bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coarse Heterogeneous Calcifications
Authors: Fischer Cheryce Poon 
Published: March 2018

Abstract
Coarse heterogeneous calcifications are irregular calcifications that are between 0.5 mm and 1 mm in size. They are usually in a group and are smaller in size than dystrophic calcifications. Although they are of intermediate risk for breast cancer (most commonly, DCIS), they are also associated with benign entities, such as hyalinized/degenerating fibroadenoma, areas of fibrosis, papilloma, and evolving dystrophic calcifications from prior surgery or trauma. Generally, numerous bilateral groups of coarse heterogeneous calcifications may be considered benign. However, baseline magnification views may be helpful to confirm the morphology of the calcifications and to exclude more suspicious pleomorphic morphology. Coarse heterogeneous calcifications in a linear or segmental distribution are suspicious. This chapter reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for coarse heterogeneous calcifications.
Skin and Trabecular Thickening
Authors: Freer Phoebe E. 
Published: March 2018

Abstract
Normal skin measures 0.5–2 mm thick, but may be thicker in the periareolar, axillary, parasternal, and inframammary fold regions. Trabecular thickening—thickening of the Cooper’s ligaments and fibrous stroma—is an imaging finding of breast edema, usually secondary to dilated lymphatics. Their differential diagnosis may be narrowed by considering the distribution of the findings; for example, considering if the finding is focal or diffuse, or if the process is unilateral or bilateral. This chapter reviews the key imaging and clinical features of skin and trabecular thickening. Skin thickening and trabecular thickening often occur together, and they have similar differential diagnoses. The differential diagnosis will be reviewed based on distribution (unilateral vs. bilateral, focal vs. diffuse). Topics discussed include mastitis, inflammatory cancer, systemic causes of edema (congestive heart failure), and other rare presentations of disease such as lymphoma and granulomatous mastitis.
Skin Lesions
Authors: Freer Phoebe E. 
Published: March 2018

Abstract
Skin lesions are commonly seen on breast imaging. Often, a raised skin lesion is encountered incidentally during screening mammography and can be mistaken for a mass within the breast parenchyma. In most cases, lesions confined within the dermis are benign. Occasionally, focal skin involvement may be the presenting sign of a breast cancer that is either locally extensive to the skin or has an inflammatory component. This chapter reviews the key imaging and clinical features of skin lesions that may be encountered either incidentally on breast imaging or on diagnostic imaging as an area of patient concern. Imaging features of skin lesions, the differential diagnoses, and further management will be reviewed. Topics discussed include benign epithelial cysts (i.e., sebaceous cyst and epidermal inclusion cysts), seborrheic keratosis, keloid and dermal nevi, cellulitis, and inflammatory and locally advanced breast cancers.
Radiology–Pathology Correlation
Authors: Denham S. LeeAnn , Umphrey Heidi R. 
Published: March 2018

Abstract
Over 1 million image-guided breast biopsies, guided by mammography, ultrasound, or magnetic resonance imaging, are performed annually in the United States. When the imaging characteristics of a lesion correspond to the histopathological diagnosis (e.g., suspicious imaging findings and malignant pathology), the biopsy results are deemed concordant. However, when the imaging characteristics differ from the pathological results (e.g., suspicious imaging findings but benign pathology), this biopsy result is considered discordant. This chapter, appearing in the section on interventions and surgical change, reviews the process of determining concordance between imaging and pathological findings, and managing discordant findings. Topics discussed include benign pathology results with suspicious imaging appearances, as well as the management of high-risk lesions, locally aggressive breast lesions, and malignant breast lesions.
Breast Implants
Authors: DeBruhl Nanette D. , Yaghmai Nazanin 
Published: March 2018

Abstract
The presence of breast implants limits the amount of tissue that can be visualized on mammography and tomosynthesis. The proper mammographic positioning of the breasts of women with implants requires special training. More tissue can be visualized in women with sub-pectoral implants than in women with sub-glandular implants. Women with implants are recommended to have age-appropriate routine interval screening mammography for detection of cancer. If an implant rupture is suspected, ultrasound and MRI are used as adjunct imaging modalities. This chapter, appearing in the section on breast implants, reviews the key imaging and clinical features, imaging protocols and pitfalls, and management recommendations for breast implants. Topics discussed include types of implants, imaging findings of intact implants, and signs of ruptured implants, using mammography, ultrasound, and magnetic resonance imaging.
Post-Reconstruction Breast
Authors: Joines Melissa M. 
Published: March 2018

