bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interobserver Reliability of Milan and Modified Milan System for Reporting Salivary Gland Cytopathology: An Institutional Experience
Authors: Bhola Ridhi , Narwal Anjali , Kamboj Mala , Devi Anju , Singh Sunita 
Published: April 2024

Background:
In 2018, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was published, defining a diagnostic categorization scheme. However, this system of classification was criticized due to its suboptimal diagnostic accuracy and low interobserver reliability. For these reasons, the modified Milan system was recently proposed by a few authors claiming it to be more clinically reliable. The present study aimed to analyze the interobserver reliability of MSRSGC and modified MSRSGC.

Methods:
A total of 100 salivary gland fine-needle aspirations were reviewed over a 1-year period and classified by two independent observers according to MSRSGC and modified MSRSGC. Interobserver reproducibility was estimated using observed agreement and chance-corrected agreement (Cohen’s kappa).

Results:
An overall chance corrected agreement of 0.37 (fair) was obtained for the original Milan system and 0.41 (moderate) for the modified one. In addition, subcategories of modified MSRSGC performed better than the MSRSGC in terms of interobserver reliability.

Conclusion:
The present study suggests that modified MSRSGC should be accepted worldwide as the clinical relevance of any categorization scheme requires diagnostic accuracy along with excellent interobserver reproducibility.
Can Mitotic Figures in Hyperchromatic Crowded Groups be Cytodiagnostic Criteria for High-Grade Squamous Intra-epithelial Lesions?
Authors: Suzuki Hisae , Kondo Yumeno , Oda Chihiro , Nishikawa Takeshi , Takeuchi Mao , Tatsumi Shigenobu , Hosokawa Sho , Irino Satoshi , Uchiyama Tomoko , Fujii Tomomi , Norimatsu Yoshiaki 
Published: April 2024

Aims:
The present study aimed to investigate whether the presence of mitoses in hyperchromatic crowded groups (HCGs) in cervical cytological specimens can serve as cytological criteria for high-grade squamous intra-epithelial lesions (HSILs).

Methods and Material:
Various parameters were examined, including the frequency of mitotic figures per high power field (HPF) in Pap, hematoxylin eosin (HE) samples, and PHH3 immunocytochemical (ICC) and immunohistochemical (IHC) analyses.

Results:
In the Pap and PHH3-ICC samples, the number of mitotic figures observed in HCGs was significantly higher in HSIL (P < 0.001) compared to other groups. Furthermore, the frequency of observing two or more mitoses was significantly higher in HSIL (Pap: P = 0.002, PHH3-ICC: P < 0.001) than in low-grade squamous intra-epithelial lesions (LSILs). Moreover, a comparison between Pap samples and PHH3-ICC showed that the frequency of two or more mitoses was significantly higher in the PHH3-ICC analysis of HSIL (P = 0.042). Regarding HE and PHH3-IHC samples, counting the number of mitoses in the lower and middle/upper layers of the squamous epithelial layer revealed that HSIL had a significantly higher value (HE: P = 0.0089, PHH3-IHC: P = 0.0002) than LSIL in the middle/upper layers.

Conclusions:
Hence, the presence of two or more mitotic figures in HCGs per HPF in cervical cytology indicates a suspicion of HSIL. The detection of mitoses in PHH3-ICC samples is more sensitive and easier to observe than in Pap samples, making it a valuable mitotic marker.
Cytologic Parameters in Predicting the Outcome of Atypical Glandular Cells on Papanicolaou Smears: A Single-Institutional Experience
Authors: Phalak Pooja A. , Shah Majal G. , Kapoor Shilpa , Goswami Saurabh J. , Samanta Satarupa T. , Trivedi Priti P. 
Published: April 2024

Background:
Atypical glandular cells (AGCs) diagnosis on Pap (Papanicolaou) smears are uncommon and may represent various benign and malignant lesions.

Objective:
This study aims to report the incidence of AGC on Pap smear, to study the relationship of AGC with malignancy, and to determine cytomorphological features that help in predicting malignancy.

