bluuebunny/crossref_metadata_2025 huggingface dataset:
MDM2 RNA In Situ Hybridization for the Diagnosis of Atypical Lipomatous Tumor
Authors: Kulkarni Anupriya S. , Wojcik John B. , Chougule Abhijit , Arora Kshitij , Chittampalli Yashaswini , Kurzawa Pawel , Mullen John T. , Chebib Ivan , Nielsen G. Petur , Rivera Miguel N. , Ting David T. , Deshpande Vikram
Published: December 2018

The distinction of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) from its benign counterpart, lipoma, may represent a challenge. MDM2 DNA amplification is used as the gold standard as MDM2 immunohistochemistry lacks specificity and sensitivity. Herein, we investigate the diagnostic utility of MDM2 RNA in situ hybridization (RNA-ISH) and compare the test with MDM2 immunohistochemistry and MDM2 DNA fluorescence in situ hybridization (FISH) in benign and malignant lipomatous neoplasms. We evaluated 109 neoplasms including 27 lipomas, 25 spindle cell lipomas, 32 ALTs/WDLs, and 25 dedifferentiated liposarcomas (DDL). The validation cohort included 14 lipoma-like neoplasms that lacked unequivocal features of ALT/WDL and in which MDM2 immunohistochemistry was either equivocal, negative or falsely positive. Immunohistochemistry, automated RNA-ISH and DNA-FISH for MDM2 were performed. Tumors with diffuse nuclear staining or >50 dots per cell on RNA-ISH were considered positive. All lipomas and lipoma variants were negative for RNA-ISH while all ALTs/WDLs and DDLs were positive. Eighty percent (24/30) and 92% (22/24) of ALTs/WDLs and DDLs were positive for MDM2 immunohistochemistry. Lipomas and its variants were negative for MDM2 amplification; 92% and 100% of ALTs/WDLs and DDLs showed MDM2 DNA amplification. The mean percentage of ALT/WDL tumor cells showing MDM2 RNA-ISH positivity was 73% compared with 24% on MDM2 immunohistochemistry. RNA-ISH correctly classified all 10 ALTs/WDLs and all 4 lipomas in the validation cohort. The performance of MDM2 RNA-ISH and MDM2 DNA-FISH are equivalent. MDM2 RNA-ISH can be of diagnostic value in histologically challenging lipomatous neoplasms. The automated MDM2 RNA-ISH assay should allow for more widespread use of MDM2 testing and for a more sensitive and specific diagnosis of ALT/WDL.
Cholangiolocellular Carcinoma With “Ductal Plate Malformation” Pattern May Be Characterized by ARID1A Genetic Alterations
Authors: Sasaki Motoko , Sato Yasunori , Nakanuma Yasuni
Published: December 2018

Cholangiolocellular carcinoma (CLC) is a unique subtype of primary liver carcinoma, which sometimes coexists with hepatocellular carcinoma (HCC), cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma (cHCC-CCA). “Ductal plate malformation” (DPM)-pattern of primary liver carcinoma, which resembles biliary lesions in Caroli disease and von Meyenburg complex, is sometimes associated with CLC. We examined genetic alterations of hTERT promoter (hTERT), IDH1 or 2 (IDH1/2), KRAS, ARID1A, PBRM1, ARID2, BAP1, p53 and their association with histologic features such as proportion of CLC and DPM-pattern in 77 patients with primary liver carcinoma diagnosed as cHCC-CCA or CLC. Primary liver carcinomas were histologically subdivided into 29 CLC-predominant (CLC component >80%), 31 with CLC (5% to 80%) and 17 without CLC (<5%). CLC-predominant group was characterized by older age, male-predominant and smaller tumor size. Genetic alterations were detected in hTERT (25%), ARID1A (21%), PBRM1 (20%), ARID2 (3%), BAP1 (1%), p53 (46%), KRAS (5%), and IDH1/2 (8%). ARID1A alteration was more frequent in CLC-predominant group, compared with other groups (P<0.05) and was correlated with the degree of DPM-pattern (P<0.01). Alterations of hTERT and p53 were less frequent in CLC-predominant group compared with “with CLC group” (P<0.05). hTERT mutation was less frequent in carcinomas with DPM-pattern (P<0.01). PBRM1 alteration was more frequent in CLC with focal HCC subgroup and without CLC group compared with other groups (P<0.05). CLC may be a distinct subgroup of primary liver carcinoma, which is different from cHCC-CCA, based on clinicopathologic and genetic alterations. ARID1A alterations may characterize CLC with DPM-pattern and could be a diagnostic immunohistochemical marker for small CLCs with DPM-pattern.
Malignant Lymphoma of the Ovary: A Diagnostic Pitfall of Intraoperative Consultation
Authors: Iizuka Noriaki , Ikura Yoshihiro , Fukuoka Yasunori , Shibata Takashi , Okamoto Masashi , Kamiya Akio , Oishi Tetsuya , Kotsuji Fumikazu , Iwai Yasuhiro
Published: December 2018

