bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Peritoneal Metastasis on Survival of Patients With Small Intestinal Neuroendocrine Tumor
Authors: Wright Martha Frances , Cates Justin , Gonzalez Raul S. , Das Satya , Berlin Jordan D. , Shi Chanjuan
Published: February 2019

The liver and peritoneum are the 2 most common distant metastatic sites for small intestinal neuroendocrine tumors (SI-NET). In this study, we evaluated the differential impact of hepatic and/or peritoneal metastasis on prognosis of SI-NET patients. Surgical Pathology archives were searched for SI-NET resections performed between January 1, 1994 and August 31, 2017. Two hundred nineteen cases with clinical follow-up data were identified. Pathology reports and electronic medical records were reviewed. The 219 patients included 104 females and 115 males with a median age of 59 years (range, 19 to 85 y). There were 71 (33%) cases without hepatic or peritoneal metastasis, 80 (37%) with hepatic metastasis only, 14 (6%) with peritoneal metastasis only, and 53 (24%) with both hepatic and peritoneal metastasis at the time of surgery or during follow-up. The number of primary tumors, largest tumor size, lymph node metastasis, pT category, and sex were not significant independent prognostic factors in multivariate Cox proportional hazard regression. Age was the only variable other than presence of metastatic disease that was associated with worse prognosis (5% increase in risk/year of age; 95% confidence interval, 1.7%-8.2%; P=0.003). After controlling for patient age, pairwise comparisons of marginal linear predictions showed increased risk with peritoneal metastasis, with or without associated hepatic metastasis, compared to hepatic metastasis only. In conclusion, although limited by the number of patients with peritoneal metastasis only, these results support substratifying patients with metastatic SI-NET by anatomic site of metastasis.
Expanding the Spectrum of Intraosseous Rhabdomyosarcoma
Authors: Agaram Narasimhan P. , Zhang Lei , Sung Yun-Shao , Cavalcanti Marcela S. , Torrence Dianne , Wexler Leonard , Francis Glenn , Sommerville Scott , Swanson David , Dickson Brendan C. , Suurmeijer Albert J.H. , Williamson Richard , Antonescu Cristina R.
Published: February 2019

Primary intraosseous rhabdomyosarcomas (RMSs) are extremely rare. Recently 2 studies reported 4 cases of primary intraosseous RMS withEWSR1/FUS-TFCP2gene fusions, associated with somewhat conflicting histologic features, ranging from spindle to epithelioid. In this study we sought to further investigate the pathologic and molecular abnormalities of a larger group of intraosseous RMSs by a combined approach using targeted RNA sequencing analysis and fluorescence in situ hybridization (FISH). We identified 7 cases, 3 males and 4 females, all in young adults, age range 20 to 39 years (median, 27 y). Three cases involved the pelvis, 2 involved the femur and 1 each involved the maxilla and the skull. Molecular studies identified recurrent gene fusions in all 7 cases tested, including: a novelMEIS1-NCOA2fusion in 2 cases,EWSR1-TFCP2in 3 cases, andFUS-TFCP2gene fusions in 1 case. One case showed aFUSgene rearrangement, without aTFCP2gene abnormality by FISH. TheMEIS1-NCOA2–positive cases were characterized by a more primitive and fascicular spindle cell appearance, while theEWSR1/FUSrearranged tumors had a hybrid spindle and epithelioid phenotype, with more abundant eosinophilic cytoplasm and mild nuclear pleomorphism. Immunohistochemically, all tumors were positive for desmin and myogenin (focal). In addition, 4 tumors withTFCP2-associated gene fusions also coexpressed ALK and cytokeratin. In conclusion, our results suggest a high incidence of gene fusions in primary RMSs of bone, with 2 molecular subsets emerging, defined by eitherMEIS1-NCOA2orEWSR1/FUS-TFCP2fusions, showing distinct morphology and immunophenotype. Additional studies with larger numbers of cases and longer follow-up data are required to definitively evaluate the biological behavior of these tumors and to establish their relationship to other spindle cell RMS genetic groups.
Antibiotic Prescription in Young Children With Respiratory Syncytial Virus–Associated Respiratory Failure and Associated Outcomes
Authors: Shein Steven L. , Kong Michele , McKee Bryan , O’Riordan MaryAnn , Toltzis Philip , Randolph Adrienne G.
Published: February 2019

Objectives:

To describe antibiotic prescribing practices during the first 2 days of mechanical ventilation among previously healthy young children with respiratory syncytial virus–associated lower respiratory tract infection and evaluate associations between the prescription of antibiotics at onset of mechanical ventilation with clinical outcomes.

Design:

Retrospective cohort study.

Setting:

Forty-six children’s hospitals in the United States.

Patients:

Children less than 2 years old discharged between 2012 and 2016 with an International Classification of Diseases diagnosis of respiratory syncytial virus–associated lower respiratory tract infection, no identified comorbid conditions, and receipt of mechanical ventilation.

Interventions:

Antibiotic prescription during the first 2 days of mechanical ventilation.

