bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of the Self-care in Motor Neuron Disease Index
Authors: Bassola Barbara , Lizio Andrea , Lucchini Marco , Sansone Valeria Ada , Lusignani Maura 
Published: October 2019

ABSTRACT

OBJECTIVE
The aim of this study was to develop and psychometrically test the properties of the Self-care in Motor Neuron Disease (SCMND) Index.

METHODS
This instrument development and validation study was conducted in 3 phases. The first is to identify self-care behaviors in people with motor neuron disease (MND), and the second is to evaluate the content validity of the SCMND Index. Then, between March 2017 and March 2018, the tool was administered to 107 people with MND for psychometric tests.

RESULTS
The SCMND Index was developed based on the middle-range theory of self-care of chronic illness, including 15 self-care behaviors related to respiration, nutrition, mobility, medication, medical visits, and complication management. Content validity was excellent. Data analysis suggests that the instrument has a good internal consistency in all 3 domains and excellent reproducibility. Increased self-care behaviors' median values were associated with mechanical ventilation, cough assistance, and dysphagia. Domains differed significantly based on access (maintenance), hospital admissions (monitoring and management), and respiratory infection (management).

CONCLUSIONS
Self-care is a patient-centered outcome, and it is a key point of healthcare. Results suggest that the SCMND Index is useful for both clinicians and researchers to evaluate self-care in MND.
Night Shift Working Is Associated With an Increased Risk of Thyroid Nodules
Authors: Rizza Stefano , Neri Anna , Capanna Alessandra , Grecuccio Chiara , Pietroiusti Antonio , Magrini Andrea , Federici Massimo , Coppeta Luca 
Published: October 2019

Objectives:
To study thyroid alterations in health care workers according to their working status.

Methods:
We performed a retrospective study including 299 hospital employers who underwent in 2016 a periodic health surveillance checks in the Service of Occupational Medicine. According to the working status (rotating night-shift working [no. 160] vs day-working [no. 139]), we divided participant's clinical, anthropometric, and thyroid echographic characteristics.

Results:
Respect to day workers, rotating night-shift workers were slightly older and more frequently male whereas had similar thyroid stimulating hormone, Ft3, Ft4 levels, and autoimmunity (anti-TPO levels more than 30). Univariate and multivariate regression analysis revealed that rotating night shift work is associated to a significantly increased number of thyroid nodules.

Conclusions:
This retrospective report suggests that the alteration in the molecular clocks typical of rotating night-shift workers harbors a higher risk of thyroid nodule development compared with diurnal workers. This novel result deserves replication in larger cohorts since thyroid nodules not rarely can represent thyroid cancers.
Tongue base varix as a source of oral bleeding
Authors: Kim Young-Mo , Kim Ji Won , Park In Suh , Choi Jeong-Seok 
Published: October 2019

Abstract

Rationale:
Oral bleeding is usually diagnosed after by referral to other department for the differential diagnosis of hematemesis or hemoptysis. If a patient presents with blood in the oral cavity with no obvious source, generally upper airway, pulmonary, or gastroesophageal lesions are considered likely bleeding foci. The tongue base is an unusual site for laryngopharyngeal varices and only a few cases have been reported.

Patient concerns:
Although varix at the tongue base in patients with liver cirrhosis has been rarely described, physicians must consider variceal bleeding from the tongue base when presented with oral bleeding. In such cases, bleeding foci can be identified and controlled by laryngoscopy. We describe the case of a 42-year-old woman complaining of small amount of hemoptysis with variceal bleeding at the tongue base controlled by laryngoscopic excision and cauterization.

Diagnosis:
A diagnosis of tongue base varix was made based on medical history, clinical manifestations, laryngoscopic findings and pathologic features for the patient.

Interventions:
The successful laryngoscopic procedures were performed.

Outcomes:
The patient has shown no recurrent oral bleeding during follow-up.

