bluuebunny/crossref_metadata_2025_split huggingface dataset:
One-View Asymmetry
Authors: Levesque Paul H. , Sheiman Laura 
Published: March 2018

Abstract
This chapter, appearing in the section “Asymmetry, Mass, and Distortion,” will discuss the presence of tissue asymmetry visualized only on one view. The distribution of fibroglandular tissue is extremely variable and unique from one patient to another; however, in most patients the parenchyma is usually distributed within the breasts symmetrically in a “mirror-image” fashion. Areas of tissue density (asymmetry) may be seen that are only visualized on the craniocaudal (CC) or mediolateral oblique (MLO) view. In the majority of patients, this finding represents superimposed normal tissue, or islands of normal parenchyma. Occasionally, underlying benign lesions may present as a tissue asymmetry. Rarely, a one-view asymmetry may represent a malignancy. This section will discuss the imaging features (including mammography, tomosynthesis, and ultrasound assessment), clinical features, differential diagnosis, and management suggestions for one-view asymmetries.
Two-View Asymmetry
Authors: Valencia Elizabeth M. , Lee Christoph I. 
Published: March 2018

Abstract
This chapter reviews key imaging features, protocols, pitfalls, differential diagnoses, and management recommendations for a two-view asymmetry. A focal asymmetry is a small amount of fibroglandular dense tissue seen on two views that is asymmetric compared to the contralateral breast. A global asymmetry is defined as a large focal asymmetry that extends beyond one breast quadrant. A developing asymmetry is defined as a focal asymmetry that is new, denser, or larger when compared to prior mammograms. In general, an asymptomatic global asymmetry is considered a normal variant. In contrast, a developing asymmetry should be evaluated with greater suspicion. Topics discussed in the chapter are superimposition, global asymmetry, developing asymmetry, and triangulation.
Non-Mass Enhancement on MRI
Authors: Lam Diana L. , Rahbar Habib 
Published: March 2018

Abstract
Breast cancer presents on MRI as an enhancing finding on post-contrast T1-weighted images that is distinct from normal background parenchymal enhancement (BPE), and these enhancing lesions can be further described as a focus, mass, or non-mass enhancement (NME). Each enhancing lesion, with the exception of a focus, can be described further with specific morphological features that are defined by the ACR BI-RADS Atlas. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of a focus of enhancement and non-mass enhancement on MRI. Topics discussed include distinguishing a focus from normal BPE, benign versus suspicious features of a focus, NME characterization, and kinetic enhancement curves.
Amorphous/Indistinct Calcifications (Group)
Authors: Wang Lilian 
Published: March 2018

Abstract
Amorphous calcifications are calcifications that are sufficiently small and/or hazy that a more specific morphological classification cannot be made. Historically, such calcifications were referred to as “indistinct” calcifications. The likelihood of malignancy and the management of amorphous calcifications largely depend on their distribution. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis with radiology–pathology correlation, and management recommendations for amorphous/indistinct calcifications in a group. Topics discussed include spot magnification views for characterization, role of distribution in BI-RADS assessment, and pathological entities, including fibrocystic change, milk of calcium, atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS).
Nipple Discharge
Authors: Winkler Nicole S. 
Published: March 2018

Abstract
Nipple discharge refers to expressible or spontaneous drainage of fluid from one or more duct orifices of the nipple. Discharge indicates excess fluid secretion into one or more ducts that will drain through an unobstructed duct orifice onto the nipple skin. The fluid content and appearance are important as they have clinical implications. Nipple discharge that is clear or bloody, unilateral (typically uniductal) and spontaneous (fluid discharges without breast or nipple compression) is considered suspicious for malignancy, though most cases are due to benign papillomas. This chapter, appearing in the section on nipple, skin and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple discharge. Topics discussed include clinical evaluation of nipple discharge, sonographic evaluation of ducts and nipple, ductography, intraductal mass, and papilloma.
Nipple Abnormalities
Authors: Winkler Nicole S. 
Published: March 2018

