bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyaline Inclusion Acanthoma
Authors: Tran Tien Anh N. , Parra Ourania , Linos Konstantinos 
Published: February 2021

Abstract:
Eosinophilic hyaline inclusions (EHIs) or globules have been reported in various cutaneous tumors including vascular lesions, myoepithelial neoplasms, and basal cell carcinoma. In basal cell carcinoma, the presence of intracytoplasmic inclusions is reportedly associated with myoepithelial differentiation. In this regard, EHI has not been conclusively documented in a cutaneous lesion of genuine squamous cell lineage without aberrant differentiation. In the current case, a biopsy from the right thigh of a 71-year-old male patient demonstrated a relatively well-demarcated intraepidermal squamous lesion featured an admixture of predominantly enlarged keratinocytes harboring distinct eccentric intracytoplasmic EHI and a smaller population of keratinocytes displaying pale cytoplasm. Cytologic atypia, mitotic activity, and inflammatory cells were not identified. The intracytoplasmic EHI stained red with Masson's trichrome and were negative with periodic-acid Schiff with and without diastase. Immunologically, the lesion was strongly and diffusely positive for various cytokeratins but negative for ubiquitin and myoepithelial markers. Only cytokeratin AE1 revealed a differential staining pattern as the suprabasal lesional cells displayed significantly stronger immunoreactivity in comparison with the adjacent normal keratinocytes. Polymerase chain reaction for low-risk and high-risk human papillomavirus was negative. Molecular studies did not reveal any mutations commonly encountered in seborrheic or lichenoid keratoses. As an analogous lesion has not previously reported in the literature, the term hyaline inclusion acanthoma is proposed for this peculiar lesion.
Influence of sex and menopausal status on the relationship between metabolic syndrome and coronary artery calcification: a Chinese community-based cross-sectional study
Authors: Yu Wenqian , Shao Baowei , Li Meng , Zhang Pengfei , Li Haijie , Teng Xilong , Wang Honglu , Su Guohai , Zhang Fengquan , Li Na 
Published: February 2021

Abstract

Objective:
To evaluate the association between metabolic syndrome and coronary artery calcification according to different sex and menopausal status.

Methods:
This cross-sectional study included 2,704 adults from the Jidong community (Tangshan, China) recruited from July 2013 to August 2014. Adults aged ≥40 years with no cardiovascular disease and with coronary artery calcification score data were included. Metabolic syndrome was defined according to the 2005 International Diabetes Federation standard. Coronary artery calcification score was determined using the Agatston method. The associations between metabolic syndrome and coronary artery calcification prevalence were evaluated using logistic regression.

Results:
In the multivariable regression analysis, metabolic syndrome was associated with coronary artery calcification (odds ratio: 1.34, 95% confidence interval: 1.04-1.71, P = 0.021). When stratified by sex, metabolic syndrome was positively associated with coronary artery calcification prevalence in female participants (odds ratio: 2.79, 95% confidence interval: 1.96-3.96, P < 0.001), whereas no association was observed in male participants. Furthermore, metabolic syndrome was associated with a higher prevalence of coronary artery calcification (P < 0.001) independent of adjustment for covariates in postmenopausal women than in premenopausal women, and coronary artery calcification prevalence increased with an increase in conditions related to metabolic syndrome.

Conclusions:
Our findings indicate that metabolic syndrome in postmenopausal women is associated with a higher prevalence of coronary artery disease than in premenopausal women and men.
The Additional Effect of Individualized Prescriber-Focused Feedback on General Guideline Instruction in Reducing Antipsychotic Polypharmacy in Inpatients
Authors: Lochmann van Bennekom Marc W.H. , Gijsman Harm J. , Groenewoud Hans , Verkes Robbert-Jan 
Published: February 2021

Abstract

Purpose/Background
Antipsychotic polypharmacy (APP) is the concurrent use of more than one antipsychotic by a patient. Multiple antipsychotics are often prescribed, although all relevant guidelines discourage this practice. These recommendations are based on a lack of evidence for effectiveness and an increased risk of serious adverse events with APP. Studies on the effects of educational interventions targeted at physicians have demonstrated inconclusive results. Moreover, it is unclear how individualized these interventions need to be. In this study, we aimed to assess the effect of a general intervention and the additional impact of an individualized, prescriber-focused intervention on guidelines adherence, that is, the prescription of APP.

