bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eccrine-Centric Melanocytic Nevus
Authors: Fertig Raymond M. , Berghoff Adar , Cervantes Jessica , Darwin Evan , Jukic Drazen 
Published: November 2017

Abstract:
Benign melanocytic neoplasms present with a diverse array of well-known histopathologic patterns. It is imperative to recognize the benign patterns to render accurate diagnoses. We describe here an interesting and hitherto not described low-power architectural pattern of a benign melanocytic lesion: eccrine-centric melanocytic nevus. The patient was a 50-year-old African American woman who noticed a new mole on her foot that began as a dark speck but quickly grew larger. The lesion was excised to exclude the possibility of melanoma. Upon review of the specimen, the lesion was noted to demonstrate a distinctive pattern consistent with a melanocytic nevus of possible congenital onset. Remarkably, the ducts of eccrine glands were increased in density and the nests of melanocytes were found solely in a peri-eccrine distribution without melanocytes in any other locations (ie, interstitial, perifollicular). Additionally, all melanocytes in the nevus were rather heavily pigmented. Although this pattern demonstrated no atypical features that would cause one to consider it malignant to the trained eye, this presentation could implicate a metastatic disease (well-delineated nests in the dermis without concomitant interstitial component) and it is important to recognize.
Immunohistochemical and Fluorescence In Situ Hybridization Analysis of MYC in a Series of 17 Cutaneous Angiosarcomas: A Single-Center Study
Authors: Requena Celia , Rubio Luis , Lavernia Javier , Machado Isidro , Llombart Beatriz , Sanmartín Onofre , Traves Víctor , Guillén Carlos , Cruz Julia 
Published: November 2017

Abstract:
Cutaneous angiosarcoma (AS) is an uncommon, aggressive sarcoma whose incidence is rising because of the increasing use of radiation therapy, especially in breast cancer. The few studies on the relevance of prognostic factors, such as MYC status in cutaneous AS, have reported inconclusive findings, with some authors reporting MYC amplification only in postirradiation and lymphedema-associated AS and others reporting evidence of MYC amplification in idiopathic AS. We analyzed 17 cases of cutaneous AS (6 idiopathic AS, 10 postirradiation AS, and 1 lymphedema-associated AS) treated at our institute between 2000 and 2015. Follow-up data were available in all cases. We compared the presence/absence of MYC amplification by fluorescence in situ hybridization (FISH) and immunohistochemical (IHC) MYC overexpression in the different AS subtypes. We also investigated potential associations between MYC amplification and prognosis. MYC amplification was observed by FISH in 6 of 14 informative cases. The positive cases were all secondary AS (5 postirradiation AS and 1 lymphedema-associated AS). IHC detected MYC overexpression in 8 of 15 informative cases (7 secondary AS and 1 idiopathic AS). In conclusion, MYC amplification and MYC overexpression were detected almost exclusively in secondary AS. No associations were found between MYC amplification/overexpression and prognosis. We found MYC amplification or overexpression in a similar proportion of the patients who died and who were still alive at the end of the study. In the group of 9 patients who died, MYC was detected by FISH in 4 cases and by IHC in 5. The corresponding figures in the group of 6 patients still alive were 2 by FISH and 3 by IHC.
Bupivacaine as an Adjunct to Lidocaine in Mohs Micrographic Surgery: A Prospective Randomized Controlled Trial
Authors: Chen Peggy , Smith Harvey , Vinciullo Carl 
Published: November 2017

BACKGROUND
In Mohs micrographic surgery (MMS), the standard local anesthetic agent used is lignocaine with adrenaline. However, MMS can be prolonged; thus reinjections of local anesthetics are often required.

OBJECTIVE
Is 0.5% bupivacaine with 1:200,000 epinephrine a useful adjunctive treatment when compared with the use of 1% lidocaine with 1:100,000 epinephrine in MMS for the nose?

