bluuebunny/crossref_metadata_2025_split huggingface dataset:
C1-2 cyst presenting with syringobulbia: a case report
Authors: Yang Michael J , Arkun Knarik , Kryzanski James T 
Published: February 2021

Abstract
Extradural atlantoaxial cysts are typically related to C1-2 degeneration. Intradural cysts may cause secondary syringobulbia depending on the size and cerebrospinal fluid flow obstruction. However, medullary syrinxes have not been previously described with extradural cysts. Treatment of symptomatic lesions involves surgical resection, often via a far-lateral approach, with consideration of fusion if C1-2 instability is present. We present a case of an extradural C1-2 cyst with intradural extension causing syringobulbia. Effective surgical resection was accomplished via a far-lateral, partial transcondylar approach without fusion. It is important to recognize that cysts of extradural origin may exhibit intradural extension and compress critical neurovascular structures.
Long-term Effectiveness of Microwave Thermoablation in Persons With Residual Limb Hyperhidrosis: A Case Series
Authors: Kravitz Shena A , Lannan Ford M , Simpson Meagan M 
Published: February 2021

ABSTRACT
Excessive sweating or focal hyperhidrosis (HH) of the residual limb in persons with amputations is thought to be a significant contributor to residual limb dermatoses, prosthesis dysfunction, and decreased quality of life. Treatment algorithms used for HH in persons without amputation do not effectively translate to residual limb HH, and research in this area is sparse. We discuss the long-term outcomes of three patients treated with microwave thermoablation (MT) on their residual limbs who had previously been unsuccessfully managed with topical antiperspirants and botulinum toxin injections. On average, there was a decrease of two points in the Hyperhidrosis Severity Scale score among the three patients 4-6 years after treatment. Although the reported side effects of post-procedure edema and prolonged time out of a prosthesis are challenging, MT of the residual limb appears to be a promising treatment modality for persons with amputation. Further investigations for standardized treatment guidelines are required to improve management of residual limb HH with MT.
Stellar-mass microlensing of gravitational waves
Authors: Cheung Mark H Y , Gais Joseph , Hannuksela Otto A , Li Tjonnie G F 
Published: February 2021

ABSTRACT
When gravitational waves (GWs) pass through the nuclear star clusters of galactic lenses, they may be microlensed by the stars. Such microlensing can cause potentially observable beating patterns on the waveform due to waveform superposition and magnify the signal. On the one hand, the beating patterns and magnification could lead to the first detection of a microlensed GW. On the other hand, microlensing introduces a systematic error in strong lensing use-cases, such as localization and cosmography studies. By numerically solving the lensing diffraction integral, we show that diffraction effects are important when we consider GWs in the LIGO frequency band lensed by objects with masses $\lesssim 100 \, \rm M_\odot$. We also show that the galaxy hosting the microlenses changes the lensing configuration qualitatively, so we cannot treat the microlenses as isolated point mass lenses when strong lensing is involved. We find that for stellar lenses with masses $\sim \! 1 \, \rm M_\odot$, diffraction effects significantly suppress the microlensing magnification. Thus, our results suggest that GWs lensed by typical galaxy or galaxy cluster lenses may offer a relatively clean environment to study the lens system, free of contamination by stellar lenses, which can be advantageous for localization and cosmography studies.
Systematic Review and Meta-Analysis of the Dose-Response and Risk Factors for Obliteration of Arteriovenous Malformations Following Radiosurgery: An Update Based on the Last 20 Years of Published Clinical Evidence
Authors: Zhu Shaoyu , Brodin N Patrik , Garg Madhur K , LaSala Patrick A , Tomé Wolfgang A 
Published: February 2021

ABSTRACT

BACKGROUND
Intracranial arteriovenous malformation (AVM) is a congenital lesion that can potentially lead to devastating consequences if not treated. Many institutional cohort studies have reported on the outcomes after radiosurgery and factors associated with successful obliteration in the last few decades.

OBJECTIVE
To quantitatively assess the dose-response relationship and risk factors associated with AVM obliteration using a systematic review and meta-analysis approach.

METHODS
Data were extracted from reports published within the last 20 yr. The dose-response fit for obliteration as a function of marginal dose was performed using inverse-variance weighting. Risk factors for AVM obliteration were assessed by combining odds ratios from individual studies using inverse-variance weighting.

