bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dialectical behaviour therapy skills reconsidered: applying skills training to emotionally dysregulated individuals who do not engage in suicidal and self-harming behaviours
Authors: Kells Mary , Joyce Mary , Flynn Daniel , Spillane Ailbhe , Hayes Aoife 
Published: January 2020

AbstractBackgroundDialectical behaviour therapy (DBT) is an evidence-based intervention for borderline personality disorder (BPD) but is an intensive treatment with significant health service costs. Access to DBT can sometimes be restricted due to limited resources. Positive results have been reported for the use of DBT skills training (DBT-ST), one of the four modes of standard DBT, in the treatment of individuals with BPD who self-harm. This study evaluates DBT-ST for a subgroup of individuals attending community mental health services who may have a diagnosis of BPD (or emerging BPD traits) but who are not actively self-harming.MethodsParticipants in this study were 100 adults attending community mental health services with a diagnosis of BPD, emerging BPD traits or emotion dysregulation who were not actively self-harming. The majority of participants were female (71%), aged 25–34 years (32%), single (48%) and unemployed (34%). Participants partook in a 24-week DBT-ST intervention delivered by DBT therapists. Outcome measures included the Difficulties in Emotion Regulation Scale (DERS), the DBT Ways of Coping Checklist (DBT-WCCL) and the Five Facet Mindfulness Questionnaire (FFMQ). Measures were administered at pre-intervention, at the end of each skills module, and at post-intervention.ResultsSignificant reductions in emotion dysregulation (DERS) and dysfunctional coping (DBT-WCCL) scores were reported from pre- to post-intervention (p < .001). A significant increase in mindfulness scores (FFMQ) and DBT skill use (DBT-WCCL) was also observed (p < .001). However, the drop-out rate was high (49% at post-intervention).DiscussionThe results of this uncontrolled study suggest that a standalone 24-week DBT-ST intervention may have a beneficial impact in terms of a reduction in emotion dysregulation and dysfunctional coping, and an increase in mindfulness and DBT skills use in patients with BPD/ emerging BPD traits who are not currently engaging in self-harm. Adequately powered randomised controlled trials are required to determine treatment efficacy in comparison to standard DBT for this population.
Role of whole-body MRI for treatment response assessment in multiple myeloma: comparison between clinical response and imaging response
Authors: Park Ho Young , Kim Kyung Won , Yoon Min A. , Lee Min Hee , Chae Eun Jin , Lee Jeong Hyun , Chung Hye Won , Yoon Dok Hyun 
Published: January 2020

Abstract
Background
Whole-body MRI (WB-MRI) including diffusion-weighted image (DWI) have been widely used in patients with multiple myeloma. However, evidence for the value of WB-MRI in the evaluation of treatment response remains sparse. Therefore, we evaluated the role of WB-MRI in the response assessment.

Methods
In our WB-MRI registry, we searched multiple myeloma patients treated with chemotherapy who underwent both baseline and follow-up WB-MRI scans. Clinical responses were categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD), using IMWG criteria. Using RECIST 1.1, MD Anderson (MDA) criteria, and MDA-DWI criteria, imaging responses on WB-MRI were rated as CR, PR, SD, or PD by two radiologists independently. Then, discrepancy cases were resolved by consensus. Weighted Kappa analysis was performed to evaluate agreement between the imaging and clinical responses. The diagnostic accuracy of image responses in the evaluation of clinical CR, objective response (CR and PR), and PD was calculated.

Results
Forty-two eligible patients were included. There was moderate agreement between imaging and clinical responses (κ = 0.54 for RECIST 1.1, κ = 0.58 for MDA criteria, κ = 0.69 for MDA-DWI criteria). WB-MRI showed excellent diagnostic accuracy in assessment of clinical PD (sensitivity 88.9%, specificity 94.7%, positive predictive value [PPV] 84.2%, negative predictive value [NPV] 96.4% in all three imaging criteria). By contrast, WB-MRI showed low accuracy in assessment of clinical CR (sensitivity 4.5%, specificity 98.1%, PPV 50.0%, NPV 71.2% in all three imaging criteria). As to the clinical objective response, the diagnostic accuracy was higher in MDA-DWI criteria than RECIST 1.1 and MDA criteria (sensitivity/specificity/PPV/NPV, 84.2%/94.4%/98.0%/65.4, 54.4%/100%/100%/40.9, and 61.4%/94.4%/97.2%/43.6%, respectively).