Primary ovarian lymphomas are rare, but can potentially evoke diagnostic problems. We present a case of ovarian lymphoma, in which an ambiguous intraoperative pathologic report led to overtreatment (unnecessary surgery). A 73-yr-old woman with fatigue and low-grade fever was diagnosed as having a left ovarian tumor by imaging modalities. Exploratory laparotomy was carried out to confirm the diagnosis. The frozen tissue sections of the ovarian tumor showed condensed proliferation of atypical round cells accompanied with a few small lymphocytes. The pathologists could not determine whether this tumor was a lymphoma or another malignancy (eg, dysgerminoma). Hence, they reported it to gynecologists who operated as simply a malignant tumor in order to evade misdiagnosis. On the basis of the inconclusive pathologic report, the gynecologists decided to change the planned laparotomy to total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection. A postoperative paraffin section–based pathologic diagnosis was diffuse large B-cell lymphoma of the ovary, which basically does not require surgical treatments. Subsequently, chemotherapy for B-cell lymphoma was initiated, and no lymphoma recurrence has been reported to date. A more robust preoperative discussion between the gynecologists and the pathologists might have avoided the overtreatment.
Ultrasonographic Assessment of Carpal Tunnel Syndrome Severity
Authors: Roomizadeh Peyman , Eftekharsadat Bina , Abedini Amin , Ranjbar-kiyakalayeh Sepideh , Yousefi Naseh , Ebadi Safoora , Babaei-Ghazani Arash
Published: December 2018

Objective

The aim of the study was to investigate the overall estimates of cross-sectional areas of the median nerve measured by ultrasonography in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity.

Design

MEDLINE (PubMed), Embase (Ovid), and Web of Science were searched for studies reporting the median nerve cross-sectional area measured by ultrasonography for mild, moderate, and severe carpal tunnel syndrome based on electrodiagnostic study. Cross-sectional area values measured at the carpal tunnel inlet were included in the analyses.

Results

Overall, 866 citations were retrieved and checked for eligibility. Finally, 16 articles were included for meta-analysis. These studies included a total sample of 2292 wrists including 776 mild, 823 moderate, and 693 severe carpal tunnel syndrome. The pooled analysis revealed a mean cross-sectional area of 11.64 mm2 (95% confidence interval = 11.23–12.05 mm2, P < 0.001) for mild carpal tunnel syndrome, a mean cross-sectional area of 13.74 mm2 (95% confidence interval = 12.59–14.89 mm2, P < 0.001) for moderate carpal tunnel syndrome, and a mean cross-sectional area of 16.80 mm2 (95% confidence interval = 14.50–19.1 mm2, P < 0.001) for severe carpal tunnel syndrome.

Conclusions

This is the first meta-analysis that provides the pooled median nerve cross-sectional area values in accordance with the electrodiagnostic classification of carpal tunnel syndrome severity. The values obtained in this study have clinical utility in ultrasonographic assessment of patients with carpal tunnel syndrome.
Strength Reduction in Unilateral Shoulder Pain
Authors: Sansone Valerio , Maiorano Emanuele , Applefield Rachel C. , Gandola Martina , Negrini Francesco
Published: December 2018

Objective

The primary aim was to ascertain whether unilateral shoulder pain is implicated in strength reduction both on the ipsilateral and contralateral side. Secondarily, we aimed to determine whether strength was affected by sonographic tendon abnormalities.

Design

A total of 122 subjects were evaluated. Sixty-six female subjects with unilateral shoulder pain in the dominant arm were recruited. Abduction strength was measured in both the dominant and nondominant arm. High-resolution ultrasonography was also conducted on both shoulders. A match-paired control group (n = 66) composed of healthy volunteers underwent the same strength and sonography tests. Subjects with any radiographic anomaly were excluded from the control group. A mixed analysis of variance was performed to test the effect of unilateral shoulder pain on abduction strength. The effect of tendinopathy on shoulder strength was investigated using a mixed 2 × 2 analysis of variance.

Results

Analysis of variance showed that patients with dominant shoulder pain had lower shoulder strength (11.65 ± 4.05 kg) when compared with controls (14.37 ± 4.00 kg; F = 10.454, P = 0.002). No statistically significant effects were found when comparing subjects with and without tendinopathy among the study group.

Conclusions

In patients with unilateral shoulder pain, abduction strength was found to be lower both on the ipsilateral and contralateral side. The presence of tendinopathy did not affect the reduction in strength. Future research is needed to substantiate these findings.
Altered Brain Structure and Functional Connectivity and Its Relation to Pain Perception in Girls With Irritable Bowel Syndrome
Authors: Bhatt Ravi R. , Gupta Arpana , Labus Jennifer S. , Zeltzer Lonnie K. , Tsao Jennie C. , Shulman Robert J. , Tillisch Kirsten
Published: December 2018

Objective

Imaging studies in adults with irritable bowel syndrome (IBS) have shown both morphological and resting state (RS) functional connectivity (FC) alterations related to cortical modulation of sensory processing. Because analogous differences have not been adequately investigated in children, this study compared gray matter volume (GMV) and RS-FC between girls with IBS and healthy controls (HC) and tested the correlation between brain metrics and laboratory-based pain thresholds (Pth).

Methods

Girls with Rome III criteria IBS (n = 32) and matched HCs (n = 26) were recruited. In a subset of patients, Pth were determined using a thermode to the forearm. Structural and RS scans were acquired. A voxel-based general linear model, adjusting for age, was applied to compare differences between groups. Seeds were selected from regions with group GMV differences for a seed-to-voxel whole brain RS-FC analysis. Significance for analyses was considered at p < .05 after controlling for false discovery rate. Significant group differences were correlated with Pth.

