bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Adenosquamous Carcinoma as a Rare Aggressive HER2-negative Subgroup of Esophageal/Gastroesophageal Junction Adenocarcinoma
Authors: Jin Zhaohui , Holubek Marie , Sukov William R. , Sattler Christopher A. , Wiktor Anne E. , Jenkins Robert B. , Wu Tsung-Teh , Yoon Harry H.
Published: December 2018

Background:

Our purpose was to evaluate the prognostic impact of pathologically confirmed esophageal adenosquamous carcinoma (ASC) and its association with HER2 status and clinicopathologic characteristics.

Methods:

Among 796 patients with esophageal or gastroesophageal junction adenocarcinoma who underwent curative resection, surgical pathology reports were reviewed, and suspected ASC was confirmed utilizing p63 and CK5/6 immunostaining. HER2 status was determined using immunohistochemistry and fluorescence in situ hybridization. Cox models were used to assess the impact of ASC on disease-specific survival and overall survival.

Results:

Overall, 2.0% (16/796) of patients had esophageal ASC, mostly demonstrating a close intermingling of squamous and adenocarcinoma cells within the same tumor. The percentage of squamous versus adenocarcinoma cells in the primary was generally recapitulated in nodal metastases, and intrapatient internodal heterogeneity was uncommon. Patients with esophageal ASC were statistically significantly more likely to be female (vs. male), have normal (vs. excess) body mass index, and harbor HER2-negative (vs. positive) tumors, as compared with patients with adenocarcinoma only. No ASC tumor was HER2-positive as compared with 16% of adenocarcinoma only tumors (P=0.018). Compared with patients with adenocarcinoma only, those with ASC demonstrated profoundly worse disease-specific survival (5-year event-free rate, 34% vs. 6%; multivariate hazard ratio, 2.87 [95% confidence interval, 1.59-4.76]; P=0.0010) and overall survival (P=0.0027) that was independent of known prognostic factors and HER2 status.

Conclusion:

ASC identifies a rare aggressive HER2-negative subgroup of esophageal/gastroesophageal junction adenocarcinoma.
Left Atrial Appendage Occlusion in the Management of Stroke in Patients With Atrial Fibrillation
Authors: Ojo Amole , Yandrapalli Srikanth , Veseli Granit , Karim Mohammad , Aronow Wilbert S. , Sharma Mala , Frishman William H. , Naidu Srihari S. , Jacobson Jason T. , Iwai Sei
Published: December 2018

Atrial fibrillation (AF) is associated with a substantially higher risk of thromboembolism, particularly stroke events, resulting in significant morbidity and mortality. Oral anticoagulation (OAC), while effective in reducing embolic events in AF patients, is associated with an increased bleeding risk. Thus, not all patients with AF are candidates for OAC and some are only candidates for OAC in the short term. Of the available nonpharmacologic strategies for the management of AF, left atrial appendage occlusion (LAAO) has emerged as a potential approach for reducing the risk of systemic thromboembolism in AF patients eligible for OAC. LAAO can be achieved either surgically or percutaneously using an epicardial, endocardial, or a combined approach. Although available data are limited, currently available LAAO devices, and those being developed, have shown promise in reducing bleeding risk in AF patients because of the reduced overall need for anticoagulation, while maintaining efficacy in preventing thromboembolism. The optimal device will reduce both embolic and hemorrhagic strokes, and other bleeds, with a high implant success rate and a low complication rate. Until that time, anticoagulation remains the gold standard that these devices strive to surpass, and thus LAAO devices are currently indicated in patients with relative contraindication to OAC therapy.
Updates on adjuvant chemotherapy and radiation therapy for endometrial cancer
Authors: Cowan Matthew , Strauss Jonathan B. , Barber Emma L. , Matei Daniela
Published: December 2018

Purpose of review

This article will provide an opinion on adjuvant treatment of stage I–III endometrial cancer based on existing and evolving evidence.

Recent findings

For early-stage (I and II) intermediate risk endometrial cancer, vaginal brachytherapy reduces the risk of locoregional relapse. Recent studies have investigated the use of chemotherapy in early stage, high-risk patient population, but did not demonstrate a survival benefit. As such, chemotherapy is only recommended for selected patients at high risk for distant recurrence. On the other hand, for stage III disease, chemotherapy has a well established role. A landmark trial recently reported confirmed that chemoradiation improves recurrence-free survival compared with radiation alone in stage III endometrial cancer. However, in another randomized phase III trial, chemoradiotherapy was not superior to chemotherapy alone in this group, raising questions as to whether addition of radiation is necessary. Therefore, improved risk stratification using molecular markers in addition to traditional pathological criteria is critically needed to better predict the risk of local and systemic recurrence and to assist therapy decision-making.

Endometrial cancer care is evolving and recent pivotal trials highlight the significance of chemotherapy to the treatment of stage III endometrial cancer and not to the approach for stage I and II cancer. The role of radiation therapy for stage III disease is raised into question.
K-RIM (Corneal Rim) Angle Surgery Training Model
Authors: Arora Anish , Nazarali Samir , Sawatzky Lauren , Gooi Malcolm , Schlenker Matt , Ahmed Ike K. , Gooi Patrick
Published: December 2018

Purpose:

To develop an angle surgery training model for training an array of microincisional glaucoma surgery (MIGS) procedures.

