bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dermatopathology of Cutaneous Cystic Lesions: A Practical Review With Diagnostic Clues and Pitfalls
Authors: Pérez-Muñoz Noelia , Llamas-Velasco Mar , Castillo-Capponi Gonzalo , Morgado-Carrasco Daniel , Iglesias-Sancho Maribel , Carrasco-García Miguel-Ángel , Fernández-Figueras María-Teresa 
Published: October 2019

Background:
Cystic lesions are common in the daily practice of dermatologists and dermatopathologists, and in most cases, a straightforward diagnosis can be done. Yet, some variants and situations may cause diagnostic problems or carry prognostic and/or systemic implications.

Objective:
To review the histopathological features of the most frequent cystic lesions, either true cysts or pseudocysts, and provide some clues and pitfalls to bear in mind for troublesome situations such as solid–cystic tumors; uncommon variants; incidental findings; artifactual, reactive, or infectious cavities; cysts as a warning of systemic and hereditary diseases; and malignant cystic tumors, either primary or metastatic.

Methods:
The histopathological diagnostic criteria of most cystic lesions and their potential caveats will be discussed, offering some diagnostic clues.

Results:
Cystic lesions of the skin can primarily be classified into true cysts and pseudocysts. The most frequent pseudocysts are sinus pilonidalis and mucin-filled cavities. True cysts can be divided according to their epithelial origin or differentiation into epidermal/pilar cysts, cysts from glandular appendages, and from embryonic remnants. Diagnostic dilemmas and possible pitfalls in cystic lesions are reviewed, offering some keys to solve them.

Conclusions:
Knowledge of the histopathology of cystic lesions contributes to their correct diagnosis, improving the management of patients.
Application of the Instrumental Inequalities to a Mendelian Randomization Study With Multiple Proposed Instruments
Authors: Diemer Elizabeth W. , Labrecque Jeremy , Tiemeier Henning , Swanson Sonja A. 
Published: October 2019

Background:
Investigators often support the validity of Mendelian randomization (MR) studies, an instrumental variable approach proposing genetic variants as instruments, via. subject matter knowledge. However, the instrumental variable model implies certain inequalities, offering an empirical method of falsifying (but not verifying) the underlying assumptions. Although these inequalities are said to detect only extreme assumption violations in practice, to our knowledge they have not been used in settings with multiple proposed instruments.

Methods:
We applied the instrumental inequalities to an MR analysis of the effect of maternal pregnancy vitamin D on offspring psychiatric outcomes, proposing four independent maternal genetic variants as instruments. We assessed whether the proposed instruments satisfied the instrumental inequalities separately and jointly and explored the instrumental inequalities’ properties via simulations.

Results:
The instrumental inequalities were satisfied (i.e., we did not falsify the MR model) when considering each variant separately. However, the inequalities were violated when considering four variants jointly and for some combinations of two or three variants (two of 36 two-variant combinations and 18 of 24 three-variant combinations). In simulations, the inequalities detected structural biases more often when assessing proposed instruments jointly, although falsification in the absence of structural bias remained rare.

Conclusions:
The instrumental inequalities detected violations of the MR assumptions for genetic variants jointly proposed as instruments in our study, although the instrumental inequalities were satisfied when considering each proposed instrument separately. We discuss how investigators can assess instrumental inequalities to eliminate clearly invalid analyses in settings with many proposed instruments and provide appropriate code.
Perivascular Adipose Tissue Modulation of Neurogenic Vasorelaxation of Rat Mesenteric Arteries
Authors: Chang Hsi-Hsien , Yang Stephen Shei-Dei , Chang Shang-Jen 
Published: October 2019

