bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mode of Anesthesia and Bladder Management Following Orthopaedic Surgery in Children With Cerebral Palsy: A System Level Analysis
Authors: Buckon Cathleen E. , Koscielniak Nikolas J. , Tucker Carole A. , Aiona Michael D. 
Published: February 2022

Background:
Postoperative urinary retention (POUR) is a surgical complication more prevalent in children with neurodisability and associated with an increase length of hospitalization. Risk factors include pre-existing bladder dysfunction, type and duration of surgery, anesthesia medications, postoperative opioid pain management, and patient demographics. The purpose of this investigation was (1) to determine the frequency of POUR following hip/lower limb orthopaedic procedures in which epidural analgesia was used for pain management; (2) to explore factors influencing postoperative bladder management.

Methods:
A retrospective analysis of clinical data was performed in an orthopaedic specialty care health care system. A health outcomes network was queried for patients with a diagnoses of cerebral palsy (ICD-9/10 codes) who had one of 57 unique CPT procedure codes corresponding to hip osteotomies or tenotomies from 2011 to 2019. All surgical observations included in analysis required a discrete data element and the confirmation of a secondary proxy. The database was also queried for postoperative medications received and patient demographics of interest.

Results:
A total of 704 surgical procedures met inclusion criteria resulting in a patient population with a mean age of 11 years, 58% male, 53% Caucasian, and 55% classified as quadriplegia [51% Gross Motor Function Classification System (GMFCS) levels IV/V]. Three hundred and thirty-five procedures (48%) involved epidural anesthesia. Sixty-five patients required intermittent catheterization (9.2%) postoperatively following foley catheter removal, of which 23 (3.3%) required recatheterization. The rate of recatheterization was similar regardless of anesthesia mode; 1.8% for general and 1.4% for epidural and was associated with a greater number of pain medications. Epidural anesthesia resulted in significantly longer periods of catheterization. For the total group the time to urinary catheter removal differed significantly among cerebral palsy subtypes, GMFCS Level, race, and ethnicity. Factors identified as significant predictors of the length of catheterization were epidural analgesia, number of pain medications, and osteotomy.

Conclusions:
The number of postoperative pain medications utilized was more predictive of POUR than the mode of analgesia delivery; however, epidural analgesia and the type of surgical procedure did significantly impact the length of catheterization.

Level of Evidence:
Level III.
Progression of Infective Dermatitis Associated with HTLV-1 to Adult T-Cell Leukemia/Lymphoma—Case Report and Literature Review
Authors: Rosa Bárbara L. , Silva Thadeu S. , Dias Maria A. , Araujo Iguaracyra , Bittencourt Achiléa L. 
Published: February 2022

Abstract:
The human T-cell lymphotropic virus type 1 is a retrovirus that may cause severe diseases such as infective dermatitis associated with HTLV-1 (IDH) and adult T-cell leukemia/lymphoma (ATL). IDH is a chronic relapsing infected eczema of childhood, and ATL is a distinct type of peripheral T-cell leukemia/lymphoma, which is classified into the following types: smoldering, primary cutaneous tumoral, chronic, lymphoma, and acute. Progression of IDH to ATL during the course of IDH has been previously reported in 3 young patients, two of them from Bahia (Brazil). We present the case of a 22-year-old man who had IDH since childhood and developed ATL 18 months ago. The lymphoma lesions were superimposed on previously existing IDH lesions (forehead, axillae, umbilical area, and neck) or in areas generally affected by IDH (external genitalia, hypogastrium, groin, and eyelid). Cutaneous lesions in ATL are very frequent, but in this patient, besides infiltrated plaques and papules presented vesicles on the skin corresponding histologically to dilated Pautrier abscesses. Vesicular ATL is a rare condition. This case constitutes a very demonstrative example of the close correlation between IDH and ATL.
Preferentially Expressed Nuclear Antigen in Melanoma Expression in Melanocytic Activation (Melanotic Macule) of the Nail Unit. A Potential Diagnostic Pitfall? A Study of 3 Cases
Authors: Perrin Christophe 
Published: February 2022

