bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of insulin resistance and leptin receptor gene polymorphism in type 2 diabetes mellitus
Authors: Adiga Usha , Banawalikar Nandit , Mayur Sriprajna , Bansal Radhika , Ameera Nafeesath , Rao Sudhindra 
Published: March 2021

Background:
Type 2 diabetes mellitus (T2DM) is a chronic disease that is characterized by impaired glucose metabolism and insulin resistance. The objectives of the study were to evaluate the pattern of leptin receptor gene polymorphism Gln223Arg in T2DM and to identify its association with the serum leptin and insulin levels as well as with insulin resistance in diabetes.

Methods:
In this cross-sectional study, genotyping of leptin receptor was done for Gln223Arg alleles by PCR-restriction fragment length polymorphism in 39 patients with type 2 diabetes. Serum leptin and insulin levels were assayed using enzyme linked sorbent assay in 39 cases and 45 nondiabetic controls. Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) formula. Statistical analysis was performed with Graph pad Instat version 3.

Results:
Hardy–Weinberg Equilibrium for the leptin receptor (LEPR) gene variants showed that alleles were in equilibrium. Leptin levels were insignificantly low in patients with diabetes compared to those in controls. Women in the control group showed significantly higher leptin levels (p < 0.05) compared with men. There was a significant difference in the serum insulin levels and insulin resistance (HOMA-IR) among patients with different genotypes (p = 0.04 and p = 0.0378, respectively).

Conclusion:
Leptin receptor gene polymorphism affected glucose metabolism by altering insulin resistance and pancreatic beta cells. Thus, single-nucleotide polymorphism of LEPR may affect the pathogenesis of T2DM.
Teleprecepting: A timely approach to clinical education during COVID-19
Authors: Johnson Deborah , Gatewood Elizabeth , Ling Amanda , Kuo Angel Chen 
Published: March 2021

ABSTRACT
Clinical training is a key component of nurse practitioner (NP) education. The rapid shift to telehealth necessitated by the pandemic has also created a need for socially distanced education and precepting. This article presents teleprecepting as a modality for clinical opportunities and connecting students to previously limited experiences, such as training in small specialties, in rural areas, and with interdisciplinary teams. Precepting NP students using telehealth follows similar principles as in-person teaching, but some modifications and additional considerations are needed to transition to the virtual environment. At a time when many NPs have swiftly adapted to telehealth in practice, this article will offer a brief “how-to” for teleprecepting. Prior to COVID-19, teleprecepting was piloted with less than 2% of NP students in the school's pilot teleprecepting project. Seven months after the initial surge of cases and restrictions, 72% of students (n = 151) in the family nurse practitioner, psychiatric mental health nurse practitioner, and pediatric nurse practitioner specialties had transitioned to teleprecepting. This project was implemented rapidly during the pandemic, and thus, evaluations comparing competency outcomes and experiences of students and preceptors are still in process. Additionally, feasibility of this educational model may change as telehealth regulations continue to evolve. COVID-19 poses challenges for both patient care and clinical training of NP students across specialties. With some adaptation, clinical placements can be transitioned to the virtual environment of telehealth. Future studies should examine student competencies based on teleprecepting experiences and preceptor training to support teleprecepting roles.
Progressive Familial Intrahepatic Cholestasis Associated With USP53 Gene Mutation in a Brazilian Child
Authors: Porta Gilda , Rigo Paula S.M. , Porta Adriana , Pugliese Renata P.S. , Danesi Vera L.B. , Oliveira Eliene , Borges Cristian C.V. , Ribeiro Cristiane , Miura Irene K. 
Published: March 2021

ABSTRACTA case of low-γ-glutamyltranspetidase cholestasis associated with ubiquitin-specific peptidase 53 (USP53) gene mutation in a Brazilian child is described. Transient jaundice and hypocholia started at the age of 10 days. Liver enzymes, total bilirubin, and total bile acids were elevated at presentation. During follow-up, he developed cholelithiasis treated with cholecystectomy, and an intracranial hemorrhage resolved with full recovery. At last, evaluation at the age of 18 months, he was not jaundiced and had normal liver tests, but experienced from moderate pruritus despite treatment with rifampicin and ursodeoxycholic acid. A genetic study revealed novel homozygous mutations c.1687_1688delinsC p.Ser563Profs∗25 in theUSP53gene. His parents carried the same heterozygous mutation in theUSP53gene.
Women's Knowledge of Postpartum Anxiety Disorders, Depression, and Cognitive Behavioral Therapy
Authors: Ponzini Gabriella T. , Snider Mira D.H. , Evey Kelsey J. , Steinman Shari A. 
Published: March 2021

