bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival outcome of upfront surgery for clinical single-station N2 non-small cell lung cancer
Authors: Hayakawa Takamitsu , Isaka Mitsuhiro , Konno Hayato , Mizuno Tetsuya , Kawata Takuya , Kenmotsu Hirotsugu , Takahashi Toshiaki , Ohde Yasuhisa
Published: January 2023

Background

Pathological N2 (pN2) non-small cell lung cancer (NSCLC) is diverse; its treatment depends on the clinical N (cN) status. We aimed to determine the efficacy of upfront surgery for cN2pN2 NSCLC.

Methods

The study included 43 cN2pN2 NSCLC patients who underwent upfront surgery at the Shizuoka Cancer Center between 2002 and 2017. Survival outcome, focusing on cN2 status, was retrospectively investigated. Mediastinal lymph nodes were pre-operatively evaluated using computed tomography and positron emission tomography. Surgical eligibility criteria included single-station cN2. N2 with N1 and skip N2 were defined as N2 with and without ipsilateral hilar lymph node metastasis, respectively. A platinum-doublet regimen was used for adjuvant chemotherapy. Survival curves were analysed using the Kaplan–Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model.

Results

Clinical-skip N2 and cN2 with N1 cases included 22 and 21 patients, respectively. Twenty-three patients received adjuvant chemotherapy. The median follow-up duration was 73 months. Clinical-skip N2 had a significantly better 5-year recurrence-free survival (RFS) than cN2 with N1 (58.3 vs 28.6%, P = 0.038) and was an independent favorable RFS predictor. Recurrence within 18 months occurred in 71% of cN2 with N1 cases. Five-year overall survival and RFS rates in patients receiving adjuvant chemotherapy vs those without adjuvant chemotherapy were 82.2 vs 41.9% (P = 0.019) and 56.5 vs 28.0% (P = 0.049), respectively.

Conclusions

Clinical-skip N2 had an excellent prognosis, and upfront surgery was acceptable. Conversely, upfront surgery followed by chemotherapy is not recommended for cN2 with N1 patients because of early recurrence.
Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study
Authors: Sun Ming , Fritz Josef , Häggström Christel , Bjørge Tone , Nagel Gabriele , Manjer Jonas , Engeland Anders , Zitt Emanuel , van Guelpen Bethany , Stattin Pär , Ulmer Hanno , Stocks Tanja
Published: January 2023

Background

Studies of obesity with or without metabolic aberrations, commonly termed metabolically unhealthy or healthy obesity, in relation to cancer risk are scarce.

Methods

We investigated body mass index (normal weight, overweight, obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk (n = 23 630) among 797 193 European individuals. A metabolic score comprising mid-blood pressure, plasma glucose, and triglycerides was used to define metabolically healthy and unhealthy status. Hazard ratios (HRs) and multiplicative interactions were assessed using Cox regression, and additive interactions were assessed using the relative excess risk for interaction. All statistical tests were 2-sided.

Results

Metabolically unhealthy obesity, with a baseline prevalence of 7%, was, compared with metabolically healthy normal weight, associated with an increased relative risk of any obesity-related cancer and of colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer (P < .05), with the highest risk estimates for endometrial, liver, and renal cell cancer (HR = 2.55-3.00). Metabolically healthy obesity showed a higher relative risk for any obesity-related cancer and colon (in men), endometrial, renal cell, liver, and gallbladder cancer, though the risk relationships were weaker. There were no multiplicative interactions, but there were additive, positive interactions between body mass index and metabolic health status on obesity-related and rectal cancer among men and on endometrial cancer (P < .05).

Conclusions

This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, metabolic aberrations further increased the obesity-induced cancer risk, suggesting that obesity and metabolic aberrations are useful targets for prevention.
Rage and the Machines? Force Mechanization and Violence against Civilians
Authors: Mehrl Marius
Published: January 2023

There is an ongoing discussion regarding the role of mechanized forces in counterinsurgency warfare. Proponents note that they boost counterinsurgents’ ability to fight while critics point out that they diminish their ability to gather information. This note adds to this discussion by focusing on violence against civilians, an outcome that theory suggests should be affected by mechanization via both of these channels. Results from quantitative analyses employing new data on mechanization and covering the period 1989–2016 indicate that mechanization is unrelated to the number of civilians killed by government forces but positively associated with that killed by rebels. These results are in line with the idea that mechanization increases counterinsurgents’ fighting but decreases their information-gathering abilities. By offering quantitative evidence that mechanized forces have a place in modern counterinsurgency, these results contribute to both academics’ and practitioners’ understanding of armed intrastate conflict.
Exogenous RNAs: promising tools for the second green revolution
Authors: Rodríguez Melo Johan , Mammarella Florencia , Ariel Federico
Published: January 2023

The impending need for increasing amounts of food for the world population poses enormous challenges to agriculture. Moreover, global warming has exacerbated abiotic and biotic stresses, accelerating the emergence of new pests and pathogens which threatens crop productivity. Therefore, the scientific community urgently needs to develop innovative solutions for sustainable agriculture, notably replacing synthetic pesticides by active and highly specific biomolecules for pest control. In this context, RNA-based technologies emerge as an outstanding genetically modified organism-free approach offering versatile solutions to boost productivity while conserving and harnessing the wide variety of local landraces. Here we review recent advances in the field, including RNA synthesis approaches and the development of the nanotechnology required for RNA stabilization and delivery, and we discuss the potential of RNA as the key molecule for versatile applications in the second green revolution.
Unbinned likelihood analysis for X-ray polarization
Authors: González-Caniulef Denis , Caiazzo Ilaria , Heyl Jeremy
Published: January 2023

