bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of job burnout and depression in standardized residency training programs in China
Authors: Zhang Yun , Chu Xiaotian , Sha Yue , Zeng Xuejun , Shen Ti 
Published: August 2019

Abstract
To evaluate job burnout and its impacts on mental health among clinical residents in a 3-year standardized residency training program in China.
This cross-sectional study was conducted among all residents in the Department of Internal Medicine of the Peking Union Medical College Hospital in August 2017. Job burnout and depressive symptoms were assessed using the Maslach Burnout Inventory-General Survey and the Center for Epidemiological Survey, Depression, respectively.
Among the 159 residents who completed the survey, comprising 69 who had graduated from 8-year medical schools and 90 from 5-year schools, the rate of job burnout was 62.2% (100/159) and the rate of depression was 28.3% (45/159). Rates of job burnout and depression in residents completed different years of training showed no significant difference. Rate of job burnout was significantly higher among graduates of 5-year medical schools (76.7%) than among those of 8-year schools (44.9%, P < .001). Pearson chi-squared test revealed a significant correlation between depression and job burnout (P < .001). Multiple logistic regression revealed a significant correlation between job burnout and attendance at 5- or 8-year medical schools (P = .044).
Job burnout may be more frequent among graduates from 5-year medical schools than among those from 8-year schools.
Ultrasound appearance of intravenous leiomyomatosis
Authors: Ge Zhitong , Wang Yahong , Qi Zhenhong , Zhang Qing , Jin Jin , Li Jianchu 
Published: August 2019

Abstract

Rationale:
Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can develop from the pelvic or uterine veins and spread into the central veins and heart. Here, we report a case of recurrent IVL in a 48-year-old woman. To the best of our knowledge, this is the first case report of IVL that describes the characteristic ultrasound features of the tumor, including the rainbow sign.

Patient concerns:
A 48-year-old woman developed a solid-cystic lesion in the inferior vena cava (IVC) 3 years after undergoing a right heart tumor resection and 5 years after undergoing hysterectomy.

Diagnoses:
Physical examination was unremarkable. However, ultrasonography showed a solid-cystic lesion in the IVC, and a diagnosis of IVL was made.

Interventions:
The patient underwent complete surgical removal of the tumor by a multidisciplinary team. The tumor was resected successfully.

Outcomes:
Pathological examination confirmed that the IVC tumor thrombus was consistent with IVL. During follow-up, there were no signs of local or distant recurrence.

Lessons:
The preoperative diagnosis of IVL is difficult, and the tumor is usually misdiagnosed as a thrombus or right atrial myxoma. A thorough understanding of the characteristic imaging features of IVL is essential for an accurate preoperative diagnosis. The lesion in our patient showed multiple tracts, a honeycomb appearance, and vividly colorful blood flow that resembled a rainbow, which we termed the rainbow sign.
Differentiating pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas by the “Duct-Road Sign”
Authors: Xiao Bo , Jiang Zhi-Qiong , Hu Jin-Xiang , Zhang Xiao-Ming , Xu Hai-Bo 
Published: August 2019

Abstract
To assess the duct-road sign and tumor-to-duct ratio (TDR) in MRI for differentiating pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal-adenocarcinomas (PDACs).
Retrospectively reviewed MRI characteristics of 78 pancreatic masses (histopathology-proven 25 PNETs and 53 PDACs). Receiver operating characteristics with TDR and diagnostic performance of the duct-road sign for differential diagnosis were performed.
The prevalence of duct-road sign in PNETs was higher than that for PDACs (84% vs 0%; P < .001). A strong correlation (r = 0.884, P < .001) was observed between MRI for PNETs and the frequency of this sign. Performance characteristics of the duct-road sign in MRI for PNET diagnosis were sensitivity (84%, [21 of 25]), specificity (100%, [53 of 53]), positive predictive value (100%, [21 of 21]), negative predictive value (92.9%, [53 of 57]), and accuracy (94.8%, [74 of 78]). In the intention-to-diagnose analysis, the corresponding values were 67.7% (21 of 31), 100% (53 of 53), 100% (21 of 21), 84.1% (53 of 63), and 88.1% (74 of 84). The TDR in PNETs was observed to be greater than that in PDACs (14.6 ± 9.3 vs 6.9 ± 3.8, P = .001). TDR with a cut-off value of 7.7 had high sensitivity (84%) and specificity (66%) with area under curve (0.802, 95% CI: 0.699, 0.904; P < .001) for distinguishing PNETs from PDACs.
The presence of duct-road sign and TDR > 7.7 on MRI may assist in diagnosis for PNET instead of PDAC.
Surgical treatment of giant chordoma in the thoracic spine combining thoracoscopic and posterior spinal surgery
Authors: Liu Shuzhong , Zhou Xi , Song An , Huo Zhen , Yao Siyuan , Wang Yipeng , Liu Yong 
Published: August 2019

