bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bulboma: A Benign Keratosis With Differentiation Toward the Lower Segment of the Hair Follicle
Authors: Sidlow Jonathan S. , Reichel Martin 
Published: March 2022

Abstract:
Bulboma is an appellation proposed to designate a distinctive solitary keratosis exhibiting differentiation toward the bulb of the lower segment of the hair follicle. Bulboma is composed of a papillated proliferation of epithelial cells beneath which is a broad front of interconnected follicular papillae. Overlying these coalescing follicular papillae are follicular germinative cells ascending into matrical cells and supramatrical cells. Cells demonstrating differentiation toward Huxley's and Henle's layer of the inner root sheath at the level of the bulb are present including strikingly bright eosinophilic trichohyalin granules and the blue-grey corneocytes of the stem. There is overlying hypergranulosis and orthokeratosis. The clinical and histopathological findings in 4 cases of bulboma, a rare, benign solitary keratosis are presented.
A Rare Case of Primary Cutaneous Signet-Ring Cell Melanoma With Discrepant Findings on Gene Expression Profiling and Chromosomal Microarray Analysis
Authors: Boothby-Shoemaker Wyatt , Kwa Michael , Kohen Laurie , Shaw Brandon , Friedman Ben J. 
Published: March 2022

Abstract:
Melanoma with signet ring cell features is an exceptionally rare variant of primary cutaneous and metastatic melanoma. The molecular mechanisms underlying this unusual cytologic phenotype in malignant melanocytes are largely unknown. In this report, we aim to add to the literature by describing the histomorphological, immunophenotypic, gene expression, and cytogenetic findings in 1 recently encountered case.
Predictors of Stimulant Medication Continuity in Children with Attention-Deficit/Hyperactivity Disorder
Authors: Kamimura-Nishimura Kelly I. , Brinkman William B. , Epstein Jeffery N. , Zhang Yin , Altaye Mekibib , Simon John , Modi Avani C. , Froehlich Tanya E. 
Published: March 2022

ABSTRACT:

Objective:
The objective of this study was to examine the simultaneous impact of patient-related and parent-related factors, medication-related factors, and health care system-related factors on attention-deficit/hyperactivity disorder (ADHD) medication continuity.

Method:
Stimulant-naïve children (N = 144, Mage = 8 yrs, 71% male) with ADHD completed a methylphenidate (MPH) trial and were followed for 1 year after trial completion and return to community care. Multivariable analysis investigated predictors of (1) having at least 1 filled ADHD prescription after return to community care versus none and (2) having more days covered with medicine after return to community care. Predictors included race; age; sex; income; baseline ADHD symptom severity; MPH trial experience; child and parent mental health conditions; and parent beliefs about ADHD, ADHD medications, and therapeutic alliance.

Results:
One hundred twenty-one children (84%) had at least 1 filled ADHD medication prescription (mean = 178 d covered by medication) in the year after return to community care. Multivariable models found that a weaker perceived clinician-family working alliance predicted not filling any ADHD prescriptions. Among those who filled ≥1 prescription, factors linked to fewer days of ADHD medication coverage included child sociodemographic factors (non-White race, older age, being female, and lower income), lower parent beliefs that the child's ADHD affects their lives, and higher parent beliefs that medication is harmful, while child oppositional defiant disorder and parental ADHD predicted having more days of medication coverage.

Conclusion:
Child demographic factors, parent beliefs, and medication-related factors are associated with continuation of ADHD medication. These findings may facilitate the development of effective strategies to improve ADHD medication continuity for children from diverse groups.
Evaluation and Management of Lower GI Bleeding
Authors: Drezdzon Melissa K. , Peterson Kent J. 
Published: March 2022

CASE SUMMARY:
A 73-year-old woman, who had received apixaban for therapeutic anticoagulation, presented with hypotension and hematochezia. After resuscitation, diagnostic colonoscopy revealed multiple polyps and old blood within the colonic lumen, but no active bleeding (Fig. 1). Nasogastric lavage and subsequent EGD were unremarkable. During her hospitalization, she was admitted to the intensive care unit with worsening anemia, hypotension, and hematochezia. CT angiogram showed extravasation at the transverse colon (Fig. 1). Formal angiogram was unable to localize the source of bleeding, despite provocation. Given the localization on CT angiography and the patient’s clinical deterioration, she underwent hand-assisted segmental transverse colectomy. Surgical pathology was notable for multiple adenomas without dysplasia. The patient had no further episodes of GI bleeding after resection.
Comprehensive Evaluation of the Lower Eyelid Aging Process Among Asian Women
Authors: Cheng Chun-Yu , Hu Sindy , Chang Shyue-Luen , Lee Mei-Ching , Huang Yau-Li 
Published: March 2022

BACKGROUND
Lower eyelid aging is a complicated process, and for that reason, a comprehensive assessment of the lower eyelid is important before treatment.

