bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Presentation of T-Cell Prolymphocytic Leukemia Mimicking Dermatomyositis
Authors: Ingrasci Giuseppe , Diaz-Perez Julio , Verne Sebastian , Romanelli Paolo , Yosipovitch Gil 
Published: February 2021

Abstract:
T-cell prolymphocytic leukemia (TPLL) is a rare form of leukemia by T lymphocytes at a post-thymic intermediate stage of development with an α/β immunophenotype. Facial involvement is common in TPLL and displays significant heterogeneity of the lesions' description and location. TPLL also contains a wide array of histology findings, cell cytology, and molecular studies. Here, we describe a TPLL patient who presented with an ill-defined erythematous patch involving the right axilla progressing to the left axilla, upper back, and face that resembled dermatomyositis. The diagnosis of TPLL was established using flow cytometry of bone marrow and peripheral blood, and histopathology of the involved skin. Dermatologists should be aware of these unique features.
Cutaneous Polymer-Coating Embolism After Endovascular Procedures: Report of Two Cases and a Literature Review
Authors: Berríos-Hernández Mario , Abou-Jokh Casas Charigan , Sainz-Gaspar Laura , Ginarte-Val Javier , Fernández Redondo Virginia , López-Otero Diego , Aliste Carlos , Suárez-Peñaranda Jose M. 
Published: February 2021

Abstract:
Different hydrophilic and hydrophobic polymers are used as lubricious coatings to reduce vascular traumas in minimally invasive percutaneous procedures. Although they are usually very safe, there is still a risk of serious complications in patients undergoing such procedures, mostly derived from the devices' coating detachment and systemic embolization. The lungs are the most common organ involved, followed by the central nervous system. Yet, cutaneous embolization is unusual, and only 19 cases are available in the literature. Most commonly, they present as asymptomatic retiform purpura on the lower legs, which tends to involve spontaneously. Correct clinical diagnosis is not suspected in most cases, being cholesterol emboly or vasculitis the preferred options. Time interval since surgical procedure and appearance of lesions vary widely but they generally start in the first few days. Histopathological identification of the embolus as bluish, amorphous intraluminal material in dermal vessels is diagnostic, but vasculitic signs are not present. We report 2 cases of skin lesions as the main manifestation of polymer embolization after endovascular surgical procedures. In both cases, biopsy allowed identification of embolized foreign material and lesions resolved without specific treatment.
Occupational Localized Cutaneous Argyria With Pseudo-Ochronosis in a Jeweler
Authors: Georgiadou Nikki , Singh Sarita , Wagner Bart , Goggin Patricia , Katsarma Effie , Singh Manuraj 
Published: February 2021

Abstract:
A case of localized argyria in a 36-year-old female jeweler is described who presented with 2 discrete and asymptomatic bluish–black pigmented macules on the pulp of her left middle finger. A skin biopsy from both lesions demonstrated deposition of brown/black pigmented granules along the basement membrane zone of eccrine glands, blood vessels, nerves, and the dermo-epidermal junction fully in keeping with silver deposition. In addition, there was yellow–brown deposition seen within the interstitial dermis mimicking an early form of ochronosis, so called “pseudo-ochronosis.” This latter feature is rarely described in cases of argyria. Transmission electron microscopy and energy dispersive x-ray spectroscopy confirmed the presence of electron dense particles up to 150 nm in diameter and the presence of silver, respectively. On further questioning, the patient had a history of localized and chronic exposure to silver, which specifically involved holding and manipulating silver wires and rings over the left middle finger. This case highlights an unusual and rare presentation of localized argyria in a jeweler. In addition, our case showed preferential silver deposition on dermal elastic fibers which has not been previously described in the literature.
Ossifying Plexiform Tumor: A Case Report
Authors: Lau Sean K. , Koh Stephen S. , Cassarino David S. 
Published: February 2021

Abstract:
Ossifying plexiform tumor is an exceedingly rare cutaneous neoplasm with distinctive histologic features. The typical microscopic appearance is that of a well-circumscribed dermal lesion composed of spindled and epithelioid cells in a myxoid appearing matrix with a plexiform architecture associated with areas of ossification. The present report details the clinicopathologic features of an ossifying plexiform tumor involving the lower extremity of a 69-year-old man. The cutaneous lesion exhibited characteristic morphologic features of this entity. By immunohistochemistry, the tumor was negative for most markers assessed, but notably exhibited diffuse positivity for SATB2. No lesional recurrence was observed. The present case serves to expand on the limited existing knowledge regarding the clinicopathologic features of this uncommon tumor. The histogenesis of ossifying plexiform tumor remains unclear; however, the demonstration of SATB2 expression in this case suggests osteoblastic differentiation.
Combining Reflective Confocal Microscopy and Dynamic Optical Coherence Tomography to Diagnose Melanoacanthoma: Case Report
Authors: Bressler Moshe Y. , Felice Skye , Yousefi Nyousha , Marghoob Nadeem , Alapati Usha , Gill Melissa , Markowitz Orit 
Published: February 2021