We present a systematic study of the unbinned, photon-by-photon likelihood technique which can be used as an alternative method to analyse phase-dependent, X-ray spectro-polarimetric observations obtained with IXPE and other photoelectric polarimeters. We apply the unbinned technique to models of the luminous X-ray pulsar Hercules X-1, for which we produce simulated observations using the ixpeobssim package. We consider minimal knowledge about the actual physical process responsible for the polarized emission from the accreting pulsar and assume that the observed phase-dependent polarization angle can be described by the rotating vector model. Using the unbinned technique, the detector’s modulation factor, and the polarization information alone, we found that both the rotating vector model and the underlying spectro-polarimetry model can reconstruct equally well the geometric configuration angles of the accreting pulsar. However, the measured polarization fraction becomes biased with respect to the underlying model unless the energy dispersion and effective area of the detector are also taken into account. To this end, we present an energy-dispersed likelihood estimator that is proved to be unbiased. For different analyses, we obtain posterior distributions from multiple ixpeobssim realizations and show that the unbinned technique yields $\sim 10{{\ \rm per\ cent}}$ smaller error bars than the binned technique. We also discuss alternative sources, such as magnetars, in which the unbinned technique and the rotating vector model might be applied.
The cosmic radio background from 150 MHz to 8.4 GHz and its division into AGN and star-forming galaxy flux
Authors: Tompkins Scott A , Driver Simon P , Robotham Aaron S G , Windhorst Rogier A , Lagos Claudia del P , Vernstrom T , Hopkins Andrew M
Published: January 2023

We present a revised measurement of the extragalactic background light (EBL) at radio frequencies based on a near complete compendium of radio source counts. We present the radio-EBL at 150 MHz, 325 MHz, 610 MHz, 1.4 GHz, 3 GHz, 5 GHz, and 8.4 GHz. In all cases the contribution to the radio-EBL, per decade of flux, exhibits a two-humped distribution well matched to the active galactic nucleus (AGN) and star-forming galaxy (SFG) populations, and with each population contributing roughly equal energy. Only at 3 GHz are the source count contributions to the EBL fully convergent, and hence we report empirical lower limits to the radio-EBL in the remaining bands. Adopting predictions from the SHARK semi-analytic model for the form of the SFG population, we can fit the fainter source counts providing measurements of the total contribution to the radio-EBL for the SFG and the AGN populations separately. This constitutes an empirically constrained model-dependent measurement for the SFG contribution, but a fully empirical measurement of the AGN contribution. Using the ProSpect spectral energy distribution code we can model the ultraviolet-optical-infrared-mm-radio SFG EBL at all frequencies from the cosmic star-formation history and the adoption of a Chabrier initial mass function. However, significant discrepancy remains (5 ×) between our source-count estimates of the radio-EBL and the direct measurements reported from the Absolute Radiometer for Cosmology, Astrophysics, and Diffuse Emission-2 (ARCADE-2) experiment. We can rule out a significant missing discrete source radio population and suggest that the cause of the high ARCADE-2 radio-EBL values may need to be sought either in the foreground subtraction or as a yet unknown diffuse component in the radio sky.
The impact of acute kidney injury with or without recovery on long-term kidney outcome in patients undergoing living liver transplantation
Authors: Chiu Ping-Fang , Lin Pei-Ru , Tsai Chun-Chieh , Hsieh Yao-Peng
Published: January 2023

Background

Acute kidney injury (AKI) is associated with an increased incidence of poor liver graft and renal outcomes in patients who have undergone liver transplantation (LT). To date, no comprehensive study has compared patients with and without post-LT AKI and analyzed patients who recovered from AKI versus those who did not.

Methods

Patients who received living LT between January 2003 and January 2019 were enrolled. We diagnosed and classified AKI patients based on AKI-KDIGO guidelines by increment of creatinine after surgery when compared with serum creatinine on the day of surgery. The recovered AKI subgroup included recipients whose estimated glomerular filtration rate (eGFR) recovered more than 90% of baseline eGFR within 90 days after surgery. The risk of chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m2) was investigated.

Results

A total of 392 patients, 77.3% men and mean ± standard deviation age 54.1 ± 8.4 years, met the eligible criteria and were divided into two groups (AKI vs non-AKI) and 243 (62%) patients developed AKI within 7 days after surgery. Compared with the non-AKI group, the AKI group was associated with an adjusted hazard ratio of 1.55 (95% CI 1.12–2.14) for the risk of incident CKD. Among AKI patients, 160 (65.8%) patients recovered renal function and 83 (34.2%) patients did not. Compared with the non-AKI group, the AKI non-recovery group was associated with an adjusted hazard ratio of 2.87 (95% CI 1.95–4.21) for the risk of incident CKD, while the AKI recovery group had no significant difference in the adjusted risk of incident CKD.

