bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scoping Review of Entrustable Professional Activities in Undergraduate Medical Education
Authors: Meyer Eric G. , Chen H. Carrie , Uijtdehaage Sebastian , Durning Steven J. , Maggio Lauren A. 
Published: April 2019

Purpose
Entrustable professional activities (EPAs) are a hot topic in undergraduate medical education (UME); however, the usefulness of EPAs as an assessment approach remains unclear. The authors sought to better understand the literature on EPAs in UME through the lens of the 2010 Ottawa Conference Criteria for Good Assessment.

Method
The authors conducted a scoping review of the health professions literature (search updated February 2018), mapping publications to the Ottawa Criteria using a collaboratively designed charting tool.

Results
Of the 1,089 publications found, 71 (6.5%) met inclusion criteria. All were published after 2013. Forty-five (63.4%) referenced the 13 Core Entrustable Professional Activities for Entering Residency developed by the Association of American Medical Colleges (AAMC). Forty (56.3%) were perspectives, 5 (7.0%) were reviews, and 26 (36.6%) were prospective empirical studies. The publications mapped to the Ottawa Criteria 158 times. Perspectives mapped more positively (83.7%) than empirical studies (76.7%). Reproducibility did not appear to be a strength of EPAs in UME; however, reproducibility, equivalence, educational effect, and catalytic effect all require further study. Inconsistent use of the term “EPA” and conflation of concepts (activity vs assessment vs advancement decision vs curricular framework) limited interpretation of published results. Overgeneralization of the AAMC’s work on EPAs has influenced the literature.

Conclusions
Much has been published on EPAs in UME in a short time. Now is the time to move beyond opinion, clarify terms, and delineate topics so that well-designed empirical studies can demonstrate if and how EPAs should be implemented in UME.
Breathing under Anesthesia
Authors: Bourgeois Thomas , Ringot Maud , Ramanantsoa Nelina , Matrot Boris , Dauger Stéphane , Delclaux Christophe , Gallego Jorge 
Published: April 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Optimal management of anesthesia-induced respiratory depression requires identification of the neural pathways that are most effective in maintaining breathing during anesthesia. Lesion studies point to the brainstem retrotrapezoid nucleus. We therefore examined the respiratory effects of common anesthetic/analgesic agents in mice with selective genetic loss of retrotrapezoid nucleus neurons (Phox2b

27Alacki/+
mice, hereafter designated “mutants”).

Methods
All mice received intraperitoneal ketamine doses ranging from 100 mg/kg at postnatal day (P) 8 to 250 mg/kg at P60 to P62. Anesthesia effects in P8 and P14 to P16 mice were then analyzed by administering propofol (100 and 150 mg/kg at P8 and P14 to P16, respectively) and fentanyl at an anesthetic dose (1 mg/kg at P8 and P14 to P16).

Results
Most mutant mice died of respiratory arrest within 13 min of ketamine injection at P8 (12 of 13, 92% vs. 0 of 8, 0% wild type; Fisher exact test, P < 0.001) and P14 to P16 (32 of 42, 76% vs. 0 of 59, 0% wild type; P < 0.001). Cardiac activity continued after terminal apnea, and mortality was prevented by mechanical ventilation, supporting respiratory arrest as the cause of death in the mutants. Ketamine-induced mortality in mutants compared to wild types was confirmed at P29 to P31 (24 of 36, 67% vs. 9 of 45, 20%; P < 0.001) and P60 to P62 (8 of 19, 42% vs. 0 of 12, 0%; P = 0.011). Anesthesia-induced mortality in mutants compared to wild types was also observed with propofol at P8 (7 of 7, 100% vs. 0 of 17,7/7, 100% vs. 0/17, 0%; P < 0.001) and P14 to P16 (8 of 10, 80% vs. 0 of 10, 0%; P < 0.001) and with fentanyl at P8 (15 of 16, 94% vs. 0 of 13, 0%; P < 0.001) and P14 to P16 (5 of 7, 71% vs. 0 of 11, 0%; P = 0.002).

