bluuebunny/crossref_metadata_2025_split huggingface dataset:
Approaching Identity Problems Common in Clinical Practice
Authors: Peteet John R. 
Published: November 2021

Abstract
The concept of identity is pervasive in psychology and culture, but clinicians have lacked a conceptual framework for addressing problems related to identity. After reviewing the development of identity, I distinguish four of the most common categories of such problems and consider approaches to each: identity diffusion, distorted identity, threats to identity, and difficulty integrating disparate aspects of one’s identity. While making identity a focus of clinical attention can strengthen the alliance and place the treatment within a larger context, doing so raises moral questions about the clinician’s role as an agent of validation or change.
Dramatic Growth of a Vestibular Schwannoma After 16 Years of Postradiosurgery Stability in Association With Exposure to Tyrosine Kinase Inhibitors
Authors: Carlstrom Lucas P. , Muñoz-Casabella Amanda , Perry Avital , Graffeo Christopher S. , Link Michael J. 
Published: November 2021

Background:
Vestibular schwannoma (VS) is a benign nerve-sheath tumor that sporadically displays aggressive behavior – often attributable to intrinsic tumor biology and an unfavorable immune microenvironment. However, the potential for idiosyncratic responses on VS growth to novel biologics is largely unknown.

Methods:
Case report.

Results:
A 57-year-old man underwent stereotactic radiosurgery (SRS) for a small intracanalicular presumed VS, which presented with left-sided hearing loss and episodic vertigo. Treatment response was excellent, with >50% reduction in tumor volume and confirmed stability at 14 years post-SRS radiographic follow-up. The patient subsequently developed an unrelated metastatic gastrointestinal tumor, and was started on tyrosine kinase inhibitors. Within 12-months of regorafenib treatment, and 16-years since SRS, the patient developed ipsilateral House-Brackmann Grade IV facial weakness. Dramatic VS expansion from 14 to 25 mm in maximum diameter, with new brain stem compression, was seen on MRI. Due to poor prognosis of his gastrointestinal malignancy, he declined surgical resection, and elected for palliative salvage SRS.

Conclusion:
We report the case of VS with radiographically proven stability for >14 years that underwent dramatic tumor progression after treatment with tyrosine kinase inhibitors. The dynamics between systemic immunomodulation and VS disease phenotype remain incompletely understood, and there may be potential for unintended iatrogenic VS progression.
Parenting Stress, Self-Efficacy, and Involvement: Effects on Spoken Language Ability Three Years After Cochlear Implantation
Authors: Cejas Ivette , Mitchell Christine M. , Barker David H. , Sarangoulis Christina , Eisenberg Laurie S. , Quittner Alexandra L. 
Published: November 2021

Objective:
This study evaluated associations among parenting stress, self-efficacy, and involvement in relation to spoken language outcomes in young children 3 years following cochlear implantation.

Study Design:
Cross-sectional.

Setting:
Six university tertiary medical centers.

Patients:
One hundred sixty-four young children with bilateral, severe-to-profound sensorineural hearing loss who had 3 years of experience with a CI; children with substantial cognitive impairments were excluded from the study.

Main Outcome Measures(s):
Family Stress Scale (FSS), Scale of Parental Involvement and Self-Efficacy (SPISE), Oral and Written Language Scales (OWLS).

Results:
Correlations were of moderate strength between FSS scores and SPISE scores (Parental Self-Efficacy, r = −0.45, p < 0.01, Parental Involvement r = −0.32, p < 0.01). As hypothesized, parents reporting higher levels of stress reported lower perceptions of self-efficacy and involvement. In addition, results showed that family stress had a direct, negative effect on spoken language (−4.43 [95% confidence interval: −6.97; −1.89]). After controlling for maternal education and activation age, parental self-efficacy mediated the negative effect between family stress and spoken language (indirect effect = −1.91 [3.45; −0.69]; proportion mediated = 0.43). No mediating effects were found for parental involvement.

