bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Young Boy With Hemophagocytic Lymphohistiocytosis Presenting With Vaccine-Related Granulomatous Dermatitis: A Case Report and Literature Review
Authors: Zengin Hatice B. , Reyes-Barron Cynthia , Cusick Elizabeth , Cordisco Maria , Katzman Philip J. , Burack W. Richard , Scott Glynis 
Published: September 2021

Abstract:
Cutaneous eruptions associated with hemophagocytic lymphohistiocytosis (HLH) have been reported in 6%–63% of patients. Clinical findings of these skin lesions vary widely and include maculopapular rashes, ulcers, and violaceous nodules. Corresponding histologic findings are also variable and are considered nonspecific. We report the case of a 4-year-old boy who initially developed a widespread popular–pustular rash 2 weeks after his 12-month measles, mumps, and rubella vaccinations. These resolved with scarring then recurred following his 24-month vaccinations. Multiple skin biopsies were negative for infectious organisms and showed a granulomatous infiltrate with perforation and necrobiosis. The differential diagnosis included perforating granuloma annulare, infection, or rheumatoid nodules. At the age of 4, he developed fever, hepatosplenomegaly, pancytopenia and other laboratory abnormalities, requiring hospitalization. A number of studies were performed including biopsies of bone marrow and liver. Molecular testing revealed 2 mutations in UNC13D known to be associated with familial HLH. His prior cutaneous lesions were likely caused by immune dysregulation exacerbated by immunizations because of underlying familial HLH. This case illustrates the importance of recognizing an unusual cutaneous manifestation of a rare disease to arrive at an earlier diagnosis in a pediatric patient. Although cutaneous eruptions usually develop concurrently with other systemic symptoms of HLH, preceding unusual skin lesions may be the first indication of this rare disease.
A Case of CD5-Positive Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type Secondary to Chronic Lymphedema
Authors: Sun Liting , Sun Yuzhen , Xin Wuyan , He Jiangman , Hu Yuan , Zhang Hanyin , Yu Jianbin , Zhang Jiang-an 
Published: September 2021

Abstract:
Primary cutaneous lymphoma occurring at the site of lymphedema is a rare complication. A total of 13 cases of primary cutaneous lymphoma associated with chronic lymphedema have been reported in international studies. We reported a case of cutaneous diffuse large B-cell lymphoma (DLBCL) (leg type) secondary to chronic lymphedema of the lower limbs. Histopathology showed hyperkeratosis of epidermis, acanthosis, and significant edema in the superficial dermis, with diffuse mononuclear infiltration in the dermis. Immunohistochemical studies revealed the expression of CD5, CD20, Pax-5, Bcl-2, Bcl-6, MUM-1, c-myc, and Ki-67. Therefore, the diagnosis of cutaneous DLBCL (leg type) was made. The study further confirmed the association between lymphoma and lymphedema. Especially, it showed CD5 expression. CD5-positive DLBCLs is a specific subgroup of DLBCLs, only approximately 10% of DLBCLs express CD5.
Risk of Serious Infection With Low-dose Glucocorticoids in Patients With Rheumatoid Arthritis
Authors: George Michael D. , Hsu Jesse Y. , Hennessy Sean , Chen Lang , Xie Fenglong , Curtis Jeffrey R. , Baker Joshua F. 
Published: September 2021

Background:
Low-dose glucocorticoids are commonly used in the treatment of rheumatoid arthritis (RA). Observational studies have found an increased risk of serious infection associated with low-dose glucocorticoids, but concerns about residual confounding remain.

Methods:
We identified adults with RA on stable immunomodulatory therapy for >6 months receiving no glucocorticoids or ≤5 mg/day using Medicare data from 2006 to 2015. We used provider preference for glucocorticoids as an instrumental variable (IV) to assess associations between low-dose glucocorticoid use and the risk of infection requiring hospitalization using a cause-specific proportional hazards model.

