bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability of residents’ assessments of their postgraduate medical education learning environment: an observational study
Authors: Brand Paul L. P. , Rosingh H. Jeroen , Meijssen Maarten A. C. , Nijholt Ingrid M. , Dünnwald Saskia , Prins Jelle , Schönrock-Adema Johanna 
Published: December 2019

Abstract
Background
Even in anonymous evaluations of a postgraduate medical education (PGME) program, residents may be reluctant to provide an honest evaluation of their PGME program, because they fear embarrassment or repercussions from their supervisors if their anonymity as a respondent is endangered. This study was set up to test the hypothesis that current residents in a PGME program provide more positive evaluations of their PGME program than residents having completed it. We therefore compared PGME learning environment evaluations of current residents in the program to leaving residents having completed it.

Methods
This observational study used data gathered routinely in the quality cycle of PGME programs at two Dutch teaching hospitals to test our hypothesis. At both hospitals, all current PGME residents are requested to complete the Scan of Postgraduate Education Environment Domains (SPEED) annually. Residents leaving the hospital after completion of the PGME program are also asked to complete the SPEED after an exit interview with the hospital’s independent residency coordinator. All SPEED evaluations are collected and analysed anonymously. We compared the residents’ grades (on a continuous scale ranging from 0 (poor) to 10 (excellent)) on the three SPEED domains (content, atmosphere, and organization of the program) and their mean (overall department grade) between current and leaving residents.

Results
Mean (SD) overall SPEED department grades were 8.00 (0.52) for 287 current residents in 39 PGME programs and 8.07 (0.48) for 170 leaving residents in 39 programs. Neither the overall SPEED department grades (t test, p = 0.53, 95% CI for difference − 0.16 to 0.31) nor the department SPEED domain grades (MANOVA, F(3, 62) = 0.79, p = 0.51) were significantly different between current and leaving residents.

Conclusions
Residents leaving the program did not provide more critical evaluations of their PGME learning environment than current residents in the program. This suggests that current residents’ evaluations of their postgraduate learning environment were not affected by social desirability bias or fear of repercussions from faculty.
KCC2 expression levels are reduced in post mortem brain tissue of Rett syndrome patients
Authors: Hinz Lisa , Torrella Barrufet Joan , Heine Vivi M. 
Published: December 2019

AbstractRett Syndrome (RTT) is a neurodevelopmental disorder caused by mutations in the Methyl CpG binding protein 2 (MECP2) gene. Deficient K+-Cl—co-transporter 2 (KCC2) expression is suggested to play a key role in the neurodevelopmental delay in RTT patients’ neuronal networks. KCC2 is a major player in neuronal maturation by supporting the GABAergic switch, through the regulation of neuronal chlorine homeostasis. Previous studies suggest that MeCP2 mutations lead to changed KCC2 expression levels, thereby causing a disturbance in excitation/inhibition (E/I) balance. To investigate this, we performed protein and RNA expression analysis on post mortem brain tissue from RTT patients and healthy controls. We showed that KCC2 expression, in particular the KCC2a isoform, is relatively decreased in RTT patients. The expression of Na+-K+-Cl− co-transporter 1 (NKCC1), responsible for the inward transport of chlorine, is not affected, leading to a reduced KCC2/NKCC1 ratio in RTT brains. Our report confirms KCC2 expression alterations in RTT patients in human brain tissue, which is in line with other studies, suggesting affected E/I balance could underlie neurodevelopmental defects in RTT patients.
Use and pattern of previous care received by infertile Nigerian women
Authors: Mohammed-Durosinlorun Amina , Adze Joel , Bature Stephen , Abubakar Amina , Mohammed Caleb , Taingson Matthew , Airede Lydia 
Published: December 2019

Abstract
Background
Prevalence of infertility in sub-Saharan Africa is high yet fertility care, its development and access is limited in resource-poor countries like Nigeria so infertile women resort to different forms of treatment. This study aimed to determine the use and pattern of previous treatments.