Abstract

Rationale:
Giant thoracic chordoma is a highly unusual disease with no standard curative managements yet. The objective of this study is to report a very rare case of giant thoracic chordoma successfully operated by combination of thoracoscopic surgery together with posterior spinal surgery. The management of these unique cases has yet to be well-documented.

Patient concerns:
A 64-year-old man presented with a 4-month history of continuous and progressive back pain. The patient, who had been diagnosed of sacral chordoma for 2 years, received surgical treatment of posterior sacral tumor resection and instrumentation. A lytic, expanding lesion of the T5 and T6 vertebral and paraspinal region with mild epidural spinal cord compression was identified.

Diagnosis:
MRI of spine and PET/CT showed spinal cord compression secondary to the epidural component of the T5 and T6 mass, with increased metastatic marrow infiltration of the left T5 and T6 vertebral and paravertebral region, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic chordoma.

Interventions:
The patient underwent 1-stage thoracoscopic release of vertebral and paravertebral tumors, posterior resection of T5-T6 vertebral and paravertebral tumors, T4-T7 spinal canal decompression, and T2-T9 pedicle screw fixation procedure via a posterior approach.

Outcomes:
The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month and 6-month follow-up visit. There were no other complications associated with the operation during the follow-up period.

Lessons:
Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, and medical oncology led to the successful diagnosis and management of this patient. Giant thoracic chordoma, although rare, should be part of the differential diagnosis when the patient has a history of sacral chordoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the giant thoracic chordoma when the tumor has caused neurological deficits. One-stage thoracoscopic release or resection of vertebral and paravertebral tumor is also a good choice for surgical treatment.
Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients
Authors: Gao Jian , Wei Limin , Xu Guangjun , Ren Chunguang , Zhang Zongwang , Liu Yanchao 
Published: August 2019

Abstract

Background:
Percutaneous tracheostomy, almost associated with cough reflex and hemodynamic fluctuations, is a common procedure for traumatic brain injury (TBI) patients, especially those in neurosurgery intensive care units (NICUs). However, there are currently a lack of effective preventive measures to reduce the risk of secondary brain injury. The aim of this study was to compare the effect of dexmedetomidine (DEX) vs sufentanil during percutaneous tracheostomy in TBI patients.

Methods:
The 196 TBI patients who underwent percutaneous tracheostomy were randomized divided into 3 groups: group D1 (n = 62, DEX infusion at 0.5 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), group D2 (n = 68, DEX infusion at 1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1), and group S (n = 66, sufentanil infusion 0.3 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.4 μg·kg–1·hour–1). The bispectral index (BIS) of all patients was maintained at 50 to 70 during surgery. Anesthesia onset time, hemodynamic variables, total cumulative dose of DEX/sufentanil, total doses of rescue propofol and fentanyl, time to first dose of rescue propofol and fentanyl, number of intraoperative patient movements and cough reflexes, adverse events, and surgeon satisfaction score were recorded.

