bluuebunny/crossref_metadata_2025 huggingface dataset:
FOXS1 acts as an oncogene and induces EMT through FAK/PI3K/AKT pathway by upregulating HILPDA in prostate cancer
Authors: Ren Ruimin , Wang Huang , Xu Yuan , Wu Jinfeng , Ma Ding , Guan Wei
Published: May 2024

Prostate cancer (PCa) is a widespread global health concern characterized by elevated rates of occurrence, and there is a need for novel therapeutic targets to enhance patient outcomes. FOXS1 is closely linked to different cancers, but its function in PCa is still unknown. The expression of FOXS1, its prognostic role, clinical significance in PCa, and the potential mechanism by which FOXS1 affects PCa progression were investigated through bioinformatics analysis utilizing public data. The levels of FOXS1 and HILPDA were evaluated in clinical PCa samples using various methods, such as western blotting, immunohistochemistry, and qRT‐PCR. To examine the function and molecular mechanisms of FOXS1 in PCa, a combination of experimental techniques including CCK‐8 assay, flow cytometry, wound‐healing assay, Transwell assay, and Co‐IP assay were employed. The FOXS1 expression levels were significantly raised in PCa, correlating strongly with tumor aggressiveness and an unfavorable prognosis. Regulating FOXS1 expression, whether upregulating or downregulating it, correspondingly enhanced or inhibited the growth, migration, and invasion capabilities of PCa cells. Mechanistically, we detected a direct interaction between FOXS1 and HILPDA, resulting in the pathway activation of FAK/PI3K/AKT and facilitation EMT in PCa cells. FOXS1 collaborates with HILPDA to initiate EMT, thereby facilitating the PCa progression through the FAK/PI3K/AKT pathway activation.
Postmenopausal Bleeding After Coronavirus Disease 2019 (COVID-19) Vaccination
Authors: Strid Penelope , Abara Winston E. , Clark Elizabeth , Moro Pedro L. , Olson Christine K. , Gee Julianne
Published: May 2024

We identified U.S. reports of postmenopausal bleeding in the VAERS (Vaccine Adverse Event Reporting System) between December 13, 2020, and December 13, 2021. Among 711,224 VAERS reports after coronavirus disease 2019 (COVID-19) vaccination, during our study period, we identified 554 presumptive postmenopausal bleeding reports; 434 were further classified as verified based on data abstracted from reports and medical records, when available. In the United States, by December 14, 2021, 58.8 million women aged 50 years or older had received at least one dose of a COVID-19 vaccine, corresponding to approximately seven verified VAERS postmenopausal bleeding reports per 1 million women aged 50 years or older who received a COVID-19 vaccine. Reports of postmenopausal bleeding after COVID-19 vaccination in VAERS were rare, and causes of postmenopausal bleeding based on medical record review were consistent with known causes of postmenopausal bleeding.
Assessing Contraceptive Switching and Discontinuation Over 3 Years in the HER Salt Lake Study
Authors: Simmons Rebecca G. , Carter Gentry , Sanders Jessica N. , Turok David K.
Published: May 2024

OBJECTIVE:

To assess contraceptive switching and discontinuation among participants enrolled in a contraceptive access project over 3 years and to identify variables associated with contraceptive change.

METHODS:

The HER Salt Lake study enrolled individuals between 2015 and 2017 from four clinics in Salt Lake County into a prospective, longitudinal cohort. All participants were able to switch or discontinue at no cost (between March 2016 and March 2020). We collected eight follow-up surveys over 3 years after enrollment. Each survey wave included questions about method use in the previous 4 weeks. We categorized participants in three ways, allowing for time-varying outcomes by wave: 1) those who reported using the same method as previous wave (continuers), 2) those who reported using a different method from previous wave (switchers), and 3) those who reported using no contraceptive method at that wave (discontinuers). We report the frequency of outcomes and conducted multinomial regression models assessing predictors of switching and discontinuation.

RESULTS:

Among 4,289 participants included in this analysis, 2,179 (50.8%) reported at least one instance of switching or discontinuation, and 2,110 (49.1%) reported continuing with their baseline method at the end of the study. Those reporting method change (switching or discontinuing) reported an average of 1.93 change events over the study follow-up period (range 1–8). Among those reporting any method change, 522 participants (23.9%) reporting at least one instance of both switching and discontinuation. Among those reporting any instance of discontinuation (n=966), 498 (51.6%) never reported uptake of a subsequent method. Among those who did report a subsequent method (n=468), 210 (44.8%) reported restarting a previously used method, and 258 (55.1%) reported starting a new method. Although we identified overlap among variables associated with switching and discontinuation, other predictors were discordant between switching and discontinuation.

CONCLUSION:

New contraceptive users commonly switch and discontinue methods. User behavior is associated with certain demographic characteristics and pregnancy planning.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02734199.
Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI
Authors: Baljoun Amna , Bradley Catharine S. , Verma Yashvi , Wedge John H. , Gargan Martin F. , Kelley Simon P.
Published: May 2024

Background:

Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI.

Methods:

This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated.

Results:

Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery (P<0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery (P=0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI (P=0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention (P=0.51), and at cast removal, there were 3 subluxations in each group (P=0.69) and 1 redislocation in the 3D group (P=1.00).

Conclusions:

Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH.