Methodology
This was a descriptive Cross Sectional study conducted at a tertiary hospital in North-Western Nigeria. Interviewer administered pretested questionnaires were administered to 236 consenting clients seen at their first visit to the gynaecology clinic with complaints of inability to conceive, between January 2016 to March 2018. We collected information on demographic and reproductive characteristics, previous fertility treatment and other data relevant to infertility. Descriptive analysis was done using SPSS software version 22.

Results
Two hundred and thirty six clients participated in the study and majority were 20–29 years (44.5%), with a mean age of 31.5 ± 7.4, while the mean age of their husbands was 41 ± 8.0. More clients were educated up to secondary level or above (80.9%), with more Muslims (65%) than Christians. All clients were married except one, most clients had been married for 5 years or more, 18.2% were in their second order of marriage and 28% were in polygamous marriages. Many of the clients were homemakers (46.6%) and earned an average monthly income of less than fifty thousand naira. About 59.3% of clients presented with primary infertility, with 15.7% being infertile for duration of more than 10 years. One hundred and forty six respondents (61.9%) had received previous hospital treatments before presentation to our facility, 37% had visited more than three hospitals, 70% did not have adequate investigations done, treatment was successful in 15% while 40.7% received traditional treatments. Husbands of women receiving previous treatment were slightly older (p value < 0.05).

Conclusion
Majority of woman have multiple and unnecessary visits to several hospitals for infertility care with little positive results despite time and resources spent. Quality of infertility care needs to be improved.
Psychological distress after the Great East Japan Earthquake: two multilevel 6-year prospective analyses
Authors: Goodwin Robin , Sugiyama Kemmyo , Sun Shaojing , Aida Jun , Ben-Ezra Menachem 
Published: December 2019

BackgroundThe Great East Japan Earthquake of 11 March 2011 led to the relocation of 300 000 survivors. Studies following disasters focus primarily on data collected in the immediate aftermath and neglect the influence of wider community factors.AimsA three-level prospective study examining associations between survivors' psychological distress and individual- and social-level factors in the 6 years following a complex disaster.MethodWe drew on two multi-wave data collections in the 6 years after the earthquake, using residents from different forms of housing. Sample 1 included six waves of private-housing residents from 2011 to 2016 (n = 1084 per wave), sample 2 five waves of residents living in prefabricated housing from 2012 to 2016 (n = 1515 per wave). We analysed prospective associations between distress and time (level 1), pre-existing disorders and disaster experiences and behaviours (level 2) and city-wide measures of support and physical activity (level 3).ResultsMultilevel models with random coefficients demonstrated greater distress in earlier waves (samples 1 and 2 respectively, adjusted β = −15 and β = −0.16, P < 0.001), among female respondents (β = 0.58, P = 0.01 and β = 1.74, P = 0.001), in those with a previous psychiatric history (β = 2.76, β = 2.06, P < 0.001) with diminished levels of activity post-earthquake (β = 1.40, β = 1.51, P < 0.001) and those lacking in social support (β = 1.95, β = 1.51, P < 0.001). Support from spouses and friends was most protective of psychological health. City-level support was negatively associated with distress, but only among those in prefabricated housing.ConclusionsPsychological distress diminished with time, but varied across gender, psychiatric history, housing, levels of activity and availability of social support. Practitioners should consider individual- and city-level factors when devising effective interventions.
Leptin: Is It Thermogenic?
Authors: Fischer Alexander W , Cannon Barbara , Nedergaard Jan 
Published: December 2019

