bluuebunny/crossref_metadata_2025 huggingface dataset:
A Computed Tomography Radiomics Nomogram in Differentiating Chordoma From Giant Cell Tumor in the Axial Skeleton
Authors: Nie Pei , Zhao Xia , Wang Ning , Ma Jinlong , Zuo Panli , Hao Dapeng , Yu Tengbo
Published: February 2023

Objective

The aim of the study is to develop and validate a computed tomography (CT) radiomics nomogram for preoperatively differentiating chordoma from giant cell tumor (GCT) in the axial skeleton.

Methods

Seventy-three chordomas and 38 GCTs in axial skeleton were retrospectively included and were divided into a training cohort (n = 63) and a test cohort (n = 48). The radiomics features were extracted from CT images. A radiomics signature was developed by using the least absolute shrinkage and selection operator model, and a radiomics score (Rad-score) was acquired. By combining the Rad-score with independent clinical risk factors using multivariate logistic regression model, a radiomics nomogram was established. Calibration and receiver operator characteristic curves were used to assess the performance of the nomogram.

Results

Five features were selected to construct the radiomics signature. The radiomics signature showed favorable discrimination in the training cohort (area under the curve [AUC], 0.860; 95% confidence interval [CI], 0.760–0.960) and the test cohort (AUC, 0.830; 95% CI, 0.710–0.950). Age and location were the independent clinical factors. The radiomics nomogram combining the Rad-score with independent clinical factors showed good discrimination capability in the training cohort (AUC, 0.930; 95% CI, 0.880–0.990) and the test cohort (AUC, 0.980; 95% CI, 0.940–1.000) and outperformed the radiomics signature (z = 2.768, P = 0.006) in the test cohort.

Conclusions

The CT radiomics nomogram shows good predictive efficacy in differentiating chordoma from GCT in the axial skeleton, which might facilitate clinical decision making.
Identification of lncRNA-miRNA-mRNA networks in late-onset pre-eclampsia
Authors: Tang Yao , Liu Zhen-Zhen , Liu Hai-Yan , Wang Cheng-Jie , Pei Jiang-Nan , Chu Nan , Peng Ting , Li Xiao-Tian , Gu Wei-Rong
Published: February 2023

Objective:

Long non-coding RNAs (lncRNAs) are implicated in multiple pathophysiological processes in placenta-related disorders; however, their expression and function in late-onset pre-eclampsia (LOPE) remain unclear. This study aimed to investigate the expression of lncRNAs in LOPE, construct a competing endogenous RNA (ceRNA) network, and identify the pathways associated with LOPE pathogenesis.

Methods:

We performed lncRNA and mRNAs microarray profiling to identify the differential expression profiles of lncRNAs and mRNAs in LOPE compared to those in normal pregnancy. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed to validate differentially expressed genes. Subsequently, we generated an interaction network between lncRNAs, (micro-RNAs) miRNAs, and mRNAs based on the Pearson’s correlation coefficient between lncRNAs and mRNAs. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to understand the functional significance of differentially expressed lncRNAs (DElncRNAs) in LOPE.

Results:

We identified 29 DElncRNAs (25 upregulated and four downregulated) and 212 differentially expressed mRNAs (DEmRNAs; 203 upregulated and nine downregulated) in LOPE placentas. Within them, six lncRNAs and four mRNAs were verified by qRT-PCR. GO and KEGG analyses revealed the potential pathways affected by these mRNAs, such as positive regulation of leukocyte chemotaxis, chemokine signaling pathway, and response to hypoxia. Finally, we constructed a ceRNA network including three DElncRNAs and 124 DEmRNAs, whose competing interactions may be mediated by 17 miRNAs. Two DElncRNAs, ENST00000515376 and ENST00000520544, were found to be hub genes, as they interacted with most miRNAs and mRNAs. ENST00000515376 is most likely related to the metabolic process of arachidonic acid, whereas ENST00000520544 is more likely related to the coagulation system, such as the regulation of blood coagulation and platelet degranulation.

Conclusion:

Differential expression profile of lncRNAs and the lncRNA-miRNA-mRNA network in LOPE provide potential therapeutic targets for this disease.
Factors Associated With Adverse Outcomes in Uveitis Related to Spondyloarthritis
Authors: Sieiro Santos Cristiana , Sendino-Tenorio Isabel , Álvarez Castro Carolina , Moriano Morales Clara , Cordero Coma Miguel , Díez Álvarez Elvira
Published: February 2023

Background

Evaluating the efficacy and refractoriness to treatment and determining factors associated with adverse outcomes in uveitis associated with spondylarthritis (SpA) are complicated by the lack of validated outcome measures.

Objectives

The aims of this study were to develop an outcome score SpA-U in patients with uveitis associated with SpA and to determine factors associated with adverse outcomes in patients with uveitis under systemic treatment.

Methods

The outcome score SpA-U was defined by best-corrected visual acuity, anterior chamber inflammation, macular edema and inflammation of posterior chamber, global assessment, and refractoriness to treatment. Factors associated with adverse outcomes in uveitis were studied using linear regression. For categorical factors, marginal averages and their SEs are displayed together with linear regression coefficients with 95% confidence intervals. For continuous factors, averages and SDs are reported in addition to linear regression coefficients with 95% confidence interval. Two regression coefficients are reported for each variable: unadjusted and adjusted for age at diagnosis and sex.