Conclusions

Post-LT AKI is associated with subsequent risk of CKD development. Taking into account recovery status, AKI was no longer associated with a higher risk of CKD if renal function recovered within 90 days after surgery. Identification and implementation of targeted and individualized therapies for patients at risk for AKI, particularly non-recovery AKI, is of paramount importance to reduce incident CKD during follow-up.
Pathological spectrum of hereditary transthyretin renal amyloidosis and clinicopathologic correlation: a French observational study
Authors: Dang Julien , Ferlicot Sophie , Misrahi Micheline , Mussini Charlotte , Kounis Ilias , Rémy Philippe , Samuel Didier , Planté-Bordeneuve Violaine , Adams David , Funalot Benoit , Snanoudj Renaud , Damy Thibaud , Moktefi Anissa , Audard Vincent , Zaidan Mohamad
Published: January 2023

Background

Cardiac and neurological involvements are the main clinical features of hereditary transthyretin (ATTRv) amyloidosis. Few data are available about ATTRv amyloid nephropathy (ATTRvN).

Methods

We retrospectively included 30 patients with biopsy-proven ATTRvN [V30M (26/30) including two domino liver recipients, S77Y (2/30), V122I (1/30) and S50R (1/30) variants] from two French reference centers. We described the pathological features by comparing amyloid deposits distribution to patients with AL or AA amyloidosis, and sought to determine clinicopathological correlation with known disease-modifying factors such as TTR variant, gender and age at diagnosis.

Results

In comparison with AL and AA amyloidosis, ATTRv patients had similar glomerular, arteriolar and arterial amyloid deposits, but more cortical and medullary tubulointerstitial (33%, 44%, 77%, P = .03) involvement. While the presence of glomerular deposits is associated with the range of proteinuria, some patients with abundant glomerular ATTRv amyloidosis had no significant proteinuria. V30M patients had more glomerular (100% and 25%, odds ratio = 114, 95% confidence interval 3.85–3395.00, P = .001) deposits, and higher estimated glomerular filtration rate [50 (interquartile range 44–82) and 27 (interquartile range 6–31) mL/min/1.73 m², P = .004] than non-V30M patients. We did not find difference in amyloid deposition according to gender or age at diagnosis.

Conclusion

ATTRvN affects all kidney compartments, but compared with AL/AA amyloidosis, ATTRvN seems to involve more frequently tubulointerstitial areas. V30M patients represents the dominant face of the disease with a higher risk of glomerular/arteriolar involvement. ATTRvN should thus be considered in patients, and potential relatives, with ATTRv amyloidosis and kidney dysfunction, regardless of proteinuria level.
GFR estimated with creatinine rather than cystatin C is more reflective of the true risk of adverse outcomes with low GFR in kidney transplant recipients
Authors: Keddis Mira T , Howard Matthew R , Galapia Leyton , Barreto Erin F , Zhang Nan , Butterfield Richard J , Rule Andrew D
Published: January 2023

Background

Serum cystatin C–based estimated glomerular filtration rate (eGFRcys) generally associates with clinical outcomes better than serum creatinine–based eGFR (eGFRcr) despite similar precision in estimating measured GFR (mGFR). We sought to determine whether the risk of adverse outcomes with eGFRcr or eGFRcys was via GFR alone or also via non-GFR determinants among kidney transplant recipients.

Methods

Consecutive adult kidney transplant recipients underwent a standardized GFR assessment during a routine follow-up clinic visit between 2011 and 2013. Patients were followed for graft failure or the composite outcome of cardiovascular (CV) events or mortality through 2020. The risk of these events by baseline mGFR, eGFRcr and eGFRcys was assessed unadjusted, adjusted for mGFR and adjusted for CV risk factors.

Results

There were 1135 recipients with a mean baseline mGFR of 55.6, eGFRcr of 54.8 and eGFRcys of 46.8 ml/min/1.73 m2 and a median follow-up of 6 years. Each 10 ml/min/1.73 m2 decrease in mGFR, eGFRcr or eGFRcys associated with graft failure [hazard ratio (HR) 1.79, 1.68 and 2.07, respectively; P < .001 for all) and CV events or mortality outcome (HR 1.28, 1.19 and 1.43, respectively; P < .001 for all). After adjusting for mGFR, eGFRcys associated with graft failure (HR 1.57, P < .001) and CV events or mortality (HR 1.49, P < .001), but eGFRcr did not associate with either. After further adjusting for CV risk factors, risk of these outcomes with lower eGFRcys was attenuated.

Conclusion

eGFRcr better represents the true relationship between GFR and outcomes after kidney transplantation because it has less non-GFR residual association. Cystatin C is better interpreted as a nonspecific prognostic biomarker than is eGFR in the kidney transplant setting.
The Crown and Anchor Tavern
Authors: Bourke Joanna
Published: January 2023

Birkbeck College was born in the Crown and Anchor Tavern, a centre of urban conviviality, in 1823. It was an unorthodox political space, renowned for its radical politics. The original call to establish the institution was made in the Mechanics’ Magazine. Its founders were Joseph Clinton Robertson (patent agent and editor), Thomas Hodgskin (economist), Henry Brougham (leading lawyer, politician, and founder of the Society for the Diffusion of Useful Knowledge), Francis Place (radical political activist and atheist), and George Birkbeck (physician and philanthropist). All five had expansive personalities, with powerful egos and preoccupations. Differences, even bitter confrontations, were inevitable. They all championed workers’ education and were immersed in a range of radical causes. For George Birkbeck, the Institution was a political as well as philanthropic project. He moved in politically radical circles. Although he was a middle-class liberal, he was the friend of working-class agitators and labour leaders, especially those working for the abolition of newspaper tax, the corn laws, and tithes. George Birkbeck was also impelled by a profound sense of social service. For others—especially Place, Hodgskin, and Brougham—politically radical ideas fired their enthusiasm for workers’ education while for Robertson the enterprise had probably as much to do with propagating his magazine and patent work as with any political objective.
Consciousness and the Collapse of the Wave Function
Authors: Chalmers David J. , McQueen Kelvin J.
Published: January 2023

