bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complete remission from peritoneal metastasis of late recurrent breast cancer by endocrine therapy: a case report
Authors: Fuke Azusa , Tabei Isao , Okamoto Tomoyoshi , Takeyama Hiroshi 
Published: December 2020

AbstractBackgroundPeritoneal dissemination associated with the postoperative recurrence of breast cancer is relatively low (3–6%). Although the prognosis of patients with peritoneal metastasis is generally short (7–26 months), we experienced a unique case in which complete remission was achieved for more than 6 years with endocrine therapy alone.Case presentationAn 81-year-old woman presented an upper abdominal tumor and loss of appetite. Computer tomography (CT) scan revealed a tumor in the duodenum and the head of pancreas, which malignant lymphoma was suspected. The exploratory laparotomy demonstrated a tumor located in the greater curvature of the pylorus to the transverse colon, and peritoneal dissemination. Because of the previous history of breast cancer 11 years ago and the immunopathological findings, recurrence of breast cancer was diagnosed. Lung metastasis was also detected postoperatively and the endocrine therapy using letrozole was introduced. After a year, CT scan confirmed complete remission from the metastasis. Two years later, tumor markers fell within the normal limit.ConclusionsA rare case of late-phase metachronous peritoneal metastasis of the breast cancer where complete remission was obtained by a single endocrine agent was presented.
A case of non-occlusive mesenteric ischaemia caused by pelvic fracture due to fall trauma
Authors: Furutani Yuichiro , Ishiguro Kaname , Tokuraku Masato , Moritomo Hitoshi 
Published: December 2020

Abstract
Background
Non-occlusive mesenteric ischaemia (NOMI) is a condition in which intestinal ischaemia arises due to spasms of peripheral blood vessels; however, there is no obstruction of the main arteries. Risk factors include hypertension, diabetes, and increasing age, but the traumatic injury triggering NOMI onset is rarely reported. We report a case of NOMI caused by a pelvic fracture due to a fall injury.

Case presentation
A 77-year-old man was transported to the hospital due to a fall injury. CT revealed a pelvic fracture and a haematoma in the pelvic extraperitoneal space. The next day, the patient developed shock, and CT revealed an increase in haematoma size. Both internal iliac arteries were embolized by transcatheter arterial embolization (TAE). The next day’s CT revealed intestinal necrosis of the ascending colon, and emergency surgery was planned. During surgery, necrosis was identified in the serosa of the ascending, transverse, and sigmoid colon. We performed subtotal excision from the ascending colon to the sigmoid colon. On postoperative day 10, melena was observed, and CT revealed partial thickening of the small intestine and a decrease in the contrast effect. Considering the post-total colectomy and general condition, we proceeded with conservative treatment. Over time, the patient developed liver and renal dysfunction and died 16 days after surgery.

Conclusions
We experienced a case of NOMI caused by bleeding from a pelvic fracture. It is important to keep in mind the risk of developing NOMI in traumatic bleeding to avoid missing this diagnosis.
An analysis of internal and external feedback in self-regulated learning activities mediated by self-regulated learning tools and open learner models
Authors: Chou Chih-Yueh , Zou Nian-Bao 
Published: December 2020