Conclusions
In the imaging response assessment of multiple myeloma, WB-MRI showed excellent performance in the evaluation of PD, but not in the assessment of CR or objective response. When adding DWI to imaging response criteria, diagnostic accuracy for objective response was improved and agreement between imaging and clinical responses was increased.
Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided microwave ablation in the treatment of small hepatocellular carcinoma
Authors: Li Zhaonan , Jiao Dechao , Han Xinwei , Si Guangyan , Li Yahua , Liu Juanfang , Xu Yanneng , Zheng Bo , Zhang Xun 
Published: January 2020

Abstract
Purpose
To evaluate the method and effectiveness of transcatheter arterial chemoembolization (TACE) combined with simultaneous DynaCT-guided Microwave ablation (MWA) for the treatment of small hepatocellular carcinoma (SHCC).

Materials and methods
From June 2015 to May 2017, a total of 28 consecutive patients with SHCC received single treatment of TACE and 23 subjects received a combination treatment of TACE with simultaneous DynaCT-guided MWA. Following 1 month of treatment, the tumor response was assessed using the mRECIST criteria and the outcomes were analyzed including intervention-associated complications, changes in liver function, imaging response, and progression-free survival (PFS).

Results
The technical success rate was 100%. The rates of CR (65%) in the combined TACE and MWA group were higher than those of the TACE group (46%). The rate of common adverse events, such as liver abscess, spontaneous bacterial peritonitis and liver dysfunction, in the combined TACE and MWA group (56%) was comparable to the corresponding rate of the TACE group (P > 0.411). The median and mean PFS of the TACE group were significantly lower than those of the combined TACE and MWA group (19.00 months vs. 29.00 months, 21.076 months vs. 24.693 months, p = 0.019, log-rank test).

Conclusion
Stereotactic DynaCT-guided MWA is a safe and effective method for the treatment of SHCC, which usually provides an effective tumor puncture path, notably for lesions that cannot be detected following TACE. Overall, the data suggested that this treatment method could improve the clinical outcome of patients with SHCC.
Numerous lymph node metastases in early gastric cancer without preoperatively enlarged lymph nodes: a case report
Authors: Tsutsumi Chikanori , Moriyama Taiki , Ohuchida Kenoki , Shindo Koji , Nagai Shuntaro , Yoneda Reiko , Fujiwara Minako , Oda Yoshinao , Nakamura Masafumi 
Published: January 2020

Abstract
Background
According to the 2018 Japanese gastric cancer treatment guidelines (ver. 5), a reduced extent of lymphadenectomy (D1 or D1+) is indicated for cT1 N0 tumors that do not meet the criteria for endoscopic resection. However, early gastric cancer with multiple lymph node metastases is not unknown, and cases have been reported. We report a case of a patient with early gastric cancer and numerous nodal metastases who underwent laparoscopic proximal gastrectomy based on a preoperative diagnosis of T1 N0.

Case presentation
A 69-year-old woman underwent emergent endoscopic hemostasis for massive hematemesis of the stomach, and endoscopic examination showed ulceration with a visible vessel. Pathological biopsy examination of the ulcer identified poorly differentiated adenocarcinoma with signet ring cells. The patient was diagnosed with early gastric cancer that was not indicated for endoscopic resection because of the ulceration and histological type. Endoscopic ultrasound showed that the third layer was poorly demarcated at the ulcer scar, indicating invasion to the submucosal layer. Computed tomography did not reveal enlarged lymph nodes or distant metastasis. The preoperative diagnosis was early gastric cancer of the fundus without nodal metastasis, and laparoscopic proximal gastrectomy with D1+ lymphadenectomy was performed. The initial postoperative pathological diagnosis was intramucosal carcinoma without lymphovascular invasion; however, the presence of 26 lymph node metastases was revealed unexpectedly. Additional pathological examination of more resected specimens transected every 2–3 mm revealed that only one lesion contained a small number of cancer cells in the lymphatic duct below the muscularis mucosa.