Conclusions:
These findings highlight the need for parenting interventions that focus on reducing stressors and increasing parents’ perceptions of self-efficacy in families of children using cochlear implants. Integration of mental health screening and tailored parenting interventions in CI clinics may increase parental self-efficacy and involvement, with measurable benefits in the child's use of spoken language.
Self-Identified Patient Barriers to Pursuit of Cochlear Implantation
Authors: Balachandra Sanjana , Tolisano Anthony M. , Qazi Shafeen , Hunter Jacob B. 
Published: November 2021

Introduction:
Cochlear implantation (CI) is an underutilized treatment for hearing loss in the United States for reasons which remain unclear. This study explores self-identified barriers to CI employing a survey of adults who qualified for CI.

Methods:
A single-institutional review of CI candidates between December 2010 and December 2018 was performed to identify patients who did not pursue surgery. A 21-question survey was developed, aimed at rating patients’ concerns regarding CI, including surgical risks, adaptation, costs, time commitment, loss of residual hearing, and lack of benefit, among others. Current hearing aid usage and familiarity with other CI users were also analyzed. The survey was administered to patients who did not pursue CI and a control group who eventually did pursue CI, via email or telephone.

Results:
There were 199 patients who initially did not pursue CI. Fifty-two survey responses were received, comprised of 27 patients who did not pursue CI and 25 patients who did. A belief that CI would not significantly improve the ability to communicate was the most common reported barrier, followed by the postoperative recovery process, risks of surgery, and risks of losing music appreciation. Anesthetic risk and cost were the least important reasons not to pursue CI. Half of patients reported concerns regarding the period of adjustment with the CI.

Conclusion:
The decision not to pursue CI despite eligibility is multifactorial and includes concern for minimal hearing benefit and perioperative risks. These factors should be taken into consideration when counseling patients on CI surgery.
An online survey on emotions, impact on everyday life, and educational needs of women with HPV positivity or abnormal Pap smear result
Authors: Ciavattini Andrea , Delli Carpini Giovanni , Giannella Luca , Del Fabro Anna , Banerji Vivek , Hall Genevieve , Barbero Maggiorino , Sopracordevole Francesco 
Published: November 2021

Abstract
This study aimed to evaluate the emotional path, impact on everyday life, and adequacy of patient education throughout the diagnostic and therapeutic journey of women who received a positive human papillomavirus (HPV) test or Pap smear result.
An online survey was designed to determine the demographic characteristics, dominant feelings throughout the diagnostic and therapeutic procedures, major lifestyle changes, impact on social life, and perceived adequacy of patient information in Italian women with a positive HPV test or abnormal cervical cytology result. In this study, the phases of the “patient's journey” included the initial test, waiting for colposcopy or biopsy, waiting for surgery, and follow-up.
Anxiety, worry, and fear were the most frequently cited emotions during the initial tests and intervals between procedures. Anxiety and fear gradually decreased during the journey until surgery, and higher levels of optimism were observed postsurgery. The most frequently reported lifestyle changes were attempts to boost the immune system, increased precautions in sexual practices, and dietary changes. Social life is affected by changes in sexual and intimate relationships with partners. Women reported receiving insufficient patient education on the diagnosis and its implications, progression, management, personal care, and resolution.
Significant attention should be given to the psychosocial aspects of the entire patient journey after receiving a positive HPV test or an abnormal Pap smear result. It is essential to establish a good rapport between patients and healthcare professionals, and to educate women regarding the condition by minimizing the gap between the perceived and desired adequacy of information.
Evaluation on curative effects of isokinetic muscle strength training for improving muscle function in patients with knee osteoarthritis
Authors: Wu Ji-Qian , Che Xin-Chong 
Published: November 2021

Abstract

Background:
Knee osteoarthritis (KOA) refers to a chronic deteriorating disease distinguished by degeneration of joint cartilage. Many clinical studies have demonstrated that isokinetic muscle strength training can improve muscle function in patients with KOA. However, although such studies deduce an excellent effect, the results remain controversial. Therefore, the present systematic review seeks to explore the curative effects of isokinetic muscle strength training to establish if it can improve muscle function in patients experiencing KOA.