Abstract:Few reported cases discuss distinguishing between melanoma and melanoacanthoma, a seborrheic keratosis (SK) variant, using noninvasive imaging devices. We present a case of a 38-year-old man with Fitzpatrick skin type IV with an asymmetric black papule showing clinical and dermoscopic features of both melanoma and SK. Reflectance confocal microscopy (RCM) and dynamic optical coherence tomography (d-OCT) were used for further evaluation. RCM revealed acanthotic epidermis with a mixed honeycomb and cobblestone pattern, polycyclic bulbous rete ridges, and bright plump cells within entrapped, edged, dermal papillae, compatible with pigmented SK. Also noted were a population of fairly uniform bright dendritic cells scattered quite evenly at all levels of the epidermis and the notable absence of concomitant features of a melanocytic neoplasm (roundish Pagetoid cells, sheets of roundish or dendritic cells at the dermal–epidermal junction, junctional thickenings, and melanocytic nests), suggesting melanoacanthoma. d-OCT showed well-circumscribed, regular, epidermal acanthosis, superficial rounded hypodense structures, normal vascular flow, and notable absence of wiry or contoured vessels, features typically seen in SKs and benign lesions, respectively. Similarly, histologic examination revealed characteristics of pigmented SK containing a population of evenly dispersed dendritic melanocytes (decorated using Melan-A stain) confirming a diagnosis of melanoacanthoma. This case highlights the advantages of incorporating both RCM and d-OCT into clinical practice to noninvasively differentiate melanoma from its clinical mimickers.
Effect of Tranexamic Acid Administration on Postoperative Ecchymosis and Edema in Excision of Lipomas
Authors: Choi Young-Jun , Park Hyeon Jeong , Lee Heun Joo , Lee Ga-Young , Kim Won-Serk 
Published: February 2021

BACKGROUND
Previous studies have shown that systemic tranexamic acid reduces bleeding during soft tissue surgeries and reduces postoperative ecchymosis and edema experienced by surgical patients.

OBJECTIVE
To evaluate the effect of postoperative tranexamic acid administration on the reduction of ecchymosis and edema after lipoma surgery.

MATERIALS AND METHODS
A total of 40 patients who underwent lipoma excision were included in the comparative analysis. In the tranexamic acid group (n = 20), 1 g of tranexamic acid was administered daily for 5 consecutive postoperative days. Tranexamic acid was not administered to the control group (n = 20). The severity of ecchymosis and edema at the first visit after surgery was rated on a 4-point scale by 2 blinded dermatologists.

RESULTS
The mean interval of the initial visit after surgery was 1.1 ± 0.5 (range: 1–4) days. Mean ecchymosis scores were significantly lower in the tranexamic acid group (0.5 ± 0.8) than in the control group (1.2 ± 1.0) (p < .05). No statistical difference was seen in mean edema scores between groups (0.5 ± 0.6 in tranexamic acid vs 0.7 ± 0.8 in control).

CONCLUSION
We observed that postoperative administration of tranexamic acid significantly decreased ecchymosis in lipoma excision.
Nicotinamide for Keratinocyte Carcinoma Chemoprevention: A Nationwide Survey of Mohs Surgeons
Authors: Desai Sheena , Olbricht Suzanne , Ruiz Emily S. , Hartman Rebecca I. 
Published: February 2021

BACKGROUND
Nicotinamide has been shown to reduce keratinocyte carcinoma (KC) in high-risk patients in a randomized controlled trial setting. Data on nicotinamide's use for KC prevention are limited.

OBJECTIVE
To characterize nicotinamide prescribing patterns among Mohs surgeons.

METHODS AND MATERIALS
We surveyed 1,500 members of the American College of Mohs Surgeons regarding their demographics, use of nicotinamide, and safety perceptions. We performed multiple logistic regression analysis to evaluate correlations between physician characteristics and nicotinamide prescribing habits.