Results

One hundred ninety-seven uveitis outbreaks were included. Sixty-two uveitis outbreaks (31%) were classified as severe, 42 as moderate (21%), and 93 as mild (47%) based on the definition and construction of outcome score. The results of the linear regression model revealed that the uveitis activity was more severe in patients with smoking history (β = 0.34), axial and peripheral involvement (β = 0.43), Ankylosing Spondylitis Disease Activity Score >2.1 (β = 0.45), positive HLA-B27 (β = 0.29), female sex (β = 0.19), patients with C-reactive protein elevation (β = 0.002), and bilateral ocular involvement (β = 0.32). At the same time, shorter disease evolution (β = −0.02) was associated with less severe uveitis activity.

Conclusion

We have determined factors associated with adverse outcomes in patients with uveitis associated with SpA by developing an outcome score SpA-U that integrates ocular inflammatory activity, visual acuity, global assessment, and refractoriness to treatment.
Clinical Outcomes With and Without Plasma Exchange in the Treatment of Rapidly Progressive Interstitial Lung Disease Associated With Idiopathic Inflammatory Myopathy
Authors: Eggleston Reid H. , Baqir Misbah , Varghese Cyril , Pennington Kelly M. , Bekele Delamo I. , Hartman Thomas E. , Ernste Floranne C.
Published: February 2023

Background/Objective

A subset of patients with idiopathic inflammatory myopathy (IIM) develops highly fatal, rapidly progressive interstitial lung disease (RP-ILD). Treatment strategies consist of glucocorticoid and adjunctive immunosuppressive therapies. Plasma exchange (PE) is an alternative therapy, but its benefit is unclear. In this study, we aimed to determine whether PE benefited outcomes for patients with RP-ILD.

Methods

In this medical records review study, we compared baseline characteristics and clinical outcomes for 2 groups of patients with IIM-related RP-ILD: those who received and did not receive PE.

Results

Our cohort consisted of 15 patients, 9 of whom received PE. Baseline demographic characteristics and severity of lung, skin, and musculoskeletal disease between the 2 groups of patients were not significantly different. Five patients required mechanical ventilation (2, PE; 3, no PE). Plasma exchange was generally a third-line adjunctive treatment option. The PE group had a longer median (interquartile range) hospitalization (27.0 [23.0–36.0] days) than the non-PE group (12.0 [8.0–14.0] days) (p = 0.02). There was a potential benefit in 30-day mortality improvement in those receiving PE (0% vs 33%, p = 0.14), with a statistically significant improvement in 2 important composite end points including 30-day mortality or need for lung transplant (0% vs 50%, p = 0.04) and 1-year mortality or need for lung transplant or hospital readmission for RP-ILD in those receiving PE (22% vs 83%, p = 0.04).

Conclusions

Plasma exchange may be an underutilized, safe salvage therapy for patients with IIM-related RP-ILD when other immunosuppressive therapies fail.
The Effect of Corticosteroids on Temporal Artery Biopsy Positivity in Giant Cell Arteritis
Authors: Papadakos Stavros P. , Papazoglou Andreas S. , Moysidis Dimitrios V. , Tsagkaris Christos , Papadakis Dimitrios L. , Koutsogianni Alexandra , Fragoulis Georgios , Papadakis Marios
Published: February 2023

Objective

Temporal artery biopsy (TAB) remains the standard criterion for the diagnosis of giant cell arteritis (GCA). Temporal artery biopsy is suggested to be performed within 2 weeks from the initiation of corticosteroids. However, the effects of TAB timing on the sensitivity of its findings still warrant further investigation.

Methods

We reviewed the medical records of patients with GCA from a tertiary medical center in Germany over an 8-year period.

Results

We analyzed data from 109 patients with a median age of 76 years and a median time from glucocorticoid treatment to TAB of 4 days. Approximately 60% of biopsies were positive. Our analysis yielded a nonsignificant trend toward shorter duration of corticosteroid treatment in the TAB(+) group (p = 0.06). A more than 7 days' duration of steroid treatment was independently linked with lower rates of positive TAB (adjusted odds ratio, 0.33; 95% confidence interval, 0.11–1.00).

Conclusion

We conclude that the duration of corticosteroid treatment seems to affect the positivity of TAB in patients with suspected GCA. Further larger studies are required to confirm the generalizability of our findings.
Repeated Contrast-Enhanced Micro-CT Examinations Decrease Animal Welfare and Influence Tumor Physiology
Authors: Baier Jasmin , Rix Anne , Darguzyte Milita , Girbig Renée Michèle , May Jan-Niklas , Palme Rupert , Tolba René , Kiessling Fabian
Published: February 2023

Objectives

Computed tomography (CT) imaging is considered relatively safe and is often used in preclinical research to study physiological processes. However, the sum of low-dose radiation, anesthesia, and animal handling might impact animal welfare and physiological parameters. This is particularly relevant for longitudinal studies with repeated CT examinations. Therefore, we investigated the influence of repeated native and contrast-enhanced (CE) CT on animal welfare and tumor physiology in regorafenib-treated and nontreated tumor-bearing mice.

Material and Methods

Mice bearing 4T1 breast cancer were divided into 5 groups: (1) no imaging, (2) isoflurane anesthesia only, (3) 4 mGy CT, (4) 50 mGy CT, and (5) CE-CT (iomeprol). In addition, half of each group was treated with the multikinase inhibitor regorafenib. Mice were imaged 3 times within 1 week under isoflurane anesthesia. Behavioral alterations were investigated by score sheet evaluation, rotarod test, heart rate measurements, and fecal corticosterone metabolite analysis. Tumor growth was measured daily with a caliper. Tumors were excised at the end of the experiment and histologically examined for blood vessel density, perfusion, and cell proliferation.

