OpenMed/multicare-articles huggingface dataset:
Using multicriteria decision analysis to support research priority setting in biomedical translational research projects
Authors: Gimon de Graaf, Douwe Postmus, Erik Buskens
Journal: Biomed Res Int (2015)
MeSH terms: Algorithms, Decision Making, Organizational, Decision Support Techniques, Needs Assessment / organization & administration, Research / organization & administration, Translational Research, Biomedical / organization & administration, Research Support, Non-U.S. Gov't, Netherlands

Translational research is conducted to achieve a predefined set of economic or societal goals. As a result, investment decisions on where available resources have the highest potential in achieving these goals have to be made. In this paper, we first describe how multicriteria decision analysis can assist in defining the decision context and in ensuring that all relevant aspects of the decision problem are incorporated in the decision making process. We then present the results of a case study to support priority setting in a translational research consortium aimed at reducing the burden of disease of type 2 diabetes. During problem structuring, we identified four research alternatives (primary, secondary, tertiary microvascular, and tertiary macrovascular prevention) and a set of six decision criteria. Scoring of these alternatives against the criteria was done using a combination of expert judgement and previously published data. Lastly, decision analysis was performed using stochastic multicriteria acceptability analysis, which allows for the combined use of numerical and ordinal data. We found that the development of novel techniques applied in secondary prevention would be a poor investment of research funds. The ranking of the remaining alternatives was however strongly dependent on the decision maker's preferences for certain criteria.
Bayesian Approach to Psychotherapy Integration: Strategic Modification of Priors
Authors: Valery Krupnik
Journal: Front Psychol (2019)
Keywords: bayesian brain, free-energy, nested hierarchy, priors, psychotherapy integration

Integrative psychotherapies have become the mainstay in mental health care. The most researched therapy, CBT, being integrative itself, continues to integrate such new elements as mindfulness, spirituality, and experiential techniques. There is no commonly accepted strategy for psychotherapy integration. New elements are sometimes added on a trial and error basis with a following post-hoc theoretical and empirical justification. Other times, they are incorporated based on an ad-hoc theoretical premise, and empirical studies follow to support or invalidate it. Nevertheless, four main integrative strategies have been identified as technical eclecticism, common factors integration, principle-based assimilative integration, and theoretical integration (Norcross, 2005). Strategies outside of these four have also been suggested. Recently, a principle of nested hierarchy has been proposed as a way of integrating different strategies into a general roadmap for building an integrative therapy (Krupnik, 2018). The nested hierarchy principle does not, however, offer a strategy for theoretical integration at the top of its hierarchy. In this report, I suggest using the Bayesian theory of psychopathology for such strategy. I propose to apply Bayesian framework to psychotherapy integration and discuss a possibility of using it as a universal strategy called Strategic Modification of Priors (SMOP). I illustrate SMOP's application with a synopsis of a clinical case.
Microhemorrhages in MELAS Lesions: A Case Report
Authors: Evelien Martens, Jelle Demeestere, Benjamin Verhaaren
Journal: J Belg Soc Radiol (2022)
Keywords: melas, mri, microbleeds, microhemorrhages, stroke-like episodes
MeSH terms: Case Reports

Introduction:
Microhemorrhages have not been described in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes syndrome (MELAS) on magnetic resonance imaging (MRI). Main symptoms and/or important findings: A MELAS-patient had a rapid succession of 3 stroke-like episodes with dysphasia, visual field deficits and paresis of the right arm. MRI showed a lesion with corticosubcortical vasogenic edema without reduced diffusion, conforming to a stroke-like MELAS-lesion. Microhemorrhages within MELAS-lesions were detected on MRI. The main diagnoses, therapeutic interventions, and outcomes: Microhemorrhages are an atypical imaging finding in MELAS. The patient was treated with L-arginine.
Conclusion:
Microhemorrhages can present on MRI in (sub)acute MELAS lesions and may reflect mitochondrial microangiopathy.
Case Report: Opioid Use Disorder Associated With Low/Moderate Dose of Loperamide in an Intellectual Disability Patient With CYP3A and P-Glycoprotein Reduced Activity
Authors: Vincent Guinchat, Nicolas Ansermot, Kuntheavy Ing Lorenzini, Dimitri Politis, Youssef Daali, Chin B Eap, Séverine Crettol
Journal: Front Psychiatry (2022)
Keywords: p-glycoprotein, case report, cytochrome p450, intellectual disability, loperamide, opioid use disorder
MeSH terms: Case Reports