Results:
We identified 163,603 qualifying treatment episodes among 120,656 patients. Glucocorticoids ≤5 mg/day were used by 25,373/81,802 (31.0%) of patients seen by a rheumatologist with low provider preference for glucocorticoids and by 36,087/81,801 (44.1%) of patients seen by a rheumatologist with high provider preference for glucocorticoids (adjusted odds ratio 1.81, 95% confidence interval 1.77, 1.84 for association between provider preference and glucocorticoids). Chronic obstructive pulmonary disease, opioids, antibiotics, previous emergency department visits, hospitalizations, and infections requiring hospitalization infections were unbalanced with regard to exposure but not to the IV. The incidence of infection requiring hospitalization was 8.0/100 person–years among patients unexposed to glucocorticoids versus 11.7/100 person–years among those exposed. The association between glucocorticoids and infection requiring hospitalization from IV analysis (hazard ratio 1.26 [1.02–1.56]) was similar to results from a standard multivariable model (hazard ratio 1.24 [1.21–1.28]).

Conclusions:
Among patients with RA on stable immunomodulatory therapy, IV analysis based on provider preference demonstrated an increased risk of infection requiring hospitalization associated with low-dose glucocorticoids, similar to a traditional analysis.
CHOROIDAL VASCULARITY INDEX IS ASSOCIATED WITH GEOGRAPHIC ATROPHY PROGRESSION
Authors: Sacconi Riccardo , Battista Marco , Borrelli Enrico , Senni Carlotta , Tombolini Beatrice , Grosso Domenico , Querques Lea , Bandello Francesco , Querques Giuseppe 
Published: September 2021

Purpose:
To investigate the correlation between choroidal vascularity index and the enlargement of geographic atrophy (GA) lesion secondary to age-related macular degeneration during the 2-year follow-up.

Methods:
In this longitudinal observational study, 26 eyes (26 patients, mean age 75.7 ± 8.8 years) affected by GA were included. Choroidal vascularity index was calculated in the subfoveal 3000-µm area. The main outcome measure included correlation analysis between baseline choroidal vascularity index and the rate of GA enlargement.

Results:
During the 2-year follow-up, the mean GA area increased from 6.99 ± 5.28 mm2 to 10.69 ± 6.61 mm2(P < 0.001), accounting for a growth rate of 0.35 ± 0.20 and 0.31 ± 0.17 mm/year after the square root transformation in the first and second year of follow-up, respectively. Stromal choroidal area significantly decreased during the 2-year follow-up (P = 0.002). Interestingly, there was a significant correlation between the baseline choroidal vascularity index and the rate of GA enlargement (r=−0.432, P = 0.027) and between stromal choroidal area and the rate of GA enlargement (r = 0.422, P = 0.032). No other significant relationship was disclosed among choroidal parameters with the rate of GA enlargement.

Conclusion:
Choroidal vascularity index impairment is strictly related to the rate of GA enlargement during the 1-year and 2-year follow-up in patients affected by GA. For this reason, choroidal vascularity index could be considered a predictor of GA progression in the clinical setting, and it could be considered as a new potential biomarker in the efficacy evaluation of new GA interventions.
Diabetes Mellitus Type 1 has a Higher Impact on Corneal Endothelial Cell Density and Pachymetry than Diabetes Mellitus Type 2, Independent of Age: A Meta-Regression Model
Authors: Amador-Muñoz Diana Patricia , Conforti Valentina , Matheus Luisa Marina , Molano-Gonzalez Nicolas , Payán-Gómez César 
Published: September 2021

Purpose:
Patients with diabetes mellitus (DM) often have keratopathy. However, the compromise of the corneal endothelium in type 1 DM (T1DM) and type 2 DM (T2DM) has so far not been well characterized.

Methods:
We performed a systematic literature search to find articles on humans combining T1DM and/or T2DM and the corneal endothelium. The period was from inception to June 2020. The meta-regression evaluated the role of each type of DM on corneal endothelial cell density (CED) and pachymetry. The statistical models included age as a modulator to discriminate between the normal changes due to age and the effect of the disease and to determine the impact of the disease duration.

Results:
The initial search identified 752 records, of which 17 were included in the meta-regression. Patients with T1DM had, on average, 193 cells/mm2 lesser than control patients (P < 0.00001). Patients with T2DM had 151 cells/mm2 less compared with control patients (P < 0.00001). The loss of corneal endothelial cells was expected because the aging was similar in patients with T1DM and T2DM and their control groups. Patients with T1DM and T2DM showed an increase in pachymetry versus control patients, and in both groups, it was associated with the duration of the disease.