Abstract
Animals that lack the hormone leptin become grossly obese, purportedly for 2 reasons: increased food intake and decreased energy expenditure (thermogenesis). This review examines the experimental evidence for the thermogenesis component. Analysis of the data available led us to conclude that the reports indicating hypometabolism in the leptin-deficient ob/ob mice (as well as in the leptin-receptor-deficient db/db mice and fa/fa rats) derive from a misleading calculation artefact resulting from expression of energy expenditure per gram of body weight and not per intact organism. Correspondingly, the body weight-reducing effects of leptin are not augmented by enhanced thermogenesis. Congruent with this, there is no evidence that the ob/ob mouse demonstrates atrophied brown adipose tissue or diminished levels of total UCP1 mRNA or protein when the ob mutation is studied on the inbred C57BL/6 mouse background, but a reduced sympathetic nerve activity is observed. On the outbred “Aston” mouse background, brown adipose tissue atrophy is seen, but whether this is of quantitative significance for the development of obesity has not been demonstrated. We conclude that leptin is not a thermogenic hormone. Rather, leptin has effects on body temperature regulation, by opposing torpor bouts and by shifting thermoregulatory thresholds. The central pathways behind these effects are largely unexplored.
Use of accelerometer-based activity monitoring in orthopaedics: benefits, impact and practical considerations
Authors: Sliepen Maik , Lipperts Matthijs , Tjur Marianne , Mechlenburg Inger 
Published: December 2019

Studies of the effectiveness of orthopaedic interventions do not generally measure physical activity (PA). Applying accelerometer-based activity monitoring in orthopaedic studies will add relevant information to the generally examined physical function and pain assessment. Accelerometer-based activity monitoring is practically feasible in orthopaedic patient populations, since current day activity sensors have battery time and memory to measure continuously for several weeks without requiring technical expertise. The ongoing development in sensor technology has made it possible to combine functional tests with activity monitoring. For clinicians, the application of accelerometer-based activity monitoring can provide a measure of PA and can be used for clinical comparisons before and after interventions. In orthopaedic rehabilitation, accelerometer-based activity monitoring may be used to help patients reach their targets for PA and to coach patients towards a more active lifestyle through direct feedback. Cite this article: EFORT Open Rev 2019;4:678-685. DOI: 10.1302/2058-5241.4.180041
P007 Double Balloon Enteroscopy in Pediatric Crohn’s Disease for Decision Therapy and 10 Years Follow up
Authors: Oba Jane , Deboni Mariana , Toma Ricardo , Azevedo Matheus , Carlos Alexandre , Milani Luciane , Damião Adérson , Saflatle Ribeiro Adriana 
Published: December 2019

BACKGROUND:
Crohn’s disease (CD) is a chronic recurrent inflammatory disease that may affect any segment of gastrointestinal tract. In 60-70% of CD may involve the small bowel (SB) and present a diagnostic challenge to decision regarding therapy. Double Balloon Enteroscopy (DBE) is one of endoscopic modality for children that allow the diagnostic and therapeutic procedures of SB disease.

Objectives:
Evaluate the feasibility, validity and safety of DBE in patients of a tertiary pediatric center with CD. In addition, we analysed its impact on treatment strategies, and established other diagnoses (malignancy, stenosis) in 10 years follow up.

METHODS:
Between 2007-10, 20 patients (age 2-20 years) with CD diagnosis, refractory to treatment were selected to undergo SB evaluation by DBE, oral route. We used general anesthesia (children < 12 y) or deep sedation with propofol (patients >13 y). Previously all had performed radiological imaging to exclude structuring. A 10-year follow up of patients was performed.

RESULTS:
Among 20 patients, 90% had SB CD in jejunum or ileum, and 10% had solely lesion in SB, which was not detected by colonoscopy. The DBE findings were: Active duodenojejunal ulcers, ulcer healing and/or pseudo polyps, sub-stenosis and mucosal granularity. Mean length of SB examined was 220 cm beyond the ligament of Treitz (range 120 to 360 cm). No significant complications were related to the procedure. Currently 14 patients are in follow up, 5 children in paediatric GI clinic and the other 9 at adult GI clinic. In 10 years follow up one patient had an extra intestinal malignancy diagnosis; one had IL-10 and/or IL-10R gene mutation and one change the diagnosis to ulcerative colitis. Curiously, the proportional number of patients in therapy, particularly biologic, had decreased.