METHODS
Participants undergoing MMS received 2.5 mL of 1% lidocaine with 1:100,000 epinephrine before commencement of Stage 1. At the end of Stage 1, participants were randomized sequentially to either 2.5 mL 0.5% bupivacaine with 1:200,000 epinephrine (Group A) or 2.5 mL of 1% lidocaine with 1:100,000 epinephrine (Group B). Effectiveness of anesthesia was assessed using 30 G needle to 5 points of the wound before further stage or repair.

RESULTS
Fifty-one patients were randomized, 26 to Group A, and 25 to Group B. No differences between the 2 groups in size of defect and time lapse between time of injection and time of testing were observed. Seven of 25 were tested positive in Group B. Zero of 26 tested positive in Group A (p = .003, 95% confidence interval: 10%–46%).

CONCLUSION
Adjunctive use of 0.5% bupivacaine with 1:200,000 epinephrine is effective in prolonging anesthesia in MMS.
Is BMI a valid measure of obesity in postmenopausal women?
Authors: Banack Hailey R. , Wactawski-Wende Jean , Hovey Kathleen M. , Stokes Andrew 
Published: November 2017

Abstract

Objective:
Body mass index (BMI) is a widely used indicator of obesity status in clinical settings and population health research. However, there are concerns about the validity of BMI as a measure of obesity in postmenopausal women. Unlike BMI, which is an indirect measure of obesity and does not distinguish lean from fat mass, dual-energy x-ray absorptiometry (DXA) provides a direct measure of body fat and is considered a gold standard of adiposity measurement. The goal of this study is to examine the validity of using BMI to identify obesity in postmenopausal women relative to total body fat percent measured by DXA scan.

Methods:
Data from 1,329 postmenopausal women participating in the Buffalo OsteoPerio Study were used in this analysis. At baseline, women ranged in age from 53 to 85 years. Obesity was defined as BMI ≥ 30 kg/m2 and body fat percent (BF%) greater than 35%, 38%, or 40%. We calculated sensitivity, specificity, positive predictive value, and negative predictive value to evaluate the validity of BMI-defined obesity relative BF%. We further explored the validity of BMI relative to BF% using graphical tools, such as scatterplots and receiver-operating characteristic curves. Youden's J index was used to determine the empirical optimal BMI cut-point for each level of BF% defined obesity.

Results:
The sensitivity of BMI-defined obesity was 32.4% for 35% body fat, 44.6% for 38% body fat, and 55.2% for 40% body fat. Corresponding specificity values were 99.3%, 97.1%, and 94.6%, respectively. The empirical optimal BMI cut-point to define obesity is 24.9 kg/m2 for 35% BF, 26.49 kg/m2 for 38% BF, and 27.05 kg/m2 for 40% BF according to the Youden's index.

Conclusions:
Results demonstrate that a BMI cut-point of 30 kg/m2 does not appear to be an appropriate indicator of true obesity status in postmenopausal women. Empirical estimates of the validity of BMI from this study may be used by other investigators to account for BMI-related misclassification in older women.
Initial investigation into the optimal dose ratio of conjugated estrogens and bazedoxifene: a double-blind, randomized, placebo-controlled phase 2 dose-finding study
Authors: Pickar James H. , Lavenberg Joanne , Pan Kaijie , Komm Barry S. 
Published: November 2017

Abstract

Objective:
The aim of the study was to explore dose-related endometrial effects of conjugated estrogens/bazedoxifene (CE/BZA).

Methods:
In this randomized, double-blind, phase 2 study, 408 nonhysterectomized, symptomatic (with hot flushes [HFs]) postmenopausal women received ≥1 dose of CE 0.3 or 0.625 mg alone or with BZA 5, 10, or 20 mg/d; placebo; BZA 5 mg/d alone; or CE 0.625 mg with medroxyprogesterone acetate 2.5 mg/d for 84 days. The primary outcome was endometrial thickness on transvaginal ultrasound. HF frequency and severity based on diaries were key secondary outcomes.

