bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiotherapy for localized gastric mucosa–associated lymphoid tissue lymphoma: long-term outcomes over 10 years
Authors: Ohkubo Yu , Saito Yoshihiro , Ushijima Hiroki , Onishi Masahiro , Kazumoto Tomoko , Saitoh Jun-ichi , Kubota Nobuko , Kobayashi Hirofumi , Maseki Nobuo , Nishimura Yu , Kurosumi Masafumi 
Published: November 2016

Abstract
This study aimed to assess the long-term outcomes of radiotherapy in patients with localized gastric mucosa–associated lymphoid tissue (MALT) lymphoma. Twenty-seven patients with Stage I gastric MALT lymphoma were treated with radiotherapy from 1999 to 2010. The median age was 65 years (range: 31–84). Fifteen patients were Helicobacter pylori–negative. Thirteen patients were treated with definitive radiotherapy alone. The other 14 patients who had refractory or residual disease following a prior treatment received salvage radiotherapy. The median dose of the radiotherapy was 30 Gy in 20 fractions (range: 30–39.5 Gy). The median follow-up period was 121 months (range: 8–176 months). The 5- and 10-year overall survival rates for all patients were 92% and 87%, respectively. No patients died from MALT lymphoma. Three patients died of other diseases at 8, 33 and 74 months after radiotherapy (myocardial infarction, pneumonia and hepatocellular carcinoma, respectively). No cases of local recurrence were observed during the follow-up period. There were no serious late gastric, liver or kidney complications during a median follow-up period of over 10 years. Two patients remain alive with distant metastases: a lung metastasis and an abdominal lymph node metastasis at 104 months and 21 months after radiotherapy, respectively. Excellent long-term local control was observed in patients with localized gastric MALT lymphoma after radiotherapy. However, lifelong follow-up should be conducted to detect cases of late recurrence, especially distant metastases.
Mitigation of whole-body gamma radiation–induced damages by Clerodendron infortunatum in mammalian organisms
Authors: Chacko Tiju , Menon Aditya , Majeed Teeju , Nair Sivaprabha V. , John Nithu Sara , Nair Cherupally Krishnan Krishnan 
Published: November 2016

AbstractSeveral phytoceuticals and extracts of medicinal plants are reported to mitigate deleterious effects of ionizing radiation. The potential of hydro-alcoholic extract of Clerodendron infortunatum (CIE) for providing protection to mice exposed to gamma radiation was investigated. Oral administration of CIE bestowed a survival advantage to mice exposed to lethal doses of gamma radiation. Radiation-induced depletion of the total blood count and bone marrow cellularity were prevented by treatment with CIE. Damage to the cellular DNA (as was evident from the comet assay and the micronucleus index) was also found to be decreased upon CIE administration. Radiation-induced damages to intestinal crypt cells was also reduced by CIE. Studies on gene expression in intestinal cells revealed that there was a marked increase in the Bax/Bcl-2 ratio in mice exposed to whole-body 4 Gy gamma radiation, and that administration of CIE resulted in significant lowering of this ratio, suggestive of reduction of radiation-induced apoptosis. Also, in the intestinal tissue of irradiated animals, following CIE treatment, levels of expression of the DNA repair gene Atm were found to be elevated, and there was reduction in the expression of the inflammatory Cox-2 gene. Thus, our results suggest a beneficial use of Clerodendron infortunatum for mitigating radiation toxicity.
Using National Health Care Databases and Problem-Based Practice Analysis to Inform Integrated Curriculum Development
Authors: Baker Amy J. , Raymond Mark R. , Haist Steven A. , Boulet John R. 
Published: November 2016

One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.
Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.
Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.
Meeting ACGME Standards Under a Unified Accreditation System: Challenges for Osteopathic Graduate Medical Education Programs
Authors: Cummings Mark 
Published: November 2016

