bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantification of trophic interactions in the Norwegian Sea pelagic food-web over multiple decades
Authors: Planque Benjamin , Favreau Aurélien , Husson Bérengère , Mousing Erik Askov , Hansen Cecilie , Broms Cecilie , Lindstrøm Ulf , Sivel Elliot
Published: July 2022

While ecosystem-based fisheries management calls for explicit accounting for interactions between exploited populations and their environment, moving from single species to ecosystem-level assessment is a significant challenge. For many ecologically significant groups, data may be lacking, collected at inappropriate scales or be highly uncertain. In this study, we aim to reconstruct trophic interactions in the Norwegian Sea pelagic food-web during the last three decades. For this purpose, we develop a food-web assessment model constrained by existing observations and knowledge. The model is based on inverse modelling and is designed to handle input observations and knowledge that are uncertain. We analyse if the reconstructed food-web dynamics are supportive of top-down or bottom-up controls on zooplankton and small pelagic fish and of competition for resources between the three small pelagic species. Despite high uncertainties in the reconstructed dynamics, the model results highlight that interannual variations in the biomass of copepods, krill, amphipods, herring, and blue whiting can primarily be explained by changes in their consumption rather than by predation and fishing. For mackerel, variations in biomass cannot be unambiguously attributed to either consumption or predation and fishing. The model results provide no support for top-down control on planktonic prey biomass and little support for the hypothesised competition for resources between the three small pelagic species, despite partially overlapping diets. This suggests that the lack of explicit accounting for trophic interactions between the three pelagic species likely have had little impact on the robustness of past stock assessments and management in the Norwegian Sea.
Length Unstable Pediatric Tibial Shaft Fracture Treated With Cerclage Augmented Elastic Intramedullary Nails: A Novel Technique
Authors: Miles Daniel T. , Scheinberg Mila , Quigley Robert S.
Published: July 2022

Introduction:

Tibial shaft fractures are common injuries in the pediatric population that can reliably be treated with conservative treatment. However, unstable tibial shaft fractures in the pediatric population have limited operative treatment options because the skeletal immaturity of these patients makes rigid intramedullary devices contraindicated in this population, and external fixation strategies are associated with a high complication rates. Elastic nailing with cerclage is a minimally invasive, and relatively soft tissue sparing technique that can decrease wide dissection and periosteal stripping associated with plating. However, treating long oblique length unstable femur fractures with elastic nails has been shown yield good result; EIN in length unstable tibia shaft fractures with elastic nails has not been explored.

Materials and Methods:

Review of 2 patients receiving novel cerclage augmented elastic nailing technique.

Results:

Patients included had complete follow-up to fracture union, had no surgical complications postoperatively, and no failure of fixation. Patients achieved full range of motion and strength compared with the contralateral uninjured limb. Both patients returned to preinjury activity levels with no limitations.

Discussion:

We present a novel technique using elastic nails in unstable long oblique tibia fractures with a cerclage augment. This can expand EIN indications to provide a load-sharing construct with relative stability to length unstable tibia fractures that EIN use would typically be contraindicated. This in turn affords the benefits of EIN such as reliable fracture healing, excellent functional and cosmetic results with a safe and reproducible surgical technique.
Characterization of Platelet Biologic Markers in the Early Pathogenesis of Postoperative Acute Respiratory Distress Syndrome
Authors: Yadav Hemang , Meade Laurie A. , Carter Rickey E. , Knutson Keith , Gajic Ognjen , Kor Daryl J.
Published: July 2022

IMPORTANCE:

Animal models and limited human studies have suggested a plausible role for platelets in the pathogenesis and resolution of acute respiratory distress syndrome (ARDS). However, there are little data regarding the role of platelets in ARDS development.

OBJECTIVES:

The objective of this study was to characterize the role of platelets in a postoperative ARDS model through an analysis of two platelet-specific biologic markers: thromboxane A2 (TxA2) and soluble CD-40-ligand (sCD40L).

DESIGN, SETTING, AND PARTICIPANTS:

This was a nested case-control study of ARDS cases matched to non-ARDS controls. Blood samples were collected from a cohort of 500 patients undergoing thoracic, aortic vascular, or cardiac surgery that placed them at high-risk of developing postoperative ARDS.

MAIN OUTCOMES AND MEASURES:

TxA2 and sCD40L were analyzed at baseline (prior to surgical incision) as well as 2 hours and 6 hours after the key intraoperative events believed to be associated with increased risk of postoperative ARDS.

RESULTS:

Of 500 patients enrolled, 20 ARDS cases were matched 1:2 to non-ARDS controls based on age, sex, surgical procedure, and surgical lung injury prediction score. Those who developed ARDS had longer surgeries, greater fluid administration, and higher peak inspiratory pressures. There were no significant differences in levels of TxA2 or sCD40L at baseline, at 2 hours, or at 6 hours. There was also no difference in the change in biomarker concentration between baseline and 2 hours or baseline and 6 hours.

CONCLUSIONS:

Two novel platelet-associated biologic markers (TxA2 and sCD40L) were not elevated in patients who developed ARDS in a postoperative ARDS model. Although limited by the relatively small study size, these results do not support a clear role for platelets in the early pathogenesis of postoperative ARDS.
Content features and its implementation in novel app-based psycho-oncological interventions for cancer survivors: a narrative review
Authors: Springer Franziska , Mehnert-Theuerkauf Anja
Published: July 2022

Purpose of review

The interest in and availability of app-based psycho-oncological interventions for cancer survivors has grown rapidly. In this narrative review, we therefore aim to provide an overview of the psychological content features included in psycho-oncological apps and how the content is implemented in the apps.