Conclusions
Ketamine, propofol, and fentanyl caused death by respiratory arrest in most mice with selective loss of retrotrapezoid nucleus neurons, in doses that were safe in their wild type littermates. The retrotrapezoid nucleus is critical to sustain breathing during deep anesthesia and may prove to be a pharmacologic target for this purpose.
Health and Economic Impact of Intensive Surveillance for Distant Recurrence After Curative Treatment of Colon Cancer: A Mathematical Modeling Study
Authors: Wanis Kerollos N. , Maleyeff Lara , Van Koughnett Julie Ann M. , H. D. Colquhoun Patrick , Ott Michael , Leslie Ken , Hernandez-Alejandro Roberto , Kim Jane J. 
Published: April 2019

BACKGROUND:
Intensive surveillance strategies are currently recommended for patients after curative treatment of colon cancer, with the aim of secondary prevention of recurrence. Yet, intensive surveillance has not yielded improvements in overall patient survival compared with minimal follow-up, and more intensive surveillance may be costlier.

OBJECTIVE:
The purpose of this study was to estimate the quality-adjusted life-years, economic costs, and cost-effectiveness of various surveillance strategies after curative treatment of colon cancer.

DESIGN:
A Markov model was calibrated to reflect the natural history of colon cancer recurrence and used to estimate surveillance costs and outcomes.

SETTINGS:
This was a decision-analytic model.

PATIENTS:
Individuals entered the model at age 60 years after curative treatment for stage I, II, or III colon cancer. Other initial age groups were assessed in secondary analyses.

MAIN OUTCOME MEASURES:
We estimated the gains in quality-adjusted life-years achieved by early detection and treatment of recurrence, as well as the economic costs of surveillance under various strategies.

RESULTS:
Cost-effective strategies for patients with stage I colon cancer improved quality-adjusted life-expectancy by 0.02 to 0.06 quality-adjusted life-years at an incremental cost of $1702 to $13,019. For stage II, they improved quality-adjusted life expectancy by 0.03 to 0.09 quality-adjusted life-years at a cost of $2300 to $14,363. For stage III, they improved quality-adjusted life expectancy by 0.03 to 0.17 quality-adjusted life-years for a cost of $1416 to $17,631. At a commonly cited willingness-to-pay threshold of $100,000 per quality-adjusted life-year, the most cost-effective strategy for patients with a history of stage I or II colon cancer was liver ultrasound and chest x-ray annually. For those with a history of stage III colon cancer, the optimal strategy was liver ultrasound and chest x-ray every 6 months with CEA measurement every 6 months.

LIMITATIONS:
The study was limited by model structure assumptions and uncertainty around the values of the model's parameters.

CONCLUSIONS:
Given currently available data and within the limitations of a model-based decision-analytic approach, the effectiveness of routine intensive surveillance for patients after treatment of colon cancer appears, on average, to be small. Compared with testing using lower cost imaging, currently recommended strategies are associated with cost-effectiveness ratios that indicate low value according to well-accepted willingness-to-pay thresholds in the United States. See Video Abstract at http://links.lww.com/DCR/A921.
The advent of human papillomavirus detection for cervical screening
Authors: Morris Brian J. 
Published: April 2019

Purpose of review
This review updates progress in the human papillomavirus (HPV)-based revolution in cervical screening and vaccination predicted to eventually eliminate cervical cancer.

Recent findings
HPV PCR, patented by the author in 1987, has recently begun to replace cytology for primary cervical screening. I highlight the findings from large randomized clinical trials that have brought about this change, and progress with implementation. Australia was the first to introduce a national, publicly-funded HPV PCR-based program of primary screening, on 1 December 2017. The United Kingdom is set to follow, as are other countries. The widespread preference of self-sampling by under-screened women in particular will increase the effectiveness of population screening when using HPV tests. Coupled with improved vaccination now that more effective (nonavalent) HPV vaccines are being introduced, recent modeling predicts that cervical cancer will be markedly reduced, or even eliminated, in coming decades.

Summary
The recent or pending change to more accurate cervical screening by HPV detection using PCR in various countries means less frequent screening for women. Women with an aversion to having their sample collected by a physician can collect their sample themselves, either at the doctor's rooms or at home, the sample then being mailed to the testing laboratory.
The Past Informs the Present, Academic New Media Pitfalls: A Primer for Plastic Surgeons
Authors: Day Kristopher M. , Rohrich Rod J. , Spiess Alexander M. 
Published: April 2019