Abstract:
Perivascular sympathetic-sensory interactions have been shown to regulate calcitonin gene-related peptide (CGRP)-mediated vasodilation in rats. We investigated whether perivascular adipose tissue (PVAT) modulates the neurogenic vasorelaxation of isolated rat mesenteric arteries. Mesenteric arterial rings were prepared with or without PVAT (PVAT+ or PVAT−) and with either an intact or denuded endothelium (EC+ or EC−). The results of myography analysis revealed that vasocontraction to phenylephrine was highest in EC−PVAT−, lowest in EC+PVAT+, and intermediate in EC−PVAT+ and EC+PVAT−. Transmural nerve stimulation (TNS) induced the tetrodotoxin-sensitive relaxation of the phenylephrine-precontracted mesenteric arteries. However, nicotine induced minor relaxation in EC−PVAT+, whereas vasorelaxation was significantly enhanced in EC−PVAT−. Nicotine-induced vasorelaxation was insensitive to propranolol and also significantly lower in sympathetically-denervated and guanethidine-treated EC−PVAT−, whereas TNS-induced vasorelaxation persisted. In EC−PVAT− depleted of CGRP via capsaicin, nicotine- and TNS-induced vasorelaxation was almost absent. Lowering the pH of Krebs' solution using HCl led to pH-dependent vasorelaxation that was sensitive to CGRP8-37. Furthermore, nicotine-induced relaxation of EC−PVAT−, which was not affected by leptin, was blocked by methyl palmitate. Methyl palmitate did not affect TNS- or HCl-induced vasorelaxation. These results suggest that PVAT plays a modulatory role in regulating sympathetic-sensory interaction-mediated CGRPergic vasorelaxation via the release of methyl palmitate.
Does early life programming influence arterial stiffness and central hemodynamics in adulthood?
Authors: Sperling Johannes , Nilsson Peter M. 
Published: October 2019

Objectives:
We aimed to investigate possible associations between birth weight and adult life carotid–femoral pulse wave velocity (cfPWV) and augmentation pressure index (AIx).

Design and method:
This study included 1598 participants, that is, 340 elderly individuals from the Malmö Birth Data Cohort (MBDC) and 1258 young-middle aged individuals from the Malmö Offspring Study (MOS) with full data on birth weight and gestational age. Participants underwent cfPWV and AIx measurements with Sphygmocor (AtCor, Australia). Analysis of data was performed with multiple linear regression models including adjustments for age, sex, gestational age and risk factors. Furthermore, comparisons were made between participants born prematurely or at term or born small-for-gestational age (SGA) or appropriate-for-gestational age (AGA).

Results:
Birth weight was positively associated with cfPWV after full adjustment (β = 0.057; P < 0.001), a finding that remained significant in the younger age group 18–27 years (β = 0.138, P = 0.008). Furthermore, birth weight was inversely associated with AIx (β = −0.058, P = 0.001). Participants born SGA had significantly higher AIx (P = 0.007) and MAP (P = 0.037) compared with AGA born. Preterm-born participants showed significantly higher SBP compared with term-born (P = 0.034). Finally, birth weight was inversely associated with MAP (β = −0.058, P = 0.017) and SBP (β = −0.047, P = 0.031), respectively.

Conclusion:
Birth weight is positively associated with cfPWV, shown strongest in the youngest individuals, a finding that could possibly be explained by increasing trends for maternal overweight/obesity in recent decades. Furthermore, birth weight is inversely associated with AIx, a risk marker of cardiovascular disease. This calls for screening of risk factors in subjects with adverse conditions at birth.
Identification and Management of Intermediate Risk Patients in the Chest Pain Unit
Authors: Prasad Pooja , Sharma Ajay Nair , Vipparla Navya Sree , Majid Muhammad , Daniela Aro , Howell Stacey J. , Wilson Machelle D. , Amsterdam Ezra A. 
Published: October 2019

Objective:We examined low risk (LR) patients admitted to our chest pain unit (CPU) with negative cardiac injury markers, normal electrocardiogram, and clinical stability. We hypothesized that there is a sub-group of intermediate risk (IR) patients within the larger LR population.Methods:Criteria for IR were the aforementioned 3 indicators of LR and ≥1 of the following: (1) known coronary artery disease (CAD), (2) men ≥45 yo, women ≥55 yo, and (3) ≥3 cardiac risk factors. We compared patient characteristics, use of pre-discharge testing (PDT), and major adverse cardiac events (MACE).Results:IR patients numbered 371, whereas LR patients totaled 70. IR patients were older (61 vs 46 years), more had known CAD (28 vs. 0%), had a higher median number of risk factors (2 vs. 1) and were less likely to be women (49 vs. 81%), allP< 0.0001. IR patients received a greater median number of tests compared with LR patients (1 vs. 0,P< 0.0001).Conclusions:Among the IR group, 16 patients (4%) had a cardiac event at the index CPU visit, 2 (0.5%) experienced MACE at 30-day follow-up, and 2 (0.5%) had MACE at 6 months follow-up. No LR patients had MACE at any point in the study. Thus, the majority of CPU patients are IR, have more risk factors than LR group, and are more likely to receive PDT. IR patients were managed safely in a CPU, while maintaining low rates of MACE post-discharge.
Effects of Intravitreal Anti-VEGF Therapy on Glaucoma-like Progression in Susceptible Eyes
Authors: Du Jeanette , Patrie James T. , Prum Bruce E. , Netland Peter A. , Shildkrot Yevgeniy (Eugene) 
Published: October 2019