Recent findings

A total of 19 studies (six randomized controlled trials, six studies with prepost design, five study protocols and two app developments), all published in the last 18 months (July 2020 to December 2021), were analyzed in terms of the described app-based interventions and their psycho-oncological content. Apps for cancer survivors are conducted for a variety of different diagnoses and often target a specific patient population, for example patients with a specific therapy. The most frequent content features are psychoeducation, self-monitoring of symptoms, and some sort of exercise or relaxation program. Depending on the app's purpose, some offer specific content, such as decision aids, medication schedules or modules to improve coping strategies. Most apps combine informative and interactive elements.

Psycho-oncological apps for cancer survivors target many relevant psychological problem areas and aim to improve patient empowerment. Available mHealth interventions can therefore be seen as a good complement for cancer care and also offer the possibility to improve patient involvement.
Immunotherapy of sarcomas with modified T cells
Authors: Mahalingam Preethika , Julve Maximilian , Huang Paul , Furness Andrew J.S. , Pollack Seth M. , Jones Robin L.
Published: July 2022

Purpose of review

To summarize the development of modified T-cell therapies in sarcomas and discuss relevant published and ongoing clinical trials to date.

Recent findings

Numerous clinical trials are underway evaluating tumor-specific chimeric antigen receptor T cells and high affinity T-cell receptor (TCR)-transduced T cells in sarcomas. Notably, translocation-dependent synovial sarcoma and myxoid/round cell liposarcoma are the subject of several phase II trials evaluating TCRs targeting cancer testis antigens New York esophageal squamous cell carcinoma-1 (NY-ESO-1) and melanoma antigen-A4 (MAGE A4), and response rates of up to 60% have been observed for NY-ESO-1 directed, modified T cells in synovial sarcoma. Challenges posed by modified T-cell therapy include limitations conferred by HLA-restriction, non-immunogenic tumor microenvironments (TME), aggressive lymphodepletion and immune-mediated toxicities restricting coinfusion of cytokines.

Cellular therapy to augment the adaptive immune response through delivery of modified T cells is an area of novel therapeutic development in sarcomas where a reliably expressed, ubiquitous target antigen can be identified. Therapeutic tools to improve the specificity, signaling, proliferation and persistence of modified TCRs and augment clinical responses through safe manipulation of the sarcoma TME will be necessary to harness the full potential of this approach.
First and further-line multidisciplinary treatment of retroperitoneal sarcomas
Authors: D’Ambrosio Lorenzo , Van Houdt Winan , Stelmes Jean-Jacques , Gronchi Alessandro
Published: July 2022

Purpose of review

To review current knowledge and recent advances in retroperitoneal sarcoma management.

Recent findings

Surgery, radiotherapy, and medical treatments of retroperitoneal sarcomas should take into account the peculiarities of each histotype and the unique anatomical site. Surgery remains the mainstay of treatment and the only chance of cure for these diseases. In low-grade retroperitoneal sarcomas, like well differentiated liposarcoma, where the leading cause of death is dominated by local rather than distant relapses, treatment of the primary tumor encompasses extended surgery with multiorgan resection and evaluation of preoperative radiotherapy. Conversely, surgery is usually more conservative and without radiotherapy in those retroperitoneal sarcomas, such as leiomyosarcoma, characterized by a high risk of metastatic spread that prompted also the evaluation of neoadjuvant, histotype-driven chemotherapy. Surgery might have a role also for relapsed disease, despite long-term disease control probability declines at each recurrence. In advanced stages, anthracyclines still retain a key role and all medical treatment strategies should follow the specific chemosensitivity of each histotype to improve patient's outcomes.

The rarity and heterogeneity in biological behavior and clinical presentation of retroperitoneal sarcomas deserves a multidisciplinary and histotype-driven treatment at all stages of the disease to be performed in highly specialized centers.
Neoantigens in precision cancer immunotherapy: from identification to clinical applications
Authors: Zhang Qiao , Jia Qingzhu , Zhang Jing , Zhu Bo
Published: July 2022

Immunotherapies targeting cancer neoantigens are safe, effective, and precise. Neoantigens can be identified mainly by genomic techniques such as next-generation sequencing and high-throughput single-cell sequencing; proteomic techniques such as mass spectrometry; and bioinformatics tools based on high-throughput sequencing data, mass spectrometry data, and biological databases. Neoantigen-related therapies are widely used in clinical practice and include neoantigen vaccines, neoantigen-specific CD8+ and CD4+ T cells, and neoantigen-pulsed dendritic cells. In addition, neoantigens can be used as biomarkers to assess immunotherapy response, resistance, and prognosis. Therapies based on neoantigens are an important and promising branch of cancer immunotherapy. Unremitting efforts are needed to unravel the comprehensive role of neoantigens in anti-tumor immunity and to extend their clinical application. This review aimed to summarize the progress in neoantigen research and to discuss its opportunities and challenges in precision cancer immunotherapy.
Targeted Muscle Reinnervation of the Supraclavicular Nerve to the Motor Branch of the Omohyoid Muscle in Patients Undergoing Thoracic Outlet Syndrome Procedures
Authors: Bombardelli Joao , Farhat Souha , De la Fuente Hagopian Alexa , Echo Anthony
Published: July 2022

