bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complex Cystic and Solid Mass
Authors: Stein Matthew A. 
Published: March 2018

Abstract
The breast ultrasound (US) finding known as “complex mass” has undergone a labeling revision with the fifth edition of the BI-RADS Atlas and is now designated as complex cystic and solid mass (CCSM). The updated BI-RADS sought to unambiguously define and differentiate an actionable finding often requiring biopsy from a lesser finding requiring, at most, imaging follow-up to confirm expected stability. This chapter, appearing in the section on nipple, skin and lymph nodes, reviews key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis, and clinical recommendations for complex cystic and solid masses. Topics include the rationale for the updated BI-RADS lexicon, the important differentiation of a complex cystic and solid mass from a complicated cyst, and a framework for the differentiation and management of actionable and non-actionable masses with complex cystic and solid features at ultrasound.
Thrombophlebitis (Mondor Disease)
Authors: Stein Matthew A. 
Published: March 2018

Abstract
This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis, and clinical recommendations of superficial thrombophlebitis of the breast and anterior chest wall (Mondor disease). The condition is quite rare; incidence rates in the literature are reported as being less than 0.1%. Mondor disease is often temporally associated with a history of recent breast surgery, core needle biopsy, inflammatory process, or episode of trauma. Topics in this chapter include discussions of the incidence of Mondor disease, its presumptive pathophysiology, typical and atypical clinical/imaging presentations, and management considerations.
Stereotactic Core Biopsy
Authors: Lee Bonmyong 
Published: March 2018

Abstract
Stereotactic biopsy systems utilize angled mammography images and parallax shift to localize and sample a target. The most common indication for stereotactic core biopsy is to sample suspicious/indeterminate calcifications, but it can be used to biopsy any mammographic finding (mass, developing asymmetry, architectural distortion). In benign cases, core biopsy may avoid unnecessary surgery. In malignant cases, core biopsy allows for a pathological diagnosis prior to lumpectomy, and better surgical planning. This chapter, appearing in the section on interventions and surgical procedures, provides a practical guide to stereotactic core biopsy. Topics discussed include stereotactic core biopsy equipment, procedure protocols and pitfalls, clinical management, and imaging follow-up.
Ultrasound-Guided Core Biopsy
Authors: Di Carlo Philip A. 
Published: March 2018

Abstract
Prior to 1993, when ultrasound-guided core breast biopsy was first described by Parker and colleagues, surgery following image-guided needle localization was necessary to obtain a histological diagnosis of breast lesions. But there are many financial, practical, and clinical advantages of image-guided core biopsy over surgical excisional biopsy. There are also many advantages to ultrasound-guided biopsy over stereotactic- or MRI-guided biopsy, detailed in this chapter. Ultrasound is now usually the modality of choice by which to perform core biopsies if the lesion is visualized by multiple imaging modalities. This chapter, appearing in the section on interventions and surgical changes, reviews the key points of performing ultrasound-guided core biopsy. Topics discussed include protocols for both spring-loaded and vacuum-assisted devices; pre-procedure and post-procedure management, and imaging follow-up.
MRI-Guided Core Biopsy
Authors: Mullen Lisa A. 
Published: March 2018

Abstract
MRI-guided breast biopsy techniques were developed to sample indeterminate and suspicious breast lesions visible only on MRI. Breast MRI performed for high-risk screening, problem solving, or assessment of extent of disease in patients with newly diagnosed breast cancer may demonstrate indeterminate findings, such as enhancing foci, masses or non-mass enhancement. If the lesion is not visible by mammography or ultrasound, and MRI follow-up is not appropriate, then MRI-guided biopsy is indicated. This chapter, appearing in the section on interventions and surgical changes, reviews the key points and procedural protocols and pitfalls for performance of magnetic resonance imaging (MRI)–guided breast core biopsy. Pre-, peri-, and post-procedure clinical management, radiology–pathology correlation, and imaging follow-up are also reviewed.
Reduction Mammoplasty
Authors: Horvath Laura J. 
Published: March 2018

