bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left parathyroid carcinoma with secondary hyperparathyroidism: a case report
Authors: Yokoyama Ko , Suganuma Nobuyasu , Rino Yasushi 
Published: May 2023

Abstract
Background
Parathyroid carcinoma is a rare disease with a frequency of 0.005% of all malignancies [1, 2]. Various aspects of its pathogenesis, diagnosis, and treatment remain poorly understood. Furthermore, cases with secondary hyperparathyroidism are fewer. In this case report, we describe a case of left parathyroid carcinoma with secondary hyperparathyroidism.

Case presentation
The patient was a 54-year-old woman who had been on hemodialysis since the age of 40 years. At 53 years of age, her calcium levels were high, and she was diagnosed with drug-resistant secondary hyperparathyroidism and was referred to our hospital for surgical treatment. Blood tests revealed calcium levels of 11.4 mg/dL and intact parathyroid hormone (PTH) levels of 1007 pg/mL. Neck ultrasonography revealed a 22-mm large round hypoechoic mass, partially indistinct margins, and D/W ratio > 1 at the left thyroid lobe. Computed tomography scans revealed a 20-mm nodule at the left thyroid lobe. No enlarged lymph nodes or distant metastases were noted. 99mTc-hexakis-2-methoxyisobutylisonitrile scintigraphy revealed an accumulation at the superior pole of the left thyroid lobe. Laryngeal endoscopy revealed paralysis of the left vocal cord, signifying recurrent nerve palsy due to parathyroid carcinoma. Based on these results, a diagnosis of secondary hyperparathyroidism and suspected left parathyroid carcinoma was made, and the patient underwent surgery. Pathology results revealed hyperplasia in the right upper and lower parathyroid glands. The left upper parathyroid gland showed capsular and venous invasion, and the diagnosis was left parathyroid carcinoma. At 4 months post-surgery, calcium levels improved to 8.7 mg/dL and intact PTH levels to 20 pg/mL, with no signs of recurrence.

Conclusions
We report a case of left parathyroid carcinoma associated with secondary hyperparathyroidism. Concomitant secondary hyperparathyroidism may cause mild hypercalcemia compared to parathyroid carcinoma alone due to the added modification of dialysis. Although our patient also presented with mild hypercalcemia, a D/W ratio > 1 on preoperative echocardiography and presence of recurrent nerve palsy on laryngoscopy led to the suspicion and treatment of parathyroid carcinoma preoperatively.
Effects of crown-to-implant ratio on marginal bone level and bone density in non-splinted single implants: a cross-sectional study
Authors: Chen Ziyuan , Li Weiting , Li Peng 
Published: May 2023

Abstract
Background
Few studies have evaluated the effects of the crown-to-implant (C/I) ratio on the marginal bone level (MBL) and bone density in non-splinted single implants. The aim of this study was to assess the effect of C/I ratio on MBL and density of peri-implant bone in non-splinted posterior implants.

Methods
The C/I ratio, MBL, and grayscale values (GSVs) for bone density were measured from X-rays. Four areas of interest (two at the apical area and two at the middle of the peri-implant area) and two control areas were selected for evaluation. Follow-up radiographs were calibrated according to the control areas.

Results
In all, 117 non-splinted posterior implants in 73 patients followed up for a mean duration of 36.23 ± 10.40 (range 24–72) months were considered. The mean anatomical C/I ratio was 1.78 ± 0.43 (range 0.93 to 3.06). The mean change in MBL was 0.28 ± 0.97 mm. There were no significant associations between the C/I ratio and MBL changes (r = -0.028, p = 0.766). Pearson correlation showed a significant correlation between changes in GSV and the C/I ratio in the middle peri-implant area (r = 0.301, p = 0.001) and apical area (r = 0.247, p = 0.009).