Measurements and Main Results:

We compared duration of mechanical ventilation and hospital length of stay between children prescribed antibiotics on both of the first 2 days of mechanical ventilation and children not prescribed antibiotics during the first 2 days of mechanical ventilation. We included 2,107 PICU children with respiratory syncytial virus–associated lower respiratory tract infection (60% male, median age of 1 mo [interquartile range, 1–4 mo]). The overall proportion of antibiotic prescription on both of the first 2 days of mechanical ventilation was 82%, decreasing over the study period (p = 0.004) and varying from 36% to 100% across centers. In the bivariate analysis, antibiotic prescription was associated with a shorter duration of mechanical ventilation (6 d [4–9 d] vs 8 d [6–11 d]; p < 0.001) and a shorter hospital length of stay (11 d [8–16 d] vs 13 d [10–18 d]; p < 0.001). After adjustment for center, demographics, and vasoactive medication prescription, antibiotic prescription was associated with a 1.21-day shorter duration of mechanical ventilation and a 2.07-day shorter length of stay. Ultimately, 95% of children were prescribed antibiotics sometime during hospitalization, but timing, duration, and antibiotic choice varied markedly.

Conclusions:

Although highly variable across centers and decreasing over time, the practice of instituting antibiotics after intubation in young children with respiratory syncytial virus–associated lower respiratory tract infection was associated with a shortened clinical course after adjustment for the limited available covariates. A prudent approach to identify and optimally treat bacterial coinfection is needed.
The Methods of PH WINS 2017: Approaches to Refreshing Nationally Representative State-Level Estimates and Creating Nationally Representative Local-Level Estimates of Public Health Workforce Interests and Needs
Authors: Leider Jonathon P. , Pineau Vicki , Bogaert Kyle , Ma Qiao , Sellers Katie
Published: February 2019

Context:

The Public Health Workforce Interests and Needs Survey (PH WINS) was first fielded in 2014 and is the largest public health workforce survey in the nation. This article elucidates the methods used for the 2017 PH WINS fielding.

Program or Policy:

PH WINS was fielded to a nationally representative sample of State Health Agency Central Office (SHA-CO) staff, as well as local health department (LHD) staff. The instrument largely mirrored 2014, though the training needs section was revised, and a validated item measuring burnout in staff was added.

Implementation:

Staff lists were collected directly from all participating state and local agencies. Forty-seven state health agencies (SHAs), 26 large LHDs, and 71 midsize LHDs participated. All SHAs were surveyed using a census approach. The nationally representative SHA-CO frame is representative of all central office staff members. The nationally representative local frame was a complex survey design, wherein staff from LHDs were randomly sampled across 20 strata, based on agency size and geographic region. Staff were also contributed with certainty from large LHDs in nondecentralized states. The frame is representative of staff at LHDs serving more than 25 000 people and with 25 or more staff members. Other LHDs are excluded, and so PH WINS is not representative of smaller LHDs. Balanced repeated replication weights were used to adjust variance estimates for the complex design.

Evaluation:

Overall, 47 604 people responded to PH WINS in 2017 across all frames. PH WINS 2017 achieved a response rate of 48%. The design effect for the SHA-CO frame was 1.46 and was 16.42 for the local frame.

Discussion:

PH WINS now offers a nationally representative sample of both SHA-CO and LHD staff across 4 major domains: workplace environment, training needs, emerging concepts in public health, and demographics. Both practice and academia can use PH WINS to better understand the perceptions and needs of staff, address training gaps, and work to recruit and retain quality staff.
Changes in the State Governmental Public Health Workforce: Demographics and Perceptions, 2014-2017
Authors: Bogaert Kyle , Castrucci Brian C. , Gould Elizabeth , Sellers Katie , Leider Jonathon P.
Published: February 2019

Context:

Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents.

Objective:

Using data from agencies that participated in 2014 and 2017, we conducted multi–cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data.

Design:

The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017.

Setting:

Thirty-three state health agency central offices that participated in both 2014 and 2017.

Participants:

Permanently employed governmental public health staff.

Main Outcome Measures:

We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott–adjusted χ2 analyses were used to compare changes between 2014 and 2017.

Results:

The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001).

Conclusions:

Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.
Top Training Needs of the Governmental Public Health Workforce
Authors: Bogaert Kyle , Castrucci Brian C. , Gould Elizabeth , Rider Nikki , Whang Christina , Corcoran Elizabeth
Published: February 2019

Context:

Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments.

Objective:

The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017.

Design:

PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design.

Setting:

Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments.

Participants:

Permanently employed governmental public health staff.

Main Outcome Measures:

Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area.

Results:

The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management.

Conclusions:

The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public health.
Examining Training Motivations Among Public Health Workers
Authors: Apathy Nate C. , Yeager Valerie A.
Published: February 2019

Context:

As public health needs and priorities evolve, maintaining a trained public health workforce is critical to the success of public health efforts. Researchers have examined training needs in various contexts and subpopulations, but a nationally representative study of what motivates public health workers to seek out training has yet to be conducted. By understanding these motivations, public health agencies and policy makers can appeal to worker motivations in both training programs and organizational incentives.

