bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case of a Malignant Cutaneous Mixed Tumor (Chondroid Syringoma) of the Scapula Treated With Staged Margin-Controlled Excision
Authors: Lal Karan , Morrell Travis J. , Cunningham Michael , O'Donnell Patrick , Levin Nikki A. , Cornejo Kristine M. 
Published: March 2018

Abstract:
Cutaneous mixed tumor (chondroid syringoma) is the cutaneous counterpart of pleomorphic adenoma of salivary glands, comprised of both epithelial and mesenchymal components. Malignant transformation is exceptionally rare, with only a few cases reported. We report a case of a malignant cutaneous mixed tumor in an 86-year-old white man who presented with a pink indurated plaque on his left scapula. He had a history of nonmelanoma skin cancers, a stage IB malignant melanoma of a lower extremity and Gleason 4 + 3 prostate cancer treated with brachytherapy, external beam irradiation, and bicalutamide. A shave biopsy was performed and histologic examination revealed infiltrative single-unit atypical cells and small ducts in a superficially transected sclerotic dermis suggestive of a poorly differentiated adenocarcinoma. No epidermal connection was identified. Immunohistochemical studies revealed that the tumor was positive for CK7, CAM5.2, and mCEA and negative for CK20, epithelial membrane antigen, P63, prostate-specific antigen, prostatic specific acid phosphatase, and alpha-methylacyl-coenzyme A racemase. A metastasis of the breast or upper digestive tract was favored, although a primary eccrine carcinoma was also considered. Imaging was performed and no other masses were identified. A slow Mohs excision was performed with negative margins. Microscopic examination revealed a biphasic neoplasm comprised of infiltrative epithelial strands and tubules consistent with an eccrine carcinoma in a hyalinized and chondromyxoid stroma within the dermis, arising from a well-circumscribed chondroid syringoma located in the deep dermis and subcutis. Areas of clear cell change, intracytoplasmic vacuolization, and mucin pools were noted. Multiple foci of perineural invasion were identified. Additional immunohistochemical studies revealed that the tumor was positive for S100 and negative for CK5/6, calponin, glial fibrillary acidic protein, GATA3, GCDFP-15, and mammoglobin. Based on the morphologic features and immunoprofile, this was diagnosed as a malignant cutaneous mixed tumor. This case highlights the importance of obtaining adequate tissue for histologic evaluation, as they can be confused with other skin neoplasms because of their clinically ambiguous presentations. Although rare, an accurate diagnosis is important given that long-term follow-up is recommended because of the risk of local recurrence and both lymph node and distant metastases.
A Variant of COL3A1 (rs3134646) Is Associated With Risk of Developing Diverticulosis in White Men
Authors: Reichert Matthias Christian , Kupcinskas Juozas , Krawczyk Marcin , Jüngst Christoph , Casper Markus , Grünhage Frank , Appenrodt Beate , Zimmer Vincent , Weber Susanne Nicole , Tamelis Algimantas , Lukosiene Jaune Ieva , Pauziene Neringa , Kiudelis Gediminas , Jonaitis Laimas , Schramm Christoph , Goeser Tobias , Schulz Antje , Malinowski Maciej , Glanemann Matthias , Kupcinskas Limas , Lammert Frank 
Published: March 2018

