109/TMI.2021.3108802DOI Listing
August 2021

Research trends of platelet-rich plasma application in orthopaedics from 2002 to 2020: a bibliometric analysis.

Int Orthop 2021 11 2;45(11):2773-2790. Epub 2021 Aug 2.

Department of Orthopedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.

Background: Platelet-rich plasma (PRP) has been widely used to treat various orthopaedic diseases, and there are a large number of studies on the matter. However, there have been no bibliometric reports on the publications in this field. Bibliometrics is an excellent method to systematically evaluate the current research status of a specific field. In this study, CiteSpace 5.7.R2 software was used to analyse the status, hotspots, and frontiers of PRP in the treatment of orthopaedic diseases in the past 19 years.

Methods: All articles about the application of PRP in orthopaedics from 2002 to 2020 were searched from the Web of Science Core Collection. The author, country, institution, journal, cited journal, and keywords were retrieved, and the bibliometric analysis was done in CiteSpace 5.7.R2.

Results: A total of 321 articles were retrieved. The analysis showed that the number of publications increased in the past 19 years, and the most productive author in this field was Brian J. Cole. The most productive country and the most productive institution were the US and the Hospital for Special Surgery in New York, respectively. The journals with the highest output and the highest citation frequency were the Journal of Orthopaedic Research and the American Journal of Sports Medicine, respectively. From the keyword analysis, we observed that the primary research hotspots were the study of the PRP composition, growth factors, and the combination of PRP and mesenchymal stem cells. The frontiers of PRP were in vivo experiments, the treatment of rotator cuff and cartilage injury, and the comparison of clinical efficacy between PRP and hyaluronic acid.

Conclusion: The efficacy of PRP in treating orthopaedic diseases remains controversial. There are still some problems with the experimental methods, such as insufficient sample size, low level of evidence, confusion of system naming, lack of standardisation of preparation methods and application programs, and lack of in-depth basic scientific research. The research status shown by co-occurrence and cluster maps and the analysis of hotspots and frontiers may help solve present problems and explore new directions.
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http://dx.doi.org/10.1007/s00264-021-05163-6DOI Listing
November 2021

Deep cross-view co-regularized representation learning for glioma subtype identification.

Med Image Anal 2021 10 9;73:102160. Epub 2021 Jul 9.

School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China; Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou 510515, China; Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou 510515, China. Electronic address:

The new subtypes of diffuse gliomas are recognized by the World Health Organization (WHO) on the basis of genotypes, e.g., isocitrate dehydrogenase and chromosome arms 1p/19q, in addition to the histologic phenotype. Glioma subtype identification can provide valid guidances for both risk-benefit assessment and clinical decision. The feature representations of gliomas in magnetic resonance imaging (MRI) have been prevalent for revealing underlying subtype status. However, since gliomas are highly heterogeneous tumors with quite variable imaging phenotypes, learning discriminative feature representations in MRI for gliomas remains challenging. In this paper, we propose a deep cross-view co-regularized representation learning framework for glioma subtype identification, in which view representation learning and multiple constraints are integrated into a unified paradigm. Specifically, we first learn latent view-specific representations based on cross-view images generated from MRI via a bi-directional mapping connecting original imaging space and latent space, and view-correlated regularizer and output-consistent regularizer in the latent space are employed to explore view correlation and derive view consistency, respectively. We further learn view-sharable representations which can explore complementary information of multiple views by projecting the view-specific representations into a holistically shared space and enhancing via adversary learning strategy. Finally, the view-specific and view-sharable representations are incorporated for identifying glioma subtype. Experimental results on multi-site datasets demonstrate the proposed method outperforms several state-of-the-art methods in detection of glioma subtype status.
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http://dx.doi.org/10.1016/j.media.2021.102160DOI Listing
October 2021

Nipple-Sparing Mastectomy: Are We Providing Proper Prophylactic Antibiotic Coverage?

Ann Surg Oncol 2021 Oct 23;28(10):5486-5494. Epub 2021 Jul 23.

Division of Breast Surgery, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.

Background: Infection after nipple-sparing mastectomy (NSM) and implant-based reconstruction (IBR) can be a devastating complication. The retained nipple may act as a portal or nidus for different ductal organisms, and as such, the bacteriology of surgical-site infections (SSIs) in this setting may not be adequately covered by current antibiotic recommendations. This study sought to evaluate SSI and reconstruction outcomes in relation to antibiotic choice and identify the different microbial species implicated.

Methods: A prospective database was reviewed for patients who underwent NSM with IBR from 2010 to 2019. Patient characteristics, operative details, antibiotic regimens, and subsequent treatment details were evaluated. The study analyzed SSI incidence, timing, and type of causative organisms.

