bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case of Concurrent Extramammary Paget Disease and Basal Cell Carcinoma of the Perianal Region
Authors: Takahashi Natsuko , Okumura Yoshiyuki , Sawaragi Eiichi 
Published: January 2020

Summary:
An 83-year-old Japanese man who had been aware of a tumor near his anus for 2 years underwent tumor resection. Although he was diagnosed with basal cell carcinoma (BCC), extramammary Paget disease (EMPD) was also accidentally found in the same specimen. In the pathological histology of EMPD, there were large round cells with ample cytoplasm spread in the epidermis; these cells were positive for cytokeratin 7 and gross cystic disease fluid protein 15. No signs that are typically associated with EMPD, such as erythema or leukoderma, were observed near the anus. There have been only 4 reports in which BCC and EMPD developed in the same area, and the authors present the fifth case. In the reported case, no clear evidence was found for the corelative development of BCC and EMPD.
Long-term blood pressure behavior and progression to end-stage renal disease in patients with immunoglobulin A nephropathy: a single-center observational study in Italy
Authors: Russo Elisa , Verzola Daniela , Salvidio Gennaro , Bonino Barbara , Picciotto Daniela , Drovandi Stefania , Pozzi Claudio , Ferrario Francesca , Pontremoli Roberto , Garibotto Giacomo , Viazzi Francesca 
Published: January 2020

Background:
Antihypertensive treatment by the use of RAAS inhibitors (RAAS-is) is of paramount importance in the management of slowly progressive IgA nephropathy (IgAN). With the aim of better understanding the relationship between BP behavior and progression, we looked at time-averaged SBP and time-averaged proteinuria and renal outcome in a single-center cohort of IgAN patients.

Methods:
Among 248 consecutive patients referred to the Clinic of Nephrology of San Martino Hospital from 1996 to 2018 for native renal biopsy with a diagnosis of IgAN, we retrospectively analyzed 145 with available data at baseline and during follow-up. All patients received Supportive Care, 39% were on RAAS-is alone, 45% plus steroids, and 16% plus steroids and immunosuppressors. Renal replacing treatment (RRT) was the primary endpoint.

Results:
During a mean follow-up of 67 ± 6 months, 23% of study patients (n = 33) progressed to RRT and 6% (n = 9) died. Patients who reached the renal endpoint, had lower baseline eGFR and higher proteinuria and proteinuria indexed at baseline. Moreover, they had higher TA-SBP (139 ± 17 vs. 130 ± 13, P = 0.0016). The incidence of RRT was higher in IgAN patients in the highest time-averaged SBP tertile as compared with the others (32 vs. 23 vs. 9%, χ
2 6.8, P = 0.033). After adjusting for baseline SBP, baseline and time-averaged proteinuria indexed, MEST-C score, and treatment, the association between TA-SBP and RRT persisted.

Conclusion:
Time-averaged low BP values were independently associated to a decreased risk of renal progression in IgAN with no evidence of a J-curve relationship even at SBP levels below 125 mmHg.
DIAGNOSTIC CHARACTERISTICS OF POLYPOIDAL CHOROIDAL VASCULOPATHY BASED ON B-SCAN SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AND ITS INTERRATER AGREEMENT COMPARED WITH INDOCYANINE GREEN ANGIOGRAPHY
Authors: Fujita Ai , Kataoka Keiko , Takeuchi Jun , Nakano Yuyako , Horiguchi Etsuyo , Kaneko Hiroki , Ito Yasuki , Terasaki Hiroko 
Published: January 2020

Purpose:
To examine the characteristics of polypoidal choroidal vasculopathy using B-scan optical coherence tomography angiography (OCTA), and determine the diagnostic criteria of polypoidal choroidal vasculopathy based on OCTA.

Methods:
This retrospective case series included patients diagnosed with treatment-naïve polypoidal choroidal vasculopathy who underwent indocyanine green angiography (ICGA) and swept-source OCTA at baseline. We compared the characteristics of the polyps detected using B-scan OCTA and ICGA. Then, the diagnostic concordance of each polypoidal lesion between ICGA and OCTA was evaluated.

Results:
Among 54 eyes of 52 patients, all 54 eyes showed flow signals indicating polyps on both ICGA and B-scan OCTA. All polyps on B-scan OCTA were detected as round/ring-like flow signals inside pigment epithelial detachments, incomplete round/ring-like flow signals overlaid with round/ring-like OCT structures inside pigment epithelial detachments, or flow signals adjacent to a pigment epithelial detachment notch. Using B-scan OCTA, 94.7% of the polypoidal lesions were detected by an independent evaluator with an overall accuracy of 92.6% for counting the polypoidal lesions per eye relative to ICGA and a Kappa value of 0.82.