AbstractIn self-regulated learning (SRL), students organize, monitor, direct, and regulate their learning. In SRL, monitoring plays a critical role in generating internal feedback and thus adopting appropriate regulations. However, students may have poor SRL processes and performance due to their poor monitoring. Researchers have suggested providing external feedback to facilitate better student SRL. However, SRL involves many meta-cognitive internal processes that are hidden and difficult to observe and measure. This study proposed a SRL model to illustrate the relationship among external SRL tools, internal SRL processes, internal feedback, and external feedback. Based on the model, this study designed a system with SRL tools and open leaner models (OLMs) to assist students in conducting SRL, including self-assessing their initial learning performance (i.e. perceived initial performance and monitoring of learning performance) after listening to a teacher’s lecture, being assessed by and receiving external feedback from the OLM (i.e. actual performance) in the system, setting target goals (i.e. desired performance) of follow-up learning, conducting follow-up learning (i.e. strategy implementation), and evaluating their follow-up learning performance (i.e. perceived outcome performance and strategy outcome monitoring). These SRL tools also externalize students’ internal SRL processes and feedback, including perceived initial, desired, and perceived outcome performances, for investigation. In addition, this study explores the impact of external feedback from the OLM on students’ internal SRL processes and feedback. An evaluation was conducted to record and analyze students’ SRL processes and performance, and a questionnaire was administered to ask students about their SRL processes. There are three main findings. First, the results showed that students often have poor internal SRL processes and poor internal feedback, including poor self-assessment, inappropriate target goals, a failure to conduct follow-up learning, and a failure to achieve their goals. Second, the results revealed that the SRL tools and external feedback from the OLM assisted most students in SRL, including monitoring their learning performance, goal-setting, strategy implementation and monitoring, and strategy outcome monitoring. Third, some students still required further support for SRL.
Value of vessel wall magnetic resonance imaging in the diagnosis of cerebrovascular diseases
Authors: Farag Sherien , El-Dien Hany Zaki , Abdelazeem Yasser , Elewa Mohammed Khaled , Abdelmaksoud Khaled , ElSadek Ahmed 
Published: December 2020

Abstract
Background
Intracranial vessel wall imaging can detect non-stenotic lesions with further characterization of stenotic lesions that have already been detected with common angiographic methods. Magnetic resonance imaging (MRI) of the intracranial vessel wall can describe the presence of both large and small atherosclerotic lesions and to characterize the lesions based on enhancement, plaque content, and vulnerability

Objectives
To assess suspicious lesions detected by magnetic resonance angiography for further evaluation by vessel wall MRI.

Methods
A total of sixteen ischemic stroke patients within 2 weeks from onset were recruited to this cross-sectional study. Magnetic resonance angiography was done to document intracranial arterial stenosis. Further high-field MR unit (3 Tesla MRI Scanner) was used to obtain vessel wall MR sequences (T1 pre-post contrast and T2 fat sat) to differentiate between intracranial atherosclerotic plaque, vasculitis, and moyamoya disease and to assess atherosclerotic plaque activity (vulnerability)

Results
Vessel wall MR imaging showed arterial wall thickening with irregular inner margin and eccentric enhancement in cases of intracranial atherosclerosis, where as in case of CNS vasculitis, it showed circumferential wall enhancement with regular smooth inner margin. In cases of moyamoya disease, the vessel wall MR showed a narrowing of the luminal artery without post-contrast enhancement of the wall, no hemorrhagic nor fatty content.

Conclusion
Vessel wall MR imaging is recommended for stroke patients with suspected intracranial large vessel atherosclerosis seen in MRA to assess atherosclerotic plaque activity and characterization of stenotic lesions
Depression and anxiety among patients with Parkinson’s disease: frequency, risk factors, and impact on quality of life
Authors: Khedr Eman M. , Abdelrahman Ahmed A. , Elserogy Yasser , Zaki Ahmed Fathi , Gamea Ayman 
Published: December 2020

Abstract
Background
Depression and anxiety are non-motor symptoms of Parkinson’s disease (PD) that are often overlooked and underrated. This study aimed to highlight the frequency and risk factors of depression and anxiety among subjects with PD.

Methods
Sixty-four patients with PD who were diagnosed according to United Kingdom Parkinson’s Disease Society (UKPDS) Brain Bank Criteria and 50 sex- and age-matched healthy control subjects are evaluated for depression and anxiety. PD severity and staging were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS) and Hoehn and Yahr scale. Depression and anxiety were diagnosed using DSM-IV TR criteria and scored using Hamilton Depression and Hamilton Anxiety Rating Scales (HAM-D and HAM-A). The World Health Organization Quality of Life (WHOQOL)-BREF was used to assess impact of depression and anxiety on quality of life.

