bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Utility of the Transthoracic Echocardiogram for Isolated Lacunar Infarcts
Authors: Nie Jeffrey Z. , Weber Matthew W. , Ume Kiddy , Bernard Joseph , Menezes Stephanie A. , Thakkar Vismay , Siddiqui Fazeel M. 
Published: December 2021

Background:
Stroke is a prominent and financially burdensome disease. Lacunar strokes are traditionally attributed to small vessel disease rather than cardioemboli, which typically occlude larger arteries. Thus, the benefit of screening for potential sources of cardioemboli in lacunar stroke patients is unclear. We evaluated the clinical utility of the transthoracic echocardiogram performed in patients with lacunar strokes.

Methods:
A single-center retrospective analysis of ischemic stroke patients from January 2013 through December 2017 was performed. Brain magnetic resonance imaging was used to select patients with a single lacunar infarct. Patients presenting with acute symptoms of cardiac disease or an abnormal electrocardiogram were excluded. Transthoracic echocardiogram results were reviewed, and their utility in decision-making was evaluated.

Results:
Of the 442 patients at our institution diagnosed with ischemic stroke during the inclusion period, 89 met inclusion criteria. Transthoracic echocardiogram detected a patent foramen ovale in 5.6% of patients, mitral annular calcification in 9.0% of patients, and abnormal wall motion in 4.5% of patients. For all patients, there were no findings that prompted anticoagulation, antibiotic, or surgical intervention. The cost of an inpatient transthoracic echocardiogram is $4100, resulting in $364,900 in unnecessary health care spending.

Conclusions:
Transthoracic echocardiogram appears to have minimal therapeutic value in most patients with lacunar strokes. In stroke patients with no acute symptoms of cardiac disease and a normal electrocardiogram, it may be reasonable to forgo the transthoracic echocardiogram if the brain magnetic resonance imaging shows an isolated lacunar infarct.
Acute Bulbar Palsy and Ophtalmoplegia Associated With Anti-GT1a IgG Antibodies
Authors: Brun Gaël , Graber Mathilde , Mohr Sophie , Béjot Yannick 
Published: December 2021

Introduction:
Although several variants of Guillain-Barré syndrome (GBS) have been described, they are uncommon, and the atypical clinical presentation of patients makes the diagnosis challenging. This article reports a case of acute bulbar palsy plus (ABPp) syndrome.

Case Report:
A 18-year-old patient was admitted to our hospital because of difficulty swallowing, slurred speech, tingling of the extremities of the 4 limbs, and diplopia. He reported abdominal pain and diarrhea 2 weeks earlier. Physical examination showed a low-pitched voice, palsy elevation of the soft palate and complete palsy of the abduction of the left eye. Electromyography and cerebrospinal fluid examination were unremarkable, but Campylobacter jejuni serology was positive, and we found an isolated immunoglobulin G (IgG) anti-GT1a antibodies positivity. A diagnosis of ABPp was finally made, and the patient fully recovered early after receiving polyvalent immunoglobulins infusion.

Conclusions:
ABPp is classified as subtype of GBS. The most frequent clinical signs of ABPp are ophthalmoplegia, facial palsy, and ataxia. IgG anti-GT1a and/or anti-GQ1b are positive in a majority of patients with ABPp; however, these antibodies are not specific and can found in other subtypes of GBS.
Brain Camp
Authors: Wei Xin Paul , Diwanji Devan , McHenry Lauren , Lea Robin , McCluskey Kate , Griffin Sandon , Comrie Alison , Margol Valerie , Josephson S. Andrew 
Published: December 2021

Background:
Despite calls to increase diversity in the health care workforce, most medical fields including neurology have seen minimal advances, owing in part to the lack of developing a robust pipeline for trainees from underrepresented backgrounds. We sought to create an immersive, replicable neurology-themed summer camp and longitudinal mentorship program for underrepresented-in-medicine (URM) high-school students to encourage them to enter the training pipeline in neuroscience-related fields.

