bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tiny Moments Matter: Promoting Professionalism in Everyday Practice
Authors: Bernabeo Elizabeth C. , Chesluk Benjamin , Lynn Lorna 
Published: May 2018

Introduction:
Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior.

Methods:
In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach.

Results:
Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning.

Discussion:
Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.
Plexiform Atypical Spitz Tumor With Rosette-Like Giant Cells: A Histologic and Immunohistochemical Study on a Case Suggesting Ganglioneuroblastic Differentiation: Review of the Literature and Considerations on Histogenesis
Authors: Castelli Elena , Orlando Elisabetta , Pistone Giuseppe , Bongiorno Maria R. 
Published: May 2018

Abstract:
Spitz nevi, atypical Spitz tumors and Spitzoid melanoma, the three clinicopathologic forms that constitute the spectrum of the Spitz-type melanocytic lesions, share a histologic picture characterized by large spindle and/or epithelioid ganglion-like cells, with various admixtures of multinucleate bizarre cells. This remarkable cytology has always been interpreted as an unusual, as well as unexplained form of atypia. We report a case of atypical Spitz tumor with Homer Wright–like rosettes, a feature characteristic of ganglioneuroblastic proliferation. Furthermore, the ganglion-like cells of the tumor showed basophilic punctuation in the cytoplasm, reminiscent of Nissl substance, and a few cells, whether spindled or epithelioid, were positive to neuron-specific enolase and glial fibrillary acid protein. Based on our findings, we hypothesize that the outstanding similarity of the ganglion-like cells of Spitz tumors to the normal parasympathetic ganglion cells and to the cells of ganglioneuroma and ganglioneuroblastoma may not be fortuitous. Instead, it may represent the expression of a specific pattern of melanocytic differentiation, analogous to the neurotization of common and cellular blue nevi, although in this case, it would privilege the parasympathetic lineage over the Schwannian, perineural, or endoneural pathway. Our hypothesis is supported by the literature reports of rosette formation and frank ganglioneuroblastic differentiation in Spitz tumors and melanoma and by the demonstration that parasympathetic neurons take origin from the same tracts of the neural crest as other neural and melanocytic cells.
Heavily Pigmented Epithelioid Melanoma With Loss of Protein Kinase A Regulatory Subunit-α Expression
Authors: Cohen Jarish N. , Spies Jessica A. , Ross Fawn , Bohlke Angela , McCalmont Timothy H. 
Published: May 2018

Abstract:
Heavily pigmented melanocytic neoplasms are genotypically and phenotypically diverse. Recently, a subset of this histopathologic spectrum was shown to harbor recurrent genetic alterations in the gene-encoding protein kinase A regulatory subunit-α (PRKAR1A). To date, no histopathologic descriptions of melanomas arising from this pathway have been described. We present a case of a darkly pigmented papule arising on the posterior neck of a 28-year-old man. Microscopically, the heavily pigmented compound melanocytic proliferation was centered in the dermis with permeation into the superficial subcutis. Tumor cells were arranged in large confluent nests and fascicles and lacked maturation with descent. The epithelioid melanocytes were characterized by enlarged vesicular nuclei with prominent nucleoli, nuclear pleomorphism, and plentiful gray-brown granular cytoplasm. Mitotic figures were readily identified. By immunohistochemistry, melanocytes were positive for mutant BRAF V600E and showed loss of Prkar1α and p16 expression. A multiplex MART-1/tyrosinase/phosophohistone-H3 immunostain demonstrated an increased mitotic index in melanocytes. The combination of highly atypical cytomorphology and architecture, increased mitoses, and p16 expression loss compelled the diagnosis of melanoma. Overall, we present the first clinicopathologic description of a PRKAR1A-inactivated melanoma to highlight morphological features and discuss mimics that may enter the differential diagnosis.
Early Self-Regulation, Early Self-Regulatory Change, and Their Longitudinal Relations to Adolescents' Academic, Health, and Mental Well-Being Outcomes
Authors: Howard Steven J. , Williams Kate E. 
Published: May 2018

ABSTRACT:

Objective:
To evaluate the extent to which early self-regulation and early changes in self-regulation are associated with adolescents' academic, health, and mental well-being outcomes.