RESULTS
The logistic model fit showed a clear association between higher marginal dose and higher rates of obliteration. There appeared to be a difference in the steepness in dose-response when comparing studies with patients treated using Gamma Knife radiosurgery (Elekta), compared to linear accelerators (LINACs), and when stratifying studies based on the size of treated AVMs. In the risk-factor analysis, AVM obliteration rate decreases with larger AVM volume or AVM diameter, higher AVM score or Spetzler-Martin (SM) grade, and prior embolization, and increases with compact AVM nidus. No statistically significant associations were found between obliteration rate and age, sex, prior hemorrhage, prior aneurysm, and location eloquence.

CONCLUSION
A marginal dose above 18 Gy was generally associated with AVM obliteration rates greater than 60%, although lesion size, AVM score, SM grade, prior embolization, and nidus compactness all have significant impact on AVM obliteration rate.
Disclosure after medical error
Authors: Spanakis Spiro G. 
Published: February 2021

Purpose of review
Disclosure after medical error is a complex process that goes beyond a single provider and the patient. The types and severity of errors occurring in the practice of anesthesiology may have more implications for patients, requiring a thoughtful approach to the patient, their families and the healthcare system as a whole.

Recent findings
Tenants of the disclosure have been established. Simulation for trainees and practitioners allows for education and preparation for such events.

Summary
Despite education and systems-based improvements in quality and safety in medicine, errors will undoubtably occur. Communication with patients and their families after an event is key in maintaining trust in the therapeutic relationship. A concerted effort is required by a team to ensure a well-executed disclosure
Nervous Nipple: Pseudopolythelia Caused by a Neurofibroma of the Areola
Authors: Caputo Alessandro , Addesso Maria , D'Antonio Antonio 
Published: February 2021

Abstract:
The presence of a supernumerary nipple inside the original areola is a rare condition termed intra-areolar polythelia. Rarely, a lesion can macroscopically resemble a nipple. We report a case of a solitary neurofibroma (by itself rare in the areola) mimicking a second, twin nipple. In this case, these 2 rare conditions merge resulting in pseudopolythelia. The relevant literature on polythelia and neurofibromas of the breast is briefly reviewed.
Epidermodysplasia Verruciformis After Hematopoietic Stem Cell Transplantation in a Patient With Severe Combined Immunodeficiency Syndrome
Authors: Bostan Ecem , Akdogan Neslihan , Gokoz Ozay 
Published: February 2021

Abstract:
Epidermodysplasia verruciformis (EV) is a rare dermatologic disorder that is characterized by skin-colored-to-light brown flat, discrete or confluent papules resembling verruca plana. EV is divided into 2 forms: a classical genetic form and an acquired form. Classical genetic EV is caused by mutations in EVER1 and EVER2 genes. Acquired EV develops in immunocompromised patients such as HIV-positive patients and transplant recipients. Patients with a prior history of hematopoietic stem cell transplantation (HSCT) have tendency to develop generalized verrucosis. We report an extraordinary case of disseminated epidermodysplasia verruciformis seen in a 7-year-old boy diagnosed with severe combined immunodeficiency syndrome who had undergone HSCT. He had plane, brown papules involving his face, forearms, neck, anterior chest, nape, back, and knees. Cutaneous biopsy showed typical characteristic findings of EV: large cells with gray–blue cytoplasm and keratohyaline granules of different sizes in the granular and spinous layers. Herein, we present an unusual case of disseminated EV in a HSCT patient with typical histopathologic findings and treatment options.
Genetics of atrial fibrillation
Authors: Kim Jitae A. , Chelu Mihail G. , Li Na 
Published: February 2021

Purpose of review
Atrial fibrillation is the most common sustained cardiac arrhythmia. In addition to traditional risk factors, it is increasingly recognized that a genetic component underlies atrial fibrillation development. This review aims to provide an overview of the genetic cause of atrial fibrillation and clinical applications, with a focus on recent developments.

Recent findings
Genome-wide association studies have now identified around 140 genetic loci associated with atrial fibrillation. Studies into the effects of several loci and their tentative gene targets have identified novel pathways associated with atrial fibrillation development. However, further validations of causality are still needed for many implicated genes. Genetic variants at identified loci also help predict individual atrial fibrillation risk and response to different therapies.

