bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abnormal medial prefrontal cortex functional connectivity and its association with clinical symptoms in chronic low back pain
Authors: Tu Yiheng , Jung Minyoung , Gollub Randy L. , Napadow Vitaly , Gerber Jessica , Ortiz Ana , Lang Courtney , Mawla Ishtiaq , Shen Wei , Chan Suk-Tak , Wasan Ajay D. , Edwards Robert R. , Kaptchuk Ted J. , Rosen Bruce , Kong Jian 
Published: February 2019

Abstract
Accumulating evidence has shown that complicated brain systems are involved in the development and maintenance of chronic low back pain (cLBP), but the association between brain functional changes and clinical outcomes remains unclear. Here, we used resting-state functional magnetic resonance imaging (fMRI) and multivariate pattern analysis to identify abnormal functional connectivity (FC) between the default mode, sensorimotor, salience, and central executive brain networks in cLBP and tested whether abnormal FCs are related to pain and comorbid symptoms. Fifty cLBP patients and 44 matched healthy controls (HCs) underwent an fMRI scan, from which brain networks were identified by independent component analysis. Multivariate pattern analysis, graph theory approaches, and correlation analyses were applied to find abnormal FCs that were associated with clinical symptoms. Findings were validated on a second cohort of 30 cLBP patients and 30 matched HCs. Results showed that the medial prefrontal cortex/rostral anterior cingulate cortex had abnormal FCs with brain regions within the default mode network and with other brain networks in cLBP patients. These altered FCs were also correlated with pain duration, pain severity, and pain interference. Finally, we found that resting-state FC could discriminate cLBP patients from HCs with 91% accuracy in the first cohort and 78% accuracy in the validation cohort. Our findings suggest that the medial prefrontal cortex/rostral anterior cingulate cortex may be an important hub for linking the default mode network with the other 3 networks in cLBP patients. Elucidating the altered FCs and their association with clinical outcomes will enhance our understanding of the pathophysiology of cLBP and may facilitate the development of pain management approaches.
Explosive Growth in British Physician Associate Education Since 2008
Authors: Ritsema Tamara S. , Roberts Karen A. , Watkins Jeannie S. 
Published: February 2019

Abstract
Physician associate (PA) education in the United Kingdom has grown substantially since the establishment of 4 PA education programs in the late 2000s. From those 4 programs in 2008, the number of universities educating PAs fell to a nadir of 2 programs in 2012 and then rose to 29 by the end of 2017. Due to program closures, the number of students enrolled in the early years fluctuated substantially. In 2008, 43 students entered PA education; in 2010, only 17 students started PA training, but in 2017, the number of students enrolled in PA programs soared to 853. Early in the course of PA education, programs were only offered in the greater London and West Midlands areas of England. As of 2017, PAs were being educated in all 4 countries of the United Kingdom, although the explosive growth in the number of programs is expected to slow as 2020 nears.
A case report of crystalline light chain inclusion-associated kidney disease affecting podocytes but without Fanconi syndrome
Authors: Ito Kiyoaki , Hara Satoshi , Yamada Kazunori , Zoshima Takeshi , Mizushima Ichiro , Fujii Hiroshi , Miyazaki Ryoichi , Kawai Yasukazu , Yachie Akihiro , Nagata Michio , Izui Shozo , Yamagishi Masakazu , Kawano Mitsuhiro 
Published: January 2019

Abstract

Rationale:
Crystalline light chain inclusion-associated kidney disease affects mainly tubular epithelial cells and is often clinically manifested as Fanconi syndrome. However, only very few case reports about the crystalline deposits within the podocytes are available, and the nature of the pathogenic monoclonal light chain implicated in these cases is still unknown. We report a case of crystalline inclusion-associated kidney disease manifested as crystalline podocytopathy in which we identified the complete structure of the pathogenic monoclonal light chain as belonging to the germ-line gene of Vκ1-39.