CONCLUSION(S):
DBE is a useful tool to make differential diagnosis in SB paediatric pathologies, especially in CD who require escalating and de-escalating treatment. DBE has a good safety profile with a low index of complications when performed in reference centers.
P030 Re-Initiation of Anti TNF Agents After a Drug Holiday or Disease Relapse in Inflammatory Bowel Diseases: A Systematic Review
Authors: Hamdeh Shadi , Kalot Mohamad , Numan Laith , Alujile Yaser , Mustafa Reem , Olyaee Mojtaba 
Published: December 2019

BACKGROUND:
Inflammatory bowel disease is a chronic condition that usually requires life-long treatment, with approximately one third of patients relapsing within 1 year after discontinuation of medications. It’s still not clear whether it’s safe and effective to start anti TNF agents after a drug holiday, with some studies showing benefit but others not. Therefore, we conducted a meta-analysis of studies that looked at restarting anti TNF medications after a drug holiday, to discern whether this can lead to clinical response/remission or not.

METHODS:
A comprehensive search of several databases including Ovid MEDLINE Epub Ahead of Print, Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was performed up to September 15, 2019. Two independent reviewers systematically identified trials that looked at restarting anti TNF drugs after a drug holiday. A meta-analysis was performed using a random effect model to assess the outcomes of clinical remission after re-initiation of anti TNF.

RESULTS:
Total of 17 studies with 918 patients retreated with anti TNF medications after a drug holiday (2 studies) or due to disease relapse (15 studies) met our inclusion criteria and were ultimately included in the final analysis. The remission rate of patients retreated with biologics was abstracted from 17 studies. A binary random effects model was used to pool the proportions of remission from all studies. The pooled rate for remission in those patients was 82.2% (76.7%–87.7%), however we found a serious inconsistency among studies with an i2 value of 79.3%. Additionally, although some of the estimates in individual studies do not fall within the confidence internal of the estimates in the other studies, the pooled estimate for remission ranging from 76.7% to 87.7% indicates precision in the results, as both ends of the confidence interval would lead to the same clinical decision of retreating patients after a drug holiday or relapse.

CONCLUSION(S):
Our results indicated that restarting anti TNF after a drug holiday or due to disease relapse may lead to clinical response and can be considered in clinical practice.
P073 Double Balloon Enteroscopy in Refractory Crohn's Disease: Jejunal Findings and Clinical Impact After 10 Years of Follow-Up
Authors: Facanali Marcio , Facanali Carolina , Queiroz Natália , Sobrado Carlos , Prazeres Tulio , Deboni Mariana , Filho Edesio , Oba Jane , Toma Ricardo , Nahas Sergio , Saflatle Ribeiro Adriana 
Published: December 2019

BACKGROUND:
Crohn's disease (CD) is a chronic inflammatory disease that can affect all segments of the gastrointestinal tract. With various phenotypes and progressive course, it can be complicated with fistulas, abscesses or stenosis. Treatment targets includes clinical remission and mucosal healing in order to avoid complicated outcomes. Double balloon enteroscopy (DBE) allows complete evaluation of the small intestine, providing diagnoses and the possibility of interventions such as biopsies, with low complication rates. Some authors suggest that involvement of the proximal small bowel may indicate worse long-term therapeutic outcomes. This study aims to correlate jejunal endoscopic findings observed in baseline DBE with the activity of CD after 10 years of follow-up.

METHODS:
Twenty paediatric refractory CD patients (2–17 years old) performed DBE by a single experienced specialist after radiological evaluation for stenosis exclusion between 2007 and 2010. After 10 years, the degree of CD activity was assessed by the Harvey-Bradshaw Index (HBI), C-Reactive Protein (CRP) serum dosage, and current therapy through collection of electronic medical records and personal communication.

