bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fatty liver index and hypertension-mediated organ damage in never-treated hypertensive patients without diabetes mellitus
Authors: Siafi Eirini , Andrikou Ioannis , Konstantinidis Dimitris , Kakouri Niki , Iliakis Panagiotis , Koskinas John , Koullias Emmanouil , Thireos Eleftherios , Tousoulis Dimitris , Thomopoulos Costas , Tsioufis Costas 
Published: August 2021

Background:
We investigated whether fatty liver index (FLI), a surrogate marker of nonalcoholic fatty liver disease (NAFLD), is associated with hypertension-mediated organ damage (HMOD) in never-treated hypertensive patients without diabetes mellitus.

Methods:
We performed both clinic and ambulatory blood pressure (BP) measurements, and calculated the FLI for all participants. A FLI of no less than 60 indicates a high-risk of underlying NAFLD, whereas a FLI of less than 60 indicates lower risk. We evaluated left ventricular mass (LVM) by echocardiography, arterial stiffness by carotid--femoral pulse wave velocity (PWV), capillary rarefaction by nailfold capillaroscopy, as well as urinary albumin-to-creatinine ratio (ACR). HMOD was defined according to the categorical thresholds for each domain, except for capillary rarefaction in which case the categorization of patients was made by the median.

Results:
We included 146 hypertensive patients (men, 43.8%; mean age, 56.6 ± 10.8 years; BMI, 30.3 ± 4.9 kg/m2; FLI, 57.2 ± 27.7; office, systolic/diastolic, and 24-h BP, 153.5 ± 15.8/94.7 ± 9.8 mmHg, and 140.5 ± 9.9/83.8 ± 9 mmHg, respectively). Patients with FLI at least 60 (n = 76) were younger, with higher BMI and 24-h SBP, compared with patients with FLI less than 60 (n = 70). FLI was associated with HMOD after adjustment (LVM indexed to height, P = 0.004; PWV, P = 0.047; reduced capillary density, P = 0.001; and logACR, P = 0.003). High-risk FLI phenotype and FLI z scores increased the likelihood of any HMOD by 3.8 (95% confidence interval, 1.6–7.1) and 5.4 (95% confidence interval, 2.3–15.0) times, respectively. However, the increased number of HMOD domains has progressively stopped being determined by the FLI z scores (P = 0.65).

Conclusion:
High-risk FLI pattern was associated with various HMOD, and may re-classify never-treated hypertensive patients without diabetes mellitus into a higher cardiovascular risk level.
“The Spinning Technique” for Unfolding Tightly Scrolled DMEK Grafts
Authors: Vasquez-Perez Alfonso , Phylactou Maria , Din Nizar , Liu Christopher 
Published: August 2021

Purpose:
We present a no-touch Descemet membrane endothelial keratoplasty (DMEK) technique which assists in unfolding of tightly scrolled grafts from young donors.

Methods:
The technique was developed following a wet-laboratory experiment using human corneas created to observe the behavior of the graft during spinning within the artificial anterior chamber. This approach involves injecting short bursts of balanced salt solution to make the scroll spin continuously in a 360-degree manner. Spinning of the graft over the surface is accompanied by rotation on its horizontal axis resulting in opening in the correct orientation. Unfolding is then completed with standard bimanual tapping maneuvers. The spinning technique was then performed in 4 patients who all had tight DMEK scrolls from young donors.

Results:
The wet laboratory confirmed that directed jets of fluid to generate spinning and rotation open the graft in the correct orientation in most occasions. All 4 cases in this study received grafts from young donors (range 37–48 years old), and the technique achieved rapid unfolding with no complications. Two of our patients had glaucoma drainage devices, 1 had anterior chamber intraocular lens, and all other cases had clear corneas and good endothelial cell count after the 1-year follow-up.

Conclusions:
Our novel technique provides a safe and effective method to unscroll tight DMEK grafts that surgeons could incorporate into their armamentarium. Success is optimized by slightly undersizing the graft (7.5–8.0 mm).
One-Year Outcomes of Micropulse Cyclophototherapy for Primary Open-angle Glaucoma
Authors: Tong Weihan , Shen Tina Yu Ting , Wong Hung Chew , Aquino Maria Cecilia , Chew Paul , Lim Dawn 
Published: August 2021

Precis:
In primary open-angle glaucoma (POAG), micropulse trans-scleral cyclophototherapy (MPTCP) is effective in lowering intraocular pressure (IOP), but its effects are not permanent. Hence, it can serve as a temporizing measure before definitive glaucoma surgery.