Results: The study analyzed 571 NSMs with IBR performed for 347 patients (55% with direct implants and 45% with tissue expanders). The preoperative antibiotics consisted of cephalosporin alone for 65% of the patients, a more broad single-antibiotic use for 12% of the patients, and dual-coverage antibiotics for 20% of the patients. During a median follow-up of 1.7 years, SSI developed in 12% of the reconstructions, with 6% requiring prosthesis removal. The most common SSI organism cultured was Staphylococcal species. Neither pre- nor postoperative antibiotic choice was associated with incidence of infection, type of bacteria, or need for prosthetic explanation.

Conclusion: For patients undergoing NSM with IBR, a more aggressive antibiotic choice is not associated with an improved SSI rate. Patient and treatment factors continue to carry the highest risk for SSI.
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http://dx.doi.org/10.1245/s10434-021-10449-5DOI Listing
October 2021

Exosomes: A Friend or Foe for Osteoporotic Fracture?

Front Endocrinol (Lausanne) 2021 21;12:679914. Epub 2021 Jun 21.

Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China.

The clinical need for effective osteoporotic fracture therapy and prevention remains urgent. The occurrence and healing of osteoporotic fracture are closely associated with the continuous processes of bone modeling, remodeling, and regeneration. Accumulating evidence has indicated a prominent role of exosomes in mediating multiple pathophysiological processes, which are essential for information and materials exchange and exerting pleiotropic effects on neighboring or distant bone-related cells. Therefore, the exosomes are considered as important candidates both in the occurrence and healing of osteoporotic fracture by accelerating or suppressing related processes. In this review, we collectively focused on recent findings on the diagnostic and therapeutic applications of exosomes in osteoporotic fracture by regulating osteoblastogenesis, osteoclastogenesis, and angiogenesis, providing us with novel therapeutic strategies for osteoporotic fracture in clinical practice.
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http://dx.doi.org/10.3389/fendo.2021.679914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256167PMC
June 2021

A novel and effective approach to generate germline-like monoclonal antibodies by integration of phage and mammalian cell display platforms.

Acta Pharmacol Sin 2021 Jul 7. Epub 2021 Jul 7.

MOE/NHC Key Laboratory of Medical Molecular Virology, Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, 200032, China.

Phage display technology allows for rapid selection of antibodies from the large repertoire of human antibody fragments displayed on phages. However, antibody fragments should be converted to IgG for biological characterizations and affinity of antibodies obtained from phage display library is frequently not sufficient for efficient use in clinical settings. Here, we describe a new approach that combines phage and mammalian cell display, enabling simultaneous affinity screening of full-length IgG antibodies. Using this strategy, we successfully obtained a novel germline-like anti-TIM-3 monoclonal antibody named m101, which was revealed to be a potent anti-TIM-3 therapeutic monoclonal antibody via in vitro and in vivo experiments, indicating its effectiveness and power. Thus, this platform can help develop new monoclonal antibody therapeutics with high affinity and low immunogenicity.
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http://dx.doi.org/10.1038/s41401-021-00707-3DOI Listing
July 2021

Effect of pre-operative opioid exposure on surgical outcomes in elective laparoscopic cholecystectomy.

Am J Surg 2021 Jun 24. Epub 2021 Jun 24.

Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. Electronic address:

Background: The effects of varying levels of pre-operative opioids on post-operative outcomes following elective laparoscopic cholecystectomy is largely unknown.

Methods: Patients who underwent elective laparoscopic cholecystectomy from 2012 to 2019 were reviewed and categorized by the number of outpatient opioid prescriptions received in the 90 days preceding surgery: none (Naïve), one (1 Rx), two (2 Rx), or three or more (Chronic). Operative time, hospital length of stay, and 30-day readmission rate were analyzed.

Results: Of the 11911 patients identified, 2958 (24.8%) used opioids pre-operatively. Among patients with an overnight admission, the Naïve, 1 Rx, and 2 Rx cohorts had a shorter length of stay compared to the Chronic cohort. The Naïve group had the lowest 30-day readmission rate (5.0%) followed by the 1 Rx (5.9%), 2 Rx and Chronic groups (9.1% and 8.7%, respectively) (p < 0.001).

Conclusions: Prevalence of pre-operative opioid use is high and warrants surgeon assessment to minimize adverse post-operative outcomes.
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http://dx.doi.org/10.1016/j.amjsurg.2021.06.011DOI Listing
June 2021

Functional interplay between long non-coding RNAs and the Wnt signaling cascade in osteosarcoma.

Cancer Cell Int 2021 Jun 15;21(1):313. Epub 2021 Jun 15.

Department of Orthopedics, The Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, 410011, Hunan, China.