Methods:

We describe a method for preparing an angle surgery training model using human cadaveric corneoscleral rims. The model provides realistic tactile tissue simulation and excellent angle visualization requiring bimanual technique. Corneoscleral rims may be used multiple times and are prepared at low cost, allowing for a high volume of practice surgeries.

Results:

This model allows for practice in bimanual surgical training using the gonioscopy lens for visualize alongside surgical tools. The in vivo surgical conditions and limited tactile feedback are recreated using human cadaveric eyes which nonhuman models fail to provide. Our model is prepared at low cost, with relative ease and also provides appropriate positioning of Schlemm canal and for high volume of practice as the canal can be used in 90-degree segments.

Conclusions:

Few angle surgery training models currently exist and none provide these necessary features. The model presented here aims to meet the growing demand for adequate training models required for technically advanced MIGS techniques.
Multiple Violaceous Tumors on the Back
Authors: Holmes Alden W. , Jacob Sharon E.
Published: December 2018

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of multiple violaceous tumors on the back.
Topical Tacrolimus (FK506, Protopic) in the Treatment of Atopic Dermatitis
Authors: Nagrani Nicole K. , Zito Patrick M.
Published: December 2018

Drugs are medications or substances that are used to modify physiologic responses and alleviate associated symptoms. In dermatology, medications and substances are utilized on a daily basis and include topical treatments to anesthetics in micrographic surgery to biologic-acting immunologic agents. The purposes of this section are to focus on drug, specifically how it works and how it is utilized, and to discuss routine alternatives (if available). In this column, we will focus on the uses, mechanism of action, adverse effects, and alternatives to topical tacrolimus (Protopic) in atopic dermatitis.
Optimizing respiratory management in resource-limited settings
Authors: Inglis Rebecca , Ayebale Emmanuel , Schultz Marcus J.
Published: December 2018

Purpose of review

This review focuses on the emerging body of literature regarding the management of acute respiratory failure in low- and middle-income countries (LMICs). The aim is to abstract management principles that are of relevance across a variety of settings where resources are severely limited.

Recent findings

Mechanical ventilation is an expensive intervention associated with considerable mortality and a high rate of iatrogenic complications in many LMICs. Recent case series report crude mortality rates for ventilated patients of between 36 and 72%. Measures to avert the need for invasive mechanical ventilation in LMICs are showing promise: bubble continuous positive airway pressure has been demonstrated to decrease mortality in children with acute respiratory failure and trials suggest that noninvasive ventilation can be conducted safely in settings where resources are low.

The management of patients with acute respiratory failure in LMICs should focus on avoiding intubation where possible, improving the safety of mechanical ventilation and expediting weaning. Future directions should involve the development and trialing of robust and context-appropriate respiratory support technology.
Airway pressure release ventilation in children
Authors: Lalgudi Ganesan Saptharishi
Published: December 2018

Purpose of review

In patients with acute respiratory distress syndrome (ARDS), airway pressure release ventilation (APRV) has been purported to have several physiological benefits. This review synthesizes recent research evaluating APRV mode and provides perspectives on the utility of this mode in children with ARDS.

Recent findings

Two single-center clinical trials on APRV, one adult and one pediatric, have been published this year. These two trials have not only elicited editorials and letters that highlight some of their strengths and weaknesses but also rekindled debate on several aspects of APRV. Despite their contradicting results, both trials provide significant insights into APRV strategies that work and those that may not. This review places the newer evidence in the context of existing literature and provides a comprehensive analysis of APRV use in children.

There have been significant recent advancements in our understanding of the clinical utility of APRV in children with ARDS. The recent trial highlights the urgent need to evolve a consensus on definition of APRV and identify strategies that work. Pending further research, clinicians should avoid the use of a zero-P
LOW Personalized-APRV strategy as a primary ventilation modality in children with moderate–severe ARDS.
Role of Prices, Utilization, and Health in Explaining Texas Medicaid Newborn Care Spending Variation
Authors: Ganduglia Cazaban Cecilia , Kim Youngran , Goodman David C. , Avritscher Elenir B. , Vogel Bruce , Franzini Luisa
Published: December 2018

Background:

Newborn care is one of the most frequent types of hospitalization and Medicaid covers over 50% of all births nationwide. However, little is known about regional variation in Medicaid newborn care spending and its drivers.

Objectives:

To measure the contribution of market-level prices, utilization, and health risk on regional variation in spending among newborn Medicaid population in Texas.

Research Design and Methods:

The study used 2014 Texas Medicaid newborn claims and encounters linked to birth and death certificate data. Newborn care spending was defined as Medicaid payments per newborn hospital stay, including hospital transfers, from birth through discharge home or death. Spending was further categorized into inpatient facility and related professional spending. Variation in spending across neonatal intensive care regions was decomposed into price and utilization, accounting for input price and health risk differences.

Results:

Newborn care spending across Texas regions varied significantly (coefficient of variation, 0.31), with most of the variation attributed to spending on inpatient facility services (91%). Both price (41%) and utilization (27%) played a role in explaining this variation, after adjusting for health status (29%) and input price (4%). Though most regions with the highest spending indexes had high price and utilization indexes, some had high spending driven mostly by high prices and others by high utilization.