Level of Evidence:

Diagnostic Study, level II.
Utilization and Outcomes in U.S. ICU Hospitalizations*
Authors: Kannan Sneha , Giuriato Mia , Song Zirui
Published: May 2024

OBJECTIVES:

Despite its importance, detailed national estimates of ICU utilization and outcomes remain lacking. We aimed to characterize trends in ICU utilization and outcomes over a recent 12-year period in the United States.

DESIGN/SETTING:

In this longitudinal study, we examined hospitalizations involving ICU care (“ICU hospitalizations”) alongside hospitalizations not involving ICU care (“non-ICU hospitalizations”) among traditional Medicare beneficiaries using 100% Medicare part A claims data and commercial claims data for the under 65 adult population from 2008 to 2019.

PATIENTS/INTERVENTIONS:

There were 18,313,637 ICU hospitalizations and 78,501,532 non-ICU hospitalizations in Medicare, and 1,989,222 ICU hospitalizations and 16,732,960 non-ICU hospitalizations in the commercially insured population.

MEASUREMENTS AND MAIN RESULTS:

From 2008 to 2019, about 20% of Medicare hospitalizations and 10% of commercial hospitalizations involved ICU care. Among these ICU hospitalizations, length of stay and ICU length of stay decreased on average. Mortality and hospital readmissions on average also decreased, and they decreased more among ICU hospitalizations than among non-ICU hospitalizations, for both Medicare and commercially insured patients. Both Medicare and commercial populations experienced a growth in shorter ICU hospitalizations (between 2 and 7 d in length), which were characterized by shorter ICU stays and lower mortality. Among these short hospitalizations in the Medicare population, for common clinical diagnoses cared for in both ICU and non-ICU settings, patients were increasingly triaged into an ICU during the study period, despite being younger and having shorter hospital stays.

CONCLUSIONS:

ICUs are used in a sizeable share of hospitalizations. From 2008 to 2019, ICU length of stay and mortality have declined, while short ICU hospitalizations have increased. In particular, for clinical conditions often managed both within and outside of an ICU, shorter ICU hospitalizations involving younger patients have increased. Our findings motivate opportunities to better understand ICU utilization and to improve the value of ICU care for patients and payers.
Deciphering the Enigma of Intramyocardial Hemorrhage Following Reperfusion Therapy in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Exploration from Mechanisms to Therapeutic Strategies
Authors: Yang Yong xin , Zhou Fei , Wen Te , Li Wen jing
Published: May 2024

Acute ST-segment elevation myocardial infarction (STEMI) is a formidable challenge in cardiovascular medicine, demanding advanced reperfusion strategies such as emergency percutaneous coronary intervention. While successful revascularization is pivotal, the persistent “no-reflow” phenomenon remains a clinical hurdle, often intertwined with microvascular dysfunction. Within this intricate scenario, the emergence of intramyocardial hemorrhage (IMH) has garnered attention as a significant contributor. This review offers a detailed exploration of the multifaceted relationship between IMH and the “no-reflow” phenomenon, delving into the mechanisms governing IMH occurrence, state-of-the-art diagnostic modalities, predictive factors, clinical implications, and the evolving landscape of preventive and therapeutic strategies. The nuanced examination aims to deepen our comprehension of IMH, providing a foundation for the identification of innovative therapeutic avenues and enhanced clinical outcomes for STEMI patients.
Unique bile acid profiles in the bile ducts of patients with primary sclerosing cholangitis
Authors: Kayashima Atsuto , Sujino Tomohisa , Fukuhara Seiichiro , Miyamoto Kentaro , Kubosawa Yoko , Ichikawa Masataka , Kawasaki Shintaro , Takabayashi Kaoru , Iwasaki Eisuke , Kato Motohiko , Honda Akira , Kanai Takanori , Nakamoto Nobuhiro
Published: May 2024

Background:

The relationship between primary sclerosing cholangitis (PSC) and biliary bile acids (BAs) remains unclear. Although a few studies have compared PSC biliary BAs with other diseases, they did not exclude the influence of cholestasis, which affects the composition of BAs. We compared biliary BAs and microbiota among patients with PSC, controls without cholestasis, and controls with cholestasis, based on the hypothesis that alterations in BAs underlie the pathophysiology of PSC.

Methods:

Bile samples were obtained using endoscopic retrograde cholangiopancreatography from patients with PSC (n = 14), non-hepato-pancreato-biliary patients without cholestasis (n = 15), and patients with cholestasis (n = 13).

Results:

The BA profiles showed that patients with PSC and cholestasis controls had significantly lower secondary BAs than non-cholestasis controls, as expected, whereas the ratio of cholic acid/chenodeoxycholic acid in patients with PSC was significantly lower despite cholestasis, and the ratio of (cholic acid + deoxycholic acid)/(chenodeoxycholic acid + lithocholic acid) in patients with PSC was significantly lower than that in the controls with or without cholestasis. The BA ratio in the bile of patients with PSC showed a similar trend in the serum. Moreover, there were correlations between the alteration of BAs and clinical data that differed from those of the cholestasis controls. Biliary microbiota did not differ among the groups.