Conclusion:
Polyp detection on B-scan OCTA demonstrates high accuracy and is comparable to that obtained on ICGA. B-scan OCTA could replace ICGA for the diagnosis of polypoidal choroidal vasculopathy.
VISUAL PROGNOSIS AFTER PNEUMATIC DISPLACEMENT OF SUBMACULAR HEMORRHAGE ACCORDING TO AGE-RELATED MACULAR DEGENERATION SUBTYPES
Authors: Lee Kook , Park Young Gun , Park Young-Hoon 
Published: January 2020

Purpose:
This study compared the visual outcome after pneumatic displacement of submacular hemorrhage among patients with different subtypes of age-related macular degeneration (AMD).

Methods:
We retrospectively reviewed the medical records of 67 patients (67 eyes) who underwent treatment for submacular hemorrhage associated with AMD. All the patients underwent pneumatic displacement. Demographic parameters, visual acuity, and anatomical features were analyzed among AMD subtypes: typical AMD, polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP).

Results:
Among the eyes with submacular hemorrhage, 24, 30, and 13 eyes had typical AMD, PCV, and RAP, respectively. Post-treatment best-corrected visual acuity was best in the PCV group and worst in the RAP group (P < 0.001). The proportion of eyes with improved visual acuity was highest in the PCV subtype and lowest in the RAP subtype (P = 0.044). Logistic regression analysis showed that AMD subtype (P = 0.016) and time to treatment (<7 days) (P = 0.037) are associated with the final visual outcome.

Conclusion:
The final post-treatment visual outcome after the incidence of submacular hemorrhage was best in the PCV group and worst in the RAP group. Age-related macular degeneration subtype is a significant factor associated with the visual prognosis of submacular hemorrhage.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES OF FOCAL CHOROIDAL EXCAVATION AND THE CHOROIDAL STROMA VARIATIONS WITH OCCURRENCE OF EXCAVATION
Authors: Rajabian Firuzeh , Arrigo Alessandro , Jampol Lee M. , Mercuri Stefano , Introini Ugo , Bandello Francesco , Battaglia Parodi Maurizio 
Published: January 2020

Purpose:
To describe retinal and choroidal vascular changes, and choroidal stroma variations occurring in focal choroidal excavation (FCE).

Methods:
Study design was a cross-sectional case series. Consecutive patients affected by FCE and healthy controls were recruited. All patients underwent complete ophthalmologic assessment and multimodal imaging, including structural optical coherence tomography and optical coherence tomography angiography. Choroidal thickness and stromal index were calculated from structural optical coherence tomography images. Moreover, we measured vessel density values of the superficial capillary plexus, deep capillary plexus and choriocapillaris at the level of the macula.

Results:
Twenty-two patients (28 eyes; mean age 57.2 ± 16.4) and 28 control eyes (mean age of 56.5 ± 9.8) were included. Five patients (23%) were asymptomatic, whereas 17 patients (77%) complained of visual symptoms. FCE was associated with choroidal neovascularization in 10 eyes (35%). Choroidal stromal component was lower in FCE patients than controls, whereas choroidal thickness was unremarkable. Stromal index values calculated in the region proximal to the FCE was significantly lower than the values obtained from the external region. Deep capillary plexus vessel density was lower in FCE than controls. Choriocapillaris was altered in the region surrounding the FCE, whereas it was normal in the external region.

Conclusion:
Deep capillary plexus and choriocapillaris plexus were significantly altered in FCE patients. Moreover, choroidal stroma was significantly reduced in the areas closer to FCE compared to the surrounding choroid in patients, as well as compared to healthy controls, suggesting the hypothesis of weakening of the architectural support, creating a more friable point, which can favor FCE development.
A SIMPLE, INEXPENSIVE, “MODIFIED LASSO” FOR REMOVAL OF SMOOTH, SPHERICAL INTRAOCULAR FOREIGN BODIES
Authors: Rice James C. , Steffen Jonel , Nyaka Tamara , van der Westhuizen Dean 
Published: January 2020

Purpose:
To report and demonstrate removal of an intraocular metallic spherical pellet and to describe the construction of a basket instrument.

Methods:
A 9-year-old boy sustained a pellet gun injury and underwent pars plana vitrectomy to remove an intraocular spherical metallic pellet. A suture loop basket constructed with 3-O nylon and 16-gauge intravenous cannula was used to grasp and remove the foreign body.

