bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Pediatric Resident Physician Depression and Burnout With Harmful Medical Errors on Inpatient Services
Authors: Brunsberg Katherine A. , Landrigan Christopher P. , Garcia Briana M. , Petty Carter R. , Sectish Theodore C. , Simpkin Arabella L. , Spector Nancy D. , Starmer Amy J. , West Daniel C. , Calaman Sharon 
Published: May 2019

Purpose
To determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians.

Method
The authors conducted a prospective cohort study from 2011 to 2013 in seven pediatric academic medical centers in the United States and Canada. Resident physicians were screened for burnout and depression using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) and Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). A two-step surveillance methodology, involving a research nurse and two physician reviewers, was used to measure and categorize errors. Bivariate and mixed-effects regression models were used to evaluate the relationship between burnout, depression, and rates of harmful, nonharmful, and total errors.

Results
A total of 388/537 (72%) resident physicians completed the MBI-HSS and HANDS surveys. Seventy-six (20%) and 178 (46%) resident physicians screened positive for depression and burnout, respectively. Screening positive for depression was associated with a 3.0-fold higher rate of harmful errors (incidence rate ratio = 2.99 [95% CI 1.40–6.36], P = .005). However, there was no statistically significant association between depression and total or nonharmful errors or between burnout and harmful, nonharmful, or total errors.

Conclusions
Resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors. This association suggests resident physician mental health could be an important component of patient safety. If further research confirms resident physician depression increases the risk of harmful errors, it will become imperative to determine what interventions might mitigate this risk.
Comparison of Preoperative Parameter Measurements Using an Optical Biometer, Automated Keratometer, and a Placido-Based Topographer Module
Authors: Gill Ekjyot S. , Le Christopher , Joseph Jacob , Munir Wuqaas M. 
Published: May 2019

Objectives:
To assess the agreement of corneal power, corneal astigmatism, axis location, and astigmatic vector component measurements using a Lenstar LS900, a T-cone add-on, and an ARK 1S autorefractor, furthermore, to assess instrument agreement in a subset of astigmatic eyes.

Methods:
Retrospective analysis of keratometric readings from 3 instruments for 66 eyes undergoing cataract surgery at the Maryland Veterans Affairs Medical Center from November 2014 to 2015. Agreement in corneal power, mean corneal power, axis location, and astigmatic vector components (J0, J45) between devices was evaluated. Comparability was assessed using intraclass correlation, analysis of variance (ANOVA) one-way analysis, Bland–Altman analysis, and power vector analysis. Intraclass correlation was then assessed for a subset of 42 eyes with corneal astigmatism greater than or equal to 1 D.

Results:
The intraclass correlation between instruments was 0.941 for corneal power, 0.788 for corneal astigmatism, 0.932 for J0, and 0.809 for J45. The ANOVA one-way repeated P values comparing Kf, Ks, Km, corneal astigmatism, axis location, J0, and J45 were all greater than 0.05. Power vector analysis showed nearly all values between instruments to be within ±0.5 D. Finally, the intraclass correlation between instruments in eyes with ≥1 D of corneal astigmatism as measured by the T-cone was 0.946 for corneal power, 0.837 for corneal astigmatism, 0.948 for J0, and 0.950 for J45.

Conclusions:
The high level of agreement between all devices indicates the instruments may be used interchangeably. Our data suggest that this may also be true for the subset of eyes with greater than or equal to 1 D in astigmatism, highlighting the toric intraocular lens population.
Causes and Management Outcomes of Acquired Corneal Opacity in a Preschool Age (0–5 Years) Group: A Hospital-Based Study
Authors: Maharana Prafulla K. , Nawaz Shah , Singhal Deepali , Jhanji Vishal , Agarwal Tushar , Sharma Namrata , Vajpayee Rasik B. 
Published: May 2019

Purpose:
To evaluate the causes and management outcomes of acquired corneal opacity in a preschool age group (0–5 years) at a tertiary care hospital.

Methods:
Medical records of all cases (0–5 years) with acquired corneal opacity presenting to the cornea clinic of a tertiary eye care hospital from February 2013 to January 2014 were evaluated for age of onset, age at presentation, sex, laterality, cause of opacity, visual acuity, nutritional status, and socioeconomic class of the parents. The etiology of corneal opacity and the type of intervention with outcome at 3 months follow-up were recorded.