Conclusions:

Patients with PSC showed characteristic biliary and serum BA compositions that were different from those in other groups. These findings suggest that the BA synthesis system in patients with PSC differs from that in controls and patients with other cholestatic diseases. Our approach to assessing BAs provides insights into the pathophysiology of PSC.
Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies
Authors: Gherbesi Elisa , Faggiano Andrea , Sala Carla , Carugo Stefano , Grassi Guido , Tadic Marijana , Cuspidi Cesare
Published: May 2024

Background:

Obesity is a risk factor for left ventricular hypertrophy (LVH) and diastolic dysfunction. Available evidence on impaired myocardial deformation in obese patients without apparent systolic dysfunction assessed by LV ejection fraction (LVEF) is based on single studies. The aim of the present meta-analysis was to provide a comprehensive and updated information on this issue.

Methods:

The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search English-language articles published from the inception up to 31 December 2023. Studies were identified by using MeSH terms and crossing the following search items: ‘myocardial strain’, ‘left ventricular mechanics’, ‘longitudinal global strain’, ‘speckle tracking echocardiography’, ‘systolic dysfunction’, ‘left ventricular ejection fraction’, and ‘obesity’.

Results:

Twenty-four studies including 5792 obese and 5518 nonobese individuals from different clinical settings were considered for the analysis. LV global longitudinal strain (GLS) was significantly impaired in the obese group [standard means difference (SMD): −0.86 ± 0.08; confidence interval (CI) −1.02 to −0.69, P < 0.0001] and this was paralleled by a significant difference in pooled LVEF between obese and controls (SMD −0.27 ± 0.06; CI −0.40 to −0.15, P < 0.0001). Unlike GLS, however, the majority of the selected studies failed to show statistically significant differences in LVEF. Furthermore, in patients with advanced obesity (BMI > 35 kg/m2, data from six studies), LV systolic dysfunction was more significantly detected by GLS (SMD −1.24 ± 0.19, CI −1.61/-0.87, P < 0.0001) than by LVEF (SMD −0.54 ± 0.27, CI −1.07 to −0.01, P = 0.046).

Conclusion:

The present meta-analysis suggests that GLS may unmask systolic dysfunction often undetected by conventional LVEF in the obese setting; thus, this parameter should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage.
Effects of potassium supplementation on plasma aldosterone: a systematic review and meta-analysis in humans
Authors: McNally Ryan J. , Farukh Bushra , Chowienczyk Philip J. , Faconti Luca
Published: May 2024

Objectives:

Effects of potassium supplementation on blood pressure (BP) may be offset by an increase in plasma aldosterone. The magnitude of potassium-dependent regulation of aldosterone secretion in humans is not fully characterized; it is not clear whether this is mediated by activation of the renin–angiotensin–aldosterone system (RAAS), as a result of a reduction in BP or other mechanisms. We performed a systematic review and meta-analysis of clinical trials assessing effects of potassium on plasma aldosterone and renin in adult individuals.

Methods:

This was carried out in accordance with PRISMA guidelines. Three databases were searched: MEDLINE, EMBASE and CENTRAL. Titles were firstly screened by title and abstract for relevance before full-text articles were assessed for eligibility. The keywords used included “aldosterone”, “potassium” and “RAAS”.

Results:

6395 articles were retrieved and after title/abstract screening, 123 full-text articles were assessed for eligibility. Thirty-six met the prespecified inclusion/exclusion criteria (of which 18/36 also reported systolic BP). Potassium supplementation caused a significant decrease in systolic BP (mean difference [95% CI] −3.69 mmHg [−4.91, −2.46], P < 0.001) and increase in serum potassium (+0.37 [0.23, 0.52] mmol/l, P < 0.001). There was an increase in plasma aldosterone (standardized difference 0.426 [0.299, 0.553], P < 0.001) but not in plasma renin activity. Meta-regression showed a significant positive correlation between change in plasma aldosterone and change in serum potassium (P < 0.001).

Conclusions:

Potassium supplementation increases plasma aldosterone concentrations, which correlates with the increase in serum potassium concentration which does not appear to be mediated by an increase in plasma renin activity.
Association of sleep traits with risk of hypertensive disorders of pregnancy: a mendelian randomization study
Authors: Zhao Huanqiang , Wen Ping , Xiong Yu , Xu Qixin , Zi Yang , Zheng Xiujie , Chen Shiguo , Qin Yueyuan , Shao Shuyi , Tu Xinzhi , Zheng Zheng , Li Xiaotian
Published: May 2024

Background:

Unhealthy sleep patterns are common during pregnancy and have been associated with an increased risk of developing hypertensive disorders of pregnancy (HDPs) in observational studies. However, the causality underlying these associations remains uncertain. This study aimed to evaluate the potential causal association between seven sleep traits and the risk of HDPs using a two-sample Mendelian randomization study.

Methods:

Genome-wide association study (GWAS) summary statistics were obtained from the FinnGen consortium, UK Biobank, and other prominent consortia, with a focus on individuals of European ancestry. The primary analysis utilized an inverse-variance-weighted MR approach supplemented by sensitivity analyses to mitigate potential biases introduced by pleiotropy. Furthermore, a two-step MR framework was employed for mediation analyses.