Results

According to the score sheet, animals showed a higher burden after anesthesia administration and in addition with CT imaging (P< 0.001). Motor coordination was not affected by native CT, but significantly decreased after CE-CT in combination with the tumor therapy (P< 0.001). Whereas tumor growth and blood vessel density were not influenced by anesthesia or imaging, CT-scanned animals had a higher tumor perfusion (P< 0.001) and a lower tumor cell proliferation (P< 0.001) for both radiation doses. The most significant difference was observed between the control and CE-CT groups.

Conclusion

Repeated (CE-) CT imaging of anesthetized animals can lead to an impairment of animal motor coordination and, thus, welfare. Furthermore, these standard CT protocols seem to be capable of inducing alterations in tumor physiology when applied repetitively. These potential effects of native and CE-CT should be carefully considered in preclinical oncological research.
Standardization and Quantitative Imaging With Photon-Counting Detector CT
Authors: McCollough Cynthia H. , Rajendran Kishore , Leng Shuai
Published: February 2023

Computed tomography (CT) images display anatomic structures across 3 dimensions and are highly quantitative; they are the reference standard for 3-dimensional geometric measurements and are used for 3-dimensional printing of anatomic models and custom implants, as well as for radiation therapy treatment planning. The pixel intensity in CT images represents the linear x-ray attenuation coefficient of the imaged materials after linearly scaling the coefficients into a quantity known as CT numbers that is conveyed in Hounsfield units. When measured with the same scanner model, acquisition, and reconstruction parameters, the mean CT number of a material is highly reproducible, and quantitative applications of CT scanning that rely on the measured CT number, such as for assessing bone mineral density or coronary artery calcification, are well established. However, the strong dependence of CT numbers on x-ray beam spectra limits quantitative applications and standardization from achieving robust widespread success. This article reviews several quantitative applications of CT and the challenges they face, and describes the benefits brought by photon-counting detector (PCD) CT technology. The discussed benefits of PCD-CT include that it is inherently multienergy, expands material decomposition capabilities, and improves spatial resolution and geometric quantification. Further, the utility of virtual monoenergetic images to standardize CT numbers is discussed, as virtual monoenergetic images can be the default image type in PCD-CT due to the full-time spectral nature of the technology.
Deep Learning Diagnosis and Classification of Rotator Cuff Tears on Shoulder MRI
Authors: Lin Dana J. , Schwier Michael , Geiger Bernhard , Raithel Esther , von Busch Heinrich , Fritz Jan , Kline Mitchell , Brooks Michael , Dunham Kevin , Shukla Mehool , Alaia Erin F. , Samim Mohammad , Joshi Vivek , Walter William R. , Ellermann Jutta M. , Ilaslan Hakan , Rubin David , Winalski Carl S. , Recht Michael P.
Published: February 2023

Background

Detection of rotator cuff tears, a common cause of shoulder disability, can be time-consuming and subject to reader variability. Deep learning (DL) has the potential to increase radiologist accuracy and consistency.

Purpose

The aim of this study was to develop a prototype DL model for detection and classification of rotator cuff tears on shoulder magnetic resonance imaging into no tear, partial-thickness tear, or full-thickness tear.

Materials and Methods

This Health Insurance Portability and Accountability Act-compliant, institutional review board–approved study included a total of 11,925 noncontrast shoulder magnetic resonance imaging scans from 2 institutions, with 11,405 for development and 520 dedicated for final testing. A DL ensemble algorithm was developed that used 4 series as input from each examination: fluid-sensitive sequences in 3 planes and a sagittal oblique T1-weighted sequence. Radiology reports served as ground truth for training with categories of no tear, partial tear, or full-thickness tear. A multireader study was conducted for the test set ground truth, which was determined by the majority vote of 3 readers per case. The ensemble comprised 4 parallel 3D ResNet50 convolutional neural network architectures trained via transfer learning and then adapted to the targeted domain. The final tear-type prediction was determined as the class with the highest probability, after averaging the class probabilities of the 4 individual models.

Results

The AUC overall for supraspinatus, infraspinatus, and subscapularis tendon tears was 0.93, 0.89, and 0.90, respectively. The model performed best for full-thickness supraspinatus, infraspinatus, and subscapularis tears with AUCs of 0.98, 0.99, and 0.95, respectively. Multisequence input demonstrated higher AUCs than single-sequence input for infraspinatus and subscapularis tendon tears, whereas coronal oblique fluid-sensitive and multisequence input showed similar AUCs for supraspinatus tendon tears. Model accuracy for tear types and overall accuracy were similar to that of the clinical readers.

Conclusions

Deep learning diagnosis of rotator cuff tears is feasible with excellent diagnostic performance, particularly for full-thickness tears, with model accuracy similar to subspecialty-trained musculoskeletal radiologists.
Single Breath-Hold 3-Dimensional Magnetic Resonance Elastography Depicts Liver Fibrosis and Inflammation in Obese Patients
Authors: Darwish Omar Isam , Gharib Ahmed M. , Jeljeli Sami , Metwalli Nader S. , Feeley Jenna , Rotman Yaron , Brown Rebecca J. , Ouwerkerk Ronald , Kleiner David E. , Stäb Daniel , Speier Peter , Sinkus Ralph , Neji Radhouene
Published: January 2023

Objectives

Three-dimensional (3D) magnetic resonance elastography (MRE) measures liver fibrosis and inflammation but requires several breath-holds that hamper clinical acceptance. The aim of this study was to evaluate the technical and clinical feasibility of a single breath-hold 3D MRE sequence as a means of measuring liver fibrosis and inflammation in obese patients.

