bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Manifestations of Castleman Disease: Histopathological Characteristics and Review of Literature
Authors: Zapata-Salazar Natalia A. , Gómez-Flores Minerva , Ocampo-Candiani Jorge , Chavez-Alvarez Sonia 
Published: May 2021

Abstract:Castleman disease (CD) is a poorly understood lymphoproliferative disorder characterized by enlarged lymph nodes. The spectrum of differential diagnoses is wide, and it is hard to differentiate from other diseases. Cutaneous involvement of CD is rare, and studies that describe cutaneous dermatopathology of CD are scarce. The aim of this study was to collect case reports of CD with cutaneous manifestations and identify potential relevant histopathological features. We found that cases of CD with cutaneous manifestations often exhibited dermal lymphoid follicles with follicle center infiltration of lymphocytes and plasma cells. These dermal follicles also had regressive or atrophic germinal centers and were penetrated by hyalinized vessels. Patients with CD also consistently exhibited perivascular and deep dermal inflammatory infiltrate, primarily composed of lymphocytes and plasma cells. We intend to raise awareness of this rare entity and provide more histopathological information regarding its dermatological manifestations.
Proficiency at Tick Identification by Pathologists and Clinicians Is Poor
Authors: Laga Alvaro C. , Granter Scott R. , Mather Thomas N. 
Published: May 2021

Objectives:
Prompt accurate identification of tick species is required for appropriate administration of single dose antimicrobial prophylaxis for Lyme disease in selected patients. To determine the proficiency of clinicians at tick identification in the northeastern United States where Lyme disease has its highest incidence, we undertook a survey.

Methods:
We analyzed the results of a voluntary survey testing proficiency in identifying tick species using high-resolution photographs of ticks.

Results:
Only 35% of ticks were correctly identified. Although 60% of respondents could identify a nonengorged adult blacklegged tick, only 34% could correctly identify a partially engorged blacklegged tick. Participants performed even worse at classifying brown dog, American dog, and Lone Star ticks.

Conclusions:
Proficiency of tick identification by pathologists and clinicians is poor.
Prognostic Utility of a Modified HEART Score When Different Troponin Cut Points Are Used
Authors: Aurora Lindsey , McCord James , Nowak Richard , Giannitsis Evangelos , Christenson Robert , DeFilippi Christopher , Lindahl Bertil , Christ Michael , Body Richard , Jacobsen Gordon , Mueller Christian 
Published: May 2021

Background:
Although the recommended cut point for cardiac troponin (cTn) is the 99th percentile, many institutions use cut points that are multiples higher than the 99th percentile for diagnosing acute myocardial infarction (AMI). Prior studies have shown that patients with a HEART score (HS) ≤ 3 and normal serial cTn values (modified HS) are at low risk for adverse events. This study aimed to evaluate the prognostic utility of the HS when various cTn cut points are used.

Methods:
This was a substudy of High Sensitivity Cardiac Troponin T assay for RAPID Rule-out of Acute Myocardial Infarction (TRAPID-AMI), a multicenter, international trial evaluating a rapid rule-out AMI study using high-sensitivity cardiac troponin T (hs-cTnT). One-thousand two-hundred eighty-two patients were evaluated for AMI from 12 centers in Europe, United States, and Australia from 2011 to 2013. Blood samples of hs-cTnT were collected at presentation and 2 hours, and each patient had a HS calculated. The US Food and Drug Administration approved 99th percentile for hs-cTnT (19 ng/L) was used.

Results:
There were 213 (17%) AMIs. Within 30 days, there were an additional 2 AMIs and 8 deaths. The adverse event rates at 30 days (death/AMI) for a HS ≤ 3 and nonelevated hs-cTnT over 2 hours using increasing hs-cTnT cut points ranged from 0.6% to 5.1%.

Conclusions:
Using the recommended 99th percentile cut point for hs-cTnT, the combination of a HS ≤ 3 with nonelevated hs-cTnT values over 2 hours identifies a low-risk cohort who can be considered for discharge from the emergency department without further testing. The prognostic utility of this strategy is greatly lessened as higher hs-cTnT cut points are used.
UTILIZATION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY TO IDENTIFY POSTERIOR VITREOUS DETACHMENT IN PATIENTS WITH RETINAL DETACHMENT
Authors: Wagley Sushant , Belin Peter J. , Ryan Edwin H. 
Published: May 2021

Abstract

Purpose:
To compare posterior vitreous detachment (PVD) identification rate between clinical examination versus spectral domain optical coherence tomography in patients with retinal detachment (RD).