Methods/Procedures
We conducted a 36-month 2-step serial intervention study with 4 stages of 9 months each (baseline, general intervention, addition of an individualized intervention, and follow-up) including all 20 inpatient units of one regional mental health organization. The primary outcome was the proportion of patients with regular prescriptions for APP ≥30 consecutive days across all patients with a prescription of at least one antipsychotic. The secondary outcome was the proportion of patient days on APP over the total number of patient days on at least one antipsychotic.

Findings/Results
The general intervention was ineffective on both outcome measures. Addition of an individualized intervention decreased the proportion of patients with prescriptions for episodes of persistent APP significantly by 49.6%. The proportion of patient days on APP significantly decreased by 35.4%.

Implications/Conclusions
In contrast to a general intervention, the addition of an individualized intervention was effective in improving adherence to guidelines with respect to APP prescription in inpatients.
Leveraging telemedicine for management of veterans with heart failure during COVID-19
Authors: de Peralta Shelly S. , Ziaeian Boback , Chang Donald S. , Goldberg Sarah , Vetrivel Reeta , Fang Yichun M. 
Published: February 2021

ABSTRACT

Background:
Telemedicine and telemonitoring have become invaluable tools in managing chronic diseases, such as heart failure (HF). With the recent pandemic, telemedicine has become the preferred method of providing consultative care.

Local Problem:
This rapid paradigm shift from face-to-face (F2F) consultations to telemedicine required a collaborative approach for successful implementation while maintaining quality of care. The processes for conducting a telemedicine visit for HF patient are not well defined or outlined.

Method:
Using a collaborative practice model and nurse practitioner led program, technology was leveraged to manage the high-risk HF population using virtual care (consultation via phone or video-to-home) with two aims: first to provide ongoing HF care using available telemedicine technologies or F2F care when necessary and, second, to evaluate and direct those needing urgent/emergent level of care to emergency department (ED).

Intervention:
The process was converted into an intuitive algorithm that describes essential elements and team roles necessary for execution of a successful HF consultation.

Results:
Following the algorithm, nurse practitioners conducted 132 visits, yielding 100% success in the conversion of F2F appointments to telemedicine, with 3 patients referred to ED for care. The information obtained through telemedicine consultation accurately informed decision for ED evaluation with resultant admission.

Conclusion:
Collaborative team-based approach delineated in the algorithm facilitated successful virtual consultations for HF patients and accurately informed decisions for higher level of care.
Charcot-Marie-Tooth Disease With Long-Term Follow-Up on Auditory Neuropathy—After Cochlear Implantation Or Hearing Aid Use
Authors: Matsuda Shinsaku , Kaga Kimitaka 
Published: February 2021

Objective:
To study the pathophysiology of Charcot-Marie-Tooth disease (CMT) with auditory neuropathy (AN) and to follow up cochlear implant or hearing aid use over the long term.

Study Design:
Clinical capsule report.

Patients:
Two adult CMT patients with AN.

Intervention:
Cochlear implantation for case 1 and hearing aid use for case 2.

Result:
Case 1 was a 50-year-old man who was diagnosed as having CMT at 15 years of age. He noted his hearing impairment at the age of 22. We considered that he had AN as a complication on the basis of the findings of normal distortion product otoacoustic emission and the absence of auditory brainstem response on both ears. We performed cochlear implantation for his progressive hearing loss when he was 41 years old. His postoperative discrimination scores for words and sentences in the CI-2004 test 4 years after cochlear implantation were 80% and 93%, respectively. His sound discrimination scores were 23/24 in the test with picture matching and 9/24 in that without picture matching 8 years after cochlear implantation.
Case 2 was a 38-year-old woman who was neurologically diagnosed as having CMT with AN as a complication on the basis of auditory brainstem response and distortion product otoacoustic emission test findings. During 15 years of follow-up, her discrimination score decreased gradually. She is currently wearing a hearing aid.

