bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of Targeted Therapy, Vismodegib, for the Treatment of Periocular Basal Cell Carcinoma
Authors: Singalavanija Tassapol , Ceylanoglu Kubra Serbest , Juntipwong Sarinee , Beser Buse Guneri , Elner Victor Maurice , Worden Francis Paul , Demirci Hakan 
Published: August 2023

Purpose:
Periocular locally advanced basal cell carcinoma (POLA-BCC) is characterized by orbital involvement and/or extensive invasion of periocular structures. Hedgehog pathway inhibitors have been used for POLA-BCC with promising outcomes.

Methods:
The authors reviewed 11 articles published in English literature from January 2012 to July 2022 and reported the outcomes of patients with POLA-BCC who were treated with vismodegib.

Results:
A total of 384 patients were treated with vismodegib. The mean age was 72 years, and the median treatment duration was 9 months. The overall response rate was 75% with a median follow-up time of 14.4 months. Following vismodegib treatment, the median number of patients who required adjuvant surgery was 43% with a median time to surgery of 6.5 months. The exenteration rate was 6% (overall 8 patients). In total 93.7% of patients experienced grade I adverse events, 26.7% to 37.5% grade II, 8.8% to 10% grade III–IV, and 0.8% to 4.8% grade V. Major side effects included dysgeusia (30–100%), muscle spasm (15–100%), alopecia (47–75%), weight loss (23–83%), and decreased appetite (19–42%). The median percentage of patients who discontinued treatment due to toxicity was 29% with a median interval of 5 months before the development of side effects. The median recurrence rate following discontinuation of vismodegib was 7.8% with a median recurrence duration of 20 months.

Conclusions:
In patients with POLA-BCC, vismodegib, a hedgehog pathway inhibitor, provided high rates of orbital preservation, reducing exenteration rates to 6%. Neoadjuvant therapy with vismodegib can also be suggested for patients with POLA-BCC. While extremely effective, side effects lead to temporary or permanent discontinuation of vismodegib in small numbers of patients.
Structural Limits of Orbital Compliance and Treatment Options for Pathologic Orbital Pressure
Authors: Chelnis James , Kim Juliet , Meador Andrew , Oester Alan E. , Fleming James C. , Fowler Brian T. 
Published: August 2023

Purpose:
The integrity of the orbit has a finite structural limit due to the compliance of its tissue. The authors investigate these limits to quantify them and inform the treatment of heightened ocular and orbital pressure.

Methods:
Cadaveric study with 12 orbits being volumized before randomization of treatment for pathologic levels of ocular and orbital pressure. First-line and second-line treatment was chosen randomly (lateral cantholysis, superior septolysis, inferior septolysis). Prior to treatment, IOP, orbital compartment pressure, and axial globe projection was measured after delivery of each 1cc aliquot and surgical treatment.

Results:
Orbital compartment pressure and IOP were well correlated (r = 0.99). The average reduction in IOP after treatment averaged a 56.2 mm Hg reduction in IOP. All treatments were statistically equivalent (p < 0.01). Loss of compliance (PLOC) was determined when the mean plus 1 standard deviation of change in IOP/ml volume was achieved with simultaneous change in exophthalmometry of <0.5 mm change/ml added volume, indicating an acceleration in pressure in the face of a steady volume. This criteria was met for 11 of 12 orbits. The 12th orbit missed this threshold by 1 mm Hg in IOP. PLOC occurred at an average IOP of 43.0 mm Hg (±5.8 mm Hg, 90% CI) and after an average injection of 13 ml (±1.4 mm, 90% CI). Additionally, lateral cantholysis, superior septolysis, and inferior septolysis were statistically equivalent in reducing IOP after PLOC.

Conclusions:
IOP and orbital compartment pressure are excellent proxies for each other in the authors’ model. Orbital compliance is a mathematic phenomenon that can be quantified, as evident in this investigation. PLOC can inform timing for orbital decompressions in the presence of heightened IOP. Multiple procedures can be used to extinguish dangerously high orbital compartment pressure.
Exploring the Barriers and Enablers to Implementing a 16-Week Low-Carbohydrate Diet for Patients With Diabetic Cardiomyopathy
Authors: Kleissl-Muir Sabine , Driscoll Andrea , Owen Alice , Zinn Caryn , Rasmussen Bodil 
Published: August 2023

Aims
Cardiac dysfunction in patients with diabetes, referred to as diabetic cardiomyopathy, is primarily precipitated by dysregulations in glucose and lipid metabolism. Diet and lifestyle changes are considered crucial for successful heart failure and diabetes management and are often difficult to achieve. Low-carbohydrate diets (LCDs) have gained popularity for the management of metabolic diseases. Although quantitative research in this field is evolving, little is known about the personal experience of patients with diabetic cardiomyopathy on specific diets. The aim of this qualitative study was to identify enablers and barriers of patients with diabetic cardiomyopathy who engage in an LCD. It further explored patients' perception of dietary education and dietary support received while in hospital.