Conclusions:

Significant regional variations in price, utilization, and health status exist in Medicaid newborn care across Texas in 2014. Disentangling the effect of each driver is important to address spending variation and improve efficiency in newborn care.
Why some organ allografts are tolerated better than others: new insights for an old question
Authors: Hull Travis D. , Benichou Gilles , Madsen Joren C.
Published: December 2018

Purpose of review

There is great variability in how different organ allografts respond to the same tolerance induction protocol. Well known examples of this phenomenon include the protolerogenic nature of kidney and liver allografts as opposed to the tolerance-resistance of heart and lung allografts. This suggests there are organ-specific factors which differentially drive the immune response following transplantation.

Recent findings

The specific cells or cell products that make one organ allograft more likely to be accepted off immunosuppression than another are largely unknown. However, new insights have been made in this area recently.

The current review will focus on the organ-intrinsic factors that contribute to the organ-specific differences observed in tolerance induction with a view to developing therapeutic strategies to better prevent organ rejection and promote tolerance induction of all organs.
Quality initiatives in pediatric transplantation
Authors: Kelly Beau , Squires James E. , Feingold Brian , Hooper David K. , Mazariegos George V.
Published: December 2018

Purpose of review

Pediatric transplantation faces unique challenges in implementing dynamic quality improvement measures because of proportionally smaller volumes compared to adults, logistics of being integrated successfully within larger or complex hospital systems, lack of adult-affiliated transplant centers, varying focus in prioritization of relevant outcome metrics, and potential lack of sufficient resources.

Recent findings

To address these challenges, multiinstitutional collaborations have developed which have proven increasingly effective in driving awareness and quality improvement measures to supplement regulatory efforts in the pediatric population. Relevant work from the Pediatric Heart Transplant Society and Studies in Pediatric Liver Transplantation will be highlighted. The introduction of learning networks such as the Improving Renal Outcomes Collaborative and the Starzl Network for Excellence in Pediatric Transplantation have further focused on continuous learning initiatives in renal and liver transplantation using collaboration and patient informed measures.

Optimal transplant performance improvement is fully integrated into health delivery at all points of the patient pathway. Progress in performance improvement will require ongoing integration of big data solutions, improved patient engagement and technology solutions.

Video Abstract:

http://links.lww.com/COOT/A4
Childhood Hearing Loss in Patients With Sickle Cell Disease in the United States
Authors: Schopper Heather K. , D’Esposito Christopher F. , Muus John S. , Kanter Julie , Meyer Ted A.
Published: December 2018

This study sought to examine if modern medical evaluations including newborn screening and early diagnosis along with better methods of disease control have improved rates of hearing loss in children with sickle cell disease (SCD). Audiometric and medical data for patients with SCD was obtained from the AudGen Database and analyzed for the presence of hearing loss, type of hearing loss, severity of hearing loss, and correlation with comorbid conditions. Children with sickle cell trait (SCT) were used as a comparison group. A total of 189 patients with SCD and 244 patients with SCT had sufficient audiologic data available. Hearing loss was present in 62% of children with SCD and 50% of children with SCT in the study population. Patients with SCD were significantly more likely than those with SCT to have a sensorineural component to their hearing loss (P<0.001, odds ratio: 2.41 [1.53 to 3.79]) and to have severe or profound hearing loss (P=0.02, odds ratio: 4.00 [1.14 to 14.04]). The true prevalence of hearing loss in children with SCD has not been established as routine screening is not being performed. Routine auditory testing should be done for these children to detect this loss before it impacts development.
The relationship between inflammatory markers extracted from complete blood count and active pulmonary tuberculosis
Authors: Valizadeh Ardalan Pooya , Servatyari Karo , Kashefi Hajar , Afrasiabian Shahla , Abdi Mohammad , Ahmadi Abbas
Published: December 2018

Background:

Pulmonary tuberculosis (PTB) is a fatal infectious disease and remains a major global health problem especially in undeveloped countries. Delay in diagnosis and treatment may cause worsening of the disease, increasing the risk of mortality and easily spreading. This investigation aims to explore the correlation between inflammatory markers extracted from complete blood count (CBC) including red cell distribution width (RDW), neutrophil-to-lymphocyte ratio, RDW to platelet count ratio (RPR), platelet-to-lymphocyte ratio, and other inflammatory markers with active PTB disease. These biomarkers are easily accessible in least possible time and low facility centers even in undeveloped regions to detect inflammation.

Method:

This is a retrospective cohort study. Recorded laboratory and clinical data of 45 diagnosed PTB patients hospitalized in Tohid Hospital (Sanandaj, Iran) were gathered by scanning the records from September 2013 to February 2017. Forty-five age-matched and sex-matched healthy individuals were included as controls. All CBC tests were done by Sysmex KX21N. All Leukocyte differential counts were done by blinded skilled hematologist.

Results:

PTB patients had a significantly higher RPR values compared with control group (0.041 versus 0.058, P = 0.0001). Neutrophil counts, RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein values were also higher in patient with active PTB opposed to control group.

