bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma Cell Vulvitis: A Classification Into Two Clinical Phenotypes
Authors: Wendling Jeanne , Plantier Françoise , Moyal-Barracco Micheline 
Published: September 2023

Objective
The etiology of plasma cell vulvitis (PCV) is debated. The authors aimed to test the hypothesis that PCV could be divided into 2 clinical phenotypes.

Methods
Patients with a clinico-pathological diagnosis of PCV and with available vulvar photos seen in a vulvar clinic were retrospectively studied. The cases of PCV were divided into 2 groups: non–lichen-associated (primary PCV) and lichen-associated (secondary PCV). The 2 groups were compared in terms of age, menopausal status, location of the PCV, and 12 histologic parameters (Fisher exact test, p < .05).

Results
Thirty-five patients (20 primary and 15 secondary PCV) were included. The 2 groups did not differ in terms of age (mean, 65; range, 50–85) or menopausal status. Primary PCV was located exclusively on the vestibule for 19/20 patients, whereas secondary PCV was extravestibular for 14 of 15 patients, either exclusively (2) or both extravestibular and vestibular (12). One patient with secondary PCV had solely vestibular involvement. Five histological features were observed significantly more often in case of secondary PCV: epidermal atrophy, parakeratosis, dermal and epidermal neutrophils, and dermal eosinophils.

Conclusions
Plasma cell vulvitis can be divided clinically into 2 phenotypes. Primary non–lichen-associated PCV is restricted to the vestibule and could be the vulvar counterpart of atrophic vaginitis. Secondary lichen-associated PCV is both extravestibular and vestibular, and its clinical and histological features should be looked for outside the PCV areas. This division of PCV into 2 clinical phenotypes could have therapeutic implications.
Correlating Vestibular Migraine Patient Assessment Tool and Handicap Inventory to Daily Dizziness Symptoms
Authors: Kim Eric K. , Hum Maxwell , Sharon Jeffrey D. 
Published: September 2023

ObjectiveInvestigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms.Study DesignProspective cohort analysis of 52 patients with vestibular migraine (VM).SettingTertiary referral center.PatientsFifty-two patients diagnosed with VM or probable VM according to Barany Society criteria.InterventionsSubjects reported their dizzy symptoms (on a scale of 0 [no symptoms], 1 [mild], 2 [moderate], and 3 [severe]) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis.Main Outcome MeasuresPearson correlation coefficient,R2value.ResultsVM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression (R2= 0.26,p= 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness (p< 0.001).ConclusionsDaily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.
Coagulation management during liver transplantation: monitoring and decision making for hemostatic interventions
Authors: Vandyck Kofi B. , Rusin Walter , Mondal Samhati , Tanaka Kenichi A. 
Published: September 2023

Purpose of review
Rebalanced hemostasis describes the precarious balance of procoagulant and antithrombotic proteins in patients with severe liver failure. This review is aimed to discuss currently available coagulation monitoring tests and pertinent decision-making process for plasma coagulation factor replacements during liver transplantation (LT).

Recent findings
Contemporary viscoelastic coagulation monitoring systems have demonstrated advantages over conventional coagulation tests in assessing the patient's coagulation status and tailoring hemostatic interventions. There is increasing interest in the use of prothrombin complex and fibrinogen concentrates, but it remains to be proven if purified factor concentrates are more efficacious and safer than allogeneic hemostatic components. Furthermore, the decision to use antifibrinolytic therapy necessitates careful considerations given the risks of venous thromboembolism in severe liver failure.

Summary
Perioperative hemostatic management and thromboprophylaxis for LT patients is likely to be more precise and patient-specific through a better understanding and monitoring of rebalanced coagulation. Further research is needed to refine the application of these tools and develop more standardized protocols for coagulation management in LT.
Ureterorenoscopy for stone disease in pregnancy: a literature review and update
Authors: Graf Sebastian , Somani Bhaskar K. 
Published: September 2023

Purpose of review
Management of stone disease in pregnancy poses a challenge for all healthcare professionals involved in their care. During pregnancy, there is an increase in the incidence of urolithiasis. Major technological and procedural advances have been seen in the last decade for endoscopic management of urolithiasis. The purpose of this review is to provide a comprehensive workup of available literature on use of ureteroscopy for stone treatment during pregnancy.