Abstract
New nipple retraction and new nipple inversion can be secondary to malignancy, post-surgical change, inflammation, or infection. Paget disease of the nipple is characterized by an inflammatory response of the nipple epidermis to malignant cells extending from ductal carcinoma in the lactiferous sinus. A mass arising within the nipple is rare and usually a variant of a papilloma arising in the nipple (nipple adenoma). This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple retraction. Topics discussed include imaging features of nipple retraction, both benign and malignant causes of nipple retraction, Paget disease of the nipple, and masses occurring in the nipple.
Skin Calcifications
Authors: Freer Phoebe E. 
Published: March 2018

Abstract
Dermal and epidermal calcifications in the breast are extremely common and are typically benign, of no clinical significance, and are unrelated to breast cancer. If the radiologist attempts to do a mammographically guided needle localization for surgical excisional biopsy of calcifications that are not recognized to be in the dermis, it is possible that the patient may proceed to surgical biopsy with no calcifications seen in the excised specimen. Therefore, it is important to recognize dermal calcifications as such at the time of screening or diagnostic imaging. This chapter reviews the key imaging and clinical features of skin calcifications that may be encountered either incidentally on breast imaging or on diagnostic imaging when a patient has been recalled from screening for grouped calcifications. Topics discussed include obtaining tangent views to accurately diagnose skin calcifications, as well as how to recognize calcifications on tomosynthesis.
Cyst/Abscess Aspiration
Authors: Falomo Eniola T. 
Published: March 2018

Abstract
Aspiration is the process of draining a fluid-filled structure, such as a cyst or an abscess, and is typically performed under ultrasound guidance. Cyst aspiration can be done for symptomatic relief (in patients with associated pain or tenderness), and for cases of presumed cysts with sonographic features that are not entirely diagnostic of a cyst. In the latter case, aspiration is performed to help distinguish between a complicated cyst and a solid mass. This chapter, appearing in the section on interventions and surgical procedures, reviews the procedural protocols and pitfalls, clinical management, and imaging follow-up involved in a cyst or abscess aspiration procedure. Topics discussed include indications for performing a cyst or abscess drainage procedure, procedural steps, post-procedure follow-up, and appropriate management of complex masses.
Evaluation of Intranasal Flap Perfusion by Intraoperative Indocyanine Green Fluorescence Angiography
Authors: Geltzeiler Mathew , Nakassa Ana Carolina Igami , Turner Meghan , Setty Pradeep , Zenonos George , Hebert Andrea , Wang Eric , Fernandez-Miranda Juan , Snyderman Carl , Gardner Paul 
Published: March 2018

Abstract

BACKGROUND
Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability.

OBJECTIVE
To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study.

METHODS
ICG near-infrared fluorescence endoscopy was performed during endoscopic endonasal surgery for skull base tumors. Intraoperative and postoperative data were collected regarding enhancement of the flap body and pedicle. Fluorescence was rated qualitatively. Postoperatively, flap perfusion was evaluated via MRI-contrast enhancement in addition to clinical outcomes (cerebrospinal fluid leak and endoscopic flap appearance).

RESULTS
Thirty-eight patients underwent ICG fluorescence angiography. Both the body and pedicle enhanced in 20 patients (53%), while the pedicle only enhanced for 12 patients (32%), the body only for 3 (8%), and neither for 3 (8%). When both the pedicle and body enhanced with ICG, the rate of postoperative MRI contrast enhancement was 100% and the rate of flap necrosis was 0%. The sensitivity and specificity of flap pedicle ICG enhancement for predicting postoperative flap MRI enhancement were 97% and 67%, respectively. Two of 3 patients without enhancement developed flap necrosis.

CONCLUSION
ICG fluorescence angiography of intraoperative flap perfusion is feasible and correlates well with outcomes of postoperative MRI flap enhancement and flap necrosis. Additional study is needed to further refine the imaging technique and optimally characterize the clinical utility.
Effectiveness of the Thoracic Pedicle Screw Placement Using the Virtual Surgical Training System: A Cadaver Study
Authors: Hou Yang , Lin Yanping , Shi Jiangang , Chen Huajiang , Yuan Wen 
Published: March 2018

Abstract

BACKGROUND
The virtual simulation surgery has initially exhibited its promising potentials in neurosurgery training.