Results

Girls with IBS had lower GMV in the thalamus, caudate nucleus, nucleus accumbens, anterior midcingulate (aMCC), and dorsolateral prefrontal cortex. They also exhibited lower RS-FC between the aMCC and the precuneus, but greater connectivity between the caudate nucleus and precentral gyrus. Girls with IBS had higher Pth with a moderate effect size (t
(22.81) = 1.63, p = .12, d = 0.64) and lower thalamic GMV bilaterally was correlated with higher Pth (left: r = −.62, p
(FDR) = .008; right: r = −.51, p
(FDR) = .08).

Conclusions

Girls with IBS had lower GMV in the PFC, basal ganglia, and aMCC, as well as altered FC between multiple brain networks, suggesting that structural changes related to IBS occur early in brain development. Girls with IBS also showed altered relationships between pain sensitivity and brain structure.
Coping, Mood, Quality of Life, and Outcomes in Recipients of Left Ventricular Assist Devices: A Cluster Analysis
Authors: Modica Maddalena , Minotti Anna , De Maria Renata , Scaglione Anna , Bordoni Bruno , Cipriani Manlio , Russo Claudio , Racca Vittorio , Ferratini Maurizio
Published: December 2018

Objective

Left ventricular assist devices (LVADs) are increasingly used for temporary circulatory support until transplant or as destination therapy for patients with end-stage heart failure. Understanding patients' attitudes and resources is crucial to support them.

Methods

Sixty-one LVAD recipients (55 [10] years, 10% women, 15% destination therapy) participating in cardiac rehabilitation (CR) postimplant underwent assessment of coping styles (Coping Orientation for Problem Experiences), quality of life (Medical Outcomes Study Short-Form 36, Minnesota Living with Heart Failure Questionnaire), and mood (Hospital Anxiety and Depression Scale).

Results

Cluster analysis identified two homogeneous groups: C1 (n = 18) patients had higher anxiety (9.6 [5.0] versus 4.0 [2.7], p < .001), depression (10 [3.0] versus 4 [2.7], p < .001), and avoidant coping (29 [5.2] versus 21.2 [3.8], p < .001) scores and worse quality of life (Short-Form 36 of the Medical Outcomes Study Physical Component Scale 31 [5.3] versus 35.6 [6.9], p < .001; Mental Component Scale 34.3 [6.8] versus 50.3 [8], p < .001; MLHFQ physical 26 [7.2] versus 13.9 [8.2], p < .001; emotional 17.7 [3.4] versus 3.86 [3.2], p < .001) than C2 participants (n = 43). During 31 (15–54) months, 20 patients (33%) died. By Cox multivariable analysis, after adjustment for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at surgery, and meters walked during 6 minutes at CR discharge, C1 was associated with mortality (hazard ratio = 2.858; 95% confidence interval = 1.102–7.408, p = .031; model χ2 = 7.286, df = 5, p = .20). Survival was 44% in C1 and 77% in C2 (log-rank p = .033).

Conclusions

Among patients discharged from CR after LVAD implant, one third show a profile characterized by worse perceived quality of life, mood disorders, and dysfunctional coping that is associated with long-term mortality, and these factors are potential targets for post-LVAD intensive support.
Incidental Finding of Intrathyroid Metastases of Prostatic Cancer on 18F-Choline PET/CT
Authors: Vija Racaru Lavinia , Gabiache Erwan , Fontaine Sebastien , D'Aure Dominique , Mourey Loic , Courbon Frederic , Zerdoud Slimane
Published: December 2018

An 85-year-old man with a 2-year history of prostate cancer, treated with radiotherapy and hormonal therapy, presented increased prostatic-specific antigen levels. 18F-choline PET/CT showed focal prostatic uptake consistent with known local recurrence, increased uptake of 2 hypodense thyroid nodules and of 2 left cervical lymph nodes, suspected as thyroid cancer. Neck ultrasound confirmed the high risk of malignancy, and a guided biopsy (of a thyroid nodule and cervical lymph node) revealed cellular infiltrates thyroid transcription factor-1 (TTF-1) negative and prostatic-specific antigen positive, confirming intrathyroid and cervical lymph node metastases of prostate cancer. PET/CT changed the disease staging. Chemotherapy was initiated.
Primary Diffuse Leptomeningeal Melanomatosis of Spine
Authors: Ayan Asli , Akbulut Aylin , Deveci Guzin , Koca Gokhan
Published: December 2018

Primary diffuse leptomeningeal melanomatosis is a rare variant of malignant melanoma of the central nervous system, arising from melanocytes of leptomeninges. It may involve leptomeninges and may invade brain superficially. The diagnosis of the disease with conventional imaging techniques is quite difficult. This case demonstrates the 18F-FDG uptake of primary diffuse leptomeningeal melanomatosis matching with MRI contrast enhancement regions particularly in the lower thoracic and superior lumbar region.
Juvenile Nasal Angiofibroma on 68Ga-PSMA PET/CT
Authors: Sakthivel Pirabu , Prashanth Arun , Thakar Alok , Kumar Rajeev , Kumar Rakesh
Published: December 2018

The prostate-specific membrane antigen (PSMA) is highly expressed in prostatic cancer. However, PSMA expression is also noted in various benign and malignant nonprostatic neoplasms in the endothelial cells of tumor-associated neovasculature. We performed 68Ga-PSMA PET/CT in a 14-year-old boy with juvenile nasal angiofibroma (JNA) to explore its theranostic potential. The scan revealed high uptake in the lesion. Performance of PSMA PET/CT in JNA opens up new frontiers with respect to radiological staging, early recurrence identification, and perhaps even radioligand therapy of residual/recurrent JNAs in the future.
Subacute Venous Infarct Mimicking Cerebral Metastasis in 18F-FDG PET/CT
Authors: Gündoğan Cihan , Yardimci Aytül Hande , Güneş Burçak Yilmaz , Çermik Tevfik Fikret
Published: December 2018