Results:

The data analyzed included 200 000–500 000 individuals for each sleep trait, along with approximately 15 000 cases of HDPs. Genetically predicted excessive daytime sleepiness (EDS) exhibited a significant association with an increased risk of HDPs [odds ratio (OR) 2.96, 95% confidence interval (95% CI) 1.40–6.26], and the specific subtype of preeclampsia/eclampsia (OR 2.97, 95% CI 1.06–8.3). Similarly, genetically predicted obstructive sleep apnea (OSA) was associated with a higher risk of HDPs (OR 1.27, 95% CI 1.09–1.47). Sensitivity analysis validated the robustness of these associations. Mediation analysis showed that BMI mediated approximately 25% of the association between EDS and HDPs, while mediating up to approximately 60% of the association between OSA and the outcomes. No statistically significant associations were observed between other genetically predicted sleep traits, such as chronotype, daytime napping, sleep duration, insomnia, snoring, and the risk of HDPs.

Conclusion:

Our findings suggest a causal association between two sleep disorders, EDS and OSA, and the risk of HDPs, with BMI acting as a crucial mediator. EDS and OSA demonstrate promise as potentially preventable risk factors for HDPs, and targeting BMI may represent an alternative treatment strategy to mitigate the adverse impact of sleep disorders.
Recognition vs resolution charts for defocus curve determination in trifocal intraocular lenses
Authors: Tañá-Rivero Pedro , Tañá-Sanz Pedro , Tañá-Sanz Santiago , Montés-Micó Robert , Cerviño Alejandro
Published: May 2024

Purpose:

To determine the impact of optotype choice on the determination of defocus curve in patients with cataract implanted with presbyopia-correcting intraocular lens (IOL).

Setting:

Oftalvist Alicante, Alicante, Spain.

Design:

Observational case-control study.

Methods:

Patients implanted with Asqelio Trifocal IOL participated in this study. Uncorrected and corrected distance visual acuity (VA) and subjective refraction were determined. Monocular defocus curves were obtained 6 months postoperatively with the Clinical Trial Suite system using either Early Treatment Diabetic Retinopathy Study (ETDRS) or Landolt C charts under photopic conditions (85 cd/m2), and range of vergence from +2.00 to −5.00 diopters (D) in 0.50 D steps.

Results:

A total of 49 patients were enrolled in the study, 24 in the ETDRS group (7 male, 17 female) and 25 in the Landolt C group (5 male, 20 female). Nonsignificant differences were found between patients conforming both groups, except for preoperative intraocular pressure and white-to-white distance. All patients were within ±1.00 D from intended refraction after surgery. 75% of patients in the ETDRS group and 84% in the Landolt C group were within ±0.50 D. Average difference between the groups across vergences provided by the defocus curve was 0.12 ± 0.05 logMAR units, significant for all vergences (P < .05). Differences in VA were significant for distance, intermediate, and near between both groups, except for uncorrected distance VA.

Conclusions:

Defocus curves created using Landolt C charts yield significantly lower through-focus outcomes than those created with standard ETDRS charts. This should be taken into account when comparing the performance of presbyopia-correcting systems across studies where recognition charts might have been used because of patient characteristics.
Comparison of complications and visual outcomes of combined phacovitrectomy vs stand-alone phacoemulsification: multicenter database study
Authors: Bakr Mohammad , Elhusseiny Abdelrahman M. , Toma Joseph , Sallam Ahmed B.
Published: May 2024

Purpose:

To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) with those with stand-alone phacoemulsification.

Setting:

A multicenter database study across 8 ophthalmology departments in the United Kingdom.

Design:

Retrospective, nonrandomized, multicenter comparative study.

Methods:

We extracted data for patients who underwent Phaco-PPV and stand-alone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME postoperatively.

Results:

The study included 2222 eyes in the combined Phaco-PPV group and 112 689 in the stand-alone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs 1.7%), dropped lens fragments (0.5% vs 0.2%), suprachoroidal hemorrhage (0.4% vs 0.1%), and CME (3.6 vs 1.1%) (P < .001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs 20/100) in the stand-alone phacoemulsification group (P < .001). VA at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs 0.22 logMAR (Snellen ∼20/100 vs 20/32), P < .001).

Conclusions:

Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative VA, when compared with stand-alone phacoemulsification surgery.
Perioperative outcomes and safety of valveless insufflation system in minimally invasive urological surgery: a systematic review and meta-analysis
Authors: Lu Youyi , Zou Qingsong , Jiang Bo , Li Qi
Published: May 2024

Background:

With the rapid development of laparoscopic and robot-assisted surgery, many technological innovations and improvements have emerged to optimize minimally invasive surgery and ensure minimal patient risk. Although AirSeal has been widely reported in the field of urology, its perioperative outcomes and safety in minimally invasive urological surgery remain unclear because of inconsistent levels of evidence.

Objectives:

The authors performed this meta-analysis to evaluate the perioperative outcomes and safety of the valveless insufflation system (VIS) in minimally invasive urological surgery compared with the conventional insufflation system (CIS).

Methods:

The authors comprehensively searched PubMed, Web of Science, Cochrane Library, and Embase databases to identify eligible studies published up to January 2024. Review Manager software (version 5.3.0) was used for the statistical analysis. Eligible studies were randomized controlled trials (RCTs) or non-RCTs of minimally invasive urological surgery with VIS vs CIS. The study outcomes included perioperative outcomes and safety. The authors excluded publication types, including letters, reviews, case reports, and animal and pediatric studies.