Abstract:
Recent studies have argued that melanocyte preferentially expressed nuclear antigen in melanoma (PRAME) is a sensitive and specific immunohistochemical marker of melanoma, including acral melanoma. In addition, loss of p16 expression has recently been suggested to have diagnostic utility in acral melanocytic tumors. The purpose of this study was to report PRAME expression in 3 cases of melanocytic activation (MAN). There were 2 men and 1 woman ranging in age at diagnosis from 46 years to 78 years (mean 61, 6 years). All cases involved a single digit. One lesion was in the fingernail (fifth finger), whereas the remaining 2 lesions were in the toenails (hallux). All the patient presented with a longitudinal melanonychia. The width of the lesions varied from 3 mm (2 cases) to 4 mm (1 case). The duration of the lesions before diagnosis varied from 12 to 24 months. Distinction of MAN from melanoma in situ is not always easy. Some morphological misleading features are illustrated in this study: (1) the suprabasal location of matrix melanocytes with long and thick dendrites within the 2–4 germinative cell layers; (2) the microconfluence of 2 melanocytes and rare melanocytes with a relatively large nucleus, however in a general context of melanocyte scarcity; and (3) the occasional nonspecific nuclear microphtalmia-associated transcription factor (MITF) staining of keratogeneous cells. Such staining could suggest a pagetoid spread of melanocytes in the keratogenous zone. PRAME antibody revealed a strong and diffuse staining in all cases. In addition, all cases were p16 negative. In this study, the melanocyte count inferior to 9 melanocytes/mm and the lack of nuclear atypia or confluence of melanocytes permitted a confident diagnosis of MAN. Limitations of our study lie largely in the small number of cases. Despite this, the expression of PRAME in some MAN seems to hamper its diagnostic value in differentiating benign from malignant lesion.
Meningothelial Hamartoma of the Scalp: Clinicopathologic Review of an Unusual Tumor Mimicking a Vascular Neoplasm With Review of Literature
Authors: Li Liping , Merchant Aziz , Ronen Shira , Suster David I. 
Published: February 2022

Abstract:An unusual benign skin lesion is reported in a 19-year-old man with no significant medical history. The lesion had been present since he was an infant and had been slowly enlarging over the past 15 years. The lesion caused pain and discomfort, and the patient underwent an excisional biopsy. Histologic examination showed a subcutaneous lesion with ill-defined borders and peripheral areas of infiltration between adnexal structures. The lesion was composed of small round to ovoid cells embedded in a collagenous stroma with prominent cystic pseudovascular appearing channels causing a pseudopapillary or lymphangitic appearance that mimicked a vascular neoplasm. Immunohistochemistry performed showed positive staining for EMA, progesterone receptor, D2-40, and vimentin within the lesional cells. The tumor cells were negative for cytokeratin AE1/AE3, CD34, CD31, HHV-8, STAT6, SMA, Desmin, S-100, Melan A, and HMB45. A next-generation sequencing study using a hybrid capture-based panel examining 50 commonly mutated genes in human neoplasia was performed and showed no molecular alterations suggesting a nonneoplastic nature. Based on the clinical presentation, histologic features, and results of ancillary studies, the case was diagnosed as a hamartoma of the scalp with meningothelial-like elements. Reported cases of this lesion have behaved in a benign manner; however, as the histologic differential includes low-grade malignant vascular neoplasms such as angiosarcoma, it is important to recognize the salient features of this lesion.
Metabolic effects of menopause: a cross-sectional characterization of body composition and exercise metabolism
Authors: Gould Lacey M. , Gordon Amanda N. , Cabre Hannah E. , Hoyle Andrew T. , Ryan Eric D. , Hackney Anthony C. , Smith-Ryan Abbie E. 
Published: March 2022

Abstract

Objectives:
To evaluate body composition, fat distribution, and metabolism at rest and during exercise in premenopausal, perimenopausal, and postmenopausal women.

Methods:
This cross-sectional study in 72 women ages 35 to 60 years evaluated body composition via a fourcompartment model, fat distribution using dual-energy x-ray absorptiometry-derived android to gynoid ratio, metabolic measures via indirect calorimetry, and lifestyle factors using surveys. One-way analyses of variance and one-way analyses of covariance covaried for age and hormone levels (estrogen and progesterone) were used to compare groups.

Results:
Body fat percent was significantly lower in premenopausal than perimenopausal women (mean difference ± standard error: - 10.29 ± 2.73%, P = 0.026) despite similarities in fat mass and fat-free mass between groups (P≥0.217). Android to gynoid ratio was significantly lower in premenopausal than perimenopausal women (MD ± SE: -0.16 ± 0.05 a.u., P = 0.031). Resting energy expenditure was similar between groups (P = 0.999). Fat oxidation during moderate intensity cycle ergometer exercise was significantly greater in premenopausal than postmenopausal women (MD ± SE: 0.09 ± 0.03 g/min, P = 0.045). The change in respiratory exchange ratio between rest and moderate intensity exercise was significantly lower in premenopausal women than peri- (MD ± SE: -0.05 ± 0.03 a.u., P = 0.035) and postmenopausal women (MD ± SE: -0.06 ± 0.03 a.u., P = 0.040). Premenopausal women reported significantly fewer menopause symptoms than peri- (MD ± SE: -6.58 ± 1.52 symptoms, P = 0.002) and postmenopausal participants (MD ± SE: -4.63 ± 1.52 symptoms, P = 0.044), while similarities between groups were observed for lifestyle factors including diet and physical activity (P>0.999).