OBJECTIVE
This study was conducted to analyze and assess the lower eyelid aging process between different age groups of Asian women.

METHODS AND MATERIALS
The authors developed the comprehensive lower eyelid age rating scale (CLEARS). The rating scale contains 3 domains and each composed of 3 items. Individuals were evaluated by the age group starting with the third decade (20–29 years) through the seventh decade (60–69 years) by 2 dermatologists working independently.

RESULTS
A total of 114 cases were evaluated. The total scores of CLEARS increased significantly between each adjacent age group. The scores of the snap test and the severity of fine lines, nasojugal groove, midcheek furrow, and eye bags increased significantly from the 3rd decade. The scores of the distraction test and the severity of palpebromalar groove and malar mound begin to increase with the 4th decade. Kappa coefficients of all items achieved moderate to substantial agreement.

CONCLUSION
This study describes the lower eyelid aging process among Asian women by CLEARS assessment. Lower eyelid aging becomes progressively more notable beginning with the third decade.
QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY REVEALS ROD PHOTORECEPTOR DEGENERATION in EARLY DIABETIC RETINOPATHY
Authors: Le David , Son Taeyoon , Lim Jennifer I. , Yao Xincheng 
Published: March 2022

Purpose:
This study is to test the feasibility of optical coherence tomography (OCT) detection of photoreceptor abnormality and to verify that the photoreceptor abnormality is rod predominated in early diabetic retinopathy (DR).

Methods:
OCT images were acquired from normal eyes, diabetic eyes with no DR, and mild nonproliferative DR (NPDR). Quantitative features, including thickness measurements quantifying band distances and reflectance intensity features among the external limiting membrane, inner segment ellipsoid, interdigitation zone, and retinal pigment epithelium were determined. Comparative OCT analysis of central fovea, parafovea, and perifovea were implemented to verify that the photoreceptor abnormality is rod predominated in early DR.

Results:
Thickness abnormalities between the inner segment ellipsoid and interdigitation zone also showed a decreasing trend among cohorts. Reflectance abnormalities of the external limiting membrane, interdigitation zone, and inner segment ellipsoid were observed between healthy, no DR, and mild NPDR eyes. The normalized inner segment ellipsoid/retinal pigment epithelium intensity ratio revealed a significant decreasing trend in the perifovea, but no detectable difference in central fovea.

Conclusion:
Quantitative OCT analysis consistently revealed outer retina, i.e., photoreceptor changes in diabetic patients with no DR and mild NPDR. Comparative analysis of central fovea, parafovea, and perifovea confirmed that the photoreceptor abnormality is rod-predominated in early DR.
A predictive model incorporating inflammation markers for high-grade surgical complications following liver resection for hepatocellular carcinoma
Authors: Wu Hsiang-Ling , Liu Hsin-Yi , Liu Wan-Chi , Hou Ming-Chih , Tai Ying-Hsuan 
Published: March 2022

Background:
Systemic inflammation and immune deficiency predispose surgical patients to infection and adversely affect postoperative recovery. We aimed to evaluate the prognostic ability of inflammation and immune-nutritional markers and to develop a predictive model for high-grade complications after resection of hepatocellular carcinoma (HCC).

Methods:
This study enrolled 1431 patients undergoing liver resection for primary HCC at a medical center. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, prognostic nutritional index, Model for End-Stage Liver Disease score, Albumin-Bilirubin score, Fibrosis-4 score, and Aspartate Aminotransferase to Platelet Ratio Index score were assessed. Stepwise backward variable elimination was conducted to determine the factors associated with Clavien-Dindo grade III to V complications within 30-day postoperative period. The predictive model was internally validated for discrimination performance using area under the receiver operating characteristic curve (AUC).