Conclusions:
We found a significant improvement in case 1 and a slight increase in hearing level in case 2. The pathoneurological findings of CMT might be either demyelination or axonal degeneration depending on the type of genetic abnormality (e.g., PMP22 and MPZ mutations). The symptoms and courses vary among patients with CMT. Therefore, the selection of an appropriate intervention for hearing loss depending on the severity and course is very important.
Are Opioids Necessary in Middle Ear Surgery? Comparing the Transcanal and Postauricular Approach
Authors: Casazza Geoffrey C. , Gurgel Richard K. , McCrary Hilary C. , Ramirez Alexander S. , Krakovitz Paul R. , Shelton Clough , Meier Jeremy D. 
Published: February 2021

Objective:
Understand opioid-prescribing patterns in otologic surgery and the difference in opioid use between transcanal and postauricular surgery.

Study Design:
Prospective survey.

Setting:
Multihospital network.

Patients:
All patients undergoing otologic surgery from March 2017 to January 2019.

Intervention:
Patients undergoing otologic surgery were surveyed regarding postoperative opioid use and their level of pain control. Patients were divided by surgical approach (transcanal vs. postauricular). Those who underwent mastoid drilling were excluded. Narcotic amounts were converted to milligram morphine equivalents (MME) for analysis.

Main Outcome Measures:
Amount of opioid was calculated and compared between the two groups. Mann–Whitney U test and Chi-square testing were used for analysis.

Results:
Fifty-five patients were included in the analysis; of these 18 (33%) had a postauricular incision. There was no difference in age (p = 0.85) or gender (p = 0.5) between the two groups. The mean amount of opioid prescribed (MME) in the postauricular and transcanal groups was 206.4 and 143 (p = 0.038) while the mean amount used was 37.7 and 37.5 (p = 0.29) respectively. There was no difference in percentage of opioid used (p = 0.44) or in patient-reported level of pain control (p = 0.49) between the two groups.

Conclusion:
Patients in both the transcanal and postauricular groups used only a small portion of their prescribed opioid. There was no difference in the amount of opioid used or the patient's reported level of pain control based on the approach. Otologic surgeons should be aware of these factors to reduce narcotic diversion after ear surgery.
Petrous Apex Cephaloceles: Radiology Features and Surgical Management of a Rare Entity
Authors: Epsten Madeline J. , Kocak Mehmet , Beer-Furlan André , Brahimaj Bledi C. , Whitmeyer Max , Tajudeen Bobby A. , Batra Pete S. , Munoz Lorenzo F. , Byrne Richard W. , Wiet R. Mark 
Published: February 2021

Objective:
To characterize the radiologic findings of petrous apex cephalocele (PAC) in a patient cohort, and report the surgical management for three symptomatic PAC patients and cerebrospinal fluid (CSF) leak via the middle cranial fossa approach.

Study Design:
Retrospective case series.

Setting:
Academic center.

Patients:
Thirty-five patients with PAC were identified by review of the imaging archive between 2008 and 2019 (29 females; mean, 55 yrs; range, 4–86 yrs). All patients underwent magnetic resonance imaging of the skull base and/or computed tomography examination.

Intervention(s):
Surgical repair of PAC.

Main Outcome Measure(s):
Radiologic features of PAC.

Results:
Radiological features of PAC: 25.7% bilateral; partial or expanded empty sella in 82.9%; arachnoid pits in 14.2%; and enlarged CSF space of optic nerve sheath in 20.0%. Coexisting pathology included temporal, sphenoid, and bilateral jugular foramen meningocele; as well as cribriform, middle crania fossa, and right temporal defect. Three case studies describing the surgical course of spontaneous CSF leak secondary to PAC were managed with the middle cranial fossa approach.

Conclusions:
PAC is an exceedingly unusual cause for CSF leak in the adult and pediatric population. A middle fossa approach may be used to treat CSF leak as a result of PAC. Typically, CSF otorrhea originates from an encephalocele that extends via a bony defect in the tegmen tympani or tegmen mastoideum. However, on occasion the source of the CSF otorrhea is not via the tegmen, instead defects in the middle fossa floor, medial to the ridge for the gasserian ganglion (tubercle of Princeteau), need to be considered.
Subjective Cognitive Symptoms and Dizziness Handicap Inventory (DHI) Performance in Patients With Vestibular Migraine and Menière's Disease
Authors: Chari Divya A. , Liu Yu-Hsi , Chung Janice J. , Rauch Steven D. 
Published: February 2021

Objective:
Cognitive symptoms in patients with vestibular disorders are far from rare, but identification of patients at risk for cognitive impairment remains poor. The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome questionnaire for dizzy patients with several questions that address cognitive function. However, the relationship between subjective cognitive symptomatology in patients with vestibular disorders and performance on DHI is poorly characterized.

