bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Portfolio in Medical Education: a systematic review
Authors: Barros Mirna D. , Lopes Cristiane , Mendes Carlos J. L. , Tempski Patricia Z. 
Published: May 2022

IntroductionThe educational landscape of medical courses was transformed by competency based learning, triggering changes in necessities of new and different learning methods and assessment tools. One of these tools was the use of the learning and assessment portfolios. Portfolio is a collection of student work that exhibits the student’s efforts, progress and achievements. In medicine, portfolios are used to study critical thinking and self‐directed learning during the development from student to the professional and the general practitioners.ObjetiveThe aim of this review is to answer how and what is the purpose the learning portfolio is applied in medical educationMethodWe performed a systematic search of PUBMED electronic database, from 2011 to 2021, resulting in 740 articles. After the inclusion and the exclusion criteria were applied, we extracted and analyzed information from the selected articles. Descriptive statistical tools were used to characterize the profile of the articles.ResultsIn total, 48 qualitative studies were included, 75.0%(n=36) about undergraduate and graduate medical students portfolios. The most frequents outcomes were: assessment portfolio and competencies (25.0%), perception, satisfaction and use of portfolio by students (20.8%) and portfolio in reflexive practice and learning self‐regulation (18.8%).ConclusionMedical schools, in several countries, use educational portfolio, mostly as an educational tool for undergraduate, graduate (residence) students and, less frequently, for medical professionals for validation or revalidation of diplomas and specialist titles. The main purpose of using portfolios is to draw on student reflection and frequent feedback to assess learning outcomes and the development of skills and competences. The heterogeneity of methods, the lack of control groups and the small number of samples found in articles about the use of the portfolio in Medicine courses were weak points for comparing the outcomes.
Histological study of a low‐cost embalming technique with preservation for nearly three years at room temperature
Authors: Masuko Telma S. , dos Santos Andrade Lucas , Ottone Nicolás E. , Baptista Carlos A. C. , Barros Mirna D. 
Published: May 2022

IntroductionThe fixation of cadavers occurs when substances prevent tissue decomposition and is also called embalming. Various techniques for fixing and preserving cadavers, more or less sophisticated, have been described over the last few years. This work is the continuation of a research line on the fixation technique published in 2020 by Masuko & Andrade, that allows the fixation and conservation of a human cadaver at room temperature for a long period (more than two years) with characteristics and mobility similar to those of a fresh corpse.Materials and MethodIn this step we use a donated 14‐years‐old female cat, that was embalmed using a solution published by Masuko & Andrade, in 2020, with peristaltic pump [alcohol 1000ml; phenol 1000mg; glycerin 1000ml; sodium nitrate 1000mg; formaldehyde 2000ml; distilled water 14000ml]. Femoral arterial accesses and complementary injections of formaldehyde were performed in muscles limbs. The cat was maintained at room temperature, ranging from 19.7 to 34.8ºC (67.46–94.64ºF) and the humidity (37–97%) in body bag covered with blackout sheet, without any additional preservation method to mantain the animal. Samples of tissues (skin and subcutaneous tissue, muscle and colon) were collected after 1m175 days of embalming and submitted to histological staining (HE).ResultsThis method resulted in a soft and flexible specimen with almost natural colors (Figs. 1, 2). Histological analysis indicated the preservation of tissue and cell structure in the different samples examined, even after 1,175 days of fixation. Epidermis and dermis structure identifiable and preserved, making it possible to visualize attachments such as hair follicles. In dermis, it is possible to identify blood vessels and the general structure of the unmodeled dense connective tissue; muscle tissue is well preserved, with the structure of muscle fibers identifiable both in the longitudinal and transversal sections; the colon presents the general structure of the tunics preserved. It is possible to identify mucosal villi, despite the poor clarity of the already altered lining epithelium, vessels in the submucosal conjunctiva and the smooth musculature of the tunica muscularis.DiscussionThe preservation technique presented in 2020 has low cost and easy execution, being effective in humans and now in animals, maintaining the morphological characteristics of the anatomical specimen for an extended period of time.ConclusionWe present an alternative anatomical technique for teaching and research in anatomy centers that have to deal with the toxicity of fixation products and the costs of obtaining and maintaining anatomical specimens.
Surgeon Variation in Perioperative Opioid Prescribing and Medium- or Long-term Opioid Utilization after Total Knee Arthroplasty: A Cross-sectional Analysis
Authors: Cen Xi , Jena Anupam B. , Mackey Sean , Sun Eric C. 
Published: May 2022

