bluuebunny/crossref_metadata_2025 huggingface dataset:
Glaucoma and biomechanics
Authors: Safa Babak N. , Wong Cydney A. , Ha Jungmin , Ethier C. Ross
Published: December 2021

Purpose of review

Biomechanics is an important aspect of the complex family of diseases known as the glaucomas. Here, we review recent studies of biomechanics in glaucoma.

Recent findings

Several tissues have direct and/or indirect biomechanical roles in various forms of glaucoma, including the trabecular meshwork, cornea, peripapillary sclera, optic nerve head/sheath, and iris. Multiple mechanosensory mechanisms and signaling pathways continue to be identified in both the trabecular meshwork and optic nerve head. Further, the recent literature describes a variety of approaches for investigating the role of tissue biomechanics as a risk factor for glaucoma, including pathological stiffening of the trabecular meshwork, peripapillary scleral structural changes, and remodeling of the optic nerve head. Finally, there have been advances in incorporating biomechanical information in glaucoma prognoses, including corneal biomechanical parameters and iridial mechanical properties in angle-closure glaucoma.

Biomechanics remains an active aspect of glaucoma research, with activity in both basic science and clinical translation. However, the role of biomechanics in glaucoma remains incompletely understood. Therefore, further studies are indicated to identify novel therapeutic approaches that leverage biomechanics. Importantly, clinical translation of appropriate assays of tissue biomechanical properties in glaucoma is also needed.
Effects of Drama Therapy on Depressive Symptoms, Attention, and Quality of Life in Patients With Dementia
Authors: LIN Li-Wei , LU Yi-Hsin , CHANG Tasi-Hsiu , YEH Shu-Hui
Published: December 2021

Background

The prevalence of dementia in Taiwan continues to rise, and related patient care is becoming challenging for family members and caregivers. Nondrug treatments are often used as a care strategy to alleviate the behaviors associated with worsening dementia. Many international researchers have examined the effectiveness of drama therapy on dementia care. However, there is a lack of related studies in Taiwan.

Purpose

The aim of this study was to examine the effects of drama therapy in terms of improving depressive symptoms, attention, and quality of life in patients with senile dementia.

Methods

A two-group pretest-and-posttest design was employed in this randomized controlled trial. Cluster sampling was employed at four dementia daycare centers in central Taiwan. Two centers were randomly assigned to the experimental group, and the other two centers were assigned to the control group.

Results

Forty-two patients with dementia (23 in the experimental group and 19 in the control group) participated in this study. The study results showed that, after 8 weeks of drama therapy, the experimental group showed a significant improvement in depressive symptoms (β = −5.07, p < .001), attention (β = 5.86, p < .001), and quality of life (β = −6.08, p < .001). Furthermore, after 12 weeks of drama therapy, the experimental group continued to show a significant improvement in depressive symptoms (β = −4.65, p < .01), attention (β = 6.76, p < .001), and quality of life (β = −4.94, p < .01).

Conclusions

On the basis of the results of this study, patients with senile dementia who participate in 8- and 12-week drama therapy programs significantly improved in terms of depressive symptoms, attention, and quality of life. The authors hope that the findings of this study provide a reference for the intervention method, content, frequency, and timing of drama therapy in patients with dementia.
Measurement of Incus and Stapes Velocity Following Sound Stimulus in the Setting of Incudostapedial Joint Separation and Reconstruction
Authors: Lally CPT John W. , Ryan Matthew , Ahmed MAJ Mostafa , Afzali Leila , Spear LTC Samuel A. , Esquivel Carlos
Published: December 2021

Objective:

Understand the biophysical property changes of incudostapedial joint (ISJ) separation and ossicular hydroxyapatite application on middle ear function.

Study Design:

Basic science.

Setting:

Cadaveric temporal bone research laboratory.

Subjects and Methods:

A complete mastoidectomy was performed on five human temporal bones. A Laser Doppler Vibrometer was utilized to obtain velocity transfer function measurements of the incus and stapes across a range of frequencies in response to an acoustic stimulus. Under binocular microscopy the ISJ was separated and subsequently repaired with bone cement. Measurements were taken prior to ISJ separation, following joint separation, 30 to 60 min postrepair of the joint, and again 24 to 48 h postrepair of the joint.

Results:

The stapes measurements taken from the intact ossicular chain and from the chains repaired with bone cement demonstrated a similar distribution of measurements. The ISJ separation showed dramatically reduced velocity transfer function stapes measurements but increased incus velocity transfer function measurements. In the early and delayed repaired chains, the mean velocity of the incus and stapes velocity peaked between 1.5 and 2 kHz, matching intact maximal velocity. Pure tone average at 0.5, 1, 2, and 3 kHz demonstrated no change in reconstructed stapes velocity at 24 to 48 h.

Conclusions:

Isolated ISJ separation in fresh frozen and thawed temporal bones produces stapes velocity transfer function changes that corresponds with the clinically experienced conductive hearing loss. Repair with bone cement produced similar velocity curves to the intact ISJ curve with excellent recovery across mid-frequencies. This model would be useful for future ossicular mechanical studies.
A Rare Complication of Chronic Otitis Media: Central Skull Base Osteomyelitis Managed With Combined Endoscopic Transmastoid and Transsphenoidal Debridement
Authors: Suresh Krish , Chari Divya A. , Bartholomew Ryan A. , Tward Aaron D. , Kozin Elliott D. , Barshak Miriam B. , Holbrook Eric H. , Lee Daniel J.
Published: December 2021

Objective:

This report describes a case of otogenic central skull base osteomyelitis (CSBO) requiring complex surgical intervention and reviews the literature on management of this entity.