OBJECTIVE
To evaluate effectiveness of the Virtual Surgical Training System (VSTS) on novice residents placing thoracic pedicle screws in a cadaver study.

METHODS
A total of 10 inexperienced residents participated in this study and were randomly assigned to 2 groups. The group using VSTS to learn thoracic pedicle screw fixation was the simulation training (ST) group and the group receiving an introductory teaching session was the control group. Ten fresh adult spine specimens including 6 males and 4 females with a mean age of 58.5 yr (range: 33-72) were collected and randomly allocated to the 2 groups. After exposing anatomic structures of thoracic spine, the bilateral pedicle screw placement of T6-T12 was performed on each cadaver specimen. The postoperative computed tomography scan was performed on each spine specimen, and experienced observers independently reviewed the placement of the pedicle screws to assess the incidence of pedicle breach.

RESULTS
The screw penetration rates of the ST group (7.14%) was significantly lower in comparison to the control group (30%, P < .05). Statistically significant difference in acceptable rates of screws also occurred between the ST (100%) and control (92.86%) group (P < .05). In addition, the average screw penetration distance in control group (2.37 mm ± 0.23 mm) was significantly greater than ST group (1.23 mm ± 0.56 mm, P < .05).

CONCLUSION
The virtual reality surgical training of thoracic pedicle screw instrumentation effectively improves surgical performance of novice residents compared to those with traditional teaching method, and can help new beginners to master the surgical technique within shortest period of time.
Intraoperative Nerve Monitoring in Robotic-Assisted Resection Of Presacral Ganglioneuroma: Operative Technique
Authors: Garzon-Muvdi Tomas , Belzberg Allan , Allaf Mohamad E , Wolinsky Jean-Paul 
Published: March 2018

Abstract

BACKGROUND
Robotic-assisted techniques have been implemented in the surgical treatment of tumors in the pelvis, abdomen, and thorax. In pelvic tumors, robotic-assisted techniques evade the need for sizable surgical exposure, but make stimulation of the nerves of the sacral plexus very difficult.

OBJECTIVE
To describe how laparoscopic robotic-assisted surgery can couple with tools such as the nerve stimulator to aid in the resection of presacral masses emanating from the neural elements and potentially improve neurological outcome by preventing inadvertent injury to involved nerves.

METHODS
A patient with a large presacral ganglioneuroma underwent resection using the DaVinci system (Intuitive Surgical, Sunnyvale, California) for robotic assistance. A nerve stimulator was coupled to the bipolar cautery instrument of the DaVinci robot to define the presence of functional nerves in the surroundings of the tumor.

RESULTS
By coupling a nerve stimulator to the bipolar cautery instrument of the DaVinci robot (Intuitive Surgical), it was possible to identify important neural structures in close proximity to the tumor. After identifying functional nerves, the surgeon was able to preserve them and preserve neurological function avoiding motor dysfunction.

CONCLUSION
The use of a nerve stimulator coupled to the bipolar cautery instrument of the DaVinci robot (Intuitive Surgical) during laparoscopic, robotic-assisted surgery for resection of presacral masses is safe and feasible. In addition to the preoperative evaluation, intraoperative monitoring and stimulation of nerves in close proximity to the tumor and also exiting through neural foramina involved by the tumor allowed the surgeon to understand the anatomy and preserve neurological function while obtaining optimal surgical resection.
Europol’s Crime Analysis System—Practical Determinants of Its Success
Authors: Safjański Tomasz , James Adrian 
Published: March 2018

