bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenging the Requirement to Treat the Contralateral Neck in Cases With >4 mm Tumor Thickness in Patients Receiving Postoperative Radiation Therapy for Squamous Cell Carcinoma of the Oral Tongue or Floor of Mouth
Authors: O’steen Lillie , Amdur Robert J. , Morris Christopher G. , Hitchcock Kathryn E. , Mendenhall William M. 
Published: September 2018

Hypothesis:
While treating patients with postoperative radiotherapy (RT) for squamous cell carcinoma of the oral tongue or floor of mouth, we hypothesized a low risk of tumor recurrence in the contralateral neck in the absence of contralateral neck RT when the primary tumor is >1 cm from the midline regardless of tumor thickness (TT) or depth of invasion (DOI)>4 mm.

Objective:
The policy at our institution for many years has been to limit postoperative RT to the ipsilateral side when the primary tumor does not cross the midline, regardless of TT or DOI. We report the rate of isolated contralateral neck failure in this group.

Materials and Methods:
We retrospectively reviewed all patients treated with postoperative RT at our institution between 1998 and 2014 for pathologic stage T1-T4 N1-N2b squamous cell carcinoma of the oral tongue or floor of mouth that did not cross the midline and thus were treated with RT limited to the primary site +/− ipsilateral neck.

Results:
Our study population included 32 patients: 75% with close (<5 mm) or positive margins and 38% with perineural invasion. No patients had a tumor that crossed the midline. TT was ≥4 mm in 75% of patients. DOI was >5 mm in 68% of patients. There were no isolated contralateral neck recurrences with a median follow-up of 5 years.

Conclusion:
While delivering postoperative RT for oral tongue or floor of mouth cancer with pathologic neck stage N0-2b, the risk of not irradiating the contralateral neck is very low when the primary tumor does not cross the midline, regardless of other factors at the primary site, such as TT and DOI.
Patterns of Care and Outcomes of Elderly Esophageal Cancer Patients Not Meeting Age-based Criteria of the CROSS Trial
Authors: Verma Vivek , Haque Waqar , Zheng Dandan , Osayande Ferdinand , Lin Chi 
Published: September 2018

Objectives:
The CROSS trial established neoadjuvant chemoradiation followed by surgery (nCRT-S) as superior to surgery alone (S) for locally advanced esophageal cancer (EC). However, because patients above 75 years of age were excluded, this comparison cannot be extrapolated to older patients. This study of a large, contemporary national database evaluated practice patterns in elderly patients ineligible for CROSS, and analyzed overall survival (OS) between nCRT+S, S, and definitive CRT (dCRT).

Materials and Methods:
The National Cancer Data Base was queried for EC patients with cT1N1M0/T2-3N0-1M0 EC (per the CROSS trial) but 76 years and above of age. Multivariable logistic regression ascertained factors associated with nCRT+S (vs. S). Kaplan-Meier analysis evaluated OS; Cox multivariate analysis determined variables associated with OS. Propensity matching aimed to address group imbalances and indication biases.

Results:
Of 4099 total patients, 594 (14%) underwent nCRT+S, 494 (12%) underwent S, and 3011 (73%) underwent dCRT. Since 2010, trimodality management has risen, corresponding to declines in S and dCRT. Median OS in the respective groups were 26.7, 20.3, and 17.8 months (P<0.05). Following propensity matching, there was a trend towards higher OS with nCRT-S over S (P=0.077); dCRT showed poorer OS than nCRT-S (P<0.001) but was equivalent to S (P=0.669). Before and following matching, nCRT-S experienced equivalent 30- and 90-day mortality as S (P>0.05), with lower 30-day readmission and postoperative hospital stay (P<0.05).

Conclusions:
Although most older patients not meeting CROSS criteria undergo dCRT, utilization of trimodality therapy is rising. Despite the trend towards higher OS with trimodality therapy without poorer postoperative outcomes, careful patient selection continues to be essential in this population.
Comparison of Clinical Characteristics and Outcomes in Relapsed Versus De Novo Metastatic Non–Small Cell Lung Cancer
Authors: Gibson Amanda J.W. , Li Haocheng , D’Silva Adrijana , Tudor Roxana A. , Elegbede Anifat A. , Otsuka Shannon , Bebb Dafydd Gwyn , Cheung Winson Y. 
Published: September 2018

Objectives:
To compare the clinical characteristics and outcomes between relapsed and de novo metastatic non–small cell lung cancer (NSCLC).