Conclusions:
Both types of DM reduced CED and increased pachymetry. These differences were higher in patients with T1DM versus control patients than patients with T2DM versus control patients. In T1DM, CED reduction was not correlated with the time from diagnosis. In both groups, patients had CED reduction due to aging similar to that of their matched control patients.
Coronavirus Disease 2019 Cluster Originating in a Primary School Teachers’ Room in Japan
Authors: Aizawa Yuta , Shobugawa Yugo , Tomiyama Nobuko , Nakayama Hitoshi , Takahashi Masako , Yanagiya Junko , Kaji Noriko , Ikuse Tatsuki , Izumita Ryohei , Yamanaka Takayuki , Hasegawa Satoshi , Tamura Tsutomu , Saito Reiko , Saitoh Akihiko 
Published: September 2021

Background:
School closures are a subject of debate during the present coronavirus disease 2019 (COVID-19) pandemic. Because children are not the main driver of COVID-19 transmission in the community, school education must be prioritized in conjunction with appropriate infection prevention and control measures, as determined by local COVID-19 incidence.

Methods:
We investigated the causes and transmission routes of a primary school cluster of COVID-19 that occurred during November and December 2020 in Niigata, Japan.

Results:
In the cluster, the virus spread among teachers, then from teachers to students, and then to their family members. This primary school cluster comprised 26 infected patients and included teachers (13/33, 39%), students (9/211, 4%), and family members (4/65, 6%). The secondary attack rate from the 3 index teachers to the remaining 30 teachers was 33%; however, the rate to students was only 4%. Factors contributing to cluster formation include the fact that 2 of the index teachers continued working while symptomatic and that the environment and infection prevention measures in the teachers’ room were inadequate.

Conclusions:
To open schools safely and without interruption, adequate measures to prevent COVID-19 infection in schools should be emphasized not only for children but also for teachers and their environment.
Evaluation of ophthalmic surgical simulators for continuous curvilinear capsulorhexis training
Authors: Raval Nilesh , Hawn Vivian , Kim Mimi , Xie Xianhong , Shrivastava Anurag 
Published: September 2021

Purpose:
To evaluate performance and assessments by expert surgeons tasked to create a continuous curvilinear capsulorhexis (CCC) on 3 commercially available surgical simulators.

Setting:
Montefiore Medical Center Department of Ophthalmology and Visual Sciences, Bronx, New York.

Design:
Randomized, cross-sectional, comparative study.

Methods:
Expert cataract surgeons (N = 7) were tasked to create a 5.5-mm CCC on 3 surgical simulators (Bioniko, Kitaro, and SimulEYE). Surgeons rated how well each simulator approximated human tissue on a modified Likert scale (1 to 7). Duration, size, and number of forceps grabs were evaluated.

Results:
7 surgeons performed a total of 63 trials. Bioniko required a greater number (6.53 ± 3.14) of forceps grabs for CCC creation than Kitaro (4.90 ± 2.47, P = .01) and SimulEYE (3.90 ± 1.34, P < .0001). Surgeons created the 5.5-mm CCC most accurately on Bioniko and SimulEYE, with the largest mean CCC performed on Kitaro (8.00 ± 0.84) compared with that on Bioniko (5.24 ± 0.60, P < .0001) and SimulEYE (5.11 ± 0.41, P < .0001). Surgeons spent more time (seconds) performing the CCC on Bioniko (41.95 ± 26.70) than that on Kitaro (32.05 ± 14.99, P = .02) and SimulEYE (28.90 ± 15.18, P = .002). Kitaro (4.56 ± 0.84, P < .0001) and SimulEYE (4.19 ± 0.92, P < .0001) were rated as more realistic than Bioniko (1.38 ± 0.80).