Purpose:
There is limited data on MPTCP in POAG. This is the first study that looks at MPTCP treatment specifically in POAG patients.

Patients and Methods:
This is an interventional, single-institution exploratory case series with 55 eyes of 48 patients with POAG. Data was collected from clinical records, including patient demographics, clinical information, number of glaucoma medications, MPTCP laser settings, complications, and clinical outcomes.

Results:
Patients had a mean age of 67.3±14.1 years with a preponderance of males. IOP was 24.8±1.0 mm Hg before MPTCP and decreased to 19.7±1.1, 21.9±1.1, and 21.8±1.1 mm Hg at postoperative month 3, 6, and 12 respectively. IOP remained below pretreatment levels throughout the postoperative period (P<0.05). Visual acuity and mean deviation remained stable before and after MPTCP. No eyes had complications. Number of glaucoma medications remained the same after MPTCP. Four eyes required additional oral acetazolamide at postoperative month 1 for IOP control. Seventeen eyes subsequently required further surgical intervention after 9.84 months. Maximal IOP decrease was greater when there were higher power settings, higher preoperative IOP, and better preoperative visual acuity.

Conclusions and Relevance:
The IOP lowering effect of MPTCP treatment in patients with POAG was found to be modest and transient with a similar medication burden, and definitive glaucoma surgery was needed in a number of patients.
Second Primary Neoplasms in Patients With Sebaceous Carcinoma of the Eyelid: A Population-based Study, 2000 to 2016
Authors: Tadrosse Abanoob F. , Tadrosse Marina F. , Ezzat Bishoy M. , Sadek Dina M. , Langer Paul D. 
Published: August 2021

Purpose:
To investigate the risk of second primary neoplasms (SPNs) after primary sebaceous carcinoma of the eyelid (SCE).

Methods:
Data on patients diagnosed with primary SCE as their first malignancy were extracted from the Surveillance, Epidemiology, and End Results database from 2000 to 2016. Observed-to-expected ratios of SPNs were calculated to estimate standardized incidence ratios (SIRs). Patients were compared with a reference population (RP) matched for age, gender, and race.

Results:
Five hundred fifty-nine patients with primary SCE were identified, 16% of whom developed SPNs. SCE patients displayed a 61% increased risk of developing SPNs compared with the RP (p < 0.001). Overall, the risk of SPNs of the lungs (SIR = 1.82; p < 0.05), pancreas (SIR = 2.94; p < 0.05), salivary glands (SIR = 41.65; p < 0.001), and skin (SIR = 8.33; p < 0.05) was elevated. Only non-Hispanic Whites were at an increased risk (SIR = 1.51; p < 0.05). Patients 40–54 years old at the time of diagnosis were at the highest risk of developing SPNs compared with the RP (SIR = 3.15; p < 0.05). Women with SCE experienced an increased risk of breast cancer (SIR = 3.6; p < 0.05) and chronic lymphocytic leukemia (SIR = 8.8; p < 0.01).

Conclusion:
SCE patients are more likely to develop SPNs of the lungs, pancreas, salivary gland, and skin than the RP. Forty to fifty-four years old Caucasian patients are at the highest risk. Women are at an increased risk of developing breast malignancies and chronic lymphocytic leukemia. Clinicians should be cognizant of these risks when managing SCE patients.
Risk factors of recurrent carotid blowout syndrome and strategy of endovascular management
Authors: Luo Chao-Bao , Lee Chien-Hui , Chang Feng-Chi , Lin Chung-Jung 
Published: August 2021

Background:
Carotid blowout syndrome (CBS) is a catastrophic complication after aggressive head and neck cancer treatment. Endovascular embolization is an effective modality to manage CBS. However, some CBS may have recurrent CBS (rCBS) after endovascular management. This study aims to report the potential rCBS risk and endovascular management strategy.

Methods:
Of the 225 patients with CBS referred for embolization in 13 years, 31 men and one woman (mean age, 55 years) with 35 rCBS with pseudoaneurysms formation were identified after endovascular management. Moreover, the rCBS preembolization angioarchitecture, rCBS cause, rCBS time interval, embolic materials selection, and final embolization clinical/angiographic outcomes were retrospectively analyzed.

Results:
rCBS with pseudoaneurysm due to disease progression (DP) occurred in 17 patients, while 15 patients had insufficient embolization (IE) with 18 rCBS. The mean rCBS timing interval was 76 days with 129 and 12 days due to DP or IE. The most common rCBS locations were the carotid bulb and the main trunk of the external carotid artery (n = 20, 57%), followed by internal carotid artery (n = 8, 23%), distal branch of the external carotid artery (n = 4, 11%), and common carotid artery (n = 3, 9%). Endovascular management was technically successful in all patients by reconstruction (n = 7, 20%) or destruction (n = 28, 80%) techniques. Three patients (9%) had procedure-related complications. No rCBS was observed in all affected arteries after the last embolization in a mean 11-month clinical follow-up.

