bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mutational Status of NRAS and BRAF Genes and Protein Expression Analysis in a Series of Primary Oral Mucosal Melanoma
Authors: Hsieh Ricardo , Nico Marcello M. S. , Camillo Cláudia M. C. , Oliveira Kátia K. , Sangueza Martin , Lourenço Silvia V. 
Published: February 2017

Abstract:
Primary oral mucosal melanoma is an extremely rare and aggressive tumor arising from melanocytes located in the mucosal epithelium of the oral cavity. Although malignant melanoma of oral mucosa shares some clinical features with its cutaneous counterpart, it has been associated with a worst prognosis; its etiopathogenesis are still only partially unraveled as there is no influence of UV radiation. It is known that the mitogen-activated protein kinase pathway mediates cellular responses to growth signals and its activation is an important phenomenon in melanoma. The aim of this study was to evaluate NRAS and BRAF genes, both components of mitogen-activated protein kinase molecular pathway, and compare with their protein expression. Point mutations of NRAS (codons 12, 13, and 61) and BRAF (codon 600) were screened by pyrosequencing method, and its results were associated to the protein expression of RAS and BRAF performed by immunohistochemistry. The authors observed mutation in BRAF 600 (3/14), NRAS codons 12 and 13 (2/14), and NRAS codon 61 (2/8). One case showed positive RAS protein expression, but no mutation was observed. Twelve in 14 cases showed positive BRAF protein expression: 3 cases showed BRAF mutation; 2 cases showed NRAS codon 61 mutation; 2 cases showed NRAS codons 12 and 13 mutation but not simultaneously. Although NRAS and BRAF mutation frequency and RAS protein expression are low, BRAF protein expression was intense; probably, NRAS and BRAF mutations are independent events and alternative molecular mechanisms in the primary oral mucosal melanoma tumorigenesis.
Zosteriform Mycosis Fungoides: A New Clinical Presentation With a Dermatomal Distribution
Authors: Rieger Kerri E. , Kim Jinah , Kim Youn H. 
Published: February 2017

Abstract:
Classic mycosis fungoides (MF) presents with patches and plaques on the trunk and proximal extremities. However, numerous clinicopathologic variants have been described, making diagnosis challenging. Here, the authors report a 21-year-old woman with immunophenotypically and molecularly confirmed MF occurring in a dermatomal distribution. Awareness of this and other rare variants of MF is critical to avoid misdiagnosis.
Lichenoid Dermatologic Toxicity From Immune Checkpoint Blockade Therapy: A Detailed Examination of the Clinicopathologic Features
Authors: Tetzlaff Michael T. , Nagarajan Priyadharsini , Chon Susan , Huen Auris , Diab Adi , Omar Pacha , Aung Phyu P. , Torres-Cabala Carlos A. , Mays Steven R. , Prieto Victor G. , Curry Jonathan L. 
Published: February 2017

Abstract:
Immunotherapy targeting the programmed cell death 1 (PD-1) receptor has demonstrated tremendous promise in the treatment of advanced solid tumors. Dermatologic toxicities, however, are an emerging consequence of this therapy and have been clearly associated with immune checkpoint blockade antibodies. Distinctive clinical and histologic subtypes of dermatologic toxicity secondary to immunotherapy are emerging and include rare autoimmune bullous reactions (eg, bullous pemphigoid) and lichenoid eruptions. We report three patients who developed lichenoid dermatitis while receiving anti-PD-1 antibody therapy. The mean time to onset of lichenoid dermatologic toxicity was 42 days (range: 1–75 days) from initiation of anti-PD-1 antibody therapy. Lesions most frequently presented on the extremities and trunk as pustules, papules, and plaques. The face was not commonly involved. Of the five skin biopsies examined, all demonstrated dense band-like lymphocytic infiltrate, hyperkeratosis, hypergranulosis, saw-tooth rete ridge pattern, and dyskeratosis. Acanthosis was a feature in all of the skin biopsies, and in one, epidermal hyperplasia was prominent. In several skin biopsies, histologic features supporting a lichenoid drug eruption were present, including parakeratosis, spongiosis, periadnexal/perivascular inflammation, and eosinophils. Furthermore, the histologic features varied in skin biopsy specimens taken from the same patient at different sites, supporting a drug reaction. All patients' skin lesions improved with use of steroids: two were treated with topical steroids and one with systemic steroids. Recognition of the histopathologic patterns of dermatologic toxicities resulting from immune checkpoint blockade therapy will become increasingly important for ensuring appropriate management of dermatologic toxicities and optimal patient care.
Dermatophytic Pseudomycetoma of the Scalp
Authors: Castro-Echeverry Eduardo , Fiala Katherine , Fernandez Martin P. 
Published: February 2017