Materials and Methods:
We reviewed all NSCLC diagnoses between January 1999 and December 2013 in the institutional Glans-Look Lung Cancer Database, which contains demographic, clinical, pathologic, treatment, and outcome information. Patients with distant metastasis at diagnosis (American Joint Committee on Cancer [AJCC] eighth edition, stage IV), the “de novo” cohort, were compared with the “relapsed” cohort, consisting of patients diagnosed with early stage disease (stage I/II) undergoing curative intent treatment and subsequently experiencing metastatic relapse. Survival analysis, along with univariate and multivariable analysis was performed.

Results:
A total of 185 relapsed and 3039 de novo patients were identified. Significantly different patterns of smoking history, histology, systemic therapy use, and disease extent were observed between the relapsed and de novo cohorts. Median overall survival from time of metastasis was significantly longer in relapsed than in de novo disease (8.9 vs. 3.7 mo, P<0.001). Relapsed patients demonstrated significant improvements in outcomes over time. In multivariate analysis, de novo metastatic disease continued to bode a worse prognosis (adjusted hazard ratio [HR], 1.4) as did male sex (HR, 1.2), never-smoking history (HR, 1.2), and presence of extrapulmonary metastases (HR, 1.3). Systemic therapy receipt conferred better outcome (HR, 0.4), although the impact of relapsed versus de novo disease on outcomes persisted regardless of systemic therapy receipt.

Conclusions:
Relapsed and de novo patients represent significantly different subpopulations within metastatic NSCLC with the latter exhibiting poorer survival. This information facilitates discussions about prognosis with patients and supports screening initiatives aimed at reducing de novo disease.
Cutaneous Mastocytosis With Predominant Infiltration of Promastocytes
Authors: Knöpfel Nicole , Colmenero Isabel , Matito Almudena , Latour Irene , Noguera-Morel Lucero , Hernández-Martín Angela , Alvarez-Twose Iván , Torrelo Antonio 
Published: September 2018

Abstract:
Mastocytosis is a heterogeneous group of disorders with a variable clinical course, ranging from indolent disease with normal life expectancy to highly aggressive disease. In the skin, mast cells may show a spindle-shape appearance or appear as round cells with wide, polygonal cytoplasm. In this study, we present a case series of 4 patients with cutaneous childhood-onset mastocytosis in whom skin mast cells showed striking nuclear pleomorphism with bilobed and multilobed nuclei. Such finding does not seem to represent a malignant phenotype of the disease in the skin, although the true biological significance and the potential prognostic impact remain to be determined.
Pigmented Facial Contact Dermatitis to Benzyl Salicylate: A Comparative Histopathological and Immunohistochemical Study of the Involved Skin and the Positive Patch Test Site
Authors: Zaaroura Hiba , Bergman Reuven , Nevet Mariela J. 
Published: September 2018

Abstract:
Pigmented contact dermatitis (PCD) is a noneczematous variant of allergic contact dermatitis, and benzyl salicylate is one of its causes. This type of PCD shows nonlichenoid interface dermatitis with pigment incontinence. We aimed to characterize the earliest histopathological changes of this reaction. A 51-year-old man presented with persistent facial eruption composed of hyperpigmented and hypopigmented macules due to exposure to benzyl salicylate present in his aftershave. The biopsies obtained from hyperpigmented and hypopigmented macules, and from the positive patch test site to benzyl salicylate, showed a nonlichenoid focal vacuolar interface dermatitis with mononuclear cells in the papillary dermis and around the pilosebaceous units, along with melanophages. A MART-1 immunostain showed intact melanocytes in all 3 biopsies. A Fontana–Masson stain demonstrated intact melanin in the basal cell layer of a facial hyperpigmented macule and the patch test site, but melanin was reduced in the biopsy taken from a hypopigmented facial macule. There were more epidermal and dermal CD1a+ Langerhans cells in the patch test biopsy than in the other 2 biopsies. Most of the mononuclear cells were CD3+. The CD4+ to CD8+ ratio was approximately 1:1 in the facial macules; yet, CD4+ cells outnumbered CD8+ cells in the patch test biopsy. There were a few TIA-1+ cells in all 3 biopsies. In conclusion, the earliest histopathological and immunophenotypical events in PCD due to benzyl salicylate are similar to those of longer-standing lesions, i.e., a nonlichenoid focal interface dermatitis involving the epidermis and pilosebaceous unit, along with dermal melanophages.
Atypical Varicella-Zoster Kaposi Varicelliform Eruption in Sézary Syndrome
Authors: Gottesman Silvija P. , Rosen Jason R. , Geller Jay D. , Freeman Benjamin B. 
Published: September 2018