Transection of the supraclavicular nerve (SCN) through supraclavicular incisions can lead to debilitating neuroma formation. Targeted muscle reinnervation (TMR) proved to be an effective technique for the prevention and treatment of neuroma. In this case series, we propose the TMR of the SCN to the motor branch of the omohyoid muscle (OM) to prevent the formation of neuroma and avoid chronic pain at the supraclavicular area after thoracic outlet syndrome (TOS) procedures. A total of 10 patients underwent the procedure. Dissection of the SCN and its branches was performed through a supraclavicular incision. The branches were transected close to the clavicle. The inferior belly of the OM was identified and its motor branch isolated. Coaptation of the SCN branches with the motor branch of the OM was performed under the microscope and the wound was closed in layers. All the patients denied pain or hypersensitivity at the supraclavicular area on follow-up. In summary, the motor branch of the OM is a viable recipient for the TMR of the SCN and can prevent and treat painful neuromas at the supraclavicular area with minimal morbidity.
Reconstruction of Chopart’s Amputation Stump with the Osteomusculocutaneous Latissimus Dorsi-Rib Flap
Authors: Trung Vo Thai , Nha Truong Minh , Bay Hoang Van
Published: July 2022

We present an original technique for reconstruction of the right forefoot after Chopart’s amputation. The case report was of a 20-year-old man who was a nonsmoker without comorbidities. He was referred to our department because of equinus deformity, pain, and prominence of the cuboid under the skin, leading to chronic ulceration at the stump. We performed flow through free latissimus dorsi flap including the eighth and tenth ribs to reconstruct the stump. Results were assessed at 18 months after operation, showing good stability and normal functional outcome of the foot. The patient is satisfied with the results achieved.
Prevalence of Comorbid Psychiatric Conditions and Chronic Pain in Patients Seeking Peripheral Nerve Surgery
Authors: Chang Brian L. , Mondshine Josh , Hill Alison , Fleury Christopher M. , Kleiber Grant M.
Published: July 2022

Background:

In peripheral nerve surgery, the presence of psychiatric diagnoses and medications may affect outcomes and perioperative neuropathic pain management. The purpose of this study was to determine the prevalence of psychiatric diagnoses and chronic pain in patients referred to a peripheral nerve surgery clinic.

Methods:

This is a retrospective review of patients seen at a peripheral nerve clinic from July 1, 2017 to June 30, 2021. Medical records were reviewed for demographics; peripheral nerve diagnosis; psychiatric diagnoses; psychotropic prescriptions; use of nonneuroleptic/nonnarcotic, neuroleptic, and narcotic medications; and peripheral nerve surgical candidacy and outcome.

Results:

Six hundred twenty-two patients were included in this study. The most common reasons for referral were 24.8% lower extremity neuroma, 23.2% lower extremity compressive neuropathy, and 14.0% upper extremity compressive neuropathy. Of the included patients‚ 37.1% had a psychiatric diagnosis, and 36.3% were taking a psychotropic medication. The percentage of patients taking chronic nonneuroleptic/nonnarcotic pain medications was 34.3%‚ with 42.8% taking neuroleptic, and 24.9% narcotic medications. Patients with a psychiatric diagnosis were more likely to be taking neuroleptic (48.9% versus 38.9%, P < 0.001) and narcotic pain medications (27.3% versus 17.4%, P = 0.004) and less likely to have a positive surgical outcome (65.7% versus 83.0%, P = 0.001).

Conclusions:

Patients referred to a peripheral nerve surgery clinic frequently have psychiatric diagnoses and take chronic psychotropic and chronic pain medications. Knowledge of this will best help the peripheral nerve surgeon evaluate a patient for surgery, optimize perioperative care, and safely and effectively manage expectations.
MACULAR BUCKLING COMBINED WITH VITRECTOMY AND INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLES WITH MACULAR RETINOSCHISIS WITHOUT RETINAL DETACHMENT IN HIGH MYOPIA
Authors: Luo Nan , Chen Shida , Zhao Xiujuan , Huang Yanqiao , Wang Yanbing , Li Jun , Zheng Yarong , Guo Ziyi , Zhao Liyi , Alimu Subinuer , Liu Bingqian , Lu Lin
Published: July 2022

Purpose:

To investigate the outcomes of macular buckling combined with vitrectomy and inverted internal limiting membrane flap technique for highly myopic full-thickness macular hole (FTMH) with macular retinoschisis.

Methods:

Twenty-six eyes of 26 consecutive patients were retrospectively included. Twelve eyes underwent macular buckling alone (buckling group). Fourteen eyes underwent macular buckling and vitrectomy with an inverted internal limiting membrane flap technique (combination group). Patients were followed for at least 9 months. Rates of FTMH closure and macular retinoschisis resolution, best-corrected visual acuity gained at the final visit were evaluated.

Results:

The mean follow-up time was 13.00 ± 3.16 months. FTMH closed in six eyes (50%) of the buckling group and 13 eyes (92.86%) of the combination group (P = 0.026) at the final visit. The macular retinoschisis resolution rate was close between two groups (100% vs. 92.86%; P = 1.000). Both groups achieved significant improvement in best-corrected visual acuity (10.42 ± 17.25 and 16.36 ± 10.39 Early Treatment Diabetic Retinopathy Study letters; P = 0.014 and P < 0.001). The combination group achieved slightly more best-corrected visual acuity improvement, but the difference fell short of significance (P =0.312).

Conclusion:

Combination of macular buckling and vitrectomy with the inverted internal limiting membrane flap technique could achieve a high FTMH closure rate and significant best-corrected visual acuity improvement in FTMH with macular retinoschisis.
Private equity in ophthalmology: differences between present versus past
Authors: Ruby Alan J. , Williams George A.
Published: July 2022

Purpose of review

The purpose of this review is to examine the differences between the current private equity model in ophthalmology practices and the failed physician practice management companies (PPMC) of the 1990s.