Methods

From November 2020 to December 2021, subjects were prospectively enrolled and divided into 2 groups. Group 1 included healthy volunteers (n = 10) who served as controls to compare the single breath-hold 3D MRE sequence with a multiple–breath-hold 3D MRE sequence. Group 2 included liver patients (n = 10) who served as participants to evaluate the clinical feasibility of the single breath-hold 3D MRE sequence in measuring liver fibrosis and inflammation. Controls and participants were scanned at 60 Hz mechanical excitation with the single breath-hold 3D MRE sequence to retrieve the magnitude of the complex-valued shear modulus (|G*| [kPa]), the shear wave speed (Cs [m/s]), and the loss modulus (G" [kPa]). The controls were also scanned with a multiple–breath-hold 3D MRE sequence for comparison, and the participants had histopathology (Ishak scores) for correlation with Cs and G".

Results

For the 10 controls, 5 were female, and the mean age and body mass index were 33.1 ± 9.5 years and 23.0 ± 2.1 kg/m2, respectively. For the 10 participants, 8 were female, and the mean age and body mass index were 45.1 ± 16.5 years and 33.1 ± 4.0 kg/m2 (obese range), respectively. All participants were suspected of having nonalcoholic fatty liver disease. Bland-Altman analysis of the comparison in controls shows there are nonsignificant differences in |G*|, Cs, and G" below 6.5%, suggesting good consensus between the 2 sequences. For the participants, Cs and G" correlated significantly with Ishak fibrosis and inflammation grades, respectively (ρ = 0.95, P < 0.001, and ρ = 0.84, P = 0.002).

Conclusion

The single breath-hold 3D MRE sequence may be effective in measuring liver fibrosis and inflammation in obese patients.
The Usefulness of Short-Interval Sequential FDG PET/CT Studies in Defining the Benignity of Hypermetabolic Lipomatous Tumor
Authors: Hod Nir , Nalbandyan Karen , Lantsberg Sophie
Published: February 2023

We present an interesting case of incidentally detected lipomatous tumor in an oncological patient that could result in a false-positive interpretation by exhibiting intense FDG activity similar to that of a malignant neoplasm. Careful evaluation of FDG uptake changes on sequential short-interval PET/CT studies was helpful in defining the benign nature of the tumor as the hypermetabolism was gradually disappearing obviating the need for a major surgery.
Complete Remission Upon Peptide Receptor Radionuclide Therapy in a G2 Pancreatic Neuroendocrine Tumor
Authors: Weich Alexander , Serfling Sebastian E. , Yi Heqing , Buck Andreas K. , Higuchi Takahiro , Werner Rudolf A.
Published: February 2023

We report the case of a 52-year-old man affected with a metastasized neuroendocrine tumor (G2) of the pancreas. After surgical removal, follow-up imaging 36 months later revealed somatostatin receptor–positive liver lesions. Because of disease progression under cold somatostatin analogs 6 months later, peptide receptor radionuclide therapy was performed, that induced complete remission (CR), supporting the notion that “hot” somatostatin analogs can achieve CR even in patients affected with pancreatic G2 neuroendocrine tumor. Of note, such cases exhibiting CR upon peptide receptor radionuclide therapy are extremely rare and further investigations may pool those exceptional treatment responders.
Nodular Fasciitis
Authors: Pitot Marika A. , Broski Stephen M. , Thompson Scott M. , Woodrum David A. , Powell Garret M.
Published: February 2023

PET/CT plays a crucial role in the management of prostate cancer with several emerging and established radiopharmaceuticals, including 18F-piflufolastat and 11C-choline. These radiotracers are thought to be relatively specific to prostate cancer; however, uptake has also been demonstrated in other benign and malignant lesions. Nodular fasciitis is a rapidly growing benign soft tissue neoplasm that is typically self-limiting. Although a few case reports describe 68Ga-PSMA uptake in nodular fasciitis, uptake of 11C-choline and other PSMA-targeted PET probes, including 18F-piflufolastat, have not previously been reported. We present a novel case of nodular fasciitis demonstrating both 18F-piflufolastat and 11C-choline avidity.
Asymptomatic Prostate Cancer Metastasis in Rectal Mucosa Revealed by 18F-PSMA-1007 PET/CT
Authors: Wang Shu , Cheng Zhiming , Du Bulin , Li Yaming , Li Xuena
Published: February 2023

Prostate cancer metastasis to the rectal mucosa, a relatively rare metastatic site, leads to a higher clinical stage and poorer prognosis. A 65-year-old man with prostate cancer underwent 18F–prostate-specific membrane antigen (PSMA) PET/CT for staging. Intense 18F-PSMA uptake occurred at the primary lesion, bladder, adjacent seminal vesicle, and rectum. PET/CT imaging revealed increased homogeneous round activity of the rectal wall. The final diagnosis was prostate cancer metastasis to the rectal mucosa. This case suggested that 18F-PSMA PET/CT may assist in locating rare metastases of prostate cancer, with potential value for early staging.
Complete Metabolic Response by 18F-FDG PET/CT to Atezolizumab Plus Bevacizumab in Patients With Advanced Hepatocellular Carcinoma
Authors: Uchida Yoichiro , Yoh Tomoaki , Fukui Ayaka , Takai Atsushi , Hatano Etsuro
Published: February 2023

Nowadays, atezolizumab plus bevacizumab is recommended for advanced hepatocellular carcinoma (HCC) as the first-line systemic chemotherapy. Nevertheless, the data with regard to the tumor response still remain limited. We report a complete metabolic response assessed by 18F-FDG PET/CT in a 74-year-old man with advanced HCC who underwent atezolizumab plus bevacizumab followed by radical hepatectomy. Furthermore, pathological examination revealed that the tumor showed complete response for this therapy. This case suggests that 18F-FDG PET/CT represents clinical relevance as a useful approach for therapeutic assessment of immune-oncology drugs in HCC.
Role of Quantitative Plaque Analysis and Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography to Assess Plaque Progression
Authors: Qiao Hong Yan , Wu Yong , Li Hai Cheng , Zhang Hai Yan , Wu Qing Hua , You Qing Jun , Ma Xin , Hu Shu Dong
Published: February 2023

Purpose:

To explore the role of quantitative plaque analysis and fractional flow reserve (CT-FFR) derived from coronary computed angiography (CCTA) in evaluating plaque progression (PP).