Abstract
Although awareness of postpartum depression (PPD) has increased, postpartum anxiety disorders (PPA) remain overlooked. Understanding women's knowledge of PPA and their effective treatments is needed given the underutilization of treatment and associated negative health outcomes. Two internet-based studies (OSF [https://osf.io/3fjvr] preregistered follow-up) were conducted to identify women's knowledge and familiarity with PPD and PPA and knowledge of cognitive behavioral therapy (CBT). Study 1 revealed that women who were planning to become pregnant, pregnant, or recently postpartum (N = 218) were less familiar with PPA than PPD and had limited familiarity with CBT. Women also reported low screening rates for PPA and low perceived treatment seeking for women with PPA and PPD. Study 2 (N = 290) revealed that recently postpartum women recognized fewer symptoms and recommended treatment less often for PPA than PPD and had limited CBT knowledge. Overall, results indicate limited knowledge of PPA compared with PPD, indicating a need for targeted information to perinatal women.
Quantitative Analysis of Mobile Proteins in Normal Brain Tissue by Amide Proton Transfer Imaging: Age Dependence and Sex Differences
Authors: Sugawara Kazuaki , Miyati Tosiaki , Ueda Ryo , Yoshimaru Daisuke , Nakamura Masanobu , Komatsu Shuhei , Hagiwara Kazuchika , Saigusa Kuniyasu 
Published: March 2021

Purpose
The aims of this study were to evaluate the relationship between age change and amide proton transfer (APT) signal in each region of the whole brain and to derive the standard value of APT signal in each brain region of normal adults.

Materials and Methods
Using the mDIXON 3-dimensional–APT sequence of the fast spin echo method, an APT image was obtained. In total, 60 patients (mean age, 49.8 ± 16.9 years) with no abnormal findings on magnetic resonance imaging data were included. For image analysis, registration parameters were created using the FMRIB Software Library 5.0.11, and then a region of interest was set in the Montreal Neurological Institute structural atlas for analysis. Statistical analyses were performed using the age-dependent and sex differences in APT signals from each brain region.

Results
No significant correlation was seen between APT signal and age and sex in all brain regions.

Conclusion
Under the APT imaging parameter conditions used in this study, local brain APT signals in healthy adults are independent of age and sex.
Benign Adrenal Nodule Mimicking Lymphoma Differentially Diagnosed by 18F-FDG and 18F-FGln PET/CT
Authors: Xu Xiaoxia , Zhu Hua , Kung Hank F. , Li Nan , Yang Zhi 
Published: March 2021

Abstract

18F-FDG and 18F-(2S,4R)4-fluoroglutamine (18F-FGln) PET/CT were performed in a 58-year-old woman with suspected small intestinal malignancy for differential diagnosis and staging. 18F-FDG and 18F-FGln PET images showed consistent intense hypermetabolic lesion activity in part of the small intestine. Moreover, 18F-FDG/PET demonstrated a focal of increased radiotracer uptake in left adrenal lesion, which did not show abnormal activity on 18F-FGln/PET. The postoperative pathology confirmed that it was a peripheral T-cell lymphomas of the intestine, and the adrenal lesion was considered benign after continuous CT follow-up for more than 2 years.
FAPI Uptake in a Vertebral Body Fracture in a Patient With Lung Cancer
Authors: Wu Junhao , Liu Huipan , Ou Lei , Jiang Guohao , Zhang Chunyin 
Published: March 2021

Abstract
A left pulmonary nodule was identified by CT scan in a 53-year-old woman who had a car accident 10 days earlier. 18F-FDG PET/CT showed multiple FDG-avid lesions located at the left lung nodule, mediastinal lymph nodules, and L4 vertebral body. 68Ga-FAPI PET/CT was performed for further evaluation. However, 68Ga-FAPI demonstrated intense FAPI uptake in the accident-related fracture of the L4 vertebral body. This case documents that the fracture of the vertebral body may cause FAPI uptake, and nuclear clinicians evaluating 68Ga-FAPI imaging should be aware of this potential pitfall.
68Ga-DOTATOC PET/CT in Pleural Solitary Fibrous Tumors
Authors: Lococo Filippo , Rufini Vittoria , Filice Angelina , Paci Massimiliano , Rindi Guido 
Published: March 2021