A 68-year-old woman with colon carcinoma was referred to 18F-FDG PET/CT imaging for staging. In addition to primary tumor involvement, PET/CT demonstrated focal FDG uptake in the right temporal lobe suggestive of primary brain tumor or metastasis. To delineate the lesion, a brain MRI scan showed sigmoid sinus thrombosis and vasogenic edema in the right temporal lobe. The patient presented a history of right-sided headache that began 1 week before the PET/CT. Neurological examination and MRI findings were concluded as subacute venous infarct due to sigmoid sinus thrombosis and that is a potential cause for false-positive FDG uptake on PET/CT.
Pretreatment Tumor 18F-FDG Uptake Improves Risk Stratification Beyond RECIST 1.1 in Patients With Advanced Nonsquamous Non–Small-Cell Lung Cancer
Authors: Moon Seung Hwan , Sun Jong-Mu , Ahn Jin Seok , Park Keunchil , Ahn Myung-Ju , Choi Joon Young
Published: December 2018

Purpose

This study investigated the prognostic role of tumor 18F-FDG uptake on pretreatment scans as an independent indicator and whether its addition improves risk prediction from Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1).

Methods

We measured the SUVmax of the most 18F-FDG–avid tumor lesions on pretreatment scans from 222 patients (age, 60.5 ± 9.5 years; males, 55.2%) with advanced nonsquamous non–small-cell lung cancer who were enrolled in a prospective phase II clinical trial. We then examined the prognostic value of SUVmax compared with other clinical factors, including chemotherapy response according to RECIST 1.1 criteria.

Results

A multivariable Cox proportional hazards model revealed that an SUVmax greater than 16.3 was an independent predictor of poor progression-free survival (hazards ratio, 3.50; 95% confidence interval, 1.89–6.51; P < 0.000) and overall survival (hazards ratio, 6.87; 95% confidence interval, 2.51–18.76; P < 0.000), whereas RECIST 1.1 did not show a significant association with any survival outcome. Furthermore, improvement was achieved by adding SUVmax to RECIST 1.1, which increased the net reclassification index (27.4%; P = 0.046) and integrated discrimination improvement (integrated discrimination improvement, 10.6%; P = 0.026). Similarly, adding RECIST 1.1 to SUVmax also improved net reclassification index (68.9%, P = 0.006) and integrated discrimination improvement (25.4%, P = 0.006) for prognosis prediction.

Conclusions

High tumor 18F-FDG uptake on a pretreatment scan is an independent prognostic indicator that can significantly improve risk stratification when added to RECIST 1.1 for patients with advanced nonsquamous non–small-cell lung cancer.
Unusual Focal Muscle FDG Activity Related to Altered Biomechanics
Authors: Gillis Eleanor , Wen Zhe , Zhuang Hongming
Published: December 2018

A 20 year old man suffered severe right knee pain, especially when his right foot touched ground. The MRI findings suggested periosteal osteosarcoma, which led to a staging FDG PET/CT. The images showed not only a hypermetabolic right knee lesion but also focally elevated activity in select muscles, which was attributed to altered biomechanics. The resected lesion was pathologically proven as periosteal chondrosarcoma instead of periosteal osteosarcoma. In a follow-up period of 4 years after the surgery, there was no recurrent disease, nor any abnormality in the muscles which showed focal FDG activity on the initial FDG PET/CT.
Small Primary Cutaneous γδT-Cell Lymphoma Lesions Successfully Treated With Pralatrexate
Authors: Imataki Osamu , Uchida Shumpei , Yokokura Shigeyuki , Uemura Makiko , Kadowaki Norimitsu
Published: December 2018

Here we report on the treatment of a 38-year-old woman with primary cutaneous γδT-cell lymphoma, which is a rare subset of cutaneous T-cell lymphoma. She presented with multiple subtle subcutaneous nodules, which were not clearly observed on computed tomography scans or after biopsy. However, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) accurately detected small cutaneous lesions. She achieved a second complete remission, as demonstrated by 18F-FDG-PET performed after pralatrexate infusion.
PET/CT and MR Features of Infiltrating Spinal Angiolipoma
Authors: Shen Guohua , Su Minggang , Kuang Anren
Published: December 2018

Spinal angiolipomas are benign tumors predominantly found in the epidural space. Infiltrating spinal angiolipoma is an extremely rare type, which tends to invade the surrounding tissue and may mimic an aggressive tumor. Herein, we reported the case of a 64-year-old woman with a thoracic angiolipoma involving the T9 vertebral body and its appendix. The lesion showed long T1 and T2 signal intensity on MRI and slightly increased FDG uptake on PET/CT. After surgery, the pathologic examination demonstrated features consistent with angiolipoma, and the patient was free of symptoms.
A Pictorial Review of Sonography of Intramammary Lymph Nodes
Authors: Hudspeth Tessa N. , Shin Kyungmin , Babiera Gildy V. , Krishnamurthy Savitri , Woodtichartpreecha Piyanoot , Karbasian Niloofar , Whitman Gary J.
Published: December 2018

This pictorial essay reviews and illustrates benign and malignant features of intramammary lymph nodes on mammography, ultrasound, and magnetic resonance imaging, including a review of the clinical and the prognostic significance in patients with known breast cancer. This pictorial essay discusses management suggestions for intramammary lymph nodes in patients with breast cancer.
A Systematic Review and Meta-analysis of Functional Shoulder Impairment After Latissimus Dorsi Breast Reconstruction
Authors: Steffenssen Mia C. W. , Kristiansen Ann-Louise H. , Damsgaard Tine E.
Published: December 2018

Purpose

The latissimus dorsi flap (LDF) is a very reliable flap and may be used for a multitude of reconstructive purposes. It is widely used for breast reconstruction when performed. It has few complications, except for a possible impact on shoulder function. The aims of this study were to evaluate the validity of the literature by investigating the level of evidence and to perform a meta-analysis.