RESULTS
76.9% of survey respondents recommend nicotinamide for KC prevention. Twenty percent of respondents have recommended nicotinamide to more than 100 patients in the past year. Forty-five percent of respondents report a duration of use of 2 years or more in their patients. 63.8% of respondents had no concerns over nicotinamide's safety with long-term use. Individuals who answered “yes,” “maybe,” or “uncertain” to having safety concerns over long-term nicotinamide use and individuals in practice for more than 10 years were less likely (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.71 and OR 0.20, 95% CI 0.05, 0.82, respectively) to have recommended nicotinamide to patients for KC prevention.

CONCLUSION
Given the widespread nicotinamide use among Mohs surgeons, additional studies on nicotinamide cost-effectiveness, safety, and use patterns are needed.
Willingness to Pay for Surgical Treatments for Basal Cell Carcinoma: A Population-Based Cross-Sectional Study
Authors: Kantor Jonathan 
Published: February 2021

BACKGROUND
Keratinocyte carcinoma (KC) treatment accounts for approximately $5 billion in spending per year, yet no studies have evaluated the US general public's willingness to pay (WTP) for these procedures.

OBJECTIVE
To determine the monetary value of surgical KC treatments, as perceived by society, as a measure of preference.

PARTICIPANTS, METHODS AND MATERIALS
We performed an internet-based age-, sex-, and race-stratified cross-sectional survey of 425 subjects representative of the US general population. Stated WTP and desirability of electrodesiccation and curettage (EDC), excision, and Mohs micrographic surgery (MMS) for facial and extrafacial basal cell carcinoma (BCC) were assessed. A discrete choice experiment was performed using maximum likelihood estimation, and a secondary analysis was performed to determine the influence of framing MMS as the best treatment option.

RESULTS
A total of 425 subjects finished their questionnaires, yielding a completion rate of 97%. Median (interquartile range) stated WTP for EDC, excision, and MMS were $1,000 (421–2,079), $1,503 (562–3,062), and $3,006 (1,250–5,084), respectively, when MMS was framed in a standard fashion. Stated WTP for MMS increased to $3,989 (2,015–5,801) when it was framed as the best option. For BCC on the back, WTP for MMS dropped by 12%.

CONCLUSION
There is markedly higher societal WTP for MMS on both the face and trunk, regardless of whether MMS is framed as the best option. Gold-standard bias may affect WTP and desirability in medical decision-making under uncertainty, inflating the WTP of options framed as the best while decreasing the desirability of alternatives.
Positive Predictive Value of Sarcoidosis Identified in an Administrative Healthcare Registry: A Validation Study
Authors: Ceder Sylvia , Rossides Marios , Kullberg Susanna , Eklund Anders , Grunewald Johan , Arkema Elizabeth V. 
Published: February 2021

Background:
International classification of disease (ICD) codes used to study sarcoidosis has previously been validated in only 1 study. We aimed to determine the accuracy of ICD codes to identify true sarcoidosis diagnoses in Sweden.

Methods:
We identified adults with at least 2 ICD codes for sarcoidosis (ICD-10 D86) at Karolinska University Hospital 2010–2013 from the National Patient Register. Of these, we randomly sampled 100 patients for validation. We collected clinical data and categorized the diagnosis of sarcoidosis as definite, probable, or unlikely. We estimated the positive predictive value for definite and probable sarcoidosis—identified with at least 2 ICD codes—with 95% confidence intervals.

Results:
We deemed 77% of the cases to be definite and 17% to be probable. The positive predictive value was 0.94 (95% confidence intervals = 0.87 to 0.98).

Conclusions:
Using at least 2 visits listing an ICD-10 code for sarcoidosis accurately identified patients with sarcoidosis from administrative health data in Sweden.
Prenatal Opioid Analgesics and the Risk of Adverse Birth Outcomes
Authors: Brogly Susan B. , Velez Maria P. , Werler Martha M. , Li Wenbin , Camden Andi , Guttmann Astrid 
Published: February 2021

Background:
It is unclear whether confounding accounts for the increased risk of preterm birth and small for gestational age (SGA) birth in opioid analgesic exposed pregnancies.

Methods:
Using universal coverage health data for Ontario, we assembled a cohort of mother–infant pairs without opioid use disorder (627,172 pregnancies and 509,522 women). We estimated risk ratios (RRs) between opioid analgesics and preterm birth, SGA birth, and stillbirth; neonatal abstinence syndrome was a secondary outcome. We used high-dimensional propensity scores and sensitivity analyses for confounding adjustment.

