bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of Radical Gastrointestinal Tumor Resection with Simultaneous off-Pump Coronary Artery bypass Surgery for Patients with Severe Heart Problems: A Retrospective Cohort Study from A Single Institutional Database
Authors: Jiang Rongrong , Xiao Ziying , Huang Jiechun , Sun Xiaotian , Chu Xianglin , Wang Fangrui , Wang Yiqing , Pang LieWen , Luo Fen 
Published: December 2020

Abstract
Background: Clinical treatment of gastrointestinal neoplasms in patients with severe coronary stenosis is difficult, and it remains controversial to perform staged or simultaneous surgeries. The purpose of this study was to retrospectively analyze the feasibility and indications for simultaneous gastrointestinal tumor resection and off-pump coronary artery bypass (OPCAB) graft surgery.Methods: Data collected from a total of five patients, including three patients with gastric cancer and two patients with colorectal cancer, who underwent simultaneous radical cancer resection and OPCAB between September 2010 and October 2019, were retrospectively analyzed. Among these patients, one had an incomplete colonic obstruction. All patients had severe coronary stenosis, and one experienced acute heart failure before surgery. OPCAB was performed first, followed by the radical cancer resection. Results: All five patients were discharged from hospital without perioperative death, major cardiovascular events or anastomotic leakage. The mean postoperative hospital stay was 9.4 days. One patient experienced slight gastrointestinal bleeding after surgery, which improved with conservative treatment. After a mean follow-up of 39 months, two patients with gastric cancer died from tumor metastasis at 28 months and 37 months, while the remaining three patients did not have tumor recurrence or metastasis. None of the patients experienced myocardial ischemia.Conclusion: It is safe and feasible to perform simultaneous OPCAB and gastrointestinal surgeries on the premise of strictly controlling the indications for patients with gastrointestinal tumors complicated with severe coronary artery stenosis.
Left Ventricular Free Wall Rupture as a Result of Delayed Presentation of an Inferior ST-Elevation Myocardial Infarction Due to Fear of COVID-19
Authors: Nasr George Hany , Glovaci Diana , Mikhail Andrew , Sinfield Steven , Chen Kevin , Patel Hardikkumar , Johl Michael , Chakravarthy Bharath , Singh Siddharth , Sagebin Fabio , El-Farra Ailin Barseghian 
Published: December 2020

Abstract
BackgroundLeft ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs one to four days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR.Case PresentationWe present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table.ConclusionsThe occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.
Exploring the Factors that Affect the Transition from Students to Health Professionals: An Integrative Review
Authors: Opoku Eric Nkansah , Khuabi Lee-Ann Jacobs-Nzuzi , Niekerk Lana Van 
Published: December 2020

Abstract
Background: The nature of a new health professional’s transition from student to health professional is a significant determinant of the ease or difficulty of the journey to professional competence. The integrative review will explore the extent of literature on the factors that impact the transition of new health professionals into practice, identify possible gaps and synthesise findings which will inform further research. The aim was to identify research conducted in the last two decades on the barriers, facilitators and coping strategies employed by new health professionals during their transition into practice.Methods: Whittemore and Knafl’s methodological framework for conducting integrative reviews was used to guide this study. Sources between 1999 and 2019 were gathered using EBSCOhost (including CINAHL, Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), PubMed, Scopus, Cochrane and Web of Science, as well as hand searching and follow-up of bibliographies followed. The Covidence platform was used to manage the project. All studies were screened against a predetermined selection criteria. Relevant data was extracted from included sources and analysed using thematic analysis approach.Results: Of the 562 studies identified, relevant data was extracted from 24 studies that met the inclusion criteria, and analysed to form this review. Thematic analysis approach was used to categorise the findings into theme areas. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates.Conclusion: The transition into practice for new health practitioners has been described as complex and a period of great stress. Increasing clinical and practical experiences during education are required to support new health professionals in the process of closing the gap between learning and practice. Continued professional development activities should be readily available and attendance of these encouraged.
Multiple Lung Cancers: Independent Primary Tumors or Intrapulmonary Metastases, A Case Report
Authors: Erem Anna Sarah , Cecchini Matthew J , Boland Jennifer M. 
Published: December 2020

Abstract
Background

The prevalence of multiple primary lung cancers is rising, highlighting the need for tools to distinguish independent primary tumors from metastases. Molecular markers and hisopathologic comparison are useful to aid in this distinction, but they have significant limitations.
Case Presentation