Abstract:
Dermatophytic pseudomycetoma represents a chronic infection characterized by a tumor-like growth containing dermatophytes arranged as clustered aggregates (grains) within the dermis. In contrast to mycetomas, they lack sinus tracts and are more common in the scalp. We describe a dermatophytic pseudomycetoma arising in the scalp of an 18-year-old African-American woman. Histopathologic examination showed a dense, mixed-cell infiltrate expanding the dermis. Accompanying this infiltrate were numerous grains scattered throughout the dermis. No sinus tracts were identified, but a number of grains were seen in the epidermal surface, admixed with serum crust. Recognition of a dermatophytic infection as a pseudomycetoma on a biopsy is important, as surgery may be required for a successful treatment.
Cost-effective Alternative for Negative-pressure Wound Therapy
Authors: Kim Jeff J. , Franczyk Mieczyslawa , Gottlieb Lawrence J. , Song David H. 
Published: February 2017

Background:
Current predominantly used equipments for negative-pressure wound therapy (NPWT) are expensive. In current healthcare climate continually emphasizing cost containment, importance in developing more cost-effective alternatives cannot be understated. Previously, therapeutically equivalent methods of providing NPWT was demonstrated using just low-cost, universally available supplies, coined Gauze-SUCtion (GSUC). Here, we examine long-term potential financial savings of utilizing GSUC over commercialized products.

Methods:
A retrospective cost analysis was performed at the University of Chicago Medical Center between 1999 and 2014. All NPWT was provided via either GSUC or commercialized vacuum-assisted closure (VAC, KCI) device. Sum of all material component costs were reviewed to determine theoretical average daily cost. For the VAC group, recorded institutional spend to KCI was also reviewed to determine actual daily cost. In the GSUC group, this figure was extrapolated using similar ratios. Labor costs for each method were determined using analysis from prior study. Patient demographics, etiology, wound location, and treatment length were also reviewed.

Results:
Total of 35,871 days of NPWT was provided during the 15-year span. Theoretical average cost of VAC was $94.01/d versus $3.61/d for GSUC, whereas actual average was $111.18/d versus $4.26/d. Average labor cost was $20.11/dressing change versus $12.32. Combined, total cost of VAC therapy was estimated at $119,224 per every 1,000 days of therapy versus $9,188 for the GSUC.

Conclusions:
There is clear and significant cost savings from utilization of GSUC method of NPWT. Furthermore, the added advantage of being able to provide NPWT from universally accessible materials cannot be overstated.
Low Uptake of Meningococcal C Vaccination in France
Authors: Le Maréchal Marion , Agrinier Nelly , Fressard Lisa , Verger Pierre , Pulcini Céline 
Published: February 2017

Background:
Meningococcal C glycoconjugate vaccine (MenCV) has been recommended in France since 2010, but its uptake remains low (64% coverage among 2-year-olds in 2014). Because general practitioners (GPs) are the cornerstone of the French vaccination program, we sought to assess their perceptions, attitudes, practices and recommendations to patients for this vaccine.

Methods:
A cross-sectional survey in 2014 asked a national sample of 1582 GPs if they would recommend MenCV for patients 12 months of age (routine vaccination) and 2–24 years of age (catch-up vaccination) and explored the barriers to vaccination.

Results:
Overall, 52% of GPs (800/1547) reported they always recommend routine MenCV vaccination and 33% (523/1572), catch-up vaccination. The most frequently reported barriers to vaccination were that parents have never heard of this vaccine (72%, 1094/1523), underestimate the risk of contracting meningococcal disease (69%, 1049/1514) and are unaware of its seriousness (55%, 838/1537). In multivariate analyses, GPs recommended routine and catch-up vaccination significantly more often when they had no doubt about the utility and safety of this vaccine, when they thought that the official MenCV recommendation was clear and when their own children were vaccinated. GPs who reported that their patients either were unaware of the severity of bacterial meningitis (P = 0.012) or had no doubts about the efficacy of MenCV recommended catch-up vaccination more often (P = 0.015).