Results:

The authors finally identified five RCTs and eight non-RCTs in this meta-analysis. The meta- analysis indicated that the operative time was comparable between the groups (P=0.57, I
2=91%). However, a VIS may increase blood loss (P=0.0004, I
2=45%) and shorten hospital stays (P<0.00001, I
2=90%). Due to the high heterogeneity of the results, the authors carefully evaluated all included studies and discovered that the studies by Bucur and Ferroni may be the sources of heterogeneity. When these two studies were excluded, heterogeneity was significantly reduced, and the operative time for VIS was significantly shorter than that for CIS (P=0.0002). Adjusted blood loss showed no difference between the VIS and CIS groups (P=0.10). In terms of safety, the pooled results revealed that the incidence of Clavien–Dindo III–IV complications in the VIS group was significantly lower than that in the CIS group (P=0.02, I
2=0%). Moreover, VIS significantly reduced general pain (P=0.02, I
2=15%) and shoulder pain (P=0.001, I
2=0%) 12–24 h postoperatively. No significant differences were observed in total complications (P=0.06, I
2=0%), blood transfusion (P=0.14, I
2=0%), and subcutaneous emphysema (P=0.96, I
2=63%) between the two groups.

Conclusions:

Our meta-analysis revealed additional perioperative advantages of the VIS in minimally invasive urological surgery. Moreover, VIS is superior to CIS owing to less severe complication rates, general pain, and shoulder pain.
Prediction of the pathological subtypes by intraoperative frozen section for patients with cT1N0M0 invasive lung adenocarcinoma (ECTOP-1015): a prospective multicenter study
Authors: Fu Zichen , Shen Xuxia , Deng Chaoqiang , Cao Hang , Jin Yan , Zheng Qiang , Yang Yongguo , Qian Bin , Yuan Chunyan , Wang Weihua , Zhang Lei , Song Qingping , Zuo Shuying , Ma Junjie , You Shuqing , Zheng Senzhong , Gao Qingli , Su Guangli , Zhang Yang , Fu Fangqiu , Chen Haiquan , Li Yuan
Published: May 2024

Background:

This study aims to assess the diagnostic accuracy of the intraoperative frozen section (FS) in determining the pathological subtypes among patients diagnosed with cT1N0M0 invasive lung adenocarcinoma.

Materials and methods:

This was a prospective, multicenter (seven centers in China) clinical trial of Eastern Cooperative Thoracic Oncology Projects (ECTOP-1015). Patients with cT1N0M0 invasive lung adenocarcinoma were enrolled in the study. Pathological images obtained from FS and final pathology (FP) were reviewed by at least two pathologists. The primary endpoint was the concordance between FS and FP diagnoses. The interobserver agreement for identifying pathological subtypes on FS was evaluated among three pathologists.

Results:

A total of 935 patients were enrolled. The best sensitivity of diagnosing the predominant subtype was 78.2% in the evaluation of the acinar pattern. The presence of an acinar pattern diagnosed by FS was an independent factor for the concordance between FS and FP (P=0.007, 95% confidence interval: 2.332–4.736). Patients with tumor size >2 cm measured by pathology showed a better concordance rate for the predominant subtype (81.6% vs. 74.6%, P=0.023). The presence of radiological ground glass opacity component did not affect the diagnosis accuracy of FS for the predominant subtype (concordance rate: 76.4% vs. 75.2%, P=0.687). Patients with ground glass opacity component showed better accuracy of the identification in the presence of lepidic pattern-predominant adenocarcinoma (82.1% vs. 71.0%, P=0.026). Substantial agreement between the FS diagnosis from three pathologists for the predominant pathological pattern was revealed with κ=0.846.

Conclusions:

This is the largest prospective trial evaluating FS diagnosing pathological subtype in cT1N0M0 invasive lung adenocarcinoma. A favorable concordance in the assessment of the pathological subtypes between FS and FP was observed, indicating the feasibility of utilizing accurate intraoperative pathological diagnoses from FS in guiding surgical strategies. A combination of radiology could improve the precision of FS.
Sleep patterns, genetic susceptibility, and digestive diseases: a large-scale longitudinal cohort study
Authors: Ma Yuying , Yu Shiyi , Li Qinming , Zhang Haifeng , Zeng Ruijie , Luo Ruibang , Lian Qizhou , Leung Felix W. , Duan Chongyang , Sha Weihong , Chen Hao
Published: May 2024

Background:

Sleep problems are prevalent. However, the impact of sleep patterns on digestive diseases remains uncertain. Moreover, the interaction between sleep patterns and genetic predisposition with digestive diseases has not been comprehensively explored.

Methods:

Four hundred ten thousand five hundred eighty-six participants from UK Biobank with complete sleep information were included in the analysis. Sleep patterns were measured by sleep scores as the primary exposure, based on five healthy sleep behaviors. Individual sleep behaviors were secondary exposures. Genetic risk of the digestive diseases was characterized by polygenic risk score. Primary outcome was incidence of 16 digestive diseases.