Results:
A total of 106 (7.4%) patients developed high-grade complications. Four factors independently predicted a high-grade postoperative complication and were integrated into the predictive model, including NLR (adjusted odds ratio: 1.10, 95% confidence interval [CI], 1.02-1.19), diabetes mellitus, extent of hepatectomy, and intraoperative blood loss. The AUC of the model was 0.755 (95% CI, 0.678-0.832) in the validation dataset. Using the cutoff value based on Youden’s index, the sensitivity and specificity of the risk score were 59.0% and 76.3%, respectively.

Conclusion:
Preoperative NLR independently predicted a high-grade complication after resection of HCC. The predictive model allows for identification of high-risk patients and appropriate modifications of perioperative care to improve postoperative outcomes.
Changes in Cervical Cytology Results and Human Papillomavirus Types Among Persons Screened for Cervical Cancer, 2007 and 2015–2017
Authors: Lewis Rayleen M. , Naleway Allison L. , Klein Nicola P. , Crane Bradley , Hsiao Amber , Aukes Laurie , Timbol Julius , Querec Troy D. , Steinau Martin , Weinmann Sheila , Unger Elizabeth R. , Markowitz Lauri E. 
Published: March 2022

Objectives
Since 2006, the US human papillomavirus (HPV) vaccination program has led to decreases in HPV infections caused by high-risk vaccine-targeted HPV types (HPV 16/18). We assessed differences in high-risk HPV prevalence by cervical cytology result among 20- to 24-year-old persons participating in routine cervical cancer screening in 2015–2017 compared with 2007.

Materials and Methods
Residual routine cervical cancer screening specimens were collected from 20- to 24-year-old members of 2 integrated healthcare delivery systems as part of a cross-sectional study and were tested for 37 HPV types. Cytology results and vaccination status (≥1 dose) were extracted from medical records. Cytology categories were normal, atypical squamous cells of undefined significance, low-grade squamous intraepithelial lesions (SIL), or high-grade SIL/atypical squamous cells cannot exclude high-grade SIL. Prevalences of HPV categories (HPV 16/18, HPV 31/33/45/52/58, HPV 35/39/51/56/59/66/68) were estimated by cytology result for 2007 and 2015–2017.

Results
Specimens from 2007 (n = 4046) were from unvaccinated participants; 4574 of 8442 specimens (54.2%) from 2015–2017 were from vaccinated participants. Overall, HPV 16/18 positivity was lower in 2015–2017 compared with 2007 in all groups: high-grade SIL/atypical squamous cells cannot exclude high-grade SIL, 16.0% vs 69.2%; low-grade SIL, 5.4% vs 40.1%; atypical squamous cells of undefined significance, 5.0% vs 25.6%; and normal, 1.3% vs 8.1%. Human papillomavirus 31/33/45/52/58 prevalence was stable for all cytology groups; HPV 35/39/51/56/59/66/68 prevalence increased among low-grade SIL specimens (53.9% to 65.2%) but remained stable in other groups.

Conclusions
Prevalence of vaccine-targeted high-risk HPV types 16/18 was dramatically lower in 2015–2017 than 2007 across all cytology result groups while prevalence of other high-risk HPV types was mainly stable, supporting vaccine impact with no evidence of type replacement.
Aspirin Use and the Risk of Hepatocellular Carcinoma
Authors: Wang Yikai , Wang Muqi , Liu Chenrui , Wang Wenjun , Shi Juanjuan , Dang Shuangsuo 
Published: March 2022

Introduction and Aim:
The use of aspirin is a potential protective factor against the development of hepatocellular carcinoma (HCC). Therefore, we conducted a meta-analysis to evaluate the contribution of aspirin to the risk of HCC.

Methods:
We searched for PubMed and EMBASE through September 2021.

Results:
Eighteen studies (16 cohort, 2 case-control) were included. Aspirin users were less likely to develop HCC than nonusers [adjusted odds ratio (OR), 0.54; 95% confidence interval (CI): 0.44-0.66]. Stratified analysis showed that aspirin reduced the risk of HCC in Asian and Western populations (OR, 0.59 vs. 0.67). Besides, aspirin has protective effects against HCC after hepatitis B virus (OR, 0.70; 95% CI: 0.52-0.93) and hepatitis C virus infections (OR, 0.41; 95% CI: 0.23-0.73). Aspirin has protective effects on people with chronic liver disease (OR, 0.46; 95% CI: 0.31-0.67) and on the general population (OR, 0.65; 95% CI: 0.54-0.79). In addition, confounding factors have an important impact on the results of aspirin prevention of liver cancer before (OR, 0.28; 95% CI: 0.06-1.27) and after (OR, 0.58; 95% CI: 0.47-0.71) adjustment. Further studies have shown that those in the long duration group do not experience better effects in preventing HCC (OR, 0.62 vs. 0.63). A further meta-analysis of 3 articles showed that the use of aspirin did not increase the risk of bleeding in patients with HCC (OR, 1.19; 95% CI: 0.87-1.64).