Methods:
Data were collected from 1 of the cohorts in a large dual-cohort cross-sequential study of Australian children. This cohort consisted of a nationally representative data set of 4983 Australian children assessed at 4 to 5 years of age, who were followed longitudinally to 14 to 15 years of age. Using regression within a path analysis framework, we first sought to investigate associations of early self-regulation (at 4–5 years and 6–7 years of age) with a broad range of academic, health, and mental well-being outcomes in adolescence (at 14–15 years). We next investigated the extent to which an early change in self-regulation (from 4 to 7 years of age) predicted these adolescents' outcomes.

Results:
Early self-regulation predicted the full range of adolescents' outcomes considered such that a 1-SD increase in self-regulation problems was associated with a 1.5- to 2.5-times greater risk of more-negative outcomes. An early positive change in self-regulation was associated with a reduced risk of these negative outcomes for 11 of the 13 outcomes considered.

Conclusion:
These results suggest the potential of early self-regulation interventions, in particular, in influencing long-term academic, health, and well-being trajectories.
Preemptive Analgesia Decreases Pain Following Anorectal Surgery: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Trial
Authors: Van Backer Justin T. , Jordan Matthew R. , Leahy Danielle T. , Moore Jesse S. , Callas Peter , Dominick Timothy , Cataldo Peter A. 
Published: May 2018

BACKGROUND:
Postoperative pain is a frequent cause for delayed discharge following outpatient procedures, including anorectal surgery. Both central and peripheral pain receptor sensitization are thought to contribute to postoperative pain. Blocking these receptors and preempting sensitization prevents hyperalgesia leading to lower pain medication requirements. Studies in the orthopedic, urologic, and gynecologic literature support this practice, but the use of preemptive analgesia in anorectal surgery is understudied.

OBJECTIVE:
This study aimed to evaluate the effectiveness of preemptive analgesia in decreasing postoperative pain.

DESIGN:
This is a randomized, double-blinded, placebo-controlled trial.

SETTING:
This study was conducted at the University of Vermont Medical Center, a tertiary care referral center in Burlington, Vermont.

PATIENTS:
Patients who were over 18 years of age, ASA Physical Status Classes I, II, or III, and undergoing surgery for anal fissure, fistula or condyloma or hemorrhoids were selected.

INTERVENTIONS:
Preoperative oral acetaminophen and gabapentin followed by intravenous ketamine and dexamethasone were given before incision compared with oral placebos.

MAIN OUTCOME MEASURES:
The primary outcomes measured were postoperative pain scores, percentage of patients utilizing breakthrough narcotics, and rates of side effects.

RESULTS:
Ninety patients were enrolled. Because of patient withdrawal, screen failures, and loss to follow-up, 61 patients were analyzed (30 in the preemptive analgesia group and 31 in the control group). Patients in the active group had significantly less pain in the postanesthesia care unit and at 8 hours postoperatively. Significantly fewer participants in the active group used narcotics in the postanesthesia care unit and at 8 hours postoperatively. Average pain scores were excellent for both groups. There was no difference in the number of medication-related side effects between the 2 groups.

LIMITATIONS:
This study was limited by the small sample size and excellent pain control in both groups.

CONCLUSIONS:
Preemptive analgesia is safe and results in decreased pain in the early postoperative period following anorectal surgery. It should be implemented by surgeons performing these procedures. See Video Abstract at http://links.lww.com/DCR/A588.
Trapeziectomy with Interpositional Arthroplasty using Acellular Dermal Matrix: Description of Technique and Early Outcomes
Authors: Cockcroft April C. , Markelov Alexey M. 
Published: May 2018

Background:
Trapeziectomy with interpositional arthroplasty using Repriza acellular dermal matrix is a novel technique to treat primary and secondary carpometacarpal joint arthritis. Early studies with nonautograft interposition indicate promising post-trapeziectomy space maintenance with results similar to ligament reconstruction with tendon interposition, without the potential risks and increased operating time of harvesting a tendon autograft.