BACKGROUND:Colonic diverticulosis is one of the most common gastroenterological disorders. Although diverticulosis is typically benign, many individuals develop diverticulitis or other aspects of diverticular disease. Diverticulosis is thought to stem from a complex interaction of environmental, dietary, and genetic factors; however, the contributing genetic factors remain unknown.OBJECTIVE:The aim of our present study was to determine the role of genetic variants within genes encoding for collagens of the connective tissue in diverticulosis.DESIGN:This was a transsectional genetic association study.SETTINGS:This study was conducted at three tertiary referral centers in Germany and Lithuania.PATIENTS:Single-nucleotide polymorphisms inCOL3A1(rs3134646,rs1800255) andCOL1A1(rs1800012) were genotyped in 422 patients with diverticulosis and 285 controls of white descent by using TaqMan assays.MAIN OUTCOME MEASURES:The association of colonoscopy-proven diverticulosis with genetic polymorphisms with herniations was assessed in multivariate models.RESULTS:Thers3134646,rs1800255, andrs1800012variants were significantly associated with the risk of developing diverticulosis in the univariate model; however, these associations were not significant in the multivariate logistic regression analysis including additional nongenetic variables. When selectively analyzing sexes, the genotype AA (AA) inrs3134646remained significantly associated with diverticulosis in men (OR, 1.82; 95% CI, 1.04–3.20;p= 0.04).LIMITATIONS:Because a candidate approach was used, additional relevant variants could be missed. Within our cohort of patients with diverticulosis, only a small proportion had diverticular disease and thus, we could not examine the variants in these subgroups. Functional studies, including the analysis of the involved collagens, are also warranted.CONCLUSIONS:Our study shows that a variant ofCOL3A1(rs3134646) is associated with the risk of developing colonic diverticulosis in white men, whereasrs1800255(COL3A1) andrs1800012(COL1A1) were not associated with this condition after adjusting for confounding factors. Our data provide novel valuable insights in the genetic susceptibility to diverticulosis. SeeVideo Abstractat http://links.lww.com/DCR/A504.
hsa-miR-320d and hsa-miR-582, miRNA Biomarkers of Aortic Dissection, Regulate Apoptosis of Vascular Smooth Muscle Cells
Authors: Shen Hong , Lu Shuyang , Dong Lili , Xue Yuan , Yao Chenling , Tong Chaoyang , Wang Chunsheng , Shu Xianhong 
Published: March 2018

Abstract:
Abnormal expression of microRNAs (miRNAs) has been associated with aortic dissection (AD). Next-generation sequencing was performed to identify the differentially expressed miRNAs in aortic tissue samples between AD and nondiseased individuals. Selected miRNAs, which showed significant variation between the 2 groups, were then transfected into human aortic vascular smooth muscle cells, and assessed for effects on cell migration and induced apoptosis. The changes in gene expression pattern in human aortic vascular smooth muscle cells transfected with the miRNAs were also investigated. Among the 314 miRNAs detected in the aortic tissues from both AD and normal subjects, 46 showed significantly different expression patterns. Only 7 of these differentially expressed miRNAs were found to be enriched in AD, whereas the majority had diminished. hsa-miR-320d and hsa-miR-582 were 2 representative miRNAs that exhibited a decrease of greater than 10-fold. Transfection of hsa-miR-320d and hsa-miR-582 did not affect the migration capability of the vascular smooth muscle cells, but remarkably enhanced the staurosporine and tumor necrosis factor-α–induced apoptosis by 15% and 29%, respectively. Furthermore, the transfection of both miRNAs affected the expression of a vast multitude of genes, most of which were related to apoptotic pathways. The fluorescence reporter assays demonstrated that hsa-miR-320d and hsa-miR-582 bind the 3′ UTR region of TRIAP1 and NET1 genes, respectively. These results suggest that hsa-miR-320d and hsa-miR-582 may serve as putative biomarkers for AD research.
Tissue selective estrogen complex (TSEC): a review
Authors: Pickar James H. , Boucher Matthieu , Morgenstern Diana 
Published: March 2018