Précis:
Intravitreal anti-vascular endothelial growth factor (VEGF) injections may accelerate glaucomatous change in patients with preexisting glaucoma or ocular hypertension (OHT). The safety of long-term injections in this specific population may be reflected in the need for additional glaucoma interventions.

Purpose:
The purpose of this study was to investigate whether repeated anti-VEGF injections accelerate structural and functional glaucomatous change in eyes with preexisting glaucoma or OHT.

Materials and Methods:
This is a retrospective, observational study of injected and noninjected fellow eyes. A total of 28 patients with preexisting glaucoma or OHT, who received ≥6 unilateral anti-VEGF injections for concurrent neovascular retinal disease, were selected for chart review. Primary outcome measures were rate of visual field loss in dB/year, rate of change in retinal nerve fiber layer (RNFL) thickness in microns/year, and need for additional glaucoma medications, surgery, or laser.

Results:
The number of eyes requiring additional glaucoma surgery or laser was 8 of 28 (28.6%) for the injected group and 2 of 28 (7.1%) for the noninjected group. A significantly greater proportion of injected eyes required invasive glaucoma intervention (P=0.034). Average rate of decline in mean deviation and change in pattern standard deviation were both significantly greater in injected eyes (P=0.029; P=0.019). Estimated mean rate of global retinal nerve fiber layer change was −4.27 µm/y for the injected group and −1.17 µm/y for the noninjected group and was significant only for injected eyes (P=0.014). Only the superior quadrant exhibited thinning that was significantly different between groups (P=0.030).

Conclusions:
Intravitreal injections were associated with accelerated functional and structural glaucoma-like change in susceptible eyes. Clinicians should assess the need for glaucoma medications or other interventions over the course of anti-VEGF therapy.
Vitreous Zonule and its Relation to Anterior Chamber Angle Characteristics in Primary Angle Closure
Authors: Shon Kilhwan , Sung Kyung Rim , Kwon Junki , Hye Jo Youn 
Published: October 2019

Precis:
Primary angle-closure (PAC) eyes with no vitreous zonule (VZ) appear to have a narrower angle despite similar lens vault and iris configuration than eyes with visible VZ.

Purpose:
To assess the clinical significance of the VZ in PAC.

Methods:
Medical records of 91 eyes of 91 participants with PAC or PAC glaucoma were retrospectively reviewed. Anterior segment parameters were measured using anterior segment optical coherence tomography; presence of the VZ was assessed with ultrasound biomicroscopy. Parameters were compared between eyes with vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Factors associated with VZ presence were determined using logistic regression analysis.

Results:
The NVZG was more likely to have PAC glaucoma than PAC (51.4% vs. 25.0%; P=0.010) and use more glaucoma medications (0.77 vs. 0.36; P=0.004) than the VZG. The NVZG had a smaller anterior chamber area than the VZG (13.6 mm2 vs. 15.1 mm2; P=0.020) but there were no significant between-group differences in anterior chamber depth (1.97 vs. 2.08 mm; P=0.119) and lens vault (1.21 vs. 1.13 mm; P=0.337). NVZG had a smaller scleral spur angle (11.5 vs. 17.4 degrees; P<0.001), angle opening distance at 500 μm (AOD500, 105 vs. 168 μm; P<0.001), and trabecular-ciliary process angle (75.7 vs. 81.9 degrees; P=0.029) than VZG. Older age [odds ratio (confidence interval), 1.087 (1.014-1.164); P=0.018], less AOD500 (0.984 (0.975-0.993); P<0.001), and less trabecular-ciliary process angle (0.938 (0.901-0.977); P=0.002) were independently associated with an absence of VZ.