In 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine signed a memorandum of understanding (MOU) with the Accreditation Council for Graduate Medical Education (ACGME) to create a unified accreditation system for graduate medical education (GME) under the ACGME. The AOA will cease to accredit GME programs on June 30, 2020. By then, AOA-accredited programs need to apply for and achieve ACGME initial accreditation. The terms of the MOU also made it advantageous for some formerly nonteaching hospitals to establish AOA programs, chiefly in primary care, as a step toward future ACGME accreditation.
In transitioning AOA programs to the ACGME system, hospitals with osteopathic GME can expect to encounter challenges related to major differences between AOA and ACGME standards. The minimum numbers of residents for ACGME programs in most specialties are greater than those for AOA programs, which will require hospitals that may already be at their federal caps to add additional residency positions. ACGME standards are also more faculty- and staff-intensive and require additional infrastructure, necessitating additional financial investments. In addition, greater curricular specificity in ACGME standards will generate new educational and financial challenges.
To address these challenges, hospitals may need to reallocate resources and positions among their current AOA programs, reducing the number of programs (and specialties) they sponsor. It is expected that a number of established and new AOA programs will choose not to pursue ACGME accreditation or will fail to qualify for ACGME initial accreditation.
Unique Educational Opportunities for PCPs and Specialists Arising From Electronic Consultation Services
Authors: Keely Erin J. , Archibald Douglas , Tuot Delphine S. , Lochnan Heather , Liddy Clare 
Published: November 2016

Health care reform should be driven by the goals of better patient experience, improved population health, lower per capita costs, and improved provider satisfaction. Electronic consultation (eConsult) services have been adopted by several jurisdictions in the United States, Canada, and Europe to improve access to specialists by primary care providers (PCPs) and are being heralded as a key component for delivery of coordinated care. The primary intent of an eConsult service is to provide PCPs with efficient, timely, direct access to specialist expertise to help guide the management of their patients, reduce the need for unnecessary face-to-face specialty consultations, and improve the quality of the initial face-to-face consultation when needed, through the preconsultative communication.
In addition to improving access to care, eConsult services have been praised by PCPs and specialists for their educational value, in particular their ability to enrich practice-based learning. Less recognized, but equally important from the educational perspective, include the abilities of eConsult programs to promote reflection by PCPs and specialists, improve collegiality and professionalism between primary and specialist care, inform continuing professional development activities and maintenance of certification, and enhance training programs’ teaching of effective communication and care coordination.
As eConsult services become increasingly available, the medical community must leverage the educational opportunities inherent in eConsult programs to further improve the delivery of coordinated specialty care. The educational role of eConsults should be considered as a priority outcome in their evaluation and must be highlighted and optimized in next iterations of eConsult systems design.
Transition to Independence: Characteristics and Outcomes of Mentored Career Development (KL2) Scholars at Clinical and Translational Science Award Institutions
Authors: Sweeney Carol , Schwartz Lisa S. , Toto Robert , Merchant Carol , Fair Alecia S. , Gabrilove Janice L. 
Published: November 2016

Purpose
To describe the transition from mentored to independent research funding for clinical and translational scholars supported by institutional KL2 Mentored Career Development programs.

Method
In 2013, faculty leaders at Clinical and Translational Science Award institutions completed an online survey, reporting characteristics of scholars in their KL2 programs from 2006 to 2013. The primary outcome variable was a report that the scholar had received independent funding as a principal investigator. Data analysis included descriptive summaries and mixed-effects regression models.

Results
Respondents from 48 institutions (of 62 eligible; 77%) provided information about 914 KL2 scholars. Of those, 620 (68%) were medical doctors, 114 (12%) had other clinical training, and 177 (19%) were nonclinician PhDs. Fifty-three percent (487) were female; 12% (108/865) were members of racial or ethnic groups underrepresented in medicine (URM). After completing KL2 training, 96% (558/582) remained engaged in research. Among scholars who completed KL2 training two or more years earlier, 39% (149/374) received independent funding. Independent funding was from non-National Institutes of Health (NIH) sources (120 scholars) more often than from NIH (101 scholars). The odds of a nonclinician attaining independent funding were twice those of a clinician (odds ratio 2.05; 95% confidence interval 1.11–3.78). Female and URM scholars were as likely as male and non-URM scholars to attain independent funding.