Summary
Continued advances in the field of genetics and molecular biology have led to significant insight into the genetic underpinnings of atrial fibrillation. Potential clinical applications of these studies include the identification of new therapeutic targets and development of genetic risk scores to optimize management of this common cardiac arrhythmia.
LASER PHOTOCOAGULATION FOR THE TREATMENT OF OPTIC NERVE HEAD PIT–RELATED MACULOPATHY IN A PATIENT WITH BILATERAL CHORIORETINAL COLOBOMA
Authors: Weinberger Yehonatan , Weinberger Dov , Priel Ethan , Gal-Or Orly , Ehrlich Rita 
Published: February 2021

Purpose:
To report a case of laser photocoagulation for the treatment of a combined coloboma and optic nerve head pit–related maculopathy in a patient with bilateral chorioretinal coloboma.

Methods:
A case report.

Results:
A 15-year-old woman, presented with the visual acuity of 20/100 in her right eye for six weeks. She was diagnosed with macular detachment secondary to optic nerve head pit in her right eye and bilateral chorioretinal coloboma. Multimodal imaging, including color photography, fluorescein angiography, and spectral-domain optical coherence tomography, was used to identify and demonstrate the location of the tract of fluid from the optic nerve head pit, isolated from the coloboma. Optical coherence tomography–guided laser photocoagulation treatment at the location of the tract resulted in complete resolution of macular fluid with visual recovery to 20/25.

Conclusion:
Our case stresses the value of correct diagnosis directing photocoagulation treatment of combined optic nerve head pit–related maculopathy in eyes with chorioretinal coloboma using multimodal imaging.
Spinal nociceptive sensitization and plasma palmitoylethanolamide levels during experimentally induced migraine attacks
Authors: De Icco Roberto , Greco Rosaria , Demartini Chiara , Vergobbi Pietro , Zanaboni Annamaria , Tumelero Elena , Reggiani Angelo , Realini Natalia , Sances Grazia , Grillo Valentina , Allena Marta , Tassorelli Cristina 
Published: February 2021

Abstract
Migraine pathophysiology has been suggested to include dysregulation of the endocannabinoid system (ES). We simultaneously evaluated plasma anandamide (AEA) and palmitoylethanolamide (PEA) levels and spinal sensitization in a validated human model of migraine based on systemic nitroglycerin (NTG) administration. Twenty-four subjects with episodic migraine (MIG) and 19 healthy controls (HC) underwent blood sampling and investigation of nociceptive withdrawal reflex thresholds (RTh: single-stimulus threshold; TST: temporal summation threshold) before and 30 (T30), 60 (T60), and 120 (T120) minutes after sublingual NTG administration (0.9 mg). At baseline, the MIG and HC groups were comparable for plasma AEA (P = 0.822) and PEA (P = 0.182) levels, and for RTh (P = 0.142) and TST values (P = 0.150). Anandamide levels increased after NTG administration (P = 0.022) in both groups, without differences between them (P = 0.779). By contrast, after NTG administration, PEA levels increased in the MIG group at T120 (P = 0.004), while remaining stable in the HC group. Nitroglycerin administration induced central sensitization in the MIG group, which was recorded as reductions in RTh (P = 0.046) at T30 and T120, and in TST (P = 0.001) at all time points. In the HC group, we observed increases in RTh (P = 0.001) and TST (P = 0.008), which suggest the occurrence of habituation. We found no significant correlations between the ES and neurophysiological parameters. Our findings suggest a role for PEA in the ictal phase of episodic migraine. The ES does not seem to be directly involved in the modulation of NTG-induced central sensitization, which suggests that the observed PEA increase and spinal sensitization are parallel, probably unrelated, phenomena.
Astrocytes mediate migraine-related intracranial meningeal mechanical hypersensitivity
Authors: Zhao Jun , Blaeser Andrew S. , Levy Dan 
Published: February 2021