Conclusions:
Perimenopause may be the most opportune window for lifestyle intervention, as this group experienced the onset of unfavorable body composition and metabolic characteristics.

Video Summary:

http://links.lww.com/MENO/A932.
Where does postmenopausal dyspareunia hurt? A cross-sectional report
Authors: Goetsch Martha F. , Garg Bharti , Lillemon Jen , Clark Amanda L. 
Published: March 2022

Abstract

Objective:
A common symptom of genitourinary syndrome of menopause (GSM) is dyspareunia, attributed to vulvovaginal atrophy. Our objective was to systematically describe the pain characteristics and anatomic locations of tenderness in a cohort with moderate/severe dyspareunia likely due to GSM.

Methods:
This cross-sectional study reports the baseline data of postmenopausal women with dyspareunia screened for an intervention trial of topical estrogen. Postmenopausal women not using hormone therapy who had moderate or severe dyspareunia were eligible if estrogen was not contraindicated. Biopsychosocial assessments were performed using the Vulvar Pain Assessment Questionnaire, and participants underwent a systematic vulvovaginal examination that included a visual assessment and cotton swab testing for tenderness rated using the Numerical Rating Scale (0-10). Vaginal pH and mucosal sensitivity were assessed; pelvic floor muscles and pelvic viscera were palpated for tenderness.

Results:
Fifty-five eligible women were examined between July 2017 and August 2019. Mean age was 59.5 ± 6.8 years, and duration of dyspareunia was 6.2 ± 4.3 years. The mean intercourse pain score was 7.3 ± 1.8, most often described as “burning” and “raw.” Ninety-eight percent had physical findings of vulvovaginal atrophy. Median pain scores from swab touch at the vulvar vestibule (just outside the hymen) were 4 to 5/10, and topical lidocaine extinguished pain. Median vaginal mucosal pain was zero.

Conclusions:
Participants described their pain as “burning” and “dry.” Tenderness was most severe and most consistently located at the vulvar vestibule. Correlating the symptom of dyspareunia with genital examination findings may further our understanding of treatment outcomes for GSM.

Video Summary:

http://links.lww.com/MENO/A916.
Sleep apnea in postmenopausal women is associated with joint pain severity and fatigability: a cross-sectional study
Authors: Odai Tamami , Terauchi Masakazu , Umeki Hidenori , Miyasaka Naoyuki , Somekawa Yoshiaki 
Published: March 2022

Abstract

Objective:
This study aimed to investigate the relationships between sleep apnea parameters and various symptoms in postmenopausal women who had treatment-resistant sleep disorders.

Methods:
The respiratory disturbance index (RDI), the number of times apnea-hypopnea occurred in an hour, and transcutaneous oxygen saturation (SpO2) were monitored during one night of sleep using a portable monitoring device in 51 postmenopausal women who did not have an improved subjective sleep quality with the use of hypnotics. Physical and psychological health statuses and subjective sleep disturbance were evaluated using validated questionnaires, including the Epworth Sleepiness Scale, the Cornell Medical Index, and the Questionnaire for Assessment of Climacteric Syndrome in Japanese Women. The associations between RDI, nadir SpO2 and various symptoms, as well as cardiovascular parameters, such as blood pressure, serum lipid profile, and glucose tolerance, were analyzed separately.

Results:
Among the 51 study participants, seven (13.7%) were diagnosed with obstructive sleep apnea. After adjustment for age, body mass index, and the background factors related to RDI and nadir SpO2, the association remained significant between a higher RDI and joint pain (Questionnaire for Assessment of Climacteric Syndrome in Japanese Women) (standardized partial regression coefficient [β] = 0.423, P
= 0.016), and between lower nadir SpO2 and fatigability (Cornell Medical Index) (β = –0.472, P
= 0.007).