Summary:
Mass communication has undergone a “new media” revolution, which includes the rise of digital, online, and social media. The impact of new media on academic processes, however, has been underappreciated. The rise of Web-based virtual platforms has profoundly impacted the way plastic surgeons publish, store, exchange, and analyze scholarly biomedical information. This new media academic phenomenon refers to electronic mechanisms with the capacity to supplant traditional publication methods, which typically rely on printed documents in the physical domain. Although such tools can be efficient and user-friendly, they also make users vulnerable to exploitation. Notable examples reveal a relative lack of regulation, oversight, reliable rating scales, user authentication, and ethical accountability in the virtual space. As with any new technique, education is key and knowledge is power. In this article, online resources related to healthcare and the practice of plastic surgery are reviewed and summarized, including open access, mega-indices, whitelists, and electronic alerts. New media provides powerful knowledge-sharing tools that can help execute scholarly endeavors, communicate between professionals, and educate the public. However, it is essential for plastic surgeons to appreciate the caveats of new media academic processes to avoid unscrupulous practices of those that may seek to manipulate these Web-based systems. This article outlines the key pitfalls associated with online information streams to better inform plastic surgeons how to navigate new media-based scholarly processes.
Prehospital termination of resuscitation rule
Authors: Morrison Laurie J. 
Published: April 2019

Purpose of review
The purpose of the review is to briefly describe the derivation, validation and implementation of the Termination of Resuscitation Rules for out-of-hospital adult cardiac arrest and to describe the controversies surrounding implementation that have been recently published.

Recent findings
New guidelines, new interventions that alter baseline survival, the use of eCPR and issues related to duration of CPR have minimal impact on the sustainability and application of the TOR rule.
Some published articles related to using only one criterion in the rule may be cavalier and miss potential survivors.
Decisions based on discretion may cause wide variation in termination rates and evidence-based decision rules are in the best interest of distributive justice for the patient and comfort for the provider.

Summary
The Universal Termination of Resuscitation Rule has a built-in sensibility to the introduction of new treatment guidelines, including emphasis on CPR metrics, changes in baseline survival rates, duration of resuscitation and new treatment options including eCPR and postarrest care. As well, the TOR rule continues to address inconsistencies in practice and improve provider comfort.
Cerebellopontine angle ependymoma in a young adult
Authors: Lan Zhigang , Richard Seidu A. , Zhang Yuekang 
Published: April 2019

Abstract

Rationale:
Cerebellopontine angle (CPA) ependymomas are atypical kind of ependymomas that characteristically occur in the pediatric age group. Therefore, finding a case of CPA ependymoma in a young male adult is not a common occurrence.

Patient concerns:
We present a case of a 28-year-old male who was involved in road traffic accident with suspected mild head injury. He did not have any antecedent complains before the accident.

Diagnoses:
An incidental computer tomographic scan of the head revealed an intracranial space-occupying lesion at the left CPA. Immunohistochemical staining of the specimens indicated WHO grade II ependymoma.

Interventions:
The tumor was surgically resected and the patient was further treated with radiotherapy.

Outcomes:
The patient recovered well postoperatively and 2 years follow-up revealed no tumor recurrence and the patient is currently well.

Lessons:
The diagnosis of ependymomas can be very challenging in adults because they are mostly mainly seen in the pediatric age group. We propose that one of the differential diagnosis of tumors in the CPA in a young adult should be CPA ependymoma.
Successful resuscitation of a patient with pernicious placenta previa and placenta accreta who had massive life-threatening bleeding during cesarean section
Authors: Jiang Xiaoqin , Lin Xuemei , Han Xueguang , Ma Yushan , Zhao Fumin 
Published: April 2019

Abstract

Rationale:
Pernicious placenta accrete (PPP) is an obstetrical complication associated with severe life-threatening hemorrhage, which is one of the leading causes of maternal mortality worldwide. Caesarean hysterectomy is the effective method to control intraoperative bleeding for this unscheduled high-risk patient. But a challenge for clinicians in this case is to determine the optimal timing of hysterectomy, because it will directly determine maternal outcome.

Patient concerns:
We here report a case diagnosed with PPP who suffered from a severe life-threatening hemorrhage during cesarean section but was successfully resuscitated and subsequently discharged from hospital after a smooth recovery.

Diagnoses:
Although binding the lower uterine segment with a tourniquet markedly reduced bleeding in the surgical field after delivery, massive concealed vaginal life-threatening bleeding occurred immediately, and the amount of vaginal blood loss within 10 minutes was as much as 3000 mL.

Interventions:
An experienced multidisciplinary team was immediately established, and an unscheduled caesarean hysterectomy was performed immediately, and cell salvage was used.

Outcome:
The patient was successfully resuscitated and both the parturient and neonate were well and discharged.