Recent findings

Over the past 5 years, there has been an accelerating expansion of private equity into ophthalmology. In 2022, there are approximately 1400 ophthalmologists affiliated with one of over 30 private equity-controlled entities and further growth appears likely. This contrasts with the PPMC era that had only a few hundred ophthalmologists across a handful of companies and collapsed within 5 years. The reasons for the failure of PPMC model included inadequate capitalization, limited experience managing ophthalmology practices, failure to grow acquired ophthalmology practices, and misperceptions about the future of healthcare. Current private equity entities are characterized by substantial capital, longer term business plans predicated on individual practice growth, increasing market share, physician controlled clinical care, and integration of physicians into administration and governance.

The current private equity model in ophthalmology continues to expand and presents a reasonable model for ophthalmologists considering a change in practice structure. Although distinctly different from the PPMC model, longer follow-up is required to determine the ultimate impact of private equity upon ophthalmology.
Orbito-Frontal Cortex Hypometabolism in Children With Post-COVID Condition (Long COVID): A Preliminary Experience
Authors: Cocciolillo Fabrizio , Di Giuda Daniela , Morello Rosa , De Rose Cristina , Valentini Piero , Buonsenso Danilo
Published: July 2022

We describe 3 children with new-onset neurocognitive problems after coronavirus disease 2019 (COVID-19), that showed, at the brain [18F]-fluorodeoxyglucose positron emission tomography/computed tomography, hypometabolism in the left orbito-frontal region. The voxel-wise analysis confirmed a cluster of hypometabolic voxels in this region with a peak at −18/46/−4mm (179 voxels, T-Score 8.1). These findings may explain neurocognitive symptoms that some children develop after COVID-19 and require further investigations
Predicting of excess body fat in children
Authors: Córdoba-Rodríguez Diana Paola , Rodriguez Gerardo , Moreno Luis A.
Published: July 2022

Purpose of review

Approximately 370 million children and adolescents worldwide showed overweight or obesity in 2016. The risk of developing severe comorbidities depends on the age of onset and the duration of obesity. This review discusses available methodologies to detect excess body fat in children as well as the early life factors that predict excess body fat and its development.

Recent findings

Factors, such as parental nutritional status, maternal weight gain during pregnancy, maternal malnutrition, maternal smoking during pregnancy, low and high birth weight, rapid weight gain, and short infant sleep duration have been independently and positively associated with neonatal, infant, and children adiposity. Early detection of excess body fat in children through the use of various tools is the first step in preventing nutrition-related diseases in adulthood.

The early detection of excess body fat and the implementation of efficient interventions to normalize the weight of children and adolescents at obesity risk are essential to prevent diseases in adult life.
Low FODMAP diet in irritable bowel syndrome: a review of recent clinical trials and meta-analyses
Authors: Whelan Kevin , Staudacher Heidi
Published: July 2022

Purpose of review

The low fermentable oligosaccharides, disaccharides, monosaccharides and polyol (FODMAP) diet is widely used in the dietary management of irritable bowel syndrome (IBS). The aim of this review is to summarize recent evidence regarding the use of the low FODMAP diet in IBS and other gastrointestinal disorders from recent clinical trials and meta-analyses.

Recent findings

Several recent systematic reviews and meta-analyses support the use of low FODMAP restriction for global symptoms in IBS in the short term. Uncontrolled follow-up studies show that at least 50% of individuals experience symptom relief following restriction, reintroduction and personalization in the long term. Although evidence from comparative trials in IBS suggests potential benefit of less burdensome approaches (e.g. standard IBS diet and low lactose diet) many studies are insufficiently powered. One established mechanism is colonic gas production that may induce pain signalling measurable in the brain, however altered gastrointestinal epithelial integrity and shifts in microbiome composition and function may also be involved.

Quality trials of the low FODMAP diet are emerging and have been transformational in supporting the widespread application to IBS management in some areas (e.g. short-term effectiveness), whereas other areas still require considerable improvements in research evidence (e.g. long-term effectiveness, mechanisms and educational delivery).
Assessment of human milk in the era of precision health
Authors: Dastmalchi Farhad , Xu Ke , Jones Helen N. , Lemas Dominick J.
Published: July 2022

Purpose of review

Precision health provides an unprecedented opportunity to improve the assessment of infant nutrition and health outcomes. Breastfeeding is positively associated with infant health outcomes, yet only 58.3% of children born in 2017 were still breastfeeding at 6 months. There is an urgent need to examine the application of precision health tools that support the development of public health interventions focused on improving breastfeeding outcomes.

Recent findings

In this review, we discussed the novel and highly sensitive techniques that can provide a vast amount of omics data and clinical information just by evaluating small volumes of milk samples, such as RNA sequencing, cytometry by time-of-flight, and human milk analyzer for clinical implementation. These advanced techniques can run multiple samples in a short period of time making them ideal for the routine clinical evaluation of milk samples.

Precision health tools are increasingly used in clinical research studies focused on infant nutrition. The integration of routinely collected multiomics human milk data within the electronic health records has the potential to identify molecular biomarkers associated with infant health outcomes.
Coronavirus disease pandemic and adolescent substance use
Authors: Calihan Jessica B. , Levy Sharon
Published: July 2022

Purpose of review

Substance use is common in adolescence and has distinct developmental, cognitive, and health consequences. Over the last 2 years, the coronavirus disease 2019 pandemic has isolated adolescents, disrupted typical developmental milestones, and caused pervasive stress and anxiety. Healthcare providers can help by recognizing and addressing these effects on adolescent mental health and substance use. This update reviews the immediate effects of the pandemic on adolescent substance use, potential future implications, and opportunities to use new strategies to improve care for adolescents with problematic use.

