bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discovering metformin-induced vitamin B12 deficiency in patients with type 2 diabetes in primary care
Authors: Herbert Laura , Ribar Alicia , Mitchell Sheryl , Phillips Cynthia 
Published: October 2019

Abstract

Background:
Although metformin is the preferred initial pharmacological choice in type 2 diabetes, there is evidence that reveals a link between metformin use and vitamin B12 deficiency. The American Diabetes Association (ADA) has recently recommended periodic measurement of B12 levels for all patients on metformin.

Local problem:
Medical record data collected for the preintervention period showed that only 5% (n = 23) of patients diagnosed with diabetes and on metformin had B12 levels checked at an internal medicine primary care practice.

Methods:
This was a quasi-experimental project of preintervention and postintervention design using a checklist containing important measures of diabetes control. The project sample population consisted of data of adults with type 2 diabetes aged 18 years and older who were prescribed metformin in the previous year at the primary care practice.

Interventions:
The intervention focused on revising an existing diabetes measures checklist to include a prompt for an annual measurement of B12 levels.

Results:
There was significant improvement in monitoring vitamin B12 levels and discovery of low vitamin B12 levels. These data show that the number of B12 levels checked increased from 23 during the preintervention to 155 during the intervention (p ≤ 0.0000).

Conclusions:
This project supports a conclusion that including a prompt to check B12 levels to an existing checklist increases B12 monitoring in this patient population. Results may encourage other providers to follow the ADA guidelines for monitoring vitamin B12 levels for patients taking metformin.
Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention
Authors: Bryant Shari , Parker Karen 
Published: October 2019

ABSTRACT
The Institute of Medicine's The Future of Nursing report recommended the extension of nurse practitioner (NP) fellowship programs to highlight and assess competencies after completion of licensure. The initiative, “Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention as nurse practitioners promptly transition from novice to expert clinician,” evaluated NP satisfaction between NPs who had not completed a fellowship versus NPs who had participated in a fellowship. Transition of an NP was evaluated through the Misener Nurse Practitioner Job Satisfaction Scale via 258 NPs through Emory Healthcare, MD Anderson, DNP discussion groups, and Show Me Your Stethoscope from social media. A series of independent t-tests were performed to determine statistical significance. The results of the analyses found that individuals who had participated in an NP fellowship had significantly higher scores on a sense of value for “what you do,” monetary bonuses, and compensation for services outside of normal duties and obtained statistical significance. Owing to the positive trends of the surveys, continuation of NP fellowships is recommended for a successful NP role transition to develop clinical growth, retention, leadership skills, and ultimately an expert clinician.
Understanding the Dizziness Handicap Inventory (DHI): A Cross Sectional Analysis of Symptom Factors That Contribute to DHI Variance
Authors: Formeister Eric J. , Krauter Roseanne , Kirk Laura , Zhu Tian Ran , Rizk Habib G. , Sharon Jeffrey D. 
Published: October 2019

Objective:
The Dizziness Handicap Inventory (DHI) is the most commonly used quality of life measure for vestibular disorders. However, there is wide variability in scores, and little is known about which variables contribute to dizziness-related quality of life. Our goal was to investigate the key demographic and symptom-related factors to that account for DHI variance.

Study Design:
Cross-sectional survey.

Setting:
Tertiary referral center.

Patients:
Adult patients presenting to a dizziness clinic.

Main Outcome Measure:
DHI variance explained by multiple linear regression.

Results:
Seventy subjects were included in our study. We performed univariate analyses on numerous demographic and dizziness-related factors, and constructed a multivariate model based on explaining the highest variance in the data with the least number of independent variables. Several validated quality of life and mental health survey scores (SF-36—quality of life; PHQ-9—depression; and GAD-7—anxiety) were significantly correlated with higher DHI scores. Additional factors, including the number of dizzy days per month, the number of dizziness descriptors (spinning, lightheadedness, disequilibrium, etc.), and the number of dizziness triggers (loud sounds, stress, riding in a car, etc.), were all significantly associated with higher DHI scores; a multiple linear regression model showed that these three aforementioned factors combined accounted for 56% of the variability in the DHI scores (p < 0.0001). Adding an index of depression, as measured by the PHQ-9, increased the adjusted R2 to 64% (p < 0.0001).