Abstract
Breast reconstruction may be performed after mastectomy to improve breast symmetry. Each reconstruction technique leads to a characteristic appearance on post-operative imaging; thus, familiarity with the surgical techniques as well as the imaging features of the reconstructed breast across multiple modalities is important for radiologists. In addition, an understanding of the common benign complications as well as features of tumor recurrence is important. This chapter, appearing in the section on interventions and surgical change, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for the reconstructed breast. Topics discussed include tissue expander/implant and autologous tissue flap reconstruction, reconstruction complications, tumor recurrence, and management recommendations.
Comparison of Fusion Rates Based on Graft Material Following Occipitocervical and Atlantoaxial Arthrodesis in Adults and Children
Authors: Robinson Leslie C , Anderson Richard C E , Brockmeyer Douglas L , Torok Michelle R , Hankinson Todd C ,   Pediatric Craniocervical Society
Published: March 2018

Abstract

BACKGROUND
Fusion rates following rigid internal instrumentation for occipitocervical and atlantoaxial instability approach 100% in many reports. Based on this success and the morbidity that can be associated with obtaining autograft for fusion, surgeons increasingly select alternative graft materials.

OBJECTIVE
To examine fusion failure using various graft materials in a retrospective observational study.

METHODS
Insurance claims databases (Truven Health MarketScan® [Truven Health Analytics, Ann Arbor, Michigan] and IMS Health Lifelink/PHARMetrics [IMS Health, Danbury, Connecticut]) were used to identify patients with CPT codes 22590 and 22595. Patients were divided by age (≥18 yr = adult) and arthrodesis code, establishing 4 populations. Each population was further separated by graft code: group 1 = 20938 (structural autograft); group 2 = 20931 (structural allograft); group 3 = other graft code (nonstructural); group 4 = no graft code. Fusion failure was assigned when ≥1 predetermined codes presented in the record ≥90 d following the last surgical procedure.

RESULTS
Of 522 patients identified, 419 were adult and 103 were pediatric. Fusion failure occurred in 10.9% (57/522) of the population. There was no statistically significant difference in fusion failure based on graft material. Fusion failure occurred in 18.9% of pediatric occipitocervical fusions, but in 9.2% to 11.1% in the other groups.

CONCLUSION
Administrative data regarding patients who underwent instrumented occipitocervical or atlantoaxial arthrodesis do not demonstrate differences in fusion rates based on the graft material selected. When compared to many contemporary primary datasets, fusion failure was more frequent; however, several recent studies have shown higher failure rates than previously reported. This may be influenced by broad patient selection and fusion failure criteria that were selected in order to maximize the generalizability of the findings.
Stereoelectroencephalography-Guided Laser Ablations in Patients With Neocortical Pharmacoresistant Focal Epilepsy: Concept and Operative Technique
Authors: Ross Louis , Naduvil Ahsan M , Bulacio Juan C , Najm Imad M , Gonzalez-Martinez Jorge A 
Published: March 2018

Abstract

BACKGROUND
Laser ablation surgery has had encouraging results in the treatment of multiple intracranial diseases including primary and metastatic brain tumors, radiation necrosis, and epilepsy. The use of the stereoelectroencephalography (SEEG) method in combination with laser thermocoagulation therapy with the goal of modulating epileptic networks in patients with neocortical nonlesional phamacoresistant epilepsy has not been previously described.

OBJECTIVE
To describe the novel methodological and conceptual aspects related to SEEG-guided laser ablations in patients with magnetic resonance imaging (MRI)-negative pharmacoresistant neocortical focal epilepsy.

METHODS
Guided by previous SEEG intracranial data, a laser ablation probe was inserted by using a robotic guidance device in a 17-yr-old medically refractory epilepsy patient with difficult to localize seizures and nonlesional MRI. The laser applicator position was confirmed by MRI, targeting the left mesial rostral superior frontal gyrus. The ablation was performed under multiplanar digital imaging views and real-time thermal imaging and treatment estimates in each plane. A postablation MRI (contrasted T1 sequence) confirmed the ablation's location and size.