Results:

Healthy sleep scores showed dose-response associations with reduced risks of digestive diseases. Compared to participants scoring 0–1, those scoring 5 showed a 28% reduced risk of any digestive disease, including a 50% decrease in irritable bowel syndrome, 37% in non-alcoholic fatty liver disease, 35% in peptic ulcer, 34% in dyspepsia, 32% in gastroesophageal reflux disease, 28% in constipation, 25% in diverticulosis, 24% in severe liver disease, and 18% in gallbladder disease, whereas no correlation was observed with inflammatory bowel disease and pancreatic disease. Participants with poor sleep and high genetic risk exhibited approximately a 60% increase in the risk of digestive diseases. A healthy sleep pattern is linked to lower digestive disease risk in participants of all genetic risk levels.

Conclusions:

In this large population-based cohort, a healthy sleep pattern was associated with a reduced risk of digestive diseases, regardless of genetic susceptibility. The authors’ findings underscore the potential impact of healthy sleep traits in mitigating the risk of digestive diseases.
99mTc-DTPA dynamic SPECT/CT renogram in adults: feasibility and diagnostic benefit
Authors: Spiliotopoulou Maria , Papathanasiou Nikolaos , Łabieniec Łukasz , Papachristou Evangelos , Fokaefs Eleftherios , Spyridonidis Trifon , Fotopoulos Andreas , Apostolopoulos Dimitrios J.
Published: May 2024

Objective

The objective of this study is to investigate the feasibility and potential advantages of 99mTc-DTPA dynamic single photon emission computed tomography/computed tomography (SPECT/CT) renogram in adults.

Methods

Fifty-five patients aged 19–80 years (mean 56.3) were enrolled. The imaging protocol included: day 1: 99mTc-DTPA planar renogram, followed by planar 99mTc-DMSA scan. Day 3: attenuation-corrected dynamic 99mTc-DTPA SPECT renogram [DSPECT(AC)] and Cr-51 ethylenediamine tetraacetic acid (EDTA) glomerular filtration rate (GFR) calculation. DSPECT(AC) included an initial CT scan followed by 12 consecutive SPECT sessions acquired via continuous-mode acquisition for a total of 24 min. Fast SPECT sequences (1–2 s/projection, 60 projections, every 6°) were obtained for the first 8 min, followed by slower acquisitions (3–4 s/projection) during the rest of the study. Renal activity was measured in the total kidney volume by regions of interest drawn on consecutive transaxial slices of the third SPECT, which were then copied on the whole 12-SPECT series. Corresponding time-activity curves were created. DSPECT(AC) parameters were compared with those of planar renogram. The reference method for split renal function was 99mTc-DMSA (geometrical mean of anterior and posterior projection counts) and for GFR the Cr-51 EDTA 2-blood sample clearance method.

Results

DSPECT(AC) images were of good quality. There was good correlation between renogram parameters (time to peak activity and NORA20) comparing the two techniques (r = 0.959 and 0.933, respectively). In 21 cases with >30% absolute difference between the two kidneys, spilt renal function calculation by DSPECT(AC) correlated perfectly (r = 0.968) with the reference method, whereas planar renogram was less accurate (r = 0.843). Anatomic information provided by nonenhanced CT offered an integrated structural-functional view valuable for final diagnosis. DSPECT(AC) early kidney uptake as a fraction of injected dose correlated better with reference GFR (r = 0.789) than the Gates’ method (r = 0.642).

Conclusion

99mTc-DTPA dynamic SPECT/CT renogram is feasible with conventional SPECT/CT systems. It allows accurate split renal function measurement, offers additional anatomical information and can be used for closer approximation of GFR compared with Gates’ method.
Molecular Classification Outperforms Histologic Classification in Prognostication of High-grade Endometrial Carcinomas With Undifferentiated and Sarcomatous Components
Authors: Hammer Phoebe M. , Wang Aihui , Vermij Lisa , Zdravkovic Sabrina , Heilbroner Lucas , Ryan Emily , Geisick Rachel L.P. , Charu Vivek , Longacre Teri A. , Suarez Carlos J. , Ho Chandler , Jenkins Taylor M. , Mills Anne M. , Bosse Tjalling , Howitt Brooke E.
Published: May 2024

Since the establishment of 4 molecular subgroups of endometrial carcinoma (EC), there has been significant interest in understanding molecular classification in the context of histologic features and diagnoses. ECs with undifferentiated, spindle, and/or sarcomatous components represent a diagnostically challenging subset of tumors with overlapping clinical and histologic features. We examined the clinicopathologic, morphologic, immunohistochemical, and molecular features of these tumors identified in our institutions’ pathology databases using immunohistochemistry and targeted sequencing. Disease-specific survival (DSS) and progression-free survival (PFS) were analyzed using Kaplan-Meier curves and log-rank tests. One hundred sixty-two ECs were included: carcinosarcomas (UCS; n=96), dedifferentiated/undifferentiated EC (DDEC/UDEC; n=49), and grade 3 endometrioid EC with spindled growth (GR3spEEC) (n=17). All molecular subgroups were represented in all histologic subtypes and included 12 (7%)POLE-mutated (POLEmut), 43 (27%) mismatch repair-deficient (MMRd), 77 (48%) p53-abnormal (p53abn), and 30 (19%) no specific molecular profile (NSMP) tumors. However, the molecular classification (irrespective of histologic diagnosis) was a significant predictor for both DSS (P=0.008) and P≤0.0001).POLEmut EC showed an excellent prognosis with no recurrences or deaths from the disease. MMRd tumors also showed better outcomes relative to NSMP and p53abn tumors. In conclusion, molecular classification provides better prognostic information than histologic diagnosis for high-grade EC with undifferentiated and sarcomatous components. Our study strongly supports routine molecular classification of these tumors, with emphasis on molecular group, rather than histologic subtyping, in providing prognostication.
New Morbidities During Critical Illness and Associated Risk of ICU Readmission: Virtual Pediatric Systems Cohort, 2017–2020*
Authors: Heneghan Julia A. , Akande Manzilat Y. , Ramgopal Sriram , Evans Michael D. , Hallman Madhura , Goodman Denise M.
Published: May 2024

OBJECTIVES:

To describe change in Functional Status Scale (FSS) associated with critical illness and assess associated development of new morbidities with PICU readmission.