Background
Whether a particular surgeon’s opioid prescribing behavior is associated with prolonged postoperative opioid use is unknown. This study tested the hypothesis that the patients of surgeons with a higher propensity to prescribe opioids are more likely to utilize opioids long-term postoperatively.

Methods
The study identified 612,378 Medicare fee-for-service patients undergoing total knee arthroplasty between January 1, 2011, and December 31, 2016. “High-intensity” surgeons were defined as those whose patients were, on average, in the upper quartile of opioid utilization in the immediate perioperative period (preoperative day 7 to postoperative day 7). The study then estimated whether patients of high-intensity surgeons had higher opioid utilization in the midterm (postoperative days 8 to 90) and long-term (postoperative days 91 to 365), utilizing an instrumental variable approach to minimize confounding from unobservable factors.

Results
In the final sample of 604,093 patients, the average age was 74 yr (SD 5), and there were 413,121 (68.4%) females. A total of 180,926 patients (30%) were treated by high-intensity surgeons. On average, patients receiving treatment from a high-intensity surgeon received 36.1 (SD 35.0) oral morphine equivalent (morphine milligram equivalents) per day during the immediate perioperative period compared to 17.3 morphine milligram equivalents (SD 23.1) per day for all other patients (+18.9 morphine milligram equivalents per day difference; 95% CI, 18.7 to 19.0; P < 0.001). After adjusting for confounders, receiving treatment from a high-intensity surgeon was associated with higher opioid utilization in the midterm opioid postoperative period (+2.4 morphine milligram equivalents per day difference; 95% CI, 1.7 to 3.2; P < 0.001 [11.4 morphine milligram equivalents per day vs. 9.0]) and lower opioid utilization in the long-term postoperative period (–1.0 morphine milligram equivalents per day difference; 95% CI, –1.4 to –0.6; P < 0.001 [2.8 morphine milligram equivalents per day vs. 3.8]). While statistically significant, these differences are clinically small.

Conclusions
Among Medicare fee-for-service patients undergoing total knee arthroplasty, surgeon-level variation in opioid utilization in the immediate perioperative period was associated with statistically significant but clinically insignificant differences in opioid utilization in the medium- and long-term postoperative periods.

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Pigmented Purpuric Dermatosis of the Hand: Clinicopathologic Analysis of Six Cases With Review of the Literature
Authors: Runge John S. , Nakamura Mio , Sullivan Annette Nichole , Harms Paul W. , Chan May P. 
Published: May 2022

Abstract:
Pigmented purpuric dermatosis (PPD) is a group of skin disorders characterized by red, brown, or golden macules and patches with cayenne pepper-like spots. Classic histopathologic features include a perivascular lymphocytic infiltrate with associated erythrocyte extravasation and hemosiderin deposition. Although PPD most commonly affects the lower extremities, upper extremity involvement has been infrequently reported. Cases involving the hands are particularly rare. We present 6 new cases of PPD involving the hand and review 17 previously reported cases in the literature. All cases in our series were unilateral and localized to the dorsum of the hand. PPD was considered clinically in only 2 of these cases. Histopathologic examination revealed hallmark features of PPD, namely a superficial perivascular lymphocytic infiltrate and extravasated erythrocytes. Previous reports of PPD involving the hand described concurrent involvement of other anatomic sites in most cases; only 4 cases (24%) were confined to the hands. Histopathologic descriptions of these reported cases were compatible with PPD. In sum, our series describes a unique and rare clinical presentation of PPD confined to the unilateral dorsal hand. Because of the unusual presentation, biopsy is often required for accurate diagnosis.
A Rare Case of Myxochondroid Metaplasia of the Plantar Foot With Review of Histopathological Mimics
Authors: Alomari Ahmed K. , Warnock Aaron , Cummings Oscar W. 
Published: May 2022