Does consciousness collapse the quantum wave function? This idea was taken seriously by John von Neumann and Eugene Wigner but is now widely dismissed. We develop the idea by combining a mathematical theory of consciousness (integrated information theory) with an account of quantum collapse dynamics (continuous spontaneous localization). Simple versions of the theory are falsified by the quantum Zeno effect, but more complex views remain compatible with empirical evidence. In principle, versions of the theory can be tested by experiments with quantum computers. The upshot is not that consciousness-collapse interpretations are clearly correct, but that there is a research program here worth exploring.
Divine Foreknowledge and Human Free Will (1985)
Authors: Zagzebski Linda Trinkaus
Published: January 2023

This paper, published in 1985, is Zagzebski’s first full-length journal article. The paper reviews and evaluates the burgeoning literature on the topic of divine foreknowledge and human free will, distinguishes pseudo-problems from real problems, and defends the logical compatibility of foreknowledge and human freedom. God’s foreknowledge of an event does not prevent either its logical or its causal contingency. The paper argues that there is nothing incoherent about backwards contingency or the idea that an event is contingent upon an event occurring after it in time, and it argues that even if God knows what a person freely does in every possible world, that is not the same as knowing problematic counterfactuals. The relation between divine foreknowledge and a free act requires an asymmetrical explanation, whether or not such an explanation is called causal. The paper concludes that even though infallible foreknowledge and free will are logically consistent, they will be in tension until there is a broader theory in theological metaphysics that shows that divine foreknowledge and human freedom are mutually plausible.
Why does creative self-expression matter?
Authors: Kaimal Girija
Published: January 2023

Why does self-expression matter? What pushes us humans uniquely toward imagination and expression of this instinct? In this chapter I provide an overview of why creative and artistic expression is fundamental to our survival and to our desire to thrive. I introduce evolutionary perspectives on human self-expression and creativity and innate attributes, including how they relate to narrative storytelling and art-making. This chapter provides an overview of the rest of the chapters to come, including the neurobiology of self-expression; the role of narrative; differences between art-making by oneself versus art-making with others; insights from indigenous and traditional art forms; developmental aspects of self-expression; trauma, adversity, and self-expression; contemporary perspectives; and, finally, reflections on the future.
Ultrasonography in the assessment of disease activity in cranial and large-vessel giant cell arteritis: a prospective follow-up study
Authors: Nielsen Berit Dalsgaard , Therkildsen Philip , Keller Kresten K , Gormsen Lars C , Hansen Ib T , Hauge Ellen-Margrethe
Published: January 2023

Objectives

We evaluated sensitivity to change and discriminative abilities of vascular US scores in disease monitoring in the follow-up of a prospective cohort of new-onset cranial and large-vessel (LV) GCA patients.

Methods

Baseline and follow-up (8 weeks, 24 weeks and 15 months) US of temporal arteries (TA), carotid and axillary arteries (LV) included assessment of halo and measurement of the intima media complex (IMC). Max IMC, max halo IMC, sum IMC, sum halo IMC, mean IMC, halo count and the Southend halo score were calculated. The provisional OMERACT US score, OGUS, was obtained, taking the average of temporal arteries and axillary arteries IMCs divided by their normal cut-off values.

Results

Baseline US was positive in 44/47 patients (72% TA, 72% LV). Sensitivity to change of all composite US scores containing TAs was evident by week 8 onward. LVs responded poorly and new axillary US lesions emerged in six patients despite clinical remission. The OGUS showed a large magnitude of change and is considered the score least prone to potential bias. All TA-based US scores showed moderate–strong correlation with disease activity markers. OGUS, TA halo count, Southend TA halo score, TA sum IMC and TA mean IMC showed potential to discriminate remission and relapse with area under the curve ≥0.8.

Conclusions

The OGUS is suggested as an outcome measurement for the assessment of treatment response in clinical trials. The abilities of US scores to discriminate remission and relapse are encouraging and should be further explored.
The Many Faces of Josefa Jaramillo: (Mis)identifications and Historical Longing in the Colonial Present
Authors: Johnson Susan Lee
Published: January 2023

Before 1970, the public had never seen a picture of Josefa Jaramillo, the Taoseña who married frontiersman Kit Carson in 1843 and stayed with him until they both died in 1868. Then, within six months, two such images crossed the portal of the Carson museum in Taos, each from a different donor. For fifty years since, historians, curators, and descendants have embraced the photos as authentic. But they are not pictures of the same person and it is possible that neither of them is an image of Jaramillo. The provenance of the pictures tells the story of a New Mexico still in the grip of colonialisms that had been unfolding for centuries, producing by 1970 a place that often ranked with southern states at the bottom of lists measuring economic and social well-being. It tells the story of a state that did not yet acknowledge what it had in common with the South: a history of slavery. It tells a story of women deemed indistinguishable from and interchangeable with one another. It tells a story of generational pain rooted in the trauma of continental empire. It tells a story of the desire for history, for connection and belonging. It tells a story of mistaken identification.
A Rapid and Reliable Method for Evaluating Cotton Resistance to Fusarium Wilt Race 4 Based on Taproot Rot at the Seed Germination Stage
Authors: Zhu Yi , Willey Kathleen , Wheeler Terry , Dever Jane K. , Whitelock Derek , Wedegaertner Tom , Hake Kater , Bissonnette Kaitlyn , Zhang Jinfa
Published: January 2023