Conclusions:
DHI score variability is explained by mental health and quality-of-life measures in addition to the daily burden of dizziness.
The Prevalence of Lean/Nonobese Nonalcoholic Fatty Liver Disease
Authors: Shi Yiwen , Wang Qianyi , Sun Yameng , Zhao Xinyan , Kong Yuanyuan , Ou Xiaojuan , Jia Jidong , Wu Shanshan , You Hong 
Published: October 2019

Background and Aim:
The prevalence of lean/nonobese nonalcoholic fatty liver disease (NAFLD) ranges widely in studies. Thus, here, we aimed to perform a meta-analysis on NAFLD prevalence in the lean or nonobese population to give clarity.

Materials and Methods:
PubMed, Embase, and the Cochrane Library databases were systematically searched to identify studies reporting NAFLD prevalence in the lean/nonobese population. Lean or nonobese was defined by body mass index cutoffs reported by authors in original studies. NAFLD prevalence based on community, population, or health checkups was combined with random-effect model after logit transformation. Subgroup analysis and meta-regression were further performed to investigate the heterogenicity.

Results:
A total of 45 studies were enrolled in the final analysis, with 55,936 lean/nonobese subjects included, among whom 7351 NAFLD patients were diagnosed. Overall, the pooled NAFLD prevalence of the lean or nonobese population was 10.2% (95% confidence interval: 7.6%-13.6%) and 15.7% (95% confidence interval: 12.5%-19.6%), respectively. Compared with western studies, the NAFLD prevalence in the lean or nonobese population was lower in eastern studies. In addition, the NAFLD prevalence in both the lean and nonobese population showed a general upward trend during recent years. The prevalence was similar in community-based and health checkup–based studies. Lean/nonobese NAFLD patients had significantly lower rates of hypertension, lower uric acid and fasting plasma glucose, and a higher level of high-density lipoprotein than nonlean/obese patients.

Conclusions:
The prevalence of NAFLD in the lean/nonobese population is not rare in either the western or eastern regions of the world. This meta-analysis of prevalence assessment and clinical characteristics should enable higher confidence in more specific interventions and health care standards for these patients.
Evaluation of the use of photobiomodulation following the placement of elastomeric separators
Authors: Ortega Silvana Machado , Gonçalves Marcela Leticia Leal , da Silva Tamiris , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansiski , Altavista Olga Maria , Olivan Silvia Regina , Santos Ana Eliza Castanho Garrini dos , Martimbianco Ana Luiza Cabrera , Mesquita-Ferrari Raquel Agnelli , Fernandes Kristianne Porta Santos , Bussadori Sandra Kalil 
Published: October 2019

Abstract

Background:
Pain stemming from the placement of elastomeric separators and the exchanging of wires and accessories is the greatest reason for abandoning orthodontic treatment. Indeed, discomfort related to treatment exerts a negative impact on quality of life due to the difficulty chewing and biting. This paper proposes a study to evaluate the analgesic effects of photomiobodulation (PBM) on individuals undergoing orthodontic treatment.

Methods:
The sample will be composed of 72 individuals who receiving elastomeric separators on the mesial and distal faces of the maxillary first molars. The patients will be randomly allocated to 2 groups: an experimental group irradiated with low-level laser and a sham group submitted to simulated laser irradiation. Upon the placement of the separators, the experimental group will receive a single application of PBM on the mesial and distal cervical portion and apical third of the molars. Perceived pain will be analyzed after one hour using the visual analog scale in both groups. Samples will be taken of the gingival crevice with absorbent paper for 30 seconds for the analysis of cytokines using ELISA and the results of the 2 groups will be compared. The patients will sign a statement of informed consent. Statistical analysis will be performed with the Student's t test and analysis of variance (ANOVA).

Discussion:
The expectation is that the patients in the irradiated group will have a lower perception of pain and lower quantity of cytokines compared to those in the sham group. The purpose of the study is to establish an effective method for PBM with the use of low-level infrared laser (Ga-Al-As with a wavelength of 808 nm and output power of 100 mW) for reductions in pain and inflammatory cytokines related to orthodontic treatment.