Methods

A systematic literature search was conducted using the databases PubMed, Scopus, and Web of Science. Predictor variables were shoulder function after breast reconstruction with the LDF. Articles were chosen according to 4 different outcomes: shoulder range of motion (ROM), shoulder strength, DASH score, and subjective evaluation.

Results

Twenty-six articles were found, including 1045 patients: 8 level II, 16 level III, 1 level IV, and 1 level V articles. The meta-analysis showed that both ROMs for flexion and abduction are significantly impaired at less than or at 3 months of follow-up.

Conclusions

There are several influencing factors, such as age, smoking, obesity, radiotherapy, and physiotherapy. Moreover, the impact on shoulder function seemed influenced by the type of thoracodorsal vessel–based flap. From the level of evidence analysis, there is a tendency that the LDF transfer does affect shoulder function. This limitation seems to be minimal, and few patients experience a major impact on shoulder function. However, the existing literature on total shoulder impairment after breast reconstruction with LDF is insufficient to draw any final conclusion. There is a need for future studies and current articles that suggest that the initial measurement should be performed preoperatively (preferably at the time of diagnosis or initial biopsy) and follow-ups with measurements at 6, 12, and 24 months (long-term effect) after surgery. We recommend measurements of both operated and nonoperated sides. Each measurement should be accompanied by a history with special emphasis on shoulder function. The methods of measuring outcomes of recommendation are DASH score, ROM with use of a goniometer preferably by a physiotherapist or a health care professional trained by a physiotherapist, and strength measured by, for example, a handheld dynamometer.
Functional and Aesthetic Outcome of Extensive Orbital Floor and Medial Wall Fracture via Navigation and Endoscope-assisted Reconstruction
Authors: Yang Jia-Ruei , Liao Han-Tsung
Published: December 2018

Background and Purpose

Extensive orbital floor and medial wall fractures compared with isolated orbital wall fractures are more likely to require surgical correction because of a higher possibility of complications like diplopia, enophthalmos, or numbness. The unique and complex contours of the orbital anatomy limit the intraoperative view of the intraorbital anatomy, and complex orbital fractures involving the buttress of the transition zone area all make orbital reconstruction surgery more challenging. The aim of this study was to describe our experience with surgical approaches using navigation- and endoscope-assisted guidance for extensive orbital floor and medial wall fracture reconstruction.

Patients and Methods

A retrospective study was conducted on consecutive 17 patients from 2015 to 2017 presenting with unilateral extensive orbital floor and medial wall fractures at the Chang Gung Memorial Hospital, Linkou Branch. The fractures were treated surgically with a preformed mesh plate and layered Medpor (Porex Surgical Inc, Atlanta, Ga) through navigation and endoscopy. The preoperative and postoperative functional and aesthetic outcomes were described.

Results

All extensive orbital floor and medial wall fractures were successfully reconstructed. Of the 17 patients, 11 experienced diplopia preoperatively, and for 2 of the 11 patients, diplopia improved immediately after surgery. In the remaining 9 patients, diplopia still persisted after surgery; however, diplopia recovered after an average of 3.44 months (range, 1–9 months). Average enophthalmos among the 10 patients, evaluated by postoperative follow-up computed tomography scan, improved from 2.99 to 0.68 mm. There were no major complications during follow-up, and all patients were satisfied with their final appearance and function.

Conclusions

On the basis of the results, our surgical approach using preformed titanium mesh plates and Medpor under the assistance of navigation and endoscopy can be a safe, accurate, and effective method for the management of extensive orbital floor and medial wall fractures and clearly optimizes functional and aesthetic outcomes.
The Potential of Acellular Dermal Matrix Combined With Neural Stem Cells Induced From Human Adipose-Derived Stem Cells in Nerve Tissue Engineering
Authors: Syu Wei-Ze , Chen Shyi-Gen , Chan James Yi-Hsin , Wang Chih-Hsin , Dai Niann-Tzyy , Huang Shih-Ming
Published: December 2018

Introduction

Reconstruction of segmental peripheral nerve gap is still challenging when the autografts are unavailable owing to limited availability of donor site and functional recovery. The creation of artificial conduits composed of biological or synthetic materials is still developing. Acellular dermal matrix (ADM) has been widely studied and its extension and plasticity properties may become suitable nerve conduits under different forms of nerve gaps. Adipose-derived stem cells (ADSCs) have the potential to differentiate into various cell types of different germ layers including neural stem cells (NSCs). The purpose of this experiment is to use ADM as a scaffold combined with NSCs induced by ADSCs to establish neural tissue engineering.

Methods

The ADSCs were isolated from syringe-liposuction adipose tissue harvested from abdominal fat and then cultured in keratinocyte serum free media to trigger into neural stem cells. Stem cells were confirmed by the expression of surface markers nestin and SOX2 in NSCs with Western blot and immunofluorescent staining. Matrix enzyme treatment was used to obtain ADM to remove immunogenic cells while maintaining the integrity of the basement membrane complex and the extracellular matrix structure of the dermis. The NSCs were cocultured with ADM for 3 days, and survival markers Ki67 and neural stem cell markers nestin were detected.