Abstract:
Chondromyxoid metaplasia can rarely lead to the formation of a distinctive tumor-like proliferation in the plantar foot. This is thought to represent a reactive or reparative process, possibly due to chronic trauma. For the unwary dermatopathologist, this could represent a diagnostic challenge. Herein, we review the clinical, histopathological, and molecular presentation of an athletic 17-year-old boy with a soft tissue mass arising in the right plantar foot. Microscopic examination showed a relatively circumscribed proliferation of spindle cells with abundant chondromyxoid stroma, hyalinization, and diffuse ERG reactivity. We also review characteristics of this entity that help differentiate it from clinical and histopathologic mimics and postulate possible links with soft tissue chondromas and immature chondroid choristoma.
Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic
Authors: Bannett Yair , Dahlen Alex , Huffman Lynne C. , Feldman Heidi M. 
Published: May 2022

ABSTRACT:

Objective:
The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care.

Method:
We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020–March 15, 2021) compared with prepandemic years (January 1, 2016–March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared.

Results:
ADHD–related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%–43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years.

Conclusion:
Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.
Physician role differentiation: Patients, practice patterns, and performance
Authors: Comfort Leeann N. , Bambury Elizabeth , Atkinson Mariam Krikorian 
Published: May 2022

Background
Multispecialty clinical settings are increasingly prevalent because of the growing complexity in health care, revealing challenges with overlaps in expertise. We study hospitalists and inpatient specialists to gain insights on how physicians with shared expertise may differentiate themselves in practice.

Purpose
The aim of this study was to explore how hospitalists differentiate themselves from other inpatient physicians when treating patient cases in areas of shared expertise, focusing on differences in patient populations, practice patterns, and performance on cost and quality metrics.

Methodology
We use mixed-effects multilevel models and mediation models to analyze medical records and disaggregated billing data for admissions to a large urban pediatric hospital from January 1, 2009, to August 31, 2015.

Results
In areas of shared physician expertise, patients with more ambiguous diagnoses and multiple chronic conditions are more likely to be assigned to a hospitalist. Controlling for differences in patient populations, hospitalists order laboratory tests and medications at lower rates than specialists. Hospitalists’ laboratory testing rate had a significant mediating role in their lower total charges and lower odds of their patients experiencing any nonsurgical adverse events compared to specialists, though hospitalists did not differ from specialists in 30- and 90-day readmission rates.

Practice Implications
Physicians with shared expertise, such as hospitalists and inpatient specialists, differentiate their roles through assignment to ambiguous diagnoses and multisystem conditions, and practice patterns such as laboratory and medication orders. Such differentiation can improve care coordination and establish professional identity when roles overlap.
Cemiplimab for Orbital Squamous Cell Carcinoma in 11 Cases
Authors: Steren Benjamin , Burtness Barbara , Bhatia Aarti , Demirci Hakan , Shinder Roman , Yoo David , Tse Brian , Pointdujour-Lim Renelle 
Published: May 2022

Purpose:
To review the demographics, clinical features, and response of orbital squamous cell carcinoma treated with cemiplimab.

Methods:
This is a retrospective multi-institutional series. Patient characteristics, drug dosing, duration, and response to treatment were evaluated.

Results:
The study cohort consisted of 11 patients from 5 institutions. All patients received a regimen of 350 mg q 3 weeks and an average of 11.2 cycles (SD 5.8). No patient experienced significant side effects requiring treatment or cessation of cemiplimab. Complete response was achieved in 9 patients (82%) treated with cemiplimab.