Patient:

A 76-year-old man presented with a nearly 20-year history of chronic otomastoiditis and cholesteatoma with ultimate progression to severe CSBO with involvement of the petrous apex, clivus, and craniocervical junction.

Interventions:

CSBO was managed with culture-directed antibiotic therapy, hyperbaric oxygen, and surgical intervention including serial combined endoscopic transmastoid and transsphenoidal debridements.

Main outcome measures:

Symptom resolution, antibiotic holiday, and stable disease on surveillance imaging.

Results:

With antibiotic treatment and surgical debridement including creation of a drainage pathway from the skull base to the sphenoid sinus, intermittent stretches of disease quiescence were realized over the course of nearly a decade. Despite extensive debridement and skull base reconstruction, the patient ultimately succumbed to the disease process.

Conclusions:

CSBO poses significant management challenges to the otologist. Herein, we present a rare case of CSBO managed over a prolonged period of time with antibiotics and combined anterior and lateral skull base debridement.
First Generation Osseointegrated Steady State Implant Benefits in Children With Hearing Loss
Authors: Gordon Karen A. , Papsin Blake C. , Feness MaryLynn , Negandhi Jaina , Cushing Sharon L.
Published: December 2021

Objective:

To assess outcomes of a new Osseointegrated Steady State Implant (OSSI) for bone conduction in adolescents.

Method:

In an initial trial, 14 adolescents (14.5 years of age, SD = 2.22) were provided with an OSSI; unilateral OSSI (n = 13), bilateral OSSI in sequential surgeries (n = 1). Outcomes measured were surgical duration, complications, hearing thresholds, speech perception and self-reported hearing benefits using the Speech and Spatial Quality of Hearing Questionnaire.

Results:

The surgical times were mean 93.6 minutes (SD = 33.3). Surgery was slightly longer in three adolescents who required skin flap reduction (n = 1) or significant bone polishing (n = 2) (121.33 minutes, SD = 8.14). Adverse events occurred in two adolescents post-implant poor external device retention in one child requiring revision flap reduction and inflammation at the incision site due to magnet overuse in another. The “Digital Link Calibration” measure was a good proxy predictor of the strength of magnet required for external device adherence (p = 0.002). The OSSI increased audibility in the implanted ear by mean 31.48 dB HL (SE = 1.58). Aided thresholds were best at 1 kHz (mean 25.33 dB HL, SD = 22.60) and only slightly poorer at 3000 and 4000 Hz (estimate decrease = 8.33 dB HL, SE = 3.54), reflecting good auditory sensitivity even at high frequencies. Speech perception when using the new device alone was good (89.67%, SD = 7.84%) and self-reported hearing by participants and parents improved in all domains assessed by the Speech and Spatial Quality of Hearing Questionnaire (estimate = 1.90 points, SE = 0.25, p < 0.0001).

Conclusion:

The OSSI provides hearing benefits with surgical safety in a carefully selected cohort of adolescents.
Characterization of Sensorineural Hearing Loss in Patients With MYH9-Related Disease: A Systematic Review
Authors: Peddu Dhiraj , Amin Sahil , Ying Yu-Lan Mary
Published: December 2021

Objectives:

To review the characteristics and progression of hearing loss in MYH9-related disease (MYH9-RD) patients and present a unique case of bilateral non-simultaneous sudden sensorineural hearing loss (SNHL) in an MYH9-RD patient. MYH9-RD is a rare autosomal dominant platelet disorder. Patients with this disorder have a variable risk of developing SNHL.

Methods:

A comprehensive literature search for scientific articles in PubMed, Scopus, and Web of Science that reported hearing loss outcomes in MYH9-RD patients.

Results:

Initial search yielded 270 studies. Eight studies with a total of 23 patients met inclusion criteria and were used for data analysis. MYH9-RD patients typically present with progressive bilateral SNHL affecting predominantly the high frequencies. Mean age of hearing loss onset was 17.1 years, progressing to severe—profound SNHL over a mean period of 14.4 years. Seventeen of the 23 patients received cochlear implant (CI) at a mean age of 37.9 years. In comparison, the study patient presented initially with bilateral progressive SNHL as a teenager and developed bilateral non-simultaneous sudden SNHL, first in her right ear at the age of 31 and 7 months later in her left ear at the age of 32. She is now a successful bilateral CI user.

Conclusions:

This is the first systematic investigation of the relationship between MYH9-RD patients and SNHL. Hearing loss in MYH9-RD patients is generally characterized as progressive SNHL. However, the study patient presented with the unique feature of bilateral non-simultaneous sudden SNHL, potentially expanding the hearing loss sequela associated with this disorder.
Predictive Effect of Bone Conduction Pattern on Hearing Outcomes of Stapes Surgery
Authors: Shapiro Scott B. , Grojean Meghan , Hong Michael , Lipschitz Noga , Breen Joseph T. , Pensak Myles L. , Samy Ravi N.
Published: December 2021

Objective:

Examine the effect of preoperative bone conduction pattern on outcomes of stapedotomy/stapedectomy.

Study Design:

Retrospective case series.