Loperamide is an over-the-counter antidiarrheal for which increasing cases of abuse or misuse are described. We report the onset of opioid use disorder associated with low to moderate doses of loperamide in an intellectual disability patient without previous history of substance use disorder (SUD). Our patient presented strongly reduced activities of CYP3A and P-glycoprotein, which are mainly involved in loperamide metabolism and transport. We suggest that this led to an increase in bioavailability, systemic exposure, and brain penetration thus allowing loperamide to act on the central nervous system and contributing to the development of SUD. Slow release oral morphine (SROM) was chosen as opioid agonist treatment, which successfully contained loperamide use and globally improved her clinical condition. This situation highlights the need for caution and awareness when prescribing loperamide, particularly in vulnerable patients with few cognitive resources to understand the risks of self-medication and little insight into its effects.
Colon metastasis from lung adenocarcinoma with BRAF V600E mutation: A case report
Authors: Yuhao Luo, Kelin Mou, Jianmei Wang, Jing Luo, Lin Peng, Hua Ye, Sheng Lin
Journal: Front Immunol (2022)
Keywords: braf v600e, colon metastasis, immunotherapy, nsclc, pd-1
MeSH terms: Adenocarcinoma of Lung / drug therapy, Adenocarcinoma of Lung / genetics, Colonic Neoplasms / drug therapy, Colonic Neoplasms / therapy, Lung Neoplasms / drug therapy, Lung Neoplasms / therapy, Rectal Neoplasms / drug therapy, Case Reports, Research Support, Non-U.S. Gov't, Antineoplastic Combined Chemotherapy Protocols / therapeutic use, B7-H1 Antigen / genetics, Humans, Imidazoles / therapeutic use, Middle Aged, Mutation, Oximes / therapeutic use, Proto-Oncogene Proteins B-raf / genetics, Pyridones / therapeutic use, Pyrimidinones / therapeutic use, B7-H1 Antigen, Imidazoles, Oximes, Pyridones, Pyrimidinones, BRAF protein, human, Proto-Oncogene Proteins B-raf

Symptomatic colon metastasis from primary lung cancer is rare in clinical practice. We report the case of a 58-year-old patient with advanced lung adenocarcinoma who developed abdominal symptoms, including abdominal distention and difficulty defecating, after immunotherapy and chemotherapy. The patient was diagnosed with lung adenocarcinoma, and systemic positron emission tomography-computed tomography confirmed multiple lymph node, pleural, and adrenal metastases. Molecular detection indicated BRAF V600E mutation and high programmed death-ligand 1 (PD-L1) expression. After first-line anti-programmed cell death protein 1 immunotherapy combined with chemotherapy, the nodes in the chest remarkably diminished. However, it was followed by colon obstruction, incomplete ileus, and bone metastasis. Endoscopic histological examination confirmed adenocarcinoma but could not identify primary or secondary tumors due to insufficient tissue. We performed colon resection to remove the obstruction, and postoperative tissue pathological microscopy confirmed metastasis from the lung adenocarcinoma. We corroborated the BRAF V600E mutation and high PD-L1 expression and supported the molecular features of lung adenocarcinoma. During hospitalization, the patient presented with unbearable pain in the bone metastases, and palliative radiotherapy was administered. Then, the patient received dabrafenib plus trametinib as the second-line therapy. This report discusses the clinical characteristics, pathology, imaging, molecular profile assessments, and treatment of primary lung adenocarcinoma with colon metastasis.
Schwannoma of the Appendix Orifice
Authors: Maha Alkhattab, Amenah Dhannoon, Rishabh Sehgal, Conor Gormley, Margaret Sheehan, Ray Mclaughlin
Journal: Case Rep Pathol (2021)
MeSH terms: Case Reports

Schwannomas are rare mesenchymal tumors. They are usually diagnosed incidentally during endoscopic or diagnostic imaging for another reason. Malignant transformation is rare. In this case report, we present an incidental schwannoma protruding through the appendiceal orifice diagnosed during endoscopy. A healthy 56-year-old female underwent a surveillance colonoscopy for family history of colorectal cancer. A prominent and edematous appendiceal orifice was noted, and the area was aggressively biopsied. Histopathological assessment revealed a benign schwannoma. Computerized topography was unremarkable. Subsequently, the patient underwent a right hemicolectomy. Patient is scheduled to undergo routine surveillance in three years. Grossly, schwannomas are white, encapsulated, and well-circumscribed lesions that stain strongly positive for S100, GFAP, and CD57. Histologically, schwannomas demonstrate spindle cell proliferation. Several imaging modalities have been utilized in the diagnosis and management of mesenchymal neoplasms. Despite the benign nature of the diagnosis, complete surgical resection with clear margins remains the gold standard management strategy. Our case highlights the presence of a relatively uncommon tumor in an unusual anatomical location.
Exoseketons: A Rehab Tech Consumer's Unexpected March to Action
Authors: C Angus
Journal: Can Prosthet Orthot J (2021)
Keywords: ankle foot orthotics, designer, disability, exoskeleton, fashion, handicap, rehabilitation