Conclusion:
rCBS may result from DP or IE. The common location of IE-related rCBS usually occurred in the carotid branches. It occurred within two weeks of CBS largely because of the underestimation of the extension of the affected carotid artery. In addition, DP is natural in head and neck cancer after aggressive treatment. Thus, endovascular management remained an effective method to manage rCBS.
Reported Signs, Symptoms, and Diagnostic Tests Before Cardiotoxicity Among Women With Breast Cancer: A Pilot Study
Authors: Attin Mina , Reifenstein Karen , Mehta Sakshi , Arcoleo Kimberly , Lin C.D. , Storozynsky Eugene 
Published: August 2021

Background
Cardiotoxicity after cancer treatment is a potentially preventable life-threatening complication among women with breast cancer. There is no algorithm to identify women with breast cancer at risk of cardiotoxicity.

Objectives
We quantified signs and symptoms as well as selected laboratory values among women with breast cancer who developed cardiotoxicity.

Methods
The clinical characteristics (n = 15) were collected from electronic health records. Spearman correlation coefficients and a nonparametric statistical test were used to analyze data.

Results
Significant statistical differences were detected in the laboratory values comparing the first and second half of 6 months before cardiotoxicity including alanine aminotransferase (U/L) (30.67 ± 26.27 and 42.31 ± 35.65, respectively; P = .03, Cohen’s d = 0.37). A negative correlation was found between estimated glomerular filtration rate and new onset of more than 1 sign or symptom (Spearman's ρ = −0.5, P = .06).

Conclusions
Investigating clinical characteristics before cardiotoxicity may determine the mechanism(s) and identify high-risk patients.
Effect of Miricorilant, a Selective Glucocorticoid Receptor Modulator, on Olanzapine-Associated Weight Gain in Healthy Subjects
Authors: Hunt Hazel J. , Donaldson Kirsteen , Strem Mark , Tudor Iulia Cristina , Sweet-Smith Suzanne , Sidhu Sharan 
Published: August 2021

Abstract

Purpose
Antipsychotic medications, including olanzapine, are associated with substantial weight gain and metabolic disturbances. We sought to determine whether coadministration of miricorilant, a selective glucocorticoid receptor modulator, with olanzapine can ameliorate these effects.

Methods
Sixty-six healthy men were enrolled in a 2-week, randomized, double-blind, placebo-controlled trial. The primary objective was to evaluate changes in body weight after 14 days coadministration of olanzapine (10 mg) + miricorilant (600 mg) compared with olanzapine (10 mg) + placebo. Secondary objectives included evaluating (a) the safety and tolerability of the combination; (b) the effects of the combination on glucose, insulin, insulin resistance, and triglycerides; and (c) the impact of the combination on hepatic enzymes.

Results
Subjects administered olanzapine + miricorilant gained less weight than subjects administered olanzapine + placebo (mean weight gain on day 15, 3.91 kg vs 4.98 kg; difference between groups, −1.07 kg; 95% confidence interval, −1.94 to −0.19; P = 0.017]). Compared with the placebo group, coadministration of miricorilant with olanzapine was associated with smaller increases in insulin (difference, −3.74 mIU/L; P = 0.007), homeostatic model assessment of insulin resistance (difference, −0.47; P = 0.007), triglycerides (difference, −0.29 mmol/L; P = 0.057), aspartate aminotransferase (difference, −32.24 IU/L; P = 0.009), and alanine aminotransferase (difference, −49.99 IU/L; P = 0.030).

Conclusions
Miricorilant may provide a promising option for ameliorating the detrimental effects of olanzapine, and investigation of this medication in patients affected by antipsychotic-induced weight gain is warranted. Two phase 2 studies of miricorilant in patients with recent and long-standing antipsychotic-induced weight gain are currently in progress.
Effectiveness of Clinical Simulation and Peer-Assisted Learning to Teaching About the Sexuality of People With Spinal Cord Injury
Authors: Hencklein Luana Cristina , da Silva Ruana Luiz Ferreira , Campos Daniel Gonçalves , Spagnol Gabriela Salim , Silva Juliany Lino Gomes , de Oliveira Sanfelice Clara Fróes , de Souza Oliveira-Kumakura Ana Railka 
Published: August 2021