Objective:

The purpose of this article was to describe overall training motivations and identify patterns of training motivations among public health workers. This study also explored whether or not training needs differ across prevalent motivational patterns.

Design and Participants:

Using data from the 2017 Public Health Workforce Interests and Needs Survey (PH WINS), the study used latent class analysis (LCA) to identify motivational patterns and logistic regression to analyze associations with training needs.

Results:

The most prominent motivation to seek training was personal growth (82.7% of respondents). LCA identified 4 motivational classes of public health workers: those motivated by organizational pressure and requirements (31.8%), those motivated indiscriminately by all factors (28.4%), those motivated primarily by personal growth (21.7%), and those motivated by organizational accommodations and supports (18.2%). Motivational class was not associated with indicating training needs in any of 8 training domains, nor was it associated with indicating any training need in any domain.

Conclusions:

Public health agencies should consider the different motivational classes present in the public health workforce. In particular, motivational classes that represent organizational choices suggest that public health agencies should both motivate workers with organizational requirements and pressure from managers and offer institutional support via paid travel and covered time for training.
Unleashing the Creativity and Innovation of Our Greatest Resource—The Governmental Public Health Workforce
Authors: Locke Rachel , Castrucci Brian C. , Gambatese Melissa , Sellers Katie , Fraser Michael
Published: February 2019

Context:

Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments.

Objective:

This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics.

Design:

The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017.

Settings and Participants:

Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people.

Results:

Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace.

Conclusion:

This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker satisfaction and the workplace environment in governmental public health agencies.
Major Depressive Disorder in Medical Illness: A Review of Assessment, Prevalence, and Treatment Options
Authors: Thom Robyn , Silbersweig David A. , Boland Robert J.
Published: February 2019

Major depression, as well as other depressive disorders, is commonly comorbid with other medical illnesses, particularly chronic and systemic medical illnesses. The co-occurrence of the disorders is so common that it challenges our notions of the meaning of comorbidity and our desire to neatly separate psychiatric and medical illnesses. The overlap between symptoms of physical illness and the neurovegetative symptoms of major depression and the initial normative emotional response to physical illness add to the challenge of accurate diagnosis and timely treatment of depression in the medically ill. We review the literature on the comorbidity of depression and the various medical illnesses, including diagnostic and treatment approaches. The differential diagnosis for major depression among medically ill patients should include delirium and medication-induced symptoms. We suggest that major depression itself may be best conceptualized as a systemic illness whose pathophysiology overlaps with other systemic medical illnesses. The initial treatment strategies for major depression in medical illness are like those for the general population; however, the comorbid medical illnesses may interfere with remission. To illustrate these points, we describe a patient with clinical characteristics covered in this review who experienced major depression as well as several chronic illnesses, including hypersensitivity pneumonitis, multiple sclerosis, chronic pain due to degenerative joint disease, and diabetes mellitus.
Prevalence and Incidence of Rheumatoid Arthritis in Canadian First Nations and Non–First Nations People
Authors: Hitchon Carol A. , Khan Sazzadul , Elias Brenda , Lix Lisa M. , Peschken Christine A.
Published: February 2019

Background

The aim of this study was to determine the prevalence, incidence, and onset age at rheumatoid arthritis (RA) diagnosis in First Nations (FN) and non-FN populations in Manitoba, Canada.

Methods

Population-based administrative health records from April 1, 1995, to March 31, 2010, were accessed for all Manitobans. The FN population was identified using the Federal Indian Registry File. Crude and adjusted RA prevalence and incidence rates (adjusted for age, sex, health region of residence) were compared using Poisson regression and reported as relative rates (RRs) with 95% confidence intervals (CIs). Mean (CI) diagnosis age and physician visits were compared with Student t tests.

Results

Rheumatoid arthritis crude prevalence increased between 2000 and 2010 to 0.65%; adjusted RA prevalence in females was 1.0% and in males was 0.53%. The 2009/2010 adjusted RA prevalence was higher in FN than non-FN (RR, 2.55; CI, 2.08–3.12) particularly for ages 29 to 48 years (RR, 4.52; CI, 2.71–7.56). Between 2000 and 2010, crude RA incidence decreased from 46.7/100,000 to 13.4/100,000. Adjusted RA incidence remained higher in FN than non-FN (2000–2010 RR, 2.1; CI, 1.7–2.6; p < 0.0001) particularly for ages 29 to 48 years (RR, 4.6; CI, 2.8–7.4; p < 0.0001). The FN population was younger at diagnosis than the non-FN population (mean age, 39.6 years [CI, 38.3–40.8 years] vs. 53.3 years [CI, 52.7–53.9 years]; p < 0.0001). The FN population had more physician visits but fewer rheumatology visits than the non-FN population.