Methods:
We established an annual, no-cost 1-week camp for local URM students with the goals of exposing them to different health care professions within neuroscience while providing them with college application resources and long-term mentorship. A postprogram survey was distributed to assess the students’ attitudes towards the camp and their desires to pursue health care careers.

Results:
Over the 4 years since the founding of the camp (2016-2020), a total of 96 students participated, of whom 53% were URM, 74% came from very low-income households, and 61% had parents who did not attend college. In total, 87 students (91%) completed the postcamp survey. Nearly all (97%) of the respondents were likely to recommend the camp to their peers, and the vast majority (85%) felt that Brain Camp made them more likely to pursue careers in health care.

Conclusions:
Brain Camp seeks to address the unmet need for low barrier-to-entry programs designed for URM high-school students interested in health care careers. We envision that our camp may serve as a blueprint for other similar programs across the nation with the goal of addressing the URM pipeline in neuroscience.
Predictors of Caregiver Satisfaction With Pediatric Laceration Repair in the Pediatric Emergency Department
Authors: Hwang Soyun , Lee Jin Hee , Kwak Young Ho , Kim Do Kyun , Jung Jin Hee , Jung Jae Yun , Kwon Hyuksool , Suh Dongbum , Choi Yoo Jin , Lee Se Uk , Park Joong Wan 
Published: December 2021

Objectives
The objective of this study was to define the care factors that are important to caregivers' satisfaction with pediatric laceration repair and the overall emergency department (ED) experience.

Methods
This was a cross-sectional observation study performed in an urban tertiary hospital. The caregivers of patients younger than 18 years who presented to the ED for laceration repair completed a survey. Demographic data were analyzed. Univariate and multivariate logistic regressions were used to determine the factors related to satisfaction with the laceration repair and the overall ED experience.

Results
Fifty-five caregivers were enrolled. Most of the children had facial lacerations (n = 44, 80%). The median length of ED stay was 181 minutes (interquartile range [IQR], 157–208 minutes). The children's median age was 41.8 months (IQR, 23–91 months); the caregivers' median age was 37 years (IQR, 35–41 years). Most lacerations were repaired by plastic surgeons (81.8%). In the multivariate regression analysis, preparation before the procedure, mid-income family, caring attitude of the nurse, cosmetic outcome, and measures to control the patient's anxiety were significantly related to the caregiver's satisfaction with laceration repair (P < 0.05), whereas preparation before the procedure and ED environment were significantly related to the caregiver's satisfaction with the overall ED experience (P < 0.05).

Conclusions
Preparation before the procedure was significantly related to the caregiver's satisfaction with both pediatric laceration repair and the overall PED experience. The strongest predictors were cosmetic outcome for laceration repair and preparation for the procedure for the overall PED experience. Our findings suggest that improvements in various aspects will increase parent satisfaction.
Eyelid Reconstruction: An Algorithm Based on Defect Location
Authors: Mukit Muntazim , Anbar Fabliha , Dadireddy Kalyan , Konofaos Petros 
Published: December 2021

Abstract
Eyelid reconstruction is a complex topic. This review looks at articles from 1990 to 2018 on eyelid reconstruction that had at least 10 patients and a mean 6 month follow-up. The authors present the results of our findings and propose an algorithm to guide the surgeon in choosing the best technique based on location, size, and lamella. Defects less than 1/3rd of the upper or lower eyelid may be closed primarily. Anterior and posterior lamella defects of the lower eyelid greater than 1/3rd in size should be reconstructed with a double mucosal and myocutaneous island flap. Those greater than 50% in size should be recreated with a Tripier flap for the anterior lamella and conchal chondroperichondral graft for the posterior lamella. For total lid reconstruction, a Fricke flap is best for the anterior lamella and the tarsoconjunctival free graft/lateral orbital rim periosteal flap is best for the posterior lamella. Fullthickness defects between 1/3rd and 2/3rd in size of the upper eyelid should be reconstructed with a myotarsocutaneous flap and those greater than 2/3rd should be reconstructed with a Cutler-Beard flap for the anterior lamella and auricular cartilage for the posterior lamella. For the medial canthal region, the island pedicle and horizontal cheek advancement flap is recommended for the anterior lamella and a composite upper lid graft for the posterior lamella. For the lateral canthal region, a bilobed flap is recommended for the anterior lamella and a periosteal flap for the posterior lamella.
Mapping Simulated-Based Learning Experiences Incorporated Into Professional Placements in Allied Health Programs
Authors: Squires Kelly , Heaney Susan , MacDonald-Wicks Lesley , Johnston Catherine , Brown Leanne 
Published: December 2021

