bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives of Patients With Mental Illness on How to Better Teach and Evaluate Diversity Education in the National Health Service
Authors: George Riya Elizabeth , Smith Karl , O'Reilly Michelle , Dogra Nisha 
Published: April 2019

Introduction:
Diversity education is a mandatory requirement for all mental-health practitioners and health care professionals in the UK National Health Service. Wide variability exists in the development, delivery, and evaluation of diversity education across health care settings, with limited evidence to suggest the optimal approach for teaching this subject. This study aimed to explore the perspectives of patients with mental illness on how to better teach and evaluate diversity education in the National Health Service.

Methods:
A participatory research approach was used with five mental-health patient organizations. Forty-two patients with mental illness took part in three participatory workshops. Data were analyzed through template analysis.

Results:
The findings indicated that a focus on the nuances and dynamics of clinical relationships would be beneficial. Specifically, the relationship considered most important to examine with respect to diversity education was the “practitioner–self” relationship.

Discussion:
Reconstructing the relationship-centered care model with the addition of the practitioner–self relationship may be better suited to theoretically informing future developments in diversity education. Further research is needed to understand what educational approaches contribute toward a relationship-centered care outlook and how relationship building behaviors, particularly those relevant to the practitioner–self relationship are best developed in diverse settings.
Acral Lentiginous Melanomas Harbour Intratumor Heterogeneity in BRAF Exon 15, With Mutations Distinct From V600E/V600K
Authors: Fernandes Mariana , Barcelos Denise , Comodo Andréia Neves , Guimarães Daiane Pereira , Lopes Carapeto Fernando Cintra , Cardili Leonardo , de Sousa Morães Lais , Cerutti, AP Janete , Landman, AP Gilles 
Published: April 2019

Abstract:
The choice of appropriate therapeutic strategies may be influenced by intratumor heterogeneity and makes cancer treatment considerably more challenging. We aimed to evaluate the heterogeneity of BRAF exon 15 mutations in different areas of acral lentiginous melanoma (ALM). The entire exon 15 was sequenced in 4 different areas of paraffin-embedded samples from 26 patients with ALM. A total of 26 of 49 cases of ≥1 mm in depth of ALM identified by clinical, anatomical, and pathological data fulfilled the inclusion and exclusion criteria for this study. Tumors had a mean Breslow depth of 7.2 mm and an average mitotic index of 3 mitosis/mm2. Mutations distinct from the common V600E and V600K were detected in 31%, and intratumor heterogeneity was observed in 31% of samples. Interestingly, 63.5% of all mutations had been previously associated with cancer. Most (62.5%) of the missense BRAF exon 15 mutations found in the ALM samples examined here were deemed “detrimental” for protein function according to at least 2 functional prediction programs, and 3 mutations (37.5%) were predicted to be “neutral,” with no effect on protein function. BRAF exon 15 mutations were detected frequently in ALM and displayed heterogeneity, a finding to be further investigated.
Performance Measures in Dermatologic Surgery: A Review of the Literature and Future Directions
Authors: Chow Conroy , Yuan Joyce T. , Ruiz Emily S. , Soon Seaver L. , Makhzoumi Zaineb , Arron Sarah T. 
Published: April 2019

BACKGROUND
In recent years, health care reform initiatives have aimed to assess quality of care through the use of performance measures. Multiple specialties, including dermatology, have implemented registries to track and report health care quality.

OBJECTIVE
The authors review the history and rationale for assessing quality in dermatologic surgery. The authors also discuss the different types of performance measures and the current efforts to develop clinically relevant dermatologic surgery-specific measures.

MATERIALS AND METHODS
An extensive literature review was conducted using OVID, MEDLINE, PubMed, and government and health care-related websites to identify articles related to surgical performance measures.

RESULTS
Few performance measures are established to assess quality in dermatologic surgery. The authors propose specific candidate measures and discuss how clinical registries can capture measures that meet federal reporting requirements.