Conclusions

Rheumatoid arthritis prevalence is increasing, and RA incidence is decreasing in Manitoba. The FN population has a greater prevalence and incidence of RA and is younger at diagnosis than the non-FN population. When combined with fewer rheumatology visits, this significant care gap highlights the need to optimize rheumatology care delivery to the FN population.
Acceleration of Double Inversion Recovery Sequences in Multiple Sclerosis With Compressed Sensing
Authors: Eichinger Paul , Hock Andreas , Schön Simon , Preibisch Christine , Kirschke Jan S. , Mühlau Mark , Zimmer Claus , Wiestler Benedikt
Published: February 2019

Objective

The aim of this study was to assess the performance of double inversion recovery (DIR) sequences accelerated by compressed sensing (CS) in a clinical setting.

Materials and Methods

We included 106 patients with MS (62 female [58%]; mean age, 44.9 ± 11.0 years) in this prospective study. In addition to a full magnetic resonance imaging protocol including a conventional SENSE accelerated DIR, we acquired a CS DIR (time reduction, 51%). We generated subtraction maps between the two DIR sequences to visualize focal intensity differences. Two neuroradiologists independently assessed these maps for intensity differences, which were categorized into definite MS lesions, possible lesions, or definite artifacts. Counts of focal intensity differences were compared using a Wilcoxon rank sum test. Moreover, conventional lesion counts were acquired for both sequences in independent readouts, and agreement between the DIR variants was assessed with intraclass correlation coefficients.

Results

No hyperintensity that was rated as definite lesion was missed in the CS DIR. Two possible lesions were only detected in the conventional DIR, one only in the CS DIR (no significant difference, P = 0.57). The conventional DIR showed significantly more definite artifacts within the white matter (P = 0.024) and highly significantly more at the cortical-sulcal interface (P < 0.001). For both readers, intraclass correlation coefficient between the lesion counts in the two DIR variants was near perfect (0.985 for reader 1 and 0.981 for reader 2).

Conclusions

Compressed sensing can be used to substantially reduce scan time of DIR sequences without compromising diagnostic quality. Moreover, the CS accelerated DIR proved to be significantly less prone to imaging artifacts.
Predicting Response to Immunotherapy by Evaluating Tumors, Lymphoid Cell-Rich Organs, and Immune-Related Adverse Events Using FDG-PET/CT
Authors: Nobashi Tomomi , Baratto Lucia , Reddy Sunil A. , Srinivas Sandhya , Toriihara Akira , Hatami Negin , Yohannan Thomas K. , Mittra Erik
Published: February 2019

Purpose

To investigate whether the evaluation of tumors, lymphoid cell-rich organs, and immune-related adverse events (IRAE) with 18F-FDG PET/CT can predict the efficacy and outcome of immunotherapy.

Methods

Forty patients who underwent 18F-FDG-PET/CT scans before and after therapy with immune checkpoint inhibitors from December 2013 to December 2016 were retrospectively enrolled (malignant melanoma, n = 21; malignant lymphoma, n = 11; renal cell carcinoma, n = 8). SUVmax of the baseline and first restaging scans were evaluated in tumors, spleen, bone marrow, thyroid and pituitary glands, and were correlated to best overall response in the first year after therapy; IRAE-affected areas were also evaluated.

Results

Interval change between the baseline and first restaging scans showed that patients with a clinical benefit had a significant decrease in tumor parameters (P < 0.001). All patients with an increase of SUVmax in the thyroid of more than 1.5 (n = 5) on the first restaging scan had a complete response (CR) in 1 year. Patients with CR within 1 year (n = 22) were significantly associated with a favorable long-term outcome (P = 0.002). Nine patients with IRAE findings had CR at final evaluation. Among IRAE, thyroiditis was seen significantly earlier than arthritis (P = 0.040).

Conclusions

The decrease of tumor parameters at early time-point PET scans was seen in patients with immunotherapy who had clinical benefit within 1 year. PET-detectable IRAE was useful for prediction of a favorable outcome. Early development of thyroiditis may particularly represent an early response indicator to immunotherapy.
Pattern of FDG and MET Distribution in High- and Low-Grade Gliomas on PET Images
Authors: Takahashi Miwako , Soma Tsutomu , Mukasa Akitake , Tanaka Shota , Yanagisawa Shunsuke , Momose Toshimitsu
Published: February 2019

Purpose of the Report

This study aimed to determine the most effective metabolic index of FDG-PET and MET-PET to differentiate high- and low-grade gliomas, and then to characterize tumor metabolism according to the 2016 WHO classification. We also developed a new calculation method of potential infiltrative tumor volume to overcome the current limitations of tumor evaluation according to metabolic index, which focuses solely on tumor core area.

Materials and Methods

Patients who underwent both FDG-PET and MET-PET, as well as surgical treatment, were retrospectively identified. All tumors were diagnosed histologically and included 44 high-grade and 19 low-grade gliomas. Metabolic indices of tumor-to-normal (T/N) ratio and maximum value within the tumor itself were compared between high- and low-grade tumors. A calculation method for potential infiltrative tumor volume was developed and compared between these 2 grades.