Trial registration:
This protocol was registered in ClinicalTrial.gov, under number NCT03939988. It was first posted and last updated in May 6, 2019.
Yoga and schizophrenia—a comprehensive assessment of neuroplasticity
Authors: Varambally Shivarama , Venkatasubramanian Ganesan , Govindaraj Ramajayam , Shivakumar Venkataram , Mullapudi Thrinath , Christopher Rita , Debnath Monojit , Philip Mariamma , Bharath Rose Dawn , Gangadhar BN 
Published: October 2019

Abstract

Introduction:
Schizophrenia is one of the most severe mental disorders with a prevalence of about 1% and a leading cause of disability among young adults. Pharmacotherapy is the mainstay in the management of schizophrenia. However, even with the best of medication, several problems like refractoriness, negative symptoms, frequent relapses, and cognitive impairments persist.

Methods:
This is a randomized-controlled clinical study including patients from an urban tertiary hospital and a semi-urban community center, with a between-group, repeated-measures, longitudinal design. This study will recruit 160 patients with DSM 5 diagnosis of schizophrenia who are on stable medication for a minimum of 6 weeks; they will be randomly assigned into 2 arms viz., yoga therapy (YT), and treatment-as-usual (TAU) with 80 patients in each arm. Participants will undergo Clinical, Laboratory, and Radiological assessments at baseline and at intervals of 1 month, 3 months, and 6 months from the baseline. It is hypothesized that yoga will improve psychopathology and emotion processing, increase serum brain derived neurotrophic factor (BDNF) and plasma oxytocin levels and effect changes in cerebral activation in areas of the brain associated with schizophrenia.

Discussion:
This study aims to measure the efficacy of a Yoga-based intervention as an adjunct in patients with schizophrenia as well as the mechanisms of these effects.

Trial registration: Registered retrospectively with Clinical Trial Registry – India (CTRI) with registration number CTRI/2017/08/009219.
Five years of follow-up of immediate quadriparesis caused by a large calcified mass in the ligamentum flavum
Authors: Cao Yafei , Li Heng , Liu Weidong , Yu Weiji , Gao Kun 
Published: October 2019

Abstract

Introduction:
Calcification of ligamentum flavum (CLF) is an important cause of spinal stenosis and spinal cord compression. CLF does not usually induce immediate quadriparesis. Here we describe a rare case of immediate quadriparesis due to a large calcified mass containing liquids in the ligamentum flavum, which was easily confused with gout crystals.

Patient concerns:
A 74-year-old Asian male felt progressive bilateral arm and leg weakness. On the fourth day, acute quadriparesis occurred.

Diagnosis:
Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large circular mass in the left posterior part of the cervical 3/4 spinal canal, protruding into the canal, and occupying one-half of the spinal canal.

Interventions:
Emergency laminectomy was performed at C3/4 level. The huge cyst was excised and 1 ml of white viscous liquid flowed out.

Outcomes:
After operation, CT and MRI showed a full laminectomy of C3/4 and complete decompression of the cervical spinal cord. Hematoxylin-eosin (HE) staining showed that large amounts of calcium was deposited around cystic tissues. Five-year follow-up after laminectomy showed good recovery.

Conclusion:
This case of immediate quadriparesis, caused by a large calcified mass containing fluid, is very rare. It should be at the earliest stage of calcification. Laminectomy is an effective treatment. This calcification was deceptive and was easily confused with gout crystals. It can help to understand the exact pathophysiology of CLF.
Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant
Authors: Hayashida Kenji , Yamakawa Sho , Shirakami Eri 
Published: October 2019

Abstract

Rationale:
Chylothorax remains a poorly understood phenomenon, and no optimal treatment or guidelines have been established. This is the first report of treating congenital chylothorax and lymphedema in a low-birth-weight infant by lymphovenous anastomosis (LVA).

Patient concerns:
We report a case of successful LVA for persistent congenital chylothorax and lymphedema resistant to other conservative therapies.

Diagnosis:
The diagnosis of chylothorax was confirmed by the predominance of lymphocytes in the pleural fluid draining from the chest tube. In addition, the infant developed oliguria and generalized lymphedema.

Interventions:
LVA under local anesthesia combined with light sedation was performed at his medial thighs and left upper arm.