Results
31.25% of patients with PD had depression while 40.6% of patients had anxiety disorder. Depression was higher in females and patients with history of depression and low socioeconomic status (SES). Anxiety was common in young patients and those who had history of anxiety. Overlap between depression and anxiety was recorded in 23.4%. Total UPDRS and Hoehn and Yahr scale accounted for 33.4% of variance for depression. Total UPDRS and earlier age of onset accounted for 39% of variance for anxiety. Advanced disease stage and severity were independent predictors for depression while disease severity and younger age of onset were the main predictors for anxiety. Depression and anxiety have a negative impact on the overall quality of life of PD patients especially on physical and psychosocial domains.

Conclusion
Depression and anxiety are relatively common in PD. Female gender, low SES, and history of depression were the main risk factors for developing depression. Young age and history of anxiety were risk factors for anxiety. Both had negative impact on quality of life.
Motor disability in patients with multiple sclerosis: transcranial magnetic stimulation study
Authors: Mohy Anssam Bassem , Hatem Aqeel Kareem , Kadoori Hussein Ghani , Hamdan Farqad Bader 
Published: December 2020

Abstract
Background
Transcranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS.

Objectives
The study aims to investigate whether single-pulse TMS measures differ between patients with MS and healthy controls and to consider if these measures are associated with clinical disability.

Patients and methods
Single-pulse TMS was performed in 26 patients with MS who hand an Expanded Disability Status Scale (EDSS) score between 0 and 9.5 and in 26 normal subjects. Different TMS parameters from upper and lower limbs were investigated.

Results
TMS disclosed no difference in all MEP parameters between the right and left side of the upper and lower limbs in patients with MS and controls. In all patients, TMS parameters were different from the control group. Upper limb central motor conduction time (CMCT) was prolonged in MS patients with pyramidal signs. Upper and lower limb CMCT and CMCT-f wave (CMCT-f) were prolonged in patients with ataxia. Moreover, CMCT and CMCT-f were prolonged in MS patients with EDSS of 5–9.5 as compared to those with a score of 0–4.5. EDSS correlated with upper and lower limb cortical latency (CL), CMCT, and CMCT-f whereas motor evoked potential (MEP) amplitude not.

Conclusion
TMS yields objective data to evaluate clinical disability and its parameters correlated well with EDSS.
Immunoglobulins to mitigate paraneoplastic Lambert Eaton Myasthenic Syndrome under checkpoint inhibition in Merkel cell carcinoma
Authors: Dohrn Maike F. , Schöne Ulrike , Küppers Charlotte , Christen Deborah , Schulz Jörg B. , Gess Burkhard , Tauber Simone 
Published: December 2020

AbstractLambert-Eaton myasthenic syndrome (LEMS) is a rare, autoimmune or paraneoplastic condition characterized by muscle weakness and fatigability. In cancer therapy, immune checkpoint inhibitors (ICI) sensitize the immune system for tumor antigens.We report a 62-year-old, female patient with paraneoplastic LEMS as first manifestation of Merkel cell carcinoma. Under avelumab, the LEMS exacerbated with worsening of limb weakness and a severely reduced vital capacity (< 1 l). To treat this immunological side effect, we added a regimen with intravenous immunoglobulins. Hereby, the LEMS improved significantly. As we were able to continue the cancer treatment, the Merkel cell carcinoma has been in remission so far.This is the first description of paraneoplastic LEMS, avelumab, and Merkel cell carcinoma. We conclude that immunoglobulins are an option to control an ICI-associated deterioration of paraneoplastic symptoms.
The changes in biventricular remodelling and function after atrial septal defect device closure and its relation to age of closure
Authors: Alkhateeb Areej , Roushdy Alaa , Hasan-Ali Hosam , Kishk Yehia Taha , Hassan Ayman K. M. 
Published: December 2020

Abstract
Background
The trans-catheter closure of atrial septal defect (ASD) usually has a rapid impact on biventricular remodelling and functions. Whether the transcatheter closure of ASD at early childhood or at adulthood age would affect the improvement in biventricular dimensions and functions remains an area of active research.