CONCLUSION
Assessment of health care quality will become increasingly important in health care reform. Physicians need to take an active role in selecting appropriate, clinically relevant performance measures that will help improve patient care while containing health care costs and meeting government-mandated reporting requirements.
Sclerosing angiomatoid nodular transformation in the spleen
Authors: Cao Peilong , Wang Kai , Wang Chunbao , Wang Hongyan 
Published: April 2019

Abstract
To assess the clinicopathologic features, differential diagnosis, and pathogenesis of sclerosing angiomatoid nodular transformation (SANT) of the spleen.
The clinical characteristics of 7 cases with SANT were retrospectively analyzed. Histochemical and immunohistochemical (EnVision method) examinations were performed. Moreover, quantitative assessment of IgG4 and IgG-positive cells was performed.
The 7 SANT patients included 1 female and 6 males, with ages ranging from 7 to 60 years (mean 33.4 years). They showed no specific clinical manifestations. Macroscopically, the surface of the excised masses was gray-white, and vague nodularity was observed. Mass sizes ranged from 3.0 to 7.0 cm (mean 5.5 cm). Microscopically, all cases were characterized based on multiple angiomatoid nodules of various sizes embedded in a fibrosclerotic stroma. The nodules were round and sometimes convoluted. Moreover, the nodules were composed of slit-like, irregularly-shaped, or slightly dilated vascular spaces lined by plump endothelial cells, and interspersed with a population of spindly or ovoid cells. Immunohistochemical examination showed a heterogeneous staining pattern, with the lining cells of small capillaries expressing CD34 and those of sinusoid-like structures expressing CD8. CD31 was stained in the lining and interspersed cells, thus resulting in a complex meshwork. Additionally, the lining cells were focally positive for CD68. Vimentin and smooth muscle antibody were expressed in all 7 cases, whereas no desmin or CD21 was detected. IgG4-positive cells accounted for 2 to 5 per high-power field (mean 3.7). Furthermore, the IgG-positive cells accounted for 2 to 8 per high-power field (mean 4.2).
SANT is a rare primary benign tumor-like lesion of the spleen, and has characteristic histopathological features and immunohistochemical profiles. SANT should be distinguished from other angiomatoid tumors and tumor-like lesions. Moreover, SANT could be treated by splenectomy, with favorable prognosis. The relationship between SANT and IgG4-related sclerosing lesions remains to be clarified.
Procalcitonin, C-reactive protein, PaCO2, and noninvasive mechanical ventilation failure in chronic obstructive pulmonary disease exacerbation
Authors: Wang Jinrong , Shang Huimian , Yang Xiaoya , Guo Shufen , Cui Zhaobo 
Published: April 2019

Abstract
It is unclear whether procalcitonin (PCT) is correlated with noninvasive ventilation (NIV) failure. This retrospective case–control study aimed to compare PCT levels, C-reactive protein (CRP) levels, and PaCO2 in patients (05/2014–03/2015 at the Harrison International Peace Hospital, China) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and NIV failure/success.
This was a retrospective case–control study of patients with AECOPD who required NIV between May 2014 and March 2015. All consecutive patients with AECOPD admitted at the Department of Critical Care Medicine and transferred from the general ward were included in the study. Hemogram, PCT, erythrocyte sedimentation rate (ESR), arterial blood gas (ABG), and CRP levels were measured ≤1 hour before NIV was used. NIV was considered to have failed if at least one of the following criteria was met: cardiac arrest or severe hemodynamic instability; respiratory arrest or gasping; mask intolerance; difficulty in clearing bronchial secretions; or worsening of ABGs or sensorium level during NIV. The factors associated with NIV failure were determined.
A total of 376 patients were included: 286 with successful NIV and 90 wither NIV failure. The multivariate analysis showed that PCT (OR = 2.0, 95%CI: 1.2–3.2, P = .006), CRP (OR = 1.2, 95%CI: 1.1–1.3, P < .001), and PaCO2 (OR = 1.1, 95%CI: 1.1–1.2, P < .001) ≤1 hour before NIV were independently associated with NIV failure. The optimal cutoff were 0.31 ng/mL for PCT (sensitivity, 83.3%; specificity, 83.7%), 15.0 mg/mL for CRP (sensitivity, 75.6%; specificity, 93.0%), and 73.5 mm Hg for PaCO2 (sensitivity, 71.1%; specificity, 100%). The area under the curve (AUC) was 0.854 for PCT, 0.849 for CRP, and 0.828 for PaCO2. PCT, CRP, and PaCO2 were used to obtain a combined prediction factor, which achieved an AUC of 0.978 (95%CI: 0.961–0.995).
High serum PCT, CRP, and PaCO2 levels predict NIV failure for patients with AECOPD. The combination of these three parameters might enable even more accurate prediction.
Endovascular treatment of multiple tuberculous mycotic aneurysm
Authors: Zhao Shenyu , Wang Zhe , Li Yong , Wang Hong , Zhao Yu 
Published: April 2019