Abstract
The genesis of the headache phase in migraine with aura is thought to be mediated by cortical spreading depression (CSD) and the subsequent activation and sensitization of primary afferent neurons that innervate the intracranial meninges and their related large vessels. Yet, the exact mechanisms underlying this peripheral meningeal nociceptive response remain poorly understood. We investigated the relative contribution of cortical astrocytes to CSD-evoked meningeal nociception using extracellular single-unit recording of meningeal afferent activity and 2-photon imaging of cortical astrocyte calcium activity, in combination with 2 pharmacological approaches to inhibit astrocytic function. We found that fluoroacetate and l-α-aminoadipate, which inhibit astrocytes through distinct mechanisms, suppressed CSD-evoked afferent mechanical sensitization, but did not affect afferent activation. Pharmacological inhibition of astrocytic function, which ameliorated meningeal afferents' sensitization, reduced basal astrocyte calcium activity but had a minimal effect on the astrocytic calcium wave during CSD. We propose that calcium-independent signaling in cortical astrocytes plays an important role in driving the sensitization of meningeal afferents and the ensuing intracranial mechanical hypersensitivity in migraine with aura.
Applying Lean Six Sigma to Improve Depression Screening and Follow-Up in Oncology Clinics
Authors: Gerard Bethlyn , Robbins Mona , Putra Joseph , Ram Mythili , Boukhari Mounia , Mutz Jacqueline , Coffie Sharron , Martin-Cook Kristin , Huffman Alexandra , Bryant Donna M. , Myers Lynn , Bajaj Puneet , Froehlich Thomas , Fish Jason 
Published: February 2021

ABSTRACT
Depression is a common and serious illness that impairs the health of individuals and societies globally. It is associated with a significant economic burden, with productivity losses exceeding $40 billion dollars annually in the United States (U.S.) alone. This project focused on the use of a systematic, data-driven approach to improve the screening rate for depression in an academic, metropolitan cancer center located in North Texas. A multidisciplinary team collaboratively applied Lean Six Sigma education, methods, and tools within oncology and psychiatry clinics to address the increased risk of depression among oncology patients. Improving the standardization of screening and follow-up processes, resulted in a 44% sustained increase in the depression screening and follow-up performance rate. This improvement was verified to be statistically significant through the use of control charts toward the end of the project.
Three-dimensional (3D) Printed Vestibular Schwannoma for Facial Nerve Tractography Validation
Authors: Epprecht Lorenz , Qureshi Ahad , Kozin Elliott D. , McInturff Stephen , Remenschneider Aaron , Huber Alexander M. , Brown Merrit Christian , Barker Frederick G. , Reinshagen Katherine L. , Lee Daniel J. 
Published: February 2021

Objectives:
Predicting the course of cranial nerve (CN) VII in the cerebellopontine angle (CPA) on preoperative imaging for vestibular schwannoma (VS) may help guide surgical resection and reduce complications. Diffusion MRI based tractography has been used to identify cranial nerve trajectory, but intraoperative validation of this novel approach is challenging. Currently, validation is based on operative report descriptions of the course of cranial nerves, but yields a simplified picture of the three-dimensional (3D) course of CN VII. In this study, we investigate the accuracy of tractography with detailed patient-specific 3D-printed VS tumors.

Design:
Retrospective case review.

Setting:
Tertiary referral center.

Participants:
Twenty adult VS surgical candidates.

Main Outcome Measures:
We compared tractography with intraoperative 3D course of CN VII. The surgeons were blinded to tractography and drew the intraoperative course of the CN VII on a patient specific 3D-printed tumor model for detailed comparison with tractography.

Results:
Of 20 patients, one was excluded due to subtotal removal and inability to assess CN VII course. In the remaining 19 patients, 84% (16/19) tractography was successful. In 94% of tumors with tractography (15/16), the intraoperative description of CN VII course matched the tractography finding. The maximum distance, however, between tractography and intraoperative course of CN VII was 3.7 mm ± 4.2 mm.

Conclusion:
This study presents a novel approach to CN VII tractography validation in VS. Although descriptions of CN VII intraoperatively match tractography, caution is warranted as quantitative measures suggest a clinically significant distance between tractography and CN VII course.
Essentials of Advocacy in Case Management: Part 2
Authors: Tahan Hussein M. 
Published: February 2021

Purpose/Objectives:
This article describes a client advocacy model for use by case managers. It delineates necessary competencies for the case manager and shares important strategies for effective client advocacy.

Primary Practice Setting(s):
All practice settings across the continuum of health and human services and case managers of diverse professional backgrounds.