Patient concerns:
We describe a 65-year-old woman with crystalline light chain inclusion-associated kidney disease showing mild proteinuria and renal insufficiency with monoclonal gammopathy of undetermined significance without Fanconi syndrome. She had crystalline inclusions mainly within podocytes, tubular epithelial cells and histiocytes in the kidney. Light microscopy showed vacuolation of podocytes and tubular epithelial cells, while eosin negative pale needle-like crystals were present within these cells. Electron microscopy showed accumulation of club-like crystals with high electron density in podocytes, proximal tubular epithelial cells and interstitial histiocytes. Clonal analysis revealed that a pathogenic monoclonal light chain was derived from germline gene, Vκ1-39.

Diagnoses:
The diagnosis of crystalline light chain inclusion-associated kidney disease was made.

Interventions and outcomes:
Bortezomib and dexamethasone were started and her renal function improved to eGFR 36 mL/min/1.73 m2 after 9 courses of therapy.

Lessons:
Patients with light chain crystalline podocytopathy may have a similar pathogenic monoclonal light chain derived from the same germline gene, Vκ1–39, to that of patients with light chain proximal tubulopathy.
Extrauterine epithelioid trophoblastic tumors presenting as lung mass
Authors: Li Jia-Wen , Hu Chang-Chang , Shi Hai-Yan , Wu Rui-Jin 
Published: January 2019

Abstract

Rationale:
Extrauterine epithelioid trophoblastic tumors (ETT) is a rare variant of gestational trophoblastic neoplasms. Here we aim to learn more clinical and pathological characteristics of ETT patient with an isolated pulmonary mass without uterine lesions, through a rare case of extra-uterine ETT and 7 cases published in English periodicals literature.

Patient concerns:
A 31-year-old Chinese woman, presented with low-level elevation of serum human chorionic gonadotropin (HCG) for more than 2 years without abnormal symptoms. Dilation and curettage (D&C) was performed and histopathology revealed a secretory phase of endometrium. Chest computed tomography (CT) scan showed a 0.8 cm nodular lesion in the upper left lobe. Then a thoracotomy with left upper lobe segmentectomy was performed.

Diagnosis:
After pathological and immunohistochemistry diagnosis, the case was confirmed as ETT (III).

Interventions:
According to FIGO guideline, the patient took 3 cycles of multivalent chemotherapy consisting of cisplatin and etoposide, alternating with etoposid, methotrexate dactinomycin (EP-EMA).

Outcomes:
The patient had no obvious signs of recurrence after 13 months of follow-up.

Lessons:
When a fertile age woman persistently shows abnormal low-level escalation of HCG, ETT should be taken into consideration, especially lung X-ray or CT showing lesions without apparent abnormality of the uterus.
Adjuvant chemotherapy improves oncological outcomes of resectable intrahepatic cholangiocarcinoma
Authors: Ma Ka Wing , Cheung Tan To , Leung Brian , She Brian Wong Hoi , Chok Kenneth Siu Ho , Chan Albert Chi Yan , Dai Wing Chiu , Lo Chung Mau 
Published: January 2019

AbstractObjective:To define the role of adjuvant chemotherapy in the management of resectable intrahepatic cholangiocarcinoma (ICC) by performing a meta-analysis.Summary background data:Oncological benefit of adjuvant chemotherapy in resectable ICC remains controversial, high-level evidence in such context is lacking.Method:A comprehensive search using Pubmed, EMbase, and Web of Science was performed from inception to October 2018. Studies compared the survival of patients receiving adjuvant chemotherapy versus surgery alone were included. Data were analyzed using random effect model. Quality of each study and presence of publication bias were assessed by Newcastle–Ottawa score (NOS) and funnel plot with Egger test respectively.Results:The present meta-analysis included 15 studies (all were retrospective series) and 5060 patients. Adjuvant chemotherapy was administered either intravenously or intra-arterially in the form of trans-arterial chemo-embolization (TACE). The average NOS for the included studies was 6.5. Pooled analysis of the included studies demonstrated significant advantage in the adjuvant chemotherapy group (HR 0.66, 0.55–079,P <.001, I-square [I2] = 20.8%). After 2 studies were removed for heterogeneity, advantage of adjuvant chemotherapy remained (HR 0.72, 0.62–0.84,P <.001, I2 = 0%). Funnel plot suggested no significant publication bias (Egger test, 2-tailedP = .203). Subgroup analyses suggested that intravenous route of chemotherapy injection (P <.001) and use of gemcitabine base regimen (P = .004) are associated with improved overall survival. Adjuvant chemotherapy did not improve disease-free survival in subgroup analysis (P = .94).Conclusion:Adjuvant chemotherapy is associated with improved overall survival and should be considered in patients with ICC following curative resection and in particular to patients with advance disease.
Clinical effects of pulsed radiofrequency to the thoracic sympathetic ganglion versus the cervical sympathetic chain in patients with upper-extremity complex regional pain syndrome
Authors: Park JungHyun , Lee Yun Jae , Kim Eung Don 
Published: January 2019

