bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pleomorphic Fibroma: A Clinicopathologic Case Series With the Review of the Literature
Authors: Potts Geoffrey A. , Adlam Taylor , Stierman Sarah C. , Moossavi Meena , Mehregan Darius 
Published: January 2021

Background:
Pleomorphic fibromas are rare flesh-colored benign neoplasms first described in 1989. Their histopathology is notable for nuclear pleomorphism of spindle cells and multinucleate giant cells but lacking mitoses. The cellular origin of these tumors is unknown. This case series describes an additional 18 lesions with discussion of histopathology and immunohistochemistry.

Methods:
This case series of 18 pleomorphic fibromas uses immunohistochemical staining for CD34, CD68, factor XIIIa, and S-100 and general histopathologic examination under light microscopy to describe the lesions.

Results:
Immunohistochemical stains for CD34 showed nearly universal positivity of the pleomorphic spindle cells, although some more focally. The pleomorphic cells were negative for CD68, variably positive for factor XIIIa, and universally negative for S-100. All the lesions showed characteristic nuclear pleomorphism with absent mitoses. Collagen thickening was variable, mucin was absent, and perivascular inflammation was present in all lesions.

Conclusions:
Pleomorphic fibromas are fibrous lesions with benign clinical course and histopathologic findings including nuclear pleomorphism. Immunohistochemical staining characteristics of the lesion, along with unique spindle cells and multinucleate giant cells help to differentiate this from other tumors.
Pure and Mixed Desmoplastic Melanomas: A Retrospective Clinicopathologic Comparison of 33 Cases
Authors: Chu Sherman , Schrom Kory P. , Tripathi Raghav , Conic Rosalynn R. Z. , Ezaldein Harib H. , Scott Jeffrey F. , Honda Kord 
Published: January 2021

Background:
Pure and mixed desmoplastic melanomas (DMs) may have different natural histories and behaviors.

Methods:
We conducted a retrospective review of patients diagnosed with DM at our institution between January 1997 and April 2019. A total of 33 unique DMs were identified and subsequently analyzed based on the histologic type (pure vs. mixed).

Results:
The majority (57.6%) of our cases were classified as pure histology. Patients with pure DMs were more likely to be men (P = 0.035) and be older than 65 years (P = 0.019) compared with patients with mixed DMs. Patients with mixed DM were more likely to have mitoses present (P = 0.001) compared with patients with pure DM. There were no differences in ulceration, perineural invasion, vascular invasion, or survival between patients with pure and mixed histologic subtypes. In addition, no differences in sentinel lymph node biopsy, radiation, or chemotherapy were noted between the 2 histologic subtypes. Immunohistochemistry showed that 27.3% of the pure DMs stained with Melan-A and HMB45 were positive for these immunomarkers.

Conclusions:
Pure and mixed variants of DM were found to have similar clinicopathologic characteristics. Patients with the mixed histologic subtype were more likely to have mitoses, but no difference in the therapeutic management or patient survival was seen between the 2 subtypes.
Differences Between Recommended Surgical Margins and Measured Histological Margins in Malignant Melanoma In Situ and Malignant Melanomas
Authors: Tababa Erin , Teulings Hansje-Eva , Bhawan Jag 
Published: January 2021

Abstract:
Wide local excision (WLE) using appropriate surgical margins is the standard surgical management for malignant melanoma in situ (MMIS) and primary cutaneous malignant melanoma (MM). The actual width of the histologic margins is frequently not assessed, whereas narrow histologic margins are associated with an increase in local melanoma recurrence. Our objective was to analyze the actual measured histological margins of WLE specimens of MMIS and MM cases and compare them with their recommended surgical margins. A retrospective study of formalin fixed specimens of MMIS and invasive MM treated with WLE from a large university-affiliated dermatopathology laboratory was conducted. Among a total of 164 MMIS and 128 MM cases, 14 MMIS (8.5%) and 7 MM (5.9%) had positive lateral margins. The median histologic margin for MMIS, after a 15% tissue shrinkage adjusted, was 2.7 mm [1.3–3.9] for LM type and 3.9 mm [2.3–5.6] for non-LM type, in contrast to the recommended 5-mm margin. In 96 MM of T1 type (≤1.0 mm), the median adjusted histologic margin was 6.7 mm [3.5–9.1] in contrast to the recommended 10-mm margin. These results show that measured and adjusted median histologic margins in WLE specimens in both MMIS and MM of T1 type were significantly narrower than the recommended surgical margins, regardless of anatomic location. These differences are concerning, whether they reflect clinicians' intentional or unintentional deviation from recommended guidelines.
Comparison of the Parents' Evaluation of Developmental Status and Ages and Stages Questionnaire Developmental Screening Tests in a Eurasian Country
Authors: Çelen Yoldaş Tuba , Karakaya Jale , Özdemir Gökçenur , Engin Erdal Ayşenur , Özmert Elif Nursel 
Published: January 2021