Results:
4% of pairs were exposed, mainly to codeine (2%), morphine (1%), and oxycodone (1%). Compared with unexposed, the adjusted risk of preterm birth was higher with any (1.3, 95% confidence interval [CI] = 1.2, 1.3), first- (RR: 1.2, 95% CI = 1.2, 1.3), and second-trimester (RR: 1.3, 95% CI = 1.2, 1.4) opioid analgesic exposure. Preterm birth risk was higher for first- and second-trimester codeine, morphine, and oxycodone exposure, and for third-trimester morphine. There was a small increase in SGA with first-trimester exposure to any opioid analgesic or to codeine. Exposed pregnancies had an elevated stillbirth risk with any (RR: 1.6, 95% CI = 1.4, 1.8), first- and second-trimester exposure. Few infants had neonatal abstinence syndrome (N = 143); the risk was higher in exposed (RR: 3.6, 95% CI = 2.1, 6.0). In sensitivity analyses of unmeasured confounding, an elevated risk in exposed pregnancies persisted for preterm birth but not SGA.

Conclusions:
Opioid analgesic-exposed pregnancies had a small increased risk of preterm birth and possibly stillbirth after accounting for confounding by indication and sociodemographic factors.
Urinary phthalate metabolite concentrations and adolescent sleep duration
Authors: Sears Clara G. , Braun Joseph M. 
Published: February 2021

Background:
Some environmental chemicals, such as phthalates, are capable of disrupting endocrine function related to the development and regulation of sleep patterns. However, the contribution of phthalate exposure to inadequate sleep during adolescence is unknown. We aim to evaluate the association between phthalate exposure and short sleep duration during adolescence.

Methods:
We used data from participants 16–17 years of age in the 2005–2010 cycles of the National Health and Nutrition Examination Survey. Participants reported typical sleep duration during weekdays, which we categorized into short sleep duration (less than 8 hours per night) and adequate sleep duration (8 or more hours) based on consensus guidelines. We used weighted logistic regression to evaluate the association between log10-transformed urinary phthalate metabolite concentrations and odds of short sleep duration.

Results:
An interquartile range increase in di(2-ethylhexyl) phthalate metabolites, monocarboxynonyl phthalate, monocarboxyoctyl phthalate, and mono-isobutyl phthalate was associated with 1.48 (95% confidence interval [95% CI] = 1.02, 2.16), 1.64 (95% CI = 1.17, 2.32), 1.46 (95% CI = 0.99, 2.16), and 1.92 (95% CI = 1.08, 3.43) times the odds of short sleep duration, respectively. Furthermore, we observed monotonic dose-response relations between some phthalate metabolites and odds of short sleep duration.

Conclusions:
Our results suggest that higher urinary concentrations of several phthalate metabolites are associated with short sleep duration during adolescence. Understanding the contribution of modifiable environmental factors to inadequate sleep duration is of great public health importance because inadequate sleep can have substantial health implications.
Risk of mortality and suicide associated with substance use disorder among healthcare professionals
Authors: Rodrigues Joao Vitor da Silva , Pereira José E. Guimarães , Passarelli Luisa Almeida , Guatura Gabrielle M.G.B. , El Dib Regina 
Published: February 2021

BACKGROUND
Previous studies have suggested that healthcare professionals may be susceptible to substance use disorders, and among the medical specialties, anaesthesia providers appear to be overrepresented.

OBJECTIVE
We aimed to compare the prevalence of substance use-related mortality and suicides between anaesthesia and nonanaesthesia professionals.

DESIGN
Systematic review of observational studies with meta-analyses. We defined anaesthesia providers as any healthcare professionals belonging to the specialty, regardless of age and duration of employment. Other healthcare professionals served as the control group.

DATA SOURCES
Ovid Medline, EMBASE, Web of Science, Scopus, Scielo, LILACS and ProQuest databases up to March 2020.

RESULTS
Thirty-nine studies were included, 31 cross-sectional studies involving 13 819 participants and eight cohorts with a total 129 811 participants proved eligible. Results suggested a higher rate of drug-related mortality with odds ratio (OR) 2.69 [95% confidence interval (CI), 1.80 to 4.00; P < 0.001; I
2 = 0%, P = 0.55; high-certainty evidence] and suicide (OR 2.18, 95% CI, 1.33 to 3.58; P = 0.002; I
2 = 0%, P = 0.68; moderate-certainty evidence) for anaesthesia providers compared with other healthcare professionals.