Abstract
Pulsed radiofrequency (PRF) to the thoracic sympathetic ganglion (TSG PRF) or to the cervical sympathetic chain (CSC PRF) can be performed to overcome transient effects of single sympathetic blocks in patients with upper-extremity complex regional pain syndrome (CRPS).
We retrospectively compared the clinical effects of TSG PRF and CSC PRF. Seven TSG PRF cases and 10 CSC PRF cases were enrolled in the present analysis. We assessed effectiveness with multiple clinical measurements: a numerical rating scale (NRS) of pain before and 1 week after the procedure, postprocedure temperature, effect duration, and a self-described patient satisfaction score.
The temperature was significantly higher in TSG PRF cases than in CSC PRF cases. Pain values (according to the NRS) 1 week after the procedure were significantly lower, and the effect duration was significantly longer, after TSG PRF than after CSC PRF.
TSG PRF is a more effective procedure than CSC PRF for managing chronic upper-extremity CRPS.
Identification of key genes and pathways in hepatocellular carcinoma
Authors: Wu Min , Liu Zhaobo , Zhang Aiying , Li Ning 
Published: January 2019

Abstract

Background:
Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide. However, the precise mechanisms of the development and progression of HCC remain unclear. The present study attempted to identify and functionally analyze the differentially expressed genes between HCC and cirrhotic tissues by using comprehensive bioinformatics analyses.

Methods:
The GSE63898 gene expression profile was downloaded from the Gene Expression Omnibus (GEO) and analyzed using the online tool GEO2R to identify differentially expressed genes (DEGs). Gene ontology (GO) functional analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of the DEGs were performed in DAVID. The STRING database was used to evaluate the interactions of DEGs and to construct a protein-protein interaction (PPI) network using Cytoscape software. Hub genes were selected using the cytoHubba plugin and were validated with the cBioPortal database.

Results:
A total of 301 DEGs were identified between HCC and cirrhotic tissues. The GO analysis results showed that these DEGs were significantly enriched in certain biological processes including negative regulation of growth and cell chemotaxis. Several significant pathways, including the p53 signaling pathway, were identified as being closely associated with these DEGs. The top 12 hub genes were screened and included TTK, NCAPG, TOP2A, CCNB1, CDK1, PRC1, RRM2, UBE2C, ZWINT, CDKN3, AURKA, and RACGAP1. The cBioPortal analysis found that alterations in hub genes could result in significantly reduced disease-free survival in HCC.

Conclusion:
The present study identified a series of key genes and pathways that may be involved in the tumorigenicity and progression of HCC, providing a new understanding of the underlying molecular mechanisms of carcinogenesis in HCC.
Fulminant type 1 diabetes mellitus
Authors: You Wei , Yang Jianming , Liu Yanqun , Wang Wen , Zhu Li , Wang Wei , Yang Jun , Chen Fangyuan 
Published: January 2019

Abstract

Rationale:
Fulminant type 1 diabetes mellitus (FT1DM) is a new subtype of type 1 diabetes mellitus that was first proposed by the Japanese scholar Imagawa in 2000. In the 2 patient cases described in this study, gastrointestinal symptoms were the first symptoms reported, and the initial blood glucose levels were very high. However, the glycosylated hemoglobin (HbA1c) levels were not very high, the islet β-cell function was almost completely lost in a short time, and the metabolic disorder was severe; the patients’ islet β cells demonstrated complete and irreversible functional damage, and the prognosis was poor.