Methods:
Eleven patients in a retrospective cohort were followed for a minimum of 6 weeks (mean, 12). Subjective and objective data were collected to assess pain, subjective improvement of symptoms, radiographic measurements of first metacarpal subsidence, key pinch strength, grip strength, and range of motion.

Results:
Early outcomes in our cohort compare favorably to other treatment series. On average, patients received a significant pain reduction of 63%, with 36% of patients admitting to complete pain resolution. One hundred percentage of patients admitted to overall subjective improvement in symptoms. Ninety-one percentage of patients achieved postoperative opposition of the thumb and fifth digit. Comparison with preoperative x-rays showed mean thumb metacarpal subsidence of 27%. Zigzag deformity and extra-articular acellular dermal matrix migration, due to lack of patient compliance with splint, were observed complications. Only 8.3% subsidence was observed with an impressive 45% pain reduction, in a salvage patient after revision surgery for a NuGrip implant.

Conclusions:
In conclusion, this is a safe and effective primary or salvage technique for Eaton grades III and IV thumb carpometacarpal arthritis with a mean subsidence within the range observed with ligament reconstruction with or without tendon interposition. Long-term study with a larger sample size is needed to investigate this technique further.
Does Sensory Retraining Improve Subjective Rating of Sensory Impairment after Bilateral Sagittal Split Osteotomy?
Authors: Yang Yea-Ling , Wen-Ching Ko Ellen , Chen Yu-Ray , Huang Chiung Shing 
Published: May 2018

Background:
Sensory retraining could ameliorate neurosensory disturbance (NSD) resulting from the injury of the inferior alveolar nerve after a bilateral sagittal split osteotomy (BSSO). The aim of this study was to measure the effects of sensory retraining on NSD.

Methods:
A randomized, prospective, single-blinded clinical trial was conducted on consecutive patients with NSD resulting from a BSSO to correct skeletal class III malocclusion. The outcome measurement of sensory recovery was performed using a patient-centered survey assessed by the total score of questionnaire (TSQ) and visual analogue scale (VAS) at preoperation (T0), 1 week after surgery (T1), each month from 1 to 6 months after surgery (T2–T7), and 1 year after surgery (T8).

Results:
In total, 115 consecutive patients were randomized into a control group (56 patients without sensory retraining) or study group (59 patients with sensory retraining). TSQ and VAS values continually decreased from T1 to T8 in both groups. The study group tended to have lower, but not significantly lower, TSQ and VAS values than the control group at each postoperative time point. Women and men responded similarly to sensory retraining at each time point. The oldest patients did not respond well to sensory retraining, compared with the youngest patients, from T1 to T8, and this age effect evaluated by the VAS reached a significant difference at T7 and T8.

Conclusion:
NSD, assessed by the TSQ and VAS, continually decreased over time after the BSSO. Sensory retraining could improve NSD, but not significantly.
LONG-TERM PROGNOSTIC FACTORS FOR VISUAL IMPROVEMENT AFTER EPIRETINAL MEMBRANE REMOVAL
Authors: Jeon Sohee , Jung Byungju , Lee Won Ki 
Published: May 2018

Purpose:
To identify prognostic factors that may predict the amount of long-term visual improvement after idiopathic epiretinal membrane removal.

Methods:
A retrospective study of 114 patients who underwent epiretinal membrane removal was performed. The central foveal thickness, inner retinal layer thickness, inner retinal irregularity index, length of the cone outer segment tip line defect, and length of the ellipsoid zone defect were measured. The optical coherence tomography parameters that were associated with the amount of visual improvement were determined at 24 months postoperatively.