Lessons:
Variceal bleeding in the tongue base is likely to cause serious massive hemorrhage. We need to consider this possibility when presented with a patient with intraoral bleeding but no evidence of hemoptysis or hematemesis.
The association between weight fluctuation and all-cause mortality
Authors: Zhang Yan , Hou Fangfang , Li Jiexue , Yu Haiying , Li Lu , Hu Shilian , Shen Guodong , Yatsuya Hiroshi 
Published: October 2019

Abstract

Background:
Many observational studies have reported an association between weight fluctuation and all-cause mortality. However, the conclusions obtained from these studies have been unclear.

Objective:
The current meta-analysis aimed to clarify the association between weight fluctuation and all-cause mortality.

Data source:
We electronically searched PubMed, Embase, and Web of Science for articles reporting an association between weight fluctuation and all-cause mortality that were published before April 30, 2018.

Study appraisal and synthesis methods:
The methodological quality of each study was appraised using the modified Newcastle Ottawa Quality Assessment Scale. The hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were extracted from the included studies and pooled using random-effect models. Meta-regression approaches were also performed to explore sources of between-study heterogeneity.

Results:
A total of 15 studies were eligible for the current meta-analysis. The pooled overall HR for all-cause mortality in the group with the greatest weight fluctuations compared with the most stable weight category was 1.45 (95% CI: 1.29–1.63). Considerable between-study heterogeneity was observed, some of which was partially explained by the different follow-up durations used by the included studies. Moreover, publication bias that inflated the risk of all-cause mortality was detected using Egger's test (P = .001).

Conclusion:
Weight fluctuation might be associated with an increased risk of all-cause mortality.
The effects of acupuncture on cognitive deficits in transgenic mouse studies of mild cognitive impairment and Alzheimer's disease
Authors: Yang Yang , Hu Shaowen , He Jiang , Zhang Jianguo , Tang Chunzhi 
Published: October 2019

Abstract

Background:
Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are neurodegenerative diseases associated with aging. The major clinical features of both are progressive memory loss and progressive cognitive loss. The objective of this systematic review protocol is to provide the methods for evaluating the effectiveness of acupuncture in the treatment on cognitive deficits in transgenic mouse.

Methods and analysis:
We will search the electronic databases of PubMed, Web of Science, Embase, PsycINFO, as well as the Chinese databases such as Chinese Biomedicine Literature (CBM), Chinese Medical Current Content (CMCC), Chinese Scientific Journal Database (VIP), WanFang Database and China National Knowledge Infrastructure (CNKI) from their inceptions to July 2019. RevMan 5.3 software will be used for the data synthesis and the quality of each study was assessed independently by use of the CAMARADES checklist.

Results:
This review will provide a high-quality synthesis based on present evidence of acupuncture treatment for AD and MCI in transgenic mouse models.

Conclusions:
This systematic review will provide evidence for weather acupuncture is an effective intervention for AD and MCI in transgenic mouse models.

Ethics and dissemination:
Ethical approval is not necessary since this protocol is only for systematic review and does not involve privacy data or conduct an animal experiment. This protocol will be disseminated by a peer-review journal or conference presentation.

Trial registration number:
PROSPERO CRD42019142985.

Strengths and limitations of this study:
This systematic review will be the first to provide new knowledge underlying the effectiveness to improve cognitive function of acupuncture treatment for AD and MCI in transgenic mouse models. The result of this systematic review may provide experimental and theoretical basis for the future clinical application of acupuncture in the treatment of AD.
The limitation of this systematic review may come from language barriers, because only English and Chinese can be included. Also, this study includes various kinds of acupuncture treatments which may result in essential heterogeneity.
Renal dysfunction in patients with radioactive iodine-refractory thyroid cancer treated with tyrosine kinase inhibitors
Authors: Iwasaki Hiroyuki , Yamazaki Haruhiko , Takasaki Hirotaka , Suganuma Nobuyasu , Sakai Rika , Nakayama Hirotaka , Toda Soji , Masudo Katsuhiko 
Published: October 2019