Fusarium oxysporum f. sp. vasinfectum race 4 (FOV4) is a soilborne fungal pathogen threatening U.S. cotton production. The objective of this study was to develop a reliable and efficient method to evaluate cotton for FOV4 resistance based on taproot rot during seed germination through five growth chamber tests and two greenhouse tests. Seeds from eight cotton cultivars (Set 1) were germinated in a paper towel for 6 days, and taproots were inoculated with a FOV4 conidial suspension using three inoculation methods (i.e., taproot dipping, taproot wounding, and paper towel drenching), in addition to seed soaking before germination. The taproot rot-based disease incidence (DI) and disease severity rating (DSR), seed germination percentage (SGP), and plant fresh weight (PFW) were measured 7 days after inoculation. Taproot dipping was the most efficient and reliable evaluation method. The SGP and PFW were not significantly correlated with the DI and DSR, making them inappropriate to use in resistance evaluation. Pima DP 359 RF and PHY 881 RF were the most resistant with the lowest root rot. The taproot dipping method was repeated in another test and confirmed in two tests using another set of eight cultivars (Set 2). The taproot rot-based DSR at germination was significantly correlated with the DSR at the seedling stage in the greenhouse in both sets and with previous results in seedling mortality in the greenhouse and field in Set 2. The results suggest that the response to FOV4 infections at the seed germination stage is overall congruent with that at the seedling stage.
Clinicopathological Characteristics of Anastomotic Recurrence After Curative Resection for Colorectal Cancer: Comparison with Non-Anastomotic Local Recurrences
Authors: Matsunaga Keigo , Sasaki Kazuhito , Nozawa Hiroaki , Kawai Kazushige , Murono Koji , Emoto Shigenobu , Kishikawa Junko , Ozawa Tsuyoshi , Yokoyama Yuichiro , Abe Shinya , Nagai Yuzo , Anzai Hiroyuki , Sonoda Hirofumi , Hata Keisuke , Ishihara Soichiro
Published: January 2023

BACKGROUND:

Anastomotic recurrence is thought to be caused by implantation of tumor cells to the anastomotic line; however, its risk factors and prognostic significance remain unclear.

OBJECTIVE:

This study aimed to clarify the risk factors for anastomotic recurrence in colorectal cancer and assess the prognosis in comparison to non-anastomotic local recurrence.

DESIGN:

A single-center retrospective observational study.

SETTINGS:

The medical records of the study participants were retrospectively collected from the Department of Surgical Oncology at the University of Tokyo Hospital database.

PATIENTS:

This study included 1584 patients with colorectal cancer who underwent surgical resection between January 2005 and December 2017. We focused on 15 patients who had anastomotic recurrence.

MAIN OUTCOME MEASURES:

The main outcome measures were the risk factors of anastomotic recurrence at the primary resection, and prognosis data in comparison to non-anastomotic local recurrence.

RESULTS:

There were 15 patients (0.95%) with anastomotic recurrence and 35 (2.21%) with non-anastomotic local recurrence. Univariate analysis revealed that lymph node metastasis and advanced T stage are the risk factors for anastomotic recurrence. The prognosis of patients with anastomotic recurrence was similar to that of those with non-anastomotic local recurrence who underwent resection.

LIMITATIONS:

The small number of patients with anastomotic recurrence is a major limitation of this study. Additionally, the retrospective study design may have increased the risk of selection bias.

CONCLUSIONS:

Lymph node metastasis and advanced T stage were associated with anastomotic recurrence. The prognosis of patients with anastomotic recurrence was similar to that with resected non-anastomotic local recurrence. Thus, surveillance should be carefully continued while considering the poor prognosis of patients with anastomotic recurrence. See Video Abstract at http://links.lww.com/DCR/C92.
Comparison of Robotic, Laparoscopic, and Open Resections of Nonmetastatic Colon Cancer
Authors: Yuval Jonathan B. , Thompson Hannah M. , Verheij Floris S. , Fiasconaro Megan , Patil Sujata , Widmar Maria , Wei Iris H. , Pappou Emmanouil P. , Smith J. Joshua , Nash Garrett M. , Weiser Martin R. , Paty Philip B. , Garcia-Aguilar Julio
Published: January 2023

BACKGROUND:

Laparoscopic resection for colon cancer has not been associated with improvements in oncological outcomes in comparison to open resection. Robotic resections are associated with increased lymph node yield and radicality of mesenteric resection in patients with right-sided tumors. It is unclear whether lymph node yield is higher in robotic resections in other parts of the colon and whether higher lymph node yield is associated with improved survival.

OBJECTIVE:

To compare survival rates between robotic, laparoscopic, and open resections in a large cohort of patients with nonmetastatic colon cancer.

DESIGN:

This is a retrospective observational study.