Summary Statement
Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.
Endoscopic Submucosal Dissection for Superficial Pharyngeal Carcinoma Is Effective and Safe
Authors: Chen Tao , Xu Aiping , Lian Jingjing , Chu Yuan , Zhao Ziying , Zhang Li , Xu Meidong 
Published: December 2021

Background:
Endoscopic submucosal dissection (ESD) of superficial squamous epithelial lesions at the pharynx is still a challenge for most endoscopists due to the limited working space and inexperience. The aim of this study was to evaluate the outcomes of ESD for superficial pharyngeal carcinomas.

Methods:
A total of 30 superficial carcinomas at the pharynx in 27 consecutively treated patients were included. The rates of en bloc resection, complete resection, major complications, local recurrence, and metastasis were evaluated retrospectively as the therapeutic outcomes.

Results:
The en bloc and complete resection rates were respectively 100% and 93.3%. No bleeding, perforation, or dyspnea during or after the ESD procedure occurred. There was 1 patient with emphysema. The median hospital stay was 6 days. During the follow-up period of 1 year, 1 patient had neck lymph node metastasis.

Conclusion:
ESD is effective and safe for resection of superficial carcinomas at the pharynx, with a high complete resection rate and favorable outcomes.
Transvaginal Specimen Extraction After Laparoscopic Gastrectomy for Tumors
Authors: Sumer Fatih , Gundogan Ersin , Kaplan Kuntay , Okut Gökalp , Kayaalp Cuneyt 
Published: December 2021

Aim:
The aim was to evaluate the feasibility of transvaginal specimen extraction after laparoscopic gastrectomy for tumors.

Method:
Inclusion criteria were females not planning to deliver a child and an accessible vaginal entry. Exclusion criteria were benign gastric pathologies and emergency cases.

Results:
There were 24 females with a mean age of 54.5±12.0. Subtotal, total, central, and vertical gastrectomies were implemented in 17, 4, 2, and 1 patients, respectively. There was no conversion to open or conventional laparoscopic surgery. Specimens were removed from the vagina in all cases successfully. Histopathologies were adenocarcinoma in 20, gastrointestinal stromal in 3, neuroendocrine tumors in 2 and high-grade dysplasia in the rest. Mean blood loss and duration of surgery were 122.5±163.4 (range: 10 to 800) ml. and 287.7±95.9 (range: 120 to 440) minutes, respectively. No patient required intraoperative blood transfusions. The median length of hospital stay was 7 days (range: 3 to 22). The mean tumor size was 7.8±6.5 (range: 0.5 to 24) cm. Fourteen of 24 cases were advanced gastric cancers. Mean dissected lymph node numbers in the patients with radical gastrectomy was 35.3±12.9 (range: 18 to 62). There were no early or late complications related to the specimen extraction and no wound-related problems were observed.

Conclusions:
In the selected cases, transvaginal specimen extraction was feasible after laparoscopic gastric resections in patients with stomach tumors. As far as we know, this was the largest study on the transvaginal extraction of gastric tumors.
Emerging treatment options for bacillus Calmette–Guérin-unresponsive non-muscle invasive bladder cancer
Authors: Kokorovic Andrea , Ory Jesse , Saad Fred 
Published: December 2021

Purpose of review
The majority of new bladder cancer diagnoses are non-muscle invasive bladder cancer (NMIBC). For patients with intermediate-risk and high-risk NMIBC, the preferred treatment after transurethral tumor resection is bacillus Calmette–Guérin (BCG) intravesical therapy; however, some patients receiving BCG do not respond and are at risk for recurrence and progression to muscle invasive disease. Currently, there is a lack of bladder-sparing therapies for patients that do not respond to BCG therapy. This review highlights recent advances in bladder-sparing therapies for NMIBC that do not respond to BCG therapy.