Osteosarcoma is a common and highly malignant bone tumor among children, adolescents and young adults. However, the underlying molecular mechanisms remain largely unexplored. LncRNAs are transcripts with no or limited protein-coding capacity in human genomes, and have been demonstrated to play crucial functions in initiation, progression, therapeutic resistance, recurrence and metastasis of tumor. Considerable studies revealed a dysregulated lncRNA expression pattern in osteosarcoma, which may act as oncogenes or suppressors to regulate osteosarcoma progression. Wnt signaling pathway is an important cascade in tumorigenesis by modulation of pleiotropic biological functions including cell proliferation, apoptosis, differentiation, stemness, genetic stability and chemoresistance. Hyperactivation or deficiency of key effectors in Wnt cascade is a common event in many osteosarcoma patients. Recently, increasing evidences have suggested that lncRNAs could interplay with component of Wnt pathway, and thereby contribute to osteosarcoma onset, progression and dissemination. In this review, we briefly summarize Wnt signaling-related lncRNAs in osteosarcoma progression, aiming to gain insights into their underlying crosstalk as well as clinical application in osteosarcoma therapeutic modalities.
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http://dx.doi.org/10.1186/s12935-021-02013-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207720PMC
June 2021

Time to Completion of Breast Cancer Treatment and Survival.

Ann Surg Oncol 2021 Dec 8;28(13):8600-8608. Epub 2021 Jun 8.

Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

Background: Breast cancer treatment delays are common. This study was designed to examine the association between the time interval from time of diagnosis to completion of all acute breast cancer treatment modalities (surgery, chemotherapy, and radiation therapy) and survival.

Methods: A retrospective analysis was performed utilizing data from the National Cancer Database (NCDB) to determine an association between the duration of time from diagnosis to completing all acute breast cancer treatment (surgery, chemotherapy, and radiation therapy) and survival. Secondary survival analysis evaluated whether delay in treatment completion varied by differences in tumor receptor status.

Results: We analyzed 2010 NCDB data of stage I-III breast cancer patients. A subset of 28,284 patients received all three modalities (surgery, chemotherapy, and radiation) as their acute treatment. Median follow-up was 5.8 years. Cox proportional hazards model identified a cut-off showing the risk of delaying completion of all treatment beyond 38 weeks was associated with a decrease in overall survival (hazard ratio [HR] 1.21). This decrease in survival was significant regardless of the major tumor receptor status: triple-negative (HR 1.188, 95% confidence interval [CI] 1.06-1.34), estrogen receptor (ER)+/progesterone receptor (PR)+/human epidermal growth factor receptor 2 (HER2)- (HR 1.22, 95% CI 1.09-1.36), ER-/PR-/HER2+ (HR 1.29, 95% CI 1.004-1.67), and ER+/PR+/HER2+ (HR 1.32, 95% CI 1.01-1.72).

Conclusion: Efforts to improve the efficiency of multimodality breast cancer treatment and reduce treatment delays should be a priority to optimize breast cancer patient outcomes.
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http://dx.doi.org/10.1245/s10434-021-10116-9DOI Listing
December 2021

Don't Judge a Letter by its Title: Linguistic Analysis of Letters of Recommendation by Author's Academic Rank.

J Surg Educ 2021 May 16. Epub 2021 May 16.

Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.

Objective: This study analyzed the linguistic differences in letters of recommendation (LORs) for general surgery residency applicants written by authors of various academic ranks. Given that many general surgery residency programs require a LOR from the Chair of surgery, this study also examined whether LORs written by the Chair demonstrate linguistic differences to support this practice.

Design: A single institution, retrospective review analyzed LORs from two application cycles of general surgery residency applicants who were selected for interview at a large academic institution. Word count (WC) and linguistic characteristics of LORs were analyzed with a previously developed institution-specific dictionary using the Linguistic Inquiry and Word Count software (LIWC2015; Pennebaker Conglomerates, Inc., Austin, Texas). WC and linguistic characteristics of LORs reported as frequencies of terms within twenty-four categories were examined based on the letter authors' academic rank. Further examination compared LORs written by a Chair of surgery with those written by non-Chairs.

Setting: A single large, Midwestern academic general surgery residency program PARTICIPANTS: Four hundred and sixty-five letters of recommendation received during two interview cycles were included for analysis.

Results: A total of 465 LORs written by assistant (n = 82), associate (n = 94), and full professors (n = 289) were included in the study. No statistically significant difference was noted in the WC of LORs based on the letter writers' academic ranks (p = 0.95). Assistant professors utilized grindstone, communal, and technical skill terms with higher frequencies compared to associate professors and full professors. LORs written by assistant professors demonstrated the highest authentic variable score followed by associate professors then full professors (4.94, 3.92, 3.28, p < 0.01). LORs written by Chairs (n = 128) had lower authentic variable scores compared to LORs written by non-Chairs (n = 337; 2.71 vs. 3.91, p = 0.001). Only 50 (39%) LORs written by Chairs indicated working directly with the applicant, and sub-group analysis demonstrated a higher authentic variable score in this group compared with LORs written by Chairs who did not indicate having worked directly with the applicant (3.51 vs. 2.5, p = 0.01).