Results:
Anesthesia onset time was significantly lower in group D2 than in both other groups (14.35 ± 3.23 vs 12.42 ± 2.12 vs 13.88 ± 3.51 minutes in groups D1, D2, and S, respectively; P < .001). Both heart rate and mean arterial pressure during percutaneous tracheostomy were more stable in group D2. Total doses of rescue propofol and fentanyl were significantly lower in group D2 than in group D1 (P < .001). The time to first dose of rescue propofol and fentanyl were significantly longer in group D2 than in both other groups (P < .001). The number of patient movements and cough reflexes during percutaneous tracheostomy were lower in group D2 than in both other groups (P < .001). The overall incidences of tachycardia and hypertension (which required higher doses of esmolol and urapidil, respectively) were also lower in group D2 than in both other groups (P < .05). Three patients in group S had respiratory depression compared to X in the D1 group and X in the D2 group. The surgeon satisfaction score was significantly higher in group D2 than in both other groups (P < .05).

Conclusions:
During percutaneous tracheostomy, compared with sufentanil, DEX (1 μg·kg–1 for 10 minutes, then adjusted to 0.2–0.7 μg·kg–1·hour–1) can provide the desired attenuation of the hemodynamic response without increased adverse events. Consequently, DEX could be used safely and effectively during percutaneous tracheostomy in TBI patients.
Neoadjuvant chemotherapy before radical prostatectomy for locally advanced prostate cancer
Authors: Lin Tianhai , Yang Xiong , Gong Lina , Xu Hang , Qiu Shi , Yu Ruichao , Sun Sheng , Liu Liangren , Zhang Peng , Han Ping , Cheng Jingqiu , Yang Lu , Wei Qiang 
Published: August 2019

Abstract

Background:
To evaluate the effectiveness and safety of neoadjuvant chemotherapy (NAC) for locally advance prostate patients undergoing radical prostatectomy.

Methods:
PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, and Cochrane Library will be searched for studies related to the topic. The identification, inclusion and exclusion flow charts will be conducted according to PRISMA guidelines. The identified reports will be critically appraised using GRADE approach. Bias and heterogeneity of included studies will be assessed, and outcome measurements from individual studies will be combined with 95% confidence interval using a fixed- or random-effects model if qualified.

Results:
This study will provide evidence and data on the tolerance and efficacy of NAC followed by radical prostatectomy (RP).

Conclusion:
The application of taxanes-based chemotherapy has been widened to metastatic hormone sensitive prostate cancer in recent years. To be more vigorous, whether neoadjuvant administration of these cytotoxic agents can improve the outcome of RP in locally advance prostate cancer patients has been explored. This study aims to synthesis data regarding the adverse effect, response rate, recurrence, and survival from multiple trials, and to guide the healthcare practitioners using an evidence-based approach.
Trends in survival based on treatment modality for esophageal cancer: a population-based study
Authors: Akhtar-Danesh Noori , Shakeel Saad , Seow Hsien , Akhtar-Danseh Gileh-Gol , Finley Christian 
Published: August 2019

Objectives
The primary objective was to examine the trends in treatment modalities and the respective survival rates for esophageal cancer in the province of Ontario, Canada.

Methods
This is a population-based study of all esophageal cancer cases diagnosed in Ontario between 2007 and 2015, including squamous cell carcinoma and adenocarcinoma, with known disease stage. Other characteristics include sex, age, date of diagnosis, and treatment modalities. Treatment modalities were classified as no-treatment, radiation only or chemotherapy only, chemoradiation, and surgical resection.

Results
In total, 2572 patients were identified with esophageal cancer from 2007 to 2015, of which 2014 (78.3%) were male. The mean age at diagnosis was 66.6 (SD = 11.7) years. Survival rate increased over time in patients who underwent chemoradiation or surgical resection but remained unchanged for the radiation-only or chemotherapy-only group and decreased for the no-treatment group. Survival considerably improved (15–20%) for patients with stages I–III disease.