DESIGN:

Retrospective, cross-sectional cohort study using the Virtual Pediatric Systems (VPS; Los Angeles, CA) database.

SETTING:

One hundred twenty-six U.S. PICUs participating in VPS.

SUBJECTS:

Children younger than 21 years old admitted 2017–2020 and followed to December 2022.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 40,654 patients, 86.2% were classified as having good function or mild dysfunction before illness. Most patients did not have a change in their FSS category during hospitalization. Survival with new morbidity occurred most in children with baseline good/mild dysfunction (8.7%). Hospital mortality increased across categories of baseline dysfunction. Of 39,701 survivors, 14.2% were readmitted within 1 year. Median time to readmission was 159 days. In multivariable, mixed-effects Cox modeling, time to readmission was most associated with discharge functional status (hazard ratio [HR], 5.3 [95% CI, 4.6–6.1] for those with very severe dysfunction), and associated with lower hazard in those who survived with new morbidity (HR, 0.7 [95% CI, 0.6–0.7]).

CONCLUSIONS:

Development of new morbidities occurs commonly in pediatric critical illness, but we failed to find an association with greater hazard of PICU readmission. Instead, patient functional status is associated with hazard of PICU readmission.
Diagnosis and Management of an Enlarging Placental Immature Teratoma: A Case Report
Authors: Delio Melissa C. , Wang Michelle J. , Young Brett , Perry John , Hecht Jonathan L.
Published: May 2024

The clinical imaging and pathology of a rare case of immature teratoma of the placenta is presented with a discussion of controversies related to classification and clinical suggestions for therapy and follow-up.
Finding Perforator “Freeway” for Design Optimization of Expanded Flaps by Indocyanine Green Angiography
Authors: Xie Tingjun , Liu Yuanbo , Zhu Shan , Li Shanshan , Chen Zixiang , Han Tinglu , Jin Shengyang , Wang Miao , Zang Mengqing
Published: May 2024

Indocyanine green angiography (ICGA) is a useful tool for the visual assessment of superficial blood flow. The authors used ICGA to visualize perforator branches and linking vessels to provide a road map for flap design of an expanded flap. Twenty-eight expansions were planned to use the back-cut technique in 26 patients. ICGA was used to visualize the perforator branching pattern with the linking vessels and the venous network in the expanded flap before expander explantation. The appropriate perforator was selected, and the flap was designed following the axiality of its branch linked by true anastomoses. The vein running closely was chosen as the axial vein. The back cut was designed to avoid transection of the axial artery and vein. Patient characteristics, defect characteristics, and reconstructive outcomes were assessed. ICGA clearly visualized the perforator branches and the linking vessels in the expanded flap at 4the head and neck, trunk, and extremity. The back-cut flap containing the axial artery and vein was raised successfully in 27 expansions. The arterial perforator and superficial vein separated greatly and resulted in design modification from back-cut to advancement flap in one expansion. All expanded flaps met the reconstructive needs and exhibited complete survival. ICGA allowed the visualization of the preoperative topography of the vascular network in the expanded flap and helped surgeons locate the vascular axis and perform an appropriate back-cut design for efficient and safe flap transfer.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Photometric Comparison of Skin Color Match between Abdominal and Thigh-Based Free Flaps for Breast Reconstruction in White Patients
Authors: Mahrhofer Maximilian , Reichert Raphael , Fierdel Frederic , Gu Xinchen , Grabenwöger Johannes , Russe Elisabeth , Schoeller Thomas , Weitgasser Laurenz
Published: May 2024

Background:

With the increasing demand for autologous breast reconstruction, different surgical techniques have emerged to provide patients with the best possible result tailored to their individual needs. The upper thigh provides an alternative tissue resource in patients where abdominal based flaps are not feasible. Although surgical outcomes and donor-site morbidity demonstrate favorable results using abdominal and thigh-based free flaps for autologous breast reconstruction, the differences in skin constitution and color between the two flap donor sites have not been investigated.

Methods:

From the authors’ flap database, 60 patients who underwent unilateral secondary breast reconstruction with free deep inferior epigastric perforator (DIEP) or transverse myocutaneous gracilis (TMG) flaps where randomly selected. In both cohorts, postoperative pictures were used for photometric color evaluation of the reconstructed breast using the delta E (ΔE) 2000 score at time A (1.5 to 3 months), time B (6 to 8 months), and time C (12 to 20 months). Standard univariate descriptive statistics and group comparisons were performed.