Results:
A total of 106 cases were included in the study. The most common cause of corneal scarring was healed infective keratitis (35.8%). Chemical injury, mechanical trauma, and keratomalacia were the other causes, affecting 21.8%, 20.8%, and 16% of the cases, respectively. Optical iridectomy was the most commonly performed procedure (35.8%), followed by lens aspiration with intraocular lens implantation (17.9%) and penetrating keratoplasty (17%). The mean corrected visual acuity (spectacle or contact lens) at the time of presentation and at 3 months after treatment was 2.9 ± 0.3 (perception of light) and 2.2 ± 0.9 (hand motions) logarithm of minimum angle of resolution (logMAR) units, respectively.

Conclusions:
Chemical injury and keratomalacia are the major causes of acquired corneal opacity in preschool age groups in India and are associated with poor visual prognosis.
Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome
Authors: Bednarska Olga , Icenhour Adriane , Tapper Sofie , Witt Suzanne T. , Tisell Anders , Lundberg Peter , Elsenbruch Sigrid , Engström Maria , Walter Susanna 
Published: May 2019

Abstract
Irritable bowel syndrome (IBS) is a visceral pain condition with psychological comorbidity. Brain imaging studies in IBS demonstrate altered function in anterior insula (aINS), a key hub for integration of interoceptive, affective, and cognitive processes. However, alterations in aINS excitatory and inhibitory neurotransmission as putative biochemical underpinnings of these functional changes remain elusive. Using quantitative magnetic resonance spectroscopy, we compared women with IBS and healthy women (healthy controls [HC]) with respect to aINS glutamate + glutamine (Glx) and γ-aminobutyric acid (GABA+) concentrations and addressed possible associations with symptoms. Thirty-nine women with IBS and 21 HC underwent quantitative magnetic resonance spectroscopy of bilateral aINS to assess Glx and GABA+ concentrations. Questionnaire data from all participants and prospective symptom-diary data from patients were obtained for regression analyses of neurotransmitter concentrations with IBS-related and psychological parameters. Concentrations of Glx were lower in IBS compared with HC (left aINS P < 0.05, right aINS P < 0.001), whereas no group differences were detected for GABA+ concentrations. Lower right-lateralized Glx concentrations in patients were substantially predicted by longer pain duration, while less frequent use of adaptive pain‐coping predicted lower Glx in left aINS. Our findings provide first evidence for reduced excitatory but unaltered inhibitory neurotransmitter levels in aINS in IBS. The results also indicate a functional lateralization of aINS with a stronger involvement of the right hemisphere in perception of abdominal pain and of the left aINS in cognitive pain regulation. Our findings suggest that glutaminergic deficiency may play a role in pain processing in IBS.
Clinical implication of maximal voluntary ventilation in myotonic muscular dystrophy
Authors: Suh Mi Ri , Kim Dong Hyun , Jung Jiho , Kim Bitnarae , Lee Jang Woo , Choi Won Ah , Kang Seong-Woong 
Published: May 2019

Abstract
Patients with myotonic muscular dystrophy type 1 (DM1) tend to exhibit earlier respiratory insufficiency than patients with other neuromuscular diseases at similar or higher forced vital capacity (FVC). This study aimed to analyze several pulmonary function parameters to determine which factor contributes the most to early hypercapnia in patients with DM1.
We analyzed ventilation status monitoring, pulmonary function tests (including FVC, maximal voluntary ventilation [MVV], and maximal inspiratory and expiratory pressure), and polysomnography in subjects with DM1 who were admitted to a single university hospital. The correlation of each parameter with hypercapnia was determined. Subgroup analysis was also performed by dividing the subjects into 2 subgroups according to usage of mechanical ventilation.
Final analysis included 50 patients with a mean age of 42.9 years (standard deviation = 11.1), 46.0% of whom were male. The hypercapnia was negatively correlated with MVV, FVC, forced expiratory volume in 1 second (FEV1), and their ratios to predicted values in subjects with myotonic muscular dystrophy type 1. At the same partial pressure of carbon dioxide, the ratio to the predicted value was lowest for MVV, then FEV1, followed by FVC. Moreover, the P values for differences in MVV and its ratio to the predicted value between ventilator users and nonusers were the lowest.
When screening ventilation failure in patients with DM1, MVV should be considered alongside other routinely measured parameters.
A mutation in PIK3CD gene causing pediatric systemic lupus erythematosus
Authors: Li Guo-Min , Liu Hai-Mei , Guan Wan-Zhen , Xu Hong , Wu Bing-Bing , Feng Jia-Yan , Sun Li 
Published: May 2019

Abstract

Rationale:
Gain of function (GOF) mutations in PIK3CD gene encoding PI3K p110δ were recently associated with a novel combined immune deficiency characterized by recurrent sinopulmonary infections, CD4
+ lymphopenia, reduced class-switched memory B cells, lymphadenopathy, cytomegalovirus and/or epstein-Barr virus (EBV) viremia, and EBV-related lymphoma. A subset of affected patients also had elevated serum IgM.