Results

These NSCs can form neurospheres and express nestin and SOX2. The NSC can further coculture with ADM, and it will continue to express survivor markers and neural stem cell markers on ADM.

Conclusions

These findings provide evidence that the combination of ADM and NSC has the same potential as neural tissue engineering as other acellular sciatic nerve.
Accuracy of Right Upper Quadrant Ultrasound in Estimating Gallbladder Wall Thickness
Authors: Cefalu Lindsay , McMurray Robert , Sizemore Grant , Bieniek Gerald , Lustik Michael , Yheulon Christopher
Published: December 2018

Objective:

Ultrasound (US) evaluation of biliary pathology can be influenced by a variety of factors. This study examines the effect of patient specific factors on the accuracy of sonographic evaluation of gallbladder wall thickness (GBW).

Methods:

We performed a retrospective review of all patients who underwent cholecystectomy at a single institution from November 2012 to October 2015. GBW measured on US was compared with pathology results. Results were analyzed in relation to patient specific factors to include BMI, age, presence of diabetes, sex, and urgent versus elective cases.

Results:

In total 601 patients underwent cholecystectomy, 484 of which had paired preoperative US GBW measurement and postoperative pathologic specimen measurement. No significant difference in accuracy or precision of US measurement of the GBW based on BMI was found. Accuracy was not related to age, sex, urgency, or diabetes. Precision decreased with pathologic thickening, age, male sex, and urgent case performance.

Conclusions:

US is accurate in measuring GB wall thickness regardless of patient specific factors. A nonsignificant trend exists with decreased precision with pathologic thickening, age, male sex, and urgently performed cases.
Laparoscopic Multiple Parenchyma-sparing Concomitant Liver Resections for Colorectal Liver Metastases
Authors: Kazaryan Airazat M. , Aghayan David L. , Barkhatov Leonid I. , Fretland Åsmund A. , Edwin Bjørn
Published: December 2018

Background:

Parenchyma-sparing concept in liver surgery has received a new incitement with the introduction of laparoscopic techniques. Multiple concomitant liver resections are a major component in the parenchyma-sparing concept.

Materials and Methods:

In total, 689 patients underwent laparoscopic liver resection for colorectal liver metastases from August 1998 to 2017, and 171 patients were eligible for this study. Patients were divided into 3 groups: group I with single liver resection (36 patients); group II with multiple concomitant liver resections (104 patients); group III with liver resection(s) combined with concomitant liver ablation (31 patients). Perioperative outcomes and survival were compared between the groups I and II, whereas variables of group III were presented as complementary information, avoiding statistically exigent multiple comparisons.

Results:

There were 6 conversions, 0, 3 (2.9%), and 2 (6.5%), respectively in the groups I, II, and III. Median operative time was 161, 186, and 224 minute in the groups I, II, and III, respectively. Median blood loss was 300 mL in groups I and II, and 200 mL in group III. It was a tendency to higher rate of postoperative complications in the group of single resections with morbidity rate of 31%, 19%, and 23% in group I, II, and III, respectively. Median postoperative stay was 3 days in all groups. Tumor-free margin resection was achieved in 92%, 86%, and 93%, respectively in the groups I, II, III. The median weight of resected specimen was significantly lower in group II (90 vs. 257 g; P<0.001). There were no significant differences in survival between the groups. The 5-year overall survival was 31%, 42%, and 43% for groups I, II, and III, respectively.

Conclusions:

Laparoscopic multiple concomitant parenchyma-sparing liver resections provide surgical and oncologic outcomes comparable with single greater resections for multiple lesions. This approach could be recommended for a wide application in specialized hepatopancreatobiliary centers.
Low Bladder Compliance in Women: A Clinical Overview
Authors: Arunachalam Divya , Heit Michael
Published: December 2018

Bladder compliance refers to the ability of the bladder to accommodate large volumes of urine. Patients with low bladder compliance may present with persistent urinary incontinence and/or evidence of upper tract damage. Clinicians often may not consider low bladder compliance in their differential for patients complaining of bothersome lower urinary tract symptoms. In this article, we aim to provide further guidance in the management of women with low bladder compliance given the lack of information on this topic in the medical literature.
Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review
Authors: Talan David A. , Saltzman Darin J. , DeUgarte Daniel A. , Moran Gregory J.
Published: December 2018

BACKGROUND

Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist.

METHODS

PUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

RESULTS

Thirty-four studies involving 2,944 antibiotic-treated participants were identified. The greatest experience with conservative treatment is in persons 5 to 50 years of age. In most trials, imaging was used to confirm localized appendicitis without evidence of abscess, phlegmon, or tumor. Antibiotics regimens were generally consistent with intra-abdominal infection treatment guidelines and used for a total of 7 to 10 days. Approaches ranged from 3-day hospitalization on parenteral agents to same-day hospital or ED discharge of stable patients with outpatient oral antibiotics. Minimum time allowed before response was evaluated varied from 8 to 72 hours. Although pain was a common criterion for nonresponse and appendectomy, analgesic regimens were poorly described. Trials differed in use of other response indicators, that is, white blood cell count, C-reactive protein, and reimaging. Diet ranged from restriction for 48 hours to as tolerated. Initial response rates were generally greater than 90% and most participants improved by 24 to 48 hours, with no related severe sepsis or deaths. In most studies, appendectomy was recommended for recurrence; however, in several, patients had antibiotic retreatment with success.

