bluuebunny/crossref_metadata_2025_split huggingface dataset:
Profiles of genomic alterations in primary esophageal follicular dendritic cell sarcoma
Authors: Ren Wei , Sun Qi , Wu Pu-Yuan , Huang Bin , Yang Ju , Yan Jing , Liu Bao-Rui 
Published: November 2018

Abstract

Rationale:
Follicular dendritic cell (FDC) sarcoma is a rare tumor with FDC differentiation that typically arises within lymph nodes but can also occur extranodally. To date, the primary esophageal FDC sarcoma has not been reported in the English literature.

Patient concerns:
We described a 67-year-old female who foremostly presented with dysphagia, and the patient was readmitted due to a dry cough and pain of his right shoulder 2 years after initial treatment.

Diagnoses:
Primary esophageal FDC sarcoma with the right superior mediastinal lymph node metastasis.

Interventions:
The esophageal tumor was removed by endoscopic submucosal dissection at the first hospitalization. At the second hospitalization 2 years after the initial visit, the tracheal stent loaded with (125) iodine radioactive seeds was placed. The profiles of genetic variations and immunotherapeutic biomarkers were also explored by next-generation sequencing protocol from the patient's blood, esophageal primary, and mediastinal metastatic tumor samples.

Outcomes:
The patient's symptom transitorily relieved, but she gave up further treatment and died 2 months after the tracheal stent was placed. As for the genomic alterations, we found 9 gene mutations in all the samples, including checkpoint kinase 2(CHEK2), FAT atypical cadherin 1 (FAT1), tumor protein 53 (TP53), DPYD, ERBB2 interacting protein (ERBB2IP), FBXW7, KMT2D, PPP2R1A, TSC2, whereas amplification of MYC was only in the metastatic example. The analysis of clonal evolution and phylogenetic tree showed the propagation and replay of polyclonal esophageal FDC sarcoma. At the same time, the detection of biomarkers for immunotherapy revealed microsatellite stable and mismatch repair-proficient (pMMR), which predicted a relatively poor anti-programmed death (PD-1)/programmed death ligand (PD-L1) immunotherapy outcome. On the contrary, the tumor mutational burdens were 10 mutations per 1 million bases in both the primary and metastatic tumor sample, which ranked the top 23.3% in solid tumors mutational burdens database of Geneseeq and might be a good predictor of the efficacy of anti-PD-1/PD-L1 immunotherapy.

Lessons:
To the best of our knowledge, this case report announced the first case of extranodal primary esophageal FDC sarcoma in the world, and firstly revealed its unique genetic alterations profiles, which might contribute to further in-depth study of this rare disease.
Predictive value of preoperative monocyte–lymphocyte ratio among patients with localized clear renal cell carcinoma of ≤7 cm on preoperative imaging
Authors: Elghiaty Ahmed , Kim Jongchan , Jang Won Sik , Park Jee Soo , Heo Ji Eun , Rha Koon Ho , Choi Young Deuk , Ham Won Sik 
Published: November 2018

Abstract
We investigated the prognostic ability of preoperative monocyte–lymphocyte ratio for oncologic outcomes in non-metastatic clear cell renal cell carcinoma of ≤7 cm on preoperative computed tomography (CT).
We retrospectively reviewed 1637 patients who underwent radical or partial nephrectomy for solid renal masses ≤7 cm (2005–2014). We included 1137 patients after exclusion of benign pathology, non-clear cell, morbidity affecting inflammatory markers, metastasis, regional lymphadenopathy, positive margin, and follow up <12 months. According to cutoff values of 0.21, we had high ≥0.21 and low <0.21 preoperative monocyte–lymphocyte ratio groups. Mann–Whitney U and chi-squared tests were used for continuous and Dichotomous variables. Univariate and multivariate Cox regression analysis were used to predict factors affecting recurrence and survival. Kaplan–Meier curve was used for survival analysis.
At a median age of 56 years with a median follow up of 65 months, 51 patients had a recurrence (4.5%). There were no statistical differences between the high and low monocyte–lymphocyte ratio groups as regard the pathological characters (P > .005). Monocyte–lymphocyte ratio was a predictor for recurrence-free and cancer-specific survivals (hazard risk [HR] 2.17, P = .012 and HR 4.06, P = .004, respectively). A higher monocyte–lymphocyte ratio was significantly associated with worse, both 10-year recurrence-free (90.2% vs 94.9%) and cancer-specific survival (89.5% vs 98.8%) (Log-rank, P = .002 and P < .001, respectively).
The preoperative monocyte–lymphocyte ratio is an independent prognostic marker for recurrence-free and cancer-specific survivals after curative surgery for non-metastatic clear cell renal cell carcinoma of ≤7 cm on preoperative CT.
Hemangiomas of the tongue and the oral cavity in a myotonic dystrophy type 1 patient
Authors: Portaro Simona , Naro Antonino , Guarneri Claudio , Di Toro Giuseppe , Manuli Alfredo , Calabrò Rocco Salvatore 
Published: November 2018