Lesson:
If binding the lower uterine segment with a tourniquet markedly reduces bleeding in the surgical field after cesarean delivery in high-risk patients with PPP, and persistence of hypotension after active resuscitation of the circulation is detected, anesthesiologist should be vigilant enough to detect the possibility of concealed vaginal life-threatening bleeding. If this is confirmed, it should be quickly identified whether bleeding can be quickly controlled within a short period of time. If not, the preferred strategy is that the earlier the unscheduled hysterectomy, the better the outcome. A well-established multidisciplinary team and autologous blood recovery and transfusion techniques are also important in ensuring successful resuscitation of patients.
The mechanism of formation of thin-walled cystic lung cancer
Authors: Zhang Jie , Deng Hui , Wu Chong Chong , Wang Zhaoyu , Zhao Dahai , Wei Bo , Zhang Jing Yuan , Tong Xinjie , Gao Jie , Pan Lei , Xue Xin Ying 
Published: April 2019

Abstract
Thin-wall cystic lung cancer is becoming of increasing interest in the study of pulmonary medicine. Consequently, more and more different images and pathologic manifestations have been found. The purpose of this article is to find pathologic characteristics and try to explain the formation mechanism of thin-walled cystic lung cancer.
Sixty-five patients with this special lung cancer were analyzed retrospectively based on the review of medical records, radiologic findings, and pathologic changes.
We found 3 pathologic types: adenocarcinoma, squamous cell carcinoma, and lymphoma. There were 60 cases of adenocarcinoma, 4 cases were squamous cell carcinoma, and only 1 lymphoma. Tumor cells, pulmonary vessels, fibrous tissues, and residual bronchi are the pathologic basis of different image findings.
Thin-walled cystic lung cancers are mostly adenocarcinoma, but other pathologic types can also appear, such as squamous cell carcinoma and lymphoma. We can see that a large amount of fibrous tissues were generated by tumors around the bronchus, resulting in airway stenosis and degeneration. Tumor cells also can invade the bronchial wall and cause structural damage. All these lesions are similar to 1-way valves which can cause gas accumulation in the tumor area and result in thin-walled cystic lung cancer.
Amyloidosis secondary to intrapulmonary Castleman disease mimicking pulmonary hyalinizing granuloma-like clinical features
Authors: Wang Shao-Ting , Wang Qi-Pu , Li Ji , Zhang Ting , Zhang Lu , Mao Yue-Ying 
Published: April 2019

Abstract

Rationale:
Amyloidosis secondary to intrapulmonary Castleman disease (CD) is a rare benign disease diagnosed by histopathology. It seems to be associated with chronic inflammation, and large amounts of IL-6 produced in the germinal center of CD may enhance the production of precursor of amyloid.

Patient concerns:
We reported a case of an 18-year-old woman presenting with dry cough and dyspnea on exertion for 6 months and detailed exams revealed multiple pulmonary nodules, positive antinuclear antibodies, hypocomplementemia, and thrombocytopenia.

Diagnoses:
A computed tomography-guided percutaneous lung biopsy revealed the histopathological features of pulmonary hyalinizing granuloma (PHG), but video-assisted pulmonary wedge resection for biopsy with immunohistochemical stains finally demonstrated a corrected diagnosis of intrapulmonary CD with secondary amyloidosis.

Interventions:
The patient had received prednisone and Tacrolimus for 6 months.

Outcomes:
There was no significant improvement in pulmonary lesions or platelet level. Chemotherapy to CD was needed.

Lessons:
Intrapulmonary CD should be considered in patients with multiple pulmonary nodules irresponsive to corticosteroid and diagnosis of PHG should be carefully considered based on small lung biopsy sample. The treatment of amyloidosis secondary to CD remains to be uncertain.
Immune imbalance is associated with the development of preeclampsia
Authors: Ma Yu , Ye Yao , Zhang Jin , Ruan Cheng-Chao , Gao Ping-Jin 
Published: April 2019