Materials and Methods:
Retrospective analytical study conducted in the Department of Oncopathology at Tertiary Cancer and Research Institute. In this retrospective study, we included cases diagnosed with AGC between July 2017 to July 2022. All slides were reviewed and subclassified according to the Bethesda 2014 classification system (TBS). The predetermined cytomorphological features observed in the smears were recorded. The follow-up histopathological diagnoses of the cases were retrieved. The significant cytomorphological and clinicopathological findings for malignancy were determined.

Results:
Pearson χ2 test with SPSS software version 22 to compare cytologic features of cases with benign and malignant follow-up. The significant cytomorphological features observed in neoplastic cases were cells in 3-dimensional clusters, nuclear overlapping, reniform nucleus, irregular nuclear membrane, increased nuclear size, single macronucleoli, engulfed neutrophils, and prominently vacuolated cytoplasm.

Conclusions:
The diagnosis of AGC on cytology is associated with clinically significant lesions, and cytomorphologic parameters can be used to predict the benign and malignant outcome.
Modification of Rapid Papanicolaou Stain with Phloxine: A Study Assessing the Utility in Gynecological Smears
Authors: Kaur Ramandeep , Somal Puneet K. , Kalra Supreet K. , Sharma Aishwarya , Sancheti Sankalp 
Published: April 2024

Background:
Rapidity and reliability are the major advantages of cytopathology in tumor diagnosis. The need for minimal turnaround time for assessing cytological smears has encouraged innovations in staining techniques that require lesser staining time with unequivocal cell morphology. Rapid Pap staining was introduced as a hybrid to conventional Pap stain. It improves staining quality, gets over the staining time in restriction, and is a more efficient technique financially. In the present study, a modified staining technique was adopted where phloxine is added as one of the cytoplasmic stain components in rapid Pap stain kits.

Objective:
The aim of this study was to assess whether the modification of the existing procedure by adding phloxine as one of the components of the cytoplasmic stain intensifies the cytoplasmic differentiation and cytoplasmic staining in gynecological smears.

Materials and Methods:
This was a prospective study done on 50 cases of gynecological smears. Two smears were collected from each patient and fixed in 100% propanol and stained with the rapid Pap stain kit procedure and modified rapid Pap stain with phloxine. Slides were then analyzed by two pathologists blinded to the staining method used. Five parameters were considered and scored (background, cell morphology, nuclear staining, cytoplasmic differentiation, and cytoplasmic staining). The quality index for each method was calculated by finding out the ratio of the actual score obtained to the maximum score possible.

Results:
Both the staining methods had comparable results. For both pathologists, the quality index calculated for modified Pap stain was found to be marginally higher than the quality index for rapid Pap. The mean quality index was comparable for modified Pap (0.91) and rapid Pap (0.89).

Conclusions:
The efficacy of modified Pap stain with phloxine to distinctly stain the cytoplasm is comparable with that of rapid Pap stain. In addition, the intensity of staining can be enhanced with little cost outlay, and this can be especially beneficial in low-resource settings.
Acute Myocardial Infarction or Broken Heart with Takotsubo Cardiomyopathy? Realm of Mystification after Suicidal Hanging
Authors: Sharma Sanjay Kumar 
Published: April 2024

Abstract
Takotsubo cardiomyopathy is a rare immune-endocrinologic cause of acute and rapidly reversible left ventricular dysfunction, usually resembling acute myocardial infarction (AMI) and triggered by emotional or physical stress. We described a case of such syndrome in a 27-year-old female after an attempted suicidal hanging, whose initial clinical symptoms and electrocardiography (ECG) findings were misleading to AMI. On admission, the patient was unconscious and hypoxic. Echocardiography demonstrated a severe left ventricular systolic dysfunction with akinesis in the mid and anterior septum and apex (a typical ballooning pattern), which raised suspicion of takotsubo cardiomyopathy. Our patient developed chest pain, a day after the suicidal attempt. Emergent coronary angiography revealed no evidence of occlusion, confirmed diagnosis of takotsubo cardiomyopathy was made. The patient was managed with medical therapy. On a week later follow-up, the patient was totally asymptomatic with a reversal of ECG changes, and the left ventricular contractility was improved within 30 days.
Could the Cytomegalovirus Viral Load Be Correlated with Cellular Rejection in Asymptomatic Heart Transplant Recipients? A Brief Report
Authors: Mozaffari Kambiz , Givtaj Nozar , Hesami Mahshid , Mirtajaddini Marzieh , Fareghbal Mahsa , Nojoomizadeh Leila , Naderi Nasim 
Published: April 2024