Abstract

Rationale:
Myotonic dystrophy type 1 (DM1) is an autosomal dominant disease caused by a cytosine, guanine, thymine (CTG) trinucleotide repeat expansion in the non-coding region of dystrophia myotonica protein kinase gene, causing a multisystem involvement. To date, few studies have been performed to evaluate skin features in DM1 patients, but none reported on the possible association between the disease and tongue hemangiomas.

Patients concerns:
We report a case of a 63-year-old woman affected by DM1 and presenting, at the intraoral examination, several swelling and buish lesions occurring on buccal and palatal mucosa, and in the anterior two-thirds and margins of the tongue.

Diagnosis:
Multiple tongue hemangiomas in DM1 patient.

Interventions:
Color Doppler ultrasound revealed hypoechoic lesions with intermittent color picking suggestive of vascular lesion. Surgical excision was performed under general anesthesia. Histopathological examination was compatible with the diagnosis of cavernous hemangiomas.

Outcomes:
At 6 months follow-up, a part from the cosmetic deformity, patient's hemangiomas did not bleed, but caused functional problems with speaking, mastication, and deglutition, in addition to the same symptoms induced by DM1.

Lessons:
This case may add new details to better characterize the DM1 phenotype, suggesting that even tongue hemangiomas may be part of the DM1 multisystem involvement.
Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system
Authors: Goshi Ariha , Fukunishi Shigeo , Okahisa Shohei , Okada Taishi , Yoshiya Shinichi 
Published: November 2018

Abstract

Rationale:
Curved periacetabular osteotomy (CPO) is a procedure with excellent surgical outcome that has been proposed for patients with development dysplasia of the hip (DDH). However, the surgical outcomes depend on the surgeon's experience and proficiency.

Patient concerns:
A 38-year-old female indicated she was experiencing left hip pain while walking.

Diagnoses:
The patient was diagnosed with early-stage hip osteoarthritis due to DDH.

Interventions:
The patient underwent CPO while a 3-dimensional flat-panel C-arm (Artis zeego; Sciemens Healthcare, Forchheim, Germany) was used to confirm the real-time 3-dimensional computed tomography (CT) images during surgery. It was possible to confirm the accurate osteotomy curve using CT images twice during surgery: at the time of the ischial osteotomy and the quadrilateral surface osteotomy.

Outcomes:
An ideal C-shaped osteotomy line was created as shown on the postoperative CT images. In addition, neither posterior column fracture nor intra-articular osteotomy was confirmed.

Lessons:
The CPO using Artis zeego resulted is a satisfactory outcome, and this is the 1st report in the world to discuss the benefits of Artis zeego in pelvic osteotomy.
Complementary and Alternative Medicine Use in Children With Inflammatory Bowel Disease
Authors: Phatak Uma P. , Alper Arik , Pashankar Dinesh S. 
Published: November 2018

ABSTRACTComplementary and alternative medicine (CAM) consists of products and practices that are not considered to be a part of conventional medicine. This article reviews pediatric studies on CAM in inflammatory bowel disease (IBD) along with relevant adult studies. Prevalence of CAM use ranges from 22% to 84% in children with IBD all over the world. CAM use in IBD includes diet changes, supplements, herbals, botanicals, and mind‐body therapies. Common reasons for using CAM include severe disease and concern for adverse effects of conventional medicines. Despite widespread use, there are limited studies on efficacy and safety of CAM in children. Small studies suggest a favorable evidence for use of probiotics, fish oil, marijuana, and mind‐body therapy in IBD. Adverse effects of CAM are reported but are rare. The article provides current state of knowledge on the topic and provides guidance to physicians to address CAM use in pediatric patients with IBD.
Using Videoconferencing for Verbal Reports to Improve Clinical Nurse Specialist Student Performance
Authors: Joiner-Rogers Glenda L. , Delville Carol L. , Timmerman Gayle M. 
Published: November 2018