Methods:

A total of 248 consecutive patients who underwent serial CCTA examinations were enrolled. All patients’ images were analyzed quantitatively by plaque analysis software. The quantitative analysis indexes included diameter stenosis (%DS), plaque length, plaque volume (PV), calcified PV, noncalcified PV, minimum lumen area (MLA), and remodeling index (RI). PP is defined as PAV (percentage atheroma volume) change rate >1%. CT-FFR analysis was performed using the cFFR software.

Results:

A total of 76 patients (30.6%) and 172 patients (69.4%) were included in the PP group and non-PP group, respectively. Compared with the non-PP group, the PP group showed greater %DS, smaller MLA, larger PV and non-calcified PV, larger RI, and lower CT-FFR on baseline CCTA (all P<0.05). Logistic regression analysis showed that RI≥1.10 (odds ratio [OR]: 2.709, 95% CI: 1.447-5.072), and CT-FFR≤0.85 (OR: 5.079, 95% CI: 2.626-9.283) were independent predictors of PP. The model based on %DS, quantitative plaque features, and CT-FFR (area under the receiver-operating characteristics curve [AUC]=0.80, P<0.001) was significantly better than that based rarely on %DS (AUC=0.61, P=0.007) and that based on %DS and quantitative plaque characteristics (AUC=0.72, P<0.001).

Conclusions:

Quantitative plaque analysis and CT-FFR are helpful to identify PP. RI and CT-FFR are important predictors of PP. Compared with the prediction model only depending on %DS, plaque quantitative markers and CT-FFR can further improve the predictive performance of PP.
The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates
Authors: Om Anjali , Marxen Troy , Kebede Sara , Losken Albert
Published: February 2023

Background

Bleeding complications are not uncommon after breast reduction surgery, and recently, tranexamic acid (TXA) as an antifibrinolytic agent has been used in various surgical specialties as a way to minimizes such adverse outcomes. We elected to evaluate the effectiveness of intravenous (IV) intraoperative TXA in reduction mammoplasty patients.

Methods

This is a retrospective chart review of clinical charts of all patients who received reduction mammoplasty by a single surgeon at Emory University Hospital or its affiliated Aesthetic Center from January 1, 2020, to March 1, 2022. Seventy-four consecutive breast reduction patients received 1-g IV TXA intraoperatively compared with 117 consecutive controls. The outcome of interest included 30-day postoperative bleeding complications.

Results

There was no significant difference in age (P = 0.92), body mass index (P = 0.98), percentage of smokers (P = 0.56), operating time (P = 0.87), estimated blood loss (P = 0.90), or weight removed (P = 0.98) between patients in each arm. There were 19 bleeding events (16.2%) in the non-TXA arm compared with 1 bleeding event (1.4%) in the TXA arm (P = 0.0143). Of the 19, 6 (5.1%) were major events, and 13 were minor events (11.1%); the only bleeding event in the TXA arm was minor. Number needed to treat all bleeding events with use of TXA was 7, and the number needed to treat minor hematomas was 11. There was no significant difference in the rate of seroma, wound healing complications, infection, or nipple necrosis between the 2 arms (P > 0.05).

Conclusions

The use of IV TXA is a safe and effective way to reduce hematoma rates in patients receiving reduction mammoplasty.
Comprehensive Strategies of Flap Design for Repairing Cranium Exposure or Defects After Malignant Tumor Resection
Authors: Zhu Jingjing , Wang Wei , Chen Liang , Zhou Yiqun , Guo Yu , Wang Heng , Dong Dong , Liu Tianyi
Published: February 2023

Free tissue transfer is a great method for the reconstruction of craniofacial defects, especially in complicated situations such as calvarial defects and dura exposure. Latissimus dorsi muscle flap, anterolateral thigh flap, and radial forearm flap are 3 commonly used flaps that have distinct characteristics. The objective of the present study is to share our experiences with microvascular free flap reconstruction of cranium exposure or defects and to compare distinct microvascular free flap options. The authors reviewed 8 cases that received resection and reconstruction of craniofacial tumors. Perioperative and reconstructive techniques employed to improve flap survival, esthetic outcome, and prevent complications in these patients were retrospectively detailed. In addition, the advantages and disadvantages of latissimus dorsi muscle flap, anterolateral thigh flap, and radial forearm flap were illustrated in this study. The authors believe that taking advantage of these flaps according to the characteristics of defects and flaps will contribute to a good functional and esthetic outcome.
INTERLEUKIN-35 DOWNREGULATES THE IMMUNE RESPONSE OF EFFECTOR CD4+ T CELLS VIA RESTRICTING HIGH MOBILITY GROUP BOX-1 PROTEIN-DEPENDENT AUTOPHAGY IN SEPSIS
Authors: Wu Tiantian , Ren Chao , Dou Xiaowei , Wu Yao , Dong Ning , Zhang Hui , Yao Yongming
Published: February 2023