Abstract
Threats to modern nation states from organized crime and terrorism create environments in which intelligence becomes a vital component of policing and security plans but the increasing use of personal data for law enforcement purposes can alter the normative relationships between stakeholders and law enforcement agencies and between agencies and citizens. For that reason, police intelligence practice demands critical examination. This paper presents a narrative inquiry, based on the authors’ experiential knowledge and empirical research, into Europol’s Crime Analysis System (ECAS). The study explains Europol’s efforts to develop data collection and analysis systems that meet the needs of EU Member States (MS). Through ECAS, it has created powerful tools intended to deliver intelligence products that help MS identify, localize, and neutralize transnational threats to a degree not witnessed before in Europe. Nevertheless, Europol’s performance in this context seems sub-optimal. Shortcomings largely are attributed to a lack of trust between Europol and MS leading to failures to share information between themselves and with the institution. The result is that the latter’s strategic intelligence products sometimes are deficient or incomplete. That should be of concern to stakeholders because Europol’s strategic intelligence efforts may be rendered ineffective. Shortcomings in Europol’s intelligence products also are significant for citizens because they may mean that the information-sharing process is less transparent and less accountable than citizens have a right to expect.
Comparison of Two Major Perioperative Bleeding Scores for Cardiac Surgery Trials
Authors: Bartoszko Justyna , Wijeysundera Duminda N. , Karkouti Keyvan ,   on behalf of the Transfusion Avoidance in Cardiac Surgery Study Investigators
Published: March 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Research into major bleeding during cardiac surgery is challenging due to variability in how it is scored. Two consensus-based clinical scores for major bleeding: the Universal definition of perioperative bleeding and the European Coronary Artery Bypass Graft (E-CABG) bleeding severity grade, were compared in this substudy of the Transfusion Avoidance in Cardiac Surgery (TACS) trial.

Methods
As part of TACS, 7,402 patients underwent cardiac surgery at 12 hospitals from 2014 to 2015. We examined content validity by comparing scored items, construct validity by examining associations with redo and complex procedures, and criterion validity by examining 28-day in-hospital mortality risk across bleeding severity categories. Hierarchical logistic regression models were constructed that incorporated important predictors and categories of bleeding.

Results
E-CABG and Universal scores were correlated (Spearman ρ = 0.78, P < 0.0001), but E-CABG classified 910 (12.4%) patients as having more severe bleeding, whereas the Universal score classified 1,729 (23.8%) as more severe. Higher E-CABG and Universal scores were observed in redo and complex procedures. Increasing E-CABG and Universal scores were associated with increased mortality in unadjusted and adjusted analyses. Regression model discrimination based on predictors of perioperative mortality increased with additional inclusion of the Universal score (c-statistic increase from 0.83 to 0.91) or E-CABG (c-statistic increase from 0.83 to 0.92). When other major postoperative complications were added to these models, the association between Universal or E-CABG bleeding with mortality remained.

Conclusions
Although each offers different advantages, both the Universal score and E-CABG performed well in the validity assessments, supporting their use as outcome measures in clinical trials.
No Reliable Association Between Recreational Noise Exposure and Threshold Sensitivity, Distortion Product Otoacoustic Emission Amplitude, or Word-in-Noise Performance in a College Student Population
Authors: Le Prell Colleen G. , Siburt Hannah W. , Lobarinas Edward , Griffiths Scott K. , Spankovich Christopher 
Published: March 2018

Objectives:
The purpose of this study was to evaluate the relationship between recreational sound exposure and potentially undiagnosed or subclinical hearing loss by assessing sound exposure history, threshold sensitivity, distortion product otoacoustic emission (DPOAE) amplitudes, and performance on the words-in-noise (WIN) test.

Design:
Survey data were collected from 74 adult participants (14 male and 60 female), 18 to 27 years of age, recruited via advertisements posted throughout the University of Florida campus. Of these participants, 70 completed both the survey and the additional functional test battery, and their preferred listening level was measured in a laboratory setting.

Results:
There were statistically significant relationships between hearing thresholds and DPOAE amplitude. In contrast, performance on the WIN was not reliably related to threshold sensitivity within this cohort with largely normal hearing. The two most common exposures included bars or dance clubs, followed by music player use. There were no statistically significant relationships between individual or composite measures of recreational sound exposure, including preferred listening level, years of music player use, number of reported sound exposures, previous impulse noise exposure, or previous noise-induced change in hearing, and functional measures including threshold, DPOAE amplitude, and WIN measures. Some subjects were highly consistent in listening level preferences, while others were more variable from song to song.

