bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restoring Faculty Vitality in Academic Medicine When Burnout Threatens
Authors: Shah Darshana T. , Williams Valerie N. , Thorndyke Luanne E. , Marsh E. Eugene , Sonnino Roberta E. , Block Steven M. , Viggiano Thomas R. 
Published: November 2017

Increasing rates of burnout—with accompanying stress and lack of engagement—among faculty, residents, students, and practicing physicians have caused alarm in academic medicine. Central to the debate among academic medicine’s stakeholders are oft-competing issues of social accountability; cost containment; effectiveness of academic medicine’s institutions; faculty recruitment, retention, and satisfaction; increasing expectations for faculty; and mission-based productivity.
The authors propose that understanding and fostering what contributes to faculty and institutional vitality is central to preventing burnout during times of change. They first look at faculty vitality and how it is threatened by burnout, to provide a framework for a greater understanding of faculty well-being. Then they draw on higher education literature to determine how vitality is defined in academic settings and what factors affect faculty vitality within the context of academic medicine. Next, they propose a model to explain and examine faculty vitality in academic medicine, followed by a discussion of the need for a greater understanding of faculty vitality. Finally, the authors offer conclusions and propose future directions to promote faculty vitality.
The authors encourage institutional decision makers and other stakeholders to focus particular attention on the evolving expectations for faculty, the risk of extensive faculty burnout, and the opportunity to reduce burnout by improving the vitality and resilience of these talented and crucial contributors. Faculty vitality, as defined by the institution, has a critical role in ensuring future institutional successes and the capacity for faculty to thrive in a complex health care economy.
Topical 5-Fluorouracil for Women With High-Grade Vaginal Intraepithelial Neoplasia
Authors: Fiascone Stephen , Vitonis Allison F. , Feldman Sarah 
Published: November 2017

OBJECTIVE:
To examine success rates of 5-fluorouracil, excision, and laser ablation as the initial and secondary management strategies for women with high-grade vaginal intraepithelial neoplasia.

METHODS:
We conducted a retrospective case series of women referred to a single center for management of biopsy-proven, high-grade vaginal intraepithelial neoplasia between April 1994 and May 2016. Data including demographic characteristics, human papillomavirus risk factors, antecedent Pap cytology, concurrent or prior cervical and vulvar dysplasia, and treatment outcome including follow-up Pap cytology were recorded. All women were counseled on options of excision, laser ablation, or 5-fluorouracil, which was administered intravaginally according to a standardized regimen. Recurrence was defined as a biopsy showing any vaginal intraepithelial neoplasia diagnosis after primary treatment.

RESULTS:
Forty-seven patients were treated initially with 5-fluorouracil, 35 were treated with excision, and 22 were treated with laser ablation. Demographics were similar between groups. No recurrence was noted in 35 women treated with 5-fluorouracil (74%; 95% CI 62–87%), 20 treated with excision (57%; 95% CI 41–74%), and nine treated with laser ablation (41%; 95% CI 20–61%). Among 13 patients treated with 5-fluorouracil for recurrence, eight (62%) did not experience a second recurrence. Nine of 58 (16%) patients ever treated with 5-fluorouracil reported a side effect, most commonly irritation and dyspareunia.

CONCLUSION:
5-fluorouracil was associated with a 74% success rate as the initial treatment modality for high-grade vaginal dysplasia. There is also a role for 5-fluorouracil in the management of recurrent or persistent high-grade vaginal intraepithelial neoplasia.
IDIOPATHIC MULTIFOCAL CHOROIDITIS PRESENTING WITH A TRANSIENT PERIPAPILLARY WHITE RING
Authors: Gattoussi Sarra , Ghadiali Quraish , Dolz-Marco Rosa , Freund K. Bailey 
Published: November 2017

Purpose:
We describe with multimodal imaging the presentation and follow-up for a patient with idiopathic multifocal choroiditis and a transient peripapillary white ring.

Methods:
Case report.