Abstract
Reduction mammoplasty is a surgical procedure performed to decrease breast size. Breast parenchyma and skin are resected, and the nipple is repositioned to a more superior location on the smaller breast mound. The goals of the procedure are to alleviate a variety of physical and psychological complaints. Because women with a history of reduction surgery are commonly seen for screening mammography and other breast imaging studies, it is important to be aware of the normal post-operative appearance. This chapter, appearing in the section on intervention and surgical change, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for reduction mammoplasty. Topics discussed include clinical indications, surgical technique, and benign post-operative changes, including scars, oil cysts, fat necrosis, and calcifications.
Neuroradiological and Neuropathological Changes After 177Lu-Octreotate Peptide Receptor Radionuclide Therapy of Refractory Esthesioneuroblastoma
Authors: Schneider Julia R , Shatzkes Deborah R , Scharf Stephen C , Tham Tristan M , Kulason Kay O , Buteau François-Alexandre , Del Prete Michela , Chakraborty Shamik , Anderson Todd A , Asiry Saeed , Beauregard Jean-Mathieu , Langer David J , Costantino Peter D , Boockvar John A 
Published: March 2018

Abstract

BACKGROUND AND IMPORTANCE
Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a malignant neoplasm with an unpredictable behavior. Currently, the widely accepted treatment is inductive chemotherapy, with or without surgery, followed by radiotherapy. Since data on genetics and molecular alterations of ENB are lacking, there is no standard molecularly targeted therapy. However, ENB commonly expresses the somatostatin receptor (SSTR) that is also expressed by neuroendocrine tumors. Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogues, such as 177Lu-octreotate, is an effective treatment for the latter. We present the complex neuroradiological and neuropathological changes associated with 177Lu-octreotate treatment of a patient with a highly treatment-resistant ENB.

CLINICAL PRESENTATION
A 60-yr-old male presented with an ENB that recurred after chemotherapy, surgery, stereotactic radiosurgery, and immunotherapy. Pathology revealed a Hyams grade 3 ENB and the tumor had metastasized to lymph nodes. Tumor SSTR expression was seen on 68Ga-octreotate positron emission tomography (PET)/computed tomography (CT), suggesting that PRRT may be an option. He received 4 cycles of 177Lu-octreotate over 6 mo, with a partial response of all lesions and symptomatic improvement. Four months after the last PRRT cycle, 2 of the lesions rapidly relapsed and were successfully resected. Three months later, 68Ga-octreotate PET/CT and magnetic resonance imaging indicate no progression of the disease.

CONCLUSION
We describe imaging changes associated with 177Lu-octreotate PRRT of relapsing ENB. To our knowledge, this is the first report describing neuropathological changes associated with this treatment. PRRT is a promising therapeutic option to improve the disease control, and potentially, the survival of patients with refractory ENB.
The Role of the Visor Flap in Scalp Reconstruction: A Case Series of 21 Patients
Authors: Ellis Marco , Hwang Lisa , Ford Ni-Ka , Slavin Konstantin 
Published: March 2018

Abstract

BACKGROUND
Full-thickness scalp defects pose a reconstructive problem, especially in the setting of infection, chemotherapy/radiation, and underlying cranial defects. Current options include dermal matrices, skin grafts, and local flaps. Local flaps often fail, requiring subsequent microvascular free flap reconstruction.

OBJECTIVE
To describe the visor flap, a novel bipedicled advancement flap design, and its role in reconstruction of scalp defects.

METHODS
A retrospective review of 21 adult patients who developed scalp defects reconstructed using the visor flap from 2013 to 2017. The visor flap is a large bipedicled advancement flap design with a triangular extension at the base, which allows redistribution of a large surface area of the scalp.

RESULTS
All 21 patients achieved complete and viable soft tissue coverage of the recipient site, but 19.0% developed complications unrelated to flap viability, requiring reoperation (infected bone flap, epidural hematoma, and recurrent glioblastoma with subdural abscess). Only 1 patient required conversion to free flap reconstruction due to cerebrospinal fluid leak. Etiologies included cancer (76.1%), cerebrovascular disease (19.0%), and traumatic brain injury (4.8%). Preoperative radiation (42.9%), bone/hardware exposure (57.1%), and previous craniotomy (85.7%) were widely prevalent. Defect size ranged from 3 to 50 cm2 (mean, 16.9 cm2), and flap size ranged from 90 to 500 cm2 (mean, 222 cm2).

CONCLUSION
The visor flap provides an innovative solution for closure of scalp defects. This technique optimizes immediate closure of tissue compromised by infection or chemotherapy/radiation without burning bridges to more complex reconstructive options.
Determinants of Lactic Acidosis in Acute Cyanide Poisonings
Authors: Baud Frédéric J. , Haidar Mohamad K. , Jouffroy Romain , Raphalen Jean-Herlé , Lamhaut Lionel , Carli Pierre 
Published: March 2018

Objectives:
To investigate the magnitude of lactic acidosis in response to cyanide poisoning compared with the secondary response caused by cardiovascular shock.