Setting:

Tertiary-care academic medical center.

Patients:

Patients who underwent stapedotomy or stapedectomy from 2013 to 2019.

Interventions:

Primary small-fenestra stapedotomy or partial stapedectomy.

Main Outcome Measures:

Association between preoperative bone conduction patterns and hearing after stapes surgery.

Results:

Complete audiometric data were available for 137 patients who had surgery. The mean preoperative air-bone gap (ABG) was 26.8 dBHL. The ABG was closed to less than 20 and 10 dBHL in 88.7 and 65.2% of patients, respectively. A notch at 2000 Hz was present in 32.1% of operated ears and was rarely found at other frequencies. There was no statistically significant association between the presence of a notch and hearing outcomes. The slope of the bone conduction line had no association with hearing outcomes, though an increased bone conduction PTA compared with the contralateral ear was associated with ABG closure less than 10 dBHL and overclosure (odds ratio: 2.14, p = 0.027 and odds ratio: 2.20, p = 0.04).

Conclusion:

In properly selected otosclerosis patients, depressions in bone conduction other than near 2000 Hz are rare and hearing outcomes are generally favorable regardless of the preoperative bone conduction pattern. Despite the association with otosclerosis, the presence of a notch at 2000 Hz is not associated with better hearing outcomes with surgery.
A Case–Case Analysis of Intralabyrinthine Schwannoma Versus Intracanalicular Vestibular Schwannoma
Authors: Selleck Anne Morgan , Hicks Kelli L. , Brown Kevin D.
Published: December 2021

Objectives:

Determine the differences in presentation of intracanalicular and intralabyrinthine schwannomas.

Study Design:

Retrospective chart review at a single center.

Setting:

Tertiary academic referral center.

Patients:

Eighteen subjects with an intralabyrinthine schwannoma (ILS) and 216 patients with an intracanalicular vestibular schwannoma (VS).

Main Outcome Measures:

Variables collected included age at diagnosis, gender, presenting signs and symptoms, imaging findings, treatment modality, pure-tone average (PTA), and word recognition scores (WRS) at presentation and at follow-up visits.

Results:

Incidence of subjective hearing loss was 100% in the ILS group and 80.6% in the intracanalicular VS group. The degree of hearing loss was significantly worse in the ILS group (average PTA of 83.9 dB; average WRS of 46.9%) compared with the VS group (average PTA of 38.7 dB; average WRS of 71.8%) (PTA p = 0.000006; WRS p = 0.007). Other subjective signs and symptoms, including vestibular symptoms, did not differ significantly between the two groups. Approximately one-third of both groups underwent microsurgical resection. 22.2% of ILSs were missed on initial imaging by radiologists.

Conclusion:

Intralabyrinthine schwannomas differ from intracanalicular schwannomas in the severity of hearing loss at presentation. Otherwise, these two tumors present in a very similar fashion—age at presentation, presenting signs and symptoms—and are treated comparably. Otolaryngologists should maintain a high degree of suspicion for ILS in patients presenting with an asymmetric hearing loss, vertigo, and tinnitus.
Cochlear Implantation Can Improve Auditory Skills, Language and Social Engagement of Children With Autism Spectrum Disorder
Authors: Jenks Carolyn M. , Hoff Stephen R. , Haney Jennifer , Tournis Elizabeth , Thomas Denise , Young Nancy M.
Published: December 2021

Objective:

To review outcomes of cochlear implantation (CI) in children diagnosed with autism spectrum disorder (ASD).

Study Design:

Retrospective case review and parent survey.

Setting:

Tertiary care children's hospital.

Patients:

Thirty children with ASD who underwent CI between 1991 and 2018. Mean age at CI = 3.5 years (0.8–11.8), mean age at diagnosis of ASD = 5.1 years (2.0–15.0) (22/30 diagnosed after CI), mean follow-up = 10.5 years (1.4–21.6). Parents of 7 children returned a survey.

Intervention:

Unilateral or bilateral cochlear implantation.

Main Outcome Measures:

Speech perception; expressive communication mode; educational placement; social engagement; consistency of CI use; parent survey of child behavior change.

Results:

Thirty-three percent of all and 45% of the 22 consistent device users developed measurable open-set speech perception by an average of 4.5 years of device use. Educational placement at last follow-up included 13% mainstreamed without interpreter, 50% Special Education programs, 10% therapeutic residential or day programs, 23% total communication programs, and one home schooled. Spoken language alone was used by 31% and spoken plus sign by 14%, with the remainder using sign alone, augmentative communication devices or no mode of communication. By parent report, 86% showed improvement in social engagement compared to pre-CI. Survey results showed the behaviors most frequently ranked as most affected by CI were communication and attention, while awareness of environment had the lowest (most affected) mean ranking.

Conclusions:

Findings support a growing body of literature that cochlear implantation has the potential to improve auditory skills, language, and enhance social engagement in some deaf children with autism spectrum disorder.
Use of unattended automated office blood pressure in Utah primary care clinics
Authors: Stuligross John , Hoj Taylor H. , Brown Brittany , Woolsey Sarah , Stults Barry
Published: December 2021

Aim

Unattended automated office blood pressure (BP) measurement (u-AOBP) improves office BP measurement accuracy and reduces white-coat BP elevation. u-AOBP is recommended as the preferred office BP measurement technique by multiple hypertension guidelines. This study examines utilization, performance, and potential barriers to implementation of u-AOBP in Utah primary care clinics following 5 years of promotional efforts by the Utah Million Hearts Coalition (UMHC).