Conclusions:
SimulEYE and Kitaro were believed to most closely approximate human capsular tissue, and surgeons performed the CCC fastest on these models. However, surgeons created a 5.5-mm CCC most accurately on SimulEYE and Bioniko. SimulEYE had the best overall performance and fidelity across all studied metrics; however, each simulator demonstrated its own unique advantages and disadvantages. Larger validation studies will help residency programs best use training tools for novice surgeons.
Comparison of different methods to calculate the axial length measured by optical biometry
Authors: Savini Giacomo , Hoffer Kenneth J. , Carballo Laura , Taroni Leonardo , Schiano-Lomoriello Domenico 
Published: September 2021

Purpose:
To compare axial length (AL) measurements in long eyes by 2 swept-source optical coherence tomography (SS-OCT) biometers, one based on the group refractive index (IOLMaster 700, Zeiss) and the other based on sum of segments (Argos, Movu Inc.), and compare these measurements with previously published methods to optimize AL.

Setting:
G.B. Bietti Foundation I.R.C.C.S., Rome, Italy.

Design:
Prospective case series.

Methods:
AL was measured with both optical biometers in patients with myopia (AL > 24.0 mm) and compared with the values obtained with Wang-Koch adjustment, polynomial equations for the Holladay 1 and 2 formulas, and Cooke-modified AL (CMAL).

Results:
In 102 eyes of 55 subjects, a statistically significant difference (P < .0001) was found among the 6 AL values. Posttest revealed that Argos measurements (26.90 ± 1.61 mm) were significantly lower compared with those provided by all methods (P < .001) but CMAL, whereas IOLMaster 700 measurements (27.01 ± 1.65) were higher (P < .001). No difference was found between the 2 Holladay equations. CMAL values did not reveal any difference compared with those of the Argos, but a proportional bias showed that in longer eyes, CMAL provided smaller values (P < .0001, r = −0.7221). AL overestimation by the IOLMaster 700 AL compared with the Argos was higher, the longer the eye was (P < .0001, r = 0.6959, r2 = 0.4842).

Conclusions:
The SS-OCT optical biometer based on the group refractive index overestimates AL compared with the device using segmented AL. CMAL provides the measurements closest to those of the device using segmented AL.
Transcriptional and cellular signatures of cortical morphometric remodelling in chronic pain
Authors: Martins Daniel , Dipasquale Ottavia , Veronese Mattia , Turkheimer Federico , Loggia Marco L. , McMahon Stephen , Howard Matthew A. , Williams Steven C.R. 
Published: September 2021

Abstract
Chronic pain is a highly debilitating and difficult to treat condition, which affects the structure of the brain. Although the development of chronic pain is moderately heritable, how disease-related alterations at the microscopic genetic architecture drive macroscopic brain abnormalities is currently largely unknown. Here, we examined alterations in morphometric similarity (MS) and applied an integrative imaging transcriptomics approach to identify transcriptional and cellular correlates of these MS changes, in 3 independent small cohorts of patients with distinct chronic pain syndromes (knee osteoarthritis, low back pain, and fibromyalgia) and age-matched and sex-matched pain-free controls. We uncover a novel pattern of cortical MS remodelling involving mostly small-to-medium MS increases in the insula and limbic cortex (none of these changes survived stringent false discovery rate correction for the number of regions tested). This pattern of changes is different from that observed in patients with major depression and cuts across the boundaries of specific pain syndromes. By leveraging transcriptomic data from Allen Human Brain Atlas, we show that cortical MS remodelling in chronic pain spatially correlates with the brain-wide expression of genes related to pain and broadly involved in the glial immune response and neuronal plasticity. Our findings bridge levels to connect genes, cell classes, and biological pathways to in vivo imaging correlates of chronic pain. Although correlational, our data suggest that cortical remodelling in chronic pain might be shaped by multiple elements of the cellular architecture of the brain and identifies several pathways that could be prioritized in future genetic association or drug development studies.
Flow-diverter stent to manage intracranial aneurysms: A single center experience
Authors: Feng Shao-Wei , Luo Chao-Bao , Lee Chien-Hui , Chang Feng-Chi , Lin Chung-Jung 
Published: September 2021

Background:
Endovascular coil embolization is an important method for managing intracranial aneurysms. However, aneurysm coiling may fail or be insufficient in geographically difficult aneurysms. A flow-diverter stent (FDS) is an alternative in these difficult coiling aneurysms. Thus, this study reports the experience and outcome of FDS management of intracranial aneurysms.