Abstract

Rationale:
We present a rare case of multiple tuberculous mycotic aneurysm. Multiple aneurysms caused by tuberculosis (TB) are difficult to treat. Here, we discuss a treatment modality using a microcore stent graft.

Patient concerns:
A 73-year-old man with pain in the back and on the right side of the chest associated with dry cough, presented with an inability to walk since 1-month.

Diagnoses:
A diagnosis of multiple aneurysms caused by TB was made, based on computed tomography (CT) scan and positive T-spot and Xpert tests.

Interventions:
We administered the empirical anti-TB regimen (pyrazinamide, isoniazid, rifampicin, and ethambutol) and performed endovascular repair using microcore stent graft.

Outcomes:
The post-operative hemodynamic analysis indicated that the patient's aneurysms no longer had a risk of rupture, and blood flow in the major branches of the aorta had been maintained. However, the patient could not survive due to a pulmonary infection acquired during recuperation at a local hospital.

Lessons:
For multiple tuberculous mycotic aneurysms, anti-TB therapy is inadequate and the microcore stent graft is a feasible option that can improve the hemodynamics in the aneurysms.
Femoral artery pseudoaneurysm after carotid artery stenting
Authors: Jeon Seung-Ho , Kang Hyun Goo , Kim Hong-Jin , Seo Man-Wook , Shin Byoung-Soo 
Published: April 2019

Abstract

Rationale:
Pseudoaneurysm, the most common complication of femoral artery catheterization, involves the formation of a space between the lumen and the surrounding fibrous tissue through the damaged arterial wall. In patients treated with antiplatelet and anticoagulant agents, the incidence of vascular complications increases with the increasing use of minimally invasive procedures.

Patient concerns:
We experienced 2 cases of procedure-induced pseudoaneurysms. A 79-year-old man with right hemiparesis visited our hospital. Brain magnetic resonance imaging showed acute left middle cerebral artery territory infarction and severe stenosis of the left proximal carotid artery. The patient was prescribed apixaban and underwent carotid stenting through the right femoral artery. Hematoma and tenderness were observed in the right inguinal region after the procedure. The hemoglobin level decreased from 16.9 g/dL to 9.4 g/dL. Another 78-year-old man with left common carotid artery stenosis was admitted. We performed stent implantation through the right femoral artery and administered aspirin and clopidogrel. After the procedure, hematoma and tenderness of the puncture site were observed. The hemoglobin level decreased from 14.5 g/dL to 10.9 g/dL.

Diagnosis:
Emergency computed tomography confirmed a pseudoaneurysm with a massive hematoma in the right inguinal area. The patients were diagnosed with infection-associated right pseudoaneurysm for which an emergency puncture site repair was performed.

Interventions:
We performed resection of pseudoaneurysm and repaired puncture site.

Outcomes:
The hemoglobin level was stabilized postoperatively and vital sign remained stable.

Lessons:
Pseudoaneurysm is an important complication of femoral artery puncture. The use of a hemostatic device was not superior to manual compression, and the incidence of this complication was significantly higher in patients who received anticoagulant or antiplatelet agents. A pseudoaneurysm may cause a bad prognosis. Therefore, the early detection of pseudoaneurysm and immediate treatment after femoral arterial puncture are needed.
Gastrointestinal stromal tumor presenting as a rectovaginal septal mass
Authors: Cheng Min , Liu Chia-Hao , Horng Huann-Cheng , Chen Yi-Jen , Lo Pei-Fen , Lee Wen-Ling , Wang Peng-Hui 
Published: April 2019

Abstract

Introduction:
Gastrointestinal stromal tumors (GISTs) arising from the gynecological tract are extremely rare. A case of GIST with an unusual presentation as a vaginal mass is presented with comprehensive literature review, aiming to gain a better understanding of the diagnostic and treatment strategy of the disease.