Background: Immunosuppression is critically involved in the development of sepsis and is closely associated with poor outcomes. The novel role of the anti-inflammatory cytokine IL-35 in sepsis was examined. Methods: Sepsis was induced by in C57BL/6 mice cecal ligation and puncture (CLP). The impacts of IL-35 on effector CD4+ T cells were investigated by examining cell proliferation and the Th1/Th2 ratio in the presence of recombinant IL-35 (rIL-35) or anti–IL-35 (EBI3). The regulatory effect of IL-35 on autophagy was evaluated by measuring autophagy markers and autophagic flux in CLP mice in vivo and in activated effector CD4+ T cells in vitro. Results: IL-35 levels were significantly increased in the serum and spleens of septic mice. rIL-35 administration after CLP further decreased proliferation and the Th1/Th2 ratio in effector CD4+ T cells and significantly shortened the survival time. Sepsis-induced autophagy activation was protective in effector CD4+ T cells and was blocked by rIL-35. The inhibitory effect of IL-35 on autophagy was observed in activated effector CD4+ T cells in vitro, and this effect was mediated by restricting high mobility group box-1 protein (HMGB1) translocation. Conclusion: IL-35 is an immunosuppressive cytokine that impairs CD4+ T-cell proliferation and differentiation in sepsis, and the effect might be mediated by reducing HMGB1-dependent autophagy.
CELLULAR SENESCENCE IMPLICATED IN SEPSIS-INDUCED MUSCLE WEAKNESS AND AMELIORATED WITH METFORMIN
Authors: Chen Juan , Chen Xin Yi , Cong Xiao Xia , Wang Shen , Xu Shui Bo , Sun Yu Ting , Zhou Yi Ting , Zheng Li Ling , Huang Man
Published: January 2023

Background: Sepsis is a life-threatening medical emergency, frequently complicated with intensive care unit–acquired weakness syndrome (ICU-AW). ICU-AW patients display flaccid weakness of the limbs, especially in the proximal limb muscles. However, little is known regarding its pathogenesis. Here, we aimed to identify the potential signaling pathway involved in ICU-AW regulation and identify a potential therapeutic drug for intervention. Methods: Both in vivo and in vitro septic mice were used. For the in vivo septic mice, either cecum ligation and puncture or intraperitoneal injection of LPS was conducted in mice. The body weight and muscle mass were then measured and recorded. Muscle strength was evaluated by limb grip strength test. The expression of proteins extracted from cells and muscles was checked through Western blot analysis. Quantitative reverse transcription-polymerase chain reaction was carried out to test the transcriptional level of genes. Senescence-associated β-galactosidase (SA-β-gal) staining and Sirius red for collagen staining were conducted. Metformin, as an antiaging agent, was then tested for any attenuation of sepsis-related symptoms. For in vitro sepsis modeling, myoblasts were treated with LPS, analyzed for senescence-related protein expression, and subsequently retested upon metformin treatment. Results: We found that both the weight and strength of muscle were dramatically reduced in cecum ligation and puncture– or LPS-induced septic mice. RNA-seq analysis revealed that various cellular senescent genes were involved in sepsis. In line with this, expression of senescence-related genes, p53 and p21 were both upregulated. Both SA-β-gal and Sirius red for collagen staining were enhanced in tibialis anterior muscles. Notably, inhibition of p53 expression by siRNA prominently reduced the number of SA-β-gal–positive myoblasts upon LPS treatment. This indicated sepsis-induced cellular senescence to be dependent on p53. Consistent with the function of metformin in antiaging, metformin attenuated cellular senescence in both murine myoblasts and skeletal muscles during sepsis. Muscle strength of septic mice was improved upon metformin treatment. Metformin intervention is therefore proposed as a potential therapeutic strategy for ICU-AW. Conclusion: Taken together, we revealed a previously unappreciated linkage between cellular senescence and sepsis-induced muscle weakness and propose metformin as a potential therapeutic drug for the treatment of ICU-AW.
A Delphi-Style Evaluation of a Skin Assessment Simulation Using Clinical Vignettes and a Breast Health Training Tool
Authors: Greene Tatiana M. , Chuisano Samantha A. , Quiroza Sofia A. , Sadovnikova Anna
Published: February 2023

Introduction

Breast and skin assessment are both required clinical skills across health professional training programs. The breast is an ideal “canvas” for the development of a simulation exercise focused on the identification and diagnosis of skin conditions that could present anywhere on the body alongside unique conditions specific to the breast and nipple-areolar complex. A skin assessment simulation on a breast model has not been described.

Methods

Investigators developed 20 clinical vignettes for breast and skin conditions (ie, features) depicted on a set of 10 single silicone breast models in 4 skin tones. A modified Delphi approach was used to evaluate the appropriateness of the clinical vignettes and realism of features. A convenience sample of 136 licensed physicians was recruited online. In round 1, participants rated the realism of features and suggested descriptors for each feature. In round 2, participants rated their agreement with descriptors from round 1, selected a diagnosis based on clinical vignettes, and assessed the utility of the Breast Health Training Tool for health professionals.

Results

In round 1, participants (n = 38) agreed (5.1/6) that the features were realistic. In round 2, participants (n = 24) agreed (4.6/6) with the descriptors. Most (>50%) participants agreed on a diagnosis for each feature. Participants (n = 27) agreed (5.3/6) that this tool is useful for health professional education.

