bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catheter directed diagnosis of ST-segment elevation myocardial infarction induced by type A aortic dissection
Authors: Huang Chi-Yao , Hung Yu-Po , Lin Tzu-Hsiang , Chang Szu-Ling , Lee Wen-Lieng , Lai Chih-Hung 
Published: January 2020

Abstract

Rationale:
Type A aortic dissection (TAAD) is a life-threatening disorder yet it is hard to diagnose. The dissection might extend to the coronary artery causing ST-segment elevation myocardial infarction (STEMI). Physicians might not recognize this particularly early in its presentation and patients proceed to receive the primary percutaneous coronary intervention. We present such a case and found that the marked pressure difference between the radial and ascending aortae could be a useful clue for diagnosing the aortic dissection-related myocardial infarction.

Patient concerns:
A 58-year-old male was presented to our emergency department for the complaint of left side chest pain that lasted for an hour with concomitant hypotension. STEMI was diagnosed at that time.

Diagnosis:
The emergent primary percutaneous intervention was performed. When the diagnostic catheter was advanced to the ascending aorta, the systolic aorta pressure became 20 mm Hg higher than radial systolic pressure. Due to the abnormally large pressure differential between the peripheral radial artery and central ascending aorta, TAAD was suspected.

Interventions:
After angiography and computer tomography confirmed the diagnosis of TAAD, the patient was sent for emergent surgery.

Outcomes:
The patient was died because of extensive dissection and shock.

Lessons:
We present such a case and found that the marked pressure difference between the radial and ascending aortae during catheterization could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. This clue had hinted our speedy examination of the occluded coronary artery and dissection flap, and led to an early and accurate diagnosis.
Renal hemosiderosis secondary to intravascular hemolysis after mitral valve repair
Authors: Lee In Hee , Kang Gun Woo , Kim Chang-Yeon , Lee Sun-Jae , Kim Min-Kyung , Ahn Dong Jik 
Published: January 2020

Abstract

Rationale:
Renal hemosiderosis is a disease in which hemosiderin deposits in the renal cortex as a form of iron overload. However, cases of renal hemosiderosis due to intravascular hemolysis following mitral valve repair have been rarely reported.

Patient concerns:
We present the case of a 62-year-old woman who developed asymptomatic urinary abnormalities including microscopic hematuria and proteinuria due to renal hemosiderosis following a mitral valve repair surgery performed two years earlier.

Diagnoses:
A percutaneous renal biopsy showed no specific glomerular abnormality, tubular atrophy, or interstitial fibrosis but extensive deposition of hemosiderin in the proximal tubule. The patient was diagnosed with renal hemosiderosis and chronic intravascular hemolysis following mitral valve repair.

Interventions:
Our patient refused a mitral valve repeat surgery and hence was treated with oral iron preparations, N-acetylcysteine, and a β-receptor blocker.

Outcomes:
Moderate mitral regurgitation with the regurgitant blood striking against the annuloplasty ring was confirmed on follow-up echocardiography. After the 24-month follow-up period, hemolytic anemia persisted, but there was no significant decline of renal function.

Lessons:
For cases of chronic intravascular hemolysis accompanied with asymptomatic urinary abnormalities, a renal biopsy is required to exclude underlying kidney pathology and predict potential renal insufficiency.
MRI findings of an atypical testicular epidermoid cyst
Authors: Liu Renwei , Li Aibo , Jiang Yixiang , Ji Jiayin , Yu Shulin , Chen Nengxue 
Published: January 2020

Abstract

Introduction:
Typical testicular epidermoid cysts (TECs) manifestate as a target sign or onion skin sign on ultrasonography and magnetic resonance (MR) imaging. Clinicians are increasingly aware of the imaging characteristics of typical TECs, which allow accurate diagnosis and successful treatment while preserving the testicle, but atypical TECs are likely to be misdiagnosed as a malignant intratesticular neoplasm, leading to complete testicular resection.

Patient concerns:
A 26 year-old male patient complained of a painless enlargement of the left testicle that had been present for 1 month. The patient had no recent medical history of scrotal trauma or systemic infection.

Diagnosis:
A round 48 mm × 45 mm × 43 mm mass was seen inside the left testicle. T2-weighted images of the lesion showed a thin hypointense capsule. T1-weighted images of the lesion showed a hyperintense nodule on the cyst wall, which appeared hypointense on T2-weighted and SPAIR images. After Gd-DTPA injection, the lesion was not enhanced; however, the nodule was enhanced on THRIVE images. These manifestations were consistent with a benign intratesticular lesion, and MR imaging diagnosed atypical TEC, which was confirmed by pathology after surgery.