AbstractObjective:This review describes historical development of selective estrogen receptor modulators (SERMs) and their combination with estrogens, termed a tissue selective estrogen complex (TSEC), and considers the potential for future TSEC development.Methods:This narrative review is based on literature identified on PubMed and the TSEC research and development experience of the authors.Results:SERMs have estrogenic and antiestrogenic effects in various tissues; however, no single agent has achieved an optimal balance of agonist and antagonist effects for the treatment of menopausal symptoms. Clinically, a number of SERMs protect against osteoporosis and breast cancer but can exacerbate vasomotor symptoms. Estrogens alleviate menopausal hot flushes and genitourinary symptoms as well as reduce bone loss, but the addition of a progestogen to menopausal hormone therapy to protect against endometrial cancer increases vaginal bleeding risk, breast tenderness, and potentially breast cancer. The search for an effective menopausal therapy with better tolerability led to the investigation of TSECs. Clinical development of a TSEC consisting of conjugated estrogens/bazedoxifene increased understanding of the importance of a careful consideration of the combination's components and their respective doses to balance safety and efficacy. Bazedoxifene is an estrogen receptor agonist in bone but an antagonist/degrader in the endometrium, which has contributed to its success as a TSEC component. Other oral TSEC combinations studied thus far have not demonstrated similar endometrial safety.Conclusions:Choice of SERM, selection of doses, and clinical trial data evaluating safety and efficacy are key to ensuring safety and adequate therapeutic effect of TSECs for addressing menopausal symptoms.
A randomized, double-blind, placebo-controlled trial of Chinese herbal medicine capsules for the treatment of premature ovarian insufficiency
Authors: Cao Xiao-jing , Huang Xuchun , Liu Jian , Ma Fei , Zeng Yuyan , Chen Changqian , Wang Ji-ju , Nie Guangning , Wang Xiao-yun 
Published: March 2018

Abstract

Objective:
This study was conducted to evaluate the treatment effectiveness of Chinese herbal medicine capsules containing the Yangyin Shugan formula (YYSG) in premature ovarian insufficiency (POI).

Methods:
One-hundred forty-six women with POI participated in this stratified, randomized, double-blind, placebo-controlled clinical trial. Participants in two groups (n = 73 in each)—the YYSG group and control group—underwent treatment for 12 weeks. Outcome measures included the Chinese version Menopause-Specific Quality of Life questionnaire (CMS), serum levels of basal follicle-stimulating hormone (bFSH), basal estradiol, and anti-Mullerian hormone (AMH), the antral follicle count (AFC), and ovarian peak systolic velocity (PSV; cm/s).

Results:
Treatment with YYSG significantly reduced the total scores of the CMS at the end of the 12th week with statistical significance (P < 0.01); the vasomotor, psychosocial, physical, and sexual domains significantly improvement after treatment (P < 0.01). Compared with the baseline hormone levels, YYSG markedly decreased the bFSH level with statistical significance (P < 0.01) and improved the AMH level (P < 0.01). Furthermore, YYSG greatly improved the participants’ AFC and ovarian PSV, compared with placebo (P < 0.01). There were no serious adverse events, and the safety indices of whole blood counts, renal function, and liver function were within the normal range, both before and after treatment.

Conclusions:
Treatment with YYSG was more effective than placebo for improving menopausal symptoms, basal hormone levels, and ovarian function in women with POI in Guangdong, China.
The influence of formal and informal policies and practices on health care innovation implementation: A mixed-methods analysis
Authors: DiMartino Lisa D. , Birken Sarah A. , Hanson Laura C. , Trogdon Justin G. , Clary Alecia S. , Weinberger Morris , Reeder-Hayes Katherine , Weiner Bryan J. 
Published: March 2018

Background:
The implementation science literature has contributed important insights regarding the influence of formal policies and practices on health care innovation implementation, whereas informal implementation policies and practices have garnered little attention. The broader literature suggests that informal implementation policies and practices could also influence innovation use.

Purpose:
We used the Organizational Theory of Innovation Implementation to further understand the role of formal and informal implementation policies and practices as determinants of implementation effectiveness. We examined their role within the context of initiatives to increase palliative care consultation in inpatient oncology.

Methods:
We used a case study design in two organizational settings within one academic medical center: medical and gynecologic oncology. We completed semistructured interviews with medical (n = 12) and gynecologic (n = 10) oncology clinicians using questions based on organizational theory. Quantitative data assessed implementation effectiveness, defined as aggregated palliative care consult rates within oncology services from 2010 to 2016. Four palliative care clinicians were interviewed to gain additional implementation context insights.

Results:
Medical oncology employed multiple formal policies and practices including training and clinician prompting to support palliative care consultation and a top-down approach, yet most clinicians were unaware of the policies and practices, contributing to a weak implementation climate. In contrast, gynecologic oncology employed one formal policy (written guideline of criteria for initiating a consult) but also relied on informal policies and practices, such as spontaneous feedback and communication; they adopted a bottom-up approach, contributing to broader clinician awareness and strong implementation climate. Both services exhibited variable, increasing consult rates over time.