Results:
Central foveal thickness and inner retinal irregularity index were not associated with best-corrected visual acuity at 24 months (P = 0.227 and P = 0.544, respectively), whereas the lengths of cone outer segment tip line defect and ellipsoid zone defect were associated with worse best-corrected visual acuity at 24 months (P = 0.015 and P < 0.001, respectively). Univariate regression analysis indicated that central foveal thickness and inner retinal irregularity index were associated with visual improvement (P = 0.011 and P < 0.001, respectively). Multivariate regression analysis indicated that inner retinal irregularity index, a marker of the inner retinal deformation, was associated with visual improvement after adjusting for age, gender, and other optical coherence tomography findings (P < 0.001).

Conclusion:
Patients with preoperative inner retinal deformation were found to have significantly improved long-term visual outcomes after epiretinal membrane removal.
Femtosecond Laser–Assisted Graft Preparation for Descemet Membrane Endothelial Keratoplasty
Authors: McKee Hamish D. , Jhanji Vishal 
Published: May 2018

Purpose:
To describe a technique of using a femtosecond laser to assist with graft preparation for Descemet membrane endothelial keratoplasty (DMEK).

Methods:
A femtosecond laser was used to assist in graft preparation for 3 DMEK procedures. The donor cornea is mounted on a proprietary artificial anterior chamber. A partial thickness deep circular cut is made with the femtosecond laser through the endothelium, Descemet membrane, and posterior stroma. Graft preparation is then completed without the use of a corneal trephine.

Results:
In all cases, graft preparation was successfully completed. Pterygium on a donor cornea resulted in an incomplete cut in 1 case that was finished manually. Subsequent keratoplasties resulted in clear corneas with endothelial cell counts within the expected range.

Conclusions:
The femtosecond laser may be a useful adjunct in graft preparation for DMEK.
Deep-learning Classifier With an Ultrawide-field Scanning Laser Ophthalmoscope Detects Glaucoma Visual Field Severity
Authors: Masumoto Hiroki , Tabuchi Hitoshi , Nakakura Shunsuke , Ishitobi Naofumi , Miki Masayuki , Enno Hiroki 
Published: May 2018

Purpose:
To evaluate the accuracy of detecting glaucoma visual field defect severity using deep-learning (DL) classifier with an ultrawide-field scanning laser ophthalmoscope.

Methods:
One eye of 982 open-angle glaucoma (OAG) patients and 417 healthy eyes were enrolled. We categorized glaucoma patients into 3 groups according to the glaucoma visual field damage (Humphrey Field Analyzer 24-2 program) [early; −6 dB (mean deviation) or better, moderate; between −6 and −12 dB, and severe as mean deviation of −12 dB or worse]. In total, 558 images (446 for training and 112 for grading) from early OAG patients, 203 images (162 for training and 41 for grading) from moderate OAG patients, 221 images (176 for training and 45 for grading) from severe OAG patients and 417 images (333 for training and 84 for grading) from normal subjects were analyzed using DL. The area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy after 100 trials.

Results:
The mean AUC between normal versus all glaucoma patients was 0.872, the sensitivity was 81.3% and the specificity was 80.2%. In normal versus early OAG, mean AUC was 0.830, the sensitivity was 83.8% and the specificity was 75.3%. In normal versus moderate OAG, mean AUC was 0.864, sensitivity was 77.5%, and specificity was 90.2%. In normal versus severe OAG glaucoma mean AUC was 0.934, sensitivity was 90.9%, and specificity was 95.8%.

Conclusions:
Despite using an ultrawide-field scanning laser ophthalmoscope, DL can detect glaucoma characteristics and glaucoma visual field defect severity with high reliability.
Influence of Sociodemographic Factors on Disease Characteristics and Vision-related Quality of Life in Primary Open-angle Glaucoma Patients: The Italian Primary Open Angle Glaucoma Study (IPOAGS)
Authors: Riva Ivano , Legramandi Lorenzo , Katsanos Andreas , Oddone Francesco , Rulli Eliana , Roberti Gloria , Quaranta Luciano 
Published: May 2018

Purpose:
The purpose of this article was to evaluate the potential association between sociodemographic factors with clinical characteristics, vision-related quality of life (QoL), and glaucoma-related symptoms scores in a large cohort of primary open-angle glaucoma patients.