Results
This prospective observational study enrolled 70 subjects (50 ASD cases and 20 control subjects). Tissue Doppler imaging (TDI) and strain (S) were performed for the control group and ASD patients at baseline and at 24 h and 1 month after ASD device closure. The total ASD group was subdivided into two subgroups: group-1—children and adolescent with ASD, who underwent transcatheter closure at age ≤ 19 years; group-2—adult who underwent ASD device closure at age > 19 years old. The right and left ventricular global longitudinal systolic strain (RV/LV-GLS) and RV free wall longitudinal strain (RV free wall LS) showed a significant decline after 24 h of device closure (RVGLS-P = 0.001, LVGLS-P = 0.048, RV free wall LS-P < 0.001). However, after a 1-month follow-up, the LVGLS increased in comparison with 24 h changes after device closure (P = 0.038). The baseline mean value of RV free wall LS of G2 was significantly lower than G1 value (P < 0.001). There was no statistically significant difference between the 2 age subgroups regarding biventricular GLS and RV free wall LS changes after device closure. The changes in LV diastolic function immediately and after 1 month of device closure showed a statistically significant change in e′ and its delta change value in group-2 in comparison with its baseline values and to group-1 delta changes (P = 0.002, P = 0.011, P = 0.019, respectively).

Conclusion
The ASD transcatheter closure reduced biventricular global and RV free wall longitudinal systolic strain within 1 day of intervention and was associated with a short-term improvement in the LV-GLSS after a 1-month duration. The progressive increase in LV preload results in its strain growth and reduction in diastolic function after transcatheter ASD closure. The older age at the time of ASD device closure was associated with a significant decrease in the RV free wall LS and septal e′ velocity towards abnormality.
Comparing VBM and ROI analyses for detection of gray matter abnormalities in patients with bipolar disorder using MRI
Authors: Seyedi Somayyeh , Jafari Raheleh , Talaei Ali , Naseri Shahrokh , Momennezhad Mahdi , Moghaddam Maliheh Dadgar , Akbari-Lalimi Hossein 
Published: December 2020

Abstract
Background
With the increasing efforts to a better understanding of psychiatric diseases, detection of brain morphological alterations is necessary. This study compared two methods—voxel-based morphometry (VBM) and region of interest (ROI) analyses—to identify significant gray matter changes of patients with bipolar disorder type I (BP I).

Results
The VBM findings suggested gray matter reductions in the left precentral gyrus and right precuneus of the patients compared to healthy subjects (α = 0.0005, uncorrected). However, no regions reached the level of significance in ROI analysis using the three atlases, i.e., hammers, lpba40, and neuromorphometrics atlases (α = 0.0005).

Conclusion
It can be concluded that VBM analysis seems to be more sensitive to partial changes in this study. If ROI analysis is employed in studies to detect structural brain alterations between groups, it is highly recommended to use VBM analysis besides.
A rapid pre-implementation evaluation to inform a family engagement navigator program during COVID-19
Authors: Taylor Stephanie Parks , Short Robert T. , Asher Anthony M. , Taylor Brice , Beidas Rinad S. 
Published: December 2020

Abstract
Background
Innovative models of family engagement and support are needed in the intensive care unit (ICU) during times of restricted visitation such as the COVID-19 pandemic. Limited understanding of the factors affecting the uptake and outcomes of different family support models hinders the implementation of best practices. We aimed to conduct a rapid pre-implementation evaluation of stakeholder-perceived facilitators and barriers to design implementation strategies to support a novel program using medical students to facilitate family-centered care in the ICU.

Methods
We conducted a 2-step process. In step 1, we gathered contextual data via interview-style open-ended questions sent to clinicians and navigator stakeholders via email. We used electronic data collection due to the physical distancing requirements, the need to prioritize brief data collection for respondent burden, and the need for rapid knowledge gain. A codebook based on the Consolidated Framework for Implementation Research (CFIR), an integrated framework from the field of implementation science, was used to analyze the findings. In step 2, a pilot of the intervention was implemented with 3 navigators over 2 weeks. Implementation strategies were developed to target barriers identified by the pre-implementation evaluation.

Results
Fourteen (70%) of the identified stakeholders responded to the survey. Ten constructs encompassing all five CFIR domains were present in responses as implementation influencers, with the Intervention domain most frequently represented. Through these results and operational feedback from navigators during the pilot period, stakeholders selected multiple implementation strategies: audit and provide feedback, develop educational materials, conduct ongoing training, promote adaptability, assess and redesign workflow, identify and prepare champions, and engage community resources.