Patient concerns:
A 78-year-old woman presented with persistent vaginal bleeding and difficulty in micturition. Although the tumor mass was diagnosed, the results of preoperative evaluations are uncertain.

Diagnosis:
Preoperative evaluation included the computed tomography examination (a 6.3×5.3 cm cervical mass lesion with rectal and vaginal invasion), colonoscopy (an external compression with an intact mucosa), tumor markers, and biopsy (spindle cell tumor). Postoperative histopathology confirmed the diagnosis of GIST.

Interventions:
Posterior exenteration with complete resection was performed. The patient received postoperative adjuvant imatinib therapy.

Outcomes:
The patient has survived without the disease for more than 3 years.

Conclusion:
It is still a challenge to diagnose GISTs in women with rectovaginal mass preoperatively. Efforts should be made, including a high suspicion and an assistance of immunohistochemistry. A precise diagnosis may offer a better surgical and treatment plan, especially on the preservation of reproductive organs and accessibility of targeted therapy.
Thirty-Day Hospital Readmissions for Granulomatosis With Polyangiitis in the United States
Authors: Luo Yiming , Jiang Changchuan , Arevalo Molina Ana Belen , Murray Shane , Anez Gustavo Contreras , Salgado Maria , Xu Jiehui 
Published: April 2019

Background/Objective
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis that often results in frequent hospitalizations. We investigated the characteristics and predictors of 30-day hospital readmissions in GPA.

Methods
We performed a cross-sectional analysis using the 2014 National Readmission Database. We included nonelective admissions with a primary or secondary diagnosis of GPA. We compared characteristics between readmissions and nonreadmissions. Independent predictors for readmissions were studied using mixed-effects multivariable logistic regression.

Results
We evaluated a total of 9749 hospital admissions with GPA, among which there were 2173 readmissions (22.3%) within 30 days of discharge. The top 5 primary reasons for readmissions were GPA, sepsis, pneumonia, acute respiratory failure, and acute kidney injury. Granulomatosis with polyangiitis readmissions were associated with higher length of stay (8.0 vs 7.2 days; p = 0.019) and less discharge home (50% vs 63%, p < 0.001). Independent predictors for readmissions were younger age (odds ratio [OR], 0.99; p = 0.013), no private insurance (OR, 0.50; p < 0.001), higher Charlson Comorbidity Index (OR, 1.12; p = 0.039), congestive heart failure (OR, 1.71; p = 0.001), acute kidney injury (OR, 1.39; p = 0.005), and discharge to home health care (OR, 1.29; p = 0.039).

Conclusions
We found a significant burden of 30-day readmissions among GPA populations. Clinicians should be vigilant regarding patients with high risk of readmissions, including those with younger age, public insurance, higher comorbidity burden, cardiac and renal complications, and unfavorable discharge dispositions.
Aesthetic and Functional Rehabilitation of Postburn Maxillofacial Deformity
Authors: Mohanty Sujata , Bodh Ranjeet , Dabas Jitender , Kumari Saroj , Kohli Sanchaita 
Published: April 2019

Abstract
Postburn maxillofacial deformities, although rare, are a significant cause of morbidity. Since contracture scars have a potential role in deforming the maxillofacial skeleton, the focus of treatment should be on growing patients, where scar contractures can drastically influence growth and morphology of the maxillofacial units. There are certain aspects of severe facial burns and deformities, especially of the jaws, that deserve sincere attention to overcome aesthetic and functional disabilities such as inability to masticate and incompetent lips. The purpose of this article, therefore, is to discuss these injuries, the mechanism of development of deformities of the jaws and associated structures and their management for better aesthetic, functional, and psychological health of patient. An interpretive clinical report is presented.
Palliative Interventional Embolization for Finding of Ectopic Noradrenaline-Secreting Pheochromocytoma in the Nasal Cavity
Authors: Chen Binghong , Wu Hui , Cheng Lilin , Hu Yaomin , Liao Yu , Qiu Yongming , Dai Jiong 
Published: April 2019