Methods and Results
Participants who previously consented to a 16-week LCD trial were invited to share their experiences. Nine patients agreed to be interviewed. Semistructured interviews and a focus group interview were conducted, which were transcribed verbatim. Data were analyzed by using the 6-step approach for thematic analysis. Four themes were identified: (1) nutrition literacy (2) disease-related health benefits, (3) balancing commitments, and (4) availability of resources and support.

Conclusion
Improvements in disease-related symptoms acted as strong enablers to engage in an LCD. Barriers such as access to resources and time constraints were identified. These challenges may be overcome with efficient communication and ongoing dietary support. More research exploring the experience of patients with diabetic cardiomyopathy on an LCD are warranted.
Fat Grafting in Vulvar Lichen Sclerosus: Long Term Follow-Up
Authors: Boero Veronica , Brambilla Massimiliano , Di Loreto Eugenia , Cetera Giulia Emily , Cipriani Sonia , Boggio Francesca , Monti Ermelinda , Libutti Giada , Caia Carlotta , Parazzini Fabio 
Published: August 2023

Objective
The rationale for the use of autologous fat grafting in the treatment of vulvar lichen sclerosus (VLS) consists in reduction of inflammation, regeneration of tissues, volume increase, and pain fiber control. The main outcome of our study was the evaluation of patients' satisfaction after treatment. Secondary outcomes included modifications in symptoms, psychosexual wellbeing, vulvar hydration, and histology after surgery.

Methods
Eligible for this study were women aged 18–85 years with a histological diagnosis of VLS who underwent at least one autologous vulvar fat grafting at our center, between 2010 and 2019. In 2021, all women underwent a clinical reevaluation, comprehensive of vulvoscopy, vulvar biopsy, and handing out of validated questionnaires.

Results
Overall, 88.7% of patients declared themselves very satisfied/satisfied with the procedure. All symptoms were improved postsurgery; in particular, the difference was statistically significant for pruritus, burning, and dyspareunia (p < .05). Sexual function was also improved at time of reevaluation, as were depressive and anxiety symptoms (p < .05). No cases of vulvar intraepithelial neoplasia or cancer occurred during follow-up and vulvar architecture remained stable, although patients reported a significantly reduced need for topical steroids (p < .0001). Lastly, in postoperative biopsies, inflammatory infiltrate was stable or reduced, and the distribution of elastic fibers was comparable or restored in most patients.

Conclusions
Patient satisfaction with fat grafting is detectable up to 11 years after surgery, and as such, it may represent a valid therapeutic option in selected cases of VLS.
Accuracy of Preoperative Cochlear Duct Length Estimation and Angular Insertion Depth Prediction
Authors: Breitsprecher Tabita , Mlynski Robert , Völter Christiane , Van de Heyning Paul , Van Rompaey Vincent , Dazert Stefan , Weiss Nora M. 
Published: August 2023

Objective
In cochlear implantation with flexible lateral wall electrodes, a cochlear coverage of 70% to 80% is assumed to yield an optimal speech perception. Therefore, fitting the cochlear implant (CI) to the patient’s individual anatomy has gained importance in recent years. For these reasons, the optimal angular insertion depth (AID) has to be calculated before cochlear implantation. One CI manufacturer offers a software that allows to visualize the AID of different electrode arrays. Here, it is hypothesized that these preoperative AID models overestimate the postoperatively measured insertion angle. This study aims to investigate the agreement between preoperatively estimated and postoperatively measured AID.

Study Design
Retrospective cross-sectional study.

Setting
Single-center tertiary referral center.

Patients
Patients undergoing cochlear implantation.

Intervention
Preoperative and postoperative high-resolution computed tomography (HRCT).

Main Outcome Measures
The cochlear duct length was estimated by determining cochlear parameters (A value and B value), and the AID for the chosen electrode was (i) estimated by elliptic circular approximation by the software and (ii) measured manually postoperatively by detecting the electrode contacts after insertion.