Study Design:
Retrospective cohort study.

Setting:
Tertiary care vestibular clinic.

Subjects:
Individuals with diagnoses of vestibular migraine (VM), Menière's disease (MD), and concomitant vestibular migraine and Menière's disease (VMMD) presenting to clinic between January 2007 and December 2019.

Results:
Of 761 subjects, 365 had VM, 311 had MD, and 85 had VMMD. Symptoms of brain fog and chronic fatigue occurred more frequently in the VM and VMMD groups compared with the MD group (χ
2 (df = 2, n = 761) = 67.8, 20.9, respectively, p < 0.0001). DHI scores were significantly higher in patients with VM and VMMD compared with those with MD (F[2,758] = 63.5, p < 0.001). A DHI score ≥ 13 suggested that the patient suffered from brain fog (sensitivity = 47.4%, specificity = 72.3%), whereas a score ≥ 15 indicated that the patient complained of chronic fatigue (sensitivity = 81.5%, specificity = 57.7%).

Conclusion:
Our results indicate a high prevalence of interictal cognitive symptoms in patients with episodic vestibular disorders. The DHI cannot be reliably used to differentiate between vestibular disorders nor detect cognitive impairment in these patient populations. Alternative methods must be used to identify vestibulopathic patients with cognitive symptoms to initiate strategies for prevention and treatment.
Association between high-density lipoprotein cholesterol and apolipoprotein A-I and severe acute pancreatitis: a case-control study
Authors: Li Yaling , Zheng Rui , Gao Feng , Wang Li , Feng Shuyi , Li Jie , Huang Zhiming 
Published: February 2021

Background
Evidence is limited concerning the association between serum concentrations of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-I (APO A-I) and severe acute pancreatitis (SAP). This study was designed to explore whether HDL-C and APO A-I were independently correlated to SAP after adjusting for covariates.

Methods
There were 1127 patients with acute pancreatitis who were recruited from a tertiary teaching hospital in Wenzhou from 1 January 2018 to 30 April 2020. The independent variables were baseline levels of HDL-C, and APO A-I collected within 24 h after admission. The dependent variable was the occurrence of SAP during hospitalization. Univariate and multivariate binary logistic regression were conducted to analyze the relationship between HDL-C and APO A-I and SAP. The receiver operating characteristic curve was applied to analyze the prediction power of lipid parameters and C-reactive protein for SAP.

Results
The incidence of SAP was 11.5% among the 678 patients included in the final analysis. The serum levels of APO A-I and HDL-C were negatively related to SAP after adjusting for confounders with an odds ratio of 0.24 [95% confidence interval (CI): 0.06–0.95] and 0.16 (95% CI, 0.04–0.56), respectively. APO A-I (area under the curve = 0.69; 95% CI, 0.63–0.76) and HDL-C (area under the curve = 0.72; 95% CI, 0.66–0.79) showed higher predictive value for SAP compared with other lipid parameters.

Conclusions
Decreased serum concentrations of HDL-C and APO A-I are associated with SAP after adjusting for covariates.
Improvement of image quality using amplitude-based respiratory gating in PET-computed tomography scanning
Authors: Kim Jung-Soo , Park Chan-Rok , Yoon Seok-Hwan , Lee Joo-Ah , Kim Tae-Yoon , Yang Hyung-Jin 
Published: February 2021

Objectives
This study sought to provide data supporting the expanded clinical use of respiratory gating by assessing the diagnostic accuracy of breathing motion correction using amplitude-based respiratory gating.

Methods
A respiratory movement tracking device was attached to a PET-computed tomography scanner, and images were obtained in respiratory gating mode using a motion phantom that was capable of sensing vertical motion. Specifically, after setting amplitude changes and intervals according to the movement cycle using a total of nine combinations of three waveforms and three amplitude ranges, respiratory motion-corrected images were reconstructed using the filtered back projection method. After defining areas of interest in the acquired images in the same image planes, statistical analyses were performed to compare differences in standardized uptake value (SUV), lesion volume, full width at half maximum (FWHM), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).