Results:
The pellet was mobilized from a subretinal position and effectively captured in the basket using the light pipe as a second instrument. The captured pellet was successfully removed without slippage via a scleral tunnel incision. Despite reattachment of the retina under silicone oil, the vision deteriorated to no light perception.

Conclusion:
A simple, readily available basket can be constructed for the effective removal of spherical foreign bodies which are difficult to grasp.
Ahmed Valve Tube Extension in Pediatric Glaucoma
Authors: Sternfeld Amir , Dotan Gad , Bohra Lisa , Roarty John 
Published: January 2020

Précis:
Ahmed valve tube extender showed good long-term outcomes for retracted tubes in pediatric glaucoma. The procedure is safe with limited complications.

Purpose:
To analyze the long-term outcomes of Ahmed valve tube extension in pediatric glaucoma patients.

Patients and Methods:
This study analyzed the records of all children who underwent surgery involving extension of a pediatric Ahmed valve tube, treated at a tertiary medical center between 2007 and 2018. Surgical success was defined as intraocular pressure between 6 and 22 mm Hg and reduced by at least 20% from its preoperative value, with or without intraocular pressure lowering medications, without additional surgical procedures and without vision loss.

Results:
Fourteen eyes of 11 children were treated with the Ahmed tube extender during the study period. Mean age of all children was 5.7±4.7 years (range, 3 mo to 16 y). The most common type of glaucoma was congenital glaucoma (n=6, 42.9%). The mean age at the time of initial valve implant was 2.39±3.89 years and the mean duration from initial insertion to the extension was 3.39±2.95 years. The mean follow-up was 72.8±43.3 months (range, 12 to 140 mo), with 85.7% followed for >2 years. The mean survival was 34.1±37.2 months after the extension. Three surgeries (21.4%) were primary failures, 8 patients (57.1%) failed during follow-up (mean, 40.6±44.4 mo after the extension; range, 1 to 125 mo), whereas 3 patients (21.4%) maintained the successful outcome until their last follow-up visit (mean, 37.7±24.1 mo; range, 12 to 70 mo).

Conclusions:
The Ahmed valve extender can often save a retracted or obstructed tube. The procedure has limited complications and long-term efficacy in one third of the patients.
Diagnostic Ability of Optical Coherence Tomography Angiography Macula Vessel Density for the Diagnosis of Glaucoma Using Difference Scan Sizes
Authors: Penteado Rafaella C. , Bowd Christopher , Proudfoot James A. , Moghimi Sasan , Manalastas Patricia I.C. , Ghahari Elham , Hou Huiyuan , Shoji Takuhei , Zangwill Linda M. , Weinreb Robert N. 
Published: January 2020

Précis:
There is diagnostic information in the outer region of optical coherence tomography angiography (OCT-A) macula scans not available in the inner region, and this information is especially useful in the early stages of glaucoma.

Purpose:
The aim of this study was to evaluate the diagnostic accuracy of 3×3 and 6×6 mm2 macula OCT-A scans for classifying healthy, mild glaucoma, and moderate to severe glaucoma eyes.

Methods:
Participants enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with good quality 3×3 and 6×6 mm2 OCT-A images of the macula acquired on the same day were included in this cross-sectional study. The area under the receiver operating characteristic (AUC) curves were calculated to assess the diagnostic accuracy of vessel density (VD) of both scan sizes for differentiating between 3 diagnostic groups.

Results:
Two hundred seventy-nine eyes (89 healthy, 127 with mild glaucoma, and 63 with moderate to severe glaucoma) from 190 subjects were included in this study. The VD of the outer area of the 6×6 mm2 scan size had higher diagnostic accuracy compared with the VD of the inner area of the 3×3 mm2 scan when differentiating between healthy and mild glaucoma (3×3 mm2 AUC=0.71 and 6×6 mm2 AUC=0.79, P=0.032). The VD of the outer area of the 6×6 mm2 scans had only similar diagnostic accuracy compared with the inner area of the 3×3 mm2 scan when differentiating between healthy and moderate to severe glaucoma eyes (AUC=0.90 for 3×3 mm2 and 0.92 for 6×6 mm2, P=0.279). The VD of the inner area of the 6×6 mm2 scan size had similar diagnostic accuracy to the corresponding area of the 3×3 mm2 scan in both diagnostic categories.