Results
A total of 80 HRCT imaging data sets from 69 patients were analyzed. The mean preoperative AID estimation was 662.0° (standard deviation [SD], 61.5°), and the mean postoperatively measured AID was 583.9° (SD, 73.6°). In all cases (100%), preoperative AID estimation significantly overestimated the postoperative determined insertion angle (mean difference, 38.1°). A correcting factor of 5% on preoperative AID estimation dissolves these differences.

Conclusions
The use of an electrode visualization tool may lead to shorter electrode array choices because of an overestimation of the insertion angle. Applying a correction factor of 0.95 on preoperative AID estimation is recommended.
Development of an Optimized Protocol for Cochlear Implant Care to Increase Cochlear Implant Access
Authors: Berg Katelyn A. , Holder Jourdan T. , Gifford René H. 
Published: August 2023

Objective
To develop an evidence-based protocol for audiology-based, cochlear implant (CI) programming in the first year after activation.

Study Design
Retrospective case review.

Setting
CI program at a tertiary medical center.

Patients
One-hundred seventy-one patients (178 ears; mean age at implantation, 62.3 yr; 44.4% female) implanted between 2016 and 2021 with postlingual onset of deafness and no history of CI revision surgery. Patients included here had confirmed CI programming optimization based on CI-aided thresholds in the 20- to 30-dB-HL range as well as upper stimulation levels guided by electrically evoked stapedial reflex thresholds.

Main Outcome Measures
Consonant-nucleus-consonant monosyllabic word recognition scores in the CI-alone and bilateral best-aided conditions at five time points: preoperative evaluation, and 1, 3, 6, and 12 months after activation.

Results
For both the CI-alone and bilateral best-aided conditions, consonant-nucleus-consonant word recognition significantly improved from preoperative evaluation to all postactivation time points. For the CI-alone condition, no significant differences were observed between 3 and 6 months, or from 6 to 12 months after activation. In contrast, for the bilateral best-aided condition, significant differences were observed between 1 and 3 months, and 3 and 6 months, but no difference in scores between 6 and 12 months.

Conclusions
Based on the current data set and associated analyses, CI centers programming adult patients could eliminate either the 3- or 6-month visit from their clinical follow-up schedule if patient mapping of lower and upper stimulation levels is validated via CI-aided audiometric thresholds and electrically evoked stapedial reflex thresholds, respectively.
Construction and Application of a Nomogram for Predicting Benign and Malignant Parotid Tumors
Authors: Liu Shuo , Yu Baoting , Zheng Xuewei , Guo Hao , Shi Lingxue 
Published: August 2023

Objective
A prediction model of benign and malignant differentiation was established by magnetic resonance signs of parotid gland tumors to provide an important basis for the preoperative diagnosis and treatment of parotid gland tumor patients.

Methods
The data from 138 patients (modeling group) who were diagnosed based on a pathologic evaluation in the Department of Stomatology of Jilin University from June 2019 to August 2021 were retrospectively analyzed. The independent factors influencing benign and malignant differentiation of parotid tumors were selected by logistic regression analysis, and a mathematical prediction model for benign and malignant tumors was established. The data from 35 patients (validation group) who were diagnosed based on pathologic evaluation from September 2021 to February 2022 were collected for verification.

Results
Univariate and multivariate logistic regression analysis showed that tumor morphology, tumor boundary, tumor signal, and tumor apparent diffusion coefficient (ADC) were independent risk factors for predicting benign and malignant parotid gland tumors (P < 0.05). Based on multivariate logistic regression analysis of the modeling group, a mathematical prediction model was established as follows: Y = the ex/(1 + ex) and X = 0.385 + (1.416 × tumor morphology) + (1.473 × tumor border) + (1.306 × tumor signal) + (2.312 × tumor ADC value). The results showed that the area under the receiver operating characteristic curve of the model was 0.832 (95% confidence interval, 0.75–0.91), the sensitivity was 82.6%, and the specificity was 70.65%. The validity of the model was verified using validation group data, for which the sensitivity was 85.71%, the specificity was 96.4%, and the correct rate was 94.3%. The results showed that the area under receiver operating characteristic curve was 0.936 (95% confidence interval, 0.83–0.98).