Conclusions: Linguistic analysis of LORs for general surgery residency applicants demonstrated minor yet statistically significant differences based on the author's academic rank. If applicants can obtain linguistically similar LORs from surgeons of any academic rank, but less authentic LORs from writers with higher academic ranks, these LORs may be less valuable for the residency programs when evaluating applicants. Based on the subgroup analysis, less than 40% of Chair LORs indicated that the Chair worked directly with the applicant, calling into question the utility of the Chair LORs as meaningful evaluation of applicants. Further study to compare LORs of applicants selected and not selected for interview may add additional insight into linguistic differences in LORs written by authors of different academic ranks.
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http://dx.doi.org/10.1016/j.jsurg.2021.04.012DOI Listing
May 2021

SARS-CoV-2 Induces Lymphocytopenia by Promoting Inflammation and Decimates Secondary Lymphoid Organs.

Front Immunol 2021 28;12:661052. Epub 2021 Apr 28.

Institute of Immunology, PLA, Third Military Medical University, Chongqing, China.

While lymphocytopenia is a common characteristic of coronavirus disease 2019 (COVID-19), the mechanisms responsible for this lymphocyte depletion are unclear. Here, we retrospectively reviewed the clinical and immunological data from 18 fatal COVID-19 cases, results showed that these patients had severe lymphocytopenia, together with high serum levels of inflammatory cytokines (IL-6, IL-8 and IL-10), and elevation of many other mediators in routine laboratory tests, including C-reactive protein, lactate dehydrogenase, α-hydroxybutyrate dehydrogenase and natriuretic peptide type B. The spleens and hilar lymph nodes (LNs) from six additional COVID-19 patients with post-mortem examinations were also collected, histopathologic detection showed that both organs manifested severe tissue damage and lymphocyte apoptosis in these six cases. hybridization assays illustrated that SARS-CoV-2 viral RNA accumulates in these tissues, and transmission electronic microscopy confirmed that coronavirus-like particles were visible in the LNs. SARS-CoV-2 Spike and Nucleocapsid protein (NP) accumulated in the spleens and LNs, and the NP antigen restricted in angiotensin-converting enzyme 2 (ACE2) positive macrophages and dendritic cells (DCs). Furthermore, SARS-CoV-2 triggered the transcription of , and genes in infected primary macrophages and DCs , and SARS-CoV-2-NP macrophages and DCs also manifested high levels of IL-6 and IL-1β, which might directly decimate human spleens and LNs and subsequently lead to lymphocytopenia . Collectively, these results demonstrated that SARS-CoV-2 induced lymphocytopenia by promoting systemic inflammation and direct neutralization in human spleen and LNs.
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http://dx.doi.org/10.3389/fimmu.2021.661052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113960PMC
May 2021

Clinical significance of diabetes control before metabolic surgery.

Surg Obes Relat Dis 2021 Jul 9;17(7):1271-1278. Epub 2021 Apr 9.

Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address:

Background: Even though observational studies have suggested that poor preoperative diabetes control increases risk after major abdominal surgery, it is unclear whether this effect is seen in metabolic surgery patients.

Objectives: To determine whether poor preoperative diabetes control is associated with worse outcomes in patients with obesity and diabetes undergoing metabolic surgery.

Setting: Metabolic and Bariatric Surgery Quality Improvement Project (MBSAQIP) database.

Methods: Using the MBSAQIP 2017 and 2018 database and preoperative glycated hemoglobin (HbA1C) as a diabetes control surrogate, we examined the association between diabetes control and major outcomes of primary laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) in patients with diabetes and obesity. Multivariate logistic regression modeling examined five 30-day postoperative outcomes: composite serious complications (composite of 10 adverse events), composite infection (composite of 7 infectious complications), length of stay >5 days, reoperation, and readmission. Models were adjusted for multiple covariates.

Results: In total, 26,674 patients with HbA1C data available within 30 days before metabolic surgery were included in the primary analysis and 35,884 patients with HbA1C data within 90 days before surgery were included in the sensitivity analysis. The mean body mass index (BMI) and preoperative HbA1C were 45.6 ± 8.2 kg/m and 8.2 ± 2.7%, respectively. The incidence of 30-day postoperative infections and serious complications were 1.62% and 1.35%, respectively. Neither primary analysis nor sensitivity analysis demonstrated any association between higher HbA1C and worsening of 5 primary outcomes of interest. The odds ratio of an overall effect for SG was 1.01 (95% CI .98-1.03; P = .58) and for RYGB was .99 (95% CI .96-1.02; P = .41).

Conclusion: Suboptimal preoperative diabetes control is not associated with increased adverse events and should not delay metabolic surgery, as metabolic surgery is generally a safe procedure and intrinsically improves diabetes control.
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http://dx.doi.org/10.1016/j.soard.2021.03.031DOI Listing
July 2021

Correction to: Survivorship and prognostic factors for pleomorphic liposarcoma: a population-based study.

J Orthop Surg Res 2021 Mar 29;16(1):228. Epub 2021 Mar 29.

Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.