Recent findings
Several clinical trials have emerged over the past several years using novel agents. Systemic immunotherapy with pembrolizumab has shown promising activity, and recently gained FDA approval for use in BCG-unresponsive NMIBC. Gene therapy using Nadofaragene firadenovec, a replication-deficient adenoviral vector delivering interferon (IFN) alfa, shows durable results and is pending regulatory approval. Several other agents are on the horizon and there will likely be an emergence of therapies over the next several years.

Summary
Patients with NMIBC that do not respond to BCG therapy are at high risk for progression to muscle invasive disease. Bladder-sparing therapeutic options for these patients are sparse but now include pembrolizumab and several other potential options are emerging. These bladder-sparing therapies will benefit patients unwilling or unable to undergo radical cystectomy.
Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder
Authors: Chan Peter , Waxman Robyn E. , Woo Simon , Docherty Claire , Rayani Kaveh , Fischler Ilan , Ghaffar Omar , Elmi Sarah 
Published: December 2021

Objectives
Neuropsychiatric symptoms (NPSs) in those with major neurocognitive disorder (MNCD) include the responsive behaviors of agitation and aggression. Electroconvulsive therapy (ECT) has shown some effectiveness based on retrospective studies and one open label prospective study. We hypothesized that ECT will reduce NPSs between baseline and after treatment in those with medication-refractory behaviors.

Method/Design
This Canadian prospective multicenter study included MNCD patients admitted to geriatric psychiatry units for the management of refractory NPSs. All treatment-refractory participants suffered from advanced MNCD. We conducted the Neuropsychiatric Inventory—Clinician version and the Pittsburgh Agitation Scale at baseline, and during and after the ECT course. A bitemporal or bifrontal ECT series based on dose titration to 1.5 to 2.5 times seizure threshold was administered.

Results
Data were collected for 33 patients with a mean age of 73 and categorized with severe MNCD using the Functional Assessment Staging of Alzheimer's Disease scale (stages 6 and 7). The data showed a drop in mean Neuropsychiatric Inventory—Clinician version from 58.36 to 24.58 (P < 0.0001). Mean Neuropsychiatric Inventory agitation subscale dropped from 7.12 to 3.09 (P = 0.007). Mean Neuropsychiatric Inventory aggression subscale dropped from 6.94 to 0.97 (P < 0.0001). There was a concomitant significant decline in Pittsburgh Agitation Scale scores. No participants dropped out because of intolerance of ECT. One participant died from pneumonia, which did not appear related to ECT.

Conclusions
In this naturalistic study, ECT was found to be a safe and effective treatment for certain NPSs in people with MNCD. This can translate into improving quality of life.
An algorithm and application to efficiently analyze DNA fiber data
Authors: Kirilov Teodor , Gospodinov Anastas , Kirilov Kiril 
Published: December 2021

AbstractThe duplication of genetic information (DNA replication) is central to life. Numerous control mechanisms ensure the exact course of the process during each cell division. Disturbances of DNA replication have severe consequences for the affected cell, and current models link them to cancer development. One of the most accurate methods for studying DNA replication is labeling newly synthesized DNA molecules with halogenated nucleotides, followed by immunofluorescence and microscopy detection, known as DNA fiber labeling. The method allows the registration of the activity of single replication complexes by measuring the length of the “trace” left by each of them. The major difficulty of the method is the labor-intensive analysis, which requires measuring the lengths of a large number of labeled fragments. Recently, the interest in this kind of image analysis has grown rapidly. In this manuscript, we provide a detailed description of an algorithm and a lightweight Java application to automatically analyze single DNA molecule images we call “DNA size finder”. DNA size finder significantly simplified the analysis of the experimental data while increasing reliability by the standardized measurement of a greater number of DNA molecules. It is freely available and does not require any paid platforms or services to be used. We hope that the application will facilitate both the study of DNA replication control and the effects of various compounds used in human activity on the process of DNA replication.
Identification of critical genes and biological signaling for metformin treated liver cancer
Authors: Zhang Tingting , Guo Hongmei , Wang Letian , Wang Mengyao , Gu Hanming 
Published: December 2021