Conclusion:

RPR is a novel useful inflammatory marker easily done and calculated from a routine CBC report which can be used as a supportive available markers to help the management of patients suffering from active PTB. The inclusion of RPR in all CBC reports is recommended.
A Concept Analysis of Organizational Health and Communication
Authors: Brittain Angela C. , Carrington Jane M.
Published: December 2018

Concepts of communication and organizational health were analyzed using the parameters set forth by Walker and Avant, including conceptual selection; clarification; synthesis; attribute exploration and identification; and review of corresponding events. Concept synthesis was initiated through exploration of medical and social science journals, and current literature regarding communication and organizational health was scrutinized to aid conceptual clarification. Concept analysis was informed by using the search engines CINAHL, PubMed, and PsycINFO, with inclusion criteria of “hospital,” “communication,” and “organizational health.” Reenvisioning communication through the lens of organizational health will illuminate issues of false centrality, thus leading to improved interdisciplinary communication in hospitals.
Future Proofing
Authors: Adams Elizabeth
Published: December 2018

In many Western democracies, nursing consumes a comparatively large proportion of the health service budget and delivers the highest proportion of direct patient care. Therefore, identifying and representing the contribution of nurses to clinical effectiveness as well as the wider social benefit to populations and the economy is crucial. Predictive models on health and social care requirements for the next quarter of a century report a staggering shift in population age, multimorbidity, and complexity of need. This is leading to the widespread realization that change is needed to ensure that health care throughout the world meets the emerging needs of humankind. Currently, 97% of health budgets are spent on treatment, while only 3% are invested in prevention. Targeted initiatives that redistribute a higher proportion of national health policy budgets to the prevention of disease offer opportunities for nurses to address gaps in service provision. Nursing Now is a campaign focused on raising the status and profile of nursing globally while maximizing the contribution that nurses make to the health and well-being of individuals and communities. Nursing Now is a 3-year campaign, launched in 2018. The campaign has a very clear strategic goal to position nursing to optimize the profession's potential to fully contribute and make a real difference to the health of the global population.
Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men
Authors: Spicknall Ian H. , Mayer Kenneth H. , Aral Sevgi O. , Romero-Severson Ethan O.
Published: December 2018

Background

Increased gonorrhea detection highlights the need for additional prevention efforts. Gonorrhea may only be acquired when there is contact between infected and uninfected anatomical sites. With 3 sites of infection, this leads to 7 plausible routes of men who have sex with men (MSM) transmission: urethra-to-rectum, rectum-to-urethra, urethra-to-oropharynx, rectum-to-oropharynx, oropharynx-to-urethra, oropharynx-to-rectum, and oropharynx-to-oropharynx. We characterize the uncertainty and potential importance of transmission from each anatomical site using a deterministic compartmental mathematical model.

Methods

We developed a model of site-specific gonococcal infection, where individuals are infected at 0, 1, 2, or all 3 sites. Sexual behavior and infection duration parameters were fixed similar to a recent model analysis of Australian MSM. Markov chain Monte Carlo methods were used to sample the posterior distribution of transmission probabilities that were consistent with site-specific prevalence in American MSM populations under specific scenarios. Scenarios were defined by whether transmission routes may or may not transmit by constraining specific transmission probabilities to zero rather than fitting them.

Results

Transmission contributions from each site have greater uncertainty when more routes may transmit; in the most extreme case, when all routes may transmit, the oropharynx can contribute 0% to 100% of all transmissions. In contrast, when only anal or oral sex may transmit, transmission from the oropharynx can account for only 0% to 25% of transmission. Intervention effectiveness against transmission from each site also has greater uncertainty when more routes may transmit.

Conclusions

Even under ideal conditions (ie, when site-specific gonococcal prevalence, relative rates of specific sex acts, and duration of infection at each anatomical site are known and do not vary), the relative importance of different anatomical sites for gonococcal infection transmission cannot be inferred with precision. Additional data informing per act transmissibility are needed to understand site-specific gonococcal infection transmission. This understanding is essential for predicting population-specific intervention effectiveness.
Rapidly Spreading Human Immunodeficiency Virus Epidemic Among Older Males and Associated Factors: A Large-scale Prospective Cohort Study in Rural Southwest China
Authors: Chen Huanhuan , Wu Xinghua , Chen Li , Lu Huaxiang , Tang Zhenzhu , Shen Zhiyong , Pan Stephen W. , Ruan Yuhua , Shao Yiming
Published: December 2018

Background

Increasing risk of human immunodeficiency virus (HIV) heterosexual transmission can raise the potential for a more diffuse and generalized epidemic. In response to the paucity of data on HIV incidence among heterosexuals in China, we conducted a large-scale, population-based cohort study located in rural southwest China.

Methods

Baseline enrollment for the study was conducted from 2013 to 2014 and follow-up at 12 months was from 2014 to 2015 among adults 20 years or older in 3 rural counties of Southwest China. Study participants were informed of the study by brochures and leaflets distributed in outreach activities. Interviews and blood collection were conducted in private rooms. Blood samples were tested for HIV infection.

Results

The HIV prevalence of the sample was 0.29% (95% confidence interval [CI], 0.27–0.30) (2063 of 722,795) among the total adult population of 1,090,296 potential participants 20 years or older at baseline. Of the 720,732 individuals who tested HIV-negative at baseline, 493,990 (69%) completed the follow-up. Overall HIV incidence was 2.73 (95% CI, 2.38–3.08) per 10,000 person-years (PY) (235 of 860,627 PY). Human immunodeficiency virus incidence was associated with males, older age, less than secondary schooling and not currently being married. Human immunodeficiency virus incidence was 71.28 (95% CI, 35.21–107.35) per 10,000 PY among males aged 50 to 69 years who had less than secondary schooling and were divorced or widowed. Heterosexual sex was the dominant transmission mode for HIV seroconversions (99.0%).