RESULTS
The entire procedure was achieved in approximately 100 min. The actual ablation was performed in less than 3 min. Approximately, additional 30 min preoperatively were used for positioning and robot registration. Precise placement of laser application (in comparison with preplanned trajectories) was achieved using the robotic guidance and confirmed by the intraoperative magnetic resonance images. No complications were reported. The patient has been seizure-free since surgery. The follow-up period is 20 mo. Two additional patients, treated with similar methodology, are also described.

CONCLUSION
The preliminary experience with the described method shows the feasibility of a unique combination of the SEEG methodology with laser thermocoagulation in patients with neocortical MRI-negative pharmacoresistant focal epilepsy.
A Novel Approach for Responsive Neural Stimulator Implantation With Infraclavicular Placement of the Internal Pulse Generator
Authors: Philipp Lucas R , Witcher Mark R , Gross Robert E 
Published: March 2018

Abstract

INTRODUCTION
The Responsive Neurostimulation System (RNS, Neuropace, Mountain View, California) has been proven to be effective at reducing seizures in patients with partial-onset epilepsy. The system incorporates a skull-mounted neurostimulator that requires a cranial incision for replacement. Although integral to the functioning of the system, in some circumstances, such as in the setting of infection, this can be disadvantageous. At present, there are no alternatives to cranial implantation of the RNS System.

METHODS
We describe a novel procedure enabling implantation of the neurostimulator within the chest wall, using components from a peripheral nerve stimulator. In a patient who achieved complete seizure freedom with the use of the RNS System, distant site implantation provided a viable means of continuing therapy in a setting where device explantation would have otherwise been inevitable as a result of cranial infection. We present continuous electrocorticographic data recorded from the device documenting the performance of the system with the subclavicular neurostimulator.

RESULTS
Band pass detection rates increased by 50%, while line length detection rates decreased by 50%. The number of detections decreased from 1046 to 846, with a resultant decrease in stimulations. Although there was some compromise of function due to the elevated noise floor, more than 2 yr following the procedure the patient remains free of seizures and infection.

CONCLUSION
The salvage procedure we describe offered an alternative therapeutic option in a patient with a complicated cranial wound issue, using heterogeneous components with marginal compromises in device functionality and no sacrifice in patient outcome.
Concurrent Placement of Bilateral Suboccipital and Supraorbital Nerve Stimulators Using On-Q* Tunneler: Technical Note
Authors: Massie Lara , Ali Rushna , Slavin Konstantin V , Schwalb Jason M 
Published: March 2018

Abstract

BACKGROUND
Stimulation of the occipital and supraorbital nerves is used to treat chronic migraine refractory to medical management. Placement of cranial leads is often challenging due to the rigid Touhy needle included in the kit for its placement.

OBJECTIVE
To report the first case of concurrent placement of bilateral supraorbital (SNS) and occipital nerve stimulators (ONS) from a unilateral approach using the On-Q* Tunneler, (Halyard Health, Alpharetta, Georgia) a flexible, blunt tipped plastic tunneler with a tear-away sheath.

METHODS
We present the case of a 49-yr-old female with debilitating daily holocephalic headaches who underwent placement of SNS and ONS through a cervical and left temporal incision at an outside hospital. She presented to our institution with purulent drainage from the temporal incision and the system was removed. We describe an alternative approach to bilateral SNS and ONS placement with a soft flexible tunneling device, which facilitated placement of the entire system through a right temporal incision, thereby avoiding her previously infected surgical sites.

RESULTS
The patient reported complete resolution of her daily headaches and was able to resume her activities as a full-time student.

CONCLUSION
The flexibility of the On-Q tunneler device (Halyard Health) allows the placement of bilateral SNS and ONS from a unilateral incision, thereby minimizing the cosmetic effect and infectious risk of this procedure.
Cultural Integration Online: The Lived Experience of English-as-a-Second-Language RN-BSN Nursing Students Learning in an Online Environment
Authors: Sailsman Sonique , Rutherford Marcella , Tovin Melissa , Cianelli Rosina 
Published: March 2018

Abstract

AIM
The aim of this study was to explore the lived experience of RN-BSN English-as-a-second-language (ESL) nursing students who are engaged in learning online.