Recent findings

Initial findings suggest that fewer teens started using substances during the pandemic. This was likely influenced by stay at home orders that reduced opportunities for social use. However, increased time at home was not beneficial for all adolescents. Furthermore, adolescents who used substances prepandemic, experienced material hardship, or reported higher pandemic-related stress tended to intensify substance use during this time.

The adverse effects of pandemic isolation, anxiety, and developmental disruption will likely have consequences for adolescent substance use for many years to come. To comprehensively address adolescent health, healthcare providers can be sensitive to these realities and use existing screening and brief intervention strategies to address use. Innovative telehealth strategies that allow for the expansion of substance use treatment offer promising opportunities to improve care for adolescents with substance use disorder.
Stevens–Johnson syndrome in children
Authors: Ramien Michele L.
Published: July 2022

Purpose of review

The concept of Stevens–Johnson syndrome (SJS) in children is evolving. This manuscript reviews recent advances with the lens of new terminology namely infection-triggered reactive infectious mucocutaneous eruption and drug-induced epidermal necrolysis, with the objective of integrating this novel terminology practically.

Recent findings

Traditionally considered to exist on a spectrum with toxic epidermal necrolysis, SJS in children is more often caused or triggered by infections instead of medications. Proposed pediatric-specific terminology can be applied to literature to gain further insights into blistering severe cutaneous adverse reactions.

Distinguishing infection-triggered from drug-triggered blistering reactions is useful for 3 main reasons: (1) early clinically recognizable different features such as isolated or predominant mucositis, (2) different initial management depending on trigger, (3) avoiding the label of a drug reaction on cases triggered by infection.
Moving Complementary Feeding Forward: Report on a Workshop of the Federation of International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) and the World Health Organization Regional Office for Europe
Authors: Theurich Melissa A. , Fewtrell Mary , Baumgartner Jeannine , Perkin Michael R. , Breda Joao , Wickramansinghe Kremlin , Weber Martin W. , Koletzko Berthold
Published: July 2022

The WHO Regional Office for Europe and the Federation of International Societies for Pediatric Gastroenterology, Hepatology, and Nutrition held a joint workshop, “Moving Complementary Feeding Forward” at the sixth World Congress Pediatric Gastroenterology, Hepatology, and Nutrition in 2021. Here we summarize workshop presentations and discussions. The workshop covered health implications of complementary feeding (CF) including allergies, challenges to meet dietary needs during the CF period, quality of commercial complementary foods (CFD) and respective marketing practices, national CF guidelines in Europe, a nutrient profiling system for CFD, and global policy perspectives on the standards and regulation of marketing for CFD. Adequate CF practices are of critical importance for short and long-term child health, prevention of nutrient deficiencies, normal growth and development, and reducing the risk of allergies. The workshop identified the need to improve feeding practices, harmonize evidence-based information and develop guidance jointly with various stakeholders, improve the composition and marketing practices of commercial CFD and their transparent labeling based on nutrient profiling. Renewed efforts for collaboration between scientists, public health experts, pediatric associations, national governments, and the WHO are necessary for advancing progress.
Approach to Mediastinal Fine Needle Aspiration Cytology
Authors: Li Zaibo , Xu Huihong , Fan Fang
Published: July 2022

Mediastinal fine needle aspirations are routinely encountered in cytopathology practice. Mediastinal lesions may pose diagnostic challenges owing to their rarity and locations associated with the complexity of the mediastinal anatomic structures in the thoracic cavity. Diagnosing mediastinal lesions and guiding patient management usually require correlating with clinical and radiologic findings, being familiar with cytomorphologic features and appropriately triaging the diagnostic material for ancillary testing. This review proposes a practical approach to interpret mediastinal fine needle aspirations and emphasizes potential diagnostic pitfalls for mediastinal lesions including benign cysts, thymic neoplasms, lymphoproliferative disorders, germ cell tumors, mesenchymal tumors, and metastatic tumors.
Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery
Authors: Blank Michael , Katsiampoura Anastasia , Wachtendorf Luca J. , Linhardt Felix C. , Tartler Tim M. , Raub Dana , Azimaraghi Omid , Chen Guanqing , Houle Tim T. , Ferrone Cristina , Eikermann Matthias , Schaefer Maximilian S.
Published: July 2022

Objective:

We examined the effects of dexamethasone on postoperative mortality, recurrence-free survival, and side effects in patients undergoing oncologic operations.

Background:

Dexamethasone prevents nausea and vomiting after anesthesia and may affect cancer proliferation.

Methods:

A total of 30,561 adult patients undergoing solid cancer resection between 2005 and 2020 were included. Multivariable logistic regression was applied to investigate the effect of dexamethasone on 1-year mortality and recurrence-free survival. Effect modification by the cancer’s potential for immunogenicity, defined as a recommendation for checkpoint inhibitor therapy based on the National Comprehensive Cancer Network guidelines, was investigated through interaction term analysis. Key safety endpoints were dexamethasone-associated risk of hyperglycemia >180 mg/dL within 24 hours and surgical site infections within 30 days after surgery.