Abstract
Solitary fibrous tumor of the pleura (SFTP) is a rare mesenchymal neoplasm. Preoperative diagnosis is usually difficult and based on radiological findings only. We report the imaging results observed in 5 patients with SFTP (2 malignant) obtained by 68Ga-DOTATOC PET/CT. At qualitative analysis, all tumors showed uptake of 68Ga-DOTATOC. Mean tumor SUVmax was 9.9 ± 5.7. The expression of SST2 (somatostatin receptors subtype 2) was confirmed by immunohistochemistry in 2 tumor samples, and by gene amplification of SST2 mRNA in all cases. These data suggest a diagnostic role of radioreceptor PET/CT in SFTP, and open novel potential treatment options in unresectable/metastatic disease.
When Benign Behaves Badly
Authors: Caserta Melanie P. , Fetzer David T. , Swensson Jordan K. , Rodgers Shuchi K. , Boyum James H. 
Published: March 2021

Abstract
Hemangioma is the most common benign liver tumor and is frequently encountered as an incidental finding on imaging. The classic enhancement pattern of hemangioma is diagnostic on contrast-enhanced ultrasound (CEUS), and it follows the same pattern of enhancement on computed tomography and magnetic resonance imaging. However, there is a subset of hemangiomas that demonstrate atypical enhancement patterns on CEUS. The ability to recognize the different enhancement patterns and discern when additional imaging or biopsy may be necessary is essential to accurately interpret an atypical hemangioma on CEUS. This article reviews various enhancement patterns of hemangioma on CEUS to avoid pitfalls in characterization of focal liver lesions on CEUS.
The Impact of Lung Ultrasound on Coronavirus Disease 2019 Pneumonia Suspected Patients Admitted to Emergency Departments
Authors: Öztürk Sönmez Leyla , Katipoğlu Burak , Vatansev Hülya , Kaykisiz Eylem Kuday , Yüce Nalan , Szarpak Lukasz , Evrin Togay 
Published: March 2021

Objective
The aim of this study was to identify the sensitivity and specificity of lung ultrasound (LUS) and show its place in diagnosing patients with known coronavirus disease 2019 (COVID-19) pneumonia, according to chest computed tomography and the COVID-19 reporting and data system (CO-RADS).

Methods
Nineteen patients who admitted to a single university hospital emergency department between March 5, 2020, and April 27, 2020, describing dyspnea were included in the study and underwent LUS by a single emergency specialist. The patient population was divided into 2 groups, COVID-19 positive and negative, and the sensitivity and specificity of LUS according to chest computed tomography were calculated for COVID-19 pneumonia diagnosis. In the subgroup analysis, the patient group was divided into real-time reverse transcription–polymerase chain reaction positive (n = 7) and negative (n = 12), and sensitivity and specificity were calculated according to the CO-RADS.

Results
According to the CO-RADS, significant differences were detected between the LUS positive and negative groups in terms of COVID-19 pneumonia presence. Only 1 patient was evaluated as CO-RADS 2 in the LUS positive group, and 2 patients were evaluated as CO-RADS 4 in the LUS negative group (P = 0.04). The sensitivity of LUS according to the CO-RADS for COVID-19 pneumonia diagnosis was measured to be 77.78% (95% confidence interval [CI], 39.9%–97.1%), specificity was 90% (95% CI, 55.5%–99.75%), positive predictive value was 87.5% (95% CI, 51.35%–97.8%), and accuracy was 84.21% (95% CI, 60.4%–96.62%; P = 0.004).

Conclusions
In conclusion, LUS is easily used in the diagnosis of COVID-19 pneumonia because it has bedside application and is fast, easy to apply, reproducible, radiation free, safe for pregnant women, and cheap.
Practice Patterns Among Hand Surgeons According to Primary Residency Training
Authors: Carter Jordan T. , Tarabishy Sami , Polmear Micheal , Gonzalez Gilberto , Herrera Fernando A. 
Published: March 2021

Introduction
Hand surgery fellowships accept applicants from 3 different residencies: general surgery, orthopedic surgery, and plastic surgery. Although all of these specialties culminate into a board-certified hand surgeon, each specialty receives drastically different training in residency, which can have effects on which procedures these surgeons feel comfortable performing in their own practices. This study aims to compare practice patterns and complication rates among hand surgeons by residency training.