Results:
CE 0.625 mg alone increased endometrial thickness compared with placebo (mean 5.5 vs 2.95 mm, P < 0.001); BZA countered this in a dose-related manner such that average thickness with the addition of BZA 5, 10, and 20 mg was 5.99, 4.33, and 3.54 mm, respectively. On average, endometrium was significantly less thick with CE 0.625 mg/BZA 20 mg than CE 0.625 mg (P < 0.001) and CE 0.3 mg/BZA 20 mg versus CE 0.3 mg (2.94 vs 3.92 mm, P < 0.05); endometrial thickness was similar to placebo with CE 0.625 mg/BZA 20 mg. Lower BZA doses failed to reduce endometrial thickness relative to the same dose of CE alone. Regimens containing CE 0.625 mg reduced HF frequency and severity versus placebo; CE 0.3 mg with BZA 10 or 20 mg was ineffective.

Conclusions:
BZA ≥20 mg is needed to counter endometrial growth resulting from treatment with CE 0.3 or 0.625 mg. CE 0.3 mg inadequately controls HFs if given with BZA 20 mg.
Associations of consuming specific fruit and vegetable subgroups with LDL-C status in early postmenopausal Chinese women
Authors: Chung Gary K.K. , Yu Ruby H.Y. , Ho Stella S.Y. , Woo Jean , Ho Suzanne C. 
Published: November 2017

Abstract

Objective:
Aging and menopausal changes contribute to increased cardiovascular risks in postmenopausal women. This study examined the associations of total and specific fruit and vegetable consumption with low-density lipoprotein cholesterol (LDL-C) status, a critical cardiovascular risk factor, in early postmenopausal Chinese women.

Methods:
A total of 508 postmenopausal Hong Kong Chinese women aged 50 to 64 years were recruited into a cohort study on cardiovascular risks. Sociodemographic characteristics, medical conditions, use of medications, and lifestyle factors were obtained via structured interviews. Dietary intake was assessed using a validated food frequency questionnaire. LDL-C and total cholesterol concentrations were determined using biochemical enzymatic techniques and categorized according to the Adult Treatment Panel III classification.

Results:
Ordinal logistic regression analysis showed that women with total fruit and vegetable intake in the highest quartile were 33% less likely (odds ratio [OR] = 0.67; 95% CI, 0.44-1.03) to have a worse LDL-C status than those with lower intake after adjustments. The intakes of total vegetables (OR = 0.63; 95% CI, 0.41-0.96) and vegetable subgroups in the highest quartiles, including darkgreen leafy vegetables (OR = 0.60; 95% CI, 0.41-0.89) and corn and tubers (OR = 0.62; 95% CI, 0.40-0.96), were significantly inversely associated with LDL-C status. Further adjustment for total cholesterol did not attenuate the associations.

Conclusions:
A daily consumption of vegetables equivalent to about four servings or more might be beneficial for LDL-C control in early Chinese postmenopausal women. In particular, darkgreen leafy vegetables, as well as corn and tubers, deserve greater advocacy for their ability to improve lipid profiles and hence cardiovascular health.
Age-related changes in luteal dynamics: preliminary associations with antral follicular dynamics and hormone production during the human menstrual cycle
Authors: Baerwald Angela , Vanden Brink Heidi , Hunter Caitlin , Beuker Denae , Lim Hyun , Lee Chel Hee , Chizen Donna 
Published: November 2017

Abstract

Objective:
The aim of the study was to test the hypothesis that the development of luteal phase dominant follicles (LPDFs) as women age is associated with abnormal luteal function.