Methods:
This review will entail a systematic review and a comprehensive examination to establish all randomized controlled studies covering curative effects of isokinetic muscle strength training to improve muscle function in patients with KOA. We will obtain data from PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and WanFang databases from inception to September 2021. In addition, the study will employ the criterion postulated by Cochrane to ascertain a quality evaluation and risk assessment of the studies included for analysis. Also, we will employ relative risk, mean differences, and standardized mean differences with 95% confidence intervals to estimate the effective measures. Also, we will employ Cochran Q test and I

2
statics to assess heterogeneity among the 2 studies.

Results:
Overall, this study anticipates providing accurate results and balanced inferences on curative effects of isokinetic muscle strength training for improving muscle function in patients with KOA.

Conclusion:
The study's inferences will offer evidence to decide whether isokinetic muscle strength training is an effective measure for improving muscle function in patients with KOA.
Comparative analysis of the recent publication trends in 4 representative journals in the spine field
Authors: Yang Kuhyun , Baek Hong-Gyu , Cho Dae-Chul , Jung Yoon Gyo , Lee Subum , Park Jin Hoon 
Published: November 2021

Abstract
We have analyzed and compared the publication trends in 4 representative spinal journals [Spine, European Spinal Journal (EUS), The Spine Journal (TSJ), and the Journal of Neurosurgery – Spine (JNS spine)] from 2016 to 2018.
A total of 3784 articles were published in the 4 representative journals: 1358, 1128, 685, and 613 articles in Spine, EUS, TSJ, and JNS spine, respectively. We compared and analyzed each periodical for the time taken (days) for the publication process, the distribution of specialties of the corresponding author, multicity of the investigative institutions, main disease entity, study type, and design.
The period from submission to online publication was 133, 216, 181, and 318 days in Spine, EUS, TSJ, and JNS spine, respectively. Corresponding authors with orthopedic specialties were more common in Spine, EUS, and TSJ than in JNS spine. Of particular note, corresponding authors who were neurosurgeons were the majority (55.8%) only in JNS spine. Single institution articles were by far the most common (average 92.8%) in all 4 journals. In all of the analyzed journals, the proportion of degenerative diseases was dominant with an average of 44.9%. The most frequent study type in all 4 journals was a clinical article (79.6, 72.1, 63.3, and 63.1%, respectively). In general, meta-analyses (average 4%) and randomized controlled comparative studies (average 5.2%) accounted for a very low percentage of the study types.
We believe that periodic analyses and comparisons of the characteristics of representative spine journals will help to shape the direction of future improvements.
Identification of chloride intracellular channels as prognostic factors correlated with immune infiltration in hepatocellular carcinoma using bioinformatics analysis
Authors: Huang Juan-Jun , Lin Jing , Chen Xiaoli , Zhu Wei 
Published: November 2021

Abstract
Chloride intracellular channel (CLIC) proteins are novel Cl-channels with 6 family members (CLIC1–6) that are known to play crucial roles in multiple physiological functions, such as neurological, cardiovascular, pulmonary, and auditory functions, and in various malignancies, including hepatocellular carcinoma (HCC). However, considerable challenges exist in identifying appropriate CLICs as therapeutic target molecules and prognostic biomarkers for HCC because the transformation of soluble or integral membrane protein forms, and specific pharmacological agents (agonists and antagonists) for distinct CLICs remains enigmatic.
To address this issue and the possible molecular basis and the signaling networks activated by CLICs in HCC, we examined the transcriptional, promoter methylation, DNA mutation, survival, and immune infiltration data of CLICs in patients with HCC using the ONCOMINE, UALCAN, GEPIA, cBioPortal, and TIMER databases.
The data showed that the expression levels of CLIC family members were differed between tumor and normal tissues. High expression levels of CLIC1 and CLIC3 were associated with advanced cancer stage in HCC patients. Low CLIC1 expression was associated with a better overall survival (OS). The DNA methylation levels of the CLIC1–3 and CLIC5–6 promoters in tumor tissue with HCC were significantly lower in HCC tissues than in normal tissues. Patients with CLIC1 alterations had a shorter OS than patients with unaltered CLIC1. Moreover, the expression levels of CLICs correlated with the infiltration of 6 different immune cells (B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages, and dendritic cells).
These results indicate that the increased mRNA expression and decreased promoter DNA methylation level of CLICs may play crucial roles in HCC tumorigenesis. The expression of CLIC family members was significantly correlated with the tumor immune status. High CLIC1 and CLIC3 expression levels could serve as biomarkers for identifying advanced-stage HCC. Moreover, a CLIC1 mutation rate of 18% was also observed and CLIC1 genetic alterations were significantly associated with lower OS in HCC patients.
In vivo effectiveness of visual inspection and laser fluorescence in the diagnosis of early pit-and-fissure carious lesions
Authors: Monea Monica , Eşian Daniela , Vlad Ramona Elena , Bica Cristina Ioana 
Published: November 2021