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http://dx.doi.org/10.1186/s13018-021-02369-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006338PMC
March 2021

The Efficacy of Ramucirumab in the Treatment of Gastric or Gastroesophageal Junction Cancer: A Meta-Analysis of RCTs.

Gastroenterol Res Pract 2021 22;2021:8960315. Epub 2021 Feb 22.

Department of General Practice, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.

Five electronic databases were searched for eligible records. Outcomes were presented and analyzed according to the objective response rate (ORR), progression-free survival (PFS) rate, and overall survival (OS) rate. Five records involving 2,024 participants were included in the study. The pooled analysis of OS and PFS were longer with ramucirumab (RAM) therapy than without RAM for OS (odds ratio (OR) = 0.90, 95% confidence interval (CI) = 0.82-1.00, = 0.05) and PFS (OR = 0.74, 95%CI = 0.57-0.96, = 0.02). Moreover, compared with the current first-line chemotherapy, the OS (OR = 0.93, 95%CI = 0.83-1.04, = 0.19) and PFS (OR = 0.82, 95%CI = 0.64-1.06, = 0.13) results were not significantly higher with RAM. The ORRs of the patients in the RAM therapy groups were significantly higher than those in the groups without RAM (OR = 1.40, 95%CI = 1.14-1.73, = 0.001).
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http://dx.doi.org/10.1155/2021/8960315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925040PMC
February 2021

Survivorship and prognostic factors for pleomorphic liposarcoma: a population-based study.

J Orthop Surg Res 2021 Mar 4;16(1):175. Epub 2021 Mar 4.

Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.

Background: Pleomorphic liposarcoma is the least common but most aggressive subtype of liposarcoma. Very few studies have presented data on pleomorphic liposarcoma specifically, often including a limited number of cases and short-term follow-up. As a result, the survivorship and prognostic characteristics of this tumor remain incompletely identified.

Study Design And Setting: Cross-sectional analysis of the Surveillance Epidemiology and End Results database (1996-2015).

Results: Overall survival for the entire series was 54% (95% confidence interval [CI], 49-58%) and 40% (95% CI, 35-45%) at 5 and 10 years, respectively. Disease-specific survival for the entire series was 60% (95% CI, 56-65%) and 53% (95% CI, 48-58%) at 5 and 10 years, respectively. Patients who survived 10 years or more were more likely to die of events unrelated to pleomorphic liposarcoma. Univariate and multivariate analysis demonstrated that not receiving cancer-directed surgery was an independent poor prognostic factor. Older age (≥ 65 years old) was associated with worse overall survival but not disease-specific survival. Tumor stage and radiotherapy showed different impact on survival depending on tumor size. In comparison to localized staged tumors, regional stage only predicts poor survival in patients with tumor size less than 5 cm, while distant stage is an independent worse prognosis factor. Radiotherapy only benefits patients with tumor size larger than 10 cm. These results were confirmed in competing risk analysis.

Conclusion: Survival rates of patients with pleomorphic liposarcoma has not changed over the past 20 years. Patients with distant stage have poor prognosis; regional stage indicates worse survival in patients with tumor size less than 5 cm. Receiving surgery could prolong the survival, while radiotherapy only benefits patients with large tumor size (> 10 cm). Older age is associated with poor overall survival but not disease-specific survival. Routine patient surveillance following initial diagnosis should at least be 10 years for pleomorphic liposarcoma.
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http://dx.doi.org/10.1186/s13018-021-02327-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931523PMC
March 2021

The clinical course and prognostic factors of severe COVID-19 in Wuhan, China: A retrospective case-control study.

Medicine (Baltimore) 2021 Feb;100(8):e23996

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.

Abstract: With the surge of newly diagnosed and severe cases of coronavirus disease 2019 (COVID-19), the death toll is mounting, this study is aimed to explore the prognostic factors of severe COVID-19. This retrospective study included 122 inpatients diagnosed with COVID-19 from January 13 to February 25, 2020. Univariate and multivariate analysis were used to identity the risk factors, receiver operating characteristics curve (ROC) analysis was used for risk stratification. The baseline neutrophil-to-lymphocyte ratio (NLR) (OR = 1.171, 95%CI = 1.049-1.306, P = .005) and Lactate dehydrogenase (LDH) (OR = 1.007, 95%CI = 1.002-1.011, P = .004) were identified as the independent risk factors for severe COVID-19 conditions, and the NLR-LDH grading system was developed to perform risk stratification. The baseline C-reactive protein (CRP) (OR = 1.019, 95%CI = 1.004-1.306, P = .016) and B-type natriuretic peptide (BNP) (OR = 1.018, 95%CI = 1.004-1.035, P = .007) were identified as the independent predictors for disease progression of severe patients. Accordingly, The NLR-LDH grading system was a useful prognostic tool for the early detection of severe COVID-19. And in the severe patients, CRP and BNP seemed to be helpful for predicting the disease progression or death.
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http://dx.doi.org/10.1097/MD.0000000000023996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909135PMC
February 2021

Antiangiogenic therapy in diabetic nephropathy: A double‑edged sword (Review).