A 76-year old woman presented with recurrent bronchorrhea, non-productive cough, and dyspnea upon exertion. She was a former smoker (15 pack-year history). Computerized tomography imaging revealed multiple lung masses: 1.9 × 2.3 cm nodule in the right upper lobe, and a 6.5 cm mass in the right lower lobe. Histologic examination of the tumors showed that the right lower lobe mass was an adenosquamous carcinoma with a mucinous adenocarcinoma component. This tumor showed visceral pleural invasion, and direct invasion of one intrapulmonary peribronchial lymph node. The upper lobe lesion was characterized by pure invasive mucinous adenocarcinoma with no squamous component. Abdominal and pelvic imaging was performed to rule out alternative primary sites, and no evidence of disease was identified outside of the chest. A cancer mutation and rearrangement panel on the adenosquamous carcinoma did not reveal any mutations.
Conclusions

In this interesting case, a patient presented with two lung tumors which had some morphologic similarities, but also some important differences, and no specific genetic mutations were present to establish the relationship between the tumors. Although current tools are useful, this case highlights an example of a case where it remains extremely difficult to determine whether two lung cancers are independent primary tumors or intrapulmonary metastases.
Breath Hold Breast Radiotherapy In The Era of Precision Medicine: Appropriate Selection for Left Descending Artery Sparing
Authors: Ippolito Edy , Greco Carlo , Marrocco Maristella , Gentile Silvia , Palizza Serena , Fiore Michele , Trodella Luca Eolo , D'Angelillo Rolando Maria , Ramella Sara 
Published: December 2020

Abstract
Background and purpose

To identify anatomical and/or preplanning characteristics correlated with left descending artery (LAD) dose and therefore provide guidance in the selection of patients with left-breast cancer that could benefit the most from the use of deep inspiration breath hold radiotherapy (DIBH-RT).
Materials and methods

We retrospectively identified patients with left-sided breast cancer who underwent whole breast radiotherapy in DIBH and extracted data from treatment plans in free-breathing (FB) and DIBH. The following anatomical parameters were obtained from the planning CTs in FB: lung volume, heart volume, breast separation, minimum distance from LAD to tangent open field. Receiving operating characteristics was also performed to define the cut-off point of parameters to use in LAD dosimetry prediction. Areas under the curve (AUCs) were calculated for all variables. Post-test probability has been calculated to evaluate advantage for parameters combination.
Results

One hundred ninety-seven patients were identified. The strongest predictor at FB CT scan of LAD maximum dose > 10 Gy and a LAD mean dose > 4 Gy was the minimum distance of LAD from tangent open fields. Adding consecutively other preplanning anatomic parameters, the positive predictive value (PPV) to identify patients at risk of higher dose to LAD was > 90%.
Conclusions

The dosimetric benefit of DIBH is valid for all patients and DIBH should be preferred for all left sided patients; however we can identify a subgroup of patients who benefit the least from DIBH. This is the group with favorable anatomy: limited breast separation, well expanded lungs, LAD distant from open tangent fields.
Transanal Proctocolectomy and Ileal Pouch-Anal Anastomosis (Taipaa) for Ulcerative Colitis: Medium Term Functional Outcomes in a Single Centre
Authors: Capolupo Gabriella Teresa , Carannante Filippo , Mascianà Gianluca , Lauricella Sara , Mazzotta Erica , Caricato Marco 
Published: December 2020

Abstract
Background: Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily.The aim of this study is to analyze our initial experience of transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA), considering postoperative complications and medium-term functional outcomes.Methods: Our Center has experienced the transanal approach for proctectomy and IPAA since August 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Fecal continence, genito-urinary activity and global quality of life at 1 and 6 months after ileostomy reversal have been assessed.Results: Until March 2019, 8 patients underwent transanal proctocolectomy and ileal pouch-anal anastomosis (TaIPAA). In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning loop ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding, not required a re-invertation. There were no cases of anastomotic leakage.Medium-term functional outcomes were determined prospectively using previously validated quality of life questionnaires (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, genitourinary and sexual functions were also investigated, showing comparable results with the literature data.Conclusions: In our experience, transanal proctocolectomy and ileal pouch-anal anastomosis provided good short and medium-term functional results in UC.
Long-term radiographic outcomes and functional evaluation of ulnar shortening osteotomy in patients with ulnar impaction syndrome and reverse oblique sigmoid notch: a retrospective case series study
Authors: Huang Hui-Kuang , Lee Steve K. , Huang Yi-Chao , Yin Cheng-Yu , Chang Ming-Chau , Wang Jung-Pan 
Published: December 2020