ABSTRACT:

Objective:
The Parents' Evaluation of Developmental Status (PEDS) and the Ages and Stages Questionnaire (ASQ) are developmental screening tools that are commonly used in pediatric practice worldwide. We aimed to compare the screening results of the PEDS and the ASQ in children with a wide range of ages and to evaluate the degree of agreement between the tests across the age groups.

Methods:
The study was conducted with the participation of 327 children aged 3 to 72 months. Participants were administered the PEDS and then the ASQ. Children with known developmental disabilities were included in the study to represent a real-world clinical practice setting and evaluated with a clinical workup.

Results:
The median age of the children was 35.1 months, with a range of 3 to 72 months. The percentage of children with known developmental disabilities was 16.5%. The actual agreement between the PEDS and ASQ was 74% with a concordance represented by Cohen κ of 0.422 (p < 0.001) in the total sample. Furthermore, the agreement was higher in children aged 25 to 36 months and 37 to 48 months than for the other ages.

Conclusion:
We compared the clinical features of the ASQ and PEDS across the age groups, and they demonstrated moderate agreement. The present study also showed the performance of the PEDS and suggests that it should certainly be used for developmental screening in routine child health care practice in Eurasia, thus supporting the use of such parent-completed developmental tools that should be encouraged for universal screening.
Sleep in Aneurysmal Subarachnoid Hemorrhage Patients During Critical and Acute Care
Authors: Fowler Susan B. , Walker Sarah , Jones Timothy W. , Gell Lauren 
Published: January 2021

Background
Nurses caring for intensive care patients diagnosed with an aneurysmal subarachnoid hemorrhage (aSAH) conduct frequent neurological assessments and vital signs over an extended period during which patients are at risk of vasospasm. The frequency of assessments can negatively impact sleep, resulting in altered thought processes and mood, including delirium. There are 2 types of sleep during the night: non–rapid eye movement (non-REM) sleep and REM sleep (also called stage R). Non-REM sleep is subdivided into 3 stages: stage N1, stage N2, and stage N3. These 4 stages of sleep are referred to as sleep architecture.

Objective
The aim of this study was to explore patterns of sleep in patients with aSAH over time during hospitalization.

Methods
Sleep data of stages and cycles were collected with use of a Fitbit activity tracker in this pilot, exploratory research study. Demographic data included age and gender. Six English-speaking patients, diagnosed with an aneurysmal SAH, confirmed by diagnostic angiogram, were followed in neuro–intensive care unit (ICU), neuro–step-down, neuroscience unit, and inpatient rehabilitation.

Results
There were a total of 226 sleep events. A sleep event encompassed a recorded start and end time on a single date. Each event included several sleep cycles. Each sleep cycle consisted of wakefulness, light sleep, deep sleep, and REM sleep. In 79 sleep events, light and deep sleep did add up to more than 4 hours; only 38 sleep events indicated more than 90 minutes of REM/night; 61 events showed the cycle of light-deep-light-REM cycles; 80 events showed 3 to 5 REM periods/night; and only 46 events demonstrated that the early-morning REM cycle was the longest. The average number of REM cycles increased from ICU (n = 4.6) to rehabilitation (n = 6.5). The percentage of days with sleep cycles also increased from ICU to rehabilitation (42 to 64).

