bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Leadership Thread on Doctor of Physical Therapist Education
Authors: Eigsti Heidi J. , Davis Alice M. 
Published: November 2018

Background and Purpose.
Health care systems worldwide are investing considerable resources in leadership development programs.
1–4
Yet there is limited evidence as to the effectiveness of leadership training in graduate health care education. The purpose of this study was to investigate the impact of a leadership curricular thread on an entry-level doctor of physical therapist (DPT) program.

Design.
This study was a prospective repeated measure design.

Methods.
Participants were 210 students (women (60%), mean age = 25.33 years (3.71) from the graduating classes of 2015, 2016, and 2017. All participants took the online Leadership Practices Inventory Self
5
in their fourth semester and last semester of an 8-semester DPT program.

Results.
There was a significant improvement in all five of Kouzes and Posner's exemplary leadership practices over time; Model the Way (mean difference = 5.24 [6.80], P = .0001), Inspire a Shared Vision (mean difference = 7.15[8.82], P = .0001), Challenge the Process (mean difference = 6.86 [8.38], P = .0001), Enable Others to Act (mean difference = 3.83[5.36], P = .0001), and Encourage the Heart (mean difference = 3.83 [8.51], P = .0001).

Conclusions.
The findings support that a focused leadership thread integrated into a 3-year DPT program can have a positive impact on student leadership behaviors.
Anti-PD-1 pembrolizumab induced autoimmune diabetes in Chinese patient
Authors: Li Sicheng , Zhang Yi , Sun Zhichun , Hu Ji , Fang Chen 
Published: November 2018

Abstract

Rationale:
Programmed cell death-1 protein (PD-1) antibody is an immune-checkpoint inhibitor that triggers anti-tumor response by enhancing immune response. Although PD-1 antibody has been reported effective in some malignant tumor, it can also induce significant immune-related adverse events (irAEs) such as autoimmune diabetes.

Patient concerns:
A 67-year-old male patient with non-small cell lung cancer (NSCLS) presented with polydipsia, polyuria, weakness, and weight loss after use of anti-programmed cell death-1 antibody therapy. Hyperglycemia, high serum ketone, low bicarbonate and high anion gap were compatible with the criteria of diabetic ketoacidosis (DKA).

Diagnoses:
Autoimmune diabetes and diabetic ketoacidosis (DKA). The presence of low serum titers of c-peptide, high blood glucose together with diabetic ketoacidosis (DKA) that occurs shortly after the use of pembrolizumab strongly supported the diagnosis of anti-PD-1 induced autoimmune diabetes.

Interventions:
The patient stopped using pembrolizumab while continuous subcutaneous insulin infusion (CSII) was started at the same time. The insulin infusion was switched to multiple daily injection (MDI) after he was discharged from hospital.

Outcomes:
The patient is now a well-controlled insulin-dependent patient with palliative care of NSCLS.

Lessons:
Autoimmune diabetes induced by anti-programmed cell death-1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) therapy is a rare, but life threatening immune-related side effect. Physicians should closely monitor diabetes-related indexes of patients who have been undergoing the treatment of anti-PD-1/PD-L1 therapy.
New methods for specialized subjective and high-precision objective evaluation of constricted ears
Authors: Wang Di , Pan Bo , Lin Lin , Yang Qinghua , He Leren , Song Yupeng , Zhou Jiayu , Jiang Haiyue 
Published: November 2018