Recent findings
We identified 268 articles on screening, of which 28 were included in the final review. Overall adverse event rates were low, with no severe complications reported in the included studies. On multivariate analysis, the only significant correlation was an inverse relationship between calculated caseload and adverse obstetric events. No further correlation could be found between caseload, operation technique and adverse event rates. Data quality was low among the included studies.

Summary
While ureteroscopy is a relatively safe and effective option for active stone treatment during pregnancy, they should be performed in experienced endourology centres in conjunction with obstetric teams.
Communicating Patient Discharge Readiness
Authors: Keniston Angela , McCreight Marina S. , Burden Marisha , Moore Susan L. , Haugen Heather , Rice John , Battaglia Catherine 
Published: September 2023

Background:
The progression of patients through a hospital from admission to discharge can be slowed by delays in patient discharge, increasing pressure on health care staff. We designed and piloted the Discharge Today tool, with the goal of improving the efficiency of patient discharge; however, adoption remained low.

Purpose:
To close this implementation gap, we deployed and evaluated a 4-part implementation strategy bundle.

Methods:
We measured the success of implementation by evaluating validated implementation outcomes using both quantitative and qualitative methods, grounded in Normalization Process Theory.

Results:
The implementation strategies used were effective for increasing use of the Discharge Today tool by hospital medicine physicians and advanced practice providers during both the active and passive implementation periods.

Conclusions:
While the implementation strategies used were effective, qualitative findings indicate that limitations in the functionality of the tool, alongside inconsistent use of the tool across clinical staff, continued to inhibit adoption.
Symptoms in Patients Receiving Noninvasive Ventilation in the Intensive Care Unit
Authors: Peterson Pamela E. , Tracy Mary Fran , Mandrekar Jay , Chlan Linda L. 
Published: September 2023

Abstract

Background
While a multitude of studies have demonstrated the effectiveness of noninvasive ventilation (NIV) for treatment of respiratory insufficiency, there have been few investigations of patients’ experiences while receiving this common treatment. Identification of the presence, intensity, and distress of symptoms during NIV will inform the development and testing of interventions to best manage them and improve patients’ intensive care unit (ICU) experiences.

Objective
The objectives of this study were to (a) identify the presence, intensity, and distress of symptoms in patients receiving NIV in the ICU using a modified version of the Edmonton Symptom Assessment Scale (MESAS) and (b) describe the most common and distressing symptoms experienced by patients.

Method
A cross-sectional descriptive design was used with a convenience sample of 114 participants enrolled from three ICUs at one Midwestern medical center. Participants were approached if they were English-speaking, age 18 or older, and had an active order for NIV; exclusions included use of personal NIV equipment, severe cognitive impairment, or problems communicating. Demographic and clinical data were obtained from the electronic health record. Presence, intensity, and distress of patient-reported symptoms were obtained once using a modified, 11-item version of the MESAS.

Results
The mean age of participants was 68 years old, and 54.4% were male. The primary type of NIV was bi-level positive airway pressure; a nasal/oral mask was most frequently used. The symptoms experienced by a majority of participants were thirst, anxiety, tiredness, and restlessness; these symptoms were rated as moderate or severe in both intensity and distress by most participants experiencing the symptoms.

Discussion
Patients in the ICU experience both intense and distressful symptoms that can be severe while undergoing treatment with NIV. Future research is warranted to determine these symptoms’ interrelatedness and develop interventions to effectively manage patient-reported symptoms.
Feasibility, Acceptability, and Preliminary Effectiveness of a Sleep Intervention in Adults at Risk for Metabolic Syndrome With Short Sleep Duration
Authors: Malone Susan Kohl , Patterson Freda , Grunin Laura , Yu Gary , Dickson Victoria Vaughan , Melkus Gail D’Eramo 
Published: September 2023

Background
The prevalence of short sleep duration is rising and is linked to chronic comorbidities, such as metabolic syndrome (MetS). Sleep extension interventions in adults with MetS comorbidities and short sleep duration are limited and vary widely in terms of approach and duration.

Objectives
This pilot study aimed to test the feasibility and acceptability of a personalized 12-week systematic sleep time extension intervention on post-intervention sleep outcomes in middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration.