Conclusions
We report a case of early gastric cancer with 26 nodal metastases in which lymph node involvement was not identified prior to surgery. These findings indicate that the extent of lymphadenectomy and the surgical procedure should be carefully decided even in cT1 N0 early gastric cancer when several risk factors for lymph node metastasis are present.
Delayed bleeding due to a sharp protruding edge of the endostaplers after a wedge resection of the lung: a case report
Authors: Yamano Kazuki , Fujikawa Ryo , Nakamura Toru 
Published: January 2020

Abstract
Background
Endoscopic devices often cause device-related surgical morbidities such as postoperative bleeding. Delayed bleeding due to a protruding edge of an endostapler has not been previously described in the literature.

Case presentation
An 80-yr-old man with a second primary lung cancer underwent a wedge resection of the right lower lobe. He developed sudden hypotension and massive bleeding from the chest tube 4 h after the surgery and underwent an emergency reoperation. A torn parietal pleura was found to have caused a persistent bleeding. There was a sharp protruding edge created by multiple firings of the endostapler. The subsequent lung expansion would have promoted a direct contact between the edge and parietal pleura resulting in delayed bleeding.

Conclusions
A protruding edge due to multiple firings of an endostapler could injure the parietal pleura and cause delayed bleeding after a lung resection. This type of injury would be more common in wedge resection cases because of the larger residual lung volume preserved, which is expected to have a better lung expansion and facilitate the direct contact of the staple line and parietal pleura.
Impact of insulin resistance and metabolic syndrome on disability in patients with multiple sclerosis
Authors: Soliman Rasha Hassan , Farhan Hanan Mohamed , Hegazy Mohamed , Oraby Mohammed Ibrahim , Kamel Shaimaa Hossam , Hassan Amr 
Published: January 2020

AbstractBackgroundCurrently, little is known regarding the association of metabolic comorbidities and disability among multiple sclerosis (MS) patients.ObjectivesTo evaluate insulin resistance (IR) and metabolic syndrome (MetS) in multiple sclerosis patients and their effect on disease progression and disability.Subjects and methodsThis case-control study was conducted on 50 MS patients and 25 healthy individuals. They were subjected to clinical evaluation and laboratory assessment for metabolic syndrome and insulin resistance. The homeostasis model assessment (HOMA) was used as a measurement of insulin sensitivity. Disability was evaluated by the Extended Disability Status Scale (EDSS).ResultsAs compared to control group, MS patients had a significantly higher prevalence of metabolic syndrome (22% vs 8%,p = 0.04) and insulin resistance (46% vs 0%,p < 0.001). Patients group had significantly higher systolic blood pressure (p = 0.005), waist circumference (p < 0.001), fasting blood sugar (p < 0.001), insulin level (p = 0.001), low-density lipoproteins (p = 0.01), triglycerides (p = 0.02), HOMA-IR (p < 0.001), and significantly lower high-density lipoproteins (p = 0.01). No differences in neurological disability was reported between patients who have MetS (p = 0.7) or IR (p = 0.3) and those who do not.ConclusionInsulin resistance and metabolic syndrome are more prevalent among MS patients; however, their association with disability and disease progression is questionable.
Assessment of effectiveness of anakinra and canakinumab in patients with colchicine-resistant/unresponsive familial Mediterranean fever
Authors: Şahin Ali , Derin Mehmet Emin , Albayrak Fatih , Karakaş Burak , Karagöz Yalçın 
Published: January 2020

Abstract
İntroduction
Familial Mediterranean fever (FMF) is a hereditary auto-inflammatory disease characterized by recurrent fever and serosal inflammation. Anti-interleukin-1 (Anti-IL-1) treatments are recommended in colchicine resistant and/or intolerant FMF patients. This study aims to evaluate the efficacy of anakinra and canakinumab in FMF patients that are resistant/intolareted to colchicine or complicated with amyloidosis.

Methods
Between January 2014 and March 2019, 65 patients following-up at Sivas Cumhuriyet University (Medical Faculty Rheumatology-Internal Medicine Department) who were diagnosed with FMF according to the criteria of Tel-Hashomer were included in the study. The laboratory values and clinical features of patients and disease activities were recorded at least every 3 months, and these data were analyzed.

Results
Forty-one (63.1%) patients used anakinra (100 mg/day) and 24 (36.9%) patients used canakinumab (150 mg/8 week). The median duration of anti-IL-1 agents use was 7 months (range, 3–30). Fifteen (23.1%) cases were complicated with amyloidosis. Seven (10.8%) patients had renal transplantation. Overall, the FMF 50 score response was 96.9%. In the group that had a glomerular filtration rate (GFR) ≥ 60 ml/min/m2, the median proteinuria decreased from 2390 mg/day (range, 1400–7200) to 890 mg/day (range, 120–2750) (p = 0.008). No serious infections were detected, except in one patient.