This paper is both a stakeholder perspectives as well as a 'case study' describing a journey from sudden disability to participant and investor in exoskeleton design. It tells of my experiences and opinions, as a successful fashion designer, when my life took a drastic turn on becoming paralysed from the waist down over the course of 24 hours, by a spinal tumour. Getting this diagnosis was 'the worst day in my life', and it was quickly followed by the 'second worst' when, in my determination to walk again, I received Knee Ankle Foot Orthotics (KAFOs) and was shocked to learn that this appeared to be the best technology solution available on the market 'suitable' for use in the community. Initial anger at the system for not being better, at the rehab team for their complacency, and at myself for allowing a feeling of helplessness to take over led to questions such as: what does this say about our society? and what are we all willing to accept, for ourselves and others? This is professional opinion and an essay about how we see ourselves and how others see us. The journey from pre-injury 'consumer' to post-injury 'disabled' person and learning that being labeled 'disabled' leads to the additional handicap of the narrow vision of "cost" taken by the mobility industry where innovative ideas are stripped down to the bare minimum with the excuse that patients are "lucky" to have what they have been "given". Grappling with these labels and inequities and seeking a better outcome, I became an integral team member of an exoskeleton development team, leading to the design of The Next Generation Exoskeleton! This is MY story, the story of Chloe Angus. It is the story of inclusive, user focused design and is a call to include and respect the end users of all assistive device technology design early in the design process and it is being told from the perspective of a person having experience and success in the world of business.
Case report: A novel surgical technique for rapid valve-in-ring implantation into the native aortic annulus during left ventricular assist device implantation
Authors: Yuriy Pya, Abdurashid Mussayev, Svetlana Novikova, Makhabbat Bekbossynova, Serik Alimbayev, Nail Khissamutdinov, Timur Kapyshev, Aidyn Kuanyshbek, Timur Lesbekov
Journal: Front Cardiovasc Med (2023)
Keywords: balloon expandable valve, heart failure, left ventricular assist device (lvad), native aortic valve, ring annuloplasty, transcatheter aortic valve replacement, valve-in-ring
MeSH terms: Case Reports

The implantation of a left ventricular assist device (LVAD) has become an essential requirement for managing patients with end-stage heart failure. However, aortic valve insufficiency is a contraindication for LVAD implantation in patients with end-stage heart failure, partly because of the decreasing efficiency of mechanical circulatory support and the eventual development of right ventricular failure. Herein, we present the first case of performing transcatheter aortic valve replacement in valve-in-ring along with LVAD implantation for the treatment of a 60-year-old male suffering from refractory heart failure due to dilated cardiomyopathy and pure aortic insufficiency in need of a new aortic bioprosthesis. A balloon-expandable bioprosthetic transcatheter heart valve was implanted into a previously sewn annulus ring into the aortic root via transaortic access. Subsequently, a centrifugal-flow LVAD was implanted. Postoperatively, the patient was in New York Heart Association Functional Class (NYHA) II with 6-min walk test of 310 m. The patient has completed 6 months of follow-up with no events. This novel and feasible surgical technique reduced the cardiopulmonary bypass time and duration of surgery. Furthermore, it avoids the risk of redo sternotomy and decreases the chances of paravalvular leakage and worsening of aortic regurgitation.
Seizure as the clinical presentation of massive pulmonary embolism: Case report and literature review
Authors: Waiian Leong, Yueqi Zhang, Xinxiang Huang, Zhendong Luo, Yanli Wang, Timothy Hudson Rainer, Abraham K C Wai, Yi Huang
Journal: Front Med (Lausanne) (2022)
Keywords: anticoagulant therapy, massive pulmonary embolism, percutaneous catheter-directed treatment, seizure, surgical embolectomy, thromboembolic disease
MeSH terms: Case Reports