Conclusion:
Our meta-analysis shows that the use of aspirin is associated with a lower risk of liver cancer.
Measuring Inconsistency in Quality Across Patient Groups to Target Quality Improvement
Authors: Agniel Denis , Martino Steven C. , Burkhart Q. , Hudson Scholle Sarah , Quigley Denise D. , Hambarsoomian Katrin , Orr Nate , Maksut Jessica L. , Darabidian Biayna , Elliott Marc N. 
Published: March 2022

Background:
Quality improvement (QI) may be aimed at improving care for all patients, or it may be targeted at only certain patient groups. Health care providers have little guidance when determining when targeted QI may be preferred.

Objectives:
The aim was to develop a method for quantifying performance inconsistency and guidelines for when inconsistency indicates targeted QI, which we apply to the performance of health plans for different patient groups.

Research Design and Measures:
Retrospective analysis of 7 Health Care Effectiveness Data and Information Set (HEDIS) measures of clinical care quality.

Subjects:
All Medicare Advantage (MA) beneficiaries eligible for any of 7 HEDIS measures 2015–2018.

Results:
MA plans with higher overall performance tended to be less inconsistent in their performance (r=−0.2) across groups defined by race-and-ethnicity and low-income status (ie, dual eligibility for Medicaid or receipt of Low-Income Subsidy). Plan characteristics were usually associated with only small differences in inconsistency. The characteristics associated with differences in consistency [eg, size, Health Maintenance Organization (HMO) status] were also associated with differences in overall performance. We identified 9 (of 363) plans that had large inconsistency in performance across groups (>0.8 SD) and investigated the reasons for inconsistency for 2 example plans.

Conclusions:
This newly developed inconsistency metric may help those designing and evaluating QI efforts to appropriately determine when targeted QI is preferred. It can be used in settings where performance varies across groups, which can be defined by patient characteristics, geographic areas, hospital wards, etc. Effectively targeting QI efforts is essential in today’s resource-constrained health care environment.
Self-reported health condition severity and ambulation status postmajor dysvascular limb loss
Authors: Mayo Amanda L. , Viana Ricardo , Dilkas Steven , Payne Michael , Devlin Michael , MacKay Crystal , Cimino Stephanie R. , Guilcher Sara J. T. , Hitzig Sander L. 
Published: March 2022

Background:
Individuals with dysvascular lower limb amputations (LLA) secondary to complications of peripheral arterial disease (PAD) and/or diabetes have high rates of co-morbidities.

Objectives:
To describe self-reported health condition severity and their association with sociodemographic factors and ambulations status among individuals with major dysvascular LLA.

Study Design:
Cross sectional telephone and in person survey with adults with major dysvascular LLA living in the community setting in Ontario, Canada.

Methods:
Survey by phone/in person, and completion of the Dysvascular Conditions Scale and Special Interest in Amputee Medicine Mobility (SIGAM) Grade by each participant.

Results:
Two hundred thirty-one individuals with major dysvascular LLAs participated in the study. Most of them were male individuals (80.5%) and had undergone a transtibial amputation (74%). On average, participants were 3.4 years postlimb loss and had five identified Dysvascular Conditions Scale health conditions. The top five reported health conditions were diabetes, hypertension, phantom limb pain, musculoskeletal pain, and back pain. With the exclusion of hypertension, these conditions were also perceived by respondents to be quite severe for their impact. Vision impairment was also rated as being severe in nature. Lower mobility Special Interest Group in Amputee Medicine grades were associated with higher health condition severity scores.