Patient concerns:
We report a patient who was diagnosed with systemic lupus erythematosus (SLE) at a young age and was recently found to carry heterozygous mutations in PIK3CD. The patient not only presented with recurrent sinopulmonary infections, CD4
+ lymphopenia, lymphadenopathy, EBV viremia, and elevated serum IgM, but also met classification criteria of SLE based on persistent proteinuria and hematuria, leukopenia and anemia, low level of serum complement, and positive autoantibody for antinuclear antibodies.

Diagnoses:
Activated PI3Kδ syndrome.

Interventions:
Oral prednisolone and hydroxychloroquine combined with mycophenolate mofetil was given to the patient. He was currently receiving intravenous immunoglobulin per month in association with hydroxychloroquine, low-dose prednisolone, and mycophenolate mofetil.

Outcomes:
At present, the level of complement restored to normal, hematuria and proteinuria disappeared, and liver function returned to normal.

Lessons:
SLE may be a novel phenotype of GOF mutation in PI3CKD gene (GOF PIK3CD).
Presence of diabetic retinopathy is lower in type 2 diabetic patients with non-alcoholic fatty liver disease
Authors: Zhang Meng , Li Li , Chen Jing , Li Bei , Zhan Yutao , Zhang Chuan 
Published: May 2019

Abstract
To analyze the association between non-alcoholic fatty liver disease (NAFLD) and the presence of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).
Total 411 T2DM patients were divided into NAFLD and control groups. NAFLD was diagnosed by ultrasound. Retinopathy was diagnosed by fundus photography. All patients were screened based on medical history, physical examinations, and laboratory measurements.
The prevalence of NAFLD and DR in T2DM patients was 60.8% and 40.9%, respectively. The presence of DR was associated with diabetes duration, systolic blood pressure (SBP), glycated hemoglobin (HbA1c), and proteinuria (all P < .001) using univariate and multivariate regression analyses. The prevalence of DR was lower in patients with NAFLD than those without NAFLD (37.2% vs 46.6%, P = .065), and significantly lower in patients with moderate and severe NAFLD (30.2% vs 46.6%, P = .012; 14.3% vs 46.6%, P = .024). The presence of DR in NAFLD patients was associated with diabetes duration (P = .032) in Chi-squared analysis.
NAFLD and DR were highly prevalent in T2DM patients. Diabetes duration, SBP, HbA1c, and proteinuria were risk factors for DR in T2DM patients. The presence of DR was lower in T2DM patients with NAFLD, which was mainly due to their shorter diabetes duration.
Dual arterial blood supply D-pouch in a patient with ulcerative colitis undergoing proctocolectomy and ileal pouch-anal anastomosis
Authors: Hu Hang , Zhang Yichao , Qian Qun , Xu Ming , Chen Min , Jiang Congqing , Ding Zhao 
Published: May 2019

Abstract

Introduction:
Pouchitis is the most common complication in Ulcerative colitis (UC) patients after restorative proctocolectomy with ileal pouch-anal anastomosis (RP-IPAA) and ischemia may be a significant contributing factor. Tension and blood supply are the primary concerns while performing the procedure. A dual arterial blood supply technique is designed to decrease tension while ensuring sufficient blood perfusion.

Patient concerns:
A 61-year-old female patient with 14 years history of UC wanted to seek surgical treatment.

Diagnoses:
Ulcerative colitis.

Interventions:
After physical examination and treatment of parenteral nutrition, the patient underwent a D-pouch with dual arterial blood supply after total proctocoloectomy.

Outcomes:
The patient recovered well and was discharged 10 days after her procedure. Postoperatively dual arterial blood supply to the D-pouch was demonstrated by computed tomography angiography (CTA).

Conclusion:
D-pouch with dual arterial blood supply is feasible and safe in patients with UC undergoing RP-IPAA.
Distal femoral physeal fractures after neonatal osteomyelitis
Authors: Wu Xing , Xia Jingdong , Li Jun , Sun Jie , Shen Xiantao 
Published: May 2019

Abstract

Rationale:
The physeal separations and septic osteomyelitis in newborns are unusual, which represents a challenging problem in diagnosis and treatment.

Patient concerns:
A 2-day-old mature male suddenly complained by parents about minimal swelling around the left knee, decreased left extremity motion and no fever.