Methods
The National Surgical Quality Improvement Program database was queried between the years of 2014 and 2018 for all Current Procedural Terminology codes pertaining to upper-extremity surgical procedures performed below the elbow. Procedures not performed by a general, orthopedic, or plastic surgeon were excluded, as well as polytraumas. Procedures were then stratified by anatomic region, tissue type, and primary specialty of the attending surgeon. Data collected included the number of each procedure, patient complexity, and complications. Statistical analysis consisted of a t test for continuous variables, χ
2 analysis for categorical variables, and linear regression analysis to compare complications rates between specialties.

Results
A total of 76,980 unique cases were included in our analysis: 4979 (6.4%) at the elbow, 43,680 (56.7%) at the forearm/wrist, 23,284 (30.2%) at the hand, 1421 (1.8%) flaps/grafts, 285 (0.4%) vascular, and 3331 (4.3%) neurological. Orthopedics performed most (79.5%) of the procedures, whereas plastic surgeons and general surgeons performed 17.3% and 3.1%, respectively. There were also significant differences by anatomic location/type of procedure, with orthopedic surgeons performing 99.2% of procedures at the elbow but only 67.7% of procedures at the hand. Linear regression analysis showed general surgeons had the lowest complication rates.

Conclusions
Our data show significant differences in the number of upper-extremity surgeries performed by surgeons from each specialty at different anatomic locations.
This could be due to differences in training during residency or proportionately more orthopedic surgeons being “full-time” hand surgeons. These data could affect hiring patterns in hospitals seeking hand surgeons depending on the variety of pathology encountered at that particular institution.
Successful Treatment of Life-Threatening COVID-19 Infection in a Face Transplant Recipient
Authors: Coombs Demetrius M. , Kwiecien Grzegorz J. , Koval Christine , Eghtesad Bijan , Papay Francis A. , Siemionow Maria , Gastman Brian R. 
Published: March 2021

Abstract
Recent literature suggests that severe COVID-19 is associated with an exaggerated immune response during viral infection, resulting in cytokine storm. Although elevated plasma interleukin 6 (IL-6) has been reported in severe COVID-19 infections, and treatment with anti–IL-6 (tocilizumab) has demonstrated promising outcomes both domestically and abroad, reports remain limited and therapeutic regimens vary considerably. Furthermore, research pertaining to transplant recipients, COVID-19 infection, and anti–IL-6 therapy remains underdeveloped. Herein, we report the successful treatment of the only reported facial vascularized composite allograft (VCA) recipient who contracted severe COVID-19 and the first reported VCA recipient with COVID-19 infection that received anti–IL-6 immunotherapy resulting in an excellent recovery despite his multiple preexisting and COVID-19–related comorbidities—adult respiratory distress syndrome, acute renal failure requiring hemodialysis, and concomitant sepsis due to extensive drug-resistant bacterial pneumonia upon presentation. To date, he has not demonstrated any anti-IL-6 drug-related adverse effects. This preliminary report also suggests that our immunosuppressed VCA patients can indeed demonstrate a robust cytokine response during COVID-19 infection and may also respond favorably to emerging anticytokine immune therapies. We hope that our experience proves helpful to other centers that might encounter critically ill VCA recipients in the ongoing COVID-19 pandemic and in the years to follow.
Central nervous system tuberculosis
Authors: Dian Sofiati , Ganiem Ahmad Rizal , van Laarhoven Arjan 
Published: March 2021

Purpose of review
Central nervous system (CNS) tuberculosis is the most devastating form of tuberculosis (TB), with mortality and or neurological sequelae in over half of individuals. We reviewed original research and systematic reviews published since 1 January 2019 for new developments in CNS TB pathophysiology, diagnosis, management and prognosis.

Recent findings
Insight in the pathophysiology is increasing steadily since the landmark studies in 1933, focussing on granuloma type classification, the relevance of the M. tuberculosis bacterial burden and the wide range of immunological responses. Although Xpert/RIF has been recommended by the WHO for extrapulmonary TB diagnosis, culture is still needed to increase the sensitivity of TB meningitis diagnosis. Sequential MRIs can improve understanding of neurological deficits at baseline and during treatment. Pharmacokinetic/pharmacodynamic modelling suggests that higher doses of rifampicin and isoniazid in TB meningitis could improve survival.