CONCLUSION

While further investigation of conservative treatment is ongoing, patients considering this approach should be advised and managed according to study methods and related guidelines to promote informed shared decision-making and optimize their chance of similar outcomes as described in published trials. Future studies that address biases associated with enrollment and response evaluation, employ best-practice pain control and antibiotic selection, better define cancer risk, and explore longer time thresholds for response, minimized diet restriction and hospital stays, and antibiotic re-treatment will further our understanding of the potential effectiveness of conservative management.

LEVEL OF EVIDENCE

Systematic review, level II.
Kidney Discard Rates in the United States During American Transplant Congress Meetings
Authors: Abdelwahab Elhamahmi Dina , Chaly Thomas , Wei Guo , Hall Isaac E.
Published: December 2018

Background

Deceased-donor kidney discard rates vary by region, but it is unknown whether discard rates and transplant outcomes vary during the American Transplant Congress (ATC) each year.

Methods

Using national registry data, we determined rates of kidney discard, delayed graft function, graft failure, and mortality from December 31, 1999, through December 30, 2015, during ATC dates and compared these rates with those on the same days of the week during the 2 weeks before and after the ATC (non-ATC). We used multivariable regression to determine associations between ATC and these outcomes.

Results

From 7902 donors (1575 ATC; 6327 non-ATC), 12 588 recipients received kidney transplants (2455 ATC; 10 133 non-ATC), and 2666 kidneys were discarded (582 ATC; 2084 non-ATC). Kidneys were more often discarded during ATC (19% vs 17%, P = 0.006; adjusted odds ratio, 1.21; 95% confidence interval, 1.05-1.40). There were no significant differences in donor, transplant, or recipient characteristics by ATC/non-ATC dates or by ATC/non-ATC transplant dates for delayed graft function, graft failure, or mortality.

Conclusions

On the basis of a 21% increased odds of discard, the ATC itself may result in 5 additional kidney discards during this important conference every year, which suggests the need for innovative staffing or other logistic solutions during these planned meetings.
Diagnostic error and neuro-ophthalmology
Authors: Stunkel Leanne , Newman Nancy J. , Biousse Valérie
Published: December 2018

Purpose of review

This review summarizes the recent literature on diagnostic error relevant to the practice of neuro-ophthalmology, and evaluates the potential for increased access to neuro-ophthalmology to decrease rates of diagnostic error, thereby reducing medical harm and spending on unnecessary tests and treatments.

Recent findings

Despite medical advances, current research continues to show alarmingly high rates of diagnostic error. Research into diagnostic error shows that many of these errors can be traced to cognitive errors. Recent studies on diagnostic problems relevant to neuro-ophthalmology, including studies of misdiagnosis of posterior communicating artery aneurysms, idiopathic intracranial hypertension, optic neuritis, and optic nerve sheath meningiomas, have identified major causes of diagnostic error in these conditions.

Studies on diagnostic error in neuro-ophthalmologic conditions show that prior to evaluation by a neuro-ophthalmologist, patients may undergo unnecessary tests and treatments that are costly and potentially harmful. Further research on diagnostic error will inform better utilization of neuro-ophthalmologists as a resource to decrease diagnostic error.
Management of patients with unruptured intracranial aneurysms
Authors: Rinkel Gabriel J.E.
Published: December 2018

Purpose of review

Intracranial aneurysms are frequent incidental findings on cranial imaging. The decision for preventive treatment depends on the presumed risk of rupture, the efficacy and risk of complications of preventive treatment, and the quality of life having to live with an unruptured aneurysms. Data on all these factors are still incomplete, and additional data are needed.

Recent findings

The current review describes advances of the last 2 years in assessment of risk of rupture, on risks of preventive aneurysms occlusion, on follow-up imaging and on medical management of patients with unruptured intracranial aneurysms.

In addition to risk factors used to predict absolute risks of rupture, also aneurysm irregularity and aneurysm growth during follow-up are potential risk factors for rupture. To what extent these factors improve risk prediction in absolute terms is yet uncertain. Uncertainty also continues on whether endovascular or surgical occlusion is the preferred method, but a trial comparing these two strategies is ongoing. Aneurysm growth can now be predicted in absolute risks. Enhancement of the aneurysm wall on MRI probably is also related to aneurysm instability and reflects inflammation. A trial assessing the effects of anti-inflammatory treatment and blood pressure lowering on aneurysm growth and rupture is currently ongoing.
Galactosylated chitosan-functionalized mesoporous silica nanoparticles for efficient colon cancer cell-targeted drug delivery
Authors: Liu Wei , Zhu Yongchao , Wang Fan , Li Xue , Liu Xiaojing , Pang Jingjing , Pan Weisan
Published: December 2018