Diagnosis:
Preliminary x-rays of the lower extremities demonstrated a displaced distal femoral physeal, Laboratory investigation indicated infection. Magnetic resonance imaging and ultrasound showed displaced distal femoral physeal. A needle aspiration confirmed the diagnosis.

Intervention:
Debridement and ultrasound guide reduction with pinning of physeal separations was performed.

Outcome:
At 5 years later, his last follow-up showed that there was only 1.6 cm limb-length discrepancy without angular deformity, the child did not report any pain and was perfectly able to perform his daily activities.

Lessons:
Distal femoral physeal fractures after neonatal osteomyelitis requires immediate and reliable decision for management. We point out the important role of the application of sonography, which is helpful to make an early diagnosis and guide reduction and percutaneous pinning of distal femoral physeal fractures.
Tracheal atresia with a cephalically developed lung bud
Authors: Lee Na Mi , Yi Dae Yong , Yun Sin Weon , Chae Soo Ahn , Lim In Seok 
Published: May 2019

Abstract

Rationale:
Tracheal atresia (TA) involves complete or partial tracheal absence below the larynx. It involves failure of complete separation of the laryngotracheal diverticulum from the foregut at the 4th gestational week. In TA, the trachea and main bronchi generally proceed in the normal caudal directions.

Patient concerns:
At the gestational age of 34 weeks and 6 days, a male baby weighing 2290 g was born via cesarean section. A brisk bag was used, and mask ventilation was performed, but was not effective. Intubation was attempted; however, the endotracheal tube did not advance below the vocal cord.

Diagnosis:
Tracheal atresia.

Interventions:
An emergent open neck exploration could not reveal the trachea. On computed tomography, the tracheoesophageal fistula (TEF) started from the lower esophagus just above the gastroesophageal junction. The trachea arose upward to form the main bronchus.

Outcomes:
His parents signed the “Do not resuscitate” form due to poor outcome. On the 23rd day of birth, the baby expired.

Lessons:
Our case involved TA with tracheoesophageal fistula forming between the trachea and main bronchi in a cephalic direction as detected on computed tomography. Further, the trachea arose from the gastroesophageal junction; thus, it does not belong to any Floyd classification. Herein, we report a TA case with a cephalically developed lung bud.
Treatment outcomes of percutaneous transhepatic variceal embolization versus transjugular intrahepatic portosystemic shunt for gastric variceal bleeding
Authors: Zhang Kai , Sun Xiaoyan , Wang Guangchuan , Zhang Mingyan , Wu Zhe , Tian Xiangguo , Zhang Chunqing 
Published: May 2019

Abstract
There have been few studies comparing percutaneous transhepatic variceal embolization (PTVE) and transjugular intrahepatic portosystemic shunt (TIPS) for the prevention of recurrent gastric variceal bleeding (GVB).
Compare the outcomes of these 2 procedures in patients with GVB.
A total of 74 cirrhosis patients with GVB who underwent TIPS and modified PTVE were enrolled. The rebleeding and mortality rates, portal vein pressure (PVP) variation, and rates of hepatic encephalopathy (HE) were compared between the 2 groups.
A total of 43 PTVE and 31 TIPS patients were enrolled in this study. The difference of rebleeding rate in the 2 groups was not statistically significant (P
= .190). The difference of early rebleeding rates and cumulative rebleeding-free rates were all not statistically significant (P
= .256, P = .200). The difference of mortality rates in the 2 groups was not statistically significant (χ2 = 1.206, P = .272). The rate of HE in TIPS group was statistically higher than that in PTVE group (P < .0001).
Both PTVE and TIPS were effective for preventing rebleeding of GVs. There were no significant differences in rebleeding and mortality rates. The incidence of HE after TIPS was higher than PTVE.
Electronic fetal monitoring characteristics of a patient with sudden onset of placental abruption and intrauterine fetal demise
Authors: Zhang Yan , Zuo Xiaohang , Yuan Ting , Teng Yue 
Published: May 2019

Abstract

Introduction:
Placental abruption (PA) is a serious complication of pregnancy, associated with significant perinatal complications, including intrauterine fetal demise (IUFD). Continuous electronic fetal monitoring (EFM) has been widely applied in China in recent decades. Exploration of potentially PA-specific patterns of EFM contributes to early detection of PA occurrence.

Patient concerns and diagnosis:
A 33-year-old woman (gravida 3, para 1) was referred to our hospital at 33+3 weeks gestation due to non-reassuring fetal heart rate (FHR) pattern, and suffered sudden onset of severe PA and subsequent intrauterine fetal demise.