Abstract
In 2014/2015, tyrosine kinase inhibitors (TKIs) were introduced as a secondary treatment for refractory differentiated thyroid cancer (DTC) in Japan. While renal dysfunction is an adverse event of TKI, data on this adverse event in TKI-treated DTC remains insufficient. Here, we investigated renal function in patients undergoing TKI treatment for DTC and evaluated the efficacy of dose reduction/withdrawal for cases of renal dysfunction.
A total of 73 cases of radioactive iodine-refractory DTC treated with sorafenib (n = 22) or lenvatinib (n = 51) were included. Patient data evaluated were TKI treatment period, estimated glomerular filtration rate (eGFR) before and after TKI therapy, incidence and degree (maximum value at time of TKI treatment) of proteinuria, and albumin levels before and after TKI therapy were compared.
The mean ΔeGFR was −6.75% with lenvatinib and +5.90% with sorafenib. It was not significant (P = .15). The mean Δalbumin was −8.90% and −5.85% with lenvatinib and sorafenib, respectively; there was no significant difference between the lenvatinib and sorafenib groups (P = .77). According to our program of TKI dose reduction and withdrawal, all patients except 2 with diabetes were successfully continuing treatment.
Overall, the present results demonstrated that renal function is negatively affected by long-term TKI treatment for RAI-refractory DTC. However, heightened proteinuria, decreased eGFR and albumin levels, and significant but apparently reversible renal dysfunction were more frequent with lenvatinib than sorafenib.
“A patient like me” – An algorithm-based program to inform patients on the likely conditions people with symptoms like theirs have
Authors: Koren Gideon , Souroujon Daniel , Shaul Ran , Bloch Allon , Leventhal Ariel , Lockett Jason , Shalev Varda 
Published: October 2019

Abstract
To date, consumer health tools available over the web suffer from serious limitations that lead to low quality health- related information. While health data in our world are abundant, access to it is limited because of liability and privacy constraints.
The objective of the present study was to develop and evaluate an algorithm-based tool which aims at providing the public with reliable, data-driven information based and personalized information regarding their symptoms, to help them and their physicians to make better informed decisions, based on statistics describing “people like you”, who have experienced similar symptoms.
We studied anonymized medical records of Maccabi Health Care. The data were analyzed by employing machine learning methodology and Natural Language Processing (NLP) tools. The NLP tools were developed to extract information from unstructured free-text written by Maccabi's physicians.
Using machine learning and NLP on over 670 million notes of patients’ visits with Maccabi physicians accrued since 1993, we developed predictors for medical conditions based on patterns of symptoms and personal characteristics.
The algorithm was launched for Maccabi insured members on January 7, 2018 and for members of Integrity Family Care program in Alabama on May 1, 2018.
The App. invites the user to describe her/ his main symptom or several symptoms, and this prompts a series of questions along the path developed by the algorithm, based on the analysis of 70 million patients’ visits to their physicians.
Users started dialogues with 225 different types of symptoms, answering on average 22 questions before seeing how people similar to them were diagnosed. Users usually described between 3 and 4 symptoms (mean 3.2) in the health dialogue.
In response to the question “conditions verified by your doctor”, 82.4% of responders (895/1085) in Maccabi reported that the diagnoses suggested by K's health dialogues were in agreement with their doctor's final diagnosis. In Integrity Health Services, 85.4% of responders (111/130) were in agreement with the physicians’ diagnosis.
While the program achieves very high approval rates by its users, its primary achievement is the 85% accuracy in identifying the most likely diagnosis, with the gold standard being the final diagnosis made by the personal physician in each individual case. Moreover, the machine learning algorithm continues to update itself with the feedback given by users.
Giant atypical lipomatous tumor/well-differentiated liposarcoma affects lower limb activity
Authors: Zhan Haibo , Cao Suixia , Gao Tian , Zhang Bin , Yu Xiaolong , Wang Lizhen , Zeng Jin , Dai Min 
Published: October 2019

Abstract

Rationale:
Liposarcomas are locally invasive mesenchymal soft tissue tumors; most deep liposarcomas are large. Liposarcomas have heterogeneous histomorphology, molecular and genetic characteristics, and clinical prognosis, making the diagnosis and treatment of giant liposarcomas difficult for bone tumor surgeons.