Conclusions:
PAC eyes with no VZ had a narrower angle and required more glaucoma medications than eyes with a VZ.
Primary Open-angle Glaucoma and Increased Risk of Chronic Kidney Disease
Authors: Park Sang Jun , Byun Seong Jun , Park Jae Yoon , Kim Martha 
Published: October 2019

Precis:
The association between primary open-angle glaucoma (POAG) and subsequent development of chronic kidney disease (CKD) was investigated using a nationwide, population-based, retrospective cohort in South Korea. POAG increases the risk of subsequent CKD development.

Purpose:
The purpose of this study was to investigate the risk of subsequent CKD development in patients with POAG.

Methods:
In this nationwide, population-based longitudinal cohort, 1,025,340 beneficiaries in the 2002-2013 Korean National Health Insurance database were included. We identified patients with incident POAG and evaluated the risk of subsequent CKD development using diagnostic codes from the database after 2-year wash-out periods. We applied time-varying covariate Cox regression analyses to determine the effect of POAG on the development of CKD: Model 1 included only POAG as a time-varying covariate; Model 2 included Model 1 and demographic information; and Model 3 included Model 2, comorbidity, comedication, and the Charlson Comorbidity Index score.

Results:
The fixed cohort included 478,303 eligible subjects, and of these subjects, 1749 suffered incident POAG, and 3157 developed CKD. POAG was associated with an increased risk of CKD development [hazard ratio (HR)=7.63; 95% confidence interval (CI), 5.89-9.87] in Model 1; HR=3.54 (95% CI, 2.73-4.58) in Model 2; and HR=2.90 (95% CI, 2.24-3.76) in Model 3].

Conclusion:
POAG increased the risk of subsequent CKD in the general population, suggesting that POAG and CKD might share a common pathogenic mechanism.
Cerebrospinal Fluid Pleocytosis and Elevated C-X-C Motif Chemokine Ligand 13 Value Predict Lyme Borreliosis in Children With Facial Palsy
Authors: Pöyhönen Heidi , Lähdesmäki Tuire , Hytönen Jukka , Peltola Ville 
Published: October 2019

Background:
Lyme borreliosis (LB) is a common cause of acute facial palsy in children living in endemic areas for Borrelia burgdorferi. The need for lumbar puncture in diagnostics of LB in children with facial palsy has been questioned. Our aim was to evaluate the prevalence of LB and the diagnostic value of a cerebrospinal fluid (CSF) sample among children with an acute facial palsy.

Methods:
We collected medical records and laboratory data of children and adolescents 0–16 years of age (n = 94) diagnosed with facial palsy between 2002 and 2016 in the Turku University Hospital. A positive B. burgdorferi serology in serum or CSF or a positive B. burgdorferi polymerase chain reaction in CSF were considered as signs of definite LB. C-X-C motif chemokine ligand 13 (CXCL13) values were measured in CSF samples from 28 children during 2014–2016.

Results:
Lumbar puncture was performed on 84 of 94 children with facial palsy. LB was confirmed in 29 of 42 children with, and in 4 of 42 without, pleocytosis. The sensitivity and specificity of pleocytosis to predict LB were 88% (95% confidence interval, 78%–98%) and 75% (62%–88%), respectively, and the positive and negative predictive values were 69% (55%–83%) and 90% (81%–99%), respectively. An increased CSF CXCL13 value had 67% (51%–83%) sensitivity and 100% specificity for LB.

Conclusions:
Because serum serology can be negative at presentation, lumbar puncture is a valuable tool when diagnosing LB among children with facial palsy. Pleocytosis and increased protein and CXCL13 values in the CSF suggest LB as the cause of facial palsy.
Comparison of Orbital Volume in Young Versus Senescent Human Skulls
Authors: Zhang Kevin R. , Chon Brian H. , Hwang Catherine J. , Jellema Lyman M. , Perry Julian D. 
Published: October 2019

Purpose:
To compare bony orbital volumes in young skulls with those of older skulls to elucidate aging-associated changes of the orbit.

Methods:
One hundred Caucasian male skulls from the Hamann-Todd collection of the Cleveland Museum of Natural History were studied. There were 50 young skulls (age range, 19–33 years) and 50 senescent skulls (age range, 79–96 years). Volcanic sand was used to fill each orbit in an identical fashion and weighed as a proxy for volume. Digital calipers were used to perform linear measurements of the orbit. The relationship between orbit measures and skull size was assessed using Pearson’s correlations and 95% CI, and statistical models to compare age groups adjusted for skull size.