Conclusions:
GPs did not appear to recommend MenCV often enough. Our results suggest that clearer recommendations and a better communications campaign directed at patients and healthcare workers could be useful.
Pseudomonas aeruginosa-associated Diarrheal Diseases in Children
Authors: Chuang Chih-Hsien , Janapatla Rajendra Prasad , Wang Yi-Hsin , Chang Hsin-Ju , Huang Yhu-Chering , Lin Tzou-Yien , Chiu Cheng-Hsun 
Published: February 2017

Background:
The gastrointestinal tract is not the common infection site of Pseudomonas aeruginosa. The role of P. aeruginosa as a causative agent for diarrhea in children without preexisting disease is controversial.

Methods:
From 2003 to 2012, we reviewed the records of 259 diarrheal patients less than 5 years of age whose stool culture grew P. aeruginosa. Virulence phenotypes of bacterial isolates were determined in vitro, including cytotoxicity, penetration and adherence to epithelial cells.

Results:
The presence of P. aeruginosa in children with diarrhea less than 5 years old is 0.91%. P. aeruginosa-associated diarrheal diseases were classified into 4 groups: Shanghai fever (enteric infection and sepsis) (5%), P. aeruginosa enterocolitis (15%), P. aeruginosa-related diarrhea (19%) and antibiotic-associated diarrhea (43%). The remaining patients had coinfection with other pathogens (18%). Shanghai fever was the most severe enteric disease with invasive infection and complications. The clinical features of P. aeruginosa enterocolitis were prolonged fever with bloody or mucoid diarrhea mimicking bacterial enterocolitis. The clinical features of P. aeruginosa-related diarrhea and antibiotic-associated diarrhea were similar to viral or toxin-mediated diarrhea. Compared with other P. aeruginosa-associated diarrheal diseases, patients with Shanghai fever were younger, usually infants, and the characteristic laboratory findings included leukopenia, thrombocytopenia, high C-reactive protein, hyponatremia and hyperglycemia. Except for Shanghai fever, antibiotic treatment is not recommended. Isolates from Shanghai fever were more cytotoxic and adherent than isolates from uncomplicated diarrheal patients.

Conclusions:

P. aeruginosa could be an enteric pathogen even in healthy children. Young age and highly virulent bacterial strains were risk factors for Shanghai fever.
Posterior Medial Canthal Thermoplasty
Authors: Vahdani Kaveh , Thaller Vladimir Theodor 
Published: February 2017

Purpose:
To describe a new, simple, quick, and minimally invasive surgical technique for managing medial canthal tendon laxity.

Methods:
The technique works by creating a directed posterior lamellar scar. Sutures are preplaced in firm medial canthal tissue, and a triangular diathermy burn is made between this fixation point and the medial tarsal plate (sparing the canaliculus). This area is then plicated horizontally by bringing the preplaced sutures through the medial tarsal plate. The authors report a retrospective case note review of a consecutive case series of 55 patients (59 procedures). All patients with moderate to severe medial canthal tendon laxity underwent a medial thermoplasty procedure in addition to standard surgery for correcting their eyelid malposition (entropion, ectropion, or symptomatic lax eyelids).

Results:
The study cohort included 30 men and 25 women, with a mean age of 77 years (range 51–93). Epiphora was the commonest presenting complaint (47%) followed by ocular irritation (44%), with the remainder heaving a combination of symptoms. Lower eyelid ectropion (n = 30, 51%) and entropion (n = 26, 44%), constituted the most common indications for surgery. The average postoperative follow-up period was 16 months (range 3–63 months). Fifty-three eyes (90%) had complete resolution of symptoms, while 2 (3.4%) had partial reduction of epiphora. With regard to the eyelid margin position, 57 eyelids (96.6%) were anatomically in a normal position, while 2 operations failed despite early satisfactory results. In terms of correction of medial canthal tendon laxity, 49 cases (83%) were deemed successful. There were no major complications, nor any significant long-term sequelae.

Conclusion:
Posterior medial canthal thermoplasty provides a simple, effective, and safe option for addressing medial canthal tendon laxity.
Dilated Superior Ophthalmic Vein: Clinical and Radiographic Features of 113 Cases
Authors: Adam Christopher R. , Shields Carol L. , Gutman Justin , Kim H. Joon , Hayek Brent , Shore John W. , Braunstein Alexandra , Levin Flora , Winn Bryan J. , Vrcek Ivan , Mancini Ronald , Linden Craig , Choe Christina , Gonzalez Mithra , Altschul David , Ortega-Gutierrez Santiago , Paramasivam Srinivasan , Fifi Johanna T. , Berenstein Alejandro , Durairaj Vikram , Shinder Roman 
Published: February 2017

Purpose:
Dilated superior ophthalmic vein (SOV) is an uncommon radiographic finding. The authors review the presentation, etiology, radiography, and visual implications of 113 patients with dilated SOV.