Methods:
Data from the Primary Retinal Detachment Outcomes Study were used for this retrospective cross-sectional study of 506 patients. Spectral domain optical coherence tomography scans were reviewed to detect the separation of the posterior hyaloid face from the retina and the optic nerve on all 31 raster cuts of a 30 × 30 scan. Statistical analysis was performed to compare spectral domain optical coherence tomography–identified PVD with PVD identified on slit-lamp biomicroscopy.

Results:
There was a significant difference in the rate of PVD identification by clinical examination versus spectral domain optical coherence tomography in patients with RD. Clinical examination identified 51.58% of patients with PVD, whereas spectral domain optical coherence tomography identified 78.42% of patients with PVD. In patients with macula-on RD, 61.68% were found to have PVD on clinical examination versus 83.90% by imaging. Spectral domain optical coherence tomography identified larger number of PVD in patients with macula-off RD compared with clinical examination, 46.28% versus 75.43%, respectively. There was low agreement between the two methods (kappa score = 0.137). There was a significant difference in surgical procedure type chosen in those with versus without PVD.

Conclusion:
Knowledge about the posterior hyaloid anatomy is important before undergoing RD repair. Spectral domain optical coherence tomography can better identify PVD than clinical examination in patients with RD.
CATASTROPHIC, BILATERAL RETINAL VASCULAR OCCLUSION AFTER INTRAVITREAL BEVACIZUMAB INJECTION
Authors: Ng Caleb C. , Brill Daniel , Cunningham Emmett T. , Burckhard Braden A. , Jumper J. Michael , Heier Jeffrey , Rifkin Lana M. , Eliott Dean , McDonald H. Richard , Sobrin Lucia 
Published: May 2021

Purpose:
To describe two cases of catastrophic, bilateral retinal vascular occlusion after intravitreal (IVT) bevacizumab injection.

Methods:
Case series. Main outcome measures included clinical and fluorescein angiography findings.

Results:
Case 1—A 65-year-old woman with calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis syndrome developed acute, severe, bilateral visual loss 2 weeks after bilateral IVT bevacizumab injection for proliferative diabetic retinopathy. Examination and fluorescein angiography revealed moderate anterior chamber inflammation, bilateral perivascular retinal hemorrhages, and near total retinal vascular occlusion. Extensive testing revealed moderately elevated anti-B2 glycoprotein (antiphospholipid) antibodies. Case 2—An 85-year-old man with polymyalgia rheumatica and left eye exudative age-related macular degeneration experienced severe, bilateral, sequential visual loss in the left eye and then right eye approximately 3 weeks after IVT bevacizumab left eye injection. Examination revealed bilateral panuveitis, diffuse perivascular exudates, and intraretinal hemorrhages. Fluorescein angiography showed diffuse venous leakage. Extensive testing revealed an elevated antinuclear antibody and mildly elevated anticardiolipin antibody.

Conclusion:
Patients with underlying retinal vascular vulnerabilities may be at increased risk of catastrophic, bilateral retinal vascular occlusion after treatment with IVT bevacizumab. The moderate-to-severe intraocular inflammation in both cases and the contralateral involvement after unilateral IVT injection in Case 2 suggest a possible delayed immune-mediated mechanism.
Physical Activity and Cardiovascular Fitness During Childhood and Adolescence: Association With Retinal Nerve Fibre Layer Thickness in Young Adulthood
Authors: Lee Samantha Sze-Yee , McVeigh Joanne , Straker Leon , Howie Erin K. , Yazar Seyhan , Haynes Andrew , Green Daniel J. , Hewitt Alex W. , Mackey David A. 
Published: May 2021

Precis:
Higher physical working capacity (PWC) at age 17 was associated with thicker peripapillary retinal nerve fiber layer (pRNFL) at age 20, suggesting a mechanistic link between cardiovascular fitness and neuroretinal integrity.