Methods:
Luteal and antral follicle diameter were quantified in ovulatory women of midreproductive age (MRA; 18-35 y; n = 9) and advanced reproductive age (ARA; 45-55 y; n = 16) every 1 to 3 days during one complete interovulatory interval. Blood was drawn at each visit and assayed for progesterone, estradiol, inhibin A, follicle-stimulating hormone, and luteinizing hormone. Luteal diameter and hormone profiles were compared within MRA and ARA women with versus without LPDFs.

Results:
Luteal growth and regression profiles were similar in MRA women with typical versus no LPDFs (13.9, 14.8 mm; P > 0.1); however, luteal phase estradiol and progesterone were greater in MRA women with typical (91.1 ng/L, 8.81 μg/L) versus no (48.8 ng/L, 7.32 μg/L) LPDFs, respectively (LPDF effect, P < 0.1). In the ARA group, mean luteal diameter was lowest in women with atypical LPDFs (12.3 mm), greatest in those with typical LPDFs (16.0 mm), and moderate in those with no LPDFs (13.6 mm), (P < 0.1). Reduced luteal growth in ARA women with atypical versus typical and/or no LPDFs occurred simultaneously to greater luteal phase estradiol (199 vs 69.0, 78.4 ng/L) lower progesterone (7.38 vs 10.7, 13.8 ug/L), and lower inhibin A (36.3, 35.6, 51.2) (P < 0.1).

Conclusions:
The development of LPDFs as women age was associated with reduced luteal growth, greater estradiol, lower progesterone, and lower inhibin A. These findings provide preliminary evidence that variations in antral folliculogenesis contribute to luteal insufficiency during the menopausal transition.
Risk factors associated with intensity of climacteric symptoms in Brazilian middle-aged women: a population-based household survey
Authors: Lui-Filho Jeffrey Frederico , Pedro Adriana Orcesi , Baccaro Luiz Francisco , Costa-Paiva Lucia 
Published: November 2017

Abstract

Objective:
To determine the factors associated with the intensity of climacteric somatovegetative, psychological, and urogenital symptoms among middle-aged women in the Metropolitan Region of Campinas, Brazil.

Methods:
A cross-sectional population-based household survey was conducted with 749 women aged 45 to 60 years. The dependent variable was the intensity of menopausal symptoms assessed using the Menopause Rating Scale. The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background.

Results:
The mean age of the women was 52.5 ± 4.4 years, and the mean age at onset of menopause was 46.5 ± 5.8 years. The intensity of menopausal symptoms was defined using the subscale scores of the median Menopause Rating Scale. Poisson multiple regression for somatovegetative, psychological, and urogenital symptoms showed several associated factors of each subscale, though some factors were common. Factors associated with moderate to severe climacteric symptoms in all the subscales of the Menopause Rating Scale were self-perception of health as “fair”/“poor”/“very poor” (P < 0.01), depression/anxiety (P < 0.01), and osteoarticular diseases (P < 0.01).

Conclusions:
The severity of climacteric symptoms in the different Menopause Rating Scale domains was related to a broad set of factors. Each Menopause Rating Scale subscale had its own set of factors, but some were common. Presence of chronic diseases, depression or anxiety, and worst self-perception of health were highlighted. A better understanding of these factors may help to not only reduce the effect of climacteric symptoms on the quality of life of middle-aged women, but also identify groups of women who need multidisciplinary health care.
Negative-Pressure Wound Therapy for Ludwig’s Angina: A Case Series
Authors: Nanda Nainika , Zalzal Habib G. , Borah Gregory L. 
Published: November 2017