Abstract
Preeclampsia (PE) is characterized by hypertension and proteinuria. It affects about 5% to 8% of pregnancies and causes maternal and perinatal mortality and morbidity. The immune imbalance and excessive inflammatory response play vital roles in the pathogenesis of PE.
In this study, we performed a case-control study to investigate the levels of cytokines, chemokines and adhesion molecules in serum and placenta of normal pregnant and PE women by Bio-Plex multiplex immunoassay and immunohistochemistry. In addition, we explored the phenotypes of monocyte and macrophage in peripheral blood and placentas in 2 groups by using flow cytometry analysis and immunohistochemistry.
Our results show that pro-inflammatory factors, including interleukin-1β (IL-1β), IL-6, IL-7, IL-8, IL-17a, monocyte chemotactic protein 1 (MCP -1), and macrophage inflammatory protein 1β (MIP-1β) were significantly increased in serum of women with PE compared with controls. In addition, we detected that IL-1β, IL-6, and MCP-1 were also increased in placentas of women with PE. We further revealed that peripheral blood monocytes showed a pro-inflammatory M1-like phenotype in women with PE. Consistently, M1 macrophage infiltration was increased in placenta of women with PE compared to that of normal pregnant women.
Our results demonstrated that immune imbalance promotes an inflammatory state during PE and it may be a potential therapeutic possibility for the management of PE.
Survey of nil per os duration of patients admitted to the emergency department due to vomiting
Authors: Yang Wen-Chieh , Chang Yu-Jun , Lin Ya-Chun , Chen Chun-Yu , Peng Yi-Chin , Wu Han-Ping 
Published: April 2019

Abstract
During the acute phase of vomiting, even a small amount of water may not be tolerated by mouth. Early refeeding may cause re-vomiting in patients, whereas late refeeding may result in dehydration and hypoglycemia. Nil per os (NPO) may be generally recommended by primary physicians, but the appropriate NPO duration for these patients is still unclear.
The study aimed to identify the ideal NPO duration for patients with acute vomiting.
We prospectively recruited patients with vomiting who underwent NPO management and were administered antiemetic agents in the emergency department (ED) and the pediatric ED. The demographics, final diagnosis, clinical manifestations, medical management, NPO duration, and laboratory data were collected and analyzed to identify the ideal NPO duration
A total of 304 patients with vomiting who were admitted in the ED were enrolled. The major diagnosis was acute gastroenteritis (AGE) (82.9%), followed by acute gastritis and colitis. Most patients were younger than 6 years (43.8%). Apart from abdominal pain and vomiting, nausea was the most common symptom (93.1%). NPO duration of 4 to 6 hours had the lowest rate of refeeding failure (3.7%) compared to the other NPO durations.
For patients with acute vomiting who are admitted to the ED, NPO duration of 4 to 6 hours may be necessary and should be recommended by primary ED physicians.
Diagnostic accuracy of red blood cell distribution width to platelet ratio for predicting staging liver fibrosis in chronic liver disease patients
Authors: Cai Ying , Liu Dina , Cui Jing , Sha Yu , Zhou Hengyu , Tang Ni , Wang Na , Huang Ailong , Xia Jie 
Published: April 2019

Abstract

Background:
Red cell volume distribution width to platelet ratio (RPR), as a novel noninvasive assessment, is frequently investigated. However, the utility of RPR to evaluate the diagnostic accuracy of liver fibrosis remains controversial. We performed a meta-analysis to determine the diagnostic performance of RPR for detecting staging liver fibrosis in patients with chronic liver disease.

Methods:
MEDLINE, EMBASE, and Cochrane Library databases were systematically searched. Summary receiver operating characteristic curves (SROC), diagnostic odds ratios (DOR), pooled estimates of sensitivity, specificity, and likelihood ratios were used to assess the diagnostic accuracy of RPR. Meta-regression and subgroup analyses were also performed to identify factors that contributed to heterogeneity. The Quality Assessment for Studies of Diagnostic Accuracy Studies-2 tool was applied to assess the quality.

Results:
Fifteen studies with a total of 3346 patients were included in the meta-analysis. The area under the curve for SROC to summarize diagnostic accuracy of RPR for prediction of significant fibrosis, advanced fibrosis, and cirrhosis was 0.73 (standard error [SE] = 0.02), 0.83 (SE = 0.03), and 0.85 (SE = 0.04), respectively. Pooled DOR with corresponding 95% confidence interval (CI) was 4.93 (95% CI: 3.78–6.43), 10.27 (95% CI: 6.26–16.84), and 12.16 (95% CI: 5.85–25.28), respectively, using a random effects model. Meta-regression showed that length of liver biopsy specimen potentially contributed to heterogeneity. There was no significant publication bias observed across the eligible studies.

Conclusions:
In chronic liver disease patients, RPR presented a good performance for prediction of significant fibrosis, advanced fibrosis, and cirrhosis. More future trials are required for prospective validation.