Methods:
An observational case series and multicenter retrospective chart review were conducted. There were 113 patients with a dilated SOV. Outcome measures included patient demographics, clinical features, radiographic findings, diagnosis, and treatment, and treatment outcomes were assessed.

Results:
Cases included 75 women (66%) and 38 men (34%) with a mean age of 49 ± 24 years (range, 0.4–90 years). Diagnoses fell under 6 categories: vascular malformation (n = 92, 81%), venous thrombosis (n = 11, 10%), inflammatory (n = 6, 5%), traumatic hemorrhage (n = 2, 2%), lymphoproliferative (n = 1, 1%), and infectious (n = 1, 1%). Imaging modalities utilized included MRI (n = 98, 87%), digital subtraction angiography (n = 77, 68%), CT (n = 29, 26%), and ultrasonography (n = 4, 4%). Disease status at last follow up included no evidence of disease (n = 57, 50%), alive with persistent disease (n = 53, 47%), and expired from disease (n = 3, 3%). Treatment and management was tailored to the underlying disease process with a mean follow up of 18 months (range, 1 day to 180 months). Visual impairment observed at presentation and last follow up across all cases was 26% and 22%, respectively.

Conclusion:
Dilated SOV is a rare radiographic finding resulting from a wide spectrum of etiologies with clinical implications ranging from benign to sight- and life-threatening. Dilated SOV is most often found with dural-cavernous fistula or carotid-cavernous fistula, orbital or facial arteriovenous malformation, and venous thrombosis. Recognition of this finding and management of the underlying condition is critical.
Photographs of Daily Activities–Youth English: validating a targeted assessment of worry and anticipated pain
Authors: Simons Laura E. , Pielech Melissa , McAvoy Shannon , Conroy Caitlin , Hogan Melinda , Verbunt Jeanine A. , Goossens Marielle E. 
Published: February 2017

Abstract
PHODA is an electronic measure that individualizes and guides treatment for individuals with chronic pain. Implicit in its design is recognition that pain-related fear is a driving force that impedes treatment progress. With this tool, patients visually rate their expectations about the harmful consequences of specific movements. This study aimed to (1) develop and validate PHODA-Youth English (PHODA-YE) and (2) evaluate the potential impact of PHODA-YE assessment on treatment outcomes. Participants were 195 youth, age 8 to 20 years, who presented to an outpatient pain clinic for evaluation (n = 99), or enrolled at the Pediatric Pain Rehabilitation Center (PPRC) intensive program (PPRC; n = 96). All patients completed the PHODA-YE along with measures of emotional functioning and disability. Patients in the PPRC completed the measure at both admission and discharge. After eliminating infrequently endorsed and poorly loading items, factor analytic procedures yielded a 4-subscale, 50-item measure with strong internal consistency (from 0.92 to 0.97 across subscales). Fear, avoidance, and functional disability were strongly associated with PHODA-YE scores, supporting construct validity. Within the PPRC sample, PHODA-YE was sensitive to changes over time in relation to functional improvements. Across the PPRC sample, patients found it helpful to complete the PHODA and target feared activities. Altogether, the PHODA-YE is a valid and concrete assessment tool that rapidly identifies specific activities and movements that elicit fearful responses from patients.
Burning pain: axonal dysfunction in erythromelalgia
Authors: Farrar Michelle A. , Lee Ming-Jen , Howells James , Andrews Peter I. , Lin Cindy S.-Y. 
Published: February 2017

Abstract
Erythromelalgia (EM) is a rare neurovascular disorder characterized by intermittent severe burning pain, erythema, and warmth in the extremities on heat stimuli. To investigate the underlying pathophysiology, peripheral axonal excitability studies were performed and changes with heating and therapy explored. Multiple excitability indices (stimulus–response curve, strength–duration time constant (SDTC), threshold electrotonus, and recovery cycle) were investigated in 23 (9 EMSCN9A+ and 14 EMSCN9A−) genetically characterized patients with EM stimulating median motor and sensory axons at the wrist. At rest, patients with EM showed a higher threshold and rheobase (P < 0.001) compared with controls. Threshold electrotonus and current–voltage relationships demonstrated greater changes of thresholds in both depolarizing and hyperpolarizing preconditioning electrotonus in both EM cohorts compared with controls in sensory axons (P < 0.005). When average temperature was raised from 31.5°C to 36.3°C in EMSCN9A+ patients, excitability changes showed depolarization, specifically SDTC significantly increased, in contrast to the effects of temperature previously established in healthy subjects (P < 0.05). With treatment, 4 EMSCN9A+ patients (4/9) reported improvement with mexiletine, associated with reduction in SDTC in motor and sensory axons. This is the first study of primary EM using threshold tracking techniques to demonstrate alterations in peripheral axonal membrane function. Taken together, these changes may be attributed to systemic neurovascular abnormalities in EM, with chronic postischaemic resting membrane potential hyperpolarization due to Na+/K+ pump overactivity. With heating, a trigger of acute symptoms, axonal depolarization developed, corresponding to acute axonal ischaemia. This study has provided novel insights into EM pathophysiology.
Psychophysical and psychological predictors of acute pain after breast surgery differ in patients with and without pre-existing chronic pain
Authors: Ruscheweyh Ruth , Viehoff Anika , Tio Joke , Pogatzki-Zahn Esther M. 
Published: February 2017