BACKGROUND
Enrollment in RN-BSN degree completion programs has increased in the last several years, leading to a rise in program offerings online. There is limited research about the experiences of students who speak ESL.

METHOD
Ten individual interviews were conducted incorporating van Manen’s methodological steps for exploring the lived experience.

RESULTS
Through phenomenological reflection, five major themes emerged: understanding the online classroom, expressing culture online, alone but not lonely, writing as a surmountable barrier, and faculty role in the online journey.

CONCLUSION
RN-BSN ESL nursing students who pursue their degree online do so for convenience and flexibility. Exploring their lived experiences offered insight into their personal challenges and triumphs with integration, writing, and obtaining support for success.
Investigation and Implementation of Commercially Available Optically Stimulated Luminescence Dosimeters for Use in Fixed Nuclear Accident Dosimeter Systems
Authors: Georgeson David L. , Christiansen Byron H. 
Published: March 2018

AbstractIdaho National Laboratory transitioned from an external dosimetry system reliant on thermoluminescent dosimeters to one that uses optically stimulated luminescence dosimeters in 2010. This change not only affected the dosimeters worn by personnel, but those found in the nuclear-accident dosimeters used across Idaho National Laboratory. The elimination of on-site use and processing of thermoluminescent dosimeters impacted Idaho National Laboratory’s ability to process nuclear-accident dosimeters in a timely manner. This change in processes drove Idaho National Laboratory to develop an alternative method for fixed nuclear-accident dosimeter gamma-dose analyses. This new method was driven by the need to establish a simple, cost-effective, and rapid-turnaround alternative to the thermoluminescent-dosimeter-based fixed nuclear-accident dosimeter system. An adaptation of existing technologies proved to be the most efficient path to this end. The purpose of this article is to delineate the technical basis for replacing the thermoluminescent dosimeter contained within the Idaho National Laboratory fixed nuclear-accident dosimeter system with optically stimulated luminescence-based Landauer, Inc., nanoDot dosimeters.
VASCULAR ALTERATIONS REVEALED WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH CHOROIDEREMIA
Authors: Battaglia Parodi Maurizio , Arrigo Alessandro , MacLaren Robert E. , Aragona Emanuela , Toto Lisa , Mastropasqua Rodolfo , Manitto Maria Pia , Bandello Francesco 
Published: March 2018

Purpose:
Choroideremia is a rare degenerative retinal disease that causes incurable blindness. It occurs as a result of the deficiency of the X-linked CHM gene, which encodes the Rab escort protein 1 (REP1). Gene therapy has been developed to treat CHM using adeno-associated viral vectors and is currently undergoing clinical trials. Expression of the CHM gene is ubiquitous throughout the retina, and it is therefore important to identify which retinal layers are affected in the disease process. The purpose of this study was to assess in particular the choriocapillaris using optical coherence tomography angiography because this layer is difficult to see with conventional imaging techniques.

Methods:
Six men with choroideremia were identified and underwent standardized optical coherence tomography angiography as part of an ethics-approved clinical study and were compared with age-matched control subjects.

Results:
The choriocapillaris appeared normal in regions where the retinal pigment epithelium remained intact, but it was deficient elsewhere. The outer retinal vasculature showed significant changes peripherally but also some changes centrally. The inner retinal vasculature appeared unaffected by the disease process.

Conclusion:
Choroideremia is a disease in which the choriocapillaris maintains a normal structure until the loss of the overlying retinal pigment epithelium. The inner retina also appears not to be affected at the vascular level. Although this study is limited by the small number of patients eligible for inclusion in the study, the observations support the concept of targeting gene therapy to the retinal pigment epithelium and outer retina because there is no evidence of independent degeneration of the choriocapillaris.
Characteristics of Linear Interstitial Keratitis by In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography
Authors: Petrovic Aleksandra , Hashemi Kattayoon , Blaser Frank , Wild Wolfgang , Kymionis George 
Published: March 2018

Purpose:
To describe the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in a case of linear interstitial keratitis (IK), a very rare entity of unknown etiology.

Methods:
IVCM and AS-OCT were used in the case of the a 23-year-old patient with recurrent unilateral linear IK.