Practice Implications:
Informal policies and practices may compensate or substitute for formal policies and practices under certain conditions (e.g., smaller health care organizations). Further research is needed to investigate the role of formal and informal policies and practices in shaping a strong and sustainable implementation climate and subsequent effective innovation implementation.
Relationships between organizational and individual support, nurses’ ethical competence, ethical safety, and work satisfaction
Authors: Poikkeus Tarja , Suhonen Riitta , Katajisto Jouko , Leino-Kilpi Helena 
Published: March 2018

Background:
Organizations and nurse leaders do not always effectively support nurses’ ethical competence. More information is needed about nurses’ perceptions of this support and relevant factors to improve it.

Purpose:
The aim of the study was to examine relationships between nurses’ perceived organizational and individual support, ethical competence, ethical safety, and work satisfaction.

Methodology:
A cross-sectional questionnaire survey was conducted. Questionnaires were distributed to nurses (n = 298) working in specialized, primary, or private health care in Finland. Descriptive statistics, multifactor analysis of variance, and linear regression analysis were used to test the relationships.

Results:
The nurses reported low organizational and individual support for their ethical competence, whereas perceptions of their ethical competence, ethical safety, and work satisfaction were moderate. There were statistically significant positive correlations between both perceived individual and organizational support, and ethical competence, nurses’ work satisfaction, and nurses’ ethical safety.

Conclusions:
Organizational and individual support for nurses’ ethical competence should be strengthened, at least in Finland, by providing more ethics education and addressing ethical problems in multiprofessional discussions. Findings confirm that organizational level support for ethical competence improves nurses’ work satisfaction. They also show that individual level support improves nurses’ sense of ethical safety, and both organizational and individual support strengthen nurses’ ethical competence.

Practice Implications:
These findings should assist nurse leaders to implement effective support practices to strengthen nurses’ ethical competence, ethical safety, and work satisfaction.
Team functioning as a predictor of patient outcomes in early medical home implementation
Authors: Wu Frances M. , Rubenstein Lisa V. , Yoon Jean 
Published: March 2018

Background:
New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes.

Purpose:
The aim of the study was to assess the relationships between primary care team functioning, patients’ use of acute care, and mortality.

Methodology/Approach:
Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia).

Results:
In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p < 0.01), ambulatory care-sensitive condition-related admissions (IRR = 0.91, p = .04), and emergency department visits (IRR = 0.91, p = .03) in the vulnerable patient subgroup.

Conclusion:
These early findings give support for the importance of team functioning within PCMH models for achieving improved patient outcomes.

Practice Implications:
A focus on team functioning is important especially in the early implementation of team-based primary care models.
POSTERIOR FUNDUS HEMORRHAGES
Authors: Zhou Jin Qiong , Wang Ya Xing , Xu Liang , Zhao Liang , Wang Shuang , Xu Jie , You Qi Sheng , Yang Hua , Wei Wen Bin , Jonas Jost B. 
Published: March 2018

Purpose:
To examine frequency and associations of retinal hemorrhages.

Methods:
The population-based Beijing Eye Study included 3,468 individuals. Monoscopic fundus photographs were examined for hemorrhages.

Results:
Retinal hemorrhages were detected in 515 eyes (429 individuals) (prevalence: 7.6%; 95% confidence interval [CI]: 7.0–8.0 per eye; 12.7%; 95% CI: 11.7–13.7 per person). Higher prevalence of retinal hemorrhages was correlated (multivariate analysis) with higher systolic blood pressure (P < 0.001; odds ratio: 1.02; 95% CI: 1.01–1.03), higher prevalence of diabetic retinopathy (P < 0.001; odds ratio: 121; 95% CI: 61–240), and higher prevalence of retinal vein occlusions (P < 0.001; odds ratio: 27; 95% CI: 17–42). Retinal hemorrhages were due to diabetic retinopathy (189 [36.7%] eyes), retinal vein occlusions (n = 65 [12.6%]), posterior vitreous detachment (n = 23 [4.5%]), glaucoma (n = 14 [2.7%]), exudative age-related macular degeneration (n = 8 [1.6%]), hypertensive retinopathy (n = 10 [1.9%]), and exudative myopic maculopathy (n = 1 [0.2%]). Retinal hemorrhages without evident ocular cause (“NOH”) were detected in 204 (3.0%) eyes (or 39.6% of all retinal hemorrhages). Higher prevalence of NOHs was correlated with higher systolic blood pressure (P < 0.001; odds ratio: 1.02; 95% CI: 1.01–1.03) after adjusting for blood glucose concentration and prevalence of cortical cataract.