Conclusions
KL2 programs supported the transition to independent funding for clinical and translational scientists. Female and URM scholars were well represented. Future studies should consider non-NIH funding sources when assessing the transition to research independence.
“It Feels Like a Lot of Extra Work”: Resident Attitudes About Quality Improvement and Implications for an Effective Learning Health Care System
Authors: Butler Jorie M. , Anderson Katherine A. , Supiano Mark A. , Weir Charlene R. 
Published: November 2016

Purpose
The learning health care system promotes development and application of evidence generated within the health care system to enhance the quality of patient care. The purpose of this study was to understand resident attitudes about quality improvement (QI) in Accreditation Council for Graduate Medical Education–approved programs.

Method
Four focus groups were conducted with 45 residents at the University of Utah School of Medicine during September and October 2014. Residents discussed the perceived value of QI and their experiences with QI. Qualitative analysis was conducted iteratively, resulting in a set of constructs that were then consolidated into overarching themes.

Results
Five themes emerged from the qualitative analysis. Four of these represented QI participation barriers: challenges with understanding the vision of QI, confusion about basic aspects of QI, a sense that resident contributions to QI are not valued/valuable to the QI process, and challenges with prioritizing responsibilities relating to QI compared with other responsibilities. One theme represented a facilitator of successful QI: factors that make QI work successfully (e.g., clear goals and a sense of being on the “same page”).

Conclusions
If resident attitudes about QI do not improve, the culture of the learning health care system is threatened. An important step in enhancing the perceived value of QI is resolving the perceived tension between providing excellent patient care and satisfying other goals. Involving residents more effectively in QI may result in improved attitudes and promote development of a better-functioning learning health care system.
The Impact of a Scholarly Concentration Program on Student Interest in Career-Long Research: A Longitudinal Study
Authors: Wolfson Rachel K. , Alberson Kurt , McGinty Michael , Schwanz Korry , Dickins Kirsten , Arora Vineet M. 
Published: November 2016

Purpose
Concerns remain regarding the future of the physician-scientist workforce. One goal of scholarly concentration (SC) programs is to give students skills and motivation to pursue research careers. The authors describe SC and student variables that affect students’ career plans.

Method
Medical students graduating from the University of Chicago SC program in 2014 and 2015 were studied. The authors measured change in interest in career-long research from matriculation to graduation, and used ordinal logistic regression to determine whether program satisfaction, dissemination of scholarship, publication, and gender were associated with increased interest in a research career.

Results
Among students with low baseline interest in career-long research, a one-point-higher program satisfaction was associated with 2.49 (95% CI 1.36–4.57, P = .003) odds of a one-point-increased interest in a research career from matriculation to graduation. Among students with high baseline interest in career-long research, both publication (OR 5.46, 95% CI 1.40–21.32, P = .02) and female gender (OR 4.83, 95% CI 1.11–21.04, P = .04) were associated with increased odds of a one-point-increased interest in career-long research.

Conclusions
The impact of an SC program on change in career plans during medical school was analyzed. Program satisfaction, publication, and female gender were associated with increased intent to participate in career-long research depending on baseline interest in career-long research. Two ways to bolster the physician-scientist workforce are to improve satisfaction with existing SC programs and to formally support student publication. Future work to track outcomes of SC program graduates is warranted.
Efficacy and Safety of Vernakalant for Cardioversion of Recent-onset Atrial Fibrillation in the Asia–Pacific Region: A Phase 3 Randomized Controlled Trial
Authors: Beatch Gregory N. , Bhirangi Kiran , Juul-Moller Steen , Rustige Jörg 
Published: November 2016