Patient concerns:
A 70-year-old man presented with a mass in the posterior part of his left lower extremity that was first noticed 3 years prior. The mass was initially fist sized but continued to grow and had been affecting lower limb mobility on presentation.

Diagnoses:
Computed tomography and magnetic resonance imaging revealed a large space-occupying lesion in the left thigh muscles, which was identified as a low-grade malignant tumor. Postoperative pathology results confirmed the diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS).

Interventions:
The patient underwent open surgery to completely remove the tumor tissue and relieve pain.

Outcomes:
At the 10-month follow-up appointment, the patient had recovered well, function of the lower extremities had returned to normal, and no signs of recurrence or metastasis were noted.

Lessons:
Although ALT/WDLPS is a locally invasive tumor with good prognosis, delayed treatment is associated with increased tumor size, which can affect lower limb mobility. Therefore, we believe that extensive surgical resection of tumor tissue is a suitable treatment for all ALT/WDLPS cases in order to avoid possible local recurrence. In addition, for ALT/WDLPS tumors that are difficult to extensively excise, long-term follow-ups are necessary due to the possibility of recurrence.
A nomogram to predict cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients
Authors: Gong Kai , Zhao Lizheng , Guo Jianfeng , Wang Zhanxiang 
Published: October 2019

Abstract
To establish a nomogram model to predict early cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.
A retrospective cohort study was held between January 2016 and October 2018. One hundred twenty seven out of 170 consecutive patients with supratentorial spontaneous intracranial hematoma were enrolled in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.
The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good discrimination ability on both development and validation dataset with AUC 0.911 and 0.919. Most patients would benefit from the model according to the decision curve analysis.
A nomogram, constructed based on bleeding volume, GCS, and IVH can provide a feasible tool to evaluate cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients.
Human neural stem cell transplant location–dependent neuroprotection and motor deficit amelioration in rats with penetrating traumatic brain injury
Authors: Hu Zhen , Gajavelli Shyam , Spurlock Markus S. , Mahavadi Anil , Quesada Liz S. , Gajavelli Ganesh R. , Andreoni Cody B. , Di Long , Janecki Julia , Lee Stephanie W. , Rivera Karla N. , Shear Deborah A. , Bullock Ross M. 
Published: October 2019

BACKGROUND
Penetrating traumatic brain injury induces chronic inflammation that drives persistent tissue loss long after injury. Absence of endogenous reparative neurogenesis and effective neuroprotective therapies render injury-induced disability an unmet need. Cell replacement via neural stem cell transplantation could potentially rebuild the tissue and alleviate penetrating traumatic brain injury disability. The optimal transplant location remains to be determined.

METHODS
To test if subacute human neural stem cell (hNSC) transplant location influences engraftment, lesion expansion, and motor deficits, rats (n = 10/group) were randomized to the following four groups (uninjured and three injured): group 1 (Gr1), uninjured with cell transplants (sham+hNSCs), 1-week postunilateral penetrating traumatic brain injury, after establishing motor deficit; group 2 (Gr2), treated with vehicle (media, no cells); group 3 (Gr3), hNSCs transplanted into lesion core (intra); and group 4 (Gr4), hNSCs transplanted into tissue surrounding the lesion (peri). All animals were immunosuppressed for 12 weeks and euthanized following motor assessment.

RESULTS
In Gr2, penetrating traumatic brain injury effect manifests as porencephalic cyst, 22.53 ± 2.87 (% of intact hemisphere), with p value of <0.0001 compared with uninjured Gr1. Group 3 lesion volume at 17.44 ± 2.11 did not differ significantly from Gr2 (p = 0.36), while Gr4 value, 9.17 ± 1.53, differed significantly (p = 0.0001). Engraftment and neuronal differentiation were significantly lower in the uninjured Gr1 (p < 0.05), compared with injured groups. However, there were no differences between Gr3 and Gr4. Significant increase in cortical tissue sparing (p = 0.03), including motor cortex (p = 0.005) was observed in Gr4 but not Gr3. Presence of transplant within lesion or in penumbra attenuated motor deficit development (p < 0.05) compared with Gr2.