Results
SUVmax increased by 89.9%, and lesion volume decreased by 27.9%. Full width at half maximum decreased by 53.9%, signal-to-noise ratio increased by 11% and contrast-to-noise ratio increased by 16.3%. Optimal results were obtained when using a rest waveform and 35% duty cycle, in which the change in amplitude in the respiratory phase signal was low, and a constant level of long breaths was maintained.

Conclusions
These results demonstrate that respiratory-gated PET-CT imaging can be used to accurately correct for SUV changes and image distortion caused by respiratory motion, thereby providing excellent imaging information and quality.
Prognostic value of pretreatment F-18 fluorodeoxyglucose PET/CT in colorectal cancer with unresectable metastasis
Authors: Choi Eun Kyoung , Oh Jin Kyoung , Seo Ye Young , Im Jooyeon Jamie , Chung Yong-An 
Published: February 2021

Purpose
The aim of the study was to assess the prognostic value of pretreatment PET/computed tomography (CT) scans in colorectal cancer (CRC) patients with unresectable metastasis.

Materials and methods
We retrospectively reviewed the pretreatment PET/CT images of 82 CRC patients with unresectable metastasis and their medical records. On PET/CT images, maximum standardized uptake value (SUVmax) of primary tumor, highest SUVmax of metastatic tumors and number of metastatic organs were identified. The patients were further divided into single and multiple organ metastases groups according to the extent of disease. Survival analysis was performed with the clinical variables and metabolic parameters from PET/CT.

Results
In a total of 82 patients, the age of patients, highest SUVmax of metastatic tumors and number of metastatic organs were independent prognostic factors for overall survival (OS) (all P < 0.05), whereas the SUVmax of primary tumor was not. On multivariate analysis, only the SUVmax of metastatic tumor was a significant prognostic factor in the single organ metastasis group (P = 0.047), whereas the age and highest SUVmax of metastatic tumors were independent prognostic factors in the multiple organ metastases group (all P < 0.05).

Conclusion
The highest SUVmax of metastatic tumors was an independent prognostic factor for OS in CRC patients with unresectable metastasis.
BRAFV600E mutation is associated with increased prevalence of contralateral lymph-node metastases in low and low-to-intermediate risk papillary thyroid cancer
Authors: Campennì Alfredo , Ruggeri Rosaria M. , Giuffrè Giuseppe , Siracusa Massimiliano , Alibrandi Angela , Cardile Davide , La Torre Flavia , Lanzafame Helena , Giacoppo Giulia , Ieni Antonio , Trimarchi Francesco , Tuccari Giovanni , Baldari Sergio 
Published: February 2021

Objective
Papillary thyroid cancer (PTC) is the most common endocrine malignancy. Despite good prognosis being generally associated with PTC, persistent/recurrent disease can be observed in a not negligible number of patients. Accurate postoperative management can lead to a significant improvement of risk stratification/staging of PTC patients identifying those at higher risk of a more aggressive clinical course. Molecular tests were introduced at the beginning of the 2000s to improve PTC risk stratification.

Methods
We reviewed the records of 354/1185 patients affected by low or low-to-intermediate risk unilateral-PTC. In these patients, BRAFV600E mutation was looked for and 131-radioiodine therapy was performed 3 months after thyroid surgery. A radioiodine post-therapeutic imaging was obtained in all patients.

Results
BRAFV600E mutation was found in 170/354 PTC patients (female = 126). Forty-two out of 170 BRAFV600E mutation +ve patients (female = 27) had ipsilateral (n = 24) or contralateral (n = 18) loco-regional metastases at post-therapeutic imaging. Significant differences in terms of 2015 American Thyroid Association risk stratification, Hashimoto thyroiditis prevalence, tumor size, multifocality, disease staging and aggressive variant were observed between BRAFV600E mutation +ve and BRAFV600E mutation −ve patients (P ≤ 0.001;P = 0.001; P ≤ 0.001; P = 0.026; P ≤ 0.001; P ≤ 0.001). Interestingly, the prevalence of contralateral lymph-node metastases was significantly higher in BRAFV600E mutation +ve than BRAFV600E mutation −ve patients (18/42 vs. 2/22, respectively; P = 0.013).

Conclusion
This study suggests that BRAFV600E mutation represents a significant risk factor for developing contralateral lymph-node metastases and confirms that BRAFV600E mutation is associated with more aggressive PTC features and a higher prevalence of metastatic disease also in low or low-to-intermediate-risk PTC patients.