Conclusions:
Individuals with dysvascular limb loss experience high multimorbidity with perceived negative impact on their overall wellness and function. Rehabilitation and self-management strategies to help patients with dysvascular LLAs to manage chronic health conditions may improve outcomes.
Heritability of cardiovascular health across three generations in South Africa: the Birth to Twenty-Plus cohort
Authors: Ware Lisa J , Maposa Innocent , Kolkenbeck-Ruh Andrea , Norris Shane , Soepnel Larske , Crouch Simone , Kagura Juliana , Naidoo Sanushka , Smith Wayne , Davies Justine 
Published: March 2022

AbstractObjectivesCardiovascular disease is increasing in many low-middle income countries, including those in Africa. To inform strategies for the prevention of cardiovascular disease in South Africa, we sought to determine the broad heritability of phenotypic markers of cardiovascular risk across three generations.DesignA cross-sectional study conducted in a longitudinal family cohort.SettingResearch unit within a tertiary hospital in a historically disadvantaged, large urban township of South Africa.Participants195 individuals from 65 biological families with all three generations including third generation children aged 4-10 years were recruited from the longest running intergenerational cohort study in Africa, the Birth to Twenty Plus cohort. All adults (grandparents and parents) were female, while children were male or female.Primary and secondary outcome measuresThe primary outcome was heritability of blood pressure (BP, brachial and central pressures). Secondary outcomes were heritability of arterial stiffness (pulse wave velocity), carotid intima media thickness (cIMT), and left ventricular mass indexed to body surface area (LVMI).ResultsWhile no significant intergenerational relationships of BP or arterial stiffness were found, there were significant relationships in LVMI across all three generations (p<0.04), and in cIMT between grandparents and parents (p=0.0166). Heritability estimates were 23-44% for cIMT and 21-39% for LVMI.ConclusionsStructural indicators of vascular health, which are strong markers of future clinical cardiovascular outcomes transmit between generations within African families. Identification of these markers in parents may be useful to trigger assessments of preventable risk factors for cardiovascular disease in offspring.StrengthsIntergenerational transmission was evaluated for a range of indicators of cardiovascular health within urban African familiesThe sample included biological family members from three generationsHeritability estimates were compared for three commonly used statistical methods.LimitationsThe sample size is a limitation with the random family statistical method used to increase the numbers of comparisons available.Only maternal family members were included.
Identification of a Novel SARS-CoV-2 Delta-Omicron Recombinant Virus in the United States
Authors: Lacek Kristine A. , Rambo-Martin Benjamin L. , Batra Dhwani , Zheng Xiao-yu , Sakaguchi Hitoshi , Peacock Thomas , Keller Matthew , Wilson Malania M. , Sheth Mili , Davis Morgan L. , Borroughs Mark , Gerhart Jonathan , Hassell Norman , Shepard Samuel S. , Cook Peter W. , Lee Justin , Wentworth David E. , Barnes John R. , Kondor Rebecca , Paden Clinton R. 
Published: March 2022

AbstractRecombination between SARS-CoV-2 virus variants can result in different viral properties (e.g., infectiousness or pathogenicity). In this report, we describe viruses with recombinant genomes containing signature mutations from Delta and Omicron variants. These genomes are the first evidence for a Delta-Omicron hybrid Spike protein in the United States.
Parental income gradients in child and adolescent mortality: Norwegian trends over half a century
Authors: Evensen Miriam , Klitkou Søren , Tollånes Mette , Juliusson Petur B , Kravdal Øystein 
Published: March 2022

ABSTRACTBackgroundChild mortality declined rapidly the last century in many high-income countries. However, little is known about the socioeconomic differences in this decline, and whether these vary across causes of death.MethodsWe use register data including all Norwegian births between 1968 to 2010 (2.1 million), and analyse how all-cause and cause-specific child (0-5) and adolescent mortality (6-21) vary with relative parental income the year before the birthResultsChild all-cause mortality decreased with increasing parental relative income within all birth cohorts. Among children aged 0-5, the socioeconomic gradient for all-cause, accidental deaths, sudden infant death syndrome and perinatal factors declined over the periode, while there was no systematic decline related to congenital malformations. Among children 6-21, the gradient did not weaken similarly, although there were indications of declines in the socioeconomic gradient related to all-cause deaths, accidents, and suicides. While the absolute differences in mortality declined over time, the relative differences remained stable.ConclusionThere has been a large reduction in child mortality in all socioeconomic groups across 50 years for all-cause and most cause-specific mortality groups. However, children of parents in the lowest part of the income distribution still have an elevated mortality, and the relative differences have not always been declining.