Abstract

Introduction:
Cytomegalovirus (CMV) infection is mainly associated with acute or chronic graft rejection in various solid organs. This study was conducted with the aim of evaluating the plasma viral load of CMV infection in postheart transplant patients and its correlation with the grading of cellular graft rejection in endomyocardial biopsies.

Materials and Methods:
In a cross-sectional study, 90 samples from 65 asymptomatic heart transplant recipients scheduled for routine endomyocardial biopsy were obtained. All the recipients had a history of positive serology for CMV infection before transplantation. Evaluation of their DNA was tracked using the polymerase chain reaction technique and the use of specific virus DNA primers, and based on this, the peak virus load (the number of virus copies per milliliter) was determined. A peak viral load >10,000 copies/mL was considered positive. Graft rejection grading was determined based on the ISHLT grading system.

Results:
The mean (standard deviation) age of the patients (37 men) was 67 (37.3) years. The graft rejection grading was as follows: 22.2% grade 0, 38.9% Quilty effect (QE), 35.6% grade 1, and 3.3% grade 2. The mean plasma viral load level of CMV infection was 2197.4 (1256.2) μg/μL, 1970.4 (1150.3) μg/μL, and 4567.2 (1669.1) μg/μL in grades 0, QE, and 1 and/or 2, respectively (P < 0.001). The virus load was significantly higher in those with higher grades of cellular rejection.

Conclusion:
The relationship between the plasma level of CMV viral load and the grading of cellular graft rejection in heart transplant patients could emphasize the role of CMV virus in the pathophysiology of graft rejection. A closer surveillance for CMV infection using the viral load is also recommended in particular in those who have higher grades of graft rejection.
Coronary Artery Bypass Graft Effect on Cardiogoniometry Characteristic in Patients with Coronary Heart Disease
Authors: Sadeghpourtabaei Ali , Behjati Mohaddeseh , Baharestani Bahador , Tohidi Fatemeh 
Published: April 2024

Abstract

Context:
Cardiogoniometry (CGM) is a noninvasive technique for quantitative three-dimensional vectorial analysis of myocardial depolarization and repolarization. We describe a method of surface electrophysiological cardiac assessment using CGM performed at rest to detect variables helpful in identifying coronary artery disease (CAD) and interplaying factors in patients who underwent coronary artery bypass graft (CABG).

Materials and Methods:
In this study, all patients with CAD undergoing CABG were enrolled. Echocardiography, CGM, and electrocardiography (ECG) were obtained before surgery and a month later. The ECG and CGM alterations were compared before and after CABG and the accuracy of those two methods was evaluated.

Results:
In this study, 50 patients were enrolled, of which 33 (66%) were male versus 17 (44%) female, with a mean age of 39.12 ± 60 years. The mean ejection fraction before and after surgery was 44.3 ± 7.9% (range: 20–55) and 40.9 ± 12.5% (20–50), respectively. Before surgery, all patients had sinus rhythm, five cases had left bundle-branch block (LBBB), and one case was with right bundle-branch block (RBBB). Subsequently, after surgery, five cases had LBBB, and two cases were found to have RBBB. The rate of postoperation bleeding was 20%. There was no significant change in echocardiographic characteristics before and after operation (P = 0.81); likewise, no significant change was seen in ECG criteria before and after operation (P = 0.96). A significant correlation was seen regarding CGM characteristics before and after CABG (P = 0.003).