SETTING:

This study was conducted at a single comprehensive cancer center.

PATIENTS:

Patients who underwent resection of nonmetastatic primary colon cancer between January 2006 and December 2018.

MAIN OUTCOME MEASURES:

Univariable and multivariable models were used to identify predictors of disease-free and overall survival. Lymph node yield and perioperative outcomes were compared between operative approaches.

RESULTS:

There were 2398 patients who met the inclusion criteria: 699 (29%) underwent open, 824 (34%) underwent laparoscopic, and 875 (36%) underwent robotic resection. Median follow-up was 3.8 years (45.4 months). Robotic surgery was associated with higher lymph node yield and radicality of mesenteric resection. On multivariable analysis, surgical approach was not associated with a difference in disease-free or overall survival. Minimally invasive colectomy was associated with fewer complications and shorter length of stay in comparison to open surgery. In a direct comparison between the two minimally invasive approaches, robotic colectomy was associated with fewer complications, shorter length of stay and lower conversion rate than laparoscopy.

LIMITATIONS:

This was a single-center retrospective study.

CONCLUSIONS:

Our data indicate that the three surgical approaches are similarly effective in treating primary resectable colon cancer and that differences in outcomes are seen primarily in the early postoperative period. See Video Abstract at http://links.lww.com/DCR/C115.
Feasibility, Indications, and Prognostic Significance of Selective Lateral Pelvic Lymph Node Dissection after Preoperative Chemoradiotherapy in Middle/Low Rectal Cancer: Results of a Multicenter Lateral Node Study in China
Authors: Zhou Sicheng , Zhang Hong , Liang Jianwei , Fu Wei , Lou Zheng , Feng Bo , Yang Yingchi , Xie Zhongshi , Liu Qian ,   on behalf of the Chinese Lateral Node Collaborative Group
Published: January 2023

BACKGROUND:

Lateral pelvic lymph node dissection after preoperative chemoradiotherapy can decrease local recurrence to lateral compartments, thereby bringing survival benefits.

OBJECTIVE:

The safety of lateral pelvic lymph node dissection after preoperative chemoradiotherapy was investigated, and the surgical indications and survival benefits of lateral pelvic lymph node dissection were established based on preoperative characteristics.

DESIGN:

A multicenter retrospective study.

SETTINGS:

Three hospitals in China.

PATIENTS:

Four hundred nine patients with clinical evidence of lateral pelvic lymph node metastasis.

INTERVENTIONS:

Patients who received lateral pelvic lymph node dissection were divided into two groups depending on whether they received chemoradiotherapy (n = 139) or not (n = 270).

MAIN OUTCOME MEASURES:

The safety, indications, and survival benefits of lateral pelvic lymph node dissection after preoperative chemoradiotherapy were investigated.

RESULTS:

The surgery times were significantly prolonged by preoperative chemoradiotherapy (291.3 vs. 265.5 min, p = 0.021). Multivariate analysis demonstrated that poor/mucinous/signet-ring adenocarcinoma (odds ratio=4.42, 95% confidence interval, 2.24–11.27; p = 0.031) and post-chemoradiotherapy lateral pelvic lymph node short-axis diameter ≥7 mm (odds ratio=15.2, 95% confidence interval, 5.89–53.01; p < 0.001) were independent predictive factors for lateral pelvic lymph node metastasis. Multivariate prognostic analysis showed that swollen lateral pelvic lymph nodes beyond the obturator or internal iliac as well as the involvement of three or more lateral pelvic lymph nodes were independent adverse prognostic factors.

LIMITATIONS:

The retrospective nature of the study and the small sample size.

CONCLUSIONS:

Preoperative chemoradiotherapy combined with lateral pelvic lymph node dissection is a practicable procedure with acceptable morbidity. Post-chemoradiotherapy lateral pelvic lymph node short-axis diameter ≥7 mm and poor/signet/mucinous adenocarcinoma could be used for predicting lateral pelvic lymph node metastasis after chemoradiotherapy. However, lateral pelvic lymph node dissection should be carefully considered in patients with swollen lateral pelvic lymph nodes beyond the obturator or internal iliac region or involvement of multiple lateral pelvic lymph nodes. See Video Abstract at http://links.lww.com/DCR/C133.
Clinical Significance of Preoperative and Postoperative Serum CEA and CA19-9 Levels in Patients Undergoing Curative Resection of Locally Recurrent Rectal Cancer
Authors: Paku Masakatsu , Uemura Mamoru , Kitakaze Masatoshi , Miyoshi Norikatsu , Takahashi Hidekazu , Mizushima Tsunekazu , Doki Yuichiro , Eguchi Hidetoshi
Published: January 2023

BACKGROUND:

Local recurrence is common after curative resection for rectal cancer. Although one expects radical resection of locally recurrent rectal cancer to be curative, the postoperative re-recurrence rate is relatively high. Therefore, identifying risk factors for recurrence may improve the prognosis of locally recurrent rectal cancer with early therapeutic intervention.

OBJECTIVE:

We evaluated the relationship between perioperative serum CEA/CA19-9 levels and prognosis in locally recurrent rectal cancer to validate their usefulness for postoperative surveillance in locally recurrent rectal cancer.

DESIGN:

This was a single-center retrospective cohort study.

SETTING:

The study is based on data obtained from procedures at Osaka University Hospital.