Conclusions
A higher C/I ratio of single non-splinted posterior implants is associated with increased peri-implant bone density, but not correlated with changes in MBL.
e-PBL with multimedia animations: a design-based research
Authors: Budakoğlu Işıl İrem , Coşkun Özlem , Özeke Vildan 
Published: May 2023

Abstract
Background
This study was conducted to explore the effectiveness of online problem-based learning (e-PBL) with multimedia animation scenarios by comparing the face-to-face (f2f) PBL method with paper-based scenarios. Adapting different f2f teaching methodologies to online environments is a significant problem that urgently needs attention, particularly in health education.

Methods
This study is part of design-based research and consists of three phases, which comprise design, analysis, and re-design. First, the animation-based problem scenarios were developed, and the learning environment (e-PBL) elements were organized. Then animation-based scenarios and the e-PBL environment were used, and problems related to the use of the environment were determined with an experimental study which was based on a pretest-posttest control group design. Finally, we used the following three measurement tools in the data collection process: a scale to determine the effectiveness of PBL, an attitude scale toward PBL, and the Clinical Objective Reasoning Exams (CORE). The study group in this research comprised 92 medical undergraduates (47 female and 45 male).

Results
There were similar scores between the two groups (e-PBL and f2f) in terms of the effectiveness of the platforms, the attitudes of the medical undergraduates, and the CORE scores. Also, there were positive relationships between the attitude scores, grade point average (GPA), and PBL scores of the undergraduates. Another significant positive relationship was found between the CORE scores and the GPA.

Conclusions
The animation-supported e-PBL environment positively effects the participants’ knowledge, skills, and attitude. Students who have high academic scores attitude positively towards e-PBL. Providing problem scenarios as multimedia animations is the innovative face of the research. They have been produced inexpensively with off-the-shelf web-based animation apps. These technological advances may democratize the production of video-based cases in the future. Although the results of this study were obtained before the pandemic, they showed no differences between e-PBL and f2f-PBL in terms of effectiveness.
Exploring lemology teaching with “internet plus” flipped classroom pedagogy
Authors: Cao Yu-Xin , Xia Shu-Lin , Zhu Zheng-Yun , Zeng Fan-Rong , Li Hai-Ning , Zhang Ting-Ting , Liu Yong-Juan 
Published: May 2023

Abstract
Background
To investigate the use of flipped classroom pedagogy based on “Internet plus” in teaching viral hepatitis in the lemology course during the COVID-19 epidemic.

Methods
This study included students from the clinical medicine general practitioner class at Nanjing Medical University’s Kangda College, with the observation group consisting of 67 students from the 2020–2021 school year and the control group consisting of 70 students from the 2019–2020 school year. The observation group used “Internet plus” flipped classroom pedagogy, while the control group used conventional offline instruction. The theory course and case analysis ability scores from the two groups were compared and analyzed, and questionnaire surveys were administered to the observation group.

Result
After the flipped classroom, the observation group had significantly higher theoretical test scores (38.62 ± 4.52) and case analysis ability scores (21.08 ± 3.58) than the control group (37.37 ± 2.43) (t = 2.024, P = 0.045) and (19.16 ± 1.15) (t = 4.254, P < 0.001), respectively. The questionnaire survey in the observation group revealed that the “Internet plus” flipped classroom pedagogy approach can help enhance students’ enthusiasm to learn, clinical thinking ability, practical application ability, and learning efficiency, with satisfaction rates of 81.7%, 85.0%, 83.3%, and 78.8%, respectively; 89.4% of students expressed hope that whenever physical classes resumed, the offline courses could be combined with this pedagogy approach.