Methods

An online questionnaire was administered to 285 Utah primary care clinics to evaluate self-reported use of u-AOBP and u-AOBP technique, interpretation of results, and perceived barriers to implementation.

Results

Seventy-nine of 285 clinics (27.7%) completed the full questionnaire. Fifty-nine clinics (74.7%) use u-AOBP. Nearly 65% first learned about u-AOBP through UMHC promotional efforts rather than from the medical literature. One-half of these clinics noted no significant barriers to u-AOBP implementation, and over 80% noted no reduction in medical staff productivity. However, important knowledge deficits concerning correct u-AOBP performance and interpretation of results were apparent from answers to the questionnaire.

Conclusion

After 5 years of UMHC promotional efforts, at least 20% of the 285 Utah primary care clinics invited to take the questionnaire and 75% of the 79 clinics completing the survey have incorporated u-AOBP and found it feasible in a primary care setting. Ongoing promotion of u-AOBP implementation at the local and regional level is required to extend its utilization. Effective, accessible educational materials and local technical assistance from public health and community partners are needed to correct knowledge and performance deficits to optimize u-AOBP utilization in primary care.
Lipidomics in diabetes
Authors: Kim Eun Ji , Ramachandran Radha , Wierzbicki Anthony S.
Published: December 2021

Purpose of review

Multiple studies have shown a strong association between lipids and diabetes. These are usually described through the effects of cholesterol content of lipid particles and in particular low-density lipoprotein. However, lipoprotein particles contain other components, such as phospholipids and more complex lipid species, such as ceramides and sphingolipids. Ceramides, such as sphingolipids are also produced intracellularly and have signalling actions in regulating cell metabolism including effects on inflammation, and potentially have a mechanistic role in the development of insulin resistance.

Recent findings

Recently, techniques have been developed to analyse detailed molecular profiles of lipid particles – lipidomics. Proteomics has confirmed the different proteins associated with different particles but far less is known about the relationship of individual lipid species with diabetes and cardiovascular risk. A number of studies have now shown that the plasma lipidome, and in particular, ceramides and sphingolipids may predict the development of diabetes.

Lipidomics had identified ceramides and sphingolipids as potential mediators of cellular dysfunction in diabetes. Further work is required to ascertain whether they have clinical utility.
The association of biological sex and long-term outcomes in patients with acute dyspnea at the emergency department
Authors: Vaittinada Ayar Prabakar , Motiejūnaitė Justina , Čerlinskaitė Kamilė , Deniau Benjamin , Blet Alice , Kavoliūnienė Aušra , Mebazaa Alexandre , Čelutkienė Jelena , Azibani Feriel
Published: December 2021

Background and importance

Marked differences have been described between women and men in disease prevalence, clinical presentation, response to treatment and outcomes. However, such data are scarce in the acutely ill. An awareness of differences related to biological sex is essential for the success of clinical care and outcomes in patients presenting with acute dyspnea, the most frequent cause of emergency department (ED) admission.

Objectives

The aim of the present study was to assess the effect of biological sex on 1-year all-cause mortality in patients presenting with acute dyspnea to the ED.

Design, settings and participants

Consecutive adult patients presenting with acute dyspnea in two Lithuanian EDs were included. Clinical characteristics, laboratory data and medication use at discharge were collected. Follow-up at 1 year was performed via national data registries.

Outcomes measure and analysis

The primary outcome of the study was 1-year all-cause mortality. Hazard ratios (HRs) for 1-year mortality according to biological sex were calculated using a Cox proportional hazards regression model, with and without adjustment for the following confounders: age, systolic blood pressure, creatinine, sodium and hemoglobin.

Main results

A total of 1455 patients were included. Women represented 43% of the study population. Compared to men, women were older [median (interquartile range [IQR]) age 74 (65–80) vs. 68 (59–77) years, P < 0.0001]. The duration of clinical signs before admission was shorter for women [median (IQR) duration 4 (1–14) vs. 7(2–14) days, P = 0.006]. Unadjusted 1-year all-cause mortality was significantly lower in women (21 vs. 28%, P = 0.001). Adjusted HR of 1-year all-cause mortality was lower in women when compared to men [HR 0.68 (0.53–0.88), P = 0.0028]. Additional sensitivity analyses confirmed the survival benefit for women in subgroups including age greater and lower than 75 years, the presence of comorbidities and causes of dyspnea (cardiac or noncardiac).

Conclusion

Women have better 1-year survival than men after the initial ED presentation for acute dyspnea. Understanding the biological sex-related differences should lead toward precision medicine, and improve clinical decision-making to promote gender equality in health.
Accuracy of Emergency Severity Index in older adults
Authors: Kemp Kirsi , Alakare Janne , Kätkä Minna , Lääperi Mitja , Lehtonen Lasse , Castrén Maaret
Published: December 2021

Background and importance

Emergency Severity Index is a five-level triage tool in the emergency department that predicts the need for emergency department resources and the degree of emergency. However, it is unknown whether this is valid in patients aged greater than or equal to 65 years.

Objective

The aim of the study was to compare the accuracy of the Emergency Severity Index triage system between emergency department patients aged 18–64 and greater than or equal to 65 years.