Interventions:
The patient was treated with organ-sparing surgery with testicular enucleation.

Outcomes:
The patient was re-examined with ultrasonography 3 months after surgery. The left residual testicular tissue appeared normal, and reproductive function was preserved.

Conclusion:
Urologists must be aware of the clinical and MR imaging characteristics of atypical TECs and the utility of preoperative MR imaging for the diagnosis of testicular lesions to ensure that organ-sparing surgery is performed rather than unnecessary orchiectomy.
Efficacy of Phellinus linteus (sanghuang) extract for improving immune functions
Authors: Jung Ga Hyeon , Kang Jae Hui 
Published: January 2020

Abstract

Background:
With the increase in the prevalence of chronic diseases, enhancing immunity has become an important challenge. Health functional foods, such as Phellitus linteus (PL), are known to improve immune function. In previous laboratory studies, it has been reported that PL has anticancer activities. In this study, we will evaluate if PL improves immune functions in adults with reduced immunity and identify its effects on immunity factors.

Methods:
This study will be a single-center, randomized, double-blinded, and placebo-controlled trial. Study participants will be randomly allocated to 3 experimental groups: those taking PL 1000 mg, PL 2000 mg, or placebo. Total duration of the clinical trial will be 8 to 10 weeks. Study participants will have follow-up visits every 4 weeks and the effect and safety will be assessed at the second and third visits. All participants will be asked to maintain a dosage schedule for this protocol. The primary outcome will be natural killer (NK) cell activity and the secondary outcomes will include peripheral white blood cell (WBC) count; levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and interleukin (IL)-1β, IL-2, IL-6, and IL-12 to assess autoimmune reactivity; and levels of immunoglobulin (Ig)G1, IgG2, and Immunoglobulin M (IgM) to assess allergic activity. Repeated measure analysis will be used to measure primary efficacy based on full analysis set.

Discussion:
This study has limited inclusion and exclusion criteria and a well-controlled intervention. It will be the first randomized controlled trial to assess the efficacy and safety of PL in adults with reduced immunity. This study will provide insights into the mechanisms underlying the immune-stimulating effects of PL and lay the groundwork for further studies.
Incomplete recovery from rocuronium-induced muscle relaxation in patients with amyotrophic lateral sclerosis using sugammadex
Authors: Chun Hea Rim , Chung Jinhun , Kim Nan Seol , Kim A. Joo , Kim Suro , Kang Kyu Sik 
Published: January 2020

Abstract

Introduction:
Patients with motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), have higher sensitivity to nondepolarizing neuromuscular blocking agents (NMBAs) and are at higher risk for a residual block. For this reason, the use of NMBAs such as rocuronium has been limited owing to the delayed reversal of muscle relaxation. It was recently reported that rapid and effective reversal of muscle relaxation occurs when sugammadex, a muscle relaxant reversal drug, is administered to patients in ALS with rocuronium-induced muscle relaxation. However, in this paper, we report the incomplete recovery and recurarization of muscle relaxation after sugammadex administration in ALS patients, and delayed recovery of muscle relaxation after additional administration of sugammadex.

Patient concerns:
A 71-year-old male patient with ALS received general anesthesia for laparoscopic nephroureterectomy.

Diagnosis:
The patient was diagnosed with ALS 2 years earlier, and scheduled to undergo laparoscopic nephroureterectomy for ureteral cancer.

Intervention:
We used sugammadex for the reversal of deep neuromuscular block. We measured a train-of-four (TOF) count of 4 and a TOF ratio of 54% at about 8 min after administration of 4 mg/kg sugammadex. However, then the TOF count decreased to 1 to 3 and tidal volume (TV) decreased to < 100 mL. Therefore, an additional 50 mg sugammadex was administered intravenously 12 min after the first dose of sugammadex was injected.

Outcomes:
The patient's vital signs were stable and his recovery from anesthesia was uneventful. Therefore, he was discharged to the intensive care unit. The patient had aspiration pneumonia symptoms owing to dysphagia on the third postoperative day, but after the symptoms improved he was transferred to the hospital for rehabilitation of dysphagia and dyspnea.