Results

T/N, calculated as tumor value divided by normal cortex value, was the most effective (area under the curve, 0.800 for FDG-PET; area under the curve, 0.773 for MET-PET) for differentiating high- and low-grade gliomas. Potential infiltrative volume effectively distinguished between high- and low-grade glioma (43.8 ± 30.2 mL vs 14.0 ± 12.6 mL; P = 0.005 [t test]). A combination of T/N, with a cutoff value of 0.9 or higher on FDG-PET and/or 3.0 or higher on MET-PET, and potential infiltrative volume, with a cutoff value of 20.0 mL or higher, provided a diagnostic accuracy of 89% in distinguishing high- from low-grade gliomas.

Conclusions

Evaluation of potential infiltrative volume surrounding the tumor core area, in addition to the T/N ratio of the tumor core, may help distinguish between high- and low-grade gliomas.
Tumor Identification of Less Aggressive or Indolent Lymphoma With Whole-Body 11C-Acetate PET/CT
Authors: Tsuchiya Junichi , Yamamoto Masahide , Bae Hyeyeol , Oshima Takumi , Yoneyama Tomohiro , Miura Osamu , Tateishi Ukihide
Published: February 2019

Purpose

The aim of this study was to investigate the diagnostic performance of whole-body [11C]acetate PET/CT in less aggressive or indolent lymphomas, wherein [18F]FDG PET/CT would exhibit limited sensitivity.

Methods

Between September 2016 and May 2018, we prospectively evaluated 17 patients (9 men, 8 women; mean age [range], 71 [45–87] years) with pathologically proven less aggressive or indolent lymphomas according to Non-Hodgkin's Lymphoma Classification Project, using both [18F]FDG PET/CT and [11C]acetate PET/CT (performed on the same day). Detected nodal lesions were recorded according to the Ann Arbor classification. Extranodal (EN) lesions were also evaluated. We compared whole-body lesion detection between [18F] FDG PET/CT and [11C]acetate PET/CT using the McNemar test.

Results

In all patients, significantly more nodal and EN lesions were detected using [11C]acetate PET/CT than [18F]FDG PET/CT (nodal: 84 vs 64 regions; P < 0.001; EN: 26 vs 19 regions, P = 0.039). Bone lesions were detected in 8 and 5 patients using [11C]acetate PET/CT and [18F]FDG PET/CT, respectively (P = 0.25). Among the 14 patients (82.4%) who underwent bone marrow biopsy, bone marrow involvement was detected with sensitivities of 100% (6/6 patients) and 80% (5/6 patients) using [11C]acetate PET/CT and [18F]FDG PET/CT, respectively. Multiple areas of focal uptake in the spleen of 1 patient were exhibited on [18F]FDG PET/CT but not [11C]acetate PET/CT.

Conclusions

[11C]acetate PET/CT exhibited greater sensitivity than [18F]FDG PET/CT for lesion detection in patients with less aggressive or indolent lymphomas, thus promising applicability as a physiological tracer in the study of such lesions.
Effect of Sentinel Node Biopsy in Clinically N0, BRAF V600E–Mutated, Small Papillary Thyroid Carcinoma
Authors: Puccini Marco , Manca Gianpiero , Neri Carlo Maria , Boni Giuseppe , Coli Virginia , Garau Ludovico Maria , Colletti Patrick M. , Rubello Domenico , Buccianti Piero
Published: February 2019

Purpose

BRAF V600E mutation papillary thyroid cancer (PTC) is more aggressive with a higher risk of lymph node involvement and a poorer prognosis. Prior studies failed to demonstrate the superiority of prophylactic lymphadenectomy. We investigated the utility of additional radio-guided sentinel node biopsy (SNB).

Methods

We analyzed 15 patients with N0 PTC by ultrasound and BRAF mutation on preoperative biopsy treated with total thyroidectomy (TT) or TT + prophylactic central neck dissection (PCND) alone or with SNB. Conventional surgery was performed before SNB. We recorded primary tumor diameter, multifocality, extrathyroid infiltration, neoplastic emboli, and tall cell variant. At follow-up, we evaluated basal and stimulated thyroglobulin and ultrasound or radioiodine scintigraphy.

Results

Of 15 consecutive patients, 5 received conventional surgery alone, and 10 had SNB. For the first group, 4 underwent TT, and 1 had TT + PCND. Among the SNB group, 1 had no sentinel node detected and underwent a simple TT, 2 had TT + PCND+ SNB in the lateral compartment, and 7 had TT + SNB in 1 to 3 neck compartments. Micrometastases were found in 1 of 3 PCND specimens. Sentinel node biopsy revealed metastasis in 3 of 6 central compartment biopsies, in 2 of 6 biopsies in the ipsilateral lateral compartment, and in none of 2 biopsies in the contralateral compartment. Sentinel node biopsy allowed the removal of micrometastases in 4 of 10 patients. At 53 months' (mean) follow-up, no relapse was documented.