RESULTS:
Sixteen 16/20 patients (80%) completed the 10 years follow up period. Two patients (2/16) changed diagnosis (1- monogenic disease, IL-10 and / or IL10R gene mutation; 1 - ulcerative colitis). Previous findings of DBE of the 14 patients corresponded to: 2 active duodenojejunal ulcers, 4 duodenojejunal scar retractions, 1 retraction and pseudopolyps in the proximal ileum, 6 hyperemia and / or edema and / or granularity of the jejunal mucosa, and 1 without alteration. After 10 years, 6/14 patients have abnormal CRP (>5 mg/L), with 3 of them having HBI between 5 and 7, 2 between 8 and 16 and 1 of 4. All of them presented previous jejunal alterations, 5/6 are currently in use of biologic and 3/6 are steroid dependent. The 2 patients who had active ulcers in baseline DBE remain steroid dependent and with higher rates of HBI activity. Eight patients (8/14) have normal CRP, all presenting HBI lower than 5. Of these, 3 are using combined therapy with immunosuppressant and biologic, 1 with biologic monotherapy, 2 with immunosuppressant, and 2 without medication.

CONCLUSION(S):
Active jejunal disease, observed through DBE, may indicate a more severe phenotype in CD after long-term follow-up, suggesting a distinct phenotype. Evaluation of the proximal small intestine should be considered in refractory paediatric CD patients or those with diagnostic uncertainty.
P090 Anal Fistula Cancer of Luminal Origin Associated With Crohn's Disease: A Case Report
Authors: Shinozaki Masaru , Tanaka Torao , Takane Kiyoko , Ota Yasunori , Yazawa Kentaro , Tateno Yoko , Furukawa Yoichi 
Published: December 2019

CASE:
Recent studies have shown that the risk of anal fistula cancer, as well as colorectal cancer, is increased in patients with Crohn's disease (CD) compared with that in the general population. The prognosis of patients with anal fistula cancer associated with CD is generally poor, and its natural course has not been clarified yet. Herein, we report a case of anal fistula cancer and rectal tumor associated with CD, which shared the same genetic mutations. A Japanese man was diagnosed with CD at the age of 25 years. When he was 38 years old, he underwent a subtotal colectomy, ileo-sigmoid colonic anastomosis for entero-entero fistula, and seton drainage for anal fistula. He received maintenance therapy consisting of azathioprine and infliximab. Additionally, annual surveillance colonoscopy had been performed. When he was 44 years old, a small reddish, slightly depressed area very close to the dentate line was detected. Although the lesion did not appear to change in size for 2 years, it got larger, and the surface pattern was indicative of neoplasm, when he was 47 years old. The tumor was biopsied for the first time, which revealed high-grade dysplasia. The patient agreed to undergo excisional biopsy under spinal anesthesia. The operation was performed as follows: after the tumor was excised, we changed our gloves and instruments and sterilized the surrounding area with povidone iodine to avoid contamination. We explored the fistula with curettage, since its primary orifice was located very close to the tumor. We also removed the surrounding mucosa separately. The biopsy specimens were submitted for pathological review. The tumor revealed high-grade dysplasia, which was restricted to the mucosal layer, and the specimen from the anal fistula also showed high-grade dysplasia. Computed tomography or magnetic resonance imaging scans revealed no evidence of malignancy. Therefore, we recommended him to undergo abdominoperineal resection to check for possible cancer at the anal fistula, for which the patient agreed. The specimen of the abdominoperineal resection showed that the remaining cancer extended to the anal fistula. The cancer spread infiltratively, spanning approximately 1 cm × 2 cm without mass formation. The histology findings revealed well-differentiated adenocarcinoma and mucinous adenocarcinoma. We performed a genetic analysis of the polypoid tumor and the anal fistula cancer. The results showed that the same somatic mutation, c.1015_1016insCTTCG, in the TP53 gene was identified in both tumors but not in the paired non-cancerous tissue, suggesting that the tumors originated from the same neoplastic cell. The morphological progression detected through the surveillance colonoscopy suggested that the polypoid tumor was the primary lesion, and the anal fistula cancer was a spread or metastasis of the polypoid lesion. Therefore, some anal fistula cancers may be of luminal origin.