Conclusion:
It is critical to monitor whether muscle relaxation is sufficiently reversed when using sugammadex in ALS patients. Further research is needed to determine the appropriate dose of sugammadex for muscle relaxation reversal.
Rare clinical presentations of pleomorphic xanthoastrocytoma with a high proliferative index
Authors: Nagaishi Masaya , Nakae Ryuta , Fujii Yoshiko , Inoue Yuki , Sugiura Yoshiki , Takano Issei , Tanaka Yoshihiro , Suzuki Kensuke 
Published: January 2020

Abstract

Introduction:
Pleomorphic xanthoastrocytomas (PXA) are rare, typically benign, slow-growing tumors that commonly occur in the cerebral hemispheres. We describe two cases of clinically aggressive PXA with uncommon locations; one was in the tectal plate, and the other had simultaneous multicentric lesions.

Patient Concerns:
The both cases presented with severe headache with no significant past medical history.

Diagnosis:
PXA World Health Organization grade II were histopathologically diagnosed from surgically resected specimens, and immunohistochemical and sequence analysis revealed a high Ki-67 proliferative index and BRAF V600E mutation in both the cases.

Interventions:
The first case presented with multicentric lesions and underwent partial resection, whereas the second case presented with a tectal plate tumor that was managed by gross total surgical resection. Strong 5-aminolevulinic acid (5-ALA)-induced fluorescence was observed in both the lesions. Postoperative radiotherapy plus concomitant and adjuvant temozolomide was administered to both the patients.

Outcomes:
Despite completing adjuvant chemo-radiotherapy, both the patients had local tumor recurrence at 2 and 5 months after the operation, respectively.

Conclusion:
The progressive clinical courses in our cases suggest that additional postoperative therapy should be considered during the treatment of PXA with a high Ki67 index, and that temozolomide with radiotherapy, followed by temozolomide maintenance therapy, may not prevent recurrence in such tumors. Importantly, our experience implies that unlike other subtypes of low grade gliomas, 5-ALA fluorescence is useful for intraoperative visualization of PXA.
Nursing Students' Attitudes Toward Nursing Education Research and Participation in Pedagogical Research
Authors: Burrell Sherry A. , Ross Jennifer Gunberg , Heverly Mary Ann , Menginie Tina M. 
Published: January 2020

Background
Nursing students overall have positive attitudes toward research, but no studies have explored students' attitudes toward education research or pedagogical research participation.

Purpose
The purposes of this study were to explore nursing students' attitudes toward research in general, education research, and participation as subjects in pedagogical research; describe the relationships among these attitudes; and identify associated factors.

Methods
A mixed-methods, descriptive, cross-sectional study design was used.

Results
Nursing students' (N = 195) attitudes about research in general, education research, and participation in pedagogical research were predominantly positive and directly correlated. Age was significantly associated with attitudes about education research and research participation, whereas program year was associated only with research participation. The most prevalent barrier to research participation was time.

Conclusions
Findings provide valuable insight about nursing students' attitudes toward research that may be used to design protocols to enhance student participation in pedagogical research.
Evidence-Based Interventions for Retention of Nursing Students
Authors: Bumby James Colin 
Published: January 2020

Background
There is a need to better understand effective student retention strategies in nursing.

Purpose
This review of course and program interventions reported in the nursing literature is intended to highlight interventions, supported by evidence, to graduate more enrolled students and recommend areas of retention efforts that need further research.

Methods
The PRISMA search strategy was used to identify and narrow the number of relevant studies. A scoring instrument to evaluate rigor, reliability, and validity of interventions was adapted from a valid and reliable tool used to evaluate studies using a health care education intervention.

Results
Evidence-based interventions that improved retention included retention program/specialist, robust orientation, mentoring and tutoring, stipends, and remediation.

Conclusion
Nurse educators are independently striving to improve retention rates of nursing students. Implementing evidence-based interventions will advance this effort.
Mobile Health Technology for Pediatric Symptom Monitoring
Authors: Vaughn Jacqueline , Gollarahalli Siddharth , Shaw Ryan J. , Docherty Sharron , Yang Qing , Malhotra Chandni , Summers-Goeckerman Erika , Shah Nirmish 
Published: January 2020

Background
Pediatric blood and marrow transplant (PBMT) patients experience significant symptom distress. Mobile health (mHealth) technologies can be leveraged to improve understanding of the patient’s symptom experience by providing continuous, real-time, in situ, patient-generated symptom data. This rich data stream can subsequently enhance symptom management strategies. However, limited research has been conducted in this area.

Objectives
This pilot study seeks to (a) explore the feasibility of integrating mHealth technologies to monitor symptom data for PBMT patients and (b) evaluate the study design, measures, and procedures.

Methods
An exploratory longitudinal design was employed to assess the feasibility of monitoring 10 PBMT patients’ symptoms using data from two mHealth technologies: (a) a smartphone mHealth application (app) to collect symptom data and (b) a wearable tracking device (Apple watch) to collect physiological data. Feasibility was measured as usability and acceptability. Monthly patient interviews and an end-of-study feasibility survey were employed and analyzed to further understand reasons for sustained interest in and attrition from the study.