Summary
Recent studies in the field of CNS-TB have largely focussed on TB meningitis. The outcome may improve by optimizing treatment dosing. This needs to be confirmed in clinical trials. Due to the important role of inflammation, these trials should be used as the platform to study the inflammatory and metabolomic responses. This could improve understanding of the biology of this disease and improve patient outlook by enabling individualised host-directed therapy.
Activation Syndrome in a Patient With Attention-Deficit/Hyperactivity Disorder Treated With Atomoxetine: A Case Report
Authors: Karakaya Sümeyra Elif Kaplan , Yektaş Çiğdem , Tufan Ali Evren 
Published: March 2021

Abstract
“Activation syndrome” represents a cluster of symptoms of excessive emotional arousal or behavioral activation, which emerges after the first few weeks of antidepressant treatment or a dose increase and resolves with dose reduction or cessation of treatment. It was reported after treatment with selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor group of agents, but no case of activation syndrome has been reported with the norepinephrine reuptake inhibitor group. Atomoxetine is a norepinephrine reuptake inhibitor and nonstimulant and is used to manage symptoms of attention-deficit/hyperactivity disorder (ADHD). Atomoxetine-related symptoms of mania and hypomania were reported in literature previously. Here, we report a case of activation syndrome arising after atomoxetine (ATX) dose titration in a prepubertal male child with ADHD. Differentiation of activation symptoms from mania/hypomania symptoms after treatment with ATX may be important for the clinicians to manage the adverse effects and understand the risk factors behind activation syndrome with use of ATX in children and adolescents diagnosed with ADHD.
Electroconvulsive Therapy for Bipolar Depression in Older Adults
Authors: Morcos Nicholas , Maixner Susan , Maixner Daniel F. 
Published: March 2021

Objectives
Electroconvulsive therapy (ECT) is a well-established treatment for mood disorders in younger adults and has been consistently shown to be safe and effective in unipolar depression in older adults. However, data on this treatment in older adults with bipolar disorder are limited. In this retrospective study, we report outcomes from all cases of older adults with bipolar depression who received ECT from a large academic institution over a 7-year period.

Methods
We retrospectively identified all patients 65 years and older with bipolar depression who were treated with ECT over a 7-year period. Patients receiving ECT for an episode of bipolar depression were included in the study based on chart review and availability of documented outcome measures. Primary outcomes were changes in Montreal Cognitive Assessment and Clinical Global Impressions scores.

Results
We identified 34 patients meeting inclusion criteria. Collectively, patients had statistically significant improvement in Montreal Cognitive Assessment scores and reductions in Clinical Global Impressions severity scores after treatment. Pre- and posttreatment Montgomery-Asberg Depression Rating Scale scores were also available for a subset of 20 patients and demonstrated a similarly significant reduction in severity with treatment. There were no serious adverse effects of treatment, and no patients discontinued treatment.

Conclusions
Electroconvulsive therapy was well tolerated and effective in treating bipolar depression in older adults. Importantly, these findings challenge commonly held worries about cognitive decline in older adults receiving ECT. It should be a regular consideration for management of this challenging illness in a population that may otherwise not respond to pharmacotherapy.
Adjuvant High-Definition Transcranial Direct Current Stimulation for Negative Symptoms in Schizophrenia
Authors: Dharani Ramamoorthy , Goyal Nishant , Mukherjee Aniruddha , Umesh Shreekantiah 
Published: March 2021

Objective
In schizophrenia, negative symptoms account for a substantial amount of the comorbidity resulting in poor performance in social interaction, interpersonal relationships, economic functioning, and recreational activities. Research has implicated hypofrontality in the pathogenesis of negative symptoms of schizophrenia. Conventional transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex has attracted significant interest as an add-on treatment for negative symptoms in schizophrenia. High-definition tDCS (HD-tDCS), an optimized form of tDCS, has the potential for more focalized neuromodulation. Hence, we aimed to evaluate the efficacy of HD-tDCS over the left dorsolateral prefrontal cortex in the improvement of negative symptoms in schizophrenia.

Methods
Fourteen patients with schizophrenia with predominantly negative symptoms were enrolled for this pilot, randomized, sham-controlled, double-blind trial. Each participant received 10 sessions of HD-tDCS at 2 mA for 20 minutes twice daily over 5 days. Negative symptoms were assessed with the Scale for Assessment of Negative Symptoms and Positive and Negative Syndrome Scale for Schizophrenia. The Calgary Depression Scale for Schizophrenia was used to rule out depressive symptoms. Assessments were carried out at baseline and at 2 weeks.

Results
The improvement in negative symptoms in the active group was statistically significant at P value of 0.05 as compared with the sham group.

Conclusion
These results suggest that HD-tDCS may lead to improvement in negative symptoms of schizophrenia. Its use as an adjunct to pharmacological treatment of negative symptoms may be worth considering.