Massive pulmonary embolism (MPE) is a high-risk medical emergency. Seizure as the clinical presentation of MPE is extremely rare, and to our knowledge, there have been no reports on successful percutaneous, catheter-based treatment of MPE presenting with new-onset seizures and cardiac arrest. In this report, we discuss the case of a 64-year-old woman who presented with an episode of seizure that lasted 5 h. Seizure occurred four times within 12 h after arrival at the hospital, and in the end, she sustained a cardiac arrest. The patient had no past history of seizure or cardiopulmonary disease. Bilateral MPE was detected by a computed tomography pulmonary angiogram, and she was successfully treated with percutaneous, catheter-directed anticoagulant therapy. Pulmonary embolism-related seizures are more difficult to diagnose and have higher mortality rates than seizures. MPE should be suspected in patients presenting with new-onset seizures and hemodynamic instability.
Bilateral thalamic glioma in a 6-year-old child
Authors: Dinesh K Rajput, Anant Mehrotra, Arun K Srivastav, Raj Kumar, Ashok K Mahapatra
Journal: J Pediatr Neurosci (2010)
Keywords: bithalamic gliomas, thalamic gliomas
MeSH terms: Case Reports

Bithalamic gliomas are extremely rare tumors of central nervous system. Although they are usually benign in nature, their outcome is poor because of the involvement of thalamic nuclei and inadequate surgical excision. Surgery is usually done to get tissue for diagnosis. Role of radiotherapy and chemotherapy is questionable. They are unique in their metabolic and neuroradiological properties. We report herein a 6-year-old male of bithalamic astrocytoma (WHO grade 2) who presented with raised intracranial pressure and tremors in right upper limb. The child had a very huge bithalamic mass which was debulked through the interhemispheric transcallosal approach in order to reduce the mass effect. He had a stormy post-operative course to recover gradually.
A Rare Clinical Presentation of Cholangiocarcinoma
Authors: Elisa Gravito-Soares, Marta Gravito-Soares, Pedro Figueiredo, Luis Tomé
Journal: Case Rep Gastrointest Med (2017)
MeSH terms: Case Reports

Cholangiocarcinoma is an uncommon tumor, often diagnosed in the context of obstructive jaundice. Brain metastasis rarely occurs with the cerebellum being a rare site of spread of this type of tumor. Few cases of cholangiocarcinoma have been reported in the literature and this type of tumor is associated with a very poor outcome. We present a very rare form of clinical presentation of cholangiocarcinoma with neurologic symptoms due to cerebellar metastases.
Multiple Giant Splenic Artery Aneurysms Causing Sinistral (Left-Sided) Portal Hypertension
Authors: Kemal Beksac, Derya Karakoc
Journal: Case Rep Gastrointest Med (2016)

Background. Splenic artery aneurysm is the most common type of visceral aneurysms. They are usually asymptomatic and have a potential for rupture and therefore life-threatening hemorrhage. It is rare for them to cause sinistral portal hypertension. Case Report. A 23-year-old female patient presented to our clinic with gastric varices, splenomegaly, pancytopenia, and normal liver functions. She was thus diagnosed with left-sided portal hypertension. Radiologic evaluation showed splenomegaly, splenic vein obstruction, and multiple aneurysms along the splenic artery ranging from 2.5 cm to 7 cm. Splenic artery aneurysm was thought to be the cause of portal hypertension and hypersplenism. We decided splenectomy is the best course of treatment. Pancytopenia could not be corrected preoperatively despite the transfusion treatment. Surgical exploration revealed multiple aneurysms deeply embedded in pancreas. Thrombocyte and erythrocyte transfusion was performed after splenic artery ligation to correct pancytopenia before further intervention. Splenic artery, spleen, and distal pancreas were resected en bloc. Patient's blood parameters became normal within first postoperative day. Patient had an uneventful postoperative course and was discharged without incident. Conclusion. Splenic artery aneurysms are rare but potentially life-threatening incidents. Therefore, it is important to know the unusual presentations and prepare accordingly.
Galli-galli disease: a rare acantholytic variant of dowling-degos disease
Authors: J Gomes, J Labareda, I Viana
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Galli-Galli disease is a rare acantholytic variant of Dowling-Degos disease, with few cases reported in the literature. We describe a case of Galli-Galli disease and review the literature.
Transpetrosal Approach to a Ruptured Distal Basilar Perforating Artery Aneurysm
Authors: Yasaman Alam, Travis Atchley, Nicholas Laskay, Andrew T Hale, Winfield S Fisher
Journal: Cureus (2023)
Keywords: basilar artery aneurysm, basilar perforating aneurysm, cerebrovascular surgery, operative video, transpetrosal approach
MeSH terms: Case Reports