Purpose:
Physical activity and cardiovascular fitness have been linked with lower odds of developing glaucoma. We tested the hypothesis that early beneficial effects of physical activity and cardiovascular fitness can be observed by measuring the pRNFL thickness in young healthy adults.

Methods:
The Raine Study is a longitudinal study that has followed a cohort since before their births in 1989-1992. Parent-reported physical activity was collected between 8 and 17 years, and latent class analysis was used to identify the participants’ physical activity trajectories. At the 20-year follow-up (participants’ mean age=20.1±0.4 y), participants’ metabolic equivalent of task-minutes/week was determined using self-reported physical activity data. Participants’ PWC was assessed at the 14- and 17-year follow-ups to estimate their level of cardiovascular fitness. An eye examination, which included spectral-domain optical coherence tomography imaging, was conducted at the 20-year follow-up for 1344 participants.

Results:
Parent-reported or participant-reported physical activity was not associated with pRNFL thickness. However, higher PWC at 17 years was associated with thicker pRNFL globally [by 0.3 µm; 95% confidence interval (CI)=0.2-0.6; P<0.001], superotemporally (by 0.4 µm; 95% CI=0.1-0.7; P=0.013), inferonasally (by 0.7 µm; 95% CI=0.1-0.9; P=0.002), and nasally (by 0.4 µm; 95% CI=0.1-0.7; P=0.006) per 10 Watt increase in PWC.

Conclusions:
The association between estimated cardiovascular fitness and pRNFL thickness suggests there may be overlapping mechanisms for cardiovascular health and retinal ganglion cell integrity. While the effect sizes were small, it is possible that larger effects and clinically significant associations may arise as we follow this cohort of participants through their later adulthood.
Comparison of Superior and Inferior Visual Field Asymmetry Between Normal-tension and High-tension Glaucoma
Authors: Park In Ki , Kim Kyoung Woo , Moon Nam Ju , Shin Jae-Ho , Chun Yeoun Sook 
Published: May 2021

Precis:
Increased severity of glaucoma heightened the hemispherical asymmetry in normal-tension and high-tension glaucoma (NTG/HTG), especially NTG. NTG showed localized superior defects in the central and paracentral areas whereas HTG showed mild asymmetry with diffuse defects.

Purpose:
The purpose of this study was to compare the patterns of visual field (VF) defects according to glaucoma severity in NTG and HTG.

Materials and Methods:
A total of 1458 eyes with NTG (936) and HTG (522) were classified by mean deviation values into mild, moderate, and severe. The mean total deviation (mTD) values for each nasal, central, paracentral, arcuate 1, and arcuate 2 region of the Glaucoma Hemifield Test (GHT) were calculated. The differences in mTD between the superior and inferior hemifields of NTG and HTG were compared, and the degree of hemifield asymmetry was plotted.

Results:
In NTG and HTG, the mTDs of the 5 regions of the superior GHT were significantly worse than those of the corresponding regions of the inferior GHT at all severity levels except for mild HTG. However, NTG showed significantly greater asymmetry than HTG in 2 regions at mild, 3 at moderate, and all 5 at severe. Moderate and severe NTG showed severe asymmetry with localized superior field defects concentrated at the central and paracentral areas with >8 dB asymmetry. However, in all HTG groups showed mild asymmetry with diffuse defects.

Conclusions:
The superior hemifield was more severely affected than the inferior hemifield in NTG and HTG. As the severity of glaucoma increased, so did the asymmetry in both groups, with NTG showing more profound asymmetric VF defects in the central and paracentral areas whereas HTG did not. Different VF patterns suggest differing pathologic mechanisms and possible need for different therapeutic strategies in NTG and HTG.
Patient Concerns Regarding Suspended Ophthalmic Care Due to COVID-19
Authors: Dar Salman , De Moraes Carlos G. , Karani Rabia , Khan Sabine , Chen Royce , Blumberg Dana , Harizman Noga , Krawitz Brian , Valenzuela Ives A. , Aliancy Joah , Tezel Tongalp , Horowitz Jason , Bearelly Srilaxmi , Coleman Donald Jackson , Chang Stanley , Cioffi George A. , Liebmann Jeffrey M. 
Published: May 2021

Purpose:
The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the coronavirus disease 2019 (COVID-19) pandemic have yet to be fully understood. Our objective is to assess patients’ self-reported impact of health care lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City.