Abstract:
Atrial fibrillation (AF) is a common clinically significant cardiac arrhythmia. This phase 3 randomized, double-blind, placebo-controlled trial assessed the efficacy and safety of vernakalant hydrochloride for the pharmacological conversion of AF to sinus rhythm in patients with recent-onset (>3 hours to ≤7 days) symptomatic AF from the Asia–Pacific region. Patients received an infusion of vernakalant (3 mg/kg) or placebo for 10 minutes. If AF had not been terminated 15 minutes later, a second infusion of vernakalant (2 mg/kg) or placebo for 15 minutes was administered. The primary efficacy end point was conversion of AF to sinus rhythm for >1 minute within 90 minutes. The study was terminated early for administrative reasons; 123 patients from Korea, Taiwan, and India were randomized to receive vernakalant (n = 55) or placebo (n = 56). A greater proportion of patients who received vernakalant (52.7%) than placebo (12.5%) met the primary end point (P < 0.001), and cardioversion was faster in the vernakalant group than in the placebo group (P < 0.001). Vernakalant was generally well tolerated; the incidence of treatment-emergent adverse events was similar between the groups. We conclude that vernakalant is efficacious in the rapid cardioversion of recent-onset AF in patients from the Asia–Pacific region.
DIFFERENT SURGICAL MODALITIES FOR MANAGEMENT OF PERSISTENT GLAUCOMA AFTER SILICONE OIL REMOVAL IN VITRECTOMIZED EYES
Authors: El-Saied Heba Magdy , Abdelhakim Mohamad Amr Salah Eddin 
Published: November 2016

Purpose:
Aim of this study was to compare outcome of four different surgical modalities for management of persistent glaucoma after silicone oil removal in vitrectomized eyes.

Methods:
This is a prospective comparative study, carried out on a cohort of 41 eyes (41 patients). Patients were randomly allocated to Group A (trabeculectomy), Group B (deep sclerectomy), Group C (Ahmed valve), or Group D (Ex-Press Minishunt). Postoperatively, all patients were followed regularly at 1 day, 1 week, 1, 3, and 6 months, and 1 year for intraocular pressure evaluation.

Results:
Postoperatively, there was significant drop in intraocular pressure in each group, and significant difference between the four groups regarding drop and percentage drop in intraocular pressure, with Group C showing the highest mean percentage drop in intraocular pressure, whereas Group B with the least. Success rate was 100% with Ex-Press minishunt, 80% with Ahmed valve, and 50% for each of trabeculectomy and deep sclerectomy. Hypotony occurred in 50% with Ahmed valve and 40% with trabeculectomy, whereas glaucoma occurred in 50% with deep sclerectomy and 30% with trabeculectomy.

Conclusion:
For controlling persistent glaucoma after silicone oil removal in our work, Ex-Press minishunt had the highest complete success rate with no postoperative complications.
ULTRA-WIDE-FIELD FUNDUS IMAGING IN THE DIAGNOSIS AND FOLLOW-UP OF SUSAC SYNDROME
Authors: Salvanos Panagiotis , Moe Morten C. , Utheim Tor P. , Bragadóttir Ragnheiður , Kerty Emilia 
Published: November 2016

Purpose:
To present the use of ultra-wide-field (UW) fundus imaging in the diagnosis and follow-up of a patient with Susac syndrome.

Methods:
Case report of a myopic patient presenting initially with rhegmatogenous retinal detachment. A significant portion of the retina was found to be avascular bilaterally at presentation. Surgery was performed with scleral buckle. Then, UW color and autofluorescent imaging and UW fluorescein angiography were obtained.

Results:
Successful retinal reattachment was obtained. Enlargement of the avascular area with neovascularization was observed at eight-month follow-up. In addition, the patient presented severe neurosensory hearing loss and clinical depression postoperatively. The results of UW fluorescein angiography revealed hyperfluorescent macular spots, arteriolar wall hyperfluorescence, leakage from retinal neovascularization, and confirmed the avascularity of two thirds of the retina, whereas the results of UW autofluorescence showed absence of the normal hypofluorescent retinal vessels outside the posterior pole. Findings of UW imaging in combination with systemic involvement led to the diagnosis of Susac syndrome. Appropriate treatment stopped the disease progress, ameliorated symptoms, and some of the occluded retinal vessels were reperfused.