Methods:
Over 29 months, FDS treated 125 patients with 163 intracranial unruptured aneurysms. This study enrolled 31 men and 94 women, ranging from 17 to 81 years (mean, 58 years). Clinical data, aneurysm characteristics, and angiographic and clinical outcomes of patients treated by FDS were retrospectively assessed.

Results:
The current study found 151 (93%) aneurysms in the internal carotid artery. Most aneurysms (n = 118; 72%) were small (<7 mm). The mean aneurysm size was 6.2 mm (range, 2–38 mm). Follow-up angiography was available in 53 patients with 74 aneurysms (mean, 13 months). Successful FDS deployment in an ideal position was found in 125 of 130 patients (96%). Complete obliteration (CO) was achieved in 58 aneurysms (78%) in the mean 13-month angiographic follow-up. Smaller aneurysms (<7 mm) had a CO tendency than larger aneurysms (p < 0.01) in midterm follow-up. Seven patients (5.6%) had intraprocedural complications (in-stent thrombosis, three patients; distal embolic, two patients; iatrogenic carotid-cavernous fistula, and subarachnoid hemorrhage, one patient). Two patients (1.6%) suffered from permanent procedure-related morbidity (n = 1) or mortality (n = 1). No late hemorrhagic events or stent displacement occurred during the follow-up period.

Conclusion:
Despite few procedural complications and some pieces of evidence of insufficient aneurismal treatment in a midterm angiographic follow-up, FDS was effective and safe in managing intracranial unruptured aneurysms, particularly in smaller aneurysms, which had better CO than larger ones.
Glycemic control was associated with nonprostate cancer and overall mortalities in diabetic patients with prostate cancer
Authors: Lin Chih-Chung , Wu Ming-Fen , Chang Yen-Lin , Sheu Wayne Huey-Herng , Liou Wen-Shyong 
Published: September 2021

Background:
Diabetes mellitus (DM) can worsen the prognosis or survival in prostate cancer (PC) patients. We investigated whether glycemic control impacts mortality in PC patients with existing diabetes.

Methods:
All PC patients with or without preexisting DM were enrolled from 2006 to 2017. Mean hemoglobin A1c (HbA1c) values (<7%, 7%-9%, ≥9%) were used to represent glycemic control. Major outcomes included all-cause, PC-specific, and non-PC mortalities. Statistical analyses were performed using Cox regression models with adjusted mean HbA1c and other related confounders.

Results:
A total of 831 PC patients were enrolled (non-DM group, n = 690; DM group with a record of mean HbA1c values, n = 141). Results showed that the DM group with mean HbA1c level ≥ 9% (n = 14) had significantly increased risk for all-cause and non-PC mortality (hazard ratio [HR], 3.09; 95% CIs, 1.15-8.32; p=0.025 and HR, 5.49; 95% CIs, 1.66-18.16; p = 0.005, respectively), but not for PC-specific mortality (HR, 1.03; 95% CIs, 0.13-8.44; p = 0.975), compared with the non-DM group.

Conclusion:
Our findings indicate that PC patients with DM who had a mean HbA1c level ≥ 9% had higher risks of all-cause and non-PC mortality compared with non-DM subjects. Further large and long-term studies are needed to verify the effect of glycemic control in PC patients with DM.
I’m Just a Person: Self-Labeling Following Sexual Assault
Authors: Graham Amy C. , Knopp Andrea F. , Beers Kymber 
Published: September 2021

ABSTRACT

Objective
The purpose of this study was to examine college women’s self-labeling as a victim or a survivor following a sexual assault and describe the relationship of self-labeling with mental health, self-blame, control over recovery, and help-seeking.

Methods
This cross-sectional study collected data in an online anonymous survey in November and December of 2018. Participants (N = 375) were recruited from two public universities, were 18- to 24-year-old undergraduate students, identified as female, and had experienced a sexual assault since entering college.

Results
Most respondents (46.4%, 174/375) chose labels other than victim or survivor. Statistically significant differences were found between choice of label (survivor, victim, or other) and depression, well-being, characterological self-blame, and perceived control over recovery. Short-answer responses revealed three major themes for alternative labels: choosing no label, normalizing, and seeking congruence.

Conclusion
As when caring for a patient with any diagnosis, nurses and other healthcare providers should see a person—not a patient, a survivor, or a victim.