Results:
A 39-year-old Asian woman was initially seen for an evaluation of lattice degeneration in 2015. Her medical history included Graves disease and psoriasis. Best-corrected visual acuity was 20/25 in her right eye and 20/25 in her left eye. Ultra–widefield fundus autofluorescence imaging showed a curvilinear hyperautofluorescent line in her right eye. One year later, the patient returned complaining of floaters in her right eye for 1 month. Her visual acuity was unchanged. Funduscopic examination showed new inflammatory yellowish lesions in the right eye corresponding to hyperreflective sub–retinal pigment epithelium lesions on structural spectral domain optical coherence tomography. Fluorescein angiography showed corresponding late staining of these active lesions. Late-phase indocyanine green angiography showed multiple nummular hypocyanescent dots. Ultra–widefield fundus autofluorescence showed large areas of hyperautofluorescence. The patient was started on a 60-mg oral prednisone taper and demonstrated subsequent regression of the inflammatory lesions. Ten months later, the patient returned emergently with complaints of floaters in both eyes for 2 days and a new temporal scotoma in her left eye. Funduscopic examination demonstrated a white ring around the optic nerve of the left eye corresponding to a hyperautofluorescent lesion. Ultra–widefield fundus autofluorescence showed new areas of hyperautofluorescence in both eyes. Structural spectral domain optical coherence tomography showed new sub–retinal pigment epithelium inflammatory lesions and a disruption of the ellipsoid zone in both eyes. The patient was again treated with a 60-mg oral prednisone taper and demonstrated subsequent restoration of the ellipsoid zone.

Conclusion:
To our knowledge, this is the first report of a transient annular white ring occurring in a case of multifocal choroiditis. There was marked restoration of the disrupted ellipsoid zone after treatment with oral corticosteroids.
ATYPICAL PERIPAPILLARY INNER RETINOSCHISIS IN STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS
Authors: Javaheri Michael , Sadda SriniVas R. 
Published: November 2017

Purpose:
To describe an atypical presentation of a patient with stellate nonhereditary idiopathic foveomacular retinoschisis with peripapillary retinoschisis of multiple layers.

Methods:
Complete ophthalmic examination including dilated extended ophthalmoscopy, fluorescein angiography, optical coherence tomography, optical coherence tomography angiography, and wide-field fundus photography.

Results:
A 36-year-old Chinese American woman with mild myopia and good visual acuity (20/20) exhibited macular splitting of the outer plexiform layer on spectral domain optical coherence tomography with an attached hyaloid in her left eye. Peripheral spectral domain optical coherence tomography also demonstrated peripapillary and midperipheral inner retinoschisis, involving the outer plexiform layer and inner retina. The right eye was unremarkable. The diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis was made because of a lack of other associated ocular conditions and no family history of retinoschisis.

Conclusion:
Stellate nonhereditary idiopathic foveomacular retinoschisis is a recently described and uncommon cause of foveomacular retinoschisis in myopic women with good visual acuity. Recent evidence suggests that peripheral imaging is key in identifying other findings, including midperipheral or peripapillary inner retinoschisis, involving the outer plexiform layer and the inner retina. Our patient may represent a variant of stellate nonhereditary idiopathic foveomacular retinoschisis that can be characterized by multilayer peripapillary retinoschisis.
A 9-YEAR-OLD GIRL WITH ACUTE MACULAR NEURORETINOPATHY
Authors: Rodríguez-Vargas Gabriel , Gutiérrez-Hernández Juan C. 
Published: November 2017

Purpose:
To report the clinical findings of the youngest confirmed case of acute macular neuroretinopathy to the best of our knowledge.

Methods:
A 9-year-old patient describing a paracentral scotoma with a normal clinical examination and normal fluorescein angiography.

Results:
Initial fundus examination was unremarkable. Fluorescein angiography findings showed no abnormalities but scotoma was confirmed using Amsler grid. Optical coherence tomography showed a parafoveal hyperreflective band in the outer layers. Subsequent optical coherence tomography showed resolution of the pathology.

Conclusion:
Acute macular neuroretinopathy is a rare condition usually presented as paracentral scotomas. Optical coherence tomography and Amsler grid testing can be used for diagnosis and to monitor findings on follow-up until resolution.
IMMUNE RETINOPATHY ASSOCIATED WITH NIVOLUMAB ADMINISTRATION FOR METASTATIC NON–SMALL CELL LUNG CANCER
Authors: Reddy Manisha , Chen Judy J. , Kalevar Ananda , Terribilini Ryan , Agarwal Anita 
Published: November 2017

Purpose:
To present a novel case of immune retinopathy associated with nivolumab therapy for non–small cell lung cancer.

Methods:
Retrospective chart review.