Discussion
“Normal” sleep patterns are disrupted in aSAH patients throughout their hospitalization. Data in this study revealed that the patients do sleep; however, it is rarely organized. Patients were not always able to progress through the expected sleep cycle of light to deep to light to REM. Hospitalized aSAH patients do engage in REM sleep, but its pattern is abnormal. Staff should strategize on minimizing interruptions, clustering care, and minimizing sounds. Nurses should advocate for the frequency of assessments and vital signs based on hospital/unit policy and individual patient needs.
NEW, SIMPLE, AND SAFE SURGICAL TECHNIQUE FOR THE REMOVAL OF A DISLOCATED CAPSULAR TENSION RING–INTRAOCULAR LENS–CAPSULAR BAG COMPLEX
Authors: Shiraki Akihiko , Sakaguchi Hirokazu , Nishida Kohji 
Published: January 2021

Background/Purpose:
To report a safe and simple surgical technique for the removal of a dislocated capsular tension ring (CTR)–intraocular lens (IOL)–capsular bag (CB) complex.

Methods:
We present an extraocular surgical removal technique for a dislocated CTR–IOL–CB complex. Although the entire complex is typically removed with a large incision, this approach applies a CTR injector and anterior capsule forceps in a less invasive manner.

Results:
After vitrectomy, the complex was moved to the anterior chamber, where the tip of the CTR was separated from the IOL–CB using anterior capsule forceps and hooked onto the tip of the CTR injector. Subsequently, the CTR, as well as part of the CB, was gradually separated from the IOL–CB and stored in the CTR injector. This was completed while also supporting the IOL–CB complex using the forceps. Once the whole CTR and the part of CB were removed from the anterior chamber, the residual IOL and CB were then removed.

Conclusion:
Our methodology, using the CTR injector and anterior capsule forceps, enables the procedure to be completed with only a small corneal incision, thereby allowing for the safe and simple removal of a CTR–IOL–CB complex.
RETINAL FLUORESCEIN ANGIOGRAPHY IN SUSAC SYNDROME: A SHIFTING PATTERN OF ARTERIOLAR WALL HYPERFLUORESCENCE—A REPORT OF TWO CASES
Authors: Van Oevelen Kathy , Dirven Werner , Tassignon Marie-José , Van Os Luc 
Published: January 2021

Background:
Susac syndrome consists of the triad of encephalopathy, branch retinal artery occlusion, and hearing loss and is believed to be an immune-mediated endotheliopathy. Arteriolar wall hyperfluorescence (AWH) on retinal fluorescein angiography (FA) has been described in the literature as a classic ophthalmic sign for Susac syndrome. In this article, we report a pattern of distally shifting segments of AWH on FA over time that was observed in two cases.

Methods:
Two cases of Susac syndrome are presented with an emphasis on FA findings, obtained at frequent intervals during follow-up.

Results:
In both cases, FA displays a shifting pattern of segments of AWH distal to the localization of the AWH observed on the previous FA.

Conclusion:
In patients with Susac syndrome, FA plays an important role in aiding diagnosis and monitoring the efficacy of treatment and disease activity during follow-up. In these two cases, the angiography revealed how the AWH can migrate along the vessel over time. This is the first published report showing an evolving distally shifting pattern of AWH in patients with Susac syndrome.
Development of Cytomegalovirus Corneal Endotheliitis During Long-Term Topical Tacrolimus and Steroid Treatment for Chronic Ocular Surface Inflammatory Diseases
Authors: Yokogawa Hideaki , Kobayashi Akira , Takemoto Yuko , Mori Natsuko , Wajima Ryotaro , Nishino Tsubasa , Sugiyama Kazuhisa 
Published: January 2021

Purpose:
We report 3 cases of patients with chronic ocular surface inflammatory disease who developed cytomegalovirus (CMV) corneal endotheliitis during immunosuppressant and steroid treatment.

Patients and Methods:
This is a retrospective observational study analyzing the clinical characteristics and outcomes of 3 patients with ocular surface inflammatory diseases (2 with Mooren ulcer and 1 with idiopathic scleritis) who developed CMV corneal endotheliitis. All patients developed CMV corneal endotheliitis between 8 and 14 months of starting steroid and immunosuppressant treatment, including topical 0.1% tacrolimus. Decimal visual acuity, endothelial counts, and intraocular pressure were analyzed.

Results:
All patients received topical 0.5% ganciclovir after the diagnosis of CMV corneal endotheliitis, which improved endothelial inflammation. However, all patients developed irreversible mydriasis and required additional surgeries, including endothelial keratoplasty, cataract surgery, and glaucoma surgery. At the final follow-up (14–46 months post-CMV corneal endotheliitis onset), fair outcomes were achieved, as demonstrated by a mean decimal best-corrected visual acuity of 0.3 and a well-controlled intraocular pressure.