Abstract
General practitioners are still facing great challenges in the management of occlusal caries. Therefore, the development of better diagnostic protocols and assessment of caries activity might improve the results of nonoperative treatment. This study aimed to evaluate the effectiveness of visual inspection based on ICDAS-II (International Caries Detection and Assessment System) and DiagnoDent pen in the detection of pit-and-fissure early lesions in young permanent molars. The evaluation of 237 occlusal surfaces and caries risk assessment were performed in 96 children aged 7 to 15 years. The presence of pit-and-fissure noncavitated lesions was recorded using ICDAS-II scoring system and laser fluorescence. Statistical analysis was performed using McNemar test, with a level of significance of P < .05. The caries risk was measured for all participants. In 109 occlusal surfaces both methods identified enamel changes (46%) and in 62 cases both methods excluded the carious lesion (26.2%). The statistical analysis showed a significant moderate agreement between ICDAS-II code and DiagnoDent pen measurements (McNemar chi-squared statistic 9.5, P = .002 and Cohen kappa coefficient = 0.427). The majority of children (69.8%) had moderate caries risk and the most frequent risk factors recorded were sugar intake between meals, lack of regular dental control and poor oral hygiene. We concluded that ICDAS-II is a valuable and reliable diagnostic tool for early pit-and-fissure lesions and could be used alone during dental examination in children. The evaluation of caries risk should become clinical routine, as parameters belonging to high risk were frequently recorded in our study group.
Vestibular paroxysmia caused by contralateral tortuous vertebral artery
Authors: Choi Jin Woo , Kim Chang-Hee 
Published: November 2021

Abstract

Rationale:
Vestibular paroxysmia (VP) is characterized by spontaneous, recurrent, short, paroxysmal attacks of vertigo with or without tinnitus.

Patient concerns:
We report a case of paroxysmal recurrent vertigo accompanying clicking tinnitus on the left side in a 61-year-old patient. He had undergone microvascular decompression to treat the left-side hemifacial spasm 6 years prior. The patient first developed vertigo attacks about 3 years after microvascular decompression, and the attacks increased in frequency over the last 4 months. Video-nystagmography revealed a background right-beating nystagmus which was reversed every 55 seconds, to left-beating nystagmus for 17 seconds.

Diagnosis:
Brain magnetic resonance imaging and angiography demonstrated a compression of the cisternal segment of the left vestibulocochlear nerve between the tortuous right vertebral artery and the posterior wall of the left porus acusticus internus.

Interventions and outcomes:
Under the diagnosis of VP, 300 mg oxcarbazepine was administered daily, which relieved the symptoms dramatically.

Lesson:
The neurovascular cross-compression of the vestibulocochlear nerve by the contralateral vertebral artery tortuosity can cause VP. Periodic paroxysms of right-beating nystagmus accompanying the left-side tinnitus during vertigo attacks in our patient can be explained by secondary central hyperactivity in both vestibular and cochlear nuclei following long-standing neurovascular cross-compression.
An empyema caused by Streptococcus constellatus in an older immunocompetent patient
Authors: Lee Young Joo , Lee Jeonghun , Kwon Byung Su , Kim Youngsun 
Published: November 2021

Abstract

Rationale:
Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which consists of S constellatus, S anginosus, and Streptococcus intermedius, as causative organisms of empyema has been increasing.