Targeted drug delivery to colon cancer cells can significantly enhance the therapeutic efficiency. Herein, we developed 5-fluorouracil (5-FU)-loaded amino-functionalized mesoporous silica nanoparticle (MSN-NH
2
)-based galactosylated chitosans (GCs), which are galactose receptor-mediated materials for colon-specific drug delivery systems. Both unmodified and functionalized nanoparticles were characterized by scanning electron microscopy, transmission electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, nitrogen sorption and dynamic light scattering. Drug loading capacity and drug release properties were determined by ultraviolet spectrophotometry. 5-FU@MSN-NH
2
/GC showed high loading capacity and possessed much higher cytotoxicity on human colon cancer cells (SW620 cells) than 5-FU@MSN-NH
2
and free 5-FU. But, MSN-NH
2
/GC did not show significant cytotoxicity. Subsequently, 5-FU@MSN-NH
2
/GC anti-cancer activity on SW620 cells
in vitro
was confirmed by cell apoptosis. These results are consistent with the cellular uptake test in which MSN-NH
2
/GC could specifically recognize and bind to cancer cells by the galectin-receptor recognition. But, it is found that pre-addition of galactose in the medium, leading to competitive binding to the galectin receptor of SW620 cells, resulted in a decrease in the binding of MSN-NH
2
/GC to the galectin receptor. The results demonstrated the inorganic–organic nanocomposite could be used as a promising drug delivery carrier for the targeted delivery of drug into galectin-positive colon cancer cells to improve therapeutic index while reducing side effects.
Locally stationary spatio-temporal interpolation of Argo profiling float data
Authors: Kuusela Mikael , Stein Michael L.
Published: December 2018

Argo floats measure seawater temperature and salinity in the upper 2000 m of the global ocean. Statistical analysis of the resulting spatio-temporal dataset is challenging owing to its non-stationary structure and large size. We propose mapping these data using locally stationary Gaussian process regression where covariance parameter estimation and spatio-temporal prediction are carried out in a moving-window fashion. This yields computationally tractable non-stationary anomaly fields without the need to explicitly model the non-stationary covariance structure. We also investigate Studentt-distributed fine-scale variation as a means to account for non-Gaussian heavy tails in ocean temperature data. Cross-validation studies comparing the proposed approach with the existing state of the art demonstrate clear improvements in point predictions and show that accounting for the non-stationarity and non-Gaussianity is crucial for obtaining well-calibrated uncertainties. This approach also provides data-driven local estimates of the spatial and temporal dependence scales for the global ocean, which are of scientific interest in their own right.
Generalized stability for discontinuous complex-valued Hopfield neural networks via differential inclusions
Authors: Wang Zengyun , Cao Jinde , Guo Zhenyuan , Huang Lihong
Published: December 2018

Some dynamical behaviours of discontinuous complex-valued Hopfield neural networks are discussed in this paper. First, we introduce a method to construct the complex-valued set-valued mapping and define some basic definitions for discontinuous complex-valued differential equations. In addition, Leray–Schauder alternative theorem is used to analyse the equilibrium existence of the networks. Lastly, we present the dynamical behaviours, including global stability and convergence in measure for discontinuous complex-valued neural networks (CVNNs) via differential inclusions. The main contribution of this paper is that we extend previous studies on continuous CVNNs to discontinuous ones. Several simulations are given to substantiate the correction of the proposed results.
Mining and biodiversity: key issues and research needs in conservation science
Authors: Sonter Laura J. , Ali Saleem H. , Watson James E. M.
Published: December 2018

Mining poses serious and highly specific threats to biodiversity. However, mining can also be a means for financing alternative livelihood paths that, over the long-term, may prevent biodiversity loss. Complex and controversial issues associated with mining and biodiversity conservation are often simplified within a narrow frame oriented towards the negative impacts of mining at the site of extraction, rather than posed as a series of challenges for the conservation science community to embrace. Here, we synthesize core issues that, if better understood, may ensure coexistence between mining and conservation agendas. We illustrate how mining impacts biodiversity through diverse pathways and across spatial scales. We argue that traditional, site-based conservation approaches will have limited effect in preventing biodiversity loss against an increasing mining footprint, but opportunities to improve outcomes (e.g. through long-term strategic assessment and planning) do exist. While future mineral supply is uncertain, projections suggest demand will grow for many metals and shift mining operations towards more dispersed and biodiverse areas. Initiating dialogue between mining companies, policy-makers and conservation organizations is urgent, given the suite of international agendas simultaneously requiring more minerals but less biodiversity loss.
Molecular palaeontology illuminates the evolution of ecdysozoan vision
Authors: Fleming James F. , Kristensen Reinhardt Møbjerg , Sørensen Martin Vinther , Park Tae-Yoon S. , Arakawa Kazuharu , Blaxter Mark , Rebecchi Lorena , Guidetti Roberto , Williams Tom A. , Roberts Nicholas W. , Vinther Jakob , Pisani Davide
Published: December 2018

Colour vision is known to have arisen only twice—once in Vertebrata and once within the Ecdysozoa, in Arthropoda. However, the evolutionary history of ecdysozoan vision is unclear. At the molecular level, visual pigments, composed of a chromophore and a protein belonging to the opsin family, have different spectral sensitivities and these mediate colour vision. At the morphological level, ecdysozoan vision is conveyed by eyes of variable levels of complexity; from the simple ocelli observed in the velvet worms (phylum Onychophora) to the marvellously complex eyes of insects, spiders, and crustaceans. Here, we explore the evolution of ecdysozoan vision at both the molecular and morphological level; combining analysis of a large-scale opsin dataset that includes previously unknown ecdysozoan opsins with morphological analyses of key Cambrian fossils with preserved eye structures. We found that while several non-arthropod ecdysozoan lineages have multiple opsins, arthropod multi-opsin vision evolved through a series of gene duplications that were fixed in a period of 35–71 million years (Ma) along the stem arthropod lineage. Our integrative study of the fossil and molecular record of vision indicates that fossils with more complex eyes were likely to have possessed a larger complement of opsin genes.