Design:
Retrospective case-control observational study.

Setting:
University Hospital of Assistance Publique – Hôpitaux de Paris.

Subjects:
Patients admitted for suspicion of cyanide poisoning or drug overdose. Medical charts provided by Assistance Publique - Hôpitaux de Paris of patients between January 1988 and December 2015.

Intervention:
None.

Measurements and Main Results:
Twelve cyanide poisoned patients were matched to 48 controls by age, sex, systolic blood pressure, catecholamine administration, and outcome at discharge from ICU. Extracted data included age, sex, vital signs, symptoms, biochemical parameters, toxicological analysis, treatment, and outcome. Non-parametric tests were used. Multivariable analysis was used to adjust for confounders causing hyperlactacidemia. The median blood lactate concentration was significantly greater in the cyanide group (15.6 mmol/L) compared to the control group (4.1 mmol/L; p = 0.0003). Similarly, blood lactate concentration greater than or equal to 8 mmol/l was observed in 83% of the cyanide cases versus 27% of the matched controls. Multivariate analysis conferred hyperlactacidemia as the lone factor which significantly predicted cyanide poisoning at an odds of 73.0 (5.7-936.1). Moreover, blood cyanide level significantly correlated with the increase of blood lactate (p = 0.0033).

Conclusions:
This study supports the hypothesis lactic acidosis primarily results from the direct toxicity of cyanide.
RETINAL NEOVASCULARIZATION FROM A PATIENT WITH CUTIS MARMORATA TELANGIECTATICA CONGENITA
Authors: Sassalos Thérèse M. , Fields Taylor S. , Levine Robert , Gao Hua 
Published: March 2018

Purpose:
To report a rare case of peripheral retinal neovascularization in a patient diagnosed with cutis marmorata telangiectatica congenita (CMTC).

Methods:
Observational case report.

Results:
A 16-year-old girl was referred to clinic for retinal evaluation. The patient had a clinical diagnosis of CMTC later confirmed by skin biopsy. Examination revealed temporal peripheral retinal sheathing, as well as lattice degeneration in both eyes. Wide-field fluorescein angiogram showed substantive peripheral retinal nonperfusion with evidence of vascular leakage from areas of presumed retinal neovascularization. The patient subsequently had pan retinal photocoagulation laser treatment to each eye without complication.

Discussion:
Cutis marmorata telangiectatica congenita is a rare vascular condition known to affect multiple organ systems including the eyes. Although ocular manifestations of CMTC are rare, instances of congenital glaucoma, suprachoroidal hemorrhage, and bilateral total retinal detachments resulting in secondary neovascular glaucoma have been reported. Our patient demonstrates the first reported findings of peripheral nonperfusion and retinal neovascularization related to CMTC in a 16-year-old girl. We propose early retinal examination, wide-field fluorescein angiogram, and early pan retinal photocoagulation laser treatment in patients with peripheral nonperfusion and retinal neovascularization from CMTC.
Maternal Carriage of Group B Streptococcus and Escherichia coli in a District Hospital in Mozambique
Authors: Madrid Lola , Maculuve Sonia Amós , Vilajeliu Alba , Sáez Emma , Massora Sergio , Cossa Anelsio , Varo Rosauro , Sitoe Antonio , Mosqueda Noraida , Anselmo Rui , Munguambe Khatia , Soto Sara M. , Moraleda Cinta , Macete Eusebio , Menéndez Clara , Bassat Quique 
Published: March 2018

Background:
In low-income countries, data on prevalence and effects of group B Streptococcus (GBS) and Escherichia coli (E. coli) colonization among pregnant women are scarce, but necessary to formulate prevention strategies. We assessed prevalence of GBS and E. coli colonization and factors associated among pregnant women, its effect in newborns and acceptability regarding the utilized sampling methods in a semirural Mozambican hospital.

Methods:
Pregnant women were recruited from June 2014 to January 2015, during routine antenatal clinics at gestational age ≥ 34 weeks (n = 200); or upon delivery (n = 120). Maternal risk factors were collected. Vaginal and vagino-rectal samples for GBS and E. coli determination were obtained and characterized in terms of antimicrobial resistance and serotype. Anti-GBS antibodies were also determined. Neonatal follow-up was performed in the first 3 months after birth. Semistructured interviews were performed to investigate acceptability of sample collection methods.