Results:
A 64-year-old woman presented with photoreceptor injury evidenced by hypoautofluorescent and hyperautofluorescent patches on fundus autofluorescence, loss of the ellipsoid zone on optical coherence tomography, and dysfunction of the rods and cones on electroretinogram. She had a history of Stage IV lung adenocarcinoma, treated with nivolumab, a checkpoint inhibitor. Serology testing was negative for paraneoplastic antibody panel, antirecoverin and antienolase antibodies, but positive for antiretinal antibodies against 30-kDa (carbonic anhydrase II), 35-kDa (GADPH), 38-kDA, 58-kDa (PKM2), and 112-kDa proteins. Cessation of the medication and high-dose oral steroids resulted in resolution of her symptoms and stability of ocular findings.

Conclusion:
The checkpoint inhibitors, including nivolumab, have significant ocular side effects. All patients receiving nivolumab should undergo a baseline comprehensive eye examination and should be counseled to seek medical attention immediately if visual changes occur.
Men Who Have Sex With Men—Identification Criteria and Characteristics From the National Health and Nutrition Examination Survey, 1999 to 2014
Authors: Esie Precious , Kang Joseph , Flagg Elaine W , Hong Jaeyoung , Chen Tianqi , Bernstein Kyle 
Published: November 2017

Objectives
This study aimed to provide identification criteria for men who have sex with men (MSM), estimate the prevalence of MSM behavior, and compare sociodemographics and sexually transmitted disease risk behaviors between non-MSM and MSM groups using data from a nationally representative, population-based survey.

Methods
Using data from men aged 18 to 59 years who took part in the National Health and Nutrition Examination Survey (NHANES), 1999 to 2014, detailed criteria were developed to estimate MSM behavior—at least one lifetime same-sex partner (MSM-ever), at least one same-sex partner in the past 12 months (MSM-current), and at least one lifetime and zero same-sex partners in the past 12 months (MSM-past).

Results
The estimated prevalence of MSM-ever was 5.5%—of these, 52.4% were MSM-current and 47.1% were MSM-past. Furthermore, MSM-ever are a nonhomogenous subpopulation, for example, 70.4% of MSM-current identified as homosexual and 71.2% of MSM-past identified as heterosexual (P < 0.001).

Conclusions
The prevalence of MSM behavior identified here is similar to other published estimates. This is also the first article, to our knowledge, to use National Health and Nutrition Examination Survey data to compare MSM by 2 recall periods (recent vs. lifetime) of last same-sex sexual behavior.
Rapid Increase in Reports of Syphilis Associated With Men Who Have Sex With Women and Women Who Have Sex With Men, Japan, 2012 to 2016
Authors: Takahashi Takuri , Arima Yuzo , Yamagishi Takuya , Nishiki Shingo , Kanai Mizue , Ishikane Masahiro , Matsui Tamano , Sunagawa Tomimasa , Ohnishi Makoto , Oishi Kazunori 
Published: November 2017

Background
In Japan, syphilis reports have recently increased rapidly. However, unlike other developed countries where men who have sex with men (MSM) were associated with the rise, the increase in Japan has been attributed more to men who have sex with women (MSW) and women who have sex with men (WSM). We report on this increase based on surveillance data.

Methods
Syphilis is a notifiable disease requiring all laboratory-confirmed cases to be reported; stage and sex of the sex partner(s) suspected as the infection source are also reported. Focusing on primary and secondary (P&S) cases, we describe the temporal, demographic, and geographic distributions of reported cases in 2012 through 2016.

Results
A total of 7040 (64.0%) of 10,997 cases were P&S; the annual rate of increase was greatest for P&S and the proportion of P&S increased over time. Among P&S cases (1609 MSM, 2768 MSW, and 1323 WSM), MSW and WSM each surpassed MSM cases in 2016. Men were older with a wider age distribution (median, 37 years; interquartile range, 28–46 years) relative to women (median, 26 years; interquartile range, 21–34 years). Among women, 20- to 24-year-olds consistently had the highest reporting rate, reaching 9.0 per 100,000 in 2016. Congenital syphilis reports increased from 0.4 in 2012 to 1.4 per 100,000 live births in 2016. Although Tokyo prefecture had the highest reporting rate (3.98 per 100,000 person-years), the proportionate contribution from Tokyo decreased in 2016.