Conclusions:
Topical steroids and immunosuppressants can induce fulminant CMV corneal endotheliitis with cataract progression and irreversible mydriasis. In these cases, early diagnosis and treatment, including topical 0.5% ganciclovir, glaucoma surgery, cataract surgery, and endothelial keratoplasty, are necessary for preserving the patient's vision.
Analysis of Efficacy and Safety of Pediatric Ahmed Glaucoma Valve (FP8) in Advanced Age Populations
Authors: Crichton Paul , Sanders Emi , Docherty Gavin , Crichton Andrew 
Published: January 2021

Precis:
The FP8 glaucoma valve was demonstrated to be reasonably safe with reliable results in an advanced age patient population.

Purpose:
As life expectancy increases, a growing number of patients with glaucoma are of an advanced age. There are little to no data looking at glaucoma surgical treatment options in patients over the age of 85. Our study describes the safety and efficacy of the FP8 Ahmed glaucoma valve in this patient population.

Materials and Methods:
This was a retrospective study of patients over 85 years of age undergoing FP8 Ahmed glaucoma valve implantation. Preoperative age, sex, intraocular pressure (IOP), and number of glaucoma medications were recorded. Primary outcome variables were IOP and number of medications. Secondary outcome variables included any intraoperative or postoperative complications.

Results:
Mean IOP preoperatively was 26 mm Hg on an average of 3 glaucoma medications (n=56). IOP was significantly reduced at all time points in follow-up for an overall reduction of 42% at 1 year and 46% at 2 years. Mean IOP at 1 year follow-up was 15 mm Hg and 14 mm Hg at 2 years follow-up. Glaucoma medications were reduced from a mean of 3 preoperatively to 2 postoperatively.

Conclusions:
Implantation of an FP8 Ahmed glaucoma valve is a relatively safe procedure to achieve satisfactory IOP and decreased reliance on glaucoma medications in an advanced age population.
The association between fungi exposure and hypersensitivity pneumonitis: a systematic review
Authors: Gomes Marta Lopes , Morais António , Cavaleiro Rufo João 
Published: January 2021

Abstract
A systematic review of published studies focused on the association between hypersensitivity pneumonitis (HP) and fungi exposure was conducted on PubMed, following PRISMA guidelines for systematic reviews. A total of 14 studies met the inclusion criteria but only 6 of these studies were eligible, as the remaining 8 represented case reports that were separately included for further discussion. HP is an interstitial lung disease (ILD) characterized by a hypersensitization response to inhalable antigens and represents 1.5% to 12% of all ILD in the European population. Several fungi species that populate the indoor environment have been associated with the incidence of HP upon cumulative exposure, with Penicillium spp and Aspergillus spp being the fungi species most frequently associated with the onset of disease. Although some studies have shown that avoiding exposure to causative HP fungi tends to improve patients’ symptoms, other studies were unable to identify the source of sensitization. More microbial exposure studies are needed to properly estimate the risk of HP development in the built environment.
Stress-related consequences of the coronavirus disease 2019 pandemic on symptoms of Crohn’s disease
Authors: Goodday Sarah M. , Travis Simon , Walsh Alissa , Friend Stephen H. 
Published: January 2021

Objectives
A link between stress and Crohn’s disease activity suggests an association, but results have been conflicting. The purpose of this study was to assess whether the stress related to the coronavirus disease 2019 (COVID-19) pandemic affected disease activity in patients with Crohn’s disease.

Basic methods
An anonymous survey was distributed to patients through gastroenterology clinics and networks. Patients were asked to report their Crohn’s disease symptoms in the months prior to the COVID-19 pandemic and again during the early stages of the COVID-19 pandemic using the Manitoba inflammatory bowel disease index in addition to questions about stress, perception of reasons for symptom change and personal impact.

Main results
Out of 243 individuals with a confirmed diagnosis of Crohn’s disease, there was a 24% relative increase in active symptoms between the pre-COVID-19 period to the during-COVID-19 period (P < 0.0001) reflecting an absolute change from 45 to 56%, respectively. The most frequent reported reason for a change in symptoms was ‘Increased stress/and or feeling overwhelmed’ (118/236), and personal impact of the pandemic was, ‘I’m worrying a lot about the future’ (113/236), both reported by approximately half of respondents.