Conclusions
We demonstrated how a conceptually based pre-implementation program evaluation can be used to rapidly inform optimal implementation strategies. We report key factors to inform design and implementation strategies for a novel ICU family engagement navigator program that may be useful to others wishing to adopt similar programs.
A qualitative pilot study exploring reasons for prosthetic preference in a veteran amputee population
Authors: Taylor Teri 
Published: December 2020

Background/Aims For people with transfemoral amputations, newer technology, microprocessor-controlled prosthetic limbs, offer a level of performance that exceeds that of older, non-microprocessor controlled limbs. They are often requested by members of Her Majesty's Armed Forces who have been discharged from service (veterans) during applications for replacement limbs. However, as microprocessor-controlled prosthetic limbs cost far exceeds that of non-microprocessor controlled limbs, justification for their provision is essential to ensure that they are seen as value for money for the NHS in the UK. To date, literature focuses on measures of objective performance when demonstrating the value of one limb over another, but it ignores individual lifestyles within this process. This project aims to explore the reasons underpinning individual requests for specific types of prosthetic lower limb in a population of veterans with amputations. Methods This pilot study explored secondary data, consisting of patient statements, from the evaluation process associated with applications for new microprocessor-controlled prosthetic limbs. The data referred to a sample population of non-serving veterans with amputations who attended a veteran prosthetic centre for the ongoing maintenance and replacement of their prosthetic limbs (n=15). Results Findings from the study suggest an interconnection between function, psychology and emotional context. Individual statements demonstrate that, while functional performance influences choice, it is the application of function to life and lifestyle that underpins the meaning of improvements in performance for the individual. Conclusions Further research investigating the meaning of limb performance to the life of an individual is essential to facilitate effective prescription of limbs that meet individual need, and ensuring accurate distribution of what are currently limited funds.
Design and Experiment of an Aerial Electrostatic Spraying System for Unmanned Agricultural Aircraft Systems
Authors: Wang Shilin , Li Xue , Zhou Hao , Lv Xiaolan , Shen Weiguo 
Published: December 2020

HighlightsA bipolar contact electrostatic spraying system is designed for an unmanned agricultural aircraft system.The electrostatic voltage does not affect the droplet size and relative span.The specific charge due to the negative electrode is higher than that due to the positive electrode.The droplets charged by the spraying system are more prone to be deposited on the underside of leaves.Abstract. Chemical application by unmanned agricultural aircraft systems (UAASs) has developed rapidly in China and other Asian countries due to their suitability to complex terrains, high working efficiency, and labor intensity reduction. To enhance spraying performance of unmanned aerial spraying systems (UASSs), an aerial electrostatic spraying system (AESS) was designed consisting of a lithium battery, electrostatic generator, positive and negative charging electrodes, tanks, pumps, and centrifugal atomizers. The AESS electrostatic voltage (EV) was adjusted from 15 to 35 kV, the atomizer rotation speed reached 9600 r/min, and the pump pressure ranged from 0.02 to 0.1 MPa. The AESS specific charge and droplet spectrum under water spraying was measured at different EVs. Results showed that the specific charge due to the negative electrostatic electrode was higher than that due to the positive electrostatic electrode. At a negative electrostatic electrode EV of 35 kV, its specific charge was 1.84 mC/kg. The negative and positive electrostatic electrode volume median diameters (VMDs) ranged from 81.39 to 84.04 µm and 86.8 to 88.80 µm, respectively, and no significant droplet size and relative span differences occurred between the different EVs for the same electrostatic electrode. The AESS was installed on single-rotor and multirotor UAASs for chemical application to pear trees. The results revealed that the electrostatic spray from the AESS has no effect on droplet deposition on the upper side of pear tree canopy leaves, while charged droplets can produce a wrap-around effect on the underside of the leaves, which promotes the adhesion of droplets on the underside of the leaves. The AESS is suitable for chemical application under aerial UAAS spraying. Keywords: Chemical application, Droplet spectrum, Deposition, Specific charge, Unmanned agricultural aircraft system.