Summary:
Negative-pressure wound therapy (NPWT) is a well-established therapeutic approach for various complex wound classes. There is currently limited information on the use of NPWT for the scope of head and neck wounds. However, NPWT has been used successfully in some cases, including malignancy, infection, and trauma. In West Virginia, the incidence of dental-related infections leading to Ludwig’s Angina is high due to lack of access to dental care. Our case series describes the application of vacuum-based therapy in conjunction with antibiotic therapy for quick, effective closure of deep tissue infections before definitive complex wound repair via graft and flap reconstructions. Over a period of 3 months, 2 patients with submental infections extending to the lateral neck demonstrated clean, efficient wound closure with NPWT for less than 14 days while hospitalized at West Virginia University Medicine. Outpatient follow-up with these patients demonstrated excellent cosmetic outcomes with minimal contracture or hypertrophy of healing tissue. NPWT promotes wound healing through decreased edema, improved perfusion, and increased granulation of tissue based on our findings. Our series encourages the use of NPWT for initial closure of complex wounds secondary to deep neck infections.
Laparoscopic Harvest of the Rectus Abdominis for Perineal Reconstruction
Authors: Agochukwu Nneamaka , Bonaroti Alisha , Beck Sandra , Liau James 
Published: November 2017

Summary:
The rectus abdominis is a workhorse flap for perineal reconstruction, in particular after abdominoperineal resection (APR). Laparoscopic and robotic techniques for abdominoperineal surgery are becoming more common. The open harvest of the rectus abdominis negates the advantages of these minimally invasive approaches. (Sentence relating to advantages of laparoscopic rectus deleted here.) We present our early experience with laparoscopic harvest of the rectus muscle for perineal reconstruction. Three laparoscopic unilateral rectus abdominis muscle harvests were performed for perineal reconstruction following minimally invasive colorectal and urological procedures. The 2 patients who underwent APR also had planned external perineal skin reconstruction with local flaps. (Sentence deleted here to shorten abstract.) All rectus muscle harvests were performed laparoscopically. Two were for perineal reconstruction following laparoscopic APR, and 1 was for anterior vaginal wall reconstruction. This was done with 4 ports positioned on the contralateral abdomen. The average laparoscopic harvest time was 60–90 minutes. The rectus muscle remained viable in all cases. One patient developed partial necrosis of a posterior thigh fasciocutaneous flap after cancer recurrence. There were no pelvic abscesses, or abdominal wall hernias. Laparoscopic harvest of the rectus appears to be a cost-effective, reliable, and reproducible procedure for perineal with minimal donor-site morbidity. Larger clinical studies are needed to further establish the efficacy and advantages of the laparoscopic rectus for perineal reconstruction.
Association between pain and frailty among Chinese community-dwelling older adults: depression as a mediator and its interaction with pain
Authors: Tian Xiaoyu , Wang Cuili , Qiao Xiaoxia , Liu Na , Dong Lijuan , Butler Mary , Si Huaxin , Jin Yaru 
Published: November 2017

Abstract
Pain and frailty are both prevalent and have severe health impacts among older adults. We conducted a cross-sectional observational study to examine the association between pain and frailty, and depression as a mediator and its interaction with pain on frailty among 1788 Chinese community-dwelling older adults. Physical frailty, pain intensity, and depressive symptoms were assessed using the Frailty Phenotype, the Faces Pain Scale-revised, and the 5-item Geriatric Depression Scale, respectively. We found that both pain (odds ratio [OR] = 1.61; 95% confidence interval [CI]: 1.32-1.97) and depressive symptoms (OR = 4.67; 95% CI: 3.36-6.50) were positively associated with physical frailty (OR = 1.61; 95% CI: 1.32-1.97), and depressive symptoms were associated with pain (OR = 1.94; 95% CI: 1.15-3.39), attenuating the association between pain and physical frailty by 56.1%. Furthermore, older adults with both pain and depressive symptoms (OR = 8.13; 95% CI: 5.27-12.53) had a higher risk of physical frailty than those with pain (OR = 1.41; 95% CI: 1.14-1.76) or depressive symptoms (OR = 3.63; 95% CI: 2.25-5.85) alone. The relative excess risk of interaction, the attributable proportion due to interaction, and the synergy index (S) were 4.08, 0.50, and 2.34, respectively. These findings suggest that the positive association of pain with frailty is persistent and partially mediated by depression, and comorbid depression and pain have an additive interaction on physical frailty. It has an implication of multidisciplinary care for frail older adults with pain.
Tactile acuity (dys)function in acute nociceptive low back pain: a double-blind experiment
Authors: Adamczyk Wacław M. , Saulicz Oskar , Saulicz Edward , Luedtke Kerstin 
Published: November 2017