Methods:
We conducted a digital, self-reported, patient care survey distributed by an e-mail at Columbia University’s Department of Ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a canceled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical records were excluded. The survey occurred between March 2, 2020, to May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including the safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as visual acuity, intraocular pressure, diagnosis, disease severity, follow-up urgency, recent treatments, and diagnostic testing data.

Results:
Of the 2594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. Overall, 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression, and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. In addition, 55% of patients were afraid of contracting COVID-19 during an office visit.

Conclusion and Relevance:
We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. In addition, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients.
Relationship Between Macular Vessel Density and Total Retinal Blood Flow in Primary Open-angle Glaucoma
Authors: Cano Jennifer , Rahimi Mansour , Xu Benjamin Y. , Richter Grace M. , Tan Ou , Huang David , Shahidi Mahnaz 
Published: May 2021

Precis:
An association between macular vessel density (VD) and total retinal blood flow (TRBF) was demonstrated in subjects with primary open-angle glaucoma (POAG) and visual field (VF) loss.

Purpose:
The purpose of this study was to report relationships of macular VD metrics and TRBF in POAG.

Materials and Methods:
A total of 24 POAG and 19 healthy control subjects participated in the study. Subjects underwent optical coherence tomography and angiography for measurements of inner retinal thickness (IRT), VD, and spacing between large vessels (SLV) and small vessels (SSV). Doppler optical coherence tomography imaging was performed for TRBF measurement. In POAG subjects, automated perimetry was performed and VF loss expressed as mean deviation was measured.

Results:
Compared with the control group, POAG group had decreased VD, TRBF, IRT, and increased SLV (P<0.0001). Decreased VD (Pearson correlation, r=0.51; P<0.0001; N=43) and increased SLV (Spearman correlation, r
s=−0.47; P=0.001) were correlated with decreased TRBF. Decreased VD and SSV (r≥0.39; P≤0.001; N=43) and increased SLV (r
s=−0.71; P<0.0001) were associated with decreased IRT. Decreased VF mean deviation was correlated with decreased VD, SSV, IRT (r≥0.53; P≤0.001; N=24), and with increased SLV (r
s=−0.84; P<0.0001).

Conclusions:
The finding of an association between macular VD and TRBF supports the role of vascular factors in the pathophysiology of POAG and potential conduct of future studies aimed at identifying multiple image-based vascular metrics for disease diagnosis.
A qualitative trajectory analysis of patients' experiences tapering opioids for chronic pain
Authors: McNeilage Amy G. , Avery Nicholas S. , Holliday Simon , Glare Paul A. , Ashton-James Claire E. 
Published: May 2021

Abstract
Tapering opioids for chronic pain can be challenging for both patients and prescribers, both of whom may be unsure of what to expect in terms of pain, distress, activity interference, and withdrawal symptoms over the first few weeks and months of the taper. To better prepare clinicians to provide patient-centred tapering support, the current research used prospective longitudinal qualitative methods to capture individual-level variation in patients' experience over the first few months of a voluntary physician-guided taper. The research aimed to identify patterns in individuals' experience of tapering and explore whether patient characteristics, readiness to taper, opioid tapering self-efficacy, or psychosocial context were related to tapering trajectory. Twenty-one patients with chronic noncancer pain commencing tapering of long-term opioid therapy were recruited from a metropolitan tertiary pain clinic (n = 13) and a regional primary care practice (n = 8). Semistructured phone interviews were conducted a mean of 8 times per participant over a mean duration of 12 weeks (N = 173). Four opioid-tapering trajectories were identified, which we characterised as thriving, resilient, surviving, and distressed. High and low readiness to taper was a defining characteristic of thriving and distressed trajectories, respectively. Life adversity was a prominent theme of resilient and distressed trajectories, with supportive relationships buffering the effects of adversity for those who followed a resilient trajectory. Discussion focuses on the implications of these findings for the preparation and support of patients with chronic pain who are commencing opioid tapering.
Distinct synaptic mechanisms underlying the analgesic effects of γ-aminobutyric acid transporter subtypes 1 and 3 inhibitors in the spinal dorsal horn
Authors: Oyama Misa , Watanabe Shun , Iwai Takashi , Tanabe Mitsuo 
Published: May 2021