Principal conclusions
This study serves as a ‘proof of concept’ demonstrating the impact of a significant and uniquely uniform stressor as a natural experiment on Crohn’s disease activity. The severity of symptoms of Crohn’s disease increased during the COVID-19 pandemic. The primary reported reason for symptom change was an increase in stress, not a change in diet, exercise or other lifestyle behaviours, corroborating the hypothesis that stress affects Crohn’s disease activity.
Nutrient sensing
Authors: Venugopal Anand , Bishu Shrinivas 
Published: January 2021

Purpose of review
Sensing of nutrients is foundational for life and allows for cellular adaption to environmental stress. The aim of this review is to provide a basic background and overview of new data on cellular nutrient sensing.

Recent findings
We focus on sensing of energy by adenosine monophosphate-activated protein kinase, sensing of amino acids via general amino acid control nonderepresible 2 and regulation of cellular metabolism via mammalian target of rapamycin pathways. Over the last 5 years, new data has elucidated how these pathways are both interconnected and regulated by amino acids.

Summary
Regulation of these pathways is complex and tightly orchestrated in order to provide unified cellular responses that meet environmental demands. Amino acids provide key cues for the regulation of mammalian target of rapamycin pathways, in particular.
Non-invasive Diagnosis of Deep Vein Thrombosis from Ultrasound with Machine Learning
Authors: Kainz Bernhard , Makropoulos Antonios , Oppenheimer Jonas , Deane Christopher , Mischkewitz Sven , Al-Noor Fouad , Rawdin Andrew C , Stevenson Matthew D , Mandegaran Ramin , Heinrich Mattias P. , Curry Nicola 
Published: January 2021

AbstractDeep Vein Thrombosis (DVT) is a blood clot most found in the leg, which can lead to fatal pulmonary embolism (PE). Compression ultrasound of the legs is the diagnostic gold standard, leading to a definitive diagnosis. However, many patients with possible symptoms are not found to have a DVT, resulting in long referral waiting times for patients and a large clinical burden for specialists. Thus, diagnosis at the point of care by non-specialists is desired.We collect images in a pre-clinical study and investigate a deep learning approach for the automatic interpretation of compression ultrasound images. Our method provides guidance for free-hand ultrasound and aids non-specialists in detecting DVT.We train a deep learning algorithm on ultrasound videos from 246 healthy volunteers and evaluate on a sample size of 51 prospectively enrolled patients from an NHS DVT diagnostic clinic. 32 DVT-positive patients and 19 DVT-negative patients were included. Algorithmic DVT diagnosis results in a sensitivity of 93.8% and a specificity of 84.2%, a positive predictive value of 90.9%, and a negative predictive value of 88.9% compared to the clinical gold standard.To assess the potential benefits of this technology in healthcare we evaluate the entire clinical DVT decision algorithm and provide cost analysis when integrating our approach into a diagnostic pathway for DVT. Our approach is estimated to be cost effective at up to $150 per software examination, assuming a willingness to pay $26 000/QALY.
Engineering a niche supporting haematopoietic stem cell development using integrated single cell transcriptomics
Authors: Hadland Brandon , Varnum-Finney Barbara , Dozono Stacey , Dignum Tessa , Nourigat-McKay Cynthia , Jackson Dana L , Itkin Tomer , Butler Jason M. , Rafii Shahin , Trapnell Cole , Bernstein Irwin D. 
Published: January 2021

ABSTRACTHaematopoietic stem cells (HSCs) develop from haemogenic endothelium (HE) within embryonic arterial vessels such as the aorta of the aorta-gonad-mesonephros region (AGM). To identify the signals responsible for HSC formation, we used single cell RNA-sequencing to simultaneously analyze the transcriptional profiles of AGM-derived cells transitioning from HE to HSC, and AGM-derived endothelial cells which provide signals sufficient to support HSC maturation and self-renewal. Pseudotemporal ordering revealed dynamics of gene expression during the HE to HSC transition, identifying surface receptors specifically expressed on developing HSCs. Transcriptional profiles of niche endothelial cells enabled identification of corresponding ligands, including those signaling to Notch receptors, VLA-4 integrin, and CXCR4, which, when integrated in an engineered platform, were sufficient to support the generation of engrafting HSCs. These studies provide a transcriptional map of the signaling interactions necessary for the development of HSCs and advance the goal of engineering HSC for therapeutic applications.