Conclusion
The use of the “Internet plus” flipped classroom pedagogy technique for teaching viral hepatitis in a lemology course boosted students’ theory learning ability as well as their case analysis ability. The majority of students were pleased with this type of instruction and hoped that whenever physical classes resumed, the offline courses may be integrated with the “Internet plus” flipped classroom pedagogical approach.
Adaptation and psychometric testing of the end-of-life professional caregiver survey in Jamaica
Authors: Edwards Rebecca L. , Bakitas Marie , Li Peng , Spence Dingle , Kahwa Eulalia , Stoltenberg Mark , Ivankova Nataliya V. , Thomas Kaesha , Segree Kammar , Kodilinye Syed Matthew , Markaki Adelais 
Published: May 2023

AbstractBackgroundUsing a validated instrument to measure palliative care (PC) educational needs of health professionals is an important step in understanding how best to educate a well-versed PC workforce within a national health system. The End-of-life Professional Caregiver Survey (EPCS) was developed to measure U.S. interprofessional PC educational needs and has been validated for use in Brazil and China. As part of a larger research project, this study aimed to culturally adapt and psychometrically test the EPCS among physicians, nurses, and social workers practicing in Jamaica.MethodsFace validation involved expert review of the EPCS with recommendations for linguistic item modifications. Content validation was carried out by six Jamaica-based experts who completed a formal content validity index (CVI) for each EPCS item to ascertain relevancy. Health professionals practicing in Jamaica (n = 180) were recruited using convenience and snowball sampling to complete the updated 25-item EPCS (EPCS-J). Internal consistency reliability was assessed using Cronbach’s$$\alpha$$coefficient and McDonald’s$$\phi$$. Construct validity was examined through confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).ResultsContent validation led to elimination of three EPCS items based on a CVI < 0.78. Cronbach’s$$\alpha$$ranged from 0.83 to 0.91 and McDonald’s$$\phi$$ranged from 0.73 to 0.85 across EPCS-J subscales indicating good internal consistency reliability. The corrected item-total correlation for each EPCS-J item was > 0.30 suggesting good reliability. The CFA demonstrated a three-factor model with acceptable fit indices (RMSEA = 0.08, CFI = 0.88, SRMR = 0.06). The EFA determined a three-factor model had the best model fit, with four items moved into theeffective patient caresubscale from the other two EPCS-J subscales based on factor loading.ConclusionsThe psychometric properties of the EPCS-J resulted in acceptable levels of reliability and validity indicating that this instrument is suitable for use in measuring interprofessional PC educational needs in Jamaica.
Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model
Authors: Chen Na , Yang Qing , Li Yin Feng , Guo Qin , Huang De Yu , Peng Jia Ling 
Published: May 2023

Abstract
Background
Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients.

Methods
This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed.

Results
A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis).

Conclusion
This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen.
Safety culture in the operating room: translation, validation of the safety attitudes questionnaire – operating room version
Authors: Pevec Teodor , Albreht Tit , Turk Eva 
Published: May 2023

Abstract
Background
Measuring the safety culture in Healthcare is an important step in improving patient safety. One of the most commonly used instruments to measure the safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the current study was to establish the validity and reliability of the Slovenian version of the SAQ for the operating room SAQ-OR.

Methods
The SAQ, consisting of six dimensions, was translated and adapted to the Slovenian context and applied in operating rooms from seven out of ten Slovenian regional hospitals. Cronbach’s alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument.

Results
The sample consisted of 243 health care professionals who hold positions in the OR, divided into 4 distinct professional classes, namely, 76 surgeons (31%), 15 anesthesiologists (6%), 140 nurses (58%) and 12 auxiliary persons (5%). It was observed a very good Cronbach's alpha (0.77 to 0.88). The CFA and its goodness-of-fit indices (CFI 0.912, TLI 0.900, RMSE 0.056, SRMR 0.056) showed an acceptable model fit. There are 28 items in the final model.

Conclusions
The Slovenian version of the SAQ-OR revealed good psychometric properties for studying the organisational safety culture.
Epigenetic reprogramming of Runx3 reinforces CD8 + T-cell function and improves the clinical response to immunotherapy
Authors: Liu Zongzhi , Li Xiang , Gao Yibo , Liu Jiejie , Feng Yating , Liu Yang , Wang Junyun , Wang Chunmeng , Wang Dongrui , He Jie , Han Weidong , Mei Qian , Sun Yingli 
Published: May 2023

Abstract
Background
Checkpoint blockade immunotherapy, represented by PD-1 or PD-L1 antibody treatment, has been of tremendous success in clinical practice. However, the low clinical response rate and lack of biomarkers for prediction of the immune response limit the clinical application of anti-PD-1 immunotherapy. Our recent work showed that a combination of low-dose decitabine and PD-1-ab significantly improved the complete response (CR) rate of cHL patients from 32 to 71%, which indicates that there is a significant correlation between epigenetic regulation and the clinical response to immunotherapy.