Abstract
The effects of therapy on constricted ears are evaluated subjectively and objectively. However, previous methods are not specific, comprehensive, precise, or effective in diagnosing and predicting surgical outcomes. This study aimed to present a personalized, subjective evaluation scale and new objective indices utilizing a digital method for the accurate evaluation of constricted ears.
Nine consecutive patients with constricted ears were selected. To perform subjective evaluations, the patients’ parents were contacted by telephone within 3 to 6 months after surgery and asked to answer questions using a scale. To perform objective evaluations, the constricted and normal ears of each patient were scanned using a 3-dimensional scanner before and 14 days after surgery. The vertical height of the auricle (VHA), transverse diameter of the auricle, minimum length of the helix (MLH), length of the inner auricle (LIA), and transverse diameter of the inner auricle were calculated using Mimics software. The Wilcoxon matched pairs signed-rank test was used for data analysis.
High satisfaction scores were reported. The folds of the ear and helix had the highest median scores, whereas the crus of the antihelix had the lowest. The difference in LIA and postoperative MLH was greater than that in VHA and preoperative MLH. The mean values of the 5 indices of the normal ear were greater than those of the indices of the preoperative constricted ear (P < .05).
The specialized subjective scale reported in this study allows comprehensive and personalized assessment of constricted ears. The new objective indices are more effective than existing methods and the digital measurement method is precise and reliable. These methods will allow the treatment of constricted ears to be better evaluated, leading to improvements in patient management and treatment selection.
Efficacy and safety of Xiaofeng powder (xiao feng san) in treating urticaria
Authors: Chen Guoming , Zhao Jinlong , Chen Tengyu , Zhang Zhaoping , Huang Chuyao , Xu Zhirui , Xu Hua 
Published: November 2018

Abstract

Background:
Urticaria is a common skin disease that has a high impact on a patient's daily life. Xiaofeng powder (XFP) is one of the most commonly used Chinese herbal formula in China for urticaria. However, due to the lack of systematic evaluations, its clinical efficacy remains controversial. This meta-analysis was performed to evaluate the effect and safety of XFP for urticaria.

Methods:
Seven databases, including Cochrane Central Register of Controlled Trials, PubMed, Embase, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and the Wanfang Database. The period will be from their inception to September 2018. Randomized controlled trials of XFS used separately against conventional Western medicine therapy in patients with urticarial were included. After the methodologic quality was assessed and the valid data were extracted, RevMan 5.3 software was used for the final meta-analysis.

Results:
The results will provide evidence regarding the efficacy and safety of XFP in treating urticaria.

Conclusion:
The conclusion of our systematic review will provide evidence to judge whether XFP is an effective intervention for patient with urticaria. This systematic review will be disseminated in peer-reviewed publications. The results of the study will provide evidence concerning the efficacy and safety of Xiaofeng Powder (xiao feng san) in treating urticaria.

PROSPERO registration number:
PROSPERO CRD 42018087260.
Clinical efficacy and safety of traditional Chinese patent medicine for hyperthyroid heart disease: study protocol for a systematic review and meta-analysis
Authors: Wang Qing , Li Chun , Di Sha , Han Lin , Zhao Linhua , Tong Xiaolin 
Published: November 2018

Abstract

Background:
Hyperthyroid heart disease (HHD), one of the most common complications of hyperthyroidism, is a serious public health problem due to the direct toxic or indirect effects of excessive thyroid hormone on the heart, resulting in high mortality and increasing health care costs. Traditional Chinese patent medicines (TCPMs), developed by combining modernized pharmaceutical technologies with ancient TCM theories, have been widely used in the treatment of HHD. However, the safety and efficacy of TCPMs used in patients with HHD has been uncertain and there has been no standard clinical trial published to confirm this. Thus, we conduct a study to evaluate the safety and efficacy of TCPMs for HHD.

Methods:
The reference lists of randomized controlled trials and 8 electronic databases will be independently and systematically searched by 2 review authors in August 2018. Four English databases [EMBASE, PubMed, National Guideline Clearinghouse (NGC), and Cochrane Central Register of Controlled Trials (CENTRAL)] and 4 Chinese databases [Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database] will be included. The primary outcomes will be assessed according to the effective rate of treatment, electrocardiogram, and thyroid hormone levels. Data synthesis will be precisely computed using the RevManV5.3 software when a data-analysis is allowed. Methodological quality will be assessed according to Cochrane Handbook.

Results:
This study will provide a high-quality synthesis of current evidence of TCPMs for HHD from different aspects, including the clinical symptoms, thyroid hormone levels, and ECG changes.

Conclusion:
The conclusion of this systematic review will provide evidence to prove whether TCPMs are effective therapeutic intervention for patient with HHD.
Rhabdomyolysis during myelosuppression in a patient with central nervous system leukemia
Authors: Le Ying , Li Huiqun , Wan Chengyao , Long Yuan , Liu Zhenfang 
Published: November 2018

Abstract

Rationale
Rhabdomyolysis is a potentially life-threatening syndrome and is a rare complication in patients with acute leukemia.