Abstract
Background: Ulnar shortening osteotomy (USO) is an effective treatment for ulnar impaction syndrome. However, there has been a concern of osteoarthritis (OA) developing at the distal radioulnar joint (DRUJ) if USO is performed on patients with a reverse oblique sigmoid notch. This study aimed to evaluate the radiographic and functional outcomes following USO in patients with a reverse oblique sigmoid notch.Methods: We retrospectively reviewed our patients with a reverse oblique sigmoid notch who underwent USO to treat ulnar impaction syndrome between 2002 and 2013. We evaluated the radiographic changes of the DRUJ and the patients’ functional outcomes.Results: We enrolled 22 patients (22 wrists) with an average age at operation of 49.6 years and mean follow-up of 93.2 (range, 36 - 179; SD 38.2) months. We found that there were changes in the inclination angle of the sigmoid notch, from an average of reverse oblique 14.9o (range, 11o - 23o; SD 3.4o) preoperatively to a more parallel 5.1o (range, 0o - 11o; SD 3.2o) at the final follow-ups. The functional results at the final follow-ups were good with a mean VAS for pain of 0.2 (range, 0 - 1; SD 0.4) at rest and 1.3 (range, 0 - 3; SD 0.9) during activity, QuickDASH of 15.1 (range, 2.3 - 34.1; SD 8.8), and modified Mayo Wrist Score of 91.6 (range, 70-100; SD 6.4). Seven wrists (31.8%) were noted to have OA changes, but the wrists did not exhibit a significantly worse function when compared to wrists without OA changes, except for supination motion and grip strength.Conclusions: For those patients with a reverse oblique sigmoid inclination following USO, we observed that the inclination angle would have a tendency to become more parallel and some patients would develop OA changes at the DRUJ, but the functional outcomes could still be good in the long term. The reverse oblique sigmoid inclination seems not to be an absolute contraindication for USO.
Reduced translation efficiency due to novel splicing variants in 5′ untranslated region and identification of novel cis-regulatory elements in canine and human BRCA2
Authors: Yoshikawa Yasunaga , Kozuma Hajime , Morimatsu Masami , Sugawara Kaori , Orino Koichi 
Published: December 2020

Abstract
Background: Breast cancer 2, early onset (BRCA2) is a tumor suppressor gene. The protein encoded by this gene plays an important role in homologous recombination (HR)-mediated DNA repair. Deleterious mutations in BRCA2 and downregulation of its expression have been associated with tumorigenesis in dogs and humans. Thus, regulation of BRCA2 expression level is important for maintaining homeostasis in homologous recombination.Results: In this study, the mechanisms that regulate the expression of BRCA2 were proposed. Novel splicing variants were identified in the 5′ untranslated region (UTR) of canine and human BRCA2 in canine testis, canine ovary, and canine and human cultured cell lines. In cultured cells, the ratio of BRCA2 splicing variants at the 5′ UTR was altered by serum starvation. These novel splicing variants, excluding one of the canine splicing variants, were found to reduce the translational efficiency. Additionally, the DNA sequence in human BRCA2 intron 1 harbored novel cis-regulatory elements. Three silencer and two enhancer cis-regulatory elements were identified in human BRCA2 intron 1.Conclusions: This study demonstrates that BRCA2 expression level is regulated via 5′ UTR splicing variants and that the BRCA2 intron 1 region harbors cis-regulatory elements.
Multiple Sclerosis incidence rate in southern Iran: A Bayesian epidemiological study
Authors: Asmarian Naeimehossadat , Sharafi Zahra , Mousavi Amin , Jacques Reis , Tamayo Ibon , Bind Marie-Abèle , abutorabi-zarchi Marzie , Moradian Mohammad Javad , Izadi Sadegh 
Published: December 2020