Design, settings, and participants

This was a retrospective observational cohort study of adults who presented to a Finnish emergency department between 1 February 2018 and 28 February 2018. All data were collected from electronic health records.

Outcome measures and analysis

The primary outcome was 3-day mortality. The secondary outcomes were 30-day mortality, hospital admission, high dependency unit or ICU admission, and emergency department length of stay. The area under the receiver operating characteristic curve and cutoff performances were used to investigate significant associations between triage categories and outcomes. The results of the two age groups were compared.

Main results

There were 3141 emergency department patients aged 18–64 years and 2370 patients aged greater than or equal to 65 years. The 3-day mortality area under the curve in patients aged greater than or equal to 65 years was greater than that in patients aged 18–64 years. The Emergency Severity Index was associated with high dependency unit/ICU admissions in both groups, with moderate sensitivity [18–64 years: 61.8% (50.9–71.9%); greater than or equal to 65 years: 73.3% (63.5–81.6%)] and high specificity [18–64 years: 93.0% (92.0–93.8%); greater than or equal to 65 years: 90.9% (90.0–92.1%)]. The sensitivity was high and specificity was low for 30-day mortality and hospital admission in both age groups. The emergency department length of stay was the longest in Emergency Severity Index category 3 for both age groups. There was no significant difference in accuracy between age groups for any outcome.

Conclusion

Emergency Severity Index performed well in predicting high dependency unit/ICU admission rates for both 18–64 years and greater than or equal to 65-year-old patients. It predicted the 3-day mortality for patients aged greater than or equal to 65 years with high accuracy. It was inaccurate in predicting 30-day mortality and hospital admission for both age groups.
Factors that lead to dialysis as the preferred treatment modality for patients with chronic kidney disease
Authors: Bleyer Anthony J.
Published: December 2021

Purpose of review

To describe forces that lead to dialysis as the preferred treatment modality for patients with chronic kidney disease.

Recent findings

Although chronic dialysis is life-saving and the only option available for many individuals, treatment of the underlying causes of kidney disease and transplantation may be preferable options for many patients. Factors that favor dialysis instead of treatment of underlying kidney disease or transplantation include lack of proper diagnosis, lack of proper treatment of underlying kidney disease, poor compliance, lack of consideration for transplantation, early initiation of dialysis therapy, and financial incentives. New developments that may reverse this trend include genetic panels that improve diagnosis of kidney disease, new methods of transplantation, and legislation that will encourage kidney transplantation.

By recognizing factors that favor dialysis over other therapies, nephrologists may be better able to provide care to their patients and prevent dialysis, researchers may be able to focus on research that will prevent the need for dialysis, and professional societies may work to prevent unneeded dialysis.
Can chronic kidney disease lead to chronic heart failure, and does worsening chronic heart failure lead to chronic kidney disease progression
Authors: Leon Silvia J. , Tangri Navdeep
Published: December 2021

Purpose of review

The objective of this review is to discuss if chronic kidney disease (CKD) leads to chronic heart failure (CHF), and does worsening CHF lead to CKD progression and how a new medication class can modify the risk of both outcomes.

Recent findings

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are similarly effective on cardiovascular (CV) - and kidney-related outcomes in the presence of CV and CKD.

SGLT2 inhibitors can reduce the risk of CHF events and CKD progression, and may have synergistic effects in patients with cardiorenal syndrome.
Lung adenocarcinoma: development of nomograms based on PET/CT images for prediction of epidermal growth factor receptor mutation status and subtypes
Authors: Huang Lele , Cao Yuntai , Zhou Fei , Li Jicheng , Ren Jialiang , Zhang Guojin , Luo Yongjun , Liu Jiangyan , He Jiangping , Zhou Junlin
Published: December 2021

Objective

To develop nomograms that combine clinical characteristics, computed tomographic (CT) features and 18F-fluorodeoxyglucose PET (18F-FDG PET) metabolic parameters for individual prediction of epidermal growth factor receptor (EGFR) mutation status and exon 19 deletion mutation and exon 21 point mutation (21 L858R) subtypes in lung adenocarcinoma.

Methods

In total 124 lung adenocarcinoma patients who underwent EGFR mutation testing and whole-body 18F-FDG PET/CT were enrolled. Each patient’s clinical characteristics (age, sex, smoking history, etc.), CT features (size, location, margins, etc.) and four metabolic parameters (SUVmax, SUVmean, MTV and TLG) were recorded and analyzed. Logistic regression analyses were performed to screen for significant predictors of EGFR mutation status and subtypes, and these predictors were presented as easy-to-use nomograms.

Results

According to the results of multiple regression analysis, three nomograms for individualized prediction of EGFR mutation status and subtypes were constructed. The area under curve values of three nomograms were 0.852 (95% CI, 0.783–0.920), 0.857 (95% CI, 0.778–0.937) and 0.893 (95% CI, 0.819–0.968) of EGFR mutation vs. wild-type, 19 deletion mutation vs. wild-type and 21 L858R vs. wild-type, respectively. Only calcification showed significant differences between the EGFR 19 deletion and 21 L858R mutations.