Results
Overall usability of the wearable was 51%, and app was 56%. Children reported devices were easy to use and acceptable. The study demonstrated acceptability with an enrollment rate of 83% and an attrition rate of 30%, with 70% of the children remaining in the study for at least 40 days.

Discussion
This pilot study is among the first to explore the feasibility of using mobile technologies to longitudinally obtain patient-generated symptom data to enhance understanding of the PBMT symptom experience. In addition, it will improve our understanding of how these data present, interact, and cluster together throughout the posttransplant period.
Perceived Infant Well-Being and Self-Reported Distress in Neonatal Nurses
Authors: Fortney Christine A. , Pratt Mercedes , Dunnells Zackery D. O. , Rausch Joseph R. , Clark Olivia E. , Baughcum Amy E. , Gerhardt Cynthia A. 
Published: January 2020

Background
Infants who are admitted to a neonatal intensive care unit (NICU) may experience significant symptom burden. Parents are often distressed by these symptoms, which can affect their long-term coping and distress. There is limited research examining nurse perceptions of infant well-being (symptoms, suffering, and quality of life [QOL]) and associations with nurse distress.

Objective
The objective of this descriptive study was to explore associations between nurse perceptions of infant well-being and self-reported distress.

Methods
Nurses caring for infants with potentially life-threatening/life-limiting conditions were recruited from a Level IV NICU in the Midwestern United States as a part of a study on infant symptom burden. Nurses reported their perceptions of infant well-being and their own distress on a 5-point Likert scale. Surveys were administered at the bedside weekly for up to 12 weeks, depending on length of stay. Infant suffering and QOL were examined in relation to nurse distress. A cross-classified multilevel model was used to account for dependence within nurse and within patient.

Results
A total of 593 surveys were collected from nurses. Using a cross-classified multilevel model with variables entered simultaneously, nurse perceptions of greater infant suffering and lower infant QOL were significantly associated with greater nurse distress.

Discussion
Preliminary evidence shows that greater perceived infant suffering and lower perceived infant QOL may be associated with greater levels of self-reported distress in NICU nurses. Further work is needed to better understand factors related to symptom management in the NICU and the potential role of caregiver distress and compassion fatigue in NICU nurses.
Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus
Authors: Dunn Navarra Ann-Margaret , Whittemore Robin , Bakken Suzanne , Rosenberg Michael J. , Gormley Maurade , Bethea John , Gwadz Marya , Cleland Charles , Liang Eva , D’Eramo Melkus Gail 
Published: January 2020

Background
Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort.

Objectives
As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior.

Methods
The information–motivation–behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16–29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources.

Results
Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control.

Discussion
Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.
Neoadjuvant Chemoradiotherapy and Liver Transplantation for Unresectable Hilar Cholangiocarcinoma: The Irish Experience of the Mayo Protocol
Authors: Zaborowski Alexandra , Heneghan Helen M. , Fiore Barbara , Stafford Anthony , Gallagher Tom , Geoghegan Justin , Maguire Donal , Hoti Emir 
Published: January 2020

Background.
Pioneered by the Mayo Clinic, multimodal therapy with neoadjuvant chemoradiotherapy and orthotopic liver transplant has emerged as a promising option for unresectable hilar cholangiocarcinoma (hCCA). This study reports the experience of the Irish National Liver Transplant Programme with the Mayo Protocol.

Methods.
All patients diagnosed with unresectable hCCA between 2004 and 2016, who were eligible for the treatment protocol, were prospectively studied.

Results.
Thirty-seven patients commenced chemoradiotherapy. Of those, 11 were excluded due to disease progression and 26 proceeded to liver transplantation. There were 24 males, the median age was 49, and 88% had underlying primary sclerosing cholangitis. R0 and pathologic complete response rates were 96% and 62%, respectively. Overall median survival was 53 months and 1-, 3-, and 5-year survival was 81%, 69%, and 55%, respectively. The median survival of patients achieving a pathologic complete response was 83.8 months compared with 20.9 months in the group with residual disease (P = 0.036). Six patients (23%) developed disease recurrence. Among the patients who developed metastatic disease during neoadjuvant treatment, median survival was 10.5 months compared with 53 months in patients who proceeded to transplant (P < 0.001).

Conclusions.
Neoadjuvant chemoradiotherapy followed by liver transplantation substantially increases the survival of patients with unresectable hCCA. Achieving a pathologic complete response confers a significant survival benefit.