Basilar perforating artery aneurysms are rare and underreported vascular anomalies in the cerebrovascular literature. Various open and endovascular treatment approaches can be employed to treat these aneurysms based on several patient- and aneurysm-specific factors. Some authors have even advocated for conservative, nonoperative management. Here, we report a case of a ruptured distal basilar perforating artery aneurysm secured by an open transpetrosal approach. A 67-year-old male presented to our institution with a Hunt-Hess grade 2, modified Fisher grade 3 subarachnoid hemorrhage (SAH). Initial cerebral digital subtraction angiography (DSA) did not identify an intracranial aneurysm or other vascular lesions. However, the patient had a re-rupture event several days after presentation. DSA at this time revealed a posteriorly projecting distal basilar perforating artery aneurysm. Initial attempts with endovascular coil embolization were unsuccessful. Thus, an open transpetrosal approach was taken to gain access to the middle and distal basilar trunk to secure the aneurysm. This case underscores the unpredictability of basilar perforating artery aneurysms and the challenges encountered when considering active treatment. We demonstrate an open surgical approach with an intraoperative video for definitive management after failed attempted endovascular treatment.
Two Cases of Pituitary Stalk Interruption Syndrome in Syrian Children
Authors: Ibrahim Alali, Reem Saad, Younes Kabalan
Journal: Case Rep Endocrinol (2020)
MeSH terms: Case Reports

Pituitary stalk interruption syndrome (PSIS) is an extremely rare cause of growth failure and delayed puberty. It can be diagnosed by magnetic resonance imaging (MRI) of the hypothalamus and pituitary gland, showing an ectopic or absent posterior pituitary, an absent or interrupted pituitary stalk, or small anterior pituitary, in combination with growth hormone or other pituitary hormone deficiencies. The exact etiology of PSIS is unknown. In this article, we describe two cases of PSIS in Syria which are, as far as we know, the first published cases.
Identification of a novel mutation in a pseudohypoparathyroidism family
Authors: Zhi-Min Miao, Can Wang, Bin-Bin Wang, Dong-Mei Meng, Dong-Mei Su, Zhi Cheng, Qiao-Lian Wen, Lin Han, Qing Yu, Xu Ma, Chang-Gui Li
Journal: Int J Endocrinol (2011)
MeSH terms: Case Reports

Pseudohypoparathyroidism type Ia (PHP Ia) is defined as a series of disorders characterized by multihormone resistance in end-organs and Albright hereditary osteodystrophy (AHO) phenotype. PHP Ia is caused by heterozygous inactivating mutations in GNAS, which encodes the stimulatory G-protein alpha subunit (Gsa). A patient with typical clinical manifestations of pseudohypoparathyroidism (PHP) (round face, short stature, centripetal obesity, brachydactyly, and multi-hormone resistance: parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), and gonadotropins) presented at our center. The sequence of the GNAS gene from the patient and her families revealed a novel missense mutation (Y318H) in the proband and her mother. An in vitro Gsa functional study showed that Gsa function was significantly impaired. These results stress the importance of GNAS gene investigation.
A Case of Feline Leishmaniosis with Panniculitis
Authors: Dimitrios Matralis, Ioanna Papadogiannaki, Evi Gkerdidani, Eleni Patsoula, Nikolaos Tegos, Emmanouil Papadogiannakis
Journal: Case Rep Vet Med (2023)
MeSH terms: Case Reports

Leishmaniases are a group of diseases caused by protozoa of the genus Leishmania and transmitted mainly by the bite of sand fly vectors. Cats are infected with at least 6 species of Leishmania. Significant associations have been found between feline leishmaniosis and coinfections mainly with FIV and/or FeLV. A 7-year-old castrated male, domestic short-haired cat was presented with unknown history and cutaneous and ocular lesions. A raised, semifirm swelling on the forehead was observed along with periocular hypotrichosis and conjunctival and third eyelid edema. The indications for pursuing a diagnosis of leishmaniosis are variable, and differing presentations may require the use of different tests. Diagnosis of feline leishmaniosis with panniculitis caused by Leishmania infantum was made by cytology, histopathology, and PCR and Leishmania antibodies (IFA). The cat responded to therapy with meglumine antimoniate and allopurinol.