Conclusions:
No reliable relationships between common recreational sound exposure or previous noise-induced changes in hearing were found during analysis of threshold sensitivity, DPOAE amplitude, or WIN performance in this cohort. However, the study sample was predominantly female and Caucasian, which limits generalizability of the results.
PERIVASCULAR THICKENING ON OPTICAL COHERENCE TOMOGRAPHY AS A MARKER OF INFLAMMATION IN BIRDSHOT RETINOCHOROIDITIS
Authors: Thomas Akshay S. , Hatef Angel L. , Stinnett Sandra S. , Keenan Robert T. , Jaffe Glenn J. 
Published: March 2018

Purpose:
In this study, we hypothesized that thickening along the major arcade vessels is a noninvasive marker of inflammation in eyes with birdshot retinochoroiditis (BRC).

Methods:
In this single-center retrospective study, patients with BRC were identified. Perivascular thickening was categorized as mild, moderate, or severe, based on a set of standard reference retinal thickness maps derived from representative spectral domain optical coherence tomography volume scans. The assigned perivascular severity thickness category was then compared with other inflammatory markers and optical coherence tomography measurements. These parameters were also examined in eyes with intermediate uveitis to assess the diagnostic specificity of perivascular thickening.

Results:
In eyes with BRC, greater perivascular thickening was associated with increased vitreous haze (P = 0.009) and retinal vascular leakage on fluorescein angiography (P = 0.0001). Perivascular thickening was correlated with central subfield thickness and total macular volume on optical coherence tomography. Controlling for central subfield thickness and total macular volume, the odds of higher severity level of perivascular thickening were nine times greater in eyes with BRC than those with intermediate uveitis (P < 0.0001). Eyes with BRC and active inflammation were more likely to have moderate or severe perivascular thickening (P = 0.02).

Conclusion:
Perivascular thickening, determined by optical coherence tomography, may be a useful noninvasive biomarker of inflammation in eyes with BRC.
Role of Dendritic Cells and Inflammatory Cells in Herpetic Endotheliitis: Analysis Using In Vivo Confocal Microscopy
Authors: Wang Ting , Dong Muchen , Jiang Yin , Wang Shuting , Shi Weiyun 
Published: March 2018

Purpose:
To observe the pathological changes in dendritic cells (DCs) and inflammatory cells in the corneal epithelium and endothelium using in vivo confocal microscopy during the management of herpetic endotheliitis.

Methods:
A total of 110 eyes with herpetic endotheliitis were included. All patients were treated with antiviral agents combined with glucocorticoids. Changes in corneal edema were observed using slit-lamp microscopy and anterior segment optical coherence tomography. DCs and inflammatory cells in the epithelium and endothelium were detected using in vivo confocal microscopy before treatment and at 1 to 2 weeks and 1 and 3 months after treatment. Recurrence was monitored for 2 years. The contralateral normal eyes were evaluated as controls.

Results:
Mean density of DCs decreased at 1 month after treatment (100 ± 14 cells/mm2) compared with before treatment (148 ± 26 cells/mm2, P < 0.001). At 3 months, DCs returned to small and dendritiform reflective corpuscular cells at a density of 44 ± 11 cells/mm2 (P < 0.001), and the mean density of endothelial cells (2011 ± 173 cells/mm2) was significantly lower than in controls (2472 ± 233 cells/mm2, P = 0.002). Inflammatory cells residing in the epithelium were significantly reduced in number and disappeared at 1 to 2 weeks, and those at the endothelial surface almost disappeared at 1 month. There was no relapse during the follow-up evaluation.

Conclusions:
DCs and inflammatory cells in the epithelial and endothelial cell layers of the cornea changed constantly in density, morphology, and distribution during the therapeutic process of herpetic endotheliitis. Adequate understanding of these alterations may help to guide the management of this disease.