Conclusions:
Detailed examination of sleep-disordered breathing is warranted in women with severe joint pain and fatigability.
The evolving field of Big Data: understanding geographic information systems analysis and its transformative potential in ophthalmic research
Authors: Soares Rebecca Russ 
Published: February 2022

Purpose of review
The purpose of this review to is to highlight alternative uses of Big Data in the pursuit of ophthalmologic public health. In particular, we highlight geographic information systems (GIS) analysis as a type of Big Data, summarize various GIS methods, and enumerate sources of geographic data.

Recent findings
The recent implementation of the IRIS Registry Data, has expanded our real-world knowledge of ophthalmology in the United States. Such innovations in Big Data allow us to better define ophthalmic diseases, treatments, and outcomes for underserved individuals and subpopulations. One underutilized source of Big Data entails use of geographic information to evaluate geographic heterogeneity and access across the United States.

Summary
GIS and Big Data allow for refined epidemiologic estimates of eye disease for specific communities. In particular, how GIS can enable researchers to examine disparities in access to ophthalmic care is reviewed. GIS best practices and some data sources for GIS in ophthalmology are also summarized.
Translational and clinical advancements in management of proliferative vitreoretinopathy
Authors: Shahlaee Abtin , Woeller Collynn F. , Philp Nancy J. , Kuriyan Ajay E. 
Published: February 2022

Purpose of review
Despite advancement in the surgical instrumentation and techniques, proliferative vitreoretinopathy (PVR) remains the most common cause for failure of rhegmatogenous retinal detachment (RRD) repair. This review discusses ongoing translational and clinical advancements in PVR.

Recent findings
PVR represents an exaggerated and protracted scarring process that can occur after RRD. The primary cell types involved are retinal pigment epithelium, glial, and inflammatory cells. They interact with growth factors and cytokines derived from the breakdown of the blood–retinal barrier that trigger a cascade of cellular processes, such as epithelial–mesenchymal transition, cell migration, chemotaxis, proliferation, elaboration of basement membrane and collagen and cellular contraction, leading to overt retinal pathology. Although there are currently no medical therapies proven to be effective against PVR in humans, increased understanding of the risks factors and pathophysiology have helped guide investigations for molecular targets of PVR. The leading therapeutic candidates are drugs that mitigate growth factors, inflammation, and proliferation are the leading therapeutic candidates.

Summary
Although multiple molecular targets have been investigated to prevent and treat PVR, none have yet demonstrated substantial evidence of clinical benefit in humans though some show promise. Advancements in our understanding of the pathophysiology of PVR may help develop a multipronged approach for this condition.
Incidence and Prevalence of Intraductal Papillary Mucinous Neoplasms in Individuals With BRCA1 and BRCA2 Pathogenic Variant
Authors: Shah Ishani , Silva-Santisteban Andy , Germansky Katharine A. , Wadhwa Vaibhav , Tung Nadine , Huang Dora C. , Kandasamy Cinthana , Mlabasati Jack , Bilal Mohammad , Sawhney Mandeep S. 
Published: February 2022

Background:
The natural history of branch-duct intraductal papillary neoplasm (BD-IPMN) in BRCA1/2 patients is unknown. Our goal was to estimate the incidence and prevalence of BD-IPMN and other pancreatic lesions in BRCA1/2 patients and compare it to that for average-risk individuals.

Methods:
We identified a cohort of BRCA1/2 patients followed at our institution between 1995 and 2020. Medical records and imaging results were reviewed to determine prevalence of pancreatic lesions. We then identified those who had undergone follow-up imaging and determined the incidence of new pancreatic lesions. We categorized pancreatic lesions as low, intermediate, or high-risk based on their malignant potential.

Results:
During the study period, 359 eligible BRCA1/2 patients were identified. Average patient age was 56.8 years, 88.3% were women, and 51.5% had BRCA1. The prevalence of low-risk pancreatic lesions was 14.4%, intermediate-risk 13.9%, and high-risk 3.3%. The prevalence of BD-IPMN was 13.6% with mean cyst size 7.7 mm (range: 2 to 34 mm). The prevalence of pancreatic cancer was 3.1%. Subsequent imaging was performed in 169 patents with mean follow-up interval of 5.3 years (range: 0 to 19.7 y). The incidence of BD-IPMN was 20.1%, with median cyst size 5.5 mm (range: 2 to 30 mm). The incidence of pancreatic cancer was 2.9%. BRCA2 patients were almost 4-times more likely to develop pancreatic cancer than BRCA1 patients, however, there was no difference in incidence or prevalence of BD-IPMN.