Conclusions
The positive trends in the survival rate for esophageal patients could be due to adoption of multimodal therapy. Despite a lower proportion of advanced disease among patients over 80, they received less curative treatments compared with other age groups. Further studies are required to identify strategies to maximize survival for patients with stage IV disease, and patients 80 years and older.
Deleterious effect of proton pump inhibitors on the disease course of cirrhosis
Authors: Janka Tamás , Tornai Tamás , Borbély Brigitta , Tornai Dávid , Altorjay István , Papp Mária , Vitális Zsuzsanna 
Published: August 2019

Objectives
Proton pump inhibitors(PPIs) are widely prescribed to patients with liver cirrhosis. We hypothesized that long-standing PPI use is associated with spontaneous bacterial peritonitis(SBP) and accelerated development of disease-specific complications and liver-related death.

Methods
A 5-year follow-up observational cohort study assessed the impact of long-standing PPI use on the clinical course of cirrhosis in a large referral patient cohort. Three hundred fifty patients with cirrhosis (alcohol:69.1%, Child-Pugh stage A/B/C:206/108/36) were assigned to two groups: regular PPI users (n=196) and nonusers (n=154). Occurrence of SBP, decompensation events (ascites, hepatic encephalopathy and variceal bleeding), and liver-related death were assessed.

Results
Regular PPI use was associated with an increased cumulative probability of SBP compared to nonusers [55% vs. 24.8%, hazard ratio(HR):4.25; P=0.05], in patients without previous SBP episode (n=84). A similar association was found between regular PPI use and decompensation events. The risk of the development of a first decompensation was higher in regular PPI users compared with nonusers, in patients with compensated clinical stage at enrollment (HR: 2.81, P= 0.008, n=146). The risk of liver-related death was also significantly increased among regular PPI users (P<0.001). In multivariate Cox-regression analysis, regular PPI use (HR:2.81, P=0.003) and MELD score (HR:1.21, P<0.001) was an independent predictor of mortality.

Conclusion
In the present follow-up cohort study, long-term PPI use was associated with the development of SBP and a progressive disease course in patients with cirrhosis that may have been caused by enhanced pathologic bacterial translocation, accelerated development of bacterial translocation-dependent disease-specific complications, and liver-related death.
Performance of B-mode ratio and 2D shear wave elastography for the detection and quantification of hepatic steatosis and fibrosis after liver transplantation
Authors: Dubois Marine , Ronot Maxime , Houssel-Debry Pauline , Brun Vanessa , Rayar Michel , Auger Magali , Beuzit Luc , Turlin Bruno , Aubé Christophe , Paisant Anita 
Published: August 2019

Objectives
To evaluate the diagnostic performance of B-mode ratio and shear wave elastography (SWE) for the assessment of steatosis and liver fibrosis after liver transplantation.

Materials and methods
Patients hospitalized for a systematic check-up after liver transplantation underwent the same day hepatic ultrasound with B-mode ratio and SWE, followed by liver biopsy and biological examinations. Steatosis was measured using hepatorenal sonographic index of B-mode ratio and liver stiffness using SWE. Liver biopsy, used as gold standard, graded steatosis S0(<5%), S1(5–<33%), S2(33–<66%), or S3(≥66%) and liver fibrosis according to the Metavir score. The results were tested against two external validation cohorts.

Results
Fifty-eight patients were included. Mean B-ratio value was significantly higher in patients with steatosis (0.95 ± 0.13 versus 1.39 ± 0.41, P < 0.001). A B-mode ratio cutoff values at least 0.985 was found optimal for steatosis’ detection [area under the receiver operating characteristic curve (AUROC) 0.902 ± 0.05, sensitivity 95%, specificity 79%]. A B-mode ratio value below 0.9 ruled out steatosis and above 1.12 ruled in steatosis. Mean SWE value for patients without significant fibrosis (≤F1) was 15.90 ± 9.2 versus 19.27 ± 7.7 kPa for patients with fibrosis (P = 0.185). A 2D-SWE value below 7.85 kPa ruled out significant fibrosis and above 26.35 kPa ruled it in.