Methods
We recruited two groups of Hodgkin lymphoma patients who were treated with anti-PD-1 and DAC+anti-PD-1. CD8+ T cells were isolated from the patients' peripheral blood, DNA methylation was analyzed by EPIC, the expression profile was analyzed by RNA-seq, and multigroup analysis was performed with IPA and GSEA functional annotations. We explored the effect of DAC on the function of CD8+ T cells in the blood, spleen, tumor and lymph nodes using a mouse model. Furthermore, we explored the function of Tils in the tumor microenvironment. Then, we constructed Runx3-knockout mice to confirm the T-cell-specific function of Runx3 in CD8+ T cells and analyzed various subtypes of T cells and cytokines using mass cytometry (CyTOF).

Results
Multiomics analysis identified that DNA methylation reprogramming of Runx3 was a crucial mediator of CD8+ T-cell function. Multiomics data showed that reversal of methylation of the Runx3 promoter promoted the infiltration of CD8+ TILs and mitigated the exhaustion of CD8+ T cells. Furthermore, experiments on tissue-specific Runx3-knockout mice showed that Runx3 deficiency reduced CD8+ T infiltration and the differentiation of effector T and memory T cells. Furthermore, Runx3 deficiency significantly decreased CCR3 and CCR5 levels. Immunotherapy experiments in Runx3 conditional knockout mice showed that DAC could not reverse the resistance of anti-PD-1 in the absence of Runx3. Moreover, both our clinical data and data from TISIDB showed that Runx3 could be a potential biomarker for immunotherapy to predict the clinical response rate.

Conclusion
We demonstrate that the DNA methylation of Runx3 plays a critical role in CD8+ T-cell infiltration and differentiation during decitabine-primed PD-1-ab immunotherapy, which provides a supporting mechanism for the essential role of epiregulation in immunotherapy.
Manipulating facial musculature with functional electrical stimulation as an intervention for major depressive disorder: a focused search of literature for a proposal
Authors: Demchenko Ilya , Desai Naaz , Iwasa Stephanie N. , Gholamali Nezhad Fatemeh , Zariffa José , Kennedy Sidney H. , Rule Nicholas O. , Cohn Jeffrey F. , Popovic Milos R. , Mulsant Benoit H. , Bhat Venkat 
Published: May 2023

Abstract
Background
Major Depressive Disorder (MDD) is associated with interoceptive deficits expressed throughout the body, particularly the facial musculature. According to the facial feedback hypothesis, afferent feedback from the facial muscles suffices to alter the emotional experience. Thus, manipulating the facial muscles could provide a new “mind-body” intervention for MDD. This article provides a conceptual overview of functional electrical stimulation (FES), a novel neuromodulation-based treatment modality that can be potentially used in the treatment of disorders of disrupted brain connectivity, such as MDD.

Methods
A focused literature search was performed for clinical studies of FES as a modulatory treatment for mood symptoms. The literature is reviewed in a narrative format, integrating theories of emotion, facial expression, and MDD.

Results
A rich body of literature on FES supports the notion that peripheral muscle manipulation in patients with stroke or spinal cord injury may enhance central neuroplasticity, restoring lost sensorimotor function. These neuroplastic effects suggest that FES may be a promising innovative intervention for psychiatric disorders of disrupted brain connectivity, such as MDD. Recent pilot data on repetitive FES applied to the facial muscles in healthy participants and patients with MDD show early promise, suggesting that FES may attenuate the negative interoceptive bias associated with MDD by enhancing positive facial feedback. Neurobiologically, the amygdala and nodes of the emotion-to-motor transformation loop may serve as potential neural targets for facial FES in MDD, as they integrate proprioceptive and interoceptive inputs from muscles of facial expression and fine-tune their motor output in line with socio-emotional context.