CONCLUSION
High-to-moderate-certainty evidence shows that there is more than a two-fold increased rate of substance use-related mortality and suicide among anaesthesia providers compared with other healthcare professionals. Investigations examining substance abuse between healthcare professionals, with particular attention to working conditions and exposure are essential to further develop preventive strategies.
Treatment of spinal anaesthesia-induced hypotension with cafedrine/theodrenaline versus ephedrine during caesarean section
Authors: Kranke Peter , Geldner Götz , Kienbaum Peter , Gerbershagen Hans Jürgen , Chappell Daniel , Wallenborn Jan , Huljic Susanne , Koch Tilo , Keller Thomas , Weber Stephan , Kunitz Oliver , Linstedt Ulf , Eberhart Leopold H.J. 
Published: February 2021

BACKGROUND
In Germany, hypotension induced by spinal anaesthesia is commonly treated with a combination of cafedrine hydrochloride (C, 200 mg) and theodrenaline hydrochloride (T, 10 mg) in 2 ml. We compared the effectiveness of C/T with ephedrine.

OBJECTIVES
The primary objectives were to assess the speed of onset and the ability to restore blood pressure without an increase in heart rate. Secondary objectives were to evaluate maternal/foetal outcomes and the number of required additional boluses or other additional measures.

DESIGN
HYPOTENS was a national, multicentre, prospective, open-label, two-armed, noninterventional study comparing C/T with ephedrine in two prospectively defined cohorts. This study relates to the cohort of patients receiving spinal anaesthesia for caesarean section.

SETTING
German hospitals using either C/T or ephedrine in their routine clinical practice.

PATIENTS
Women aged at least 18 years receiving spinal anaesthesia for caesarean section.

INTERVENTIONS
Bolus administration of C/T or ephedrine at the discretion of the attending anaesthesiologist.

MAIN OUTCOME MEASURES
Endpoints within 15 min after initial administration of C/T or ephedrine were area under the curve between the observed SBP and the minimum target SBP; and incidence of newly occurring heart rate of at least 100 beats min−1.

RESULTS
Although effective blood pressure stabilisation was achieved with both treatments, this effect was faster and more pronounced with C/T (P < 0.0001). The incidence of tachycardia and changes in heart rate were higher with ephedrine (P < 0.01). Fewer additional boluses (P < 0.01) were required with C/T. Although favourable neonatal outcomes were reported in both groups, base deficit and lactate values were greater with ephedrine (P < 0.01). Physician satisfaction was higher with C/T.

CONCLUSIONS
After C/T, tachycardia was not a problem, providing an advantage over ephedrine. Fewer additional boluses were required with C/T, suggesting greater effectiveness. An increased base deficit with ephedrine suggests reduced oxygen supply or increased demands in foetal circulation.

TRIALS REGISTRATION
Clinicaltrials.gov: NCT02893241, German Clinical Trials Register: DRKS00010740.
Perspectives of Women Who Forgo Post-mastectomy Breast Reconstruction: A Mixed Methods Analysis
Authors: Singh Tanvee , Goparaju Lakshmi , Giladi Aviram M. , Aliu Oluseyi , Song David H. , Fan Kenneth L. 
Published: February 2021

Background:
Despite a growing body of evidence suggesting improved psychosocial well-being and survival after post-mastectomy breast reconstruction (PMBR), rates remain stagnant at approximately 40%. Although PMBR access and utilization have been well reported, there is much less known from the point of view of women who decide not to undergo PMBR. This study uses a mixed methods approach to fill that gap by investigating the patient-level decisions that lead to foregoing PMBR.

Methods:
A concurrent triangulation model under mixed methods research (MMR) was employed using in-depth qualitative interviews and the BREAST-Q questionnaire. Interviews were conducted until data saturation was reached and were analyzed using iterative methodologies under the grounded-theory framework. Reliability checks included inter-rater reliability using Cohen’s kappa statistic (mean kappa = 0.99) and triangulation.

Results:
Interviews with 8 patients who declined PMBR revealed (1) lack of trust in plastic surgeons; (2) reliance on self-developed support; (3) desire to resume normal life; (4) perceived lack of equivalency between reconstructed and natural breasts. Concurrent triangulation between the data revealed dissonance between the BREAST-Q scores for psychosocial well-being and reported levels of satisfaction.

Conclusions:
Women in this study highlighted certain deficits in the current pathway to reconstruction: lack of trust, resources, and counseling. Such feelings of suspicion and reported opposition to PMBR are at odds with low scores for satisfaction with breasts and sexual well-being. These findings can be used to guide efforts that engender confidence, provide support, empower vulnerable patient groups, and increase utilization of PMBR.