Interventions:
We analyzed the characteristics of her non-stress tests (NSTs) 1 day and 10 min before the detection of PA, aiming to explore potentially PA-specific patterns of EFM and provide reference for early detection of asymptomatic PA occurrence in obstetric practice.

Outcomes:
Unfavored characteristics of FHR patterns before PA onset are analyzed.

Conclusion:
For those who sense decreased fetal movements (DFMs), a NST and a biophysical profile (BPP) are recommended for exclusion of potential adverse maternal and fetal complications.
Clinical characterization of icotinib-induced chemoresistance in erlotinib-treated lung adenocarcinoma patient with EGFR mutations
Authors: Wu Ka , Guo Chao , Li Rong 
Published: May 2019

Abstract

Rationale:
Mounting evidences reveal that mutation of epidermal growth factor receptor (EGFR) may induce the resistance of tyrosine kinase inhibitors (TKIs). TKI-resistant lung cancer cells are sensitive to inhibition of the EGFR pathway. This case report aimed to characterize the therapeutic benefits of erlotinib, a targeted drug, on an advanced lung cancer patient with somatic EGFR mutation.

Patient concerns:
A 52-year-old non-smoking Chinese woman was suffered from pneumonia-based chest pains, and the patient was diagnosed as advanced lung cancer through medical imaging, thoracoscopy, and pathological examination.

Diagnoses:
Blood tests, pathological examination, thoracoscopy, computed tomography (CT)/positron emission computed tomography (PET) scans, next-generation sequencing (NGS) testing were subjected to the patient's samples before and after targeted drug treatments.

Interventions:
After icotinib-induced resistance, the chemoresistance mechanism was involved in EGFR mutations before being prescribed with erlotinib.

Outcomes:
The therapeutic effectiveness of icotinib for 4-month showed undetected carcinomatous metastasis. The lung tumor sizes were reduced, and improved quality of life (QOL) was described by the patient. Followed by monotherapy with erlotinib for 1.5-year, the icotinib-resistant patient benefited from longer survival rate without tumor enlargement and neoplastic metastasis. In therapeutic duration of erlotinib, T790M mutation of EGFR, R248W mutation of tumor protein p53 (TP53), K844S mutation of retinoblastoma protein 1 (RB1) were identified through NGS test.

Lessons:
In conclusion, the anti-cancer benefits of icotinib and erlotinib against advanced lung cancer may contribute to suppress neoplastic growth and metastasis. Further, erlotinib exerts potent efficacy for extended survival rate of patient because detectable mutations may not or limitedly induce erlotinib-resistance. In addition, reduced circulating hormones by menopause may enhance the therapeutic effectiveness of erlotinib.
Predictive factors for the development of renal insufficiency following partial nephrectomy and subsequent renal function recovery
Authors: Lee Kwang Suk , Kim Dae Keun , Kim Kwang Hyun , Bang Woo Jin , Kim Hyung Joon , Park Sung Yul , Rha Koon Ho , Chung Byung Ha , Cho Jin Seon , Koo Kyo Chul 
Published: May 2019

Abstract
Patients who undergo partial nephrectomy (PN) may exhibit renal function insufficiency, and a subset of these patients achieves renal function recovery. We evaluated the predictors of renal insufficiency and subsequent renal function recovery following PN. Data on 393 patients who underwent PN for solid renal tumors between March 2001 and November 2013, obtained from 6 institutions, were retrospectively reviewed. Renal insufficiency was defined as new onset of chronic kidney disease stage ≥3 postoperatively on the second of 2 consecutive tests. Renal function recovery was defined as an estimated glomerular filtration rate ≥60 ml/minute/1.73 m2 following renal insufficiency. Tumor complexity was stratified according to the RENAL classification system. The median (interquartile range) age, tumor size, and follow-up period were 53 (45–63) years, 2.6 (1.9–3.8) cm, and 36 (12–48) months, respectively. Tumors were of low complexity in 258/393 (65.6%) of cases. Renal insufficiency developed in 54/393 (13.5%) patients, in which age ≥60 years and preoperative creatinine ≥1.1 mg/ml were independent predictors. Tumor complexity, clamp type, and operative method were not significant prognostic factors. Among patients with newly developed renal insufficiency, 18/54 (33.3%) patients exhibited renal function recovery within a median period of 18 months, of which preoperative creatinine <1.1 mg/ml was an independent predictor. Age ≥60 years and preoperative creatinine ≥1.1 mg/ml were risk factors for renal insufficiency following PN. Patients with renal insufficiency whose preoperative creatinine was <1.1 mg/ml were likely to have renal function recovery.