Conclusions
Anti-IL-1 agents are effective and safe in the treatment of FMF patients. These agents are particularly effective at reducing proteinuria in patients with GFR ≥ 60 ml/min/m2, but less effective in cases with FMF associated with arthritis and sacroiliitis. Large and long follow-up studies are now needed to establish the long-term effects of these treatments.
Effects of Stachys sylvatica hydroalcoholic extract on the ovary and hypophysis-gonadal axis in a rat with polycystic ovary syndrome
Authors: Alizadeh F. , Ramezani M. , Piravar Z. 
Published: January 2020

Abstract
Background
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women. The purpose of this study is to evaluate the effects of Stachys sylvatica hydroalcoholic extract on biochemical and histological parameters in a rat model of polycystic ovary syndrome. Thirty adult female Wistar rats with an average weight of 180 g were divided into five groups of six rats. Animals were divided into groups of control, PCOS (intramuscular injection of 2 mg estradiol valerate, Aburaihan Co., Iran/rat, once), and treated with hydroalcoholic extract of Stachys sylvatica. After 60 days of PCOS induction, 100, 250, and 500 mg/kg BW Stachys sylvatica hydroalcoholic extract were injected intraperitoneally. The control group was just injected with olive oil as a solvent. After 10 days of treatment, animals were weighed and then sacrificed and blood samples were taken from their heart for hormonal studies. Ovaries of all groups were cut for histological studies and fixed in formaldehyde, and 7-μm sections were prepared by microtome and stained using hematoxylin–eosin. The data were analyzed by one-way ANOVA and Tukey-Kramer post hoc test with the SPSS software. The significant level was p < 0.05.

Results
The Stachys sylvatica extract can improve obesity in the PCOS group. The histological and hormonal results showed that PCOS induction can decrease the number of preantral, antral, and Graafian follicles as well as corpus luteum in comparison with the control (p < 0.001), whereas the number of cystic follicles increased significantly (p < 0.001). After treatment with Stachys sylvatica hydroalcoholic extract (500 mg/kg), a significant increase was observed in all these parameters. In addition, the number of cystic follicles decreased significantly (p < 0.001). The level of LH and FSH hormones decreased significantly (p < 0.01) in the PCOS group compared with the control. In contrast, the estrogen level increased significantly (p < 0.01). In the 250 and 500 mg/kg group, treatment with the extract could increase FSH and decrease estrogen concentration significantly relative to the PCOS group (p < 0.01). Results of antral follicle morphometry indicated an increase in follicle diameter and theca thickness, but the thickness of the granulosa layer decreased significantly. An improvement in these measurements was observed in the treated PCOS groups with all doses.

Conclusions
It can be concluded that Stachys sylvatica hydroalcoholic extract can improve some symptoms of polycystic ovary syndrome because of components such as iridoids, flavonoids, and sesquiterpenes with antioxidant and anti-inflammatory effects. In this experiment, 500 mg/kg dose of extract was considered as the most effective dose.
Kinome Profiling Reveals Abnormal Activity of Kinases in Skeletal Muscle From Adults With Obesity and Insulin Resistance
Authors: Qi Yue , Zhang Xiangmin , Seyoum Berhane , Msallaty Zaher , Mallisho Abdullah , Caruso Michael , Damacharla Divyasri , Ma Danjun , Al-janabi Wissam , Tagett Rebecca , Alharbi Majed , Calme Griffin , Mestareehi Aktham , Draghici Sorin , Abou-Samra Abdul , Kowluru Anjaneyulu , Yi Zhengping 
Published: January 2020

Abstract

Context
Obesity-related insulin resistance (OIR) is one of the main contributors to type 2 diabetes and other metabolic diseases. Protein kinases are implicated in insulin signaling and glucose metabolism. Molecular mechanisms underlying OIR involving global kinase activities remain incompletely understood.

Objective
To investigate abnormal kinase activity associated with OIR in human skeletal muscle.

Design
Utilization of stable isotopic labeling-based quantitative proteomics combined with affinity-based active enzyme probes to profile in vivo kinase activity in skeletal muscle from lean control (Lean) and OIR participants.

Participants
A total of 16 nondiabetic adults, 8 Lean and 8 with OIR, underwent hyperinsulinemic-euglycemic clamp with muscle biopsy.