CONCLUSION
In aggregate, injury milieu supports transplanted cell proliferation and differentiation independent of location. Unexpectedly, cortical sparing is transplant location dependent. Thus, apart from cell replacement and transplant mediated deficit amelioration, transplant location–dependent neuroprotection may be key to delaying onset or preventing development of injury-induced disability.

LEVEL OF EVIDENCE
Preclinical study evaluation of therapeutic intervention, level VI.
Unsupervised generative and graph representation learning for modelling cell differentiation
Authors: Bica Ioana , Andrés-Terré Helena , Cvejic Ana , Liò Pietro 
Published: October 2019

AbstractUsing machine learning techniques to build representations from biomedical data can help us understand the latent biological mechanism of action and lead to important discoveries. Recent developments in single-cell RNA-sequencing protocols have allowed measuring gene expression for individual cells in a population, thus opening up the possibility of finding answers to biomedical questions about cell differentiation. In this paper, we explore unsupervised generative neural methods, based on the variational autoencoder, that can model cell differentiation by building meaningful representations from the high dimensional and complex gene expression data. We use disentanglement methods based on information theory to improve the data representation and achieve better separation of the biological factors of variation in the gene expression data. In addition, we use a graph autoencoder consisting of graph convolutional layers to predict relationships between single-cells. Based on these models, we develop a computational framework that consists of methods for identifying the cell types in the dataset, finding driver genes for the differentiation process and obtaining a better understanding of relationships between cells. We illustrate our methods on datasets from multiple species and also from different sequencing technologies.
Caffeine-induced Plasticity of Grey Matter Volume in Healthy Brains: A placebo-controlled multimodal within-subject study
Authors: Lin Y.-S. , Weibel J. , Landolt H.-P. , Santini F. , Meyer M. , Borgwardt S. , Cajochen C. , Reichert C. 
Published: October 2019

AbstractDisturbed sleep homeostatic states have been found to alter neuronal homeostasis and reduce grey matter (GM) volume. Caffeine intake that interferes with sleep homeostasis through antagonizing adenosine receptors can impair hippocampal synaptic strength, neurogenesis, as well as memory and learning in rats. In this study, reduced medial temporal GM volume was observed after daily caffeine intake in humans (3 × 150 mg × 10 days compared to 10-day placebo administration). The potential bias from reduced cerebral blood flow was controlled, and the GM reduction was independent of the change in sleep pressure. A decrease in working memory during daily caffeine intake was observed, albeit no association with the magnitude of GM changes. The findings indicate that daily caffeine intake might induce rapid cerebral plasticity and be detrimental for higher order cognitive performance in the long run. They may call into question whether the neuroprotective effects of caffeine found in acute or low dose administration in animals are generalizable onto the daily usage in humans.
The Role of State Uncertainty in the Dynamics of Dopamine
Authors: Mikhael John G. , Kim HyungGoo R. , Uchida Naoshige , Gershman Samuel J. 
Published: October 2019

AbstractReinforcement learning models of the basal ganglia map the phasic dopamine signal to reward prediction errors (RPEs). Conventional models assert that, when a stimulus predicts a reward with fixed delay, dopamine activity during the delay should converge to baseline through learning. However, recent studies have found that dopamine ramps up before reward in certain conditions even after learning, thus challenging the conventional models. In this work, we show that sensory feedback causes an unbiased learner to produce RPE ramps. Our model predicts that, when feedback gradually decreases during a trial, dopamine activity should resemble a ‘bump,’ whose ramp-up phase should furthermore be greater than that of conditions where the feedback stays high. We trained mice on a virtual navigation task with varying brightness, and both predictions were empirically observed. In sum, our theoretical and experimental results reconcile the seemingly conflicting data on dopamine behaviors under the RPE hypothesis.