Conclusions
Reports on P&S syphilis increased yearly among MSW and WSM. Young women seem to be at particular risk, and with increased reports of congenital syphilis, syphilis prevention and control is currently a public health priority in Japan.
Prepectoral Immediate Direct-to-Implant Breast Reconstruction with Anterior AlloDerm Coverage
Authors: Jones Glyn , Yoo Aran , King Victor , Jao Brian , Wang Huaping , Rammos Charalambos , Elwood Eric 
Published: November 2017

Background:
Staged subpectoral expander-implant breast reconstruction is widely performed. Disruption of the pectoralis major origin and the frequent occurrence of animation deformity and functional discomfort associated with subpectoral reconstruction remain ongoing concerns. Prepectoral single-stage direct-to-implant reconstruction resolves many of these issues. In this study, the authors explored the rationale for prepectoral single-stage implant-based breast reconstruction with anterior AlloDerm coverage as an alternative to the staged approach.

Methods:
Seventy-three breasts in 50 patients were reconstructed using a single-stage direct-to-implant prepectoral approach with total anterior AlloDerm coverage during a 24-month period. The decision to proceed with single-stage reconstruction was predicated upon the adequacy of mastectomy skin flap blood flow based on indocyanine green fluorescence perfusion assessment. The patients were followed up for a maximum of 32 months.

Results:
Ninety-seven percent of patients achieved complete healing within 8 weeks. There were 2 implant losses (2.7%) due to infection. Major seroma rate requiring repeated aspiration and drain insertion was 1.2%. There were no full-thickness skin losses. Capsular contracture was 0% in nonradiated patients. There were no cases of animation deformity. The authors were unable to establish significant correlation between complications and any of the usually stated risk factors, such as smoking, obesity, and large mastectomy weights, presumably due to the rigorous application of intraoperative skin perfusion assessment.

Conclusion:
Single-stage direct-to-implant reconstruction using a prepectoral approach appears to be a safe and effective means of breast reconstruction in many patients, assuming adequate skin perfusion is present.
Evidence-Based Medicine: Abdominoplasty
Authors: Gutowski Karol A. 
Published: November 2017

Learning Objectives:
After reading this article, the participant should be able to: 1. Differentiate between techniques for standard abdominoplasty and lipoabdominoplasty. 2. Assess patients for risk associated with abdominoplasty alone and combined with other procedures. 3. Implement newer modalities for abdominoplasty perioperative pain management. 4. Better understand the implications and techniques for rectus diastasis correction by rectus sheath plication. 5. Understand the evidence for eliminating the need for drains in abdominoplasty.

Summary:
This update to past Maintenance of Certification articles offers new perspectives and builds on past knowledge regarding patient assessment, perioperative management, surgical execution, and complications of abdominoplasty.
Effect of Age on High T1 Signal Intensity of the Dentate Nucleus and Globus Pallidus in a Large Population Exposed to Gadodiamide
Authors: Quattrocchi Carlo Cosimo , Errante Yuri , Mallio Carlo Augusto , Marinelli Luca , LoVullo Gianguido , Giannotti Gabriele , Della Sala Sabino Walter , van der Molen Aart J. , Beomonte Zobel Bruno 
Published: November 2017

Objective
The purpose of this study was to assess the effect of age and number of previous injections of gadodiamide on the signal intensity of unenhanced T1-weighted (T1w) images of the dentate nucleus and globus pallidus in a large population.

Materials and Methods
A large, single-center retrospective population survey was designed and received institutional review board approval. Between January 2014 and December 2014, T1w signal intensity ratios were obtained from a large population of 2500 consecutive enhanced brain magnetic resonance imaging (MRI) scans. Of these, 1906 MRI scans of patients not previously exposed to any gadolinium (Gd)-based contrast agent were used as control group and were compared with 892 MRI scans of patients with documented prior exposure to intravenous gadodiamide. A quantitative study was conducted to assess the T1w signal intensity of dentate nucleus-to-pons (Dn/Po) and globus pallidus-to-thalamus (Gp/Th) ratios. Multiple regression analysis was used to test the effect of age, time delay, and number of previous Gd-based contrast agent injections as predictor variables of T1w signal intensity ratios.

Results
In the Gd-exposed patients, multivariate regression analysis showed age (β = −0.285; P < 0.0001) and the number of previous injections of gadodiamide (β = 0.224; P < 0.0001) to be powerful predictors of Dn/Po ratio. Similarly, age (β = 0.269; P < 0.0001) and the number of previous injections of gadodiamide (β = 0.127; P < 0.0001) predicted Gp/Th ratio.

