bluuebunny/crossref_metadata_2025 huggingface dataset:
Age-group-specific trend analyses of oropharyngeal squamous cell carcinoma incidence from 1989 to 2018 and risk factors profile by age-group in 2015–2018: a population-based study in The Netherlands
Authors: Al-Jamaei Aisha A.H. , Helder Marco N. , Forouzanfar Tymour , Brakenhoff Ruud. H. , Leemans C. René , de Visscher Jan G.A.M , van Dijk Boukje A.C.
Published: July 2021

Incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally and the human papillomavirus (HPV) has been linked to this increase. This study aimed to present a comprehensive overview of OPSCC trends in incidence rates by age group and investigate differences in risk factors profile. Netherlands Cancer Registry data from 1989–2018 were analyzed to calculate the annual percentage change (APC) over European standardized incidence rates by gender and age group using joinpoint regression software. Smoking, alcohol drinking and HPV-status were available for 2015–2018. During 1989–2018, 13 048 cases of OPSCC were reported with a male-to-female ratio of 2.1:1. The overall incidence rate increased by 5.4% (APC) annually from 1989 to 1996 but slowed thereafter by 1.2%. Significant declines were found in patients of 35–44 years (APCs −3.7%). Adults aged 45–59 years displayed significant increases from 1989 to 2001, followed by a significant decline. In patients ≥60 years, the incidence rates increased overall, with APC for women being consistently higher than men. The data on HPV status was available for 69% of the patients, of whom 47% were HPV+. Smoking and alcohol consumption were more prevalent, that is 75 and 76 % respectively. The declining trends of OPSCC for Dutch people aged 35–44 years from 1989 to 2018 and for those aged 45–59 years from 2002 onwards are inconsistent to trends reported elsewhere in the developed countries. The prevalence of smoking and drinking alcohol was quite high in all age groups, whereas the proportion of HPV-positivity was relatively low.
Cancer mortality predictions for 2021 in Latin America
Authors: Carioli Greta , Bertuccio Paola , Malvezzi Matteo , Boffetta Paolo , Levi Fabio , Negri Eva , La Vecchia Carlo
Published: July 2021

We estimated cancer mortality statistics for the current year in seven major Latin American countries, with a focus on colorectal cancer. We retrieved official death certification data and population figures from the World Health Organization and the Pan American Health Organization databases. We analysed mortality from all neoplasms combined and for selected cancer sites. We estimated numbers of deaths and age-standardized mortality rates for the year 2021 using a logarithmic Poisson count data joinpoint model. Total cancer mortality is predicted to decline in all countries considered for both sexes, with the exception of Argentinian women. The lowest total mortality rates were predicted in Mexico (65.4/100 000 men and 62.3 in women), the highest ones were in Cuba (133.3/100 000 men and 91.0 in women). Stomach cancer rates have been decreasing since 1970 in all countries; colorectal cancer started to decline over recent calendar periods. Rates for this cancer were unfavourable in the youngest age group. Lung cancer trends declined in males and remained comparatively low in all countries except Cuba. In Cuba, lung cancer rates in women overtook those for breast. Mortality from cancers of the breast, (cervix) uterus, ovary, prostate and bladder, as well as leukemia mostly showed favourable trends. A marked variability in rates across Latin American countries persists, and rates were relatively high for stomach, uterus, prostate and lung cancers, as compared to Europe and North America, suggesting the need to improve preventive strategies. Colorectal cancer mortality was relatively low in Latin America, except in Argentina, and short-term predictions remain moderately favourable.
Circulating immune- and inflammation-related biomarkers and early-stage noncardia gastric cancer risk
Authors: Song Minkyo , Rabkin Charles S. , Ito Hidemi , Oze Isao , Koyanagi Yuriko N. , Pfeiffer Ruth M. , Kasugai Yumiko , Matsuo Keitaro , Camargo M. Constanza
Published: July 2021

Background

In Helicobacter pylori-driven gastric cancer, mucosal colonization induces chronic inflammation that may variably progress to cancer. Prospective studies of circulating inflammation-related proteins have suggested weak associations with gastric cancer risk. To assess potential utility as a screening tool in clinical settings, we examined circulating levels of a wide range of key inflammation molecules for associations with early-stage gastric cancer.

Methods

We used pretreatment EDTA plasma from 239 individuals with early-stage noncardia gastric cancer (203 stage I and 36 stage II) and 256 age-frequency-matched H. pylori-seropositive cancer-free controls within the Hospital-based Epidemiologic Research Program at Aichi Cancer Center. Levels of 92 biomarkers were measured by proximity extension assays using Olink’s Proseek Immuno-oncology Panel. Odds ratios (ORs) for association with gastric cancer risk were calculated for quantiles (two to four categories) of each biomarker from unconditional logistic regression models, adjusted for age, sex, smoking and alcohol consumption. Two-sided P values <0.05 were considered as significant. The false discovery rate (FDR) was used to correct for multiple comparisons.

Results

Of 83 evaluable biomarkers, lower levels of TNFRSF12A (per quartile OR, 0.82; nominal P-trend = 0.02) and ADGRG1 (per quartile OR, 0.84; nominal P-trend = 0.03) were associated with early-stage gastric cancer but were not statistically significant after FDR correction.

Conclusion

Our study did not identify any inflammation-related biomarkers that may be useful for early disease detection. To date, this is the first assessment of circulating inflammation-related proteins in early-stage gastric cancer. Given the complex inflammation processes preceding malignant transformation, further investigation of other biomarkers is warranted.
EPIRETINAL MEMBRANE SURGERY IN PATIENTS WITH MULTIFOCAL VERSUS MONOFOCAL INTRAOCULAR LENSES
Authors: Lee Jong Young , Joo Kwangsic , Park Sang Jun , Woo Se Joon , Park Kyu Hyung
Published: July 2021

Purpose:

To compare the visual/anatomical outcomes and feasibility of epiretinal membrane surgery between patients with multifocal or monofocal intraocular lenses (IOLs).

Methods:

We reviewed the medical records of 46 patients who underwent epiretinal membrane surgery under multifocal or monofocal IOL pseudophakia. The operation time, mean changes in best-corrected visual acuity, and central macular thickness, and complications were compared between the groups.

Results:

Macular surgery was performed in 22 and 24 eyes with multifocal and monofocal IOLs, respectively. The total operation time and the total membrane peeling time were similar in both groups (P = 0.125, P = 0.462, respectively). The mean time to create a membrane edge or flap with retinal microforceps was longer for multifocal than for monofocal IOLs (P = 0.013). The mean changes in best-corrected visual acuity and central macular thickness were similar in both groups (P = 0.682, P = 0.741, respectively). Complications were similar between groups.

Conclusion:

With multifocal IOLs, vision outside the central surgical field was blurred, requiring more time to create the membrane flap. Retinal surgeons should anticipate the difficulty in precise focusing when creating a membrane flap in macular surgery in patients with multifocal IOLs and should pay more attention to the macular surgery.
COMPARISON OF RETROBULBAR, SUB-TENON ANESTHESIA AND MEDIAL CANTHUS EPISCLERAL ANESTHESIA FOR 25-GAUGE POSTERIOR VITRECTOMY
Authors: Roman-Pognuz Derri , Scarpa Giuseppe , Virgili Gianni , Roman-Pognuz Erik , Paluzzano Giacomo , Cavarzeran Fabiano
Published: July 2021

Purpose:

The aim of the study is to compare the efficacy, safety, and globe akinesia between retrobulbar anesthesia, sub-Tenon anesthesia, and medial canthus episcleral anesthesia for 25-gauge posterior vitrectomy.

Methods:

A total of 340 25-gauge vitrectomy data sheets were retrospectively collected between November 2017 and June 2019. Ninety patients were included in the study. These patients were matched by sex and age to receive retrobulbar anesthesia (group 1, n = 30), sub-Tenon anesthesia (group 2, n = 30), and medial canthus episcleral anesthesia (group 