PATIENTS:

Ninety patients underwent radical resection for locally recurrent rectal cancer between January 2000 and January 2015.

MAIN OUTCOME MEASURES:

We evaluated the correlation between perioperative serum CEA/CA19-9 levels and prognosis after complete resection of locally recurrent rectal cancer and the serum CEA and CA19-9 levels at the diagnosis of postoperative re-recurrence.

RESULTS:

The median preoperative serum CEA and CA19-9 levels were 4 ng/mL and 12 U/mL, respectively. Of the 90 patients, 43.3% had serum CEA ≥5 ng/mL, and 15.6% had serum CA19-9 ≥37 U/mL. Preoperatively, this serum CA19-9 level strongly correlated with poorer prognoses regarding cancer-specific survival. Postoperatively, serum CEA ≥5 ng/mL significantly correlated with a worse prognosis. At the time of diagnosis of re-recurrence after resection of locally recurrent rectal cancer, 53.2% of patients had serum CEA ≥5 ng/mL, and 23.4% of patients had serum CA19-9 ≥37 U/mL.

LIMITATIONS:

The study was limited by its single-center retrospective design, an insufficient sample size, and relatively long study period.

CONCLUSIONS:

High serum levels of CA19-9 preoperatively and CEA postoperatively are associated with poor prognosis after locally recurrent rectal cancer. Furthermore, we found a high rate of serum CEA elevation in the diagnosis of postoperative re-recurrence. See Video Abstract at http://links.lww.com/DCR/Bxxx
Efficacy and safety of ciprofol vs. propofol for the induction and maintenance of general anaesthesia
Authors: Liang Peng , Dai Meng , Wang Xiao , Wang Dongxin , Yang Mengchang , Lin Xuemei , Zou Xiaohua , Jiang Ke , Li Yalan , Wang Liangrong , Shangguan Wangning , Ren Jinghua , He Hefan
Published: January 2023

BACKGROUND

HSK3486 (ciprofol) is a 2,6-disubstituted phenol derivative that acts like propofol as an agonist at the gamma-aminobutyric acid-A (GABAA) receptor.

OBJECTIVE

To investigate the efficacy and safety of HSK3486 for general anaesthesia induction and maintenance.

DESIGN

A single-blinded, randomised, parallel-group, phase 3 trial.

SETTING

Involving 10 study centres, from November 24, 2020 to January 25, 2021.

PATIENTS

A total of 129 patients undergoing nonemergency, noncardiothoracic, and nonneurosurgical elective surgery.

INTERVENTION

Patients were randomly assigned at a 2:1 ratio into HSK3486 or propofol groups, to receive HSK3486 (0.4 mg kg−1) or propofol (2.0 mg kg−1) for induction before a maintenance infusion at initial rates of 0.8 and 5.0 mg kg−1 h−1, and were adjusted to maintain a bispectral index (BIS) of 40–60 until the end of surgery.

MAIN OUTCOME MEASURES

Noninferiority between the drugs was evaluated as the lower limit of the 95% confidence interval (CI) for the between-group difference in the success rate of anesthetic maintenance (primary outcome) >−8%. Secondary outcomes included successful anaesthetic induction, full alertness and spontaneous breathing recovery, time until leaving the postanaesthesia care unit and changes in BIS. Safety profiles were also measured.

RESULTS

Of 129 enrolled patients, 128 completed the trial, with 86 in the HSK3486 group and 42 in the propofol group. The success rate for the maintenance of general anaesthesia was 100% for both groups, and noninferiority of HSK3486 was confirmed (95% CI −4.28% to 8.38%). No significant differences were found between the two groups of patients with regard to secondary outcomes (all P > 0.05). There appeared to be a comparable incidence of treatment for emergency adverse events (TEAEs) (80.2% vs. 81.0%, P = 1.000) and drug-related TEAEs (57.0% vs. 64.3%, P = 0.451) in the HSK3486 and propofol groups.

CONCLUSION

HSK3486 had a noninferior efficacy profile compared to propofol, exhibiting excellent tolerance.

TRIAL REGISTRATION

Clinicaltrials.gov, identifier: NCT04511728.
Periosteal Ewing Sarcoma: Imaging Features and Clinical Outcomes in 7 Patients
Authors: Kumar Rajendra , Mohanan Shilpa
Published: January 2023

Objective

The aim of this study was to describe imaging features, treatment, and prognosis of patients with periosteal Ewing sarcoma (PES).

Materials and Methods

Seven patients with PES treated between 2001 and 2020 were studied retrospectively for presenting symptoms, imaging features, treatment, and prognosis.

Results

Among the 7 patients (mean age, 27.3 years) with local pain and/or mass of less than 6 months duration, 4 were males and 3 females (1.3:1). These surface tumors involved 3 long bones and 4 pelvic bones. Radiographs showed cortical erosions with 2 and CT with 4 long bone tumors. All 7 surface tumors showed normal marrow on MRI, and 4 tumors demonstrated normal marrow activity on 18FFDG fluorodeoxyglucose PET-CT. The only exception was a PES involving iliac bone with thin cortex and marrow extension, which demonstrated hypermetabolic marrow activity. All patients were treated initially with chemotherapy and optional radiation treatment with complete tumor resolution of a tibial PES in 1 patient. The remaining 2 patients with long bone PES had tumor resection and limb-salvage surgery and the 4 patients with pelvic bone PES had hemipelvectomy after chemotherapy/radiation treatment. Five patients were disease-free with long-term survival. A patient with a long bone PES and solitary lung metastasis at onset had tumor resection and metastasectomy with complete recovery without tumor recurrence. The 2 patients with pubic bone PES had complete recovery without tumor recurrence; however, the remaining 2 patients with iliac bone PES developed distant metastases and died within 2 years of diagnosis.

Conclusions

Periosteal Ewing sarcoma arises in periosteum of bone and spares medullary cavity. As compared with its intramedullary counterpart, the tumor has better prognosis with long-term survival. Rarely, the surface tumor arising at a bone with thin cortex, such as iliac bone or scapula, may have medullary involvement. We have described our experience in diagnosis and clinical management in 7 patients of this rare surface variant of the more common intramedullary Ewing sarcoma.
Is Contrast-Enhanced Computed Tomography Redundant for Suspected Intracranial Infection in the Emergency Setting?
Authors: Patel Jeet , Jenson Matthew , Hernandez Mauricio , Fiester Peter , Rao Dinesh
Published: January 2023

Objective

There are currently no guidelines for when to use intravenous contrast with head computed tomography (CT) when there is suspected acute intracranial infection. The purpose of our study was to determine the proportion of cases with enhancing findings on CT that also have conspicuous correlating associated findings on noncontrast CT, which would have on their own merited further evaluation with magnetic resonance imaging, the criterion standard for evaluating central nervous system pathology.

Methods

A retrospective keyword search of the history and clinical information fields in radiology reports for CT examinations of the head without and with contrast from the period January 1, 2004, to October 31, 2021 was performed. Patients with prior head surgery or a history of cancer were excluded. For remaining patients, the noncontrast CT was reviewed for vasogenic edema or mass effect as markers of a possible acute infection, and the presence of background hypodense white matter changes was noted and graded as either absent, mild/scattered, or confluent. Subsequently, the companion contrast-enhanced CT was reviewed for an enhancing abnormality. Chart review was performed to confirm that an infectious process was the ultimate clinical diagnosis in patients with enhancing abnormalities.

Results

Of 343 patients meeting study inclusion/exclusion criteria, 39 had acute infections with an enhancing abnormality on CT (prevalence 11.3%). Thirty-two of these 39 patients also had correlative findings on the noncontrast CT. Noncontrast CT had a positive predictive value of 100%, negative predictive value of 97.7%, sensitivity of 82.1%, specificity of 100%, and accuracy of 98.0% for detecting markers (vasogenic edema and/or mass effect) associated with an enhancing abnormality. Vasogenic edema was the most common noncontrast CT finding in patients who had an infectious enhancing lesion (32 of 39), followed by mass effect (22 of 39). The 7 cases where the acute infection was occult on noncontrast CT were due to leptomeningitis (n = 3), confluent background white matter changes masking the vasogenic edema surrounding intra-axial lesions (n = 3), and a small 0.5 cm extra-axial abscess.

Conclusions

Most acute intracranial infections with an enhancing CT finding also have a correlative conspicuous noncontrast finding that on its own would merit further evaluation with magnetic resonance imaging, the criterion standard for investigating central nervous system disease, and therefore, in the setting of suspected intracranial infection, contrast-enhanced CT is redundant in most cases. Contrast-enhanced CT primarily provides diagnostic benefit in patients with confluent background white matter changes that may mask vasogenic edema on noncontrast CT.
From Mild Gait Difficulties to a Sudden Coma: A Rare Case of Marchiafava-Bignami Disease
Authors: De Ryck Henri , Van Cauter Sofie , Bekelaar Kim
Published: January 2023

In this case report we describe the case of a 66-year old man with subacute gait difficulties, with a progression to confusion coma with multiple generalised epileptic seizures during the following days. Biochemical analysis showed hyperglycaemia, cerebrospinal fluid (CSF) testing showed a mild lymphocytic pleocytosis and an elevated protein and lactate. Broad-spectrum antibiotics and antiviral therapy where initiated. However, all other CSF testing remained negative. Magnetic resonance imaging of the brain showed remarkably symmetric hyperintense T2 white matter lesions most noticable in the corpus callosum. The lesion pattern was suggestive of a metabolic or toxic encephalopathy, the preponderance for the corpus callosum was furthermore suggestive for Marchiafava-Bignami disease (MDB), as was the clinical course since admission of the patient. A high dose IV substitution of vitamin B1, B6 and B12 was started and antibiotic and antiviral therapy was discontinued. After one day the patient showed progressive regaining of consciousness and he returned to premorbid functioning in a matter of 1-2 weeks. MRI of the brain after 1 week showed notable improvement of the white matter lesions. At routine follow-up two weeks later he presented with icterus and a diagnosis of Epstein-Barr virus (EBV) hepatitis was made, lymph node biopsies showed an EBV positive diffuse large cell B-cell lymphoma (DLCBL). MDB is mostly associated with severe alcoholism, with malnourishment being the second leading cause, however there are case reports describing MDB in patients with chronically poorly controlled diabetes mellitus. We hypothesize that his condition may have been precipitated by his poorly controlled diabetes mellitus. However it is also possible that weight loss (probably related to the DLCBL diagnosis) might have contributed to a state of malnourishment and therefore played a role in the aetiology as well.