Conclusions

This is the first evaluation of a simulation tool for teaching breast examination and identification of skin conditions on the nipple-areolar complex and breast tissue in multiple skin tones, simultaneously filling the gap in women's breast, lactation, and skin health education.
Reducing Hemorrhage-Related Maternal Morbidity Using Interdisciplinary Simulation Training
Authors: Gerard Jessica L. , Turrentine Mark A. , Leong-Kee Susan
Published: February 2023

Introduction

Postpartum hemorrhage (PPH) remains a major cause of preventable maternal morbidity in the United States. Postpartum hemorrhage simulations were developed to improve provider recognition and treatment; however, there exist few studies that investigate their effects on individual outcomes. Our objective is to estimate the effect of a simulation-based educational intervention on PPH-related maternal morbidity outcomes.

Methods

We conducted a retrospective cohort analysis of hemorrhage outcomes at a single institution between March 2012 and January 2016 during the implementation of a high-fidelity PPH simulation. Women with PPH defined as an estimated blood loss greater than 500 mL for vaginal delivery and 1000 mL for cesarean delivery were included. The primary outcome was a composite of hemorrhage-related maternal morbidity (maternal death, hysterectomy, intensive care unit admission, blood transfusion, or unanticipated procedures to treat postpartum bleeding). Multivariable logistic regression adjusted for confounding variables between presimulation and postsimulation outcomes.

Results

During the study period, 19,927 deliveries occurred with 4.5% of patients (888) experiencing hemorrhage. Women in the presimulation (n = 278) versus postsimulation groups (n = 610) had similar demographics. Although the PPH rate increased after simulation [2.8% pre vs. 6.1% post, odds ratio (OR), 2.25; 95% confidence interval (CI), 1.95–2.60], composite hemorrhage-related morbidity was lower after simulation training (44% pre vs. 35% post; OR, 0.70; 95% CI, 0.52–0.93). This reduction persisted after adjusting for confounding variables of mode of delivery and time from delivery to first uterotonic use (adjusted OR, 0.66; 95%, CI 0.49–0.89).

Conclusions

Despite an increased PPH rate, simulation education was associated with a reduction in a hemorrhage-related maternal composite morbidity.
Exploring the Frameworks, Needs, and Barriers of Interprofessional Education and Simulation in Emergency Medicine
Authors: Rutherford-Hemming Tonya , Linder Gary
Published: February 2023

Summary Statement

This manuscript focuses on interprofessional education (IPE) using simulation and its use between emergency department and emergency medical services personnel. It explores the theoretical frameworks behind IPE and applies them to simulation-based emergency medical services education. There is a notable lack of research on the use of IPE using simulation between these 2 professions. The need for IPE using simulation as well as barriers and recommendations to remove the barriers are discussed.
Long-Term Outcomes of Exercise Therapy Versus Revascularization in Patients With Intermittent Claudication
Authors: Shirasu Takuro , Takagi Hisato , Yasuhara Jun , Kuno Toshiki , Kent K. Craig , Farivar Behzad S. , Tracci Margaret C. , Clouse W. Darrin
Published: February 2023

Objective:

The aim was to analyze the risk of progression to chronic limb-threatening ischemia (CLTI), amputation and subsequent interventions after revascularization versus noninvasive therapy in patients with intermittent claudication (IC).

Background:

Conflicting evidence exists regarding adverse limb outcomes after each treatment strategy.

Methods:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. MEDLINE, Web of Science, and Google Scholar were searched aided by a health sciences librarian through August 16, 2022. Randomized control trials (RCTs) comparing invasive (endovascular or surgical revascularization) and noninvasive treatment (exercise and/or medical treatment) were included. PROSPERO registration was completed (CRD42022352831).

Results:

A total of 9 RCTs comprising 1477 patients (invasive, 765 patients; noninvasive, 712 patients) were eligible. During a mean of 3.6-year follow-up, progression to CLTI after invasive [5 (2–8) per 1000 person-years] and noninvasive treatment [6 (3–10) per 1000 person-years] were not statistically different [rate ratio (RR): 0.77; 95% CI, 0.35–1.69; P=0.51, I
2=0%]. Incidence of amputation (RR: 1.69; 95% CI, 0.54–5.26; P=0.36, I
2=0%) and all-cause mortality (hazard ratio: 1.26; 95% CI, 0.91–1.74; P=0.16, I
2=0%) also did not differ between the groups. However, the invasive treatment group underwent significantly more revascularizations (RR: 4.15; 95% CI, 2.80–6.16; P<0.00001, I
2=83%). The results were not changed by fixed effect or random-effects models, nor by sensitivity analysis.

Conclusions:

Although there is equivalent risk of progression to CLTI, major amputation and all-cause mortality compared with noninvasive treatment, invasive treatment for patients with IC led to significantly more revascularization procedures and should be used selectively in patients with major lifestyle limitation. Guideline recommendation of noninvasive treatment for first-line IC therapy is supported.
Radical Resection Combined With Intestinal Autotransplantation for Locally Advanced Pancreatic Cancer After Neoadjuvant Therapy
Authors: Liang Tingbo , Zhang Qi , Wu Guosheng , Liu Chaoxu , Bai Xueli , Gao Shunliang , Ma Tao , Sun Ke , Yan Senxiang , Xiao Wenbo , Jiang Tian’an , Lu Fangyan , Zhang Yuntao , Shen Yan , Zhang Min , Zhang Xiaochen , Shan Jianzhen
Published: February 2023

Objective:

To achieve radical resection of locally advanced pancreatic ductal adenocarcinoma (PDAC), and tested the safety and benefits of intestinal autotransplantation in pancreatic surgery.