ABSTRACT

BACKGROUND: The sexuality of people with spinal cord injury (SCI) is a subject often neglected by healthcare professionals because of their lack of knowledge or understanding of how to proceed in this context. Different teaching strategies can be used to fill this knowledge gap, such as clinical simulation and peer-assisted learning. This study evaluates the effects of an educational intervention on nursing students' knowledge acquisition about the sexuality of individuals with SCI and on the students' self-confidence and satisfaction with the experience. METHODS: Quasi-experimental, pretest-posttest design was conducted with nursing students (N = 54). The intervention was the application by a senior-level nursing student of 2 scenarios of high-fidelity clinical simulation. The primary outcome was the knowledge about the sexuality of people with SCI. The secondary outcome was the satisfaction and self-confidence in learning. We performed descriptive and inferential statistics and built multiple linear regression models. RESULTS: The effect of the intervention on knowledge acquisition ranged from the mean of 1.26 in the pretest to 3.10 in the posttest. The means in the scores of satisfaction and self-confidence were considered excellent and correlated with knowledge acquisition. Previous attendance of a class on SCI positively interfered in the scale of knowledge acquisition. CONCLUSION: We verified an effect size ranging from medium to large magnitude for knowledge acquisition, and great satisfaction and self-confidence in learning through the use of simulated experience and peer-assisted learning.
Simultaneous Cochlear Implantation After Translabyrinthine Vestibular Schwannoma Resection: A Report of 41 Cases
Authors: Sanna Mario , Piccirillo Enrico , Kihlgren Caterina , Cagliero Gloria , Guidi Mariapaola , Saleh Essam 
Published: August 2021

Objective:
To study the auditory outcome of simultaneous translabyrinthine vestibular schwannoma (VS) resection and cochlear implantation (CI) after successful cochlear nerve preservation.

Study Design:
A retrospective case series and patient questionnaire.

Setting:
Quaternary referral center for skull base pathologies.

Patients:
Patients with small (<2 cm) sporadic or neurofibromatosis 2 related tumors were included in this study.

Intervention:
Vestibular schwannoma resection + simultaneous cochlear implantation.

Main Outcome Measure:
Audiological performance postimplantation and perceived patients’ benefits.

Results:
Forty-one patients were included. Thirty-three were sporadic VS and eight were neurofibromatosis 2. Auditory perception postimplantation was achieved in 33 patients (80.5%). At the last follow-up, 20 patients (48.8%) were users and 21 (51.2%) were nonusers. In the users’ group, and after 1 year of implant activation, vowel identification was 75.3%, disyllabic word recognition 54%, sentence recognition 60.7%, and common phrase comprehension 61%, whereas in the nonusers’ group and after 1 year of implant activation, vowel identification was 22.9%, disyllabic word recognition 14.8%, sentence recognition 15.3%, and common phrase comprehension 14%. Sixteen users were classified into 10 high performers, three intermediate performers, and three poor performers. In the user’ group, the mean postimplantation pure tone average was 63.4 dB and the mean speech discrimination score was 63.7%.

Conclusions:
Simultaneous CI and VS resection is a viable option with many patients achieving auditory perception and nearly half the patients are CI users at long follow-up.
Neurodevelopmental outcomes in congenital heart disease through the lens of single ventricle patients
Authors: Burns Joseph , Varughese Robin , Ganigara Madhusudan , Kothare Sanjeev V. , McPhillips Lindsey A. , Dhar Arushi 
Published: August 2021

Purpose of review
This review aims to summarize and organize the current body of literature on this contemporary topic, alongside a more general discussion of neurodevelopmental complications of congenital heart disease.

Recent findings
It is theorized that the causes of the neurodevelopment disabilities are multifactorial resulting from structural central nervous system abnormalities, haemodynamic alterations and/or biochemical changes. It is therefore imperative that all patients with single ventricle anatomy and physiology receive long-term neurologic and developmental assessments in addition to their cardiac monitoring.

Summary
Advancements in surgical techniques and medical management have improved survivorship of these medically complex patients. Neurodevelopmental sequelae are one of the most common comorbidities affecting this patient population leading to long-term challenges in motor, language, social and cognitive skills.
Osteoclast-Like Giant Cell Tumors of the Pancreas
Authors: Ueberroth Benjamin E. , Liu Alex J. , Graham Rondell P. , Bekaii-Saab Tanios S. , McWilliams Robert R. , Mahipal Amit , Truty Mark J. , Mody Kabir , Sonbol M. Bassam , Halfdanarson Thorvardur R. 
Published: August 2021

Objectives
This study sought to better characterize patient characteristics, treatment options, and outcomes for osteoclast-like giant cell carcinoma of the pancreas, a rare subtype of pancreatic adenocarcinoma.