Abstract:
Patients with mycosis fungoides experience considerable morbidity and mortality from secondary bacterial and viral infections. Staphylococcus aureus, β-hemolytic streptococci, herpes simplex virus, and herpes zoster virus remain the most common infectious pathogens in this group of patients. With depressed cellular immunity and diminished skin barrier as the main precipitating risk factors, immunocompromised patients can often present with an atypical presentation of a common dermatologic condition. The case herein discusses a clinically atypical nonvesicular Kaposi varicelliform eruption secondary to a varicella-zoster virus in a patient with Sézary syndrome. Concurrent polypharmacy in these patients is also a risk factor for development of drug hypersensitivity reactions. However, given their immunocompromised status, first and foremost, a careful inspection should be made of every atypical skin eruption in search of an infectious etiology, and afterward, an appropriate treatment should be promptly initiated.
Prospective Multicenter Clinical Trial of a Temperature-Controlled Subcutaneous Microneedle Fractional Bipolar Radiofrequency System for the Treatment of Cellulite
Authors: Alexiades Macrene , Munavalli Gilly , Goldberg David , Berube Dany 
Published: September 2018

BACKGROUND
A bipolar fractional radiofrequency (RF) device was developed to generate cutaneous thermal injuries using a temperature-controlled microneedle electrode array.

OBJECTIVE
Evaluate safety and efficacy of a novel subcutaneous microneedle RF for treatment of posterolateral thigh cellulite.

METHODS
The study design was an institutional review board-approved multicenter clinical trial after a per-protocol analysis. Fifty subjects with Nurnberger–Muller Grade II or III cellulite were enrolled at 4 treatment centers and received 1 subcutaneous microneedle RF treatment (67°C/4-second duration). Efficacy was evaluated by blinded grading by 3 dermatologists using randomized, standardized photographs and investigator grading at baseline, 1-, 3-, and 6-month follow-up. As per the Food and Drug Administration, treatment success was defined by ≥1-point improvement on dimple number or severity of undulation irregularities scales by at least 2 of 3 blinded physicians. Study subjects' self-assessments and satisfaction questionnaires and procedural pain levels and adverse events were monitored.

RESULTS
Blinded physician evaluations revealed a procedural success rate of 93% at 6-month follow-up. Procedural pain level was 3.74 ± 1.96 on a 10-point scale. There were no adverse events. Seventy-five percent of subjects were satisfied with the results at 6-month follow-up.

CONCLUSION
The results indicate that subcutaneous microneedle RF treatment is safe and effective for long-term treatment of Type II and III cellulite in a single session.
Fire Safety in Mohs Micrographic Surgery
Authors: Li Janet Y. , Kampp Jeremy T. 
Published: September 2018

BACKGROUND
Surgical fire is a rare event, but one with potentially devastating patient outcomes.

OBJECTIVE
This study was conducted to investigate the incidence, risk factors, and outcome of surgical fires experienced by members of the American College of Mohs Surgeons (ACMS).

METHODS
An internet survey was developed and sent to ACMS members. Data collected included total years of experience, total number of cases, typical management of supplemental oxygen, and surgical fires experienced.

RESULTS
Eighty participants contributed data on 886,200 cases of MMS. Nine surgeons (11%) reported at least 1 surgical fire, yielding an estimated incidence of 1 fire per 88,620 cases (0.001%). The most common site of involvement was the scalp (67%). Common ignition sources included monopolar electrosurgical devices (78%) and battery-powered thermal cautery (22%). Fuel sources included towels or drapes, gauze, isopropyl alcohol, aluminum chloride, hairspray, and diethyl ether. Supplemental oxygen was not involved in any of the cases. Five patients suffered singed hair while 4 patients did not suffer any injuries. None suffered any permanent functional or aesthetic deformities.

CONCLUSION
The overall risk of surgical fire in MMS is minimal. However, safety measures and greater awareness of fire risks are necessary to prevent patient harm.
Medical Professional Radiation Dosimeter Usage: Reasons for Noncompliance
Authors: McCulloch Molly M. , Fischer Karl W. , Kearfott Kimberlee J. 
Published: September 2018

Abstract
The purpose of this study was to assess the attitudes of occupationally exposed employees at a large teaching hospital about wearing their assigned personal radiation dosimeters. A 16‐question multiple-answer survey was used to report the reasons why medical professionals may not wear their dosimetry during procedures involving ionizing radiation. In all, 302 employees responded to the survey. The majority of respondents who reported always or almost always wearing their dosimeters do so because they consider themselves well informed concerning the importance of personal dosimetry measurement and appreciate the importance of federal and state regulations. For respondents who reported not always wearing their dosimeters, the most commonly stated reason was the inconvenience of remembering to bring and wear their dosimeters when working in multiple locations, for which a potential solution would be to provide dosimeters to each affected wearer in each location where they work.
RECURRENT ACUTE RETINAL PIGMENT EPITHELIITIS: SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES
Authors: Toledo Juan José , García Jesús Ramón , Asencio Mónica , Schlincker Armelle , López Alejandro 
Published: September 2018

Purpose:
To describe an atypical case of acute retinal pigment epitheliitis including spectral domain optical coherence tomography (OCT) and OCT angiography features.