Mol Med Rep 2021 04 8;23(4). Epub 2021 Feb 8.

Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Kunming, Yunnan 650118, P.R. China.

Diabetes and the associated complications are becoming a serious global threat and an increasing burden to human health and the healthcare systems. Diabetic nephropathy (DN) is the primary cause of end‑stage kidney disease. Abnormal angiogenesis is well established to be implicated in the morphology and pathophysiology of DN. Factors that promote or inhibit angiogenesis serve an important role in DN. In the present review, the current issues associated with the vascular disease in DN are highlighted, and the challenges in the development of treatments are discussed.
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http://dx.doi.org/10.3892/mmr.2021.11899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893700PMC
April 2021

The value of lncRNAs as prognostic biomarkers on clinical outcomes in osteosarcoma: a meta-analysis.

BMC Cancer 2021 Feb 27;21(1):202. Epub 2021 Feb 27.

Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China.

Background: In recent years, emerging studies have demonstrated critical functions and potential clinical applications of long non-coding RNA (lncRNA) in osteosarcoma. To further validate the prognostic value of multiple lncRNAs, we have conducted this updated meta-analysis.

Methods: Literature retrieval was conducted by searching PubMed, Web of Science and the Cochrane Library (last update by October 2, 2019). A meta-analysis was performed to explore association between lncRNAs expression and overall survival (OS) of osteosarcoma patients. Relationships between lncRNAs expression and other clinicopathological features were also analyzed respectively.

Results: Overall, 4351 patients from 62 studies were included in this meta-analysis and 25 lncRNAs were identified. Pooled analyses showed that high expression of 14 lncRNAs connoted worse OS, while two lncRNAs were associated with positive outcome. Further, analysis toward osteosarcoma clinicopathologic features demonstrated that overexpression of TUG1 and XIST indicated poor clinical parameters of patients.

Conclusions: This meta-analysis has elucidated the prognostic potential of 16 lncRNAs in human osteosarcoma. Evidently, desperate expression and functional targets of these lncRNAs offer new approaches for prognosis and therapy of osteosarcoma.
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http://dx.doi.org/10.1186/s12885-021-07882-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912917PMC
February 2021

h-Index and Academic Rank by Gender Among Breast Surgery Fellowship Faculty.

J Womens Health (Larchmt) 2021 Feb 24. Epub 2021 Feb 24.

Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.

Gender disparities in academic promotion and leadership are well documented. Scholarly impact is essential for promotion. The Hirsch-index (h-index) is a measure of impact using number of publications and citations. We sought to (i) evaluate breast surgery fellowship faculty in North America by academic rank and research impact using the h-index, (ii) determine whether there is a gender difference in scholarly productivity, and (iii) determine the relationship between academic rank, h-index, and gender. A retrospective cross-sectional study of h-index and academic rank disparity in breast surgery faculty by gender was performed. We reviewed the faculty of Society of Surgical Oncology-accredited breast surgery fellowships in February 2019. Rank, gender, academic appointment, years in practice, program directorship, National Cancer Institute-designated cancer center association, size of the program, and h-index (via Scopus) were recorded. Univariate and multiple linear regression analyses were performed. Fifty-two programs were identified, and 209 faculty had an h-index. Of them, 69.9% were women and 30.1% were men. h-index increased with academic rank although there was considerable overlap between ranks. Women were underrepresented at the professor level (46.4%), but accounted for the majority of assistant professors (91.5%,  < 0.001), and program directors (70.7%). Men professors had a significantly higher mean h-index than women professors,  < 0.001. However, women associate professors had a higher mean h-index than men, but this did not reach significance. Mean h-index increased with increasing rank among breast surgery faculty for both genders. Average h-index was significantly higher for men professors compared to women professors. No significant gender difference in h-index was found for assistant professors. For associate professors, h-index for women was higher than for men. Women are underrepresented at higher academic ranks despite forming the majority of breast surgical teaching faculty.
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http://dx.doi.org/10.1089/jwh.2020.8579DOI Listing
February 2021

Corrigendum: Construction of a Five-Super-Enhancer-Associated-Genes Prognostic Model for Osteosarcoma Patients.

Front Cell Dev Biol 2020 19;8:631453. Epub 2021 Jan 19.

Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, China.

[This corrects the article DOI: 10.3389/fcell.2020.598660.].
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http://dx.doi.org/10.3389/fcell.2020.631453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7853077PMC
January 2021

Circular RNAs in osteoarthritis: indispensable regulators and novel strategies in clinical implications.

Arthritis Res Ther 2021 01 12;23(1):23. Epub 2021 Jan 12.

Department of Orthopedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, P.R. China.