Conclusions

Older heterosexual males were at disproportionate risk of HIV infection. Health authorities in China need to develop and implement innovative interventions suitable for the broader population of older heterosexuals.
Resistance Profile of Neisseria gonorrhoeae in KwaZulu-Natal, South Africa Questioning the Effect of the Currently Advocated Dual Therapy
Authors: Rambaran Santhuri , Naidoo Kavitha , Dookie Navisha , Moodley Prashini , Sturm Adriaan Willem
Published: December 2018

Background

We report on the antimicrobial resistance profile of Neisseria gonorrhoeae isolates and the distribution of tetM genes in isolates with high-level tetracycline resistance in KwaZulu-Natal, South Africa.

Methods

Male and female patients presenting with urethral and/or vaginal discharge were recruited into the study. Urethral and cervical secretions were cultured on New York City agar. Confirmatory tests for N. gonorrhoeae included Gram stain, catalase, oxidase, and carbohydrate utilization tests. Beta-lactamase was tested by means of the chromogenic cephalosporin test. Minimum inhibitory concentrations were determined using agar dilution with multipoint inoculation. Polymerase chain reaction with gel electrophoresis was used to detect the presence and type of the tetM gene.

Results

N. gonorrhoeae was isolated from the specimens of 319 (26%) of the 1220 recruited patients. Of these 319 isolates, 71% were resistant to 3 or more drugs. Resistance to azithromycin was found in 68% of the isolates. All isolates showed high-level tetracycline resistance with minimum inhibitory concentration values of 16 and 32 mg/mL. The tetM gene was present in 293 (92%). The American type was found in 264 (90%) and the Dutch type in 29 (10%). Twenty-six (8%) did not carry a tetM gene.

Conclusions

The current syndromic management with dual ceftriaxone and azithromycin is due to the high level of azithromycin resistance factually single-drug therapy. High-level tetracycline resistance based on a resistance mechanism other than ribosome protection by the tetM gene product is present in N. gonorrhoeae infecting South African patients.
p53-Family Proteins in Odontogenic Cysts: An Immunohistochemical Study
Authors: Mascitti Marco , Togni Lucrezia , Balercia Andrea , Balercia Paolo , Rubini Corrado , Santarelli Andrea
Published: December 2018

The present study investigated the immunohistochemical expression of p53, p63, and p73 in different types of odontogenic cysts (OC), a group of common intraosseous jaw lesions, to provide a better understanding of p53-family functions in odontogenic lesions. We carried out immunohistochemical analysis to evaluate the expression of p53, p63, and p73 in 60 samples of OC, including dentigerous cysts, radicular cysts, orthokeratinized OC, and odontogenic keratocysts (OKC). The epithelial expression of p53-family members was evaluated both in the basal-parabasal and in the superficial layers, measuring the percentage of positive cells and the value of expression intensity. The expression of p53-family members showed a significant difference between the “OKC” and “non-OKC” groups. In particular, p53 positivity in the basal-parabasal layers, as well as p63 positivity in the superficial layers, were more common in OKC (P<0.0001; P=0.0237). p73 expression in the superficial layers was significantly more expressed in the “non-OKC” group (P<0.0001). No significant differences of staining intensity scores were reported between the groups. The Spearman test showed a positive correlation between p53 and p73 expression at the basal-parabasal level in all cysts (r=0.6626; P<0.0001). These results showed a significantly different expression of p53-family members in OC groups, in particular between the “OKC” and “non-OKC” groups, suggesting the existence of a p53-family pathway in the epithelial lining of OC.
A Practical Roadmap for Writing of Medical Scientific Publications
Authors: Ugarte-Gil Manuel Francisco , Alarcón Graciela S.
Published: December 2018

In this article, we are providing a general description of the process of moving a research project from completion to publication; we are describing the process of assigning authors, the drafting of the manuscript, the review process, and how to respond to comments received from reviewers and editors. This roadmap is meant to stimulate the scientific productivity of junior researchers across the continent.
99mTc-MIBI Uptake in a Benign Thymic Cyst
Authors: Lee Hwan , Gault Christopher R. , Cheng Gang , Shah Jagruti C. , Pantel Austin R.
Published: December 2018

A 34-year-old man with end-stage renal failure status post rejection of a deceased donor kidney transplant presented with bone pain in the setting of elevated serum parathyroid hormone and calcium levels. A 99mTc-MIBI SPECT/CT was performed before planned subtotal parathyroidectomy. SPECT/CT imaging revealed a 1.9-cm anterior mediastinal lesion with radiotracer uptake on both the immediate and delayed images. Surgical pathology of the lesion showed a benign thymic cyst with no parathyroid component.
Diffuse Large B-Cell Lymphoma Recurring as Neurolymphomatosis on FDG PET/CT
Authors: Ganeshalingam Rueben , Roach Paul , Schembri Geoffrey Paul
Published: December 2018