Background:

PDAC has an extremely dismal prognosis. Radical resection was proved to improve the prognosis of patients with PDAC; however, the locally advanced disease had a very low resection rate currently. We explored and evaluated whether the combination of modern advances in systemic treatment and this macroinvasive surgery was feasible in clinical practice.

Methods:

Patients diagnosed as PDAC with superior mesenteric artery involvement and with or without celiac trunk involvement were included. Patients were treated with modified-FOLFIRINOX chemotherapy with or without anti-PD-1 antibodies and were applied to tumor resection combined with intestinal autotransplantation. Data on operative parameters, pathologic results, mortality, morbidity, and survival were analyzed.

Results:

A total of 36 consecutive cases were applied to this strategy and underwent radical resection combined with intestinal autotransplantation. Among these patients, 24 of them received the Whipple procedure, 11 patients received total pancreatectomy, and the other 1 patient received distal pancreatectomy. The median operation time was 539 minutes. Postoperative pathology showed an R0 resection rate of 94.4%, and tumor invasion of a superior mesenteric artery or superior mesenteric vein was confirmed in 32 patients. The median number of dissected lymph nodes was 43, and 25 patients were positive for lymph node metastasis. The median time of intensive care unit stay was 4 days. Two patients died within 30 days after surgery due to multiorgan failure. The severe postoperative adverse events (equal to or higher than grade 3) were observed in 12 out of 36 patients, and diarrhea, gastroparesis, and abdominal infection were the most frequent adverse events. Postoperative hospital stay was averagely of 34 days. The recurrence-free survival is 13.6 months. The median overall survival of patients after diagnosis and after surgery was 21.4 months and 14.5 months, respectively.

Conclusions:

Our attempt suggests the safety of this modality and may be clinically beneficial for highly selected patients with PDAC. However, the experience in multidisciplinary pancreatic cancer care and intestinal transplantation is warranted.
Prophylactic Mesh Placement During Formation of an End-colostomy
Authors: Brandsma Henk-Thijs , Hansson Birgitta ME. , Aufenacker Theo J. , de Jong Nienke , V Engelenburg Klaas CA. , Mahabier Chander , Donders Rogier , Steenvoorde Pascal , de Vries Reilingh Tammo S. , Leendert van Westreenen Hendrik , Wiezer Marinus J. , de Wilt Johannes H.W. , Rovers Maroeska , Rosman Camiel ,   the Dutch Prevent Study Group
Published: February 2023

Objective:

The aim of this study was to determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term.

Background:

A PSH is the most frequent complication after stoma formation. Prophylactic placement of a mesh has been suggested to prevent PSH, but long-term evidence to support this approach is scarce.

Methods:

In this multicentre superiority trial patients undergoing the formation of a permanent colostomy were randomly assigned to either retromuscular polypropylene mesh reinforcement or conventional colostomy formation. Primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life, and cost-effectiveness.

Results:

A total of 150 patients were randomly assigned to the mesh group (n = 72) or nonmesh group (n = 78). For the long-term follow-up, 113 patients were analyzed, and 37 patients were lost to follow-up. After a median follow-up of 60 months (interquartile range: 48.6–64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the nonmesh group (P = 0.22; RD: −9.4%; 95% CI: −24, 5.5). The cost related to the meshing strategy was € 2.239 lower than the nonmesh strategy (95% CI: 491.18, 3985.49), and quality-adjusted life years did not differ significantly between groups (P = 0.959; 95% CI: −0.066, 0.070).

Conclusions:

Prophylactic mesh placement during the formation of an end-colostomy is a safe procedure but does not reduce the incidence of PSH after 5 years of follow-up. It does, however, delay the onset of PSH without a significant difference in morbidity, mortality, or quality of life, and seems to be cost-effective.
Discrepancy in Reporting of Perioperative Complications
Authors: Gomes Nuno V. , Polutak Amar , Schindler Christian , Weber Walter P. , Steiner Luzius A. , Rosenthal Rachel , Dell-Kuster Salome
Published: February 2023

Objective:

To assess the discrepancy between perioperative complications, prospectively recorded during a cohort study versus retrospectively from health records.

Background:

Perioperative adverse events are relevant for patient outcome, but incomplete reporting is common.

Methods:

Two physicians independently recorded all intraoperative adverse events according to ClassIntra and all postoperative complications according to the Clavien-Dindo classification based on all available health records. These retrospective assessments were compared with the number and severity of those prospectively assessed in the same patients during their inclusion in 1 center of a prospective multicenter cohort study.

Results:

Interrater agreement between both physicians for retrospective recording was high [intraclass correlation coefficient: 0.89 (95% CI, 0.86, 0.91) for intraoperative and 0.88 (95% CI, 0.85, 0.90) for postoperative complications]. In 320 patients, the incidence rate was higher retrospectively than prospectively for any intraoperative complication (incidence rate ratio: 1.79; 95% CI, 1.50, 2.13) and for any postoperative complication (incidence rate ratio: 2.21; 95% CI, 1.90, 2.56). In 71 patients, the severity of the most severe intraoperative complication was higher in the retrospective than in the prospective data collection, whereas in 69 the grading was lower. In 106 patients, the severity of the most severe postoperative complication was higher in the retrospective than in the prospective data collection, whereas in 19 the grading was lower.

Conclusions:

There is a noticeable discrepancy in the number and severity of reported perioperative complications between these 2 data collection methods. On the basis of the double-blinded assessment of 2 independent raters, our study renders prospective underreporting more likely than retrospective overreporting.