Methods:
We report a 41-year-old woman with 3 episodes of acute retinal pigment epitheliitis over a 3-year period. Spectral domain OCT and OCT angiography images were acquired with Cirrus 5,000 spectral domain OCT.

Results:
Although acute retinal pigment epitheliitis is described as a benign, self-limited pathology, as this case shows, recurrences are possible. OCT angiography shows a choriocapillaris alteration and further recovery during the acute episodes.

Conclusion:
Acute retinal pigment epitheliitis can present as a recurrent disease.
DEVELOPMENT OF PACHYCHOROID PIGMENT EPITHELIOPATHY AND TRANSFORMATION TO CENTRAL SEROUS CHORIORETINOPATHY AFTER INTRAVITREAL DEXAMETHASONE IMPLANTATION
Authors: Ersoz Mehmet Giray , Hocaoglu Mumin , Sayman Muslubas Isil , Arf Serra , Karacorlu Murat 
Published: September 2018

Purpose:
To report first case of sequential development of pachychoroid pigment epitheliopathy (PPE) and central serous chorioretinopathy (CSC) after repeated intravitreal dexamethasone implantations for diabetic macular edema treatment.

Methods:
We present a case of a 54-year-old man having intravitreal dexamethasone implant for bilateral diabetic macular edema.

Results:
We observed development of pachychoroid pigment epitheliopathy, seen as a small pigment epithelial detachment on optical coherence tomography after a fourth dexamethasone implantation. A fifth implantation caused transformation of pachychoroid pigment epitheliopathy to central serous chorioretinopathy.

Conclusion:
Consecutive administration of dexamethasone implants may have a cumulative effect on retinal pigment epithelium, Bruch membrane, and choroid.
MULTIMODAL IMAGING OF PHOTIC MACULOPATHY FROM ARC WELDING
Authors: Park Dong-Wouk , Alonzo Brock , Faridi Ambar , Bhavsar Kavita V. 
Published: September 2018

Purpose:
Photic retinal toxicity induced by exposure to arc welding can lead to irreversible vision loss. Serial multimodal imaging is characterized in a patient with outer retinal damage secondary to welder's maculopathy.

Methods:
A single case was retrospectively reviewed.

Results:
Spectral domain optical coherence tomography acutely revealed disruption of the ellipsoid zone, hyperreflective bands through the outer nuclear layer, and outer retinal cavitation consistent with phototoxicity. Subsequently, disruption and hypertrophy of the subfoveal retinal pigment epithelium developed. Autofluorescence depicted central hypoautofluorescence.

Conclusion:
We report serial multimodal imaging in welder's maculopathy to better characterize the evolution of lesions. Multimodal imaging including spectral domain optical coherence tomography in arc welding phototoxicity may share features with other forms of phototoxicity such as hand-held laser maculopathy.
Clinical Results and Utility of Herpesviruses Multiplex Polymerase Chain Reaction: Assessment of Aqueous Humor Samples From Patients With Corneal Endotheliitis and High Intraocular Pressure
Authors: Kim Gyu-Nam , Cho Min-Chul , Yoo Woong-Sun , Kim Rock-Bum , Chung Jin-Kwon , Kim Seong-Jae 
Published: September 2018

Purpose:
The main purpose of this study was to evaluate herpesvirus infection in patients with corneal endotheliitis and high intraocular pressure (IOP) using multiplex polymerase chain reaction (PCR) in aqueous humor samples.

Materials and Methods:
This was a retrospective, observational study of immunocompetent patients living in South Korea. Eligible subjects had typical corneal endotheliitis with an IOP≥21 mm Hg or required antiglaucoma medication. Multiplex PCR was performed using aqueous humor samples obtained at first visit to detect the DNA of 6 herpesviruses.