Abstract
Normalization of the excitatory and inhibitory balance by increasing the levels of endogenous inhibitory neurotransmitters by blocking their reuptake is a promising therapeutic strategy for relieving chronic pain. Pharmacological blockade of spinal γ-aminobutyric acid (GABA) transporter subtypes 1 and 3 (GAT1 and GAT3) has been reported to generate analgesic effects in animal models of neuropathic pain. Here, we explored the synaptic mechanisms underlying their analgesic effects in the spinal dorsal horn. Whole-cell recordings were made from dorsal horn neurons in spinal slices with attached dorsal roots from adult mice, and the effects of GAT inhibitors on miniature and evoked postsynaptic currents were examined. Behaviorally, GAT inhibitors were intrathecally applied to assess their effects on mechanical hypersensitivity in mice developing neuropathic pain after partial sciatic nerve ligation. The GAT1 inhibitor NNC-711 reduced the frequency of miniature excitatory postsynaptic currents (EPSCs) and the amplitude of C-fiber-mediated EPSCs, and the GAT3 inhibitor SNAP-5114 reduced the amplitude of A-fiber-mediated and C-fiber-mediated EPSCs. These effects were antagonized by the GABAB receptor antagonist CGP55845. Consistently, the analgesic effect of intrathecally injected NNC-711 and SNAP-5114 in mice developing mechanical hypersensitivity after partial sciatic nerve ligation was abolished by CGP55845. Thus, GAT1 and GAT3 inhibitors exert distinct GABAB receptor–mediated inhibitory effects on excitatory synaptic transmission in the spinal dorsal horn, which most likely contributes to their analgesic effects.
A Mixed-Methods Exploration of Adolescents' Lived Realities of HIV Stigma: “It's Something You Wear, Something That's Like a Shadow All Over Where You Go”
Authors: Crowley Talitha , van der Merwe Anita , Skinner Donald 
Published: May 2021

Abstract
This study aimed to explore how adolescents living with HIV experience stigma and the contextual factors influencing such. The authors used an exploratory, sequential, mixed-method design, including interpretive phenomenological individual interviews and focus groups with adolescents ages 13 to 18 years, their caregivers, and health care workers (n = 56) and a cross-sectional survey (n = 385) in health care facilities in the Western Cape, South Africa. Data were analyzed using an equal-status sequential mixed-methods analysis approach. Enacted, perceived, and anticipated stigma fueled fears of rejection and affected disclosure patterns of adolescents living with HIV. Experiencing HIV-related stigma was associated with being an older adolescent, being disclosed to after the age of 12 years, and residing with one's biological mother. Internalized stigma was associated with poor adherence and viral nonsuppression. Multifaceted interventions involving various individuals and groups across ecological systems are needed to interrupt the stigma process and mitigate its effects.
Understanding the Social and Emotional Dimensions of HIV Self-Management: A Qualitative Study of Newly Diagnosed People Living With HIV in Queensland, Australia
Authors: Hollingdrake Olivia , Dean Judith , Mutch Allyson , Lui Chi-Wai , Howard Chris , Fitzgerald Lisa 
Published: May 2021

Abstract
Understanding of HIV self-management increasingly focuses on treatment adherence and associated health-related behaviors, yet people living with HIV (PLWH) seldom perform these actions in a social vacuum. Thus, delivering comprehensive self-management support programs for PLWH requires an understanding of the social and emotional dimensions of HIV self-management. Through thematic analysis of in-depth interviews with 35 newly diagnosed PLWH, this descriptive qualitative study highlights these dimensions and their effect on experiences of HIV diagnosis and care. HIV self-management involves interpersonal interactions that affect efforts to seek support and reimagine one's personal identity in a changed reality. Managing disclosures and navigating stigma constitute everyday work for many PLWH. Because stigma continues to impede care engagement and well-being for PLWH, health practitioners must extend focus beyond viral suppression and prioritize support for emotional and social self-management. Nurses can create safe, nonstigmatizing spaces for conversations about HIV, uphold the rights of PLWH around disclosure, and ensure that PLWH are connected to peer support services.