Conclusions:
A significant association was seen regarding CGM characteristics before and after undergoing an operation. In addition, the specificity and sensitivity of the CGM and ECG before and after operation improved well.
Longitudinal Stent Elongation: A Rare Complication of Third-Generation Drug-eluting Stent Platform
Authors: Baruah Dibya Kumar , Darimireddi Anuradha , Telikicherla Ravikant , Chakradhar Pedada 
Published: April 2024

Abstract
Longitudinal stent deformation (LSD) is an infrequent complication of percutaneous coronary intervention. While the occurrence of gross LSD is a rare phenomenon, minor changes in length are common and have been recognized as accepted behavior of stents during implantation. Due to the proximity of the guide catheter, ostial or ostio-proximal lesions are prone to stent deformation either by the guide or other devices during navigation. Moreover, to satisfy the fractal geometry of coronary bifurcation, the proximal optimization technique is commonly performed during different bifurcation procedures, which can subject the stent to extreme overexpansion resulting in structural deformation. We describe two cases of longitudinal stent elongation during ostial deployment and try to analyze the factors behind this rare, yet complicated behavior of the latest-generation drug-eluting stent.
Evaluation of alveolar bone level after orthodontic clear aligners treatment: A retrospective study
Authors: Alasqah Mohammed , Alshammery Dalal Abdullah , Baseer Mohammad Abdul , Aladwane Hussah , Alsakr Abdulaziz 
Published: April 2024

Introduction:
Clear aligners have increased in popularity as an alternative to conventional fixed equipment in orthodontic treatment. However, the impact of clear aligner orthodontic therapy on the periodontium, particularly the periodontal tissues, has generated curiosity in research.

Aim:
This study aimed to evaluate the relationship between clear aligner orthodontic treatment and the height of the alveolar bone level.

Materials and Method:
Ninety-two panoramic radiographs (pretreatment and posttreatment) from 46 adult patients treated with clear aligner therapy were selected for the current study. Linear measurements have been performed in the panoramic radiographs to measure the alveolar bone. Patient data, including age, gender, type of malocclusion, duration of the orthodontic treatment, inter-proximal striping done or not during the orthodontic treatment, and changes in alveolar bone level in millimeters, were documented.

Results and Discussion:
Posttreatment significantly increased alveolar defects (p=<0.001). Moreover, the pretreatment and posttreatment alveolar bone defect was compared in different teeth that showed that significant difference in teeth #21(p=0.007), #17(p=0.006), #31(p<0.001), #32(p=0.011), #33(p =0.003), #41(p <0.001), #42(p =0.003) and #44(p<0.001), #45(p <0.001) and #46 (p=0.009). Comparison of pretreatment and posttreatment alveolar bone defects also showed significant differences in patients with interproximal striping (p=<0.001). Other variables exhibited no significant differences (p>0.05). Pretreatment and posttreatment mean differences in alveolar bone defects were statistically significant across all the studied variables (p<0.05) except in the Class III malocclusion (p=0.082). Moreover, there is a significant positive correlation observed between the age of the study participants and pretreatment (p=0.007) and posttreatment bone defects (p=0.002) along with pretreatment and posttreatment alveolar bone defect (p= <0.001).

Conclusion:
This study advances the understanding of the complexities surrounding malocclusion, clear aligner orthodontic treatment, and alveolar bone height.
Social media analysis of the nature of shared online content for orthodontic functional appliances: An observational study
Authors: Hakami Zaki , Alassiry Ahmed Mohammed , Mohana Arwa J. , Somili Alanood , Masmali Lujain M. , Jabari Amal Mohammed , Shami Shumua , Halboub Esam , Marghalani Hussain Y. A. 
Published: April 2024

Introduction:
Increased smartphone accessibility has enhanced the speed and diversity of the dissemination of data, ideas, and thoughts. Notably, patients often turn to social media platforms to gather information on treatment options, share personal experiences, offer opinions, and choose the best health-care providers. Social media has been employed to distribute health information.

Aims:
This study aimed to analyze the content regarding orthodontic functional appliances posted on various social media platforms.

Materials and Methods:
The study analyzed content posted in August 2020 on four social media sites, namely, Instagram, YouTube, Twitter, and Reddit, focusing on terms related to orthodontic functional appliances. Data from the first 100 posts per keyword were collected and then recorded and coded in spreadsheets. Descriptive and statistical analyses were performed to elucidate the nature of the posted content.