Outcomes:
Although his subcutaneous edema markedly improved, the decrease in chest tube drainage was gradual. No additional treatment was required.

Lessons:
LVA is of considerable value as a surgical treatment option in the setting of persistent congenital chylothorax and lymphedema, because LVA is a less invasive procedure.
Aberrant hTERT promoter methylation predicts prognosis in Chinese patients with acral and mucosal melanoma
Authors: Xu Haixia , Wang Weijia , Zhao Juan , Li Tingting , Kang Xiaojing 
Published: October 2019

Abstract

Background:
To evaluate the methylation levels of human telomerase reverse transcriptase (hTERT) promoter three CpG island (CGIs) regions and its prognostic impact in Chinese patients with acral and mucosal melanoma.

Methods:
Bioinformatics software was used to analyze hTERT gene promoter. Fresh frozen tissues were taken from 14 patients with melanoma (6 acral melanoma and 8 mucosal melanoma) and 14 pigmented nevus as control subjects (14 acral pigmented nevus). Bisulfite sequencing PCR (BSP) combined TA clone sequencing was used to assess the methylation levels of hTERT promoter CGIs regions. The relative expression level of hTERT mRNA was measured by quantitative real-time polymerase chain reaction (qRT-PCR).

Results:
CGIs-1 (-1392–-1098 bp), CGIs-2 (-945–-669 bp), and CGIs-3 (-445–-48 bp) were selected for our study. Our results indicated that the methylation levels of hTERT promotor CGIs regions in melanoma were greater than pigmented nevus (CGIs-1: 69.3 ± 18.7% vs 46.8 ± 20.4%, t = 3.048 P = .005; CGIs-2: 73.8 ± 14.7% vs 55.6 ± 16.0%, t = 3.120 P = .004; CGIs-3: 5.8 ± 2.2% vs 2.2 ± 1.3%, t = 5.164 P < .001). The relative expression level of hTERT in melanoma was greater than in pigmented nevus (50.39 ± 9.16 vs 26.10 ± 7.25, t = 7.778, P < .001). Linear regression analysis showed that the methylation level of CGIs-2 in melanoma was positively correlated with the relative expression level of hTERT mRNA (R2 = .490, F = 13.478, P = .003). Combined with the analysis of clinicopathological features, the methylation level of CGIs-2 in melanoma with lymph node metastasis was greater than in melanoma without lymph node metastasis, and the methylation level of CGIs-2 increased with TNM staging.

Conclusion:
CGIs-2 methylation level was associated with the relative expression level of hTERT mRNA, lymph node metastasis and TNM staging, suggesting that CGIs-2 hypermethylation might be used to evaluate the prognosis in Chinese patients with acral and mucosal melanoma.
Association between dietary iron intake and the prevalence of nonalcoholic fatty liver disease
Authors: Yang Zidan , Wu Jing , Li Xiaoxiao , Xie Dongxing , Wang Yilun , Yang Tubao 
Published: October 2019

Abstract
The aim was to test the association between dietary iron intake and the prevalence of nonalcoholic fatty liver disease (NAFLD) in a large sample of middle-aged and elderly Chinese population.
The data included in this analysis were collected from a population-based cross-sectional study, that is, the Xiangya Hospital Health Management Center Study. Dietary iron intake was assessed using a validated semiquantitative food frequency questionnaire. The relationship between dietary iron intake and the prevalence of NAFLD was examined using logistic and spline regressions.
A cross-sectional study including 5445 subjects was conducted. The prevalence of NAFLD was 36.9%. Compared with the lowest quintile, the energy-adjusted odds ratios (ORs) of NAFLD were 1.33 (95% confidence interval [CI]: 1.07–1.64), 1.80 (95% CI: 1.41–2.29) and 2.11 (95% CI: 1.60–2.80) in the 3rd, 4th, and 5th quintile of iron intake, respectively (P-value for trend <.001). In addition, dietary iron intake was positively associated with the OR of NAFLD in a dose–response relationship manner (test for trend P < .001). However, after stratifying the data by gender, such association only remained in the male, but not in the female population. With adjustment of additional potential confounders, the results did not change materially.
Subjects with higher dietary iron intake were subject to a higher prevalence of NAFLD in a dose–response relationship manner. However, such association probably only exists in males, but not in females.
A test for treatment effects in randomized controlled trials, harnessing the power of ultrahigh dimensional big data
Authors: Lee Wen-Chung , Lin Jui-Hsiang 
Published: October 2019