Conclusions:
Incidence and prevalence of BD-IPMNs in BRCA1/2 patients was similar to that reported for average-risk individuals. BRCA2 patients were more likely than BRCA1 patients to develop pancreatic cancer but had similar rates of BD-IPMN.
Clinical Features Associated With Need for Mechanical Ventilation in Children With Guillain-Barré Syndrome: Retrospective Cohort From India
Authors: Randhawa Manjinder Singh , Iyer Rajalakshmi , Bansal Arun , Mukund Bal , Angurana Suresh Kumar , Nallasamy Karthi , Jayashree Muralidharan , Singhi Sunit C. , Singhi Pratibha , Baranwal Arun Kumar , Sankhyan Naveen 
Published: February 2022

OBJECTIVES:
To analyze the clinical features associated with the need for mechanical ventilation (MV) in children with Guillain-Barré syndrome (GBS).

DESIGN:
Retrospective cohort study, 2010–2019.

SETTING:
PICU.

PATIENTS:
All children, 1 month to 12 years old, diagnosed with GBS in our single-center PICU.

Intervention:
Retrospective chart and data review.

MEASUREMENTS AND MAIN RESULTS:
Out of 189 children identified with a diagnosis of GBS, 130 were boys (69%). The median (interquartile range [IQR]) age was 6 years (3–9 yr). At admission, the Hughes disability score was 5 (4–5), and cranial nerve palsies were present in 81 children (42%). Autonomic instability subsequently occurred in a total of 97 children (51%). In the 159 children with nerve conduction studies, the axonal variant of GBS (102/159; 64%) predominated, followed by the demyelinating variant (38/189; 24%). All children received IV immunoglobulins as first-line therapy at the time of admission. The median (IQR) length of PICU stay was 12 days (3–30.5 d). Ninety-nine children (52%) underwent invasive MV, and median duration of MV was 25 days (19–37 d). At admission, upper limb power less than or equal to 3 (p = 0.037; odds ratio (OR), 3.5 [1.1–11.5]), lower limb power less than or equal to 2 (p = 0.008; OR, 3.5 [1.4–8.9]), and cranial nerve palsy (p = 0.001; OR, 3.2 [1.6–6.1]) were associated with subsequent need for MV. Prolonged (> 21 d) MV was associated with more severe examination findings at admission: upper limb power less than or equal to 2 (p < 0.0001; OR, 4.2 [2.5–6.9]) and lower limb power less than or equal to 1 (p < 0.0001; OR, 4.5 [2.6–7.9]).

CONCLUSIONS:
In children with GBS, referred to our center in North India, severe neuromuscular weakness at admission was associated with the need for MV. Furthermore, greater severity of this examination was associated with need for prolonged (> 21 d) MV. Identification of these signs may help in prioritizing critical care needs and early PICU transfer.
Contrast Media–Enhanced Breast Computed Tomography With a Photon-Counting Detector
Authors: Berger Nicole , Marcon Magda , Wieler Jann , Vorburger Denise , Dedes Konstantin J. , Frauenfelder Thomas , Varga Zsuzsanna , Boss Andreas 
Published: February 2022

Objectives
The aim of this study was to investigate the feasibility, the image quality, and the correlation with histology of dedicated spiral breast computed tomography (B-CT) equipped with a photon-counting detector in patients with suspicious breast lesions after application of iodinated contrast media.

Materials and Methods
The local ethics committee approved this prospective study. Twelve women with suspicious breast lesions found in mammography or B-CT underwent contrast-enhanced spiral B-CT and supplementary ultrasound. For all lesions, biopsy-proven diagnosis and histological workup after surgical resection were obtained including the size of cancer/ductal carcinoma in situ, which were correlated to sizes measured in B-CT. Signal-to-noise ratio and contrast-to-noise ratio were evaluated for tumor, glandular tissue, and fatty tissue.

Results
Of the 12 patients, 15 suspicious lesions were found, 14 were malignant, and 1 benign lesion corresponded to a chronic inflammation. All lesions showed strong contrast media uptake with a signal-to-noise ratio of 119.7 ± 52.5 with a contrast-to-noise ratio between glandular tissue and breast cancer lesion of 12.6 ± 5.9. The correlation of the size of invasive tumors measured in B-CT compared with histological size was significant and strong R = 0.77 (P < 0.05), whereas the correlation with the size of the peritumoral ductal carcinoma in situ was not significant R = 0.80 (P = 0.11).

Conclusions
Contrast-enhanced B-CT shows high contrast between breast cancer and surrounding glandular tissue; therefore, it is a promising technique for cancer detection and staging depicting both soft tissue lesions and microcalcifications, which might be a substantial advantage over breast MRI.