Two patients with diffuse large B-cell lymphoma relapsing as neurolymphomatosis diagnosed on FDG PET/CT are presented. Both patients were treated initially with chemotherapy and had a complete metabolic response. Patient 1 represented with lower-limb pain. An FDG PET/CT demonstrated intense uptake throughout the sciatic nerves bilaterally extending distally with relapse confirmed on biopsy. Patient 2 represented to hospital with worsening mobility, neuropathic pain, and facial asymmetry. An FDG PET/CT demonstrated relapse within the spinal cord, left sciatic nerve, and facial nerve branches. Neurolymphomatosis is an uncommon finding on FDG PET/CT and can be the only site of relapse.
Richter Syndrome Presenting With Colon Localization
Authors: Lavalle Mariadea , Minordi Laura Maria , Hohaus Stefan , Manfredi Riccardo , Rufini Vittoria
Published: December 2018

A 75-year-old man, who had been diagnosed with small lymphocytic lymphoma with cervical localization, underwent 18F-FDG PET/CT with iodinated contrast medium due to the appearance of cervical swelling suspected of illness relapse. PET/CT revealed intense 18F-FDG uptake in multiple cervical and subdiaphragmatic lymph nodes and in the left parotid. Moreover, diffuse uptake and wall thickening of the colon were evident; endoscopy with biopsy revealed a diffuse large B-cell lymphoma. Transformation into a more aggressive lymphoma occurs in 2% to 8% of small lymphocytic lymphoma, the so-called Richter syndrome. Extranodal localization in the sigmoid colon is an extremely rare site for transformed lymphoma.
Arterial Phase 18F-Fluorocholine PET/CT in Hepatocellular Carcinoma
Authors: Legendre Alexandre , Collet Guillaume , Lahousse Hélène , Aziz Anne-Laure , Petyt Grégory
Published: December 2018

A 57-year-old man was referred to our institution for 18F-fluorocholine PET/CT to characterize a pulmonary nodule in a context of hepatocellular carcinoma. 18F-FDG PET/CT did not show any uptake of the pulmonary nodule. 18F-fluorocholine PET/CT showed high uptake of the pulmonary nodule, confirming its metastatic origin. Furthermore, liver early dynamic acquisitions allowed better visualization of the hepatocellular carcinoma during the “arterial phase” than at equilibrium.
Incidental 18F-NaF Uptake in Drug-Induced Gynecomastia
Authors: Kothekar Esha , Raynor William Y. , Al-Zaghal Abdullah , Werner Thomas J. , Alavi Abass
Published: December 2018

Gynecomastia is not uncommon in men older than 50 years of age and is characterized by glandular proliferation of breast tissue. Non-physiologic gynecomastia is mostly caused by a variety of external medical interventions. Medications that belong to classes of antiandrogens, antipsychotics, or antibiotics alter the levels of estrogen and testosterone and are commonly implicated in patients with gynecomastia. We are presenting a case of bilateral 18F-NaF uptake in the breast tissue of a 56-year-old man with known history of prostate cancer.
Increased 99mTc Pertechnetate Uptake But Unimpressive 131I Activity in the Metastatic Mediastinal Lymph Nodes in a Thyroid Cancer Patient
Authors: Shao Fuqiang , Zhou Dan , Lan Xiaoli
Published: December 2018

False negative 131I accumulation in metastatic lesions of thyroid carcinoma could be due to various etiologies. Here we present a 33-year-old woman with a history of papillary thyroid cancer who had increased 99mTc pertechnetate activity in the mediastinal metastatic lymph nodes, which was not clearly seen on whole body 131I scan due to adjacent activity from lung metastases.
The Application of Ultrasound and Fine-Needle Aspiration in Low-Volume Lateral Lymph Nodes of Papillary Thyroid Carcinoma Patients
Authors: Chen Yilai , Zhan Weiwei , Zhou Wei , Dong Yijie
Published: December 2018

This research investigates the application of high-frequency ultrasound (US) examination and US-guided fine-needle aspiration (US-FNA) in diagnosing low-volume metastatic lateral lymph nodes (LLNs) from papillary thyroid carcinoma patients. This study reviewed the medical records of 996 LLNs from 858 patients with suspicious thyroid nodules or after thyroidectomy from January 2013 to January 2016. All patients took US-FNA. The US characteristics and the malignancy rate of LLNs classified into group A and group B based on size were analyzed and compared (group A, ≥6 mm; group B, <6 mm). Size was not an independent predictor for malignancy (P > 0.005) in multiple regression analysis, whereas the malignancy rate in the large LLNs (286/425; 67.3%) was slightly higher than that in the small LLNs (338/571; 59.2%) (P = 0.01). However, no significant difference was observed between the groups in terms of calcification, absence of hilum, and peripheral vascularization. The prevalence of malignant LLNs was slightly higher in the small LLNs than that in the large ones when there were less than 3 suspicious US features (P < 0.05), and there was no significant difference between the small and large LLNs when there were 3 or more suspicious US features (P > 0.05). The results indicate that metastases may occur in the lymph nodes even when they were small. Ultrasound and US-FNA showed excellent performance in the diagnosis of low-volume metastatic lateral lymph nodes from papillary thyroid carcinoma patients.
A Clinical Study Comparing the Diagnostic Performance of Assist Strain Ratio Against Manual Strain Ratio in Ultrasound Breast Elastography
Authors: Barr Richard G. , Managuli Ravi A.
Published: December 2018

Objective

Strain ratio (SR) is a semiquantitative parameter in differentiating benign from malignant tumors in breast ultrasound elastography. Currently, SR is computed manually and, thus, user dependent. The objective of this study was to evaluate the performance of a new tool assist strain ratio (ASR) and determine how it performs compared with an expert sonologist.