Conclusion

EGFR 21 L858R mutation was more likely to be nonsolid texture with air bronchograms and pleural retraction on CT images. And they were more likely to be associated with lower FDG metabolic activity compared with those wild-types. The sex difference was mainly caused by the 19 deletion mutation, and calcification was more frequent in them.
Semiautomatic assessment of whole-body tumor burden with 18F-PSMA-1007 in biochemical recurrent prostate cancer
Authors: Cardoza-Ochoa David R. , Cristancho-Rojas Cesar , Pérez David J. , Moreno-Izaguirre Paola , Guzman Melissa , Gutiérrez-Rivera María C. , Gaxiola-Mascareño Aarón P. , Avila-Rodríguez Miguel A. , Rivera-Bravo Belén
Published: December 2021

Objective

The aim of the study was to evaluate the 18F-PSMA-1007 PET/computed tomography (CT) semiautomatic volumetric parameters to assess the whole-body tumor burden and its correlation with prostate-specific antigen (PSA) and Gleason score in patients with biochemically recurrent prostate cancer (PCa).

Materials and methods

A total of 110 patients referred for 18F-PSMA-1007 PET/CT due to biochemical recurrence were retrospectively analyzed. Whole-body total lesion prostate-specific membrane antigen (wbTl-PSMA) and whole-body PSMA-derived tumor volume (wbPSMA-TV) metrics on 18F-PSMA-1007 were obtained semiautomatically in dedicated software. A Spearman test was performed to explore the correlation of volumetric imaging parameters with PSA levels and Gleason score. To analyze the association between volumetric measures and PSA subgroups, we used a Kruskal–Wallis test and a Dunn’s test to identify each group causing an observed difference.

Results

A total of 492 metastatic lesions were analyzed, and a significant correlation was found between wbTL-PSMA (R = 0.63, P < 0.0001) and wbPSMA-TV (R = 0.49, P < 0.0001) with serum PSA. A statistically significant difference with wbTL-PSMA was found in patients with a PSA less than or equal 0.5 ng/ml and PSA in the range of 0.51–1.0 ng/ml.

Conclusion

18F-PSMA-1007 PSMA volumetric parameters can provide a quantitative imaging biomarker for whole-body tumor burden.
Radiomics model based on preoperative 18F-fluorodeoxyglucose PET predicts N2-3b lymph node metastasis in gastric cancer patients
Authors: Xue Xiu-Qing , Yu Wen-Ji , Shao Xiao-Liang , Li Xiao-Feng , Niu Rong , Zhang Fei-Fei , Shi Yun-Mei , Wang Yue-Tao
Published: December 2021

Objective

The aim of the study was to construct and validate 18F-fluorodeoxyglucose (18F-FDG) PET-based radiomics nomogram and use it to predict N2-3b lymph node metastasis in Chinese patients with gastric cancer (GC).

Methods

A total of 127 patients with pathologically confirmed GC who underwent preoperative 18F-FDG PET/CT imaging between January 2014 and September 2020 were enrolled as subjects in this study. We use the LIFEx software to extract PET radiomic features. A radiomics signature (Rad-score) was developed with the least absolute shrinkage and selection operator algorithm. Then a prediction model, which incorporated the Rad-score and independent clinical risk factors, was constructed and presented with a radiomics nomogram. Receiver operating characteristic (ROC) analysis was used to assess the performance of Rad-score and the nomogram. Finally, decision curve analysis (DCA) was applied to evaluate the clinical usefulness of the nomogram.

Results

The PET Rad-score, which includes four selected features, was significantly related to pN2-3b (all P < 0.05). The prediction model, which comprised the Rad-score and carcinoembryonic antigen (CEA) level, showed good calibration and discrimination [area under the ROC curve: 0.81(95% confidence interval: 0.74–0.89), P < 0.001)]. The DCA also indicated that the prediction model was clinically useful.

Conclusion

This study presents a radiomics nomogram consisting of a radiomics signature based on PET images and CEA level that can be conveniently used for personalized prediction of high-risk N2-3b metastasis in Chinese GC patients.
Diagnostic value of single-photon emission computed tomography-CT foot and ankle studies
Authors: Kaneria Nirav , Redman Stewart , Little David , Graham Richard
Published: December 2021

Aim

The aim of this study is to determine the impact of foot and ankle single-photon emission computed tomography (SPECT) CT on patient management.

Method and materials

A retrospective review over a 7-year period investigating whether the study identified or confirmed a source of symptoms. The electronic patient record was reviewed to see whether the test was helpful to the onward management of the patient.

Results

In total 44 patients were included and pathology was identified in 40 of the 44 patients, with four having normal studies. SPECT CT was deemed helpful in the management of 39 of the patients with the positive usefulness overall calculated as 89%. The remaining five patients where the test was not helpful have been discussed.

Conclusion

SPECT-CT is a helpful imaging test in the diagnosis of foot and ankle disorders with 89% of studies being diagnostically useful.
Cellular senescence in the cholangiopathies
Authors: Bogert Pamela S. , O’Hara Steven P. , LaRusso Nicholas F.
Published: December 2021

Purpose of review

Cellular senescence (i.e. permanent withdrawal from the cell cycle) is increasingly recognized as a pathologic feature in a variety of inflammatory liver diseases, including primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and additional cholangiopathies. Herein, we provide an update on the interplay between cholangiocytes, cellular senescence and the cholangiopathies.

Recent findings

The themes covered by this review include novel models for studying the role of senescent cholangiocytes and the cholangiopathies, identification and modulation of key pathways or molecules regulating cholangiocyte senescence, and discovery of druggable targets to advance therapeutic options for the cholangiopathies. Most recent studies focused on PSC; however, the concepts and findings may be applied to additional cholangiopathies.