Over the past decades, circular RNAs (circRNAs) have emerged as a hot spot and sparked intensive interest. Initially considered as the transcriptional noises, further studies have indicated that circRNAs are crucial regulators in multiple cellular biological processes, and thus engage in the development and progression of many diseases including osteoarthritis (OA). OA is a prevalent disease that mainly affects those aging, obese and post-traumatic population, posing as a major source of socioeconomic burden. Recently, numerous circRNAs have been found aberrantly expressed in OA tissues compared with counterparts. More importantly, circRNAs have been demonstrated to interplay with components in OA microenvironments, such as chondrocytes, synoviocytes and macrophages, by regulation of their proliferation, apoptosis, autophagy, inflammation, or extracellular matrix reorganization. Herein, in this review, we extensively summarize the roles of circRNAs in OA microenvironment, progression, and putative treatment, as well as envision the future directions for circRNAs research in OA, with the aim to provide a novel insight into this field.
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http://dx.doi.org/10.1186/s13075-021-02420-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802294PMC
January 2021

TARGIT-R (Retrospective): 5-Year Follow-Up Evaluation of Intraoperative Radiation Therapy (IORT) for Breast Cancer Performed in North America.

Ann Surg Oncol 2021 May 12;28(5):2512-2521. Epub 2021 Jan 12.

St. Luke's University Health Network, Bethlehem, PA, USA.

Background: Intraoperative radiation therapy (IORT) has been investigated for patients with low-risk, early-stage breast cancer. The The North American experience was evaluated by TARGIT-R (retrospective) to provide outcomes for patients treated in "real-world" clinical practice with breast IORT. This analysis presents a 5-year follow-up assessment.

Methods: TARGIT-R is a multi-institutional retrospective registry of patients who underwent lumpectomy and IORT between the years 2007 and 2013. The primary outcome of the evaluation was ipsilateral breast tumor recurrence (IBTR).

Results: The evaluation included 667 patients with a median follow-up period of 5.1 years. Primary IORT (IORT at the time of lumpectomy) was performed for 72%, delayed IORT (after lumpectomy) for 3%, intended boost for 8%, and unintended boost (primary IORT followed by whole-breast radiation) for 17% of the patients. At 5 years, IBTR was 6.6% for all the patients, with 8% for the primary IORT cohort and 1.7% for the unintended-boost cohort. No recurrences were identified in the delayed IORT or intended-boost cohorts. Noncompliance with endocrine therapy (ET) was associated with higher IBTR risk (hazard ratio [HR], 3.67). Patients treated with primary IORT who were complaint with ET had a 5-year IBTR rate of 3.9%.

Conclusion: The local recurrence rates in this series differ slightly from recent results of randomized IORT trials and are notably higher than in previous published studies using whole-breast radiotherapy for similar patients with early-stage breast cancer. Understanding differences in this retrospective series and the prospective trials will be critical to optimizing patient selection and outcomes going forward.
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http://dx.doi.org/10.1245/s10434-020-09432-3DOI Listing
May 2021

Diagnostic and Prognostic Significance of Dysregulated Expression of Circular RNAs in Osteosarcoma.

Expert Rev Mol Diagn 2021 Feb 22;21(2):235-244. Epub 2021 Jan 22.

Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.

Objective: This study aimed to perform an updated meta-analysis to explore the clinical, diagnostic, and prognostic values of circRNAs in osteosarcoma.

Methods: : PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library were systematically searched up to December 15, 2020. Eligible studies regarding the relationship between circRNAs levels and clinicopathological, diagnostic, and prognostic values in osteosarcoma were included for study.

Results: 31 studies involving 1979 osteosarcoma patients were enrolled, with 22 studies on clinicopathological parameters, eleven on diagnosis, and 23 on prognosis. For clinical parameters, overexpression of oncogenic circRNAs was intimately correlated with larger tumor size, advanced Enneking stage, poor differentiation, and distant metastasis (DM). In contrast, the downregulated circRNAs showed negative correlation with Enneking stage and DM. For the diagnostic values, the summary area under the curve of circRNA for the discriminative efficacy between osteosarcoma patients and non-cancer counterparts was estimated to be 0.87, with a weighted sensitivity of 0.79, specificity of 0.81, respectively. For the prognostic significance, oncogenic circRNAs had poor overall survival (OS) and disease-free survival, while elevated expression of tumor-suppressor circRNAs were closely related to longer OS.

Conclusion: This study showed that aberrantly expressed circRNA signatures could serve as potential biomarkers in diagnosis and prognosis in osteosarcoma.
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http://dx.doi.org/10.1080/14737159.2021.1874922DOI Listing
February 2021

Association of Bariatric Surgery with Clinical Outcomes of SARS-CoV-2 Infection: a Systematic Review and Meta-analysis in the Initial Phase of COVID-19 Pandemic.

Authors:
Ali Aminian Chao Tu

Obes Surg 2021 06 8;31(6):2419-2425. Epub 2021 Jan 8.

Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Obesity worsens clinical outcomes of coronavirus disease 2019 (COVID-19). The aim of this study was to measure the association between history of bariatric surgery and the severity of COVID-19.

Methods: Data source included PubMed/MEDLINE, Scopus, Google Scholar, and pre-print servers between January and November 1, 2020. Literature was screened and selected to extract the relevant data. The two outcomes of this meta-analysis were the difference in mortality and hospitalization rates in patients with SARS-CoV-2 infection with and without history of bariatric surgery. Random-effect models were used to estimate the pooled effects.

Results: The systematic review yielded 3 retrospective studies on 9022 patients. The risk of mortality without previous bariatric surgery was 133 per 1000 cases and its risk with previous bariatric surgery was 33 per 1000 (summary OR 0.22, 95% CI 0.19-0.26). No heterogeneity was observed between the included studies (I = 0%, P = 0.98 for heterogeneity). In the pooled analysis, the hospitalization rate in patients without previous bariatric surgery was 412 per 1000 cases and its rate in patients with previous bariatric surgery was 164 per 1000 (summary OR 0.28, 95% CI 0.12-0.65). No heterogeneity was observed between the included studies (I = 0%, P = 0.71 for heterogeneity). There was a substantial risk of bias across the studies for confounding and selection bias.

Conclusion: Findings of this meta-analysis of observational studies suggest that prior bariatric surgery is associated with a lower rate of mortality and hospital admission in patients with obesity who become infected with SARS-CoV-2. Confirmation of these findings will require larger studies with better quality data.
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http://dx.doi.org/10.1007/s11695-020-05213-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792914PMC
June 2021

Super-Enhancer Associated Five-Gene Risk Score Model Predicts Overall Survival in Multiple Myeloma Patients.

Front Cell Dev Biol 2020 3;8:596777. Epub 2020 Dec 3.

Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.

Multiple myeloma (MM) is a malignant plasma cell tumor with high heterogeneity, characterized by anemia, hypercalcemia, renal failure, and lytic bone lesions. Although various powerful prognostic factors and models have been exploited, the development of more accurate prognosis and treatment for MM patients is still facing many challenges. Given the essential roles of super-enhancer (SE) associated genes in the tumorigenesis of MM, we tried to initially screen and identify the significant prognostic factors from SE associated genes in MM by the least absolute shrinkage and selection operator (Lasso) penalized Cox regression, univariate and multivariate Cox regression analysis using GSE24080 and GSE9782 datasets. Risk score model of five genes including , , , , and , was further constructed and the Kaplan-Meier (K-M) curves showed that the low-risk group seems to have better clinical outcome of survival compared to the high-risk group. Time-dependent receiver operating characteristic (ROC) curves presented the favorable performance of the model. An interactive nomogram consisting of the five-gene risk group and eleven clinical traits was established and identified by calibration curves. Therefore, the risk score model of SE associated five genes developed here could be used to predict the prognosis of MM patients, which may assist the clinical treatment of MM patients in the future.
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http://dx.doi.org/10.3389/fcell.2020.596777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744621PMC
December 2020

Presence of Liver Steatosis Is Associated With Greater Diabetes Remission After Gastric Bypass Surgery.

Diabetes Care 2021 02 15;44(2):321-325. Epub 2020 Dec 15.

Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH

Objective: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and β-cell dysfunction. Ectopic fat accumulation in liver and muscle causes IR. Since bariatric and metabolic surgery significantly improves fatty liver disease, we hypothesized that coexistence of liver steatosis (i.e., when hepatic IR contributes in T2DM) would be associated with greater diabetes improvement after surgery.

Research Design And Methods: A total of 519 patients with T2DM who underwent Roux-en-Y gastric bypass and simultaneous liver biopsy and had a minimum 5-year follow-up were analyzed to assess the independent association between biopsy-proven liver steatosis and postoperative long-term diabetes remission (glycated hemoglobin <6.5% [48 mmol/mol] off medications).

Results: Of the 407 patients with biopsy-proven liver steatosis, long-term diabetes remission was achieved in 211 (52%) patients compared with remission in 44 out of 112 (39%) patients without steatosis ( = 0.027). In multivariable analysis, presence of liver steatosis was an independent predictor of long-term diabetes remission (odds ratio 1.96 [95% CI 1.04-3.72]; = 0.038). Hepatocyte ballooning, lobular inflammation, or fibrosis at baseline did not predict diabetes remission.

Conclusions: This study, for the first time, suggests that in patients with T2DM who are considering bariatric and metabolic surgery, coexistence of liver steatosis is associated with better long-term glycemic outcomes. Furthermore, our data suggest that there are distinct variants of T2DM in which metabolic responses to surgical weight loss are different. A subgroup of patients whose T2DM is characterized by the presence of hepatic steatosis (presumably associated with worse IR) experience better postoperative metabolic outcomes.
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http://dx.doi.org/10.2337/dc20-0150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176204PMC
February 2021
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