Results:

Dexamethasone was administered to 38.2% (11,666/30,561) of patients (6.5±2.3 mg). Overall, 3.2% (n=980/30,561) died and 15.4% (n=4718/30,561) experienced cancer recurrence within 1 year of the operation. Dexamethasone was associated with a −0.6% (95% confidence interval: −1.1, −0.2, P=0.007) 1-year mortality risk reduction [adjusted odds ratio (ORadj): 0.79 (0.67, 0.94), P=0.009; hazard ratio=0.82 (0.69, 0.96), P=0.016] and higher odds of recurrence-free survival [ORadj: 1.28 (1.18, 1.39), P<0.001]. This effect was only present in patients with solid cancers who were defined as not to respond to checkpoint inhibitor therapy [ORadj: 0.70 (0.57, 0.87), P=0.001 vs ORadj: 1.13 (0.85, 1.50), P=0.40]. A high (>0.09 mg/kg) dose of dexamethasone increased the risk of postoperative hyperglycemia [ORadj: 1.55 (1.32, 1.82), P<0.001], but not for surgical site infections [ORadj: 0.84 (0.42, 1.71), P=0.63].

Conclusions:

Dexamethasone is associated with decreased 1-year mortality and cancer recurrence in patients undergoing surgical resection of cancers that are not candidates for immune modulators. Dexamethasone increased the risk of postoperative hyperglycemia, however, no increase in surgical site infections was identified.
Defining Global Benchmarks for Laparoscopic Liver Resections
Authors: Goh Brian K.P. , Han Ho-Seong , Chen Kuo-Hsin , Chua Darren W. , Chan Chung-Yip , Cipriani Federica , Aghayan Davit L. , Fretland Asmund A. , Sijberden Jasper , D’Silva Mizelle , Siow Tiing Foong , Kato Yutaro , Lim Chetana , Nghia Phan Phuoc , Herman Paulo , Marino Marco V. , Mazzaferro Vincenzo , Chiow Adrian K.H. , Sucandy Iswanto , Ivanecz Arpad , Choi Sung Hoon , Lee Jae Hoon , Gastaca Mikel , Vivarelli Marco , Giuliante Felice , Ruzzenente Andrea , Yong Chee-Chien , Yin Mengqui , Chen Zewei , Fondevila Constantino , Efanov Mikhail , Rotellar Fernando , Choi Gi-Hong , Campos Ricardo R. , Wang Xiaoying , Sutcliffe Robert P. , Pratschke Johann , Lai Eric , Chong Charing C. , D’Hondt Mathieu , Monden Kazuteru , Lopez-Ben Santiago , Coelho Fabricio F. , Kingham Thomas Peter , Liu Rong , Long Tran Cong duy , Ferrero Alessandro , Sandri Giovanni B. Levi , Saleh Mansour , Cherqui Daniel , Scatton Olivier , Soubrane Olivier , Wakabayashi Go , Troisi Roberto I. , Cheung Tan-To , Sugioka Atsushi , Hilal Mohammad Abu , Fuks David , Edwin Bjørn , Aldrighetti Luca ,   International Robotic and Laparoscopic Liver Resection Study Group Investigators
Published: July 2022

Objective:

To establish global benchmark outcomes indicators after laparoscopic liver resections (L-LR).

Background:

There is limited published data to date on the best achievable outcomes after L-LR.

Methods:

This is a post hoc analysis of a multicenter database of 11,983 patients undergoing L-LR in 45 international centers in 4 continents between 2015 and 2020. Three specific procedures: left lateral sectionectomy (LLS), left hepatectomy (LH), and right hepatectomy (RH) were selected to represent the 3 difficulty levels of L-LR. Fifteen outcome indicators were selected to establish benchmark cutoffs.

Results:

There were 3519 L-LR (LLS, LH, RH) of which 1258 L-LR (40.6%) cases performed in 34 benchmark expert centers qualified as low-risk benchmark cases. These included 659 LLS (52.4%), 306 LH (24.3%), and 293 RH (23.3%). The benchmark outcomes established for operation time, open conversion rate, blood loss ≥500 mL, blood transfusion rate, postoperative morbidity, major morbidity, and 90-day mortality after LLS, LH, and RH were 209.5, 302, and 426 minutes; 2.1%, 13.4%, and 13.0%; 3.2%, 20%, and 47.1%; 0%, 7.1%, and 10.5%; 11.1%, 20%, and 50%; 0%, 7.1%, and 20%; and 0%, 0%, and 0%, respectively.

Conclusions:

This study established the first global benchmark outcomes for L-LR in a large-scale international patient cohort. It provides an up-to-date reference regarding the “best achievable” results for L-LR for which centers adopting L-LR can use as a comparison to enable an objective assessment of performance gaps and learning curves.
Socioeconomic Mediation of Racial Segregation in Pancreatic Cancer Treatment and Outcome Disparities
Authors: Poulson Michael R. , Papageorge Marianna V. , LaRaja Alexander S. , Kenzik Kelly M. , Sachs Teviah E.
Published: July 2022

Objective:

To understand the mediating effect of socioeconomic factors on the association between residential segregation and racial disparities in pancreatic cancer (PC).

Background:

Black patients with PC present at a later stage and have worse mortality than White patients. These disparities have been explained by the level of residential segregation.

Methods:

Data were obtained from Surveillance, Epidemiology, and End-Results (SEER) and included all Black and White patients who were diagnosed with PC between 2005 and 2015. The primary exposure variable was the Index of Dissimilarity, a validated measure of segregation. County-level socioeconomic variables from the US Census were assessed as mediators. The primary outcomes were advanced stage at diagnosis, surgical resection for localized disease, and overall mortality. Generalized structural equation modeling was used to assess the mediation of each of the socioeconomic variables.