Results and Discussion:
A total of 1204 posts were included in the study. Of these, 29.8.2% were photos and 51.8% were videos. Majority of the posts (65.3%) were about information sharing and uploaded by doctors (51.2%). The type of malocclusion was described as Class II in 18.4% of the posts but not specified in 72.8%. The overall usefulness of the posts was low. Posts of photos, posts on Instagram, and posts by doctors were found to be more significantly useful (P < 0.001).

Conclusion:
Patients, doctors, and academics extensively use social media platforms to disseminate orthodontic information. However, more useful posts on orthodontic functional appliances should be uploaded, including those on treatment effectiveness, patient experience, and patient–clinician relationships, which have been widely disregarded.
Rituximab versus tacrolimus as corticosteroid-sparing therapy for children with steroid-dependent nephrotic syndrome: A systematic review and meta-analysis of randomized and nonrandomized controlled trials
Authors: Ang Jessica Felicia , Widjanarko Nicolas Daniel , Ekaputra Anthony 
Published: April 2024

ABSTRACT

Objectives:
Prolonged use of corticosteroids induced complicated course in children with steroid-dependent nephrotic syndrome (SDNS), and the use of tacrolimus, a first-line alternative calcineurin inhibitor (CNI) agent was related to some unwanted adverse effects. Rituximab, a second alternative treatment has been proven to reliably reduce the number of relapses within 12 months with minimal adverse effects.

Materials and Methods:
Our review follows Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. All the databases were derived from MEDLINE, Proquest, EBSCOhost, Wiley, and Google Scholar within the past 11 years. The risk of bias was evaluated using the Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions. Meta-analysis used Review Manager (version 5.4) with a random effect model to obtain a pooled mean difference (MD) and odds ratio with 95% confidence intervals (CIs).

Results:
Four studies were included based on our eligibility criteria, and only three were included in the quantitative analysis. Three studies had low and one study had a moderate risk of bias. Pooled data results indicated that Rituximab was superior to tacrolimus in reducing the number of patients with 1–2 relapses (MD = 0.44, [95% CI: 0.21–0.91]) and had higher eGFR values (MD = 6.67; [CI − 2.92–10.61]). However, Rituximab showed insignificant superiority compared to tacrolimus in reducing the number of patients with 3 relapses, sustained remission, cumulative steroid use, serum cholesterol, and serum albumin concentrations.

Conclusion:
Rituximab exhibits more advantages in treating SDNS compared to tacrolimus, although the treatment options are highly individualized. Both regimens must also be weighed against their potential side effects to achieve a better overall health status.
Visual disturbances in a 12-year-old male patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome
Authors: Merdžo Ivan , Jurišić Darija , Ćavar Ivan , Striber Neda 
Published: April 2024

Abstract:
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare condition. Here, we present a case of a male patient with a very unique combination of symptoms that started at the age of 12. Transient symptoms manifested after 4 days of high fever and included lethargy, a loss of appetite, and an inability to recognize faces. After that, the patient was symptom-free for 4 years before he was hospitalized again with a working diagnosis of acute disseminated encephalomyelitis. The ophthalmic symptoms at this stage were photophobia and discrete horizontal nystagmus. One year later, the patient had another seizure and during hospitalization, predominantly displayed cerebral symptoms such as dystaxia, dysmetria, generalized muscle hypotrophy, and absent myotonic reflexes. Like before, an ophthalmic examination demonstrated a best-corrected visual acuity of 1.0 and a normal anterior segment. A fundus examination revealed a slightly rarefied retina, along with areas of perifoveal and parapapillary atrophy, in addition to increased vascular tortuosity. Optical coherence tomography scans of the macula and the optic disc depicted a mild thinning of the retinal layers. Visual field testing showed an isopter contraction with a predominant loss of the temporal visual field in both eyes. A genetic serum analysis was positive for mitochondrial mutation m.3243A>G, and a diagnosis of MELAS was confirmed. The treatment included anticonvulsive drugs and dietary precautions. Patients with MELAS syndrome can manifest a wide range of visual disturbances, meaning that a detailed ophthalmic examination is required.