Conclusions:
Immune checkpoint inhibitors, such as cemiplimab provide a globe-sparing option for the treatment of orbital squamous cell carcinoma. It is important to consider these agents especially when orbital exenteration is the alternative.
Emerging roles of circular RNAs in cancer: a narrative review
Authors: Guo Shixiang , Zhang Junfeng , Tao Junyu , Zhu Jinfeng , Zheng Ruixin , Wang Huaizhi 
Published: May 2022

Abstract
Circular RNAs (circRNAs) constitute a novel class of endogenous noncoding RNAs characterized by a covalently closed structure and involved in multiple biological processes. The main biological functions and properties of circRNAs can be defined by five features: a “sponging” effect on other RNA species, post-transcriptional regulation, rolling circle translation, generation of pseudogenes, and splicing interference. Although circRNAs were first detected decades ago, the role of circRNAs and the mechanisms underlying their actions remain incompletely characterized. Recently, circRNAs were reported to play indispensable roles in regulating metabolic and signal transduction events controlling the proliferation, migration, and survival of cells. Importantly, many studies demonstrated that dysregulated circRNA expression is associated with the development of multiple diseases, including cancer. In this review, we summarize current knowledge on the roles and mechanisms of circRNAs in cancer and discuss their functions as oncogenes or tumor suppressors in different tumor types.
The Mental Effect of Music on the Personal State in Terms of Depressive Personality Disorders
Authors: Zhang Ling 
Published: May 2022

Abstract
The use of music as a basis for overcoming depressive personality disorders is possible only if the individual is ready for this therapy. Music therapy affects, first of all, the very structure of personality, its dynamic filling with current social and political tendencies, and allows to highlight problem areas, which are often viewed as complex in the structure of other psychological problems. The purpose of the current study was the determination and justification of the corresponding criteria in relation to this, as well as the methodology for diagnosing the studied phenomenon. The diagnostics involved five groups of psychologists (in general, 438 persons). The preparedness of therapists for preventive and remedial work with patients with depressive conduct disorder was evaluated. To test the truth of the statistical hypothesis the Wilcoxon-Mann-Whitney criterion was used. The novelty of the article is determined by the fact that the use of music is considered only as a therapeutic measure, and not associated with the use of medication or sedation. The developed system of the use of music therapy can be implemented only under the condition of applying special factors and principles. These factors include, first of all, the ability to respond to the personality and, if necessary, adjust the therapy strategy.
Immunomodulation of Acellular Dermal Matrix Through Interleukin 4 Enhances Vascular Infiltration
Authors: Cottler Patrick S. , Kang Hannah , Nash Victoria , Salopek Lisa , Bruce Anthony C. , Spiller Kara L. , Campbell Chris A. 
Published: May 2022

Background
Acellular dermal matrix (ADM) supported implant-based reconstruction remains the most commonly performed mode of reconstruction after breast cancer. Acellular dermal matrix clinical usage has reported benefits but requires rapid and efficient vascular and cellular incorporation into the recipient to have the best outcomes. Orderly transition from M1 to M2 macrophage phenotypic profile, coordinated in part by interleukin 4 (IL-4), is an important component of vascular stabilization and remodeling. Using the ADM substrate as a delivery device for immunomodulation of macrophage phenotype holds the potential to improve integration.

Methods
Interleukin 4 was adsorbed onto ADM samples and drug elution curves were measured. Next, experimental groups of 8 C57BL/6 mice had 5-mm ADM discs surgically placed in a dorsal window chamber with a vascularized skin flap on one side and a plastic cover slip on the other in a model of implant-based breast reconstruction. Group 1 consisted of IL-4 (5 μg) adsorbed into the ADM preoperatively and group 2 consisted of an untreated ADM control. Serial gross examinations were performed with histology at day 21 for markers of vascularization, mesenchymal cell infiltration, and macrophage lineage.