Results:
In total, 21.3% of women recruited were GBS carriers, while 16.3% were positive for E. coli. Prevalence of HIV was 36.6%. No association was found between being colonized by GBS and E. coli and maternal risk factors. GBS isolates were fully susceptible to penicillin and ampicillin. Serotypes V (32.4%), Ia (14.7%) and III (10.3%) were the most commonly found and 69.2% of the women tested had immunoglobuline G antibodies against GBS. E. coli isolates showed resistance to ampicillin in 28.9% and trimethoprim/sulfamethoxazole in 61.3% of the cases.

Conclusion:
Prevalence of GBS and/or E. coli colonization among pregnant women is high in this semirural community and comparable with those reported in similar settings. Four serotypes accounted for nearly 70% of all isolates of GBS. Population-based data on infant GBS infections would enable the design of prevention strategies for GBS disease in Mozambique.
Human Parechovirus 1, 3 and 4 Neutralizing Antibodies in Dutch Mothers and Infants and Their Role in Protection Against Disease
Authors: Karelehto Eveliina , Wildenbeest Joanne G. , Benschop Kimberley S. M. , Koen Gerrit , Rebers Sjoerd , Bouma-de Jongh Saskia , Westerhuis Brenda M. , de Jong Menno D. , Pajkrt Dasja , Wolthers Katja C. 
Published: March 2018

Background:
Human parechoviruses (HPeVs) are common pathogens in young children, and in the Netherlands, HPeV1, HPeV3 and HPeV4 are the most frequently detected genotypes. HPeV3 in particular has been associated with severe disease in young infants below 3 months of age while the other genotypes more often infect older children and elicit mild symptoms. We investigated if maternal neutralizing antibodies (nAbs) against HPeV1, HPeV3 and HPeV4 protect young Dutch infants from severe disease related to HPeV infection.

Methods:
We conducted a prospective case–control study of Dutch mother–infant pairs. Thirty-eight HPeV-infected infants and their mothers were included as cases, and 65 HPeV-negative children and their mothers as controls.

Results:
In control infants, we observed nAb seropositivity rates of 41.4%, 33.3% and 27.6%, with median nAb titers of 1:16, 1:12 and 1:8, against HPeV1, HPeV3 and HPeV4, respectively. In control mothers, nAb seropositivity rates were 84.6%, 55.4% and 60.0% with median nAb titers of 1:128, 1:32 and 1:45 against HPeV1, HPeV3 and HPeV4, respectively. The HPeV3 nAb seroprevalence was significantly lower in HPeV3-infected infants and their mothers (0.0% with P < 0.05 and 10.0% with P < 0.001, respectively). In contrast, no differences in nAb seroprevalence against HPeV1 or HPeV4 could be detected between case and control infants or mothers.

Conclusions:
Our results suggest that young Dutch infants are protected against severe disease related to HPeV1 and HPeV4 by maternal nAbs, but less so against HPeV3 explaining the distinct age distributions and disease severity profiles of children infected with these HPeV genotypes.
Brown adipose tissue and lipid metabolism
Authors: Heeren Joerg , Scheja Ludger 
Published: March 2018

Purpose of review
This article explores how the interplay between lipid metabolism and thermogenic adipose tissues enables proper physiological adaptation to cold environments in rodents and humans.

Recent findings
Cold exposure triggers systemic changes in lipid metabolism, which increases fatty acid delivery to brown adipose tissue (BAT) by various routes. Next to fatty acids generated intracellularly by de-novo lipogenesis or by lipolysis at lipid droplets, brown adipocytes utilize fatty acids released by white adipose tissue (WAT) for adaptive thermogenesis. WAT-derived fatty acids are internalized directly by BAT, or indirectly after hepatic conversion to very low-density lipoproteins and acylcarnitines. In the postprandial state, chylomicrons hydrolyzed by lipoprotein lipase – activated specifically in thermogenic adipocytes – are the predominant fatty acid source. Cholesterol-enriched chylomicron remnants and HDL generated by intravascular lipolysis in BAT are cleared more rapidly by the liver, explaining the antiatherogenic effects of BAT activation. Notably, increased cholesterol flux and elevated hepatic synthesis of bile acids under cold exposure further promote BAT-dependent thermogenesis.