Abstract
A 52-year-old male who had chronic hypertension for several years presented with abrupt epistaxis. The CT scan revealed a 40 mm × 40 mm mass in the nasal cavity intended to the maxillary sinus and the base of skull. Nasal endoscope biopsy and serum/urinary catecholamine detection conformed an ectopic noradrenaline-secreting pheochromocytoma. The present research was to discuss the clinical characteristics of the rare pheochromocytoma and the palliative interventional embolization for it.
Severe Biallelic Loss-of-function Mutations inNicotinamide Mononucleotide Adenylyltransferase 2 (NMNAT2)in Two Fetuses with Fetal Akinesia Deformation Sequence
Authors: Lukacs Marshall , Gilley Jonathan , Zhu Yi , Orsomando Giuseppe , Angeletti Carlo , Liu Jiaqi , Yang Xiuna , Park Joun , Hopkin Robert J. , Coleman Michael P. , Zhai R. Grace , Stottmann Rolf W. 
Published: April 2019

AbstractThe three nicotinamide mononucleotide adenylyltransferase (NMNAT) family members synthesize the electron carrier nicotinamide adenine dinucleotide (NAD+) and are essential for cellular metabolism. In mammalian axons, NMNAT activity appears to be required for axon survival and is predominantly provided by NMNAT2. NMNAT2 has recently been shown to also function as a chaperone to aid in the refolding of misfolded proteins.Nmnat2deficiency in mice, or in its orthologdNmnatinDrosophila, results in axon outgrowth and survival defects. Peripheral nerve axons in NMNAT2-deficient mice fail to extend and innervate targets, and skeletal muscle is severely underdeveloped. In addition, removing NMNAT2 from established axons initiates axon death by Wallerian degeneration. We report here on two stillborn siblings with fetal akinesia deformation sequence (FADS), severely reduced skeletal muscle mass and hydrops fetalis. Clinical exome sequencing identified compound heterozygousNMNAT2variant alleles in both cases. Both protein variants are incapable of supporting axon survival in mouse primary neuron cultures when overexpressed.In vitroassays demonstrate altered protein stability and/or defects in NAD+synthesis and chaperone functions. Thus, both patientNMNAT2alleles are null or severely hypo-morphic. These data indicate a previously unknown role forNMNAT2in human neurological development and provide the first direct molecular evidence to support the involvement of Wallerian degeneration in a human axonal disorder.
A self-administered, artificial intelligence (AI) platform for cognitive assessment in multiple sclerosis (MS)
Authors: Khaligh-Razavi Seyed-Mahdi , Sadeghi Maryam , Khanbagi Mahdiyeh , Kalafatis Chris , Nabavi Seyed Massood 
Published: April 2019

AbstractBackgroundCognitive impairment is common in patients with MS. Accurate and repeatable measures of cognition have the potential to be used as a marker of disease activity. We developed a 5-minute computerized test to measure cognitive dysfunction in patients with MS. The proposed test –named Integrated Cognitive Assessment (ICA)– is self-administered and language-independent.ObjectiveTo determine ICA’s validity as a digital biomarker for assessing cognitive performance in MS.Methods91 MS patients and 83 healthy controls (HC) took part in substudy 1, in which each participant took the ICA test and the Brief International Cognitive Assessment for MS (BICAMS). We assessed ICA’s test-retest reliability, its correlation with BICAMS, its sensitivity to discriminate patients with MS from the HC group, and its accuracy in detecting cognitive dysfunction. In substudy 2, we recruited 48 MS patients, and examined the association between the level of serum neurofilament light (NfL) in these patients and their ICA scores.ResultsICA demonstrated excellent test-retest reliability (r=0.94), with no learning bias (i.e. no significant practice effect); and had high level of convergent validity with BICAMS. ICA was sensitive in discriminating the MS patients from the HC group, and demonstrated a high accuracy (AUC = 95%) in discriminating cognitively normal from cognitively impaired participants. Additionally, we found a strong association (r=-0.79) between ICA score and the level of NfL in MS patients.ConclusionsICA can be used as a digital biomarker for assessment and monitoring of cognitive performance in MS patients. In comparison to standard cognitive tools for MS (e.g. BICAMS), ICA is shorter in duration, does not show a learning bias, is independent of language, and takes advantage of artificial intelligence (AI) to identify cognitive status of patients more accurately. Being a digital test, it further has the potential for easier electronic health record or research database integration.