Results
Drug elution curves showed sustained IL-4 release for 10 days after adsorption. Serial gross examination showed similar rates of superficial vascular investment of the ADM beginning at the periphery by day 14 and increasing through day 21. Interleukin-4 treatment led to significantly increased CD31 staining of vascular endothelial cells within the ADM over the control group (P < 0.05) at 21 days. Although vimentin staining did not indicate a significant increase in fibroblasts overall, IL-4 did result in a significant increase in expression of α-smooth muscle actin. The expression of macrophage phenotype markers Arginase1 and iNOS present within the ADM were not significantly affected by IL-4 treatment at the day 21 time point.

Conclusions
Acellular dermal matrix has the potential to be used for immunomodulatory cytokine delivery during the timeframe of healing. Using implanted ADM as a delivery vehicle to drive IL-4 mediated angiogenesis and vascular remodeling significantly enhanced vascularity within the ADM substrate.
Brief: Implementation of a Novel Clinic/Community Partnership Addressing Food Insecurity Among Adults with HIV in the Southern United States
Authors: Turner Wesli H. , Kay Emma Sophia , Raper James L. , Musgrove Karen , Gaddis Kathy , Ferrell Anastasia , Yester Donna , Glenn Joshua , Atwater Meredith , Hutchins Kris , Tamhane Ashutosh , Long Dustin M. , Kellar Polly , Creger Tom , Eaton Ellen , Willig Amanda L. 
Published: May 2022

AbstractFood insecurity is highly prevalent among people with HIV. Traditional calorie-rich, nutrient poor food assistance programs may improve food security but increase risk for other chronic diseases. This case study describes the process evaluation of a novel clinic/community partnership to provide nutritionally adequate, tailored food assistance to adults with HIV in Alabama. Methods used include semi-structured interviews with program staff at Birmingham AIDS Outreach and the University of Alabama at Birmingham’s 1917 HIV/AIDS Clinic, and analysis of descriptive characteristics of individuals enrolled in the food program for a minimum of one year between 2017-2019. The new program served 1,311 patients and enabled more than 300 previously lost-to-follow-up patients to re-engage in HIV care. The program implementation reviewed here can serve as a roadmap to develop clinic/community partnerships focused on a variety of health outcomes and quality of life among food insecure patients.
Design and validation of HIV peptide pools for detection of HIV-specific CD4+ and CD8+ T cells
Authors: Alkolla Rita , Grifoni Alba , Crotty Shane , Sette Alessandro , Gianella Sara , Dan Jennifer 
Published: May 2022

AbstractReagents to monitor T cell responses to the entire HIV genome, based on well characterized epitopes, are missing. Evaluation of HIV-specific T cell responses is of importance to study natural infection, and therapeutic and vaccine interventions. Experimentally derived CD4+ and CD8+ HIV epitopes from the HIV molecular immunology database were developed into Class I and Class II HIV megapools (MPs). We assessed HIV responses in persons with HIV pre combined antiretroviral therapy (cART) (n=17) and post-cART (n=18) and compared these responses to 15 controls without HIV (matched by sex, age, and ethnicity). Using the Activation Induced Marker (AIM) assay, we quantified HIV-specific total CD4+, memory CD4+, circulating T follicular helper, total CD8+ and memory CD8+ T cells. We also compared the Class I and Class II HIV MPs to commercially available HIV gag peptide pools. Overall, HIV Class II MP detected HIV-specific CD4+ T cells in 21/35 (60%) HIV positive samples and 0/15 HIV negative samples. HIV Class I MP detected an HIV-specific CD8+ T cells in 17/35 (48.6%) HIV positive samples and 0/15 HIV negative samples. Our innovative HIV MPs are reflective of the entire HIV genome, and its performance is comparable to other commercially available peptide pools. Here, we detected HIV-specific CD4+ and CD8+ T cell responses in people on and off cART, but not in people without HIV.