Conclusions

Radio-guided SNB correctly and efficiently stages cN0 BRAF–mutated PTC patients. Sentinel node biopsy could limit time-consuming, risk-exposing compartmental prophylactic dissections.
Hepatocellular Carcinoma Mimicking Neuroendocrine Tumor Metastasis on 68Ga-DOTATATE PET/CT
Authors: Ulaner Gary A. , Bodei Lisa
Published: February 2019

68Ga-DOTATATE is a radiolabeled somatostatin analog used for the detection and characterization of somatostatin receptor (SSR)–overexpressing tumors, particularly well-differentiated neuroendocrine tumors. We present a case of a 65-year-old man with well-differentiated pancreatic neuroendocrine tumor post–Whipple surgery and a new liver lesion on CT. 68Ga-DOTATATE PET/CT was performed for SSR characterization and restaging, which demonstrated the lesion to be intensely SSR positive and interpreted as a neuroendocrine metastasis. However, subsequent pathology proved the lesion to be a hepatocellular carcinoma. This case adds hepatocellular carcinoma as a potentially DOTATATE-avid malignancy to be considered in the differential diagnoses of SSR-positive liver lesions.
Primary Pulmonary Paraganglioma Revealed by FDG PET/CT
Authors: Shen Guohua , Su Minggang , Kuang Anren
Published: February 2019

Primary pulmonary paraganglioma is a rare type of extra-adrenal paragangliomas arising from neuroectodermal-derived paraganglionic tissue. We report herein the case of a 49-year-old woman with a round-like well-defined nodule in the right middle lobe detected by chest CT. FDG PET/CT also revealed this homogeneous nodule with increased FDG accumulation. Finally, the patient underwent right middle lobe resection, and the pathological findings demonstrated the diagnosis of pulmonary paraganglioma.
Resolution of Hypoxic Tissue in Cerebellar Hemispheres After Arterial Bypass Surgery in a Patient With Symptomatic Bilateral Vertebral Artery Occlusion
Authors: Oikawa Kohki , Kobayashi Masakazu , Beppu Takaaki , Terasaki Kazunori , Ogasawara Kuniaki
Published: February 2019

A 48-year-old man experienced recurrent vertigo refractory to antiplatelet medications. Cerebral angiography showed occlusion of bilateral vertebral arteries with poor collateral circulation. PET using 15O2 gas showed reduced blood flow and metabolic rate of oxygen and elevated oxygen extraction fraction in bilateral cerebellar hemispheres. Subsequent 18F-FRP170 (1-(2-18F-fluoro-1-[hydroxymethyl]ethoxy)methyl-2-nitroimidazole) PET, which depicts hypoxic but viable tissue, revealed elevated tracer uptake in the same regions. After superficial temporal artery-posterior cerebral artery anastomosis, 15O-gas PET showed normalization of blood flow, metabolic rate of oxygen, and oxygen extraction fraction in bilateral cerebellar hemispheres. Abnormally elevated 18F-FRP-170 uptake was also resolved in those regions.
Acral Involvement of Lymphoblastic Lymphoma Revealed on FDG PET/CT
Authors: Wen Zhe , Zhuang Hongming
Published: February 2019

Lymphoma rarely involves hand or foot. We presented the FDG PET/CT findings of lymphoblastic lymphoma in a 28-year-old man who had recurrent disease in many bones, including those of the hand and foot without any lymph node involvement 17 years after initial diagnosis.
68Ga-PSMA Uptake in Prostate Cancer Sciatic Nerve Metastasis
Authors: Gouveia Patrícia Barros , Violante Liliana Catarina Sobral , Teixeira Ricardo Jorge Valpaços , da Silva Trindade Duarte Luís Hugo
Published: February 2019

Most prostate cancers spread to regional lymph nodes, axial skeleton and lungs. Perineural malignant involvement is very rare. We present a 68Ga-PSMA PET/CT image of a sciatic nerve metastasis in a 65-year-old man with recurrent prostate cancer.
Facial Resurfacing With Prefabricated Induced Expanded Skin Flap
Authors: Yang Da-Ping , Zhang Pan
Published: February 2019

Massive facial damages extremely affect the facial appearance and function. In existing publications, the surgical flap transfer was still prior to other methods in repairing the facial injury. Among them, the prefabricated induced expanded skin flap seems more effective based on the facial specific features and damage range. In this study, a literature research was carried out in the database of PubMed. A total of 85 patients were included and all of them underwent the method of prefabricated expanded flap to reconstruct the massive facial defects. The prefabricated induced expanded skin flaps harvested from the neck and chest area have prominent advantage in resetting massive facial deformities. All the flaps survived demonstrated an excellent texture and color match with the facial defects areas. However, the unsolved problems are still existed in these flaps and further research is necessary to obtain a satisfactory outcome for both patients and surgeons.
Fat Grafting in the Management of War Injuries
Authors: Mazzola Riccardo F. , Mazzola Isabella C.
Published: February 2019

The healing potential of fat grafting was empirically noted by the surgeons who were confronted with the dramatic facial disfigurements resulting from World War 1. Fat was transplanted into the wounds either en bloc or in parcels to promote the healing capacity or to correct the uneven, depressed scars from gunshot wounds, enabling the poor soldiers to step back to society and families in a shorter period of time.