Results:
The volume of the orbits (P < 0.001), the horizontal diameter of the orbit (P = 0.015), and the orbital depth (P < 0.001) were significantly larger in the senescent group of skulls after adjusting for skull surface area. No significant differences were found in the vertical diameters of the orbit between the 2 groups. Skull size did not statistically differ between the age groups.

Conclusions:
Increases in the depth and horizontal dimensions of the orbit lead to increasing bony orbital volume with increasing age. These changes in size and shape of the orbit with age may contribute to phenotypic changes of aging and may affect disease processes and management.
A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment
Authors: LIAO Ru-Wen , YEH Mei-Ling , LIN Kuan-Chia , WANG Kwua-Yun 
Published: October 2019

ABSTRACT

Background
Nurses may experience different levels of occupational burnout in different unit and hospital settings. However, pooling multilevel data in an analysis ignores independent, environmental, and sociocultural contexts of ecological validity.

Purpose
This study aimed to explore a hierarchical model of occupational burnout that is associated with job-induced stress, nurse self-concept, and practice environment in nurses working in different units and hospitals.

Methods
A cross-sectional study was conducted, and 2,605 nurses were recruited from seven hospitals. The outcomes were measured using the Maslach Occupational Burnout Inventory-Human Services Survey, Nurses' Self-Concept Instrument, Nurse Stress Checklist, and Nursing Work Index-Revised. Hierarchical Linear Modeling 6.0 software was used to conduct hierarchical analysis on the study data.

Results
On the nurse level, job-induced stress was a significant factor affecting emotional exhaustion (β = 0.608, p < .001) and depersonalization (β = 2.439, p < .001), whereas nurse self-concept was a significant factor affecting emotional exhaustion (β = −0.250, p < .001), depersonalization (β = −1.587, p < .001), and personal accomplishment (β = 4.126, p < .001). Furthermore, emotional exhaustion and depersonalization were significantly related to level of education (β = 0.111, p < .01; β = 0.583, p < .05). No significant unit-level associations were identified between occupational burnout and the factors of job-induced stress, nurse self-concept, and practice environment (p > .05). The intragroup correlation coefficient for emotional exhaustion was 2.86 (p < .001).

Conclusions/Implications for Practice
The findings of this study confirm that individual nurse characteristics are strong predictors of emotional exhaustion, depersonalization, and personal accomplishment as these relate to occupational burnout. In addition, nurse self-concept was identified as the most important predictor of all three aspects. In clinical practice, self-concepts about nursing may reduce occupational burnout. Nursing managers formulating new policies should consider nursing background and offer autonomous control over practice.
Exploration of the Association Between Religious Affiliation and Attitude Toward Spiritual Care in Clinical Nurses
Authors: CHIANG Yi-Chien , LEE Hsiang-Chun , CHU Tsung-Lan , HAN Chin-Yen , HSIAO Ya-Chu 
Published: October 2019

ABSTRACT

Background
Religion is an important cultural asset that is known to affect the thoughts, behaviors, and lifestyles of individuals. However, the impact of religious affiliation, religious activities, and religious beliefs on the attitudes of nurses toward providing spiritual care to their patients is an issue that has been inadequately explored.

Purposes
The aim of this study was to explore the relationship between religion (including religious affiliation, religious activities, and religious beliefs) and attitude toward spiritual care in clinical nurses.

Methods
This study used a cross-sectional correlation study design. Six hundred nineteen nurses were included as participants. The measurements used included a questionnaire on religious affiliation, religious activities, and religious beliefs; the Spiritual Health Scale-Short Form; the Spiritual Care Attitude Scale; and a sociodemographic datasheet. The study employed hierarchical regression modeling to establish the relationships between the aspects and degrees of religious belief and practice as well as the attitudes of participants toward spiritual care.

Results
Most of the participants participated infrequently in religious activities. After controlling for demographic variables and spiritual health, religious belief was found to be an important factor impacting participants' attitudes toward providing spiritual care.

Conclusions/Implications for Practice
The findings indicate that religious belief is an important factor impacting the attitudes of nurses toward providing spiritual care and that the religious/spiritual beliefs of nurses may impact on their fitness to provide spiritual care to patients. Education on religion may be needed to improve the attitude of nurses toward providing spiritual care.