Patient concerns:
We report a 37-year-old and 48-year-old male patients. The first patient was addmited with emesis and diarrhea for 2 days and the second patient had stomachache for 8 days, emesis and dyspnea for half an hour before admission. Both patients had no history of hypertension, coronary heart disease, or hyperglycemia.

Diagnosis:
Two patients had same scenario: acute onset, hyperglycemia, ketoacidosis, β cell function deficiency, and HbA1c <8.5%.

Interventions:
After admission, the administration of adequate liquid infusion, the intravenous injection of regular insulin to reduce the blood glucose levels, and the correction of electrolyte disturbance and acid-base imbalance were conducted.

Outcomes:
Subsequently, the blood glucose level of the patients was gradually reduced, the acidosis was corrected, and the disease conditions gradually stabilized. For both patients, the long-term insulin replacement therapy of “insulin aspart plus insulin glargine” was selected.

Lessons:
FT1DM is a new subtype of type 1 diabetes mellitus. The onset of this disease is rapid, and the function of islet β cells is almost completely lost in a short time period. This metabolic disorder is severe, and the clinical manifestations are nonspecific. Unless a timely and accurate diagnosis is made, and patients receive prompt treatment, it is difficult to control the disease and the risk of death is high.
Rapid Cycle Deliberate Practice Versus Reflective Debriefing for Pediatric Septic Shock Training*
Authors: Cory Melinda J. , Colman Nora , McCracken Courtney E. , Hebbar Kiran B. 
Published: February 2019

Objectives:
Rapid cycle deliberate practice is a simulation training method that cycles between deliberate practice and directed feedback to create perfect practice; in contrast to reflective debriefing where learners are asked to reflect on their performance to create change. The aim of this study is to compare the impact of rapid cycle deliberate practice versus reflective debriefing training on resident application and retention of the pediatric sepsis algorithm.

Design:
Prospective, randomized-control study.

Setting:
A tertiary care university children’s hospital simulation room, featuring a high-fidelity pediatric patient simulator.

Subjects:
Forty-six upper-level pediatric residents.

Interventions:
Simulation training using rapid cycle deliberate practice or reflective debriefing.

Measurements and Main Results:
Knowledge was assessed with a quiz on core sepsis management topics. The application of knowledge was assessed with a sepsis management checklist during the simulated scenario. The residents were assessed before and after the intervention and again at a follow-up session, 3–4 months later, to evaluate retention. Both groups had similar pre-intervention scores. Post-intervention, the rapid cycle deliberate practice group had higher checklist scores (rapid cycle deliberate practice 18 points [interquartile range, 18–19] vs reflective debriefing 17 points [interquartile range, 15–18]; p < 0.001). Both groups had improved quiz scores. At follow-up, both groups continued to have higher scores compared with the pre-intervention evaluation, with the rapid cycle deliberate practice group having a greater change in checklist score from pre-intervention to follow-up (rapid cycle deliberate practice 5 points [interquartile range, 3.5–7] vs reflective debriefing 3 points [interquartile range, 1.5–4.5]; p = 0.019). Both groups reported improved confidence in diagnosing and managing septic shock.

Conclusions:
Both rapid cycle deliberate practice and reflective debriefing are effective in training pediatric residents to apply the sepsis algorithm and in improving their confidence in the management of septic shock. The rapid cycle deliberate practice method was superior immediately post-training; however, it is unclear if this advantage is maintained over time. Both methods should be considered for training residents.
Reward Dysfunction in the Manic Spectrum: Unable to Win? The Use of Biographical Information to Refine Neurobiological Modeling
Authors: GOTTLIEB JOHN F. 
Published: February 2019