Methods
A single-arm, 12-week, 12-session systematic sleep time extension intervention was delivered weekly via videoconferencing. Feasibility and acceptability were assessed using retention rates and mean sleep diary completions. Sleep was estimated for 14 consecutive days prior to and immediately following the 12-week intervention using wrist actigraphy. Daytime sleepiness was assessed using the Epworth Sleepiness Scale. Paired sample t-tests modeled changes in study outcomes.

Results
Study participants (N = 41) had a mean age of 52 years and were mostly female and White; 86% attended >80% of sessions, and mean sleep diary completion was 6.7 diaries/week. Significant improvements in sleep from pre- to post-intervention included increased total sleep time, earlier sleep onsets, more regular sleep onsets, a higher sleep regularity index, and reduced daytime sleepiness. Extending sleep, as well as improving sleep timing and regularity in middle-aged adults with actigraphy-estimated short sleep duration and at risk for MetS, is feasible and acceptable.

Discussion
Behavioral sleep characteristics may be modifiable and present a novel behavioral paradigm for mitigating MetS risk. This pilot study provides a proof of concept for the feasibility, acceptability, and preliminary effectiveness of a systematic sleep time extension for middle-aged adults at risk for MetS with actigraphy-estimated short sleep duration.
Radioguided Occult Lesion Localization Technique for Biopsy of Nonpalpable Subcutaneous Lesions in Suspected Metastatic Melanoma
Authors: Di Lorenzo Sara , Milia Walter R. , Corradino Bartolo , Rinaldi Gaetana , Rao Marco , Cordova Adriana 
Published: September 2023

Summary:
In patients with a history of melanoma, the risk of recurrence depends on the stage at diagnosis. Patients who present with more advanced disease are more likely to experience recurrence; patients with less advanced disease at presentation have slower progression and lower likelihood of recurrence. The aim of this study was to evaluate the use of a minimally invasive and targeted technique as a diagnostic and therapeutic tool for the excision of nonpalpable lesions suspected to be melanoma metastases. The authors evaluated 21 patients with stage IIB, IIC, or III melanoma and subcutaneous nonpalpable lesions with a high risk of malignancy on positron emission tomography/computed tomography scan during oncologic follow-up. To guide biopsy, the authors used the radioguided occult lesion localization technique, using intralesional injection of technetium-99m albumin macroaggregates the day before surgery. During surgery, a handheld gamma probe was used to locate the lesions. Surgical localization of radiolabeled lesions was achieved in all cases. Relapsed melanoma was histologically confirmed in 13 patients. This technique proved to be a simple, safe, and effective method to detect and biopsy nonpalpable or difficult-to-locate lesions in suspected metastatic melanoma. The main advantage was disease restaging (eg, from stage II to III), allowing patients to access adjuvant therapies not approved as early-stage melanoma treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Intraoperative Evaluation of Textured Anatomical Implant Rotation: A Prospective Study
Authors: Gary Cyril S. , Kirloskar Kunal M. , Koh Min Jung , Abadeer Andrew I. , Wang Jessica S. , del Corral Gabriel , Fan Kenneth L. , Song David H. 
Published: September 2023

Background:
Textured implants were developed with the goal of reducing rates of capsular contracture and preventing implant malposition (eg, malrotation). Recent evidence has questioned whether textured implants are as resistant to malrotation as previously reported.

Methods:
Women presenting to a single health care system for removal of textured implants were prospectively enrolled in the study from September of 2019 to July of 2022. Patients who underwent removal of an anatomical, textured implant in the operating room were included in the study; whereas those who did not undergo implant removal, or were found to have a smooth implant, or a round, textured implant, were excluded. The degree of implant rotation on removal of the implant was measured intraoperatively. Information regarding implant-specific factors, patient demographics, clinical factors, and operative characteristics, was collected.

Results:
A total of 51 patients (80 implants) were included in the study; 45% of implants were malrotated (rotated >30 degrees), and the median degree of rotation was 30 degrees. Having more than one previous revision of the breast pocket was predictive of implant rotation (42 degrees) on multivariate linear regression analysis. Patients who presented with a complaint of “aesthetic dissatisfaction” had 2.89 increased odds of having an implant rotated greater than 30 degrees.