Abstract

Background:
The randomized controlled trial (RCT) is the gold-standard research design in biomedicine. However, practical concerns often limit the sample size, n, the number of patients in a RCT. We aim to show that the power of a RCT can be increased by increasing p, the number of baseline covariates (sex, age, socio-demographic, genomic, and clinical profiles et al, of the patients) collected in the RCT (referred to as the ‘dimension’).

Methods:
The conventional test for treatment effects is based on testing the ‘crude null’ that the outcomes of the subjects are of no difference between the two arms of a RCT. We propose a ‘high-dimensional test’ which is based on testing the ‘sharp null’ that the experimental intervention has no treatment effect whatsoever, for patients of any covariate profile.

Results:
Using computer simulations, we show that the high-dimensional test can become very powerful in detecting treatment effects for very large p, but not so for small or moderate p. Using a real dataset, we demonstrate that the P value of the high-dimensional test decreases as the number of baseline covariates increases, though it is still not significant.

Conclusion:
In this big-data era, pushing p of a RCT to the millions, billions, or even trillions may someday become feasible. And the high-dimensional test proposed in this study can become very powerful in detecting treatment effects.
Timescale of tumor volume of a young breast cancer patient with luminal B subtype
Authors: Mao Xiaoyun , Zhou Ming , Fan Chuifeng , Chen Bo , Jin Feng 
Published: October 2019

Abstract

Rationale:
It is largely unknown about the tumor growth of breast cancer naturally. We devised and analyzed an appropriate mathematical tool of the equations that describe how fast tumors grow without treatment on the basis of the ellipsoid shape of solid breast cancer.

Patient concerns:
A 31-year-old woman presented with a painless palpable lump in her left breast for 5 months.

Diagnosis:
Infiltrated ductal breast cancer (histologic grade II) of luminal B

Interventions:
The patient did not receive any therapy due to her private reasons for 2 years, the analysis of the tumor volume growth was done regarding the growth rate of the tumor in the absence of intervention.

Outcomes:
After 2 years of diagnosis of breast cancer, the tumor mass occupied the whole left breast with skin implanted and nipple abnormality. As this case indicated that the tumor's early growth rate was very slow. When the tumor volume reached 300 cm3, its fast growth began without treatment. Later growth approached the maximum, when the tumor volume was more than 800 cm3.

Lessons:
The tumor growth is segmental without therapy. Early diagnosis and treatment is the key to good prognosis for every breast cancer patient.
Adenosquamous carcinoma development as a recurrence of squamous cell carcinoma in the oral floor
Authors: Eguchi Takanori , Basugi Akihiko , Kanai Ikuyo , Miyata Yukinaga , Suzuki Takamasa , Hamada Yoshiki 
Published: October 2019

Abstract

Rationale:
Oral adenosquamous carcinoma (ASC) is rare and its origins are controversial. We here present a patient with oral ASC that developed after surgery for oral squamous cell carcinoma (SCC).

Patient concerns:
A 70-year-old man with SCC on the oral floor underwent surgical resection. However, the enlarged ulcer presented on the oral floor 9 month after surgery.

Diagnoses:
The biopsy of the ulcer revealed a SCC. Imaging examinations detected enhancement of a large lesion expanded to the tongue, but no evidence of regional lymph node or distant metastasis was shown. Based on these results, local recurrence of the cancer was diagnosed (cT4aN0M0).

Interventions:
The surgery for the recurrent tumor was performed.

Outcomes:
The pathological examination of the surgical specimen indicated recurrent tumor was ASC. Thus, histopathological and immunohistochemical analyses of both the initial SCC and the subsequent ASC were performed in an attempt to explore the origin of the ASC. As the results, pathological review of both tumors suggested the subsequent ASC was developed from the tumor cells with adenoid phenotype in the initial SCC.

Lessons:
This report suggests that the oral ASC was origin from the oral SCC, which can contribute to new knowledge for pathogenesis of oral cancer.