Conclusion:
The diagnostic accuracy of VD using the 6×6 mm2 macula OCT-A scan was better than the 3×3 mm2 scan when differentiating between healthy and mild glaucoma eyes, and similar to the 3×3 mm2 scan when differentiating between healthy and moderate to severe glaucoma eyes.
Evaluation of mechanical resistance to tearing of the anterior lens capsule after staining with different concentrations of trypan blue
Authors: Sándor Gábor L. , Kiss Zoltán , Bocskai Zoltán I. , Tóth Gábor , Temesi Tamás , Nagy Zoltán Z. 
Published: January 2020

Purpose:
To evaluate and compare the mechanical resistance to tearing of the anterior lens capsule opening after staining with different concentrations of trypan blue in ex vivo porcine eyes.

Setting:
Semmelweis University, and Budapest University of Technology and Economics, Budapest, Hungary.

Design:
Experimental study.

Methods:
The study comprised 75 porcine eyes. The capsule was unstained in the Control Group (n = 25 eyes), 0.06% trypan blue was used to stain the capsule in Stained 1 Group (n = 25 eyes), and 0.1% trypan blue was used to stain the capsule in Stained 2 Group (n = 25 eyes). After capsulorhexis, the capsule openings were stretched with custom-designed testing equipment until they ruptured. The rupture force (RF), circumference stretching ratio (CSR), and secant modulus at 10 mN (SM10mN) and 50 mN (SM50mN) were evaluated.

Results:
In total, 75 eyes were enrolled. There were no statistically significant differences in the RF (P = .8924) or CSR (P = .3876) among the groups. There were no statistically significant differences in the SM10mN (P = .8215) or SM50mN (P = .4184) among the groups.

Conclusions:
In this porcine eye model, the trypan blue concentrations that are routinely used in cataract surgery had no effect on capsular rim stability.
Comparison of accelerated CXL alone, accelerated CXL-ICRS, and accelerated CXL-TG-PRK in progressive keratoconus and other corneal ectasias
Authors: Singal Neera , Ong Tone Stephan , Stein Raymond , Bujak Matthew C. , Chan Clara C. , Chew Hall F. , El-Defrawy Sherif , Jin Yaping , Kranemann Christoph , Rabinovitch Theodore , Rootman David S. , Slomovic Allan R. , Cohen Ashley , Dai David , Hatch Wendy 
Published: January 2020

Purpose:
To compare accelerated corneal crosslinking (CXL) alone, CXL with simultaneous intrastromal corneal ring segments (CXL-ICRS), and CXL with simultaneous topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus, pellucid marginal degeneration (PMD), or laser in situ keratomileusis (LASIK)-induced ectasia.

Setting:
The Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada.

Design:
Prospective nonrandomized interventional study.

Methods:
Visual and topographical outcomes using a comparative analysis adjusting for preoperative maximum keratometry (Kmax) were evaluated 1 year postoperatively.

Results:
Four hundred fifty-two eyes from 375 patients with progressive keratoconus, PMD, or LASIK-induced ectasia that underwent accelerated (9 mW/cm2, 10 minutes) CXL alone (n = 204), CXL-ICRS (n = 126), or CXL-TG-PRK (n = 122) were included. Change in logarithm of the minimum angle of resolution uncorrected distance visual acuity was significant with CXL-ICRS (−0.31; 95% CI, −0.38 to −0.24) and CXL-TG-PRK (−0.16; 95% CI, −0.24 to −0.09), but not with CXL alone. No significant differences in change were found between the 3 groups. Change in corrected distance visual acuity (CDVA) was significant in all 3 groups: −0.12 (95% CI, −0.15 to −0.10) with CXL alone, −0.23 (95% CI, −0.27 to −0.20) with CXL-ICRS, and −0.17 (95% CI, −0.21 to −0.13) with CXL-TG-PRK. Improvement in CDVA was greater with CXL-ICRS than with CXL alone (−0.08 ± 0.02; P < .0001) and CXL-TG-PRK (−0.05 ± 0.02; P = .005). Change in Kmax was significant with CXL-ICRS [−3.21 diopters (D); 95% CI, −3.98 to −2.45] and CXL-TG-PRK (−3.69 D; 95% CI, −4.49 to −2.90), but not with CXL alone (−0.05 D; 95% CI, −0.66 to 0.55).