Conclusions
Manipulating facial muscles may represent a mechanistically novel treatment strategy for MDD and other disorders of disrupted brain connectivity that is worthy of investigation in phase II/III trials.
Pathological characteristics and immune microenvironment of SMARCA4-deficient undifferentiated uterine sarcoma
Authors: Gao Jie , Fan Ruirui , Chen Dahong , Hou Jinlin , Chen Hanlin , Lu Mingzhi 
Published: May 2023

AbstractSMARCA4-deficient undifferentiated uterine sarcoma (SDUS) is a highly invasive single-gene malignant tumor caused by mutations in the SMARCA4 gene. SDUS has a poor prognosis, with no established treatment strategy at present. Further, there is a lack of relevant research on the role of the immune microenvironment in SDUS worldwide. Here, we report a case of SDUS that was diagnosed and analysed using morphological, immunohistochemical, and molecular detection techniques, along with the analysis of the immune microenvironment. By immunohistochemistry, the tumor cells showed retained INI-1 expression, focal CD10 expression, and loss of BRG1, CK-pan, synaptophysin, desmin, and ER expression. Further, some of the immune cells expressing CD3 and CD8 had infiltrated into the SDUS, but no PD-L1 expression was detected. The multiple immunofluorescent staining results showed that a proportion of the immune cells and SDUS cells expressed CD8/CD68/PD-1/PD-L1. Therefore, our report will help in the diagnostic awareness of SDUS.
Comparison of postoperative analgesic effects of erector spinae plane block and quadratus lumborum block in laparoscopic liver resection: study protocol for a randomized controlled trial
Authors: Bang Yu Jeong , Kwon Ji-Hye , Kang RyungA , Kim Gaab Soo , Jeong Ji Seon , Kim Myungsuk , Choi Gyu-Seong , Kim Jong Man , Ko Justin Sangwook 
Published: May 2023

AbstractBackgroundCompared with open surgery, laparoscopic liver resection is a minimally invasive surgical technique. However, a number of patients experience moderate-to-severe postoperative pain after laparoscopic liver resection. This study aims to compare the postoperative analgesic effects of erector spinae plane block (ESPB) and quadratus lumborum block (QLB) in patients undergoing laparoscopic liver resection.MethodsOne hundred and fourteen patients undergoing laparoscopic liver resection will be randomly allocated to three groups (control, ESPB, or QLB) in a 1:1:1 ratio. In the control group, participants will receive systemic analgesia consisting of regular NSAIDs and fentanyl-based patient-controlled analgesia (PCA) according to the institutional postoperative analgesia protocol. In the two experimental groups (ESPB or QLB group), the participants will receive preoperative bilateral ESPB or bilateral QLB in addition to systemic analgesia according to the institutional protocol. ESPB will be performed at the 8th thoracic vertebra level with ultrasound guidance before surgery. QLB will be performed in the supine position on the posterior plane of the quadratus lumborum with ultrasound guidance before surgery. The primary outcome is cumulative opioid consumption 24 h after surgery. Secondary outcomes are cumulative opioid consumption, pain severity, opioid-related adverse events, and block-related adverse events at predetermined time points (24, 48, and 72 h after surgery). Differences in plasma ropivacaine concentrations in the ESPB and QLB groups would be investigated, and the quality of postoperative recovery among the groups will be compared.DiscussionThis study will reveal the usefulness of ESPB and QLB in terms of postoperative analgesic efficacy and safety in patients undergoing laparoscopic liver resection. Additionally, the study results will provide information on the analgesic superiority of ESPB versus QLB in the same population.Trial registrationProspectively registered with the Clinical Research Information Service on August 3, 2022; KCT0007599.