Patient's concerns
A 20-year-old male was admitted to our hospital due to skin ecchymosis in his trunk and lower limbs for 10 days.

Diagnoses
Based on the precise diagnosis of leukemia, namely cell morphology, immunology, cytogenetics, and molecular biological typing (MICM), the patient was diagnosed with acute T-lymphocytic leukemia (T-ALL).

Interventions
The patient received hyper-Cyclophosphamide, Vincristine,Adriamycin, Dexamethasone (hyper-CVAD) regimen chemotherapy (methotrexate, pirarubicin, vincristine and dexamethasone alternating with methotrexate and cytarabine) for 3 courses of chemotherapy. After 3 months of treatment, the patient developed intermittent pain, blurred vision, and inarticulate speech. Therefore, the patient was considered as central nervous system leukemia (CNSL) and immediately received 2 courses of chemotherapy with hyper-CVAD-B combined with polyethylene glycol conjugated asparaginase (PEG-ASP).

Outcomes
On the seventh day after the completion of chemotherapy, the patient was diagnosed with rhabdomyolysis because he complained of perianal pain and hematuria, and his creatine kinase (CK) increased suddenly to 3136 U/L. Finally, the patient died despite all kinds of active rescue.

Lessons
Rhabdomyolysis may occur after chemotherapy of leukemia. When patients developed hematuria, muscle weakness, or even asymptomatic elevation of CK levels, physicians should pay attention to the occurrence of rhabdomyolysis and take active hydration treatment.
Clinical, cytogenetic, and molecular findings in a fetus with ultrasonic multiple malformations, 4q duplication, and 7q deletion
Authors: Yue Fagui , Jiang Yuting , Yu Yang , Yang Xiao , Zhang Hongguo , Liu Ruizhi , Wang Ruixue 
Published: November 2018

Abstract

Rationale:
Chromosome deletion/duplication has been reported to be associated with mental disability and dysmorphism according to the accumulated research evidence.

Patient concerns:
A 25-year-old woman underwent amniocentesis for cytogenetic and single-nucleotide polymorphism (SNP) array analysis at 18 weeks of gestation due to the increased Down syndrome risk of 1/13.

Diagnoses:
The fetal chromosomal analysis revealed a seemingly “normal” chromosomal karyotype, but the SNP array results showed a partial duplication of chromosome 4q34.1q35.2 and a deletion of chromosome 7q34q36.3fluorescence in situ hybridization (FISH) analysis showed that the couple had normal chromosome 4 and 7, whereas there was a partial signal fragment of chromosome 4 attached on the long arm of chromosome 7 for the fetus.

Interventions:
The couple finally chose to terminate the pregnancy based on the ultrasonic multiple malformations and the abnormal SNP array results.

Outcomes:
The duplicated/deleted segments of the fetus were de novo. Meanwhile, we consider SHH and XRCC2 as good candidate genes, which may, in part, explain the observed abnormalities for the fetus.

Lessons:
The combination of SNP array and FISH analysis can give a molecular chromosomal diagnosis, which will offer more clear cytogenetic diagnosis and genetic counseling.
Focal therapy versus robot-assisted partial nephrectomy in the management of clinical T1 renal masses
Authors: Yoon Young Eun , Lee Hyung Ho , Kim Ki Hong , Park Sung Yul , Moon Hong Sang , Lee Seung Ryeol , Hong Young Kwon , Park Dong Soo , Kim Dae Keun 
Published: November 2018

Abstract

Background:
Robot-assisted partial nephrectomy (RPN) and focal therapy (FT) have both been successfully employed in the management of small renal masses. However, despite this being the era of minimally invasive surgery, few comparative studies exist on RPN and FT. The aim of our study is to review perioperative, renal functional and oncologic outcomes of FT and RPN in cT1 renal masses.

Methods:
Literature published in Medline, EMBASE, and Cochrane Library databases up to April 22, 2018, was systematically searched. We included literature comparing outcomes of FT (radiofrequency ablation, cryoablation, microwave ablation, and irreversible electroporation) and RPN. Studies that reported only on laparoscopic partial nephrectomy or open partial nephrectomy, and review articles, editorials, letters, or cost analyses were excluded. In total, data from 1166 patients were included.