Conclusion:
In a population-based recruited cohort of individuals aged 50+ years, prevalence of any fundus hemorrhage was about 8% per eye and 13% per individual. Approximately 60% of the hemorrhages were due to ocular reasons, mainly diabetic retinopathy, retinal vein occlusions, and posterior vitreous detachment, whereas 40% of the bleedings were not evidently associated with ophthalmologic causes but strongly with elevated systolic blood pressure.
RAPIDLY PROGRESSIVE NEOVASCULAR GLAUCOMA FROM CYTOMEGALOVIRUS RETINITIS IN A NON–HUMAN IMMUNODEFICIENCY VIRUS PATIENT
Authors: Cho Jane , Siegel Nicole , Subramanian Manju L. , Ying Howard , Ness Steven 
Published: March 2018

Purpose:
To describe a case of neovascular glaucoma from cytomegalovirus (CMV) retinitis in a human immunodeficiency virus–negative patient with immunosuppression after stem-cell transplant for multiple myeloma.

Methods:
Retrospective case report.

Results:
A 71-year-old man on monthly infusion of daratumumab for multiple myeloma after stem-cell transplant presenting with a 2-week history of floaters, photophobia, and blurry vision was found to have polymerase chain reaction–confirmed CMV retinitis associated with diffuse occlusive vasculitis. The patient was human immunodeficiency virus negative with a CD4 count of 450/mm3. Despite immediate aggressive treatment, the patient developed neovascular glaucoma with poor visual outcome.

Conclusion:
Cytomegalovirus retinitis in human immunodeficiency virus–negative patients is becoming more prevalent with increasing use of systemic immunosuppression therapy for various reasons. Patients with non–human immunodeficiency virus related CMV retinitis can have severe ischemia atypical of the classic CMV retinitis and should be followed closely for neovascularization.
Thin Rigid Contact Lens Used in Vitreous-Retinal Surgery for Corneal Protection: A Randomized Controlled Trial
Authors: Hu Zizhong , Ding Yuzhi , Zheng Xinhua , Yuan Songtao , Li Jia , Xie Ping , Liu Qinghuai 
Published: March 2018

Purpose:
To design a rigid contact lens (CL) to be used in combination with a wide-angle viewing system and analyze its protection for corneal epithelial during vitreous-retinal surgery.

Methods:
A thin and lightweight rigid CL was designed and constructed. The impact of the CL on the visualized fundus range was evaluated using a concrete eye model. Patients with severe proliferative diabetic retinopathy (PDR) were randomized to either the CL group, corneal protective agent (CPA) group, or balanced salt solution (BSS) group. All patients underwent phacoemulsification and a standard 23-gauge three-port vitrectomy. Surgery time and corneal fluorescein staining score (FSS) postoperatively were mainly measured.

Results:
In the eye model, a larger area of fundus was visualized with the use of our CL under 128 D or 60 D Resight lens. The mean surgery time was 51.36±8.06 min, 50.89±8.26 min, and 55.46±9.14 in CL, CPA, and BSS group, respectively (F=2.325, P=0.105). In eight eyes in the BSS group, corneal epithelial layer was peeled off because the dryness of the cornea could not maintain a clear fundus image. The FSS in BSS group was markedly higher than that of CL and BSS group 1 day (P<0.001), 3 days (P<0.001), and 7 days (P=0.002) postoperatively. There was no statistical significance of the FSS between CL and CPA group at each follow-up endpoint.

Conclusions:
The CL that we designed can slightly enlarge the visible fundus range and efficiently protect corneal epithelium during vitrectomy for patients with PDR.