Results:

Black patients in the highest levels of segregation saw a 12% increased risk [relative risk=1.12; 95% confidence interval (CI): 1.08, 1.15] of presenting at an advanced stage, 11% decreased likelihood of undergoing surgery (relative risk=0.89; 95% CI: 0.83, 0.94), and 8% increased hazards of death (hazard ratio=1.08; 95% CI: 1.03, 1.14) compared with White patients in the lowest levels. The Black share of the population, insurance status, and income inequality mediated 58% of the total effect on the advanced stage. Poverty and Black income immobility mediated 51% of the total effect on surgical resection. Poverty and Black income immobility mediated 50% of the total effect on overall survival.

Conclusions:

These socioeconomic factors serve as intervention points for legislators to address the social determinants inherent to the structural racism that mediate poor outcomes for Black patients.
Timing of a Major Operative Intervention After a Positive COVID-19 Test Affects Postoperative Mortality
Authors: Kougias Panos , Sharath Sherene E. , Zamani Nader , Brunicardi F. Charles , Berger David H. , Wilson Mark A.
Published: July 2022

Background:

Studies indicate that coronavirus disease 2019 (COVID-19) infection before or soon after operations increases mortality, but they do not comment on the appropriate timing for interventions after diagnosis.

Objective:

We sought to determine what the safest time would be for COVID-19 diagnosed patients to undergo major operative interventions.

Methods:

High-risk operations, between January 2020 and May 2021, were identified from the Veterans Affairs COVID-19 Shared Data Resource. Current Procedural Terminology (CPT) codes were used to exact match COVID-19 positive cases (n=938) to negative controls (n=7235). Time effects were calculated as a continuous variable and then grouped into 2-week intervals. The primary outcome was 90-day, all-cause postoperative mortality.

Results:

Ninety-day mortality in cases and controls was similar when the operation was performed within 9 weeks or longer after a positive test; but significantly higher in cases versus controls when the operation was performed within 7 to 8 weeks (12.3% vs 4.9%), 5 to 6 weeks (10.3% vs 3.3%), 3 to 4 weeks (19.6% vs 6.7%), and 1 to 2 weeks (24.7% vs 7.4%) from diagnosis. Among patients who underwent surgery within 8 weeks from diagnosis, 90-day mortality was 16.6% for cases versus 5.8% for the controls (P<0.001). In this cohort, we assessed interaction between case status and any symptom (P=0.93), and case status and either respiratory symptoms or fever (P=0.29), neither of which were significant statistically.

Conclusions:

Patients undergoing major operations within 8 weeks after a positive test have substantially higher postoperative 90-day mortality than CPT-matched controls without a COVID-19 diagnosis, regardless of presenting symptoms.
A DNA Methylation-based Epigenetic Signature for the Identification of Lymph Node Metastasis in T1 Colorectal Cancer
Authors: Zhao Yinghui , Peng Fuduan , Wang Chuanxin , Murano Tatsuro , Baba Hideo , Ikematsu Hiroaki , Li Wei , Goel Ajay
Published: July 2022

Objective:

This study aimed to unravel the lymph node metastasis (LNM)-related methylated DNA (mDNA) landscape and develop a mDNA signature to identify LNM in patients with T1 colorectal cancers (T1 CRC).

Background:

Considering the invasiveness of T1 CRC, current guidelines recommend endoscopic resection in patients with LNM-negative, and radical surgical resection only for high-risk LNM-positive patients. Unfortunately, the clinicopathological criteria for LNM risk stratification are imperfect, resulting in frequent misdiagnosis leading to unnecessary radical surgeries and postsurgical complications.

Methods:

We conducted genome-wide methylation profiling of 39 T1 CRC specimens to identify differentially methylated CpGs between LNM-positive and LNM-negative, and performed quantitative pyrosequencing analysis in 235 specimens from 3 independent patient cohorts, including 195 resected tissues (training cohort: n=128, validation cohort: n=67) and 40 pretreatment biopsies.

Results:

Using logistic regression analysis, we developed a 9-CpG signature to distinguish LNM-positive versus LNM-negative surgical specimens in the training cohort [area under the curve (AUC)=0.831, 95% confidence interval (CI)=0.755–0.892; P<0.0001], which was subsequently validated in additional surgical specimens (AUC=0.825; 95% CI=0.696–0.955; P=0.003) and pretreatment biopsies (AUC=0.836; 95% CI=0.640–1.000, P=0.0036). This diagnostic power was further improved by combining the signature with conventional clinicopathological features.

Conclusions:

We established a novel epigenetic signature that can robustly identify LNM in surgical specimens and even pretreatment biopsies from patients with T1 CRC. Our signature has strong translational potential to improve the selection of high-risk patients who require radical surgery while sparing others from its complications and expense.
Inhibition of the JAK/STAT Pathway With Baricitinib Reduces the Multiple Organ Dysfunction Caused by Hemorrhagic Shock in Rats
Authors: Patel Nikita M. , Collotta Debora , Aimaretti Eleonora , Ferreira Alves Gustavo , Kröller Sarah , Coldewey Sina M. , Collino Massimo , Thiemermann Christoph
Published: July 2022

Objective:

The aim of this study was to investigate (a) the effects of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway inhibitor (baricitinib) on the multiple organ dysfunction syndrome (MODS) in a rat model of hemorrhagic shock (HS) and (b) whether treatment with baricitinib attenuates the activation of JAK/STAT, NF-κB, and NLRP3 caused by HS.