Summary
Although pathways providing fatty acids for activated BAT have been identified, more research is needed to understand the integration of lipid metabolism in BAT, WAT and liver, and to determine the relevance of BAT for human energy metabolism.
Mucosal Impedance Measurements Differentiate Pediatric Patients With Active Versus Inactive Eosinophilic Esophagitis
Authors: Lowry Mary Allyson , Vaezi Michael F. , Correa Hernan , Higginbotham Tina , Slaughter James C. , Acra Sari 
Published: March 2018

ABSTRACTBackground and Aims:Eosinophilic esophagitis (EoE) is a chronic disorder in children that requires continued assessment of disease activity, involving repeated sedation, endoscopy, and biopsy analysis. We investigated whether mucosal impedance measurements can be used to monitor disease activity in pediatric patients with EoE.Methods:We measured mucosal impedance at 3 locations in the esophagus in pediatric patients (1–18 years old; 32 with active EoE, 10 with inactive EoE, 32 with nonerosive reflux disease [NERD]) and 53 children with symptoms but normal findings from histologic analyses (controls) undergoing routine esophagogastroduodenoscopy at the Vanderbilt Pediatric Gastroenterology Clinic. Pathologists reviewed biopsies per routine protocol, determined eosinophilic density, and graded spongiosis on an ordinal visual scale. Mucosal impedance measurements were compared within patient groups. The primary outcome was correlation of mucosal impedance measurements with disease activity, based on severity of spongiosis and eosinophil counts.Results:Mucosal impedance measurements were significantly lower in patients with active EoE at 2, 5, and 10 cm above the squamo‐columnar junction (median values of 1069, 1368, and 1707, respectively) compared to patients with inactive EoE (median values of 3663, 3657, and 4494, respectively), NERD (median values of 2754, 3243, and 4387), and controls (median values of 3091, 3760, and 4509) (P < 0.001 for all comparisons to patients with active EoE). We found inverse correlations between mucosal impedance measurements and eosinophil count (P < 0.001), and spongiosis severity (P < 0.001).Conclusions:Mucosal impedance measurements may provide immediate information about mucosal inflammation in children. Patients with active EoE have significantly lower mucosal impedance values than patients with inactive EoE, NERD, or controls; mucosal impedance measurements correlate inversely with eosinophil counts and spongiosis severity. Mucosal impedance is a promising rapid and less‐invasive method to monitor EoE activity in pediatric patients with EoE; it could reduce costs and risks of disease monitoring.
Anatomic Study on Sphenoidal Emissary Foramen by Using Cone-Beam Computed Tomography
Authors: Bayrak Seval , Kurşun-Çakmak Emine Şebnem , Atakan Cemal , Orhan Kaan 
Published: March 2018

Objectives:
The goal of this retrospective study is to evaluate the radiologic anatomy of sphenoidal emissary foramen (SEF) by using cone-beam computed tomography (CBCT) scans.

Methods:
Three hundred seventeen (189 female and 128 male) full-head CBCT images were evaluated in this study. Incidence, diameter, shape, confluence to foramen ovale, and distance to anatomic structures of SEF were noted.

Results:
In the 317 analyzed images, the SEF was identified in 89 (28.1%) images. Of these, 67 (21.1%) were unilateral, 22 were (6.9%) bilateral. The maximum mean diameter of SEF was measured 2.66 mm on the right side and 2.82 mm on the left side (P = 0.16). The most observed SEF shape was oval with the incidence of 68.5% (P ≤ 0.05). Confluence was observed in 23.4% of SEF whereof 84.6% were in the left side (P ≤ 0.05).

Conclusion:
Observations in this study tender new anatomic parameters regarding SEF incidence, characteristics, and distances to proximate anatomic structures. Knowledge related to SEF variations will be helpful for neurosurgeons and radiologist.
Neurological syndromes driven by postinfectious processes or unrecognized persistent infections
Authors: Johnson Tory P. , Nath Avindra 
Published: March 2018

Purpose of review
The immune system serves a critical role in protecting the host against various pathogens. However, under circumstances, once triggered by the infectious process, it may be detrimental to the host. This may be as a result of nonspecific immune activation or due to a targeted immune response to a specific host antigen. In this opinion piece, we discuss the underlying mechanisms that lead to such an inflammatory or autoimmune syndrome affecting the nervous system. We examine these hypotheses in the context of recent emerging infections to provide mechanistic insight into the clinical manifestations and rationale for immunomodulatory therapy.

Recent findings
Some pathogens endure longer than previously thought. Persistent infections may continue to drive immune responses resulting in chronic inflammation or development of autoimmune processes, resulting in damage to the nervous system. Patients with genetic susceptibilities in immune regulation may be particularly vulnerable to pathogen driven autoimmune responses.

Summary
The presence of prolonged pathogens may result in chronic immune stimulations that drives immune-mediated neurologic complications. Understanding the burden and mechanisms of these processes is challenging but important.