Results:
From 858 total articles, 7 nonrandomized, observational studies were included. Compared with RPN, FT was associated with a significantly lower decrease of estimated glomerular filtration rate (weighted mean difference [WMD] −8.06 mL/min/1.73 m2; confidence interval [CI] −15.85 to −0.26; P = .04), and lower estimated blood loss (WMD −49.61 mL; CI −60.78 to −38.45; P < .001). However, patients who underwent FT had a significantly increased risk of local recurrence (risk ratio [RR] 9.89; CI 4.24–23.04; P < .001) and distant metastasis (RR 6.42; CI 1.70–24.33; P = .006). However, operative times, lengths of stay, and complication rates were revealed to be similar between FT and RPN.

Conclusion:
RPN has a substantial advantage in preventing cancer recurrence. However, in the era of minimally invasive surgery, FT has advantages in renal function preservation and less bleeding. Long-term follow-up for survival rates and comparative analysis of microwave ablation and irreversible electroporation are needed to extend FT for patients with significant morbidities and for those who need sufficient renal function preservation with minimal bleeding.
Response of germline BRCA2-mutated advanced pancreatic acinar cell carcinoma to olaparib
Authors: Li Mao , Mou Yu , Hou Shengzhong , Cao Dan , Li Ang 
Published: November 2018

Abstract

Rationale:
Pancreatic acinar cell carcinoma (PACC) is a relatively rare malignancy of the exocrine pancreas. BRCA2, a cancer susceptibility gene, has been widely studied in breast and ovarian carcinomas as mutation carriers for this gene are at a high risk for cancer development. Olaparib, an oral poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor, has been approved for the treatment of ovarian cancer with any BRCA 1/2 mutations. Herein, we report the first case of a germline BRCA2-mutated unresectable advanced PACC patient who responded well to olaparib treatment.

Patient concerns:
A 59-year-old male with a family history of cancer presented with a persistent epigastric dull pain for 3 months.

Diagnosis:
The patient was diagnosed with advanced PACC based on computed tomography (CT) scan, laparotomy, and pathology.

Interventions:
Exploratory laparotomy, intratumoral brachytherapy by radioiodine-125 seeds, modified FOLFIRINOX chemotherapy, and targeted therapy with olaparib were administered.

Outcomes:
The patient responded well to olaparib until the occurrence of severe adverse drug reactions, he died as a result of multiple organ failure with an overall survival period of 12 months.

Lessons:
As a PARP inhibitor, olaparib has remarkable curative effect not only on breast and ovarian cancers, but also on other malignancies with BRCA mutations. Patients with advanced cancer could benefit from active targeted therapy with improvement in overall survival and quality of life.
TA pharmacopuncture as a primary and independent treatment for frequent sprains occurring over 9 months in a patient with needle sickness
Authors: Hwang Ji Hye , Jung Hyo Won 
Published: November 2018

Abstract

Rationale:
Sprains, stretching or tearing of ligaments are common injuries. Clinicians should try to prevent acupuncture-associated vasovagal responses (AAVR) when treating patients with such injuries. In this study, we report the treatment of frequent sprains of various body parts in a patient with a history of AAVR using only TA (a 7-herb extract consisting of Scutellaria baicalensis, Phellodendron amurense, Pulsatilla koreana, Sophora tonkinensis, Aucklandia lappa, Aquilaria agallocha, and Carthamus tinctorius L.) pharmacopuncture.

Patient concerns:
The patient was a 47-year-old woman who was injured 23 times in 9 months. The injuries occurred in the knees, thumb, wrist, ankle, and low back region due to overextension during physical activity or frequent exercise. This patient had great fear of acupuncture after fainting due to her experience with a previous fire needling on an ankle sprain 18 years ago. Therefore, she did not want to undergo conventional acupuncture, including needle retention.

Diagnoses:
With the exception of the bruising and sprain of a knee occurring over 1 week after onset at the initial visit, the injuries were diagnosed as acute sprains of grade 1 with pain without range of movement limitation in various parts of the knee, ankle, thumb, and lower back. Time to onset of these injuries was within 3 days.