Conclusions
Combined with tumor morphology, tumor ADC, tumor boundary, and tumor signal, the established prediction model provides an important reference for preoperative diagnosis of benign and malignant parotid gland tumors.
Comparison Between a Modified Fast 3-Dimensional Turbo Spin-Echo and Diffusion-Weighted Imaging With Background Suppression in Evaluation of Lumbosacral Plexus and Its Branches
Authors: Zhang Nan , Zeng Jiaqi , Lv Peng , Miao Xiyin , Chen Caizhong , Lin Jiang 
Published: August 2023

Objectives
To compare the fast 3-dimensional NerveVIEW (3D NerveVIEW) with diffusion-weighted imaging with background suppression (DWIBS) in imaging of lumbosacral plexus and its branches.

Methods
A prospective study was performed on 30 healthy volunteers and patients who had undergone compressed sensing 3D NerveVIEW and DWIBS scans. There were 11 healthy subjects, 15 patients with lumbar disc herniation, and 4 patients with chronic inflammatory demyelinating polyradiculoneuropathy. Image quality was rated using a 4-point subjective scale. Quantitative evaluation of the nerves was done by measuring signal-to-noise ratio, contrast-to-noise ratio, and signal-to-background ratio, and the consistency in the measurements of nerve root cross-sectional areas was also assessed. The differences of signal-to-noise ratio, contrast-to-noise ratio, signal-to-background ratio, and the scores of image quality between 2 sequences were compared.

Results
The overall average image quality score of 3D NerveVIEW was significantly higher than that of DWIBS (2.72 ± 0.45 and 2.45 ± 0.81, respectively; P < 0.01). In terms of individual nerves, there was no significant difference between the 2 sequences in the display of the nerves from L2 to S1; however, 3D NerveVIEW was significantly better than DWIBS in demonstration of the S2–S3 nerves, as well as the nerve details. Regarding quantitative measurements, these sequences achieved comparable results with excellent interobserver agreements.

Conclusion
Fast 3D NerveVIEW was superior to DWIBS with improved conspicuity of small distal nerves of S2–S3 and nerve details.
Segmentation-Based Analysis of T2- and T1-Weighted Dynamic Magnetic Resonance Images Provides Adequate Observer Agreement in the Evaluation of Interstitial Lung Disease
Authors: Ruano Carina A. , Veiga José , Antunes Natalie , Carvalho Vera B. , Fernandes Otília , Borba Alexandra , Oliveira Francisco P. M. , Moraes-Fontes Maria Francisca , Bilhim Tiago , Irion Klaus L. 
Published: August 2023

Objective
The aim of the study is to quantify observer agreement in the magnetic resonance imaging (MRI) classification of inflammatory or fibrotic interstitial lung disease (ILD).

Methods
Our study is a preliminary analysis of a larger prospective cohort. The MRI images of 18 patients with ILD (13 females; mean age, 65 years) were acquired in a 1.5 T scanner and included axial fat-saturated T2-weighted (T2-WI, n = 18) and coronal fat-saturated T1-weighted images before and 1, 3, 5, and 10 minutes after gadolinium administration (n = 16). The MRI studies were evaluated with 2 different methods: a qualitative evaluation (visual assessment and measurement of few regions of interest; evaluations were performed independently by 5 radiologists and 3 times by 1 radiologist) and a segmentation-based analysis with software extraction of signal intensity values (evaluations were performed independently by 2 radiologists and twice by 1 radiologist). Interstitial lung disease was classified as inflammatory or fibrotic, based on previously described imaging criteria.

Results
Regarding the qualitative evaluation, intraobserver agreement was excellent (κ = 0.92, P < 0.05) for T2-WI and fair (κ = 0.29, P < 0.05) for T1 dynamic study, while interobserver agreement was moderate (κ = 0.56, P < 0.05) and poor (κ = 0.11, P = 0.18), respectively. In contrast, upon segmentation-based analysis, intraobserver and interobserver agreement were excellent for T2-WI (κ = 0.886, P < 0.001; κ = 1.00, P < 0.001; respectively); for T1-WI, intraobserver agreement was excellent (κ = 0.87, P < 0.05) and interobserver agreement was good (κ = 0.75, P < 0.05).

Conclusions
Segmentation-based MRI analysis is more reproducible than a qualitative evaluation with visual assessment and measurement of few regions of interest.
Apparent Variation in Measurement Size of Colorectal Cancer Metastases to the Liver on Dual Contrast MRI
Authors: Ngnitewe Massa'a Ruben , Wawrzyn Peter , Mao Lu , Reeder Scott B. , Kelcz Frederick , Wentland Andrew L. 
Published: August 2023

Purpose
The aim of this study was to formally investigate the apparent variation in lesion size of hepatic metastatic lesions from colorectal cancer on hepatobiliary phase (HBP) and dual contrast images of magnetic resonance imaging performed with both hepatobiliary and extracellular contrast agents.