Conclusion:
The authors’ study found a high rate of malrotation of textured shaped implants on explantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Chest Wall Injury Society recommendation for surgical stabilization of nonunited rib fractures to decrease pain, reduce opiate use, and improve patient reported outcomes in patients with rib fracture nonunion after trauma
Authors: Forrester Joseph D. , Bauman Zachary M. , Cole Peter A. , Edwards John G. , Knight Ariel W. , LaRoque Michael , Raffa Taylor , White Thomas W. , Kartiko Susan 
Published: September 2023

BACKGROUND
Rib fractures are common injuries which can be associated with acute pain and chronic disability. While most rib fractures ultimately go on to achieve bony union, a subset of patients may go on to develop non-union. Management of these nonunited rib fractures can be challenging and variability in management exists.

METHODS
The Chest Wall Injury Society’s Publication Committee convened to develop recommendations for use of surgical stabilization of nonunited rib fractures (SSNURF) to treat traumatic rib fracture nonunions. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Using a process of iterative consensus, all committee members voted to accept or reject the recommendation.

RESULTS
No identified studies compared SSNURF to alternative therapy and the overall quality of the body of evidence was rated as low. Risk of bias was identified in all studies. Despite these limitations, there is lower-quality evidence suggesting that SSNURF may be beneficial for decreasing pain, reducing opiate use, and improving patient reported outcomes among patients with symptomatic rib nonunion. However, these benefits should be balanced against risk of symptomatic hardware failure and infection.

CONCLUSION
This guideline document summarizes the current CWIS recommendations regarding use of SSNURF for management of rib nonunion.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
The non-local Lotka–Volterra system with a top hat kernel—Part 1: dynamics and steady states with small diffusivity
Authors: Needham D. J. , Billingham J. 
Published: September 2023

We study the dynamics of the non-local Lotka–Volterra system

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time scale, and that these patterns become quasi-steady on a time scale proportional to the inverse diffusivity. These then interact on a longer time scale proportional to the inverse interaction scale, and approach a meta-stable state. Finally, a stable steady state is achieved on a much longer timescale, which is exponentially large relative to the preceding time scales. We are able to quantify this interaction process by determining a planar dynamical system that governs the temporal evolution of the separation between the two periodic arrays of humps on these sequentially algebraically and then exponentially long time scales. We find that, once the humps no longer overlap, the subsequent dynamics lead to a symmetric disposition of the humps, occurring on the exponentially long time scale. Numerical solutions of the full evolution problem cannot access the behaviour on this final extreme time scale, but it can be fully explored through the dynamical system.
Coupling of 12 chromosomal inversions maintains a strong barrier to gene flow between ecotypes
Authors: Moan Alan Le , Stankowski Sean , Rafajlovic Marina , Ortega-Martinez Olga , Faria Rui , Butlin Roger , Johannesson Kerstin 
Published: September 2023

AbstractChromosomal rearrangements lead to the coupling of reproductive barriers, but whether and how they contribute to completion of speciation remains unclear. Marine snails of the genusLittorinarepeatedly form hybrid zones between taxa segregating for inversion arrangements, providing opportunities to study this question. Here, we analysed two adjacent transects across hybrid zones between large and dwarf ecotypes ofLittorina fabaliscovering wave exposure gradients in a Swedish island. Applying whole-genome sequences we found 12 putative inversions reaching near differential fixation between the opposite ends of each transect, and being in strong linkage disequilibrium. These inversions cover 20% of the genome and carry 93% of divergent SNPs. Bimodal hybrid zones in both transects indicate that the two ecotypes ofLittorina fabalismaintain their genetic and phenotypic integrity following contact due to strong coupling between inversion clines that strengthened the reproductive barrier. The bimodality resulting from the linked inversions extends into collinear parts of the genome, suggesting a genome-wide coupling. Demographic inference suggests that the coupling built up during a period of allopatry, and has been maintained for more than 1K generations after secondary contact. Overall, this study shows that the coupling of multiple chromosomal inversions contributes to strong reproductive isolation. Importantly, two of the inversions overlap with inverted genomic regions associated with ecotype differences in a closely-related species (L. saxatilis), suggesting the same regions, with similar structural variants, repeatedly contribute to ecotype evolution in distinct species.