Results:
Forty-two eyes from 42 patients with >6 months’ follow-up were analyzed. Of these, 16 were herpesvirus-positive: 3 herpes simplex virus 1, 3 varicella-zoster virus, 9 cytomegalovirus, and 1 Epstein-Barr virus. Eyes with coin-shaped or fine keratic precipitates (kps), high IOP, and a low baseline endothelial cell count were more likely to show a positive result on multiplex PCR. Univariate analysis showed that male sex (P=0.014), a previous history of uveitic glaucoma (P=0.048), and the presence of fine kps (P=0.031) were significantly associated with a positive PCR result. On multivariate analysis, male sex (P=0.010) and a previous history of uveitic glaucoma (P=0.031) showed a significant positive association.

Conclusions:
Cytomegalovirus was the most commonly detected herpesvirus in patients with corneal endotheliitis and high IOP. A positive PCR result was seen more frequently in male individuals and patients with fine kps or a history of uveitic glaucoma.
Long-term Outcomes of Baerveldt Glaucoma Implant Shunts as a Primary Versus Secondary Procedure
Authors: Bouhenni Rachida , Krasniqi Mirela , Dunmire Jeffrey , Lagouros Evan , Woodruff Todd , Bates James , Edward Deepak P. 
Published: September 2018

Purpose:
To determine the 5-year success rate for Baerveldt glaucoma implant (BGI) in patients who received the implant as a primary (primary BGI, used as the initial surgical procedure) or secondary (secondary BGI, used after trabeculectomy) by a single surgeon between year 1994 and 2010.

Patients and Methods:
A total of 117 eyes from patients who underwent BGI placement as a primary or secondary procedure were included in this study. Demographics, previous history, type of glaucoma, intraocular pressure (IOP), visual acuity (VA), glaucoma medication use, and early and late postoperative complications were collected. Postoperative data were collected at day 1, 30, 60, and every year until the last visit (minimum of 2 y). IOP was the main outcome measure. Secondary outcome measures included VA, glaucoma medication use, and early and late postoperative complications. Overall success rates were calculated for primary and secondary BGI using Kaplan-Meier survival analysis. Differences between survival curves were determined using log-rank test. Risk factors for success were defined by Cox proportional-hazards regression model.

Results:
At the 5-year follow-up, the overall success rates (determined as IOP between 6 and 21 mm Hg) in the primary and secondary BGI were 58% (49/79) and 53% (20/38), respectively (P=0.56). The overall success rate dropped by an average 10% and 13% per year for the primary and secondary BGI groups, respectively (P=0.05). The complete success rates at the 5-year follow-up for primary and secondary BGI were 24% (19/79) and 13% (5/38), respectively, whereas the qualified success rates were 34% (27/79) and 39% (15/38), respectively. There was a significant decrease in IOP [from 31.23 (±9.51) to 12.86 (±4.84) mm Hg (P<0.001) for the primary BGI group, and from 26.35 (±7.22) to 13.92 (±5.90) mm Hg (P<0.001) for the secondary BGI group]. There was also a significant drop in medication use but a significant worsening in VA in both groups (P<0.05) likely from cataract. The difference in the incidence of postoperative complications was not statistically significant between the groups.

Conclusions:
Although, the success rates were similar for the primary and secondary BGI at the 5-year follow-up, the drop in the success rate per year was significantly higher in the secondary BGI group. In contrast, both procedures had similar incidence of postoperative complications.
XEN Gel Stent to Treat Intraocular Hypertension After Dexamethasone-Implant Intravitreal Injections: 5 Cases
Authors: Rezkallah Amina , Mathis Thibaud , Denis Philippe , Kodjikian Laurent 
Published: September 2018

Introduction:
Intravitreal injections (IVI) of slow-release dexamethasone (DEX) are generally well tolerated. Ocular hypertension (OHT) and cataracts are the most common adverse effects of DEX-implant (DEX-I).

Material and Methods:
The cases reported concern 5 eyes in four DEX-I IVI high-responder patients whose intraocular pressure (IOP) returned to normal after administration of a XEN gel stent with mitomycin subconjunctival injection, thus allowing the continued use of DEX-I which was the only therapeutic option for these patients. All patients were pure steroid responders with normal optic nerves.

Results:
No hypertension was observed in any of the eyes after DEX-implant intravitreal reinjection following XEN-surgery.
All patients were successfully treated with XEN surgery and were retreated with DEX-implant with no further increase in IOP. The mean duration of follow-up after the MIGS procedure was 5 months (min-max, 2-12). None of the patients required needling.

Conclusions:
XEN gel stent would seem to represent a safe and effective solution for treating steroid-induced hypertension. It allows for the medium and long-term use of DEX-I in high responders. It could be of clinical interest to study this combination in a prospective trial with a large number of patients and long-term follow-up.