The idea of transplanting fat into the wound of the facially disfigured started with Hippolyte Morestin (1869–1919), surgeon in chief at Val-de Grace Military Hospital in Paris and was widely adopted by HD Gillies (1882–1960), Erich Lexer (1867–1937), Gustavo Sanvenero Rosselli (1897–1974), and others, achieving amazing results. Successful treatment of facially injured individuals showed the importance of plastic surgical procedures, the social role of the discipline, basis for obtaining the official recognition as surgical specialty.
Improved Tumor Resection on the Palpebral Margin
Authors: Xu Haitao , Qiu Yang , Wang Xingxing , Tian Rui , Zhang Jialu , Jiang Mengyang , Du Yuanyuan
Published: February 2019

Objective:

To resect benign tumors on the palpebral margin using an improved minimally invasive surgery, and to observe the outcome and analyze the possible healing mechanism of this improved surgical technique.

Methods:

Fifty-five patients with a benign tumor on the palpebral margin measuring 2- to 10 mm in diameter were included in this study. The tumors were resected along their edge and basal layer, causing minimal damage to the surrounding structures. Postoperative outcome measures included the following: the wound status, epithelial healing, eyelash growth, recurrence, and complications. Postoperative follow-up time points were 1 day, 7 days, 14 days, 1 month, 3 months, and 12 months.

Results:

The wound status ranged from edema to contraction in the early stage postoperatively. The eyelashes that were excised during the operation began to grow from 7 to 14 days postoperatively, and the epithelium began to close simultaneously. From 14 days to 3 months postoperatively, the eyelash and epithelium grew completely, and the scar disappear gradually. Except in 1 patient with trichiasis at 3 months and one patient with tumor recurrence at 12 months postoperatively, there were no other complications, such as ablepharon deformities, alopecia palpebralis, etc.

Conclusion:

Our improved minimally invasive technique not only resected the tumor effectively but also preserved the important anatomical structure of the palpebral margin. The favorable outcomes resulted from the mechanism of wound healing. This new surgical method is worth implementing in clinical practice.
Perioperative Outcomes of Secondary Frontal Orbital Advancement After Posterior Vault Distraction Osteogenesis
Authors: Zhang Rosaline S. , Lin Lawrence O. , Hoppe Ian C. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A.
Published: February 2019

Background:

Posterior cranial vault distraction osteogenesis (PVDO) has gained popularity as the initial intervention in patients with syndromic craniosynostosis. Patients may require secondary frontal orbital advancement (FOA) following PVDO, but little is known about the perioperative risks associated with this staged management. The purpose of this study is to compare the perioperative morbidity profile of secondary FOA (study) to that of primary FOA (control).

Methods:

A retrospective review was conducted for patients with syndromic or complex craniosynostosis undergoing FOA between 2004 and 2017. Univariate and multivariate analysis of demographic and perioperative data were performed.

Results:

Forty-three subjects met inclusion criteria, 17 in the study cohort and 26 in the control cohort. The 2 cohorts were similar with regards to diagnosis and suture involvement, as well as weight-adjusted estimated blood loss, blood transfusion volume, and length of hospital stay (P > 0.050). Secondary FOA procedures required longer operating time (231 ± 58 versus 264 ± 62 min, P = 0.031) and anesthesia time (341 ± 60 versus 403 ± 56 min, P = 0.002). The secondary FOA cohort had a significantly greater proportion of procedures with difficult wound closure (19% versus 59%, P = 0.008). Two subjects in the study cohort developed a wound dehiscence, compared with 1 subject in the control cohort (P = 0.552). Frontal orbital advancement as a secondary procedure after PVDO was a predictor variable in multivariate analysis for wound difficulties (odds ratio 8.6, P = 0.038).

Conclusion:

Syndromic and complex craniosynostosis may safely be managed with initial PVDO followed by FOA, with some increased wound closure difficulty.
The Use of Patient-Specific Three-Dimensional Printed Surgical Models Enhances Plastic Surgery Resident Education in Craniofacial Surgery
Authors: Lobb David C. , Cottler Patrick , Dart Dwight , Black Jonathan S.
Published: February 2019

Purpose:

A significant challenge in surgical education is to provide a meaningful hands-on experience with the pathology the trainee will see in independent practice. Craniofacial anatomy is challenging and unfamiliar to the learner.

Methods:

Using preoperative computed tomography data, the authors produced an accurately sized, three-dimensional (3D) printed model of the congenital craniofacial anatomy of patients treated by the same attending surgeon–PGY4 resident surgeon pair over the course of a 6-month rotation. A preoperative stepwise surgical plan was written by the attending and resident, and the plan was marked on the 3D model by the attending and resident separately. The written and marked plans were measured for accuracy and time to completion. The resident surgeon's applicable milestone levels were assessed.