Materials and Methods:
Multicenter, cross-sectional study involving academic and nonacademic centers. Previously diagnosed primary open-angle glaucoma patients aged >18 years were enrolled. At baseline, information on demographic characteristics, social, medical and ocular history, clinical presentation and treatments was collected. Vision-related QoL was evaluated by means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), while glaucoma-related symptoms were evaluated using the Glaucoma Symptom Scale (GSS) questionnaire. The associations between sociodemographic factors with clinical characteristics (mean deviation, pattern standard deviation, best-corrected visual acuity), NEI-VFQ-25, and GSS scores were evaluated by means of univariate and multivariate general linear models.

Results:
A total of 3227 patients were enrolled. Older age and male sex were significantly associated with lower mean deviation (P<0.01) and higher pattern standard deviation (P<0.01), whereas older age was associated with lower best-corrected visual acuity (P<0.01). The composite GSS score was related to age (P=0.02), sex (P<0.01), employment (P=0.01), and profession (P=0.04), while the total NEI-VFQ-25 score was associated with sex (P<0.01), marital status (P=0.02), and employment (P=0.02).

Conclusions:
Age and sex were significantly associated with almost all indicators of glaucoma severity at baseline. Other variables, such as employment, profession, and marital status were significantly associated with vision-related QoL scores.
Thyroid Stimulating Hormone Receptor Antibodies in Thyroid Eye Disease—Methodology and Clinical Applications
Authors: Diana Tanja , Kahaly George J. 
Published: May 2018

Background:
Thyroid stimulating hormone receptor antibodies (TSHR-Ab) cause autoimmune hyperthyroidism and are prevalent in patients with related thyroid eye disease (TED).

Purpose:
To provide a historical perspective on TSHR-Ab and to present evidence-based recommendations for clinical contemporary use.

Methods:
The authors review the recent literature pertaining to TSHR-Ab in patients with TED and describe the various immunoassays currently used for detecting TSHR-Ab and their clinical applications.

Results:
We provide a historical summary and description of the various methods used to detect TSHR-Ab, foremost, the functional TSHR-Ab. Increasing experimental and clinical data demonstrate the clinical usefulness of cell-based bioassays for measurements of functional TSHR-Ab in the diagnosis and management of patients with autoimmune TED and in the characterization of patients with autoimmune-induced hyperthyroidism and hypothyroidism. Thyroid stimulating hormone receptor antibodies, especially the functional stimulating antibodies, are sensitive, specific, and reproducible biomarkers for patients with autoimmune TED and correlate well with clinical disease activity and clinical severity. Unlike competitive-binding assays, bioassays have the advantage of indicating not only the presence of antibodies but also their functional activity and potency.

Conclusions:
Measurement of TSHR-Ab (especially stimulating antibodies) is a clinically useful tool for the management of patients with TED.
Orbital Decompression for Thyroid-Related Orbitopathy During the Quiescent Phase
Authors: Ediriwickrema Lilangi S. , Korn Bobby S. , Kikkawa Don O. 
Published: May 2018

Purpose:
To describe historical and modern surgical approaches to orbital decompression in patients with thyroid-related orbitopathy in the quiescent phase.

Methods:
A literature review of published techniques using the National Institutes of Health PubMed database.

Results:
Historically, orbital decompression has been accomplished via transantral, transcranial, transnasal, and orbital approaches. Current techniques use predominately periocular incisions to achieve effective decompression and proptosis reduction. Based on exophthalmometry and desired proptosis reduction, the authors propose a graded surgical approach to decompression for thyroid orbitopathy beginning with fat reduction, followed by deep lateral orbit via a superior eyelid crease incision, then medial wall by retro-caruncular approach, then posterior medial orbital floor either via transconjunctival or swinging eyelid approach, and finally with lateral orbital rim removal by superior eyelid crease incision as needed. These approaches can result in a range of proptosis reduction of up to 10 mm.

Conclusions:
A structured approach to orbital decompression results in predictable and effective outcomes in proptosis reduction.