Patient concerns:
A 78-year-old man initially presented with dyspnea and chills for 4 days. He had no medical history.

Diagnosis:
Chest X-ray and chest computed tomography showed a large and multiloculated pleural effusion with an air bubble on the right side. Cultivation of the pleural effusion using clone library analysis of the 16S rRNA gene revealed S constellatus positivity.

Interventions:
The patient was treated by drainage of the pleural effusion and intravenous ceftriaxone and clindamycin for the possibility of anaerobes, followed by 10 weeks of oral antibiotics.

Outcomes:
On the 11th day of admission, the thoracic drainage tube was removed. After 1 year of treatment, there were no sequelae of empyema.

Lessons:
Although S constellatus can cause serious infections in patients with underlying diseases and immunosuppression, physicians need to consider S constellatus infection in community-acquired empyema in elderly individuals. It should be treated with early pleural drainage and antibiotics to avoid surgical decortication and prolonged hospitalization.
Targeting 3 Tiers of Psychiatric Problems in Patient-focused Psychiatric Practice: Diagnostic Signs, Symptoms, and Impairments; Specific Complex Subjective Complaints; and Contributing Meta-problems
Authors: Yager Joel 
Published: November 2021

Background:
While contemporary psychiatric assessments ordinarily focus on signs, symptoms, and impairments comprising formal diagnoses, these assessments sometimes minimize or ignore specific complaints and other contributing problems that are the sources of patients’ and families’ greatest distress. Neglect of these problems may decrease patient satisfaction and reduce the quality of care.

Methods:
The author reviewed limitations of previous problem-oriented efforts in psychiatry and limitations of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. This review provided the basis for reconceptualizing how problems might be identified and framed in clinical assessments.

Results:
A clinically practical 3-tier framework for psychiatric problems is suggested. The first tier encompasses diagnostic contents, including subjective symptoms, observable signs, and impairments. The second tier consists of additional specific complex subjective complaints in the patient’s and family’s own words, comprised of highly individualized distressing intrapsychic, interpersonal, and environmental situations and conflicts. The third tier consists of contributing meta-problems, comprised of significant additional patient-related or systems-related difficulties noted by clinicians that contribute substantially to complicated clinical problem sets.

Conclusions:
Diagnostic or not, specific problems expressed by patients and families and contributing meta-problems should be integrated into initial formulations and tracked during treatment. Whereas only some of these problems may fall within a clinician’s scope of responsibilities, all should fall within the scope of concern, some to be referred to others, and some exceeding caregivers’ capacities. Periodic review of problem lists for patients’ and families’ most distressing concerns can contribute to the therapeutic alliance, increase patient satisfaction, and perhaps improve outcomes.
Robust and unbiased estimation of the background distribution for automated quantitative imaging
Authors: Silberberg Mauro , Grecco Hernán E. 
Published: November 2021

AbstractQuantitative analysis of high-throughput microscopy images requires robust automated algorithms. Background estimation is usually the first step and has an impact on all subsequent analysis, in particular for foreground detection and calculation of ratiometric quantities. Most methods recover only a single background value, such as the median. Those that aim to retrieve a background distribution by dividing the intensity histogram yield a biased estimation in images in non-trivial cases. In this work, we present the first method to recover an unbiased estimation of the background distribution directly from an image and without any additional input. Through a robust statistical test, our method leverages the lack of local spatial correlation in background pixels to select a subset of pixels that accurately represent the background distribution. This method is both fast and simple to implement, as it only uses standard mathematical operations and an averaging filter. Additionally, the only parameter, the size of the averaging filter, does not require fine tuning. The obtained background distribution can be used to test for foreground membership of individual pixels, or to estimate confidence intervals in derived quantities. We expect that the concepts described in this work can help to develop a novel family of robust segmentation methods.