Results:

Seven congenital craniofacial anomalies met criteria for inclusion: 4 craniosynostosis cases, 2 mandibular distractions, and 1 LeFort I distraction. The number of inaccuracies of the written plan improved from 5 to 0 for sagittal synostosis and 4 to 0 for mandibular distraction. The time to complete the written plan decreased by 22% for sagittal synostosis and 45% for mandibular distraction. The number of inaccuracies of the marked plan decreased from 5 to 0 for sagittal synostosis and 2 to 0 for mandibular distraction. Time to completion of the marked plan decreased by 76% for sagittal synostosis and 50% for mandibular distraction. Milestone scores increased an average of 1.875 levels.

Conclusion:

Three-dimensional printed craniofacial models are a positive addition to resident training and have been objectively quantified to improve the accuracy and time to completion of the surgical plan as well as progression in the plastic surgery milestones.
Open Versus Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms
Authors: O’Donnell Thomas F. X. , Boitano Laura T. , Deery Sarah E. , Schermerhorn Marc L. , Schanzer Andres , Beck Adam W. , Green Richard M. , Takayama Hiroo , Patel Virendra I.
Published: February 2019

Objective:

To compare outcomes of fenestrated (FEVAR) and open repairs of complex abdominal aortic aneurysms (cAAA).

Background:

FEVAR has emerged as an alternative to open surgery for treating cAAA, but direct comparisons are limited.

Methods:

We studied all repairs of intact or symptomatic cAAA in the Vascular Quality Initiative between 2012 and 2018, excluding chimney/snorkels and any devices implanted under Investigational Device Exemption studies. We compared open repairs, commercially available FEVAR devices and physician-modified endografts (PMEG) using inverse probability weighting. As a secondary analysis, we compared PMEG separately.

Results:

We identified 3253 cAAA repairs: 2125 open (65%), 877 FEVAR (27%), and 251 PMEG (8%). Patients undergoing FEVAR were older, with larger aneurysms, and more comorbidities. Propensity-weighted perioperative mortality was similar between open repair and FEVAR (4.7% vs 3.3%, respectively, P = 0.17), but open repair was associated with higher rates of myocardial infarction (5.0% vs 3.0%, P = 0.03), acute kidney injury (25% vs 16%, P < 0.001), and new dialysis (4.3% vs 2.1%, P = 0.003). However, propensity-weighted long-term mortality was higher following FEVAR [Hazard Ratio (HR) 1.7 (1.1–2.6), P = 0.02]. Although outcomes of commercially available FEVAR and PMEG were similar, there was a trend toward higher long-term mortality with PMEG compared to FEVAR [HR 1.7 (0.9–3.1), P = 0.09).

Conclusions:

In patients undergoing cAAA repair, open surgery was associated with higher overall survival than FEVAR and similar perioperative mortality, but longer lengths of stay, and higher rates of postoperative renal dysfunction and MI. PMEG were associated with similar perioperative results as commercially available FEVAR, but further study is needed to establish their long-term durability.
Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children
Authors: Podda Mauro , Gerardi Chiara , Cillara Nicola , Fearnhead Nicola , Gomes Carlos Augusto , Birindelli Arianna , Mulliri Andrea , Davies Richard Justin , Di Saverio Salomone
Published: February 2019

Objective:

The aim of this meta-analysis was to summarize the current available evidence on nonoperative management (NOM) with antibiotics for uncomplicated appendicitis, both in adults and children.

Summary Background Data:

Although earlier meta-analyses demonstrated that NOM with antibiotics may be an acceptable treatment strategy for patients with uncomplicated appendicitis, evidence is limited by conflicting results.

Methods:

Systematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized and nonrandomized studies comparing antibiotic therapy (AT) and surgical therapy-appendectomy (ST) for uncomplicated appendicitis. Literature search was completed in August 2018.

Results:

Twenty studies comparing AT and ST qualified for inclusion in the quantitative synthesis. In total, 3618 patients were allocated to AT (n = 1743) or ST (n = 1875). Higher complication-free treatment success rate (82.3% vs 67.2%; P < 0.00001) and treatment efficacy based on 1-year follow-up rate (93.1% vs 72.6%; P < 0.00001) were reported for ST. Index admission antibiotic treatment failure and rate of recurrence at 1-year follow-up were reported in 8.5% and 19.2% of patients treated with antibiotics, respectively. Rates of complicated appendicitis with peritonitis identified at the time of surgical operation (AT: 21.7% vs ST: 12.8%; P = 0.07) and surgical complications (AT: 12.8% vs ST: 13.6%; P = 0.66) were equivalent.

Conclusions:

Antibiotic therapy could represent a feasible treatment option for image-proven uncomplicated appendicitis, although complication-free treatment success rates are higher with ST. There is also evidence that NOM for uncomplicated appendicitis does not statistically increase the perforation rate in adult and pediatric patients receiving antibiotic treatment. NOM with antibiotics may fail during the primary hospitalization in about 8% of cases, and an additional 20% of patients might need a second hospitalization for recurrent appendicitis.