Findings and Conclusion:
Advocacy is a primary role and necessary competency of professional case managers functioning in various care settings. It is rooted in ethical theory and principles. Successful case managers apply ethical principles of advocacy at every step of the case management process and in the decisions they make. Part II of this two-part article presents a client advocacy model for case managers to apply in their practice, describes the role of advocacy in client engagement, and identifies important strategies and a set of essential competencies for effective case management advocacy. Part I already explored the ethical theories and principles of advocacy, the perception of case management-related professional organizations of advocacy, and the common types of advocacy based on scope, complexity, impact, and reach.

Implications for Case Management:
Acquiring foundational knowledge, skills, and competencies in what advocacy is and how to effectively enact its related behaviors is essential for success of case managers and for achieving desired outcomes for both the clients and health care agencies/providers alike. Case management leaders are urged to use the knowledge shared in this article to develop advocacy training and competency management programs for their case managers.
Baclofen Toxicity Mimicking Brain Death
Authors: Pearson Rachel P. , Hoang LeAnn K. , Roufail John , Muhonen Michael G. , Galion Anjalee W. 
Published: February 2021

Background
Baclofen is commonly used in both pediatric and adult patients to treat spasticity secondary to spinal cord and cerebral pathology. A broad range of symptoms and severity of baclofen toxicity have been described. However, to our knowledge, there are no reports to date of baclofen toxicity mimicking brain death in pediatric patients.

Objective
We reviewed the presentation, clinical course, diagnostic studies including imaging and electroencephalography, and outcome of a patient with transient coma and loss of brainstem reflexes mimicking brain death secondary to baclofen toxicity.

Methods
During a baclofen pump refill, a 12-year-old boy with cerebral palsy had inadvertent injection of 12,000 μg of baclofen into the pocket around his pump. Within an hour, he presented with acute altered mental status that rapidly progressed to a comatose state with absent brainstem reflexes.

Results
After appropriate management, the patient returned to his neurological baseline by hospital day 3.

Discussion
We reviewed the literature for varying presentations of baclofen toxicity and associated electroencephalography findings, mechanism of overdose, and different management options. In this case, the mechanism of baclofen toxicity was suspected to be secondary to extravasation from the pump pocket and subsequent systemic absorption.

Conclusions
Patients with baclofen toxicity may have a dramatic presentation and an initial examination mimicking brain death. Given its rarity, this clinical entity may not be readily recognized, and there is potential for misinterpretation of diagnosis and prognosis. It is important for physicians to be familiar with this clinical scenario to avoid false declaration of brain death.
Hepatitis C Knowledge and Recent Diagnosis Affect Hepatitis C Treatment Willingness in Persons Living With HIV
Authors: Cachay Edward R. , Torriani Francesca J. , Hill Lucas , Rajagopal Amutha , Yin Jeffrey , Bamford Laura , Mathews William C. 
Published: February 2021

Background:
We assessed the impact of health literacy and hepatitis C (HCV) knowledge on HCV treatment willingness among people living with HIV (PLWH) at an academic HIV clinic.

Methods:
Cross-sectional analysis of PLWH coinfected with HCV who completed health literacy, HIV literacy, and HCV knowledge inventories. We estimated the prevalence of low health literacy, HIV knowledge, and HCV knowledge sampled from 3-comparison groups: PLWH not referred for HCV, referred but who “not showed” to the HCV clinic, and referred and attended the HCV clinic. We used mixed-model linear and logistic regression to ascertain predictors of low health literacy, HIV knowledge, HCV knowledge, and predictors of willingness to start HCV treatment.

Results:
We enrolled 151 PLWH; 17% were female, 38% non-White, and 60% without a high-school education. Approximately, 68% were men who have sex with men, of whom 62% used intravenous drugs. The prevalence of low health, HIV knowledge, and HCV knowledge was 10%, 32%, and 29%, respectively. Predictors of low health literacy were being Hispanic, cirrhotic, and not completing high-school education. Low HCV knowledge was observed in female, non-White, and those diagnosed with HCV for a decade. In adjusted analyses, PLWH living with HCV for a decade (OR: 0.23) were less likely to be very willing to be treated for HCV. By contrast, those with high HCV knowledge were more likely to be very willing to receive treatment (OR: 1.27).

Conclusion:
Low HCV knowledge and living with HCV for at least a decade are under-recognized negative predictors for PLWH's willingness to receive HCV treatment.

Clinical Trials Registration:
ClinicaTrials.gov identifier: NCT20170991.