Methods
This is a retrospective study of all patients with osteoclast-like giant cell carcinoma of pancreatic origin treated at Mayo Clinic from 2000 to present. Baseline patient characteristics, treatment modalities utilized, and outcomes were compiled. Overall survival (OS) and progression-free survival were assessed using Kaplan-Meier analysis with a significance level of P ≤ 0.05.

Results
Fifteen patients met criteria for inclusion. Four patients had distant metastases at diagnosis, the remaining 11 with locoregional disease. Median OS for the entire cohort was 11 months. Metastatic disease was associated with significantly shorter OS (3.5 vs 14.1 months; P = 0.005). Three patients had no evidence of disease at time of analysis; all 3 were treated with complete resection followed by adjuvant chemotherapy.

Conclusions
Osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy with poor prognosis. For patients with locoregional disease, surgical resection followed by adjuvant chemoradiation may play a role in extended disease-free survival. Metastatic disease presents a challenging entity to treat with little data to support any effective chemotherapy regimens.
Clinical and Histopathologic Features Can Help Target Immunohistochemical Stain Use in the Diagnosis of Viral Esophagitis
Authors: Desai Nirali , Albahra Said , Lucas Elena , Singal Amit G. , Hammer Suntrea T.G. , Gopal Purva 
Published: August 2021

Objectives:
Herpes simplex virus (HSV) and cytomegalovirus (CMV) immunohistochemical stains (IHC) are frequently applied on esophageal biopsies. Our aims were to identify IHC use patterns in viral esophagitis (VE), and clinicopathologic features of VE that could guide IHC use.

Methods:
We included 58 VE cases and 60 controls, defined as patients with negative HSV/CMV IHC between January 2006 and July 2017. Biopsies were reviewed and histologic features and clinical data recorded.

Results:
Thirteen cases required IHC for diagnosis. IHC was performed in 13 HSV and 5 CMV cases where diagnostic viral inclusions were present. VE patients were more likely to have endoscopic ulcer (P=0.002) and be immunocompromised (P<0.001). Pretest clinical concern for VE was common (P=0.006). Histologically, VE patients were more likely to have ulcer (P=0.004), ulcer exudate rich in neutrophils and histiocytes (P=0.001), neutrophils in squamous mucosa (P<0.001), histiocyte aggregates >15 (P<0.001) and spongiosis (P<0.001). Controls had frequent eosinophils, alone (P=0.008) or admixed with other inflammatory cells (P<0.0001).

Conclusions:
IHC is used in VE biopsies despite definite viral inclusions on hematoxylin and eosin and in patients without concerning histology or clinical concern for VE. History, endoscopic findings, and histology can be used to better target IHC use in VE.
Precision of Low-Cost Augmented Reality in Prefabricated Cutting Guide for Fibular Free Flap Surgery
Authors: Yodrabum Nutcha , Rudeejaroonrung Krit , Chaikangwan Irin , Prompattanapakdee Jiraya , Noraset Thanapon 
Published: August 2021

Background:
Augmented reality (AR) is an imaging technology encompassing an interactive experience of a real-world environment enhanced by computer-generated perceptual information. It has been introduced to current medical practice to help the preoperative planning in many surgical fields.

Methods:
The authors applied AR to the computed tomography angiography of 8 patient's legs. Computed tomography angiography images were processed into Digital Imaging and communications in Medicine files to make a prefabricated cutting guide and customized titanium plate. Also, three-dimensional reconstruction of the arterial supply of the leg was performed to identify the perforators.

Results:
Followed by preoperative marking of operative details on patient's skins in antero-posterior view, lateral view, and combination of both views. Inaccuracy of measurement was confirmed by duplex ultrasound which average error of the combination of antero-posterior and lateral viewed of both legs was lowest (0.7 ± 0.2 cm). Followed by lateral view (1.0 ± 0.3 cm) and antero-posterior view (1.2 ± 0.4 cm), respectively.

Conclusions:
Augmented reality can improve patient's safety by directly locate the perforator and easily to design the skin paddle. Followed by satisfaction and confidence in patients and their relatives. Augmented reality also promoted understanding of operative steps for related assistants, residents, or fellows. Augmented reality can perform with existing equipment, mobile phone application, and can save the cost for preoperative planning. Distortion in the depth view can be more accurate by combining of AR in antero-posterior and lateral view.