Conclusion
The B-mode ratio is an efficient and accurate tool for the noninvasive diagnostic of steatosis in postliver transplantation patients. Yet, because liver stiffness is higher in postliver transplantation patients, 2D-SWE is not reliable in the diagnosis of significant fibrosis after liver transplantation.
Where Do Oregon Medicaid Enrollees Seek Outpatient Care Post-affordable Care Act Medicaid Expansion?
Authors: Holderness Heather , Angier Heather , Huguet Nathalie , O’Malley Jean , Marino Miguel , Springer Rachel , DeVoe Jennifer 
Published: August 2019

Background:
Previous studies suggest the newly Medicaid insured are more likely to use the emergency department (ED) however they did not differentiate between patients established or not established with primary care.

Objectives:
To understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion (ED, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization.

Research design:
A retrospective cohort study.

Subjects:
Adults continuously insured from 2014 through 2015 who were either newly, returning, or continuously insured post-PPACA.

Measures:
Site of first and last outpatient visit, established with primary care status, and outpatient care utilization.

Results:
The odds of being established with primary care at their first visit were lower among newly [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.18–0.19] and returning insured (OR, 0.22; 95% CI, 0.22–0.23) than the continuously insured. Continuously insured, new patients with primary care had higher odds of visiting the ED (OR, 2.15; 95% CI, 2.01–2.30) at their first visit than newly or returning insured. Patients established with a single primary care provider in all insurance groups had lower rates of ED visit, whereas those established with multiple primary care providers had the highest ED visit rates.

Conclusions:
Most newly and returning insured Medicaid enrollees sought primary care rather than ED services and most became established with primary care. Our findings suggest that both insurance and primary care continuity play a role in where patients seek health care services.
Understanding and managing intimate partner violence in the pediatric primary care setting: a review
Authors: Wang Amanda Y. , Pannell Melissa 
Published: August 2019

Purpose of review
To highlight the impact of intimate partner violence (IPV), also known as domestic violence, on children and families and to provide a framework for pediatricians in managing IPV-affected families.

Recent findings
Children living with a victim of IPV are at a much higher risk of being physically abused themselves. Exposure to IPV places children at high risk for multiple adverse childhood experiences, long-term health morbidity, and increased chance of intergenerational transmission of child abuse and future IPV. Exposure to a violent home environment alone is considered a form of child maltreatment. Furthermore, recent studies have proposed that maternal posttraumatic stress disorder and ineffective parenting styles by a victim of IPV mediate children's negative developmental outcomes, such as aggressive or internalizing behavior, mental health issues, and developmental delays. Trauma-informed care and a better understanding of the child abuse reporting process allow pediatricians to address specific needs of children and families exposed to IPV, to serve as mandated reporters with sensitivity and empathy, and to promote resiliency in families.

Summary
IPV is a public health issue that affects children in a variety of ways. Pediatricians can better manage this very serious and personal issue in their offices through an understanding of the unique healthcare needs of children and families impacted by IPV.
Brain-related outcome measures in trials recruiting critically-ill children
Authors: Fink Ericka L. , Tasker Robert C. 
Published: August 2019

Purpose of review
Randomized controlled trials leading to innovations that improve outcomes in acute life-threatening illnesses in children are scarce. A key issue is how we refocus research on outcomes that matter and are more relevant to those making emergency decisions, and those involved with managing and living with the late-outcome. We have used information from recent trials in critically ill children – in particular those illnesses without any primary neurologic involvement – to develop an approach to brain-related outcomes that will maximize child and family benefit from research.

Recent findings
Fifteen recent pediatric critical care trials illustrate four types of brain-related outcomes assessment: death or organ-system-failures – as illustrated by studies in systemic illness; neurological and neuropsychological outcomes – as illustrated by the glycemic control studies; cognitive outcomes – as illustrated by a sedative trial; and composite outcomes – as illustrated by the therapeutic hypothermia studies.

Summary
The 15 research trials point to five areas that will need to be addressed and incorporated into future trial design, including use of: neurologic monitoring during intensive care unit admission; postdischarge outcomes assessments; strategies to improve retention in long-term follow-up; child and family-centered outcomes; and core outcomes datasets.