Methods

Ninety-one patients scheduled for breast biopsy were included in this institutional review board–approved/Health Insurance Portability and Accountability Act-compliant study. For manual strain ratio (MSR), fat and lesion were manually outlined, whereas for ASR, the clinician indicated the lesion center and the fat-to-lesion ratio is computed automatically. Three measurements were obtained for each lesion. The same raw data were used to calculate the MSR and ASR.

Results

The SR thresholds to differentiate benign from malignant tumors were determined using the Youden index. For MSR, the cutoff was 2.7, and for ASR was 2.8. The MSR showed a sensitivity of 88%, specificity of 64%, accuracy of 77%, positive predictive value of 72%, and negative predictive value of 92.1%. Corresponding ASR showed a sensitivity of 86%, specificity of 76%, accuracy of 81%, positive predictive value of 79%, and negative predictive value of 84%. The areas under the curve for the MSR and ASR were 0.83 and 0.85, respectively. The average coefficients of variation for the MSR and ASR measurements were 43% and 30%, respectively.

Conclusion

Assist strain ratio demonstrated similar diagnostic performance compared with MSR. In addition, the coefficient of variation of ASR is lower, implying lower intraoperator dependency. Thus, ASR may aid less-experienced scanners in obtaining improved results.
Linea Arcuate Hernia Following Transversus Abdominis Release Incisional Hernia Repair
Authors: McCulloch Ian Lambourne , Mullens Cody L. , Hardy Kristen M. , Cardinal Jon S. , Ueno Cristiane M.
Published: December 2018

Open abdominal surgery continues to be most commonly complicated by postoperative herniation at the incision line. In 2012, Novitsky et al described a novel hernia repair technique that utilized a transversus abdominis release coupled with a posterior (retrorectus) component separation (TAR-PCS) of the ventral abdominal wall. Early reports attest to the versatility and low recurrence rate of this technique, particularly when repairing large and complex defects. We present a rare case of herniation below the linea arcuate (LAH) following repair via TAR-PCS. Given its novelty compared with more widely utilized techniques, literature review revealed less discussion regarding potential pitfalls associated with this type of reconstruction, in particular the potential for LAH. To date, only 9 cases of symptomatic LAH have been described, although 2 previously described “suprapubic” herniations following TAR-PCS may represent previously mischaracterized cases of this type of complication. Nonetheless, none of these reports were in the setting of ventral hernia repair.
Perception of Lip Cant as a Sign of Facial Deformity
Authors: Lee Shou-Fan , Dumrongwongsiri Sarayuth , Lo Lun-Jou
Published: December 2018

Objective

Lip cant is a feature of facial deformity and commonly seen in patients with facial asymmetry. Because of its importance in aesthetic assessment, it is necessary to define the perceptions of lip cant and investigate differences in perception between laypersons and professionals. These data were insufficient in the literature.

Methods

Photographs of 30 male and 30 female individuals with normal faces were collected, and the lip line angles were measured. A composite facial photograph was generated from superimpositions of the normal faces. Lip line angles from 0° to 9° were made, with other facial features remaining unchanged. The test photographs were arranged in random fashion and evaluated by 64 laypersons and 30 professionals. Comparisons and cumulative frequency were performed.

Results

The lip line angle from the 60 normal persons was 1.20° ± 0.94°. From the composite test photographs, the average first perception of lip cant was 3.25° 1± 1.36° in the laypersons and 1.70° ± 0.69° in the professionals. The average first perception of unacceptable lip cant was 6.40° ± 1.79° in the laypersons and 4.40°1. ± 1.65° in the professionals. Significant differences were found between the first perception and perception as unacceptable lip cant, as well as between the laypersons and the professionals. Cumulative data showed that 82.8% of the laypersons perceived lip cant at 4°, and 17.2% of them felt it aesthetically unacceptable. Few laypersons (1.6%) considered less than 4° unacceptable.

Conclusions

The data in this study provide helpful information in the evaluation of lip cant. A lip cant of 4° or more could be considered an indication for clinical management.
Comparison of the Effects of Epidural Analgesia and Patient-controlled Intravenous Analgesia on Postoperative Pain Relief and Recovery After Laparoscopic Gastrectomy for Gastric Cancer
Authors: Kikuchi Satoru , Kuroda Shinji , Nishizaki Masahiko , Matsusaki Takashi , Kuwada Kazuya , Kimura Yoshikazu , Kagawa Shunsuke , Morimatsu Hiroshi , Fujiwara Toshiyoshi
Published: December 2018

Purpose:

Epidural analgesia (EDA) is an imperative modality for postoperative pain relief after major open abdominal surgery. However, whether EDA has benefits in laparoscopic surgery has not been clear. In this study, the effects of EDA and patient-controlled intravenous analgesia (PCIA) after laparoscopic distal gastrectomy (LDG) were compared.

Methods:

This was a retrospective study that included 82 patients undergoing LDG for gastric cancer. Patients received either EDA (n=67) or PCIA (n=15) for postoperative pain relief. Postoperative outcomes and analgesia-related adverse events were compared between the two modalities.