Cholangiopathies present unique and divergent clinicopathological features, causes and genetic backgrounds, but share several common disease processes. Cholangiocyte senescence in the cholestatic cholangiopathies, primarily PSC and PBC, is regarded as a key pathogenetic process. Importantly, senescent cholangiocytes exhibit phenotypic features including the senescence-associated secretory phenotype (SASP) and resistance to apoptosis that provide new directions for basic research and new prognostic and therapeutic approaches for clinical practice.
The congenital dyserythropoieitic anemias: genetics and pathophysiology
Authors: King Richard , Gallagher Patrick J. , Khoriaty Rami
Published: December 2021

Purpose of review

The congenital dyserythropoietic anemias (CDA) are hereditary disorders characterized by ineffective erythropoiesis. This review evaluates newly developed CDA disease models, the latest advances in understanding the pathogenesis of the CDAs, and recently identified CDA genes.

Recent findings

Mice exhibiting features of CDAI were recently generated, demonstrating that Codanin-1 (encoded by Cdan1) is essential for primitive erythropoiesis. Additionally, Codanin-1 was found to physically interact with CDIN1, suggesting that mutations in CDAN1 and CDIN1 result in CDAI via a common mechanism. Recent advances in CDAII (which results from SEC23B mutations) have also been made. SEC23B was found to functionally overlap with its paralogous protein, SEC23A, likely explaining the absence of CDAII in SEC23B-deficient mice. In contrast, mice with erythroid-specific deletion of 3 or 4 of the Sec23 alleles exhibited features of CDAII. Increased SEC23A expression rescued the CDAII erythroid defect, suggesting a novel therapeutic strategy for the disease. Additional recent advances included the identification of new CDA genes, RACGAP1 and VPS4A, in CDAIII and a syndromic CDA type, respectively.

Establishing cellular and animal models of CDA is expected to result in improved understanding of the pathogenesis of these disorders, which may ultimately lead to the development of new therapies.
The significance of CUX1 and chromosome 7 in myeloid malignancies
Authors: Jotte Matthew R.M. , McNerney Megan E.
Published: December 2021

Purpose of review

Loss of chromosome 7 has long been associated with adverse-risk myeloid malignancy. In the last decade, CUX1 has been identified as a critical tumor suppressor gene (TSG) located within a commonly deleted segment of chromosome arm 7q. Additional genes encoded on 7q have also been identified as bona fide myeloid tumor suppressors, further implicating chromosome 7 deletions in disease pathogenesis. This review will discuss the clinical implications of del(7q) and CUX1 mutations, both in disease and clonal hematopoiesis, and synthesize recent literature on CUX1 and other chromosome 7 TSGs.

Recent findings

Two major studies, including a new mouse model, have been published that support a role for CUX1 inactivation in the development of myeloid neoplasms. Additional recent studies describe the cellular and hematopoietic effects from loss of the 7q genes LUC7L2 and KMT2C/MLL3, and the implications of chromosome 7 deletions in clonal hematopoiesis.

Mounting evidence supports CUX1 as being a key chromosome 7 TSG. As 7q encodes additional myeloid regulators and tumor suppressors, improved models of chromosome loss are needed to interrogate combinatorial loss of these critical 7q genes.
Limits and potential implementation of the present pN classification for oral squamous cell carcinoma
Authors: Mortensen Jonas , Mirian Christian , Ovesen Therese
Published: December 2021

Purpose of review

The purpose of this review is to highlight the most important changes in the eighth TNM classification system for oral squamous cell carcinomas compared with the seventh edition with focus on lymph node staging (pN). Nodal involvement is crucial when addressing prediction of survival, and staging must mirror the disease extension. pN classification will be evaluated with respect to lymph node yield (LNY), lymph node density (LND), and a recently proposed classification: pN-N+ reflecting positive regional lymph nodes (metastatic burden) and extra nodal extension.

Recent findings

TNM8 was introduced in 2018, and the most noteworthy changes were depth of invasion (DOI) and extranodal extension (ENE). Recent studies indicate, that TNM8-related pN is not superior to TNM7 with respect to predicting survival. LNY and LND are biased with ecological interference fallacy, and currently not recommended in future iterations of TNM. In contrast, the pN-N+ classification has demonstrated improved survival prediction compared with TNM8.

The recent findings support the inclusion of pN-N+, that is, metastatic burden and extranodal extension in future iterations of TNM.
Kidney transplantation in pediatric patients with rheumatologic disorders
Authors: Cody Ellen , Hooper David K.
Published: December 2021

Purpose of review

Providers caring for children with end-stage kidney disease from rheumatologic conditions face questions such as when to proceed with kidney transplantation, how common is disease recurrence posttransplant, how does recurrent disease impact patient and allograft outcomes, and what approaches are available to prevent and treat recurrent disease. We discuss recent developments and relevant literature that address these questions for the most common rheumatologic disorders that lead to end-stage kidney disease in childhood namely, systemic lupus erythematosus, IgA nephropathy, IgA Vasculitis/Henoch Schoenlein Purpura, and Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis.