Purpose:
Clear, concise verbal reports are essential to clinical nurse specialists’ practice, yet current literature addressing the development of this skill is sparse. The purpose of this study is to determine the effectiveness of using videoconferencing for verbal reports as a learning strategy for improving clinical nurse specialist students’ communication competencies and advanced practice decision making.

Description of the Project:
Videoconferencing, using iPad minis issued to faculty and students, was used routinely for verbal reports on clinical cases to faculty, which included immediate faculty feedback. A verbal report template of patient chief complaint, applicable history, review of systems, physical examination/labs, differential diagnoses, and management was developed and provided to students.

Outcome:
Initial student verbal reports were disorganized, lengthy, lacking content, or containing extraneous details. After students routinely gave verbal reports via videoconferencing, verbal report time for the class decreased from more than 20 minutes to 3 to 5 minutes and the accuracy of reports also increased.

Conclusion:
A concise, clinically relevant verbal report template, combined with videoconferencing that allowed for frequent and immediate feedback from faculty, improved student communication competencies. Current technology, such as tablets and smart phones, provide videoconferencing opportunities that can be used to enhance learning for students.
Embolization of Endocardial Vegetation With Stroke Presentation
Authors: Birsic George W. , Fulcher James W. , Fiester Steven E. 
Published: November 2018

Abstract
This case report details the unique cause of death of a 37-year-old Caucasian woman with a history significant for intravenous drug abuse. Before her death, she complained of extremity weakness and pain. Although her death was discovered to be the result of endocarditis, her symptoms were similar to that of a stroke. Autopsy revealed a large endocardial vegetation infecting both the tricuspid and mitral valves and a patent foramen ovale. The subsequent embolization of this vegetation caused blockages in the lungs, liver, and brain. An acute embolization of these vegetations to the bilateral middle cerebral arteries is the cause of the stroke presentation. Other comorbidities, such as cardiomegaly, microscopic evidence of myocardial infarction, and atherosclerotic disease, also contributed to the cause of death. As the opioid crisis continues in the United States, it is important to review cases involving the effects of drug use. The multiple interactions between endocarditis and the aforementioned conditions are documented to not only serve as references for future autopsies but also for the treatment of patients who have similar symptoms and comorbidities.
Consecutive Immunohistochemical Staining on a Single Slide is Effective in Confirming Melanocytic Derivation
Authors: Campbell Katelynn K. , Gardner Jerad M. , Hall Kim , Osborne Amanda , Shalin Sara C. 
Published: November 2018

Background:
Metastatic melanoma in sentinel lymph nodes is often elusive to detect with morphology alone. Per American Joint Committee on Cancer staging guidelines, a single atypical melanocyte in lymph node qualifies as metastasis, whether identified by morphology or immunohistochemistry, but single cell staining must be convincing. We propose that the use of a second immunohistochemical run performed on a single slide will allow for more confident diagnosis of micrometastases.

Materials and Methods:
We designed a technical study to determine whether a second antibody application on previously stained slides can successfully detect the same population of cells. Melanocytic neoplasms were stained with SOX-10 using Ventana Benchmark Ultra stainers, coverslipped, and examined, followed by coverslip removal and application of MART-1 (Ventana A103). The order of antibody application and chromagen detection kit (AP-RED vs. DAB) was reversed to establish reliability and robustness of the protocol.

Results:
All melanocytes marked with SOX-10 and MART-1, and produced a range of staining quality that varied based on order of stain application and chromagen kit were used. The optimal combination was red MART-1 applied first followed by brown SOX-10 applied second.