Objective:The manic spectrum is thought to be characterized by a hypersensitive biobehavioral reward system, the behavioral activation system. Evidence for this framework comes from questionnaire-based, self-report data collected in cross-sectional and prospective studies of mania, mania in remission, and proneness to hypomania, and from functional neuroimaging investigations of brain reward circuit activity during incentivized choice protocols. Although heightened reward anticipation is consistently documented, the status of later goal attainment activity, hedonic responses, and satiety reactions is less clear. This report examines the status of such reward receipt processes as they operate in the manic spectrum.Methods:A case report of a typical subject with bipolar II disorder with a hyperthymic temperament is presented using longitudinal, biographical data.Results:Diminished reward receipt, pleasure, and satiety were demonstrated indicating impaired hedonic processing in hyperthymic temperament. This impairment indicates a dissociation between early, intensified reward pursuit processes and later, blunted, reward attainment activity.Conclusions:The experience and neural correlates of hedonic processing may be impaired in the manic spectrum. Possible mechanisms for this impairment and its dissociation from the earlier stage of reward processing characterized by hyperactive reward pursuit are considered. Clinical reports and longitudinal, life-based follow-up can provide important data to supplement more experimentally based neurobiological models of reward dysfunction in bipolar disorders.
Use of Rapid Response Teams in Psychiatry: Variables that Impact Safety
Authors: GREYTAK RYAN , WANG JOANNA Y. , HSU YEA-JEN , MARSTELLER JILL , JAYARAM GEETHA 
Published: February 2019

Objective:
The addition of rapid response teams (RRTs) has emerged as a treatment option for medically deteriorating psychiatric inpatients. The goal of this study was to identify risk factors for use of RRTs at the time of initial psychiatric evaluation and develop measures to predict use of this emergent medical intervention. We have not located any studies that have previously addressed this issue.

Methods:
We studied the use of RRTs and code teams (CTs) on inpatient general and specialty psychiatric services in a large urban academic psychiatric hospital. RRT or CT calls were made for 60 patients on these units between January, 2010 and December, 2012. Our retrospective chart review study compared the cases of these 60 patients with 120 matched controls. Using χ2 and the Fisher exact tests, we identified variables that differed significantly between the case and control groups. Next, we used a forward stepwise regression model to create prediction tools to risk stratify patients at the time of initial assessment.

Results:
Bivariate analyses identified 14 independent statistically significant patient variables. We created 2 risk prediction tools: (1) an “exhaustive” tool (which used 12 of the total 38 factors we considered) based on a stepwise regression model that yielded an area under the receiver operating curve (AUC) of 0.91, and (2) a simplified tool referred to by the acronym “SCHEME” with 6 factors and an AUC of 0.76.

Conclusions:
We propose the acronym SCHEME to refer to a tool that can be used to quickly and easily assess medical risk in prospective psychiatric inpatients at the time of admission, which can help reduce the use of RRTs and CTs.
Outcomes of Acute Partial Hospital Treatment: Comparison of Two Programs and a Waiting List Control
Authors: LIEBERMAN PAUL B. , VILLALBA RENDUELES , FARRIS SAMANTHA G. 
Published: February 2019

Objective:
To investigate the effectiveness of acute, very brief partial hospital treatment, and the comparative benefits of different types of partial hospitalization programs (PHPs), this exploratory study examined changes in psychiatric symptoms and elements of cognitive functioning during an acute PHP compared with a waiting list control, and also compared such changes in 2 PHPs that treated similar patient groups but used different treatment approaches.

Methods:
Patients were admitted to 2 PHPs, one utilizing cognitive-behavioral therapy and the other interpersonal and existential psychotherapy. Assessments were collected at the start of a waiting list control period, as well as at admission to and discharge from the PHP. In both programs, patients completed self-report assessments of anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), hopelessness (Beck Hopelessness Scale), and resilience (Dispositional Resilience Scale) at admission and discharge; a subset of cognitive-behavioral therapy patients completed the same measures while on a waiting list.

Results:
During acute partial hospitalization (mean length of stay, 5.3±3.0 d), patients (N=2000) improved significantly (Cohen d=0.39 to 1.1) on all 4 measures of symptom severity and cognitive functioning. Although some changes were observed in the subjects on the 2-week waiting list, they were less than during a 1-week PHP admission. No significant differences in outcomes were found between the 2 PHPs.

Conclusions:
Across 2 different acute PHPs, significant reductions in symptom severity and improvements in elements of cognitive functioning were observed. Findings indicate that acute PHP treatment may produce moderate-sized treatment effects in a 1-week period that seem unrelated to specific psychotherapeutic methods.