Conclusions
In this study, we confirm that the number of previous gadodiamide injections is a powerful predictor of the signal intensity increase of the Dn/Po and Gp/Th ratios on unenhanced T1w images and demonstrate that aging influences the T1 signal intensity of DN and GP in Gd-naïve and in Gd-exposed subjects.
Testicular Estrogen-Secreting Leydig Cell Tumor in 18F-FDG PET/CT
Authors: Van Der Gucht Axel , Maged Zaher , Burruni Rodolfo , Barras Jean-Luc , Schaefer Niklaus 
Published: November 2017

Abstract
We present images of a 50-year-old man who referred for treatment of a classic Hodgkin lymphoma. While 18F-FDG PET/CT demonstrated a complete metabolic remission after chemotherapy, an increased 18F-FDG uptake of a right testicular lesion in 18F-FDG PET/CT and an unexplained bilateral gynecomastia were observed. A benign Leydig cell tumor was histopathologically proved after a right radical orchiectomy. The serum estradiol level was abnormally elevated reflecting the estrogen-secreting profile. This report highlights that a focal 18F-FDG uptake in the testicular region with unexplained gynecomastia should suggest the diagnosis of an estrogen-secreting Leydig cell tumor on 18F-FDG PET/CT.
Pseudolesions Impersonating Osseous Tumor Involvement on Both Contrast Enhanced CT and FDG PET/CT
Authors: Peterson Jessica K. , Morgan Rustain L. , Donald Joseph S. , Perry Mark A. 
Published: November 2017

Abstract
A 27-year-old man with stage IV-B Hodgkin's lymphoma status post autologous peripheral stem cell transplant in 2015 with complete response, presented in 2017 with increasing back pain. Restaging contrast enhanced CT demonstrated left brachiocephalic vein occlusion with peripheral nodular high density areas within C7–T2 vertebral bodies with corresponding radiotracer uptake on same day PET/CT. No matching lesion was seen on noncontrast CT. Findings were consistent with pooling of contrast and radiotracer within vertebral venous plexus collaterals at the cervicothoracic junction secondary to brachiocephalic vein occlusion. Repeat PET/CT with contralateral injection of radiotracer and MRI confirmed absence of osseous lymphomatous involvement.
Multiple Hypermetabolic Subcutaneous Lesions From Hidradenitis Suppurativa Mimicking Metastases on 18F-FDG PET/CT
Authors: Asamoah Philip , Wale Daniel J. , Viglianti Benjamin L. , Wong Ka Kit , Gross Milton 
Published: November 2017

Abstract
Hidradenitis suppurativa is an inflammatory disease associated with subcutaneous nodules/abscesses that occur commonly in the axillary, inguinal, and perineal regions. We describe a case of a 64-year-old man presenting for 18F-FDG PET/CT for staging of a left vocal cord squamous cell carcinoma. The scan showed uptake in the left vocal cord malignancy and multiple hypermetabolic subcutaneous foci in the right axilla, right buttocks, and scalp in known locations of skin lesions related to hidradenitis suppurativa. This case illustrates an unusual inflammatory cause of 18F-FDG incidental uptake that should not be mistaken for metastases.
Luxury retailers’ entry and expansion strategies in China
Authors: Bai Huifeng , McColl Julie , Moore Christopher 
Published: November 2017

Purpose
The purpose of this paper is to examine internationalising luxury fashion retailers’ entry and post-entry expansion strategies in mainland China.

Design/methodology/approach
The study adopts a pragmatic mixed-methods research approach, including a quantitative mail survey and qualitative face-to-face in-depth executive interviews.

Findings
Different from initial single entry methods, multiple methods are increasingly popular for luxury fashion retailers’ post-entry expansion in mainland China. Although directly controlled expansion strategies have become significant, local partnerships are still important and omnichannel distribution strategies are rapidly growing.

Research limitations/implications
The findings were generated in mainland China only.

Originality/value
This work provides an understanding of luxury fashion retailers’ activities in the Chinese market from both macro and micro perspectives. It examines luxury fashion retailers’ initial entry strategies, as well as their post-entry expansion strategies in mainland China. Few studies in the area of international luxury fashion retailing have employed a mixed-methods approach with this number of participants.