Conclusion:
In conclusion, UW fundus imaging is a valuable modality in the diagnosis and follow-up of patients with Susac syndrome. Early diagnosis and treatment is critical, particularly as it can lead to reperfusion of occluded retinal vessels.
BILATERAL METASTATIC CUTANEOUS MELANOMA TO RETINA AND VITREOUS AFTER IPILIMUMAB TREATED WITH PARS PLANA VITRECTOMY AND RADIOTHERAPY
Authors: Kanavati Sam , Ottensmeier Christian , Foria Vipul , Krishnan Radhika 
Published: November 2016

Purpose:
To report a patient with bilateral metastatic cutaneous melanoma to the retina and vitreous presenting as a right panuveitis.

Methods:
A 63-year-old woman with metastatic malignant cutaneous melanoma treated with ipilimumab and prolonged high-dose steroids presented with a right panuveitis and right blurred vision. Dilated fundus examination revealed bilateral, off-white, large, globular vitreous opacities and bilateral retinal lesions. These retinal lesions had a pale yellow appearance with a cuff of haemorrhage. The unpigmented appearance of the vitreous opacities raised the suspicion of candida endophthalmitis.

Results:
Bilateral, sequential pars plana vitrectomy with pathomorphologic examination of the vitreous specimen demonstrated metastatic melanoma. Ocular radiotherapy followed by cataract surgery resulted in the regression of retinal lesions in both eyes and no recurrence of the vitreous metastases.

Conclusion:
The development of vitreous and retinal metastases despite a systemic response to ipilimumab identifies the challenge of immunotherapy in an immune privileged site. Treatment is challenging, and outcomes are variable. A local approach of bilateral pars plana vitrectomy, external beam radiotherapy, and subsequent bilateral cataract surgery provided an excellent visual result with no recurrence at 12 months.
THE “DOUBLE-RING SIGN” IN ANEMIC RETINOPATHY EVALUATED BY SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Authors: Goel Neha 
Published: November 2016

Purpose:
To describe three cases of anemic retinopathy who demonstrated premacular hemorrhage with a “double-ring sign.”

Methods:
Three patients with anemia were found to have a premacular hemorrhage and a double-ring sign either at presentation or after laser membranotomy. Spectral domain optical coherence tomography was performed to ascertain the level of the hemorrhage.

Results:
To the best of the author's knowledge, there is no report of a double-ring sign in anemic retinopathy. In two eyes, spectral domain optical coherence tomography revealed that the double-ring sign consisted of an outer subhyaloid and inner sub-internal limiting membrane hemorrhage. However, in the third case, spectral domain optical coherence tomography confirmed that the double-ring sign consisted of a sub-internal limiting membrane hemorrhage only.

Conclusion:
Spectral domain optical coherence tomography evaluation is essential to determine the level of hemorrhage in premacular hemorrhage with a double-ring sign. It may not always indicate concurrent occurrence of a subhyaloid and sub-internal limiting membrane hemorrhage, as was previously believed.
MACULAR TELANGIECTASIA TYPE 2 IN AN OTHERWISE HEALTHY TEENAGE BOY WITH CONSANGUINEOUS PARENTS
Authors: Ryu Christina L. , Mikhail Mikel , Khan Ayesha , Chen John C. , Omar Amer 
Published: November 2016

Purpose:
To report a case of macular telangiectasia Type 2 in a teenage boy with consanguineous parents.

Method:
Clinical case report and literature review.

Results:
A healthy 14-year-old boy presented with mildly reduced vision in both eyes. Visual acuity was 20/30 in the right eye and 20/25 in the left eye. Fundus examination revealed intraretinal crystals in both eyes and an intraretinal pigment plaque temporal to the fovea in the left eye. Neither eye showed evidence of choroidal neovascular membrane or peripheral telangiectasia. Fluorescein angiography revealed temporal juxtafoveal leakage in both eyes. Spectral-domain optical coherence tomography showed ellipsoid layer and external limiting membrane disruption in the right eye and an inner retinal pigment plaque with shadowing in the left eye. The patient was of South Asian descent, and his parents were first cousins. His younger brother and parents were unaffected with a normal fundus examination.

Conclusion:
This is the youngest reported case of a healthy individual with MacTel Type 2, which usually manifests in the fifth or sixth decade. This is also the only reported case of MacTel Type 2 with consanguineous parents. This proband offers a unique opportunity to study possible monogenic etiologies of the condition.