Interventions:
The patients received only TA pharmacopuncture at 4 to 6 ouch points (ashi points). The patient returned to work immediately after the conclusion of treatment without any posttreatment such as infrared and hot pack which can help absorbing the extract and calming the injection site.

Outcome:
The treatment was usually completed within 4 sessions, and led to a reduction in pain (visual analog scale [VAS] score of 1). In the absence of mild swelling and warmth or when there was mild pain (VAS score <3) in the affected area, the patient reported reduced pain and smoother joint movement immediately after 1 to 2 sessions.

Lessons:
Although our report is a single case study, our results indicate that TA pharmacopuncture can be effective in treating various acute sprains and is a potential acupuncture method for the treatment of patients with AAVR.
Novel homozygous inactivating mutation of the calcium-sensing receptor gene in neonatal severe hyperparathyroidism responding to cinacalcet therapy
Authors: Sun Xiaomei , Huang Liang , Wu Jin , Tao Yuhong , Yang Fan 
Published: November 2018

Abstract

Rationale:
Calcium-sensing receptor (CaSR) mutations can cause life-threatening neonatal severe hyperparathyroidism (NSHPT). The medical management of NSHPT is often challenging and complex. Here, we present a case of NSHPT caused by a novel homozygous CaSR mutation.

Patient concerns:
A Chinese female infant presented with poor feeding, constipation, severe hypotonia, and periodic bradycardia. Biochemistry tests revealed markedly elevated serum levels of Ca2+ and parathyroid hormone (PTH).

Diagnoses:
Genetic sequencing revealed a previously undescribed CaSR mutation in exon 3 (c.242T>A; p.I81K). A diagnosis of NSHPT secondary to homozygously inherited familial hypocalciuric hypercalcemia syndrome was established.

Interventions:
Cinacalcet was administered after the common treatments (low-calcium intake, hydration, and furosemide), calcitonin, and pamidronate therapy all failed.

Outcomes:
Serum Ca2+ decreased and stabilized with cinacalcet therapy. During a 10-month follow-up, total calcium was maintained within the high-normal range and PTH was normalized.

Lessons:
A trial of cinacalcet therapy might be undertaken in cases of NSHPT while definitive results of the genetic analysis are awaited.
Lack of antiretroviral therapy is associated with higher risk of neurosyphilis among HIV-infected patients who remain serofast after therapy for early syphilis
Authors: Pastuszczak Maciej , Sitko Marek , Bociaga-Jasik Monika , Kucharz Jakub , Wojas-Pelc Anna 
Published: November 2018

Abstract
Resolution of clinical symptoms and at least 4-fold decline in nontreponemal antibody titers after treatment of syphilis is regarded as “proof of cure.” However, a substantial proportion of patients demonstrates <4-fold reduction of titers after recommended therapy (serofast state). It remains unclear whether the serofast state is indicative of persistence of bacteria or only a residual immune response.
The aim of the present study was to determine the association between the serofast state and the risk of neurosyphilis in human immunodeficiency virus (HIV)-infected individuals and to identify potential predictors of neurosyphilis.
Thirty-three patients with early syphilis and HIV co-infection were included. One year after the recommended treatment of syphilis, all patients who did not achieve proper serologic response underwent lumbar puncture and cerebrospinal fluid (CSF) examination.
Twelve months after completing therapy for syphilis, the proportion of patients with serofast state after syphilis therapy was 36.4% (n = 12). Among them, 5 (41.7%) had neurosyphilis. Individuals who remained serofast and had neurosyphilis (n = 5) when compared to those without neurosyphilis (n = 7) were characterized by significantly lower CD4+ cell count and higher HIV RNA levels (P < .05). Moreover, a significantly higher proportion of patients with neurosyphilis was not receiving antiretroviral therapy (ART). The nonreceipt of ART independently increased the risk of neurosyphilis in the analyzed group of serofast HIV-infected patients (odds ratio = 4.5; 95% confidence interval 1.5–13.59, P = .003).
Patients co-infected with HIV require careful serologic and clinical follow-up after therapy for syphilis. In all of the patients who do not respond serologically after treatment for syphilis, especially in those who are not receiving ART, lumbar puncture and CSF examination should be considered.