Methods
Patients with known colorectal carcinoma who had undergone dual contrast liver magnetic resonance imaging were identified in our institutional database. Metastatic lesions were measured semiautomatically on both HBP and dual contrast images with a custom software tool that automatically identifies the lesion edge and thereby the lesion diameter. Lesion measurements from both sets of images were compared with a Student t test and Bland-Altman analysis. Lesions were also measured on both HBP and dual contrast images by 2 fellowship-trained abdominal radiologists. Measurements from the software and radiologists were compared with a Student t test and Bland-Altman analysis; interreader agreement was evaluated with the intraclass correlation coefficient.

Results
A total of 70 liver lesions in 39 patients was identified. Software-based measurements were significantly larger on HBP than dual contrast images (P < 0.001), with a mean lesion size of 10.9 ± 4.2 mm for HBP and 10.5 ± 4.2 mm for dual contrast measurements. Radiologist-based measurements showed a similar trend, with HBP measurements being significantly larger than dual contrast measurements (P < 0.001). Bland-Altman analysis indicated a mean bias ± 2 SD of +0.4 ± 1.6 mm for software-based measurements and +0.9 ± 2.9 mm and +0.7 ± 2.1 mm for readers 1 and 2, respectively. The intraclass correlation coefficient for interreader agreement was 0.9.

Conclusions
Both software-based and radiologist-based measurements of colorectal cancer liver metastases are significantly larger on HBP than dual contrast images. Based on these findings, we recommend that longitudinal assessment be performed consistently on either HBP or dual contrast phases to avoid introduction of avoidable variability.
Usefulness of Ag Additional Filter on Image Quality and Radiation Dose for Low-Dose Chest Computed Tomography
Authors: Kawamoto Keishin , Sato Hideyuki , Kogure Yosuke 
Published: August 2023

Objective
This study aimed to evaluate the effect of a silver (Ag) additional filter on dose characteristics and image quality in low-dose chest computed tomography (CT).

Methods
A dose evaluation phantom, physical evaluation phantom, and chest phantom were scanned with and without an Ag additional filter. The doses were adjusted so that the displayed the volume CT dose indexes (CTDIvol) were from 0.3 to 1.6 mGy. For dose characteristics, the spectrum of photon energies and the measured CTDIvol were calculated for each scanning condition. For task-based image quality analysis, task transfer function, noise power spectrum, and system performance were evaluated. Streak artifacts, image noise, and contrast-to-noise ratio were quantified using a chest phantom.

Results
With the Ag additional filter, mean energy was 22% higher and the CTDIvol was approximately 30% lower than those without the Ag additional filter. The task transfer function and noise power spectrum with the Ag additional filter were lower than those without the Ag additional filter. The system performance with the Ag additional filter was similar to that without the Ag additional filter. The Ag additional filter reduced streak artifact near the lung apex and image noise in the lung fields. The contrast-to-noise ratio was slightly higher with the Ag additional filter than that without the Ag additional filter.

Conclusions
The output dose and spatial resolution with the Ag additional filter were lower than those without the Ag additional filter. However, this filter helped reduce the radiation dose, image noise, and streak artifacts, particularly when scanning at ultralow doses.
Idiopathic Palatal Fistula of the Left Soft Palate
Authors: Suzuki Yushi , Toriumi Masahiro , Takano Junji 
Published: August 2023

Palatal fistulas, often congenital or trauma-induced, are occasionally encountered in the field of plastic surgery. We report a case of a non-medial 3 mm soft palate fistula in a 43-year-old woman, with no apparent trigger or history of local trauma or infection. The fistula, extending 2 cm toward the lateral pharyngeal wall, was surgically removed under general anesthesia as it was impacting the patient’s quality of life. The lumen was stained, and the fistula was removed in one mass. The excised tissue was covered with stratified squamous epithelium and was surrounded by adherent tonsil tissue. No recurrence was observed postoperatively. Despite an initial suspicion of a congenital cause, the fistula’s lateral extension and histology suggested a possible origin from the second pharyngeal pouch. To date, there are no reports of fistulas opening on the soft palate. Therefore, this presents an exceptionally rare instance of a soft palate fistula.