Results:

The DIEP flap demonstrated a better skin color match at time A (P < 0.001), time B (P = 0.003), and time C (P = 0.009). Over time, both flaps showed improved ΔE 2000 values, and patient age was only associated with higher ΔE 2000 values in TMG flaps after 1.5 to 3 months (P = 0.021).

Conclusions:

The study provides the first objective analysis of skin color match in secondary autologous breast reconstruction. The DIEP flap reconstruction shows a preferable color match compared with the TMG flap. Both free flaps demonstrate an improved skin color match 12 to 20 months after secondary breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Estimated Fetal Radiation Dose From 18F-FDG PET/CT During the Second and Third Trimesters of Pregnancy
Authors: Al Mansour Laure , Tylski Perrine , Chene Gautier , Plaisant Franck , Janier Marc , Bolze Pierre Adrien , You Benoit , Defez Didier , Tordo Jérémie , Flaus Anthime
Published: May 2024

Purpose

Data published in the literature concerning the doses received by fetuses exposed to a 18F-FDG PET are reassuring but were obtained from small and heterogeneous cohorts, and very few data are available concerning the fetal dose received after exposure to both PET and CT. The present study aimed to estimate the fetal dose received following a PET/CT exposure using methods that include anthropomorphic phantoms of pregnant women applied on a large cohort.

Patients and Methods

This retrospective multicenter study included 18 pregnant patients in the second and third trimesters. For PET exposure, the fetal volume and mean concentration of radioactivity in the fetus were measured by manually drawing regions of interest. Those data, combined with the time-integrated activities of the fetus and the mother’s organs, were entered into the OLINDA/EXM software 2.0 to assess the fetal dose due to PET exposure. To estimate the fetal dose received due to CT exposure, 2 softwares were used: CT-Expo (based on geometric phantom models of nonpregnant patients) and VirtualDose (using pregnant patient phantoms).

Results

The fetal dose exposure for PET/CT examination in the second trimester ranged from 5.7 to 15.8 mGy using CT-Expo (mean, 11.6 mGy) and from 5.1 to 11.6 mGy using VirtualDose (mean, 8.6 mGy). In the third trimester, it ranged from 7.9 to 16.6 mGy using CT-Expo (mean, 10.7 mGy) and from 6.1 to 10.7 mGy using VirtualDose (mean, 7.6 mGy).

Conclusions

The estimated fetal doses were in the same range of those previously published and are well below the threshold for deterministic effects. Pregnancy does not constitute an absolute contraindication for a clinically justified hybrid 18F-FDG PET/CT.
Triple Tumors (Neuroendocrine Tumor, Schwannoma, and Papillary Thyroid Carcinoma) With Brain Lesions in a Single Patient Demonstrating Avidity on 68Ga-DOTATATE PET/CT and Their Characterization With FDG-PET/CT and Brain MRI
Authors: Parghane Rahul V. , Basu Sandip
Published: May 2024

Neuroendocrine tumor (NET) typically spreads to the liver, lymph nodes, lungs, and skeleton. Brain metastasis in NET is uncommon. Therefore, each case of detected brain metastases in NET is crucial for the development of treatment guidelines for these types of tumors. We present a unique case of triple tumors (NET, papillary thyroid carcinoma, and schwannoma) in a single patient who presented with neurological symptoms and somatostatin receptor–avid T2 hyperintense multiple metastatic brain lesions from NET on 68Ga-DOTATATE-PET/CT scan and brain MRI. Despite the rarity of brain metastases in NET, we conclude that the presence of neurological sign or symptoms and/or the detection of somatostatin receptor–avid brain lesions in patients with NET should raise suspicion of brain metastases.
The Development of a European Multidisciplinary Cleft Lip and Palate Registry by the European Reference Network CRANIO: Experiences, Barriers, And Facilitators
Authors: van der Goes Philip A.J. , Ombashi Saranda , van Roey Victor , Hakelius Malin , Mathijssen Irene M.J. , Mink van der Molen Aebele B. , Versnel Sarah L.
Published: May 2024

The European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders aims to improve care for patients with such afflictions, including cleft lip and palate (CL/P) across Europe. Cleft treatment remains varied throughout European centers, inhibiting meaningful comparison of treatment outcomes. To overcome these issues, a European-wide common CL/P dataset and registry was developed, facilitating standardized treatment endpoints and outcome measures for international comparison and benchmarking of CL/P centers. Questionnaires and semi-structured interviews were used to determine the set-up of the registry. Previous CL/P initiatives were analyzed to create an initial dataset, refined through consensus meetings. In total, 87 cleft specialists working in specialized CL/P centers from 16 European nations participated. Consensus on a common dataset was reached. A “Level 1” dataset, with mandatory clinical and patient-reported outcome measures, and “Level 2” dataset with additional outcome measures. Finally, 2 dashboards were developed for data dissemination. The development of the European CL/P common dataset and registry tackled challenges with resource disparities, variations in specialists within CL/P teams, regulatory differences in patient data usage, patient-reported outcome measures availability in European languages, and use of assessment tools. This study described the successful development of the European Reference Network for Rare Craniofacial Aanomalies and Ear-Nose-Throat disorders CL/P common dataset and registry. This achievement will help improve patient care and outcomes for patients with CL/P in Europe. Furthermore, this study provides useful information for initiatives with similar aims.