Conclusions:
CXL alone might be best for keratoconic patients who meet the inclusion criteria. CXL-ICRS might be more effective for eyes with more irregular astigmatism and worse CDVA and CXL-TG-PRK for eyes requiring improvements in irregular astigmatism but still have good CDVA.
Placebo effect in children: the role of expectation and learning
Authors: Gniß Silke , Kappesser Judith , Hermann Christiane 
Published: January 2020

Abstract
Classical conditioning and expectations are well-known underlying mechanisms of placebo hypoalgesia. Only little is known about their differential effect in adults, however, and even less in children. Previous studies in children evoked placebo hypoalgesia either with expectations alone or in combination with classical conditioning and revealed conflicting results. Furthermore, these studies investigated children of different ages making it even more difficult to draw conclusions. This study tried to disentangle classical conditioning and expectations by investigating them separately. To examine age effects, n = 172 children (6-9, 10-13, and 14-17 years) as well as n = 32 adults (> = 18 years) were tested using a heat pain paradigm investigating the effectiveness of creams some of which were bogusly introduced as analgesic. In addition to subjective pain intensity ratings, peripheral physiological measures were recorded. Results showed a successful induction of placebo hypoalgesia by both mechanisms for pain ratings and heart rate acceleration. Placebo hypoalgesia was particularly pronounced in children younger than 14 years. Furthermore, placebo hypoalgesia was more marked in children whose mothers raised the expectations. It was also stronger in participants who noticed a strong pain reduction during learning trials. These results encourage the use of placebo effect in clinical practice, particularly for younger children. They underline the relevance of an initial pain reduction and encourage the inclusion of parents in treatment.
Quantification of neonatal procedural pain severity: a platform for estimating total pain burden in individual infants
Authors: Laudiano-Dray Maria Pureza , Pillai Riddell Rebecca , Jones Laura , Iyer Rajeshwari , Whitehead Kimberley , Fitzgerald Maria , Fabrizi Lorenzo , Meek Judith 
Published: January 2020

Abstract
There is increasing evidence that long-term outcomes for infants born prematurely are adversely affected by repeated exposure to noxious procedures. These interventions vary widely, for example, in the extent of damage caused and duration. Neonatal intensive care unit (NICU) procedures are therefore likely to each contribute differently to the overall pain burden of individual neonates, ultimately having a different impact on their development. For researchers to quantify the procedural pain burden experienced by infants on NICU, we aimed to estimate the pain severity of common NICU procedures using published pain scores. We extracted pain scores over the first minute (pain reactivity) from the literature, using 59 randomized controlled trials for 15 different procedures. Hierarchical cluster analysis of average pain scores resulted in 5 discrete severity groups; mild (n = 1), mild to moderate (n = 3), moderate (n = 7), severe (n = 3), and very severe (n = 1). The estimate of the severity of individual procedures provided new insight into infant pain reactivity which is not always directly related to the invasiveness and duration of a procedure; thus, both heel lance and skin tape removal are moderately painful procedures. This estimate of procedural pain severity, based on pain reactivity scores, provides a novel platform for retrospective quantification of an individual neonate's pain burden due to NICU procedures. The addition of measures that reflect the recovery from each procedure, such as brain activity and behavioural regulation, would further improve estimates of the pain burden of neonatal intensive care.
UC Care Check—A Postoperative Neurosurgery Operating Room Checklist: An Interrupted Time Series Study
Authors: Lau Catherine Y. , Seymann Gregory , Imershein Sarah , Amin Alpesh , Afsarmanesh Nasim , Uppington Jeffrey , Aledia Anna , Pretanvil Sarah , Wilson Bridget , Wong Josefina , Varma Jennifer , Boggan James , Hsu Frank P. K. , Carter Bob , Berger Mitchel , Harrison James D. 
Published: January 2020

ABSTRACT

Background:
The effectiveness of neurosurgical operating room (OR) checklists to improve communication, safety attitudes, and clinical outcomes is uncertain.

Purpose:
To develop, implement, and evaluate a post-operative neurosurgery operating room checklist.

Methods:
Four large academic medical centers participated in this study. We developed an evidence-based checklist to be performed at the end of every adult-planned or emergent surgery in which all team members pause to discuss key elements of the case. We used a prospective interrupted time series study design to assess trends in clinical and cost outcomes. Safety attitudes and communication among OR providers were also assessed.

Results:
There were 11,447 neurosurgical patients in the preintervention and 10,973 in the postintervention periods. After implementation, survey respondents perceived that postoperative checklists were regularly performed, important issues were communicated at the end of each case, and patient safety was consistently reinforced. Observed to expected (O/E) overall mortality rates remained less than one, and 30-day readmission rate, length of stay index, direct cost index, and perioperative venous thromboembolism and hematoma rates remained unchanged as a result of checklist implementation.

Conclusion:
A neurosurgical checklist can improve OR team communication; however, improvements in safety attitudes, clinical outcomes, and health system costs were not observed.