Abstract
Background: Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanisms and clinical impacts on young people. The prevalence of this disease in Iran is reported to be 5.30 to 74.28 per 100,000-person. Because of high prevalence of this disease in Fars province, the purpose of this study was to assess the spatial pattern of MS incidence rate by modeling both the effects of spatial dependence between neighboring regions and risk factors in a Bayesian Poisson model, which can lead to the improvement of health resource allocation decisions.Method: Data from 5,468 patients diagnosed with MS were collected, according to the McDonald’s criteria. New cases of MS were reported by the MS Society of Fars province from 1991 until 2016. The association between the percentage of people with low vitamin D intake, smoking, abnormal BMI and alcohol consumption in addition to spatial structure in a Bayesian spatio-temporal hierarchical model were used to determine the relative risk and trend of MS incidence rate in 29 counties of Fars province. Results: County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000-person population. The highest relative risk was estimated at 1.80 in the county of Shiraz, the capital of Fars province, while the lowest relative risk was estimated at 0.11 in Zarindasht county in southern of Fars. The percentages of vitamin D supplementation intake and smoking were significantly associated with the incidence rate of MS. The results showed that 1% increase in vitamin D supplementation intake is associated with 2% decrease in the risk of MS and 1% increase in smoking is associated with 16% increase in the risk of MS.Conclusion: Bayesian spatio-temporal analysis of MS incidence rate revealed that the trend in the south and south east of Fars province is less steep than the mean trend of this disease. The lower incidence rate was associated with a higher percentage of vitamin D supplementation intake and a lower percentage of smoking. Previous studies have also shown that smoking and low vitamin D, among all covariates or risk factors, might be associated with high incidence of MS.
How Do They Learn: Types and Characteristics of Medical Student Engagement in the Simulation-Based Learning Environment
Authors: Wang Yashuang , JI YAN 
Published: December 2020

Abstract
Background Student engagement can predict successful learning outcomes and academic development. Expansion of simulation-based medical education will bring about challenges to educators and require them to help medical students to engage themselves in a simulation-based learning environment. Methods We conducted semi-structured interviews with ten medical students to explore their learning types and characteristics in the simulation-based learning environment. The thematic analysis was used to analyze the data. Results The interviews were thematically analyzed to form three types of student engagement in the simulation-based learning environment: reflective engagement, performance engagement, and interactive engagement. The analysis also identified eight sub-themes: active, persistent, and focused thinking engagement; self-directed-learning thinking engagement with the purpose of problem solving; active “voice” in class; strong emotional experience and disclosure; demonstration of professional leadership; interaction with realistic learning situations; support from teammates; and friendship-like facilitator-student interaction.Conclusions The findings explain the mechanisms behind student engagement in the simulation-based learning environment from two perspectives: the two-way construction of individuality and space in learning along with the interdependence of the learner and the learning community. That is, expanding the learning space centering around “inquiry” helps strengthen reflective communication and dialogue. It also facilitates imagination, stimulates empathy, and builds an inter-professional learning community. In this way, medical students are expected to learn from the two-way transmission of information, cultivate and reshape the interpersonal relationship, so as to improve engagement in the simulation-based learning environment.
Mutation screening of the UBE3A gene in Chinese Han population with autism
Authors: Zhao Xue , Zhang Ran , Yu Shunying 
Published: December 2020

Abstract
Background15q11-13 region is one of the most complex chromosomal regions in the human genome. UBE3A is an important candidate gene of autism spectrum disorder (ASD), which located at the 15q11-13 region and encodes ubiquitin-protein ligase E3A. Previous studies about UBE3A gene and ASD have shown inconsistent results and few studies were performed in Chinese population. This study aimed to detect the genetic mutations of UBE3A gene in Chinese Han population with ASD and analyze genetic association between these variants and ASD.MethodsThe samples consisted of 192 patients with autism according to the DSM-IV diagnostic criteria and 192 healthy controls. We searched for mutations at coding sequence (CDS) regions and their adjacent non-coding regions of UBE3A gene using the high resolution melting (HRM) and Sanger sequencing methods. We further increased sample size to validate the detected variants using HRM and conducted association analysis between case and control groups.ResultsA known single nucleotide polymorphism (T>C, rs150331504) located at the CDS4 and a known 5bp insertion/deletion variation (AACTC+/-, rs71127053) located at the intron region of the upstream 288bp of the CDS2 of UBE3A gene were detected using Sanger sequencing method. The ASD samples of case group were 391 for rs71127053, 384 for rs150331504 and 384 healthy controls, which were used to make an association analysis. The results of association analysis suggested that there were no significant difference about the allele and genotype frequencies of rs71127053 and rs150331504 between case and control groups after extending the sample size. Besides, rs150331504 is a synonymous mutation and we compared the secondary structure and minimum free energy (MFE) of mRNA harboring the allele T or C of rs150331504 using RNAfold software. We found that the centroid secondary structure apparently differs along with the polymorphisms of rs150331504 T>C, the results suggested that this variant might change the secondary structure of mRNA of UBE3A gene. We did not detect mutations in other coding regions of UBE3A gene. ConclusionsThese findings showed that UBE3A gene might not be a major disease gene in Chinese ASD cases.