Abstract
Research shows that chronic pain is related to cortical alterations that can be reflected in reduced tactile acuity, but whether acute pain perception influences tactile acuity has not been tested. Considering the biological role of nociception, it was hypothesized that nociceptive pain will lead to a rapid improvement in tactile acuity and that this effect is correlated with pain intensity and pain distribution. In this randomised double-blind controlled experiment (trial no. NCT03021278), healthy participants were exposed to 1 of 3 experimental conditions: acute, nociceptive low back pain induced by saline injection, a sham injection (without piercing the skin) potentially inducing nocebo pain, or no intervention. Tactile acuity was measured by a battery of tests, including two-point discrimination threshold (TPD), before, during the pain experience, and after it subsided. We found that TPD did not improve but deteriorated during pain induction in the experimental group compared with the control group (P < 0.001; η2 = 0.20) and changed from 56.94 mm (95% confidence interval: 53.43-60.44) at baseline to 64.22 mm (95% confidence interval: 60.42-68.02) during the pain experience. Maximum reported pain was a significant predictor (β = 0.55, P = 0.01) and accounted for 26% of the variance in TPD (P < 0.05). Other tests, point-to-point test and two-point estimation task, changed with a similar trend but did not reach significance. We concluded that acute, nociceptive pain does not improve but deteriorates tactile acuity linearly. The biological role of the observed phenomenon is unknown, and therefore, future studies should address this question.
Surgical Management of Tumors Involving Meckel's Cave and Cavernous Sinus: Role of an Extended Middle Fossa and Lateral Sphenoidectomy Approach
Authors: Sun Daniel Q. , Menezes Arnold H. , Howard Matthew A. , Gantz Bruce J. , Hasan David M. , Hansen Marlan R. 
Published: November 2017

Objective:
To study the indications and outcomes of lateral sphenoidectomy as part of a combined skull base approach in the treatment of tumors involving Meckel's cave (MC) and cavernous sinus (CS).

Study Design:
Retrospective patient series.

Setting:
Tertiary referral center.

Patients:
Twenty-two consecutive patients (mean age: 45 yr, range: 16–76) who underwent transzygomatic, extended middle fossa approaches for tumors involving MC and CS.

Interventions:
Surgical access to MC and CS was achieved via extended middle fossa, trans-clinoid approach. Lateral sphenoidectomy was defined as drill-out of the greater sphenoid wing lateral to foramen rotundum and ovale, decompression of superior orbital fissure, and removal of anterior clinoid process. Reconstruction was achieved using combination of autologous and synthetic materials. Eleven patients (50%) received adjuvant radiation.

Main Outcome Measures and Results:
Tumor pathologies included meningioma (16 patients), epidermoid cyst (2), trigeminal schwannoma (2), invasive pituitary adenoma (1), and chondrosarcoma (1). Mean (range) preoperative tumor size was 4.0 cm (1.3–9). Mean (range) length of follow-up was 4 years (range 0.1–10). Overall tumor control and gross total resection were achieved in 95 and 23% of patients, respectively. Lateral sphenoidectomy was performed in 16 patients (73%) for enhanced surgical access and/or tumor extension to the infratemporal fossa (6 patients). Postoperatively, cranial nerve deficits occurred in 12 (55%) patients (V–9 patients; III, IV, or VI–4; VII–2; VIII–2). Cerebrospinal fluid leak and hydrocephalus occurred in two and four patients, respectively.

Conclusion:
In combination with middle fossa-based approaches to tumors involving MC and CS, lateral sphenoidectomy may play a viable role in tumor access and control.