AbstractLiver cancer is a leading source of cancer-related mortality in the world. A number of studies have shown the correlation of metformin treatment with a decrease in cancer risk. However, the relevant molecules and mechanisms are not clear during the treatment. In this study, our aim is to identify the significant molecules and signaling pathways in the treatment of metformin in liver cancer cells by analyzing the RNA sequence. The GSE190076 dataset was created by performing the Illumina NovaSeq 6000 (Homo sapiens). The KEGG and GO analyses indicated that DNA synthesis and cell cycle are the main processes during the treatment of metformin. Moreover, we determined numerous genes including RRM2, CDC6, CDC45, UHRF1, ASF1B, ZWINT, PCNA, ASPM, MYC, and TK1 by using the PPI network. Therefore, our study may guide the clinical work on the treatment of liver cancer by using metformin.
Relationship between quality of life and physical fitness in adults with intellectual disabilities
Authors: Cuesta Vargas Antonio , Perez Cruzado David , Rodriguez Moya Alejandro 
Published: December 2021

Purpose
People with intellectual disabilities have lower levels of physical fitness compared with peers without intellectual disability, because of the high levels of sedentary behaviour in this population. This study aims to know the relationship between quality of life and physical fitness in adults with intellectual disability.

Design/methodology/approach
Ninety-six adults with intellectual disability were assessed with quality of life questionnaire and physical fitness tests, which involve balance, muscle strength, flexibility and aerobic condition.

Findings
Adults with higher self-reported levels of quality of life reported higher levels of physical fitness in balance, muscular strength and flexibility. In contrast, in aerobic condition were not found significant correlations with self-reported quality of life.

Originality/value
These findings support the hypothesis that people with intellectual disability with lower levels of physical fitness could influence in their levels of quality of life. This insight is useful for improving treatments to improve physical fitness in this population.
Front-of-pack nutrition labels: perceptions and preferences of Brazilian adult consumers
Authors: Mazzonetto Ana Claudia , Fernandes Ana Carolina , de Souza Aretusa Dias , Rodrigues Vanessa Mello , Scapin Tailane , Uggioni Paula Lazzarin , Veiros Marcela Boro , Bernardo Greyce Luci , Proença Rossana Pacheco da Costa 
Published: December 2021

PurposeThis study aimed to examine the perceptions and preferences of Brazilian adult consumers about four different front-of-pack (FOP) food labeling systems proposed by the Brazilian National Health Regulatory Agency.Design/methodology/approachThis is a qualitative study conducted with 33 participants allocated in six focus groups. Four different types of FOP labels were displayed on processed and packaged bread: three interpretive warning labels (black triangle, black octagon and red ellipse) and a hybrid model (nutritional traffic light). Thematic analysis was used to identify the key topics addressed by participants.FindingsThree topics were identified: label design, clarity and precision of information. The results demonstrated an influence of labels on product development and consumers' food choices. Most participants expressed a preference for black warning labels and reported the importance of statements endorsed by the Ministry of Health, which provide credibility and could influence food choices. Furthermore, participants agreed that the traffic light system provides more information but is difficult to interpret when comparing products. Warning labels were reported to have the greatest influence on purchase decisions. However, participants were concerned about how to understand the lack of warning labels on some products.Practical implicationsThe results may help and support the Brazilian Health Regulatory Agency to identify and recommend the most effective FOP labeling system to be adopted in Brazil.Originality/valueFew studies investigating adult consumers' perceptions of different FOP label formats have been conducted in the Brazilian context. Our study contributes to the small pool of evidence on the topic by demonstrating that FOP labels can be helpful for consumers when they are presented in an intuitive, interpretative and trustworthy format.