Recent findings

Recent data suggest that children with IgA nephropathy, IgA vasculitis, and ANCA-associated vasculitis have similar patient and allograft survival to other conditions despite the risk of recurrent disease, yet those with lupus have worse posttransplant patient and allograft outcomes. A period of disease quiescence may be prudent prior to transplantation to decrease the risk of recurrence, which is associated with decreased allograft survival. Data on preventive strategies and treatment options are limited.

It is recommended that patients with systemic rheumatologic conditions not be excluded from kidney transplantation but that patients be counseled on the risk of potential recurrent disease with its impact on transplant outcomes.
Technical advances in nerve-sparing and continence preservation
Authors: Pedraza Adriana M. , Wagaskar Vinayak , Parekh Sneha , Tewari Ashutosh
Published: December 2021

Purpose of review

Urinary incontinence and erectile dysfunction are common after radical prostatectomy. These side effects greatly impact patients’ quality of life. Therefore, surgical techniques and technology tools are constantly being developed to optimize trifecta outcomes. Here we focus on advances in nerve-sparing (NS) and continence preservation.

Recent findings

New surgical techniques dedicated to preservation rather than reconstruction have been developed to improve urinary continence (UC) and NS. On the other hand, intraoperative assessment of prostatic and periprostatic structures has shown promising outcomes toward NS whereas avoiding omission of extracapsular extension (ECE). Likewise, neural regeneration strategies are under research to improve return of erectile function and UC.

Superb outcomes after Robot-Assisted Radical Prostatectomy require a proper balance between NS and risk of ECE. Detailed anatomic knowledge together with an accurate surgical planning are cornerstone for tailoring the approach in each case.
Lasers in laparoscopic and robotic surgery: is there a need for them
Authors: Pushkar Dmitry Y. , Kolontarev Konstantin B.
Published: December 2021

Purpose of review

The application of lasers in treating urological disorders is a developing area. In the laparoscopic and robotic surgery, laser energy is not so popular as in the treatment of stone disease and benign prostatic hyperplasia. The aim of this review is to clarify the current status of laser applications in laparoscopic and robotic urology.

Recent findings

Laser welding of the pyeloureteral anastomosis is not performed in routine clinical practice. Most investigation of laser applications in laparoscopic and robotic urology has centered on laparoscopic partial nephrectomy and robot-assisted partial nephrectomy. Much less work has been done with regard to lower tract laser laparoscopic and robotic applications. However, laser laparoscopic radical prostatectomy has been investigated.

Current literature regarding lasers in laparoscopic and robotic surgery is extremely limited. Available data consist mostly of small cohorts providing a low level of evidence. Even though initial studies with currently available laser modalities demonstrated promising results, several drawbacks in each technique need to be addressed before being widely accepted as a standard care. Despite investigation, laser usage during laparoscopic and robotic urological procedures has not gained widespread acceptance and remains experimental at this time.
Thulium fiber laser in urology: physics made simple
Authors: Taratkin Mark , Azilgareeva Camilla , Cacciamani Giovanni E. , Enikeev Dmitry
Published: December 2021

Purpose of review

In this narrative review, we will focus on a novel thulium fiber laser's physical properties in terms of its clinical applicability.

Recent findings

TFL has successfully moved forward from the preclinical trials into clinical practice and now is being widely used in clinics around the world. The available data suggest that the device effectively operates in soft tissues – benign prostate hyperplasia (BPH) and bladder tumors, as well as in lithotripsy. Also, the first promising results were obtained from laparoscopic surgery showing its possible applicability in the management of renal cell carcinoma. The constructional changes in fiber laser's design, lead to alteration of laser–tissue interactions, which resulted in clinical advantages of the device. Yet, the exact mechanism often is considered complex for understanding. With this work, we are aiming to build a bridge between biophysics and clinical practice and give a simple explanation of how the devices is working and why the knowledge of it is important for a clinician.

The more effective wavelength (closer to the water absorption peak), favorable beam profile, different modes of action allowing to decrease carbonization on one hand and retropulsion on the other, all this makes TFL an evolution in urologic surgery. Further trials investigating on the possible pros and cons of the device are awaited.
Best nonsurgical managements of acute urinary retention: what's new?
Authors: Baboudjian Michael , Peyronnet Benoit , Boissier Romain , Robert Grégoire , Cornu Jean-Nicolas , Misrai Vincent , Pradere Benjamin
Published: December 2021

Purpose of review

To provide a comprehensive review of the nonsurgical management of acute urinary retention (AUR).

Recent findings

A recent meta-analysis confirmed that α-blockers are associated with higher rates of successful trial without catheter (TWOC) compared with placebo, while combination therapies do not significantly reduce the rate of recatheterization. Compared with standard TWOC, bladder perfusion with physiological serum prior to catheter removal is a simple and cost-effective method to increase TWOC success rates (odds ratio 2.41, 95% confidence interval 1.53–3.8), and to reduce time-to-discharge (−89.68 min, 95% confidence interval −160.55, −18.88). Clean intermittent catheterization (CIC) is increasingly used for urinary retention in patients with benign prostatic hyperplasia as existing data suggest that it may decrease the risk of urinary tract infections, accelerate spontaneous voiding recovery and might be more cost-effective compared with indwelling urethral catheterization. Ongoing trials are examining whether office-placed prostate stent may be a promising solution in patients with AUR.

The recent development of alternative approaches to traditional TWOC may lead to new therapies for treating patients with AUR. Further studies are needed as the level of evidence from published studies remains low.