Background:

Posttraumatic MODS, which is in part due to excessive systemic inflammation, is associated with high morbidity and mortality. The JAK/STAT pathway is a regulator of numerous growth factor and cytokine receptors and, hence, is considered a potential master regulator of many inflammatory signaling processes. However, its role in trauma-hemorrhage is unknown.

Methods:

An acute HS rat model was performed to determine the effect of baricitinib on MODS. The activation of JAK/STAT, NF-κB, and NLRP3 pathways were analyzed by western blotting in the kidney and liver.

Results:

We demonstrate here for the first time that treatment with baricitinib (during resuscitation following severe hemorrhage) attenuates the organ injury and dysfunction and the activation of JAK/STAT, NF-κB, and NLRP3 pathways caused by HS in the rat.

Conclusions:

Our results point to a role of the JAK/STAT pathway in the pathophysiology of the organ injury and dysfunction caused by trauma/hemorrhage and indicate that JAK inhibitors, such as baricitinib, may be repurposed for the treatment of the MODS after trauma and/or hemorrhage.
Preoperative Computed Tomography Morphological Features Indicative of Incisional Hernia Formation After Abdominal Surgery
Authors: McAuliffe Phoebe B. , Desai Abhishek A. , Talwar Ankoor A. , Broach Robyn B. , Hsu Jesse Y. , Serletti Joseph M. , Liu Tiange , Tong Yubing , Udupa Jayaram K. , Torigian Drew A. , Fischer John P.
Published: July 2022

Objective:

To investigate key morphometric features identifiable on routine preoperative computed tomography (CT) imaging indicative of incisional hernia (IH) formation following abdominal surgery.

Background:

IH is a pervasive surgical disease that impacts all surgical disciplines operating in the abdominopelvic region and affecting 13% of patients undergoing abdominal surgery. Despite the significant costs and disability associated with IH, there is an incomplete understanding of the pathophysiology of hernia.

Methods:

A cohort of patients (n=21,501) that underwent colorectal surgery was identified, and clinical data and demographics were extracted, with a primary outcome of IH. Two datasets of case-control matched pairs were created for feature measurement, classification, and testing. Morphometric linear and volumetric measurements were extracted as features from anonymized preoperative abdominopelvic CT scans. Multivariate Pearson testing was performed to assess correlations among features. Each feature’s ability to discriminate between classes was evaluated using 2-sided paired t testing. A support vector machine was implemented to determine the predictive accuracy of the features individually and in combination.

Results:

Two hundred and twelve patients were analyzed (106 matched pairs). Of 117 features measured, 21 features were capable of discriminating between IH and non-IH patients. These features are categorized into three key pathophysiologic domains: 1) structural widening of the rectus complex, 2) increased visceral volume, 3) atrophy of abdominopelvic skeletal muscle. Individual prediction accuracy ranged from 0.69 to 0.78 for the top 3 features among 117.

Conclusions:

Three morphometric domains identifiable on routine preoperative CT imaging were associated with hernia: widening of the rectus complex, increased visceral volume, and body wall skeletal muscle atrophy. This work highlights an innovative pathophysiologic mechanism for IH formation hallmarked by increased intra-abdominal pressure and compromise of the rectus complex and abdominopelvic skeletal musculature.
Efficacy and Safety of Radiofrequency Ablation of Thyroid Nodules
Authors: Kandil Emad , Omar Mahmoud , Aboueisha Mohamed , Attia Abdallah S. , Ali Khalid M. , Abu Alhuda Ruba F. , Issa Peter P. , Wolfe Samantha , Omari Sara , Buti Yusef , Abozaid Omar , Toraih Eman , Shama Mohamed A. , Lee Grace , Tufano Ralph P. , Russell Jonathon O.
Published: July 2022

Background:

Radiofrequency ablation (RFA) has been recently adopted into the practice of thyroidology in the United States, although its use as an alternative to traditional thyroid surgery in Asia and Europe came near the turn of the 21st century. In the United States, only a few studies with small sample sizes have been published to date. We examined outcomes of benign thyroid nodules treated with RFA from 2 North American institutions.

Methods:

We performed a prospective, multi-institutional cohort study of thyroid nodules treated with RFA between July 2019 and January 2022. Demographics, sonographic characteristics of thyroid nodules, thyroid function profiles, procedural details, complications, and nodule volume measurements at 1, 3, 6, and 12 months follow-up were evaluated. Adjusted multivariate logistic regression analysis was performed to identify sonographic features associated with treatment failure.

Results:

A total of 233 nodules were included. The median and interquartile range of volume reduction rate (VRR) at 1, 3, 6, and 12 months were 54% [interquartile range (IQR): 36%–73%], 58% (IQR: 37%–80%), 73% (IQR: 51%–90%), and 76% (IQR: 52%–90%), respectively (P<0.001). Four patients presented with toxic adenomas. All patients were confirmed euthyroid at 3-month postprocedure follow-up. Two patients developed temporary hoarseness of voice, but no hematoma or nodular rupture occurred postprocedure. Elastography was significantly associated with VRR. Compared with soft nodules, stiff nodules were more likely to have a lower VRR (odds ratio: 11.64, 95% confidence interval: 3.81–35.53, P<0.05), and mixed elasticity was also more likely to have a lower VRR (odds ratio: 4.9; 95% confidence interval: 1.62–14.85, P<0.05).

Conclusions:

This is the largest multi-institutional North American study examining thyroid nodule treatment response to RFA. RFA is a safe and effective treatment option that allows preservation of thyroid function with minimal risk of procedural complications.