Results:
On AS-OCT, inflammation appeared confined to the anterior part of the stroma. Similar to color photography, inflammation appeared beaded. On IVCM, there was microcystic epithelial edema, dense fibrosis of the anterior stroma, highly reflective spiculated structures, and disorganization of the stromal architecture.

Conclusions:
Although linear IK appeared as localized anterior stromal inflammation on AS-OCT, panstromal inflammation was revealed by IVCM.
Perioperative Ocular Parameters Associated With Persistent Dry Eye Symptoms After Cataract Surgery
Authors: Choi Young Joon , Park Si Yoon , Jun Ikhyun , Choi Moonjung , Seo Kyoung Yul , Kim Eung Kweon , Kim Tae-im 
Published: March 2018

Purpose:
To evaluate perioperative dry eye (DE) syndrome and meibomian gland dysfunction (MGD) parameters associated with persistent DE symptoms after cataract surgery.

Methods:
We enrolled patients who underwent uncomplicated cataract surgery without previous ocular comorbidities and previous use of ophthalmic treatment except for artificial tears at a single tertiary hospital. Lipid layer thickness, meibomian gland (MG) dropout, tear breakup time, Oxford staining score, lid margin abnormality, meibum quality, meibum expressibility, MG orifice obstruction, MGD stage, Ocular Surface Disease Index (OSDI), and Schirmer test score were prospectively assessed in order at baseline and 1 and 3 months postoperative. Patients with an OSDI score >12 at 3 months postoperative were defined as patients with persistent DE symptoms after cataract surgery. Multivariate logistic regression was then used to determine risk factors for persistent DE symptoms.

Results:
A total of 116 eyes of 116 patients were enrolled, and 96 patients completed all examinations until 3 months postoperative. Thirty-one patients had persistent DE symptoms at 3 months postoperative. The Oxford staining score, lid margin abnormality, meibum quality, and MGD stage were improved over time. Baseline high OSDI scores [odds ratio (OR), 1.072; P = 0.001] and 1 month postoperative low tear breakup time, low MG orifice obstruction scores, and increased MG dropout (OR, 0.322; P < 0.001, OR, 0.291; P = 0.015, OR, 1.145; P = 0.007, respectively) were determined as risk factors for persistent DE symptoms after cataract surgery.

Conclusions:
Ocular parameters at baseline and at 1 month postoperative were important in predicting persistent DE symptoms after cataract surgery.
Immunologic Stromal Rejection After Deep Anterior Lamellar Keratoplasty With Grafts of a Larger Size (9 mm) for Various Stromal Diseases
Authors: Giannaccare Giuseppe , Weiss Jayne S. , Sapigni Laura , Bovone Cristina , Mattioli Leila , Campos Emilio C. , Busin Massimo 
Published: March 2018

Purpose:
To evaluate the rate and outcomes of immunologic stromal rejection occurring after large deep anterior lamellar keratoplasty (DALK) and the effect of the underlying disease on the cumulative probability of rejection.

Methods:
This was a retrospective chart review of all eyes that underwent a 9-mm DALK at Ospedali Privati Forlì (Forlì, Italy). On the basis of preoperative diagnosis, eyes were assigned to group 1: keratoconus, group 2: stromal disease with a low risk for rejection, or group 3: stromal disease with a high risk for rejection. The cumulative probability of experiencing a rejection episode over time was assessed by Kaplan–Meier analysis and was compared among the 3 groups using the log-rank test. Values of corrected distance visual acuity, central corneal thickness, and endothelial cell density before and 6 months after rejection were compared.

Results:
Twenty of 377 eyes (5.3%) experienced an episode of stromal rejection [17/265 (6.4%) in group 1, 2/71 (2.8%) in group 2, and 1/41 (2.4%) in group 3]. The mean time interval between DALK and the rejection onset was 11.8 months (range 1–24). The cumulative probability of rejection episodes did not differ significantly among the 3 groups. All episodes resolved within 6 months after the onset, with no significant differences between prerejection and 6-month postrejection values of corrected distance visual acuity, central corneal thickness, and endothelial cell density.

Conclusions:
The rate of immunologic stromal rejection after large 9-mm DALK is within the range reported in the literature for conventional DALK, regardless of the indication for surgery.