Results
We identified the first active kinome, comprising 54 active protein kinases, in human skeletal muscle. The activities of 23 kinases were different in OIR muscle compared with Lean muscle (11 hyper- and 12 hypo-active), while their protein abundance was the same between the 2 groups. The activities of multiple kinases involved in adenosine monophosphate–activated protein kinase (AMPK) and p38 signaling were lower in OIR compared with Lean. On the contrary, multiple kinases in the c-Jun N-terminal kinase (JNK) signaling pathway exhibited higher activity in OIR vs Lean. The kinase-substrate–prediction based on experimental data further confirmed a potential downregulation of insulin signaling (eg, inhibited phosphorylation of insulin receptor substrate-1 and AKT1/2).

Conclusions
These findings provide a global view of the kinome activity in OIR and Lean muscle, pinpoint novel specific impairment in kinase activities in signaling pathways important for skeletal muscle insulin resistance, and may provide potential drug targets (ie, abnormal kinase activities) to prevent and/or reverse skeletal muscle insulin resistance in humans.
Management of Orthostatic Hypotension
Authors: Palma Jose-Alberto , Kaufmann Horacio 
Published: January 2020

ABSTRACT

PURPOSE OF REVIEW
This article reviews the management of orthostatic hypotension with emphasis on neurogenic orthostatic hypotension.

RECENT FINDINGS
Establishing whether the cause of orthostatic hypotension is a pathologic lesion in sympathetic neurons (ie, neurogenic orthostatic hypotension) or secondary to other medical causes (ie, non-neurogenic orthostatic hypotension) can be achieved by measuring blood pressure and heart rate at the bedside. Whereas fludrocortisone has been extensively used as first-line treatment in the past, it is associated with adverse events including renal and cardiac failure and increased risk of all-cause hospitalization. Distinguishing whether neurogenic orthostatic hypotension is caused by central or peripheral dysfunction has therapeutic implications. Patients with peripheral sympathetic denervation respond better to norepinephrine agonists/precursors such as droxidopa, whereas patients with central autonomic dysfunction respond better to norepinephrine reuptake inhibitors.

SUMMARY
Management of orthostatic hypotension is aimed at improving quality of life and reducing symptoms rather than at normalizing blood pressure. Nonpharmacologic measures are the key to success. Pharmacologic options include volume expansion with fludrocortisone and sympathetic enhancement with midodrine, droxidopa, and norepinephrine reuptake inhibitors. Neurogenic supine hypertension complicates management of orthostatic hypotension and is primarily ameliorated by avoiding the supine position and sleeping with the head of the bed elevated.
Physiology and Pathophysiology of the Autonomic Nervous System
Authors: Benarroch Eduardo E. 
Published: January 2020

ABSTRACT

PURPOSE OF THE REVIEW
This article reviews the anatomic, functional, and neurochemical organization of the sympathetic and parasympathetic outputs; the effects on target organs; the central mechanisms controlling autonomic function; and the pathophysiologic basis for core symptoms of autonomic failure.

RECENT FINDINGS
Functional neuroimaging studies have elucidated the areas involved in central control of autonomic function in humans. Optogenetic and other novel approaches in animal experiments have provided new insights into the role of these areas in autonomic control across behavioral states, including stress and the sleep-wake cycle.

SUMMARY
Control of the function of the sympathetic, parasympathetic, and enteric nervous system functions depends on complex interactions at all levels of the neuraxis. Peripheral sympathetic outputs are critical for maintenance of blood pressure, thermoregulation, and response to stress. Parasympathetic reflexes control lacrimation, salivation, pupil response to light, beat-to-beat control of the heart rate, gastrointestinal motility, micturition, and erectile function. The insular cortex, anterior and midcingulate cortex, and amygdala generate autonomic responses to behaviorally relevant stimuli. Several nuclei of the hypothalamus generate coordinated patterns of autonomic responses to internal or social stressors. Several brainstem nuclei participate in integrated control of autonomic function in relationship to respiration and the sleep-wake cycle. Disorders affecting the central or peripheral autonomic pathways, or both, manifest with autonomic failure (including orthostatic hypotension, anhidrosis, gastrointestinal dysmotility, and neurogenic bladder or erectile dysfunction) or autonomic hyperactivity, primary hypertension, tachycardia, and hyperhidrosis.