AbstractThe prediction of acute postoperative pain would be of great clinical advantage, but results of studies investigating possible predictors are inconsistent. Here, we studied the role of a wide variety of previously suggested predictors in 74 patients undergoing breast surgery. Preoperatively, patients filled out the Pain Sensitivity Questionnaire (PSQ) and a set of psychological questionnaires (the Beck Depression Inventory [BDI], State-Trait Anxiety Inventory [STAI], and Pain Catastrophizing Scale [PCS]) and participated in an experimental pain testing session, including assessment of conditioned pain modulation (CPM), temporal summation, and responses to heat, pinprick, and pressure pain. Postoperatively, patients reported pain intensity. Stepwise linear regression analysis was used to test for prediction of maximal pain on postoperative day 1 in the whole cohort and in the subgroups of patients with and without pre-existing chronic pain. In the total group, linear regression identified only the expectation of postoperative pain intensity as significant predictor (F[1,65] = 6.5,P< 0.05), explaining 9% of the variance. In patients without pre-existing chronic pain, a smaller CPM effect predicted more postoperative pain, explaining 17% of the variance (F[1,48] = 9.9,P< 0.01). In patients with pre-existing chronic pain, higher PSQ and PCS scores predicted more postoperative pain, together explaining 54% of the variance (F[2,19] = 11.1,P< 0.001). In conclusion, prediction of acute postoperative pain in the whole group was limited. This might be due to differing predictors in specific subgroups of patients. Although CPM predicted pain in patients without pre-existing chronic pain, PSQ and PCS predicted pain in patients with pre-existing chronic pain.
Clinical Outcomes of Concomitant Use of Warfarin and Selective Serotonin Reuptake Inhibitors
Authors: Dong Yaa-Hui , Bykov Katsiaryna , Choudhry Niteesh K. , Donneyong Macarius M. , Huybrechts Krista F. , Levin Raisa , Schneeweiss Sebastian , Gagne Joshua J. 
Published: February 2017

Abstract

Background
Patients treated with warfarin are often coprescribed selective serotonin reuptake inhibitors (SSRIs) for coexisting depression. Some SSRIs are potent CYP2C9 inhibitors that may increase warfarin plasma concentrations and the risk of bleeding. We aimed to examine the effect of the putative CYP2C9-mediated warfarin-SSRI interaction on clinical outcomes.

Methods
We conducted an observational cohort study among warfarin initiators who had a subsequent SSRI prescription in 5 US claims databases. Patients were followed for up to 180 days as long as they were exposed to both warfarin and their index SSRI groups. Cox regression models were used to estimate hazard ratios and 95% confidence intervals for bleeding events, ischemic or thromboembolic events, and mortality comparing patients treated with SSRIs that are potent CYP2C9 inhibitors (fluoxetine, fluvoxamine) with those treated with other SSRIs after propensity score matching.

Findings
The eligible cohort comprised 52,129 patients. Hazard ratios were 1.14 (95% confidence interval [CI], 0.94–1.38) for bleeding events, 1.03 (95% CI, 0.87–1.21) for ischemic or thromboembolic events, and 0.90 (95% CI, 0.72–1.14) for mortality. Results were consistent across individual component outcomes, different warfarin stabilization periods, and subgroup analyses.

Conclusions
Patients concomitantly treated with warfarin and SSRIs that are potent CYP2C9 inhibitors had comparable rates of bleeding events, ischemic or thromboembolic events, and mortality as did patients cotreated with warfarin and other SSRIs, although small but potentially meaningful effects on bleeding cannot be completely excluded. SSRI inhibition of CYP2C9 does not appear to affect major safety or effectiveness outcomes of warfarin treatment in clinical practice, where patients may be closely monitored.