Results:

EDA and PCIA patients showed no differences in the incidence of complications [9 (13%) vs. 2 (13%); P=0.99] and the length of postoperative hospital stay (9.6±4.5 d vs. 9.7±4.0 d; P=0.90), although the PCIA included poorer preoperative physical status (PS) patients. The number of additional doses of analgesics was higher in the EDA than in the PCIA (1.8±2.4 vs. 0.9±1.0; P=0.01), although postoperative pain scores were similar in the 2 groups. Though the time to first passage of flatus was shorter in the EDA (P<0.05), more EDA patients developed postoperative hypotension as an adverse event (P<0.01). The full mobilization day and the day of oral intake tolerance were not significantly different between the 2 groups after surgery.

Conclusions

After LDG, EDA may not be indispensable, while PCIA may be the optimal modality for providing safe and effective postoperative analgesia and recovery.
Clinical Outcomes of Elective Laparoscopic Cholecystectomy: Retrospective Comparative Study Between Patients With and Without Xanthogranulomatous Cholecystitis
Authors: Domínguez-Comesaña Elias , Tojo-Artos Iria , Domínguez-Fernández Rubén , Tojo-Ramallo Sergio , Rial-Durán Agata , Estévez-Fernández Sergio M.
Published: December 2018

Aim:

The aim of this study was to evaluate the results of laparoscopic cholecystectomy (LC) in patients with xanthogranulomatous cholecystitis (XGC) compared with patients without XGC.

Methods:

A retrospective study was performed including patients who had undergone elective LC between January 2003 and November 2017. Results of patients with XGC (25) were compared with those of patients without XGC (2181) with respect to operative time, conversion rate, drain use, postoperative complications, and postoperative stay.

Results:

The mean operative times in patients with and without XGC were 112.8 and 66.3 minutes, respectively (P=0.001). The conversion rate was 36% in patients with XGC and 3.89% in patients without XGC (P=0.001). Drains were used in 76% of patients with XGC and in 24% of patients without XGC (P=0.001). Postoperative complication rate was 16% and 9.9% in patients with and without XGC, respectively (P=0.309). Mean postoperative stays in patients with and without XGC were 4.3 and 2.3 days, respectively (P=0.001).

Conclusions:

LC in patients with XGC is associated with significantly longer operative time, higher conversion rate, greater drain use, and longer postoperative stay compared with patients without XGC.
Prospective Comparison of Bleeding Complications Between Right and Left Approaches in Percutaneous Biliary Drainage
Authors: Houghton Eduardo J. , Zeledón Manuel , Acquafresca Pablo , Finger Caetano , Palermo Mariano , Giménez Mariano E.
Published: December 2018

Purpose:

The present study aimed to determine whether the percentage of bleeding complications differs between the right and the left approaches in percutaneous biliary drainage (PBD) in adult patients.

Materials and Methods:

This was a prospective, descriptive, nonrandomized comparative and longitudinal study. We included adult patients over 18 years of age who underwent a PBD. We excluded those with a bilateral PBD for the comparative study. Usually, but not exclusively, we performed the right approach under fluoroscopic guidance and the left one under ultrasound and fluoroscopy.

Results:

Of 150 cases, 63 were performed using the right approach and 61 with the left; 26 were performed with the bilateral. The right approach faced less dilated biliary ducts and more benign diseases. We experienced 20 bleeding complications (13.33%, confidence intervals of 95%=8.3-19.8), 7 in the bilateral approach, 10 in the right approach, and 3 in the left one. The difference between the right and the left approaches was statistically significant (Fisher P=0,04). No procedures were required to obtain hemostasis, and only one patient (0.66%, confidence intervals of 95%=0.009-3.66) (in the right side) required a red blood cell transfusion. We found no related mortality.

Conclusions:

Global bleeding complications are more likely to appear in the right approach in which less dilated biliary ducts and more benign diseases probably contributed to a higher number of needle passes, portal and hepatic vein punctures, and, therefore, to an increase in the risk of bleeding complications. The significant bleeding complication rate was low (0.66%).
Management of intracranial haemorrhage, unruptured aneurysms and arteriovenous malformations during and after pregnancy
Authors: Acciarresi Monica , Altavilla Riccardo , Mosconi Maria G. , Caso Valeria
Published: December 2018

Purpose of review

The absolute risk of pregnancy-associated intracranial haemorrhage (ICH) has been reported to be relatively low and often associated with high risks of life-long disabilities and mortality. The aim of this narrative review was obtaining a better understanding of the current management practices for ICH, unruptured aneurysms and/or arteriovenous malformations during pregnancy, as well as the effects of future pregnancies, and the uses of oral contraceptive or HRT.

Recent finding

General guidelines for the management of ICH are used for pregnant women but additional expedient and thorough evaluation of foetal viability and its gestational age are requested. Recent epidemiological data suggest that menopause can be an independent risk factor for the development of aneurysmal subarachnoid haemorrhage. Furthermore, several population-based studies performed on women with aneurysmal subarachnoid haemorrhage observed a lower risk of bleeding with HRT.

The current review observed that the management practices for ICH during pregnancy were seen to be somewhat uniform. Whereas, the practices regarding future pregnancies and the prescriptions of either oral contraceptives or HRT do not follow coherent patterns. In light of this, we recommend the establishment of an international registry that would collect data on women with ICH during pregnancy.