Conclusions:
Consecutive staining of melanocytes with SOX-10 and MART-1 may improve diagnostic confidence of melanocyte identification, particularly in detection of single cell, micrometastases in sentinel lymph nodes or in situations where dual immunohistochemical stains may be unavailable.
Pursuing Public Health Accreditation: A Focus on HOW
Authors: Carman Angela L. , Scutchfield F. Douglas , McGladrey Margaret L. , Vorbeck Jonathan 
Published: November 2018

Introduction:
Balancing competing imperatives of conserving scarce resources while improving organizational performance and community health, many local health departments (LHDs) have decided to pursue national, voluntary public health accreditation as a guide to improvement, but how to do so in the most efficient way possible remains a question for many.

Methods:
This study employed a participatory action research approach in which LHD directors and accreditation coordinators from 7 accredited and 3 late-stage accreditation ready Kentucky LHD jurisdictions participated. Participants organized a set of accreditation deliverables into a chronological sequencing of each site's accreditation readiness process, which was then coded by researchers to identify similarities and differences.

Results:
All participating jurisdictions had all-hazards emergency operations plans and public health emergency operations plans while none had workforce development plans, quality improvement plans, or performance management plans before launching accreditation readiness activities. Also identified were the number of accreditation deliverables attempted, simultaneously, by each site and the importance of specific deliverables having a singular focus. Sequences of work on specific deliverables by the majority of participants included completing work on the quality improvement plan immediately, followed by the performance management plan, the Community Health Assessment before the Community Health Improvement Plan, and a strategic plan, followed by a workforce development plan. Factors influencing accreditation readiness processes, elements for sustaining processes, and lessons learned throughout the pursuit of accreditation were also provided by participants.

Conclusions:
Recognizing the impact of staff availability, staff skill sets, training, and available financial resources on the pursuit of accreditation, participants determined that aggregating lessons learned into a flowchart highlighting the interconnectedness of accreditation deliverables could produce a road map for LHDs. Accreditation deliverables could be attempted in a logical, efficient order particularly valuable to small LHDs with limited resources and yet adaptable for those jurisdictions able to devote more resources to the process.
Safety and Efficacy of EB-001, a Novel Type E Botulinum Toxin, in Subjects with Glabellar Frown Lines: Results of a Phase 2, Randomized, Placebo-Controlled, Ascending-Dose Study
Authors: Yoelin Steve G. , Dhawan Sunil S. , Vitarella Domenico , Ahmad Wajdie , Hasan Fauad , Abushakra Susan 
Published: November 2018

Background:
Botulinum neurotoxins, which are widely used commercially for therapeutic and cosmetic applications, have historically belonged to serotypes A and B. Serotype E has a distinct profile with a faster onset and shorter duration of effect. EB-001 is a proprietary formulation of serotype E in development for aesthetic (cosmetic) and therapeutic uses.

Methods:
This first-in-human, randomized, double-blinded, placebo-controlled, ascending-dose cohort study enrolled 42 subjects who received EB-001 (n = 35) or placebo (n = 7). The efficacy primary outcome was the proportion of subjects with a two-grade investigator-rated improvement in glabellar frown line severity at maximum frown. Safety evaluations included adverse events, laboratory tests, and physical examinations.

Results:
A two-grade investigator-rated response was observed starting in the third cohort (EB-001), with increased rates observed at higher doses. Onset of clinical effect was within 24 hours, with a duration ranging between 14 and 30 days for the highest doses. Adverse event incidence was low, with the most common being mild to moderate headache. There were no serious adverse events or ptosis, and there were no clinically significant changes in other safety assessments.

Conclusions:
In this clinical study in glabellar frown lines, EB-001 showed favorable safety, tolerability, and dose-dependent efficacy, with an 80 percent response rate at the highest dose. The maximum clinical effect of EB-001 was seen within 24 hours and lasted between 14 and 30 days. This differentiated EB-001 profile supports its development for aesthetic and therapeutic applications where fast onset and short duration of effect are desirable.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Predictable Location of Breast Sensory Nerves for Breast Reinnervation
Authors: Knackstedt Rebecca , Gatherwright James , Cakmakoglu Cagri , Djohan Michelle , Djohan Risal 
Published: November 2018

Summary:
The sensory innervation to the breast originates from the medial and lateral cutaneous branches of the third to fifth intercostal nerves, which are at risk for injury or loss during mastectomy. Providing reinnervation after mastectomy was introduced almost 20 years ago, but it is not widely performed, perhaps because of the difficulty of locating a recipient nerve. The authors have performed cadaveric dissections to allow for precise anatomical localization of the lateral intercostal branch providing breast sensation. Bilateral chest dissections were performed on 10 female cadavers. The lateral intercostal nerve providing sensation to breast tissue was identified. The distances from the sternum, the midclavicular line, and the lateral pectoralis minor—in addition to nerve diameter—were measured. The nerve was successfully identified bilaterally in all cadavers. The majority of nerves (16 of 20) exited from under the fourth rib. The average distance from the sternum was 13.1 ± 1.3 cm (range, 10 to 15 cm) and the average distance from the midclavicular line was 11.8 ± 2.2 cm (range, 8 to 16 cm). The nerve exited at the lateral border of the pectoralis minor or within 2 cm from the lateral border for all cadavers. The diameter of the nerve was consistently 2 mm. The nerve traveled under the thoracodorsal vessels, aiding in identification. The authors identified the predictable location of the lateral intercostal nerve providing sensation to the breast. The authors hope that by enabling surgeons to locate this nerve, more well-conducted studies will be performed investigating techniques and outcomes for breast reinnervation.
Locational Relationship between the Lateral Border of the Frontalis Muscle and the Superior Temporal Line
Authors: Lee Kyu-Lim , Choi You-Jin , Gil Young-Chun , Hu Kyung-Seok , Tansatit Tanvaa , Kim Hee-Jin 
Published: November 2018

Background:
The frontalis is a representative target muscle for botulinum neurotoxin type A injections aimed at treating horizontal wrinkles in the forehead region. However, a lack of information regarding the shape and thickness of the frontalis may lead to unexpected side effects.

Methods:
This study dissected hemifaces of 44 embalmed Korean and Thai cadavers and performed ultrasound examinations on 20 Korean volunteers. Two anatomical types were identified: (1) the lateral portion of the frontalis covered the superior temporal line in type I, and (2) the lateral border of the frontalis and the superior temporal line almost coincided in type II. A horizontal line was drawn laterally from the midpoint between the metopion and the glabella, and landmarks F1, F2, and F3 were defined as points where this horizontal reference line intersected with vertical lines from the midpoint of the pupil, the lateral canthus, and the lateral orbital rim, respectively.

Results:
Type I was more common than type II [84 percent (37 of 44) versus 16 percent (seven of 44)]. When the lateral border of the frontalis ran along the border, there were no cases in which the superior temporal line was not visible. The mean minimum distance in type I was 10.53 mm. The muscle thicknesses at F1, F2, and F3 were 1.80 ± 0.44 mm (mean ± SD), 1.61 ± 0.37 mm, and 0.11 ± 0.04 mm, respectively.

Conclusions:
This study yielded data on the location and thickness of the lateral border of the frontalis. An anatomical study–based, ultrasound-guided injection technique can achieve reliable results when noninvasive treatment is applied to the forehead area.
68Ga-PSMA Uptake in Anal Fistula on PET/CT Scan
Authors: Klingenberg Søren , Jochumsen Mads Ryø , Nielsen Tomas Frahm , Bouchelouche Kirsten 
Published: November 2018

Abstract

68Ga–prostate-specific membrane antigen (PSMA) PET/CT scan for primary staging discovered increased 68Ga-PSMA uptake in a known anal fistula in a recently diagnosed high-risk prostate cancer patient. The patient had an ongoing history of surgical revisions of complex fistulas in the perianal region, contributing to active inflammation and infection. Recently, reports have demonstrated increased 68Ga-PSMA uptake in different benign inflammatory conditions. This case demonstrates another case of a benign condition associated with increased 68Ga-PSMA uptake.
Quality and Safety in Health Care, Part XLIX
Authors: Harolds Jay A. 
Published: November 2018

Abstract
Mentoring and coaching are activities that are quite helpful in having doctors become happy, engaged, and successful in their work and also help prevent burnout. Coaching helps promote a better balance between work, rest, family, and fun pursuits. Coaching also helps the one being coached develop better emotional awareness, become more cognizant of the good he/she has done, develop a positive outlook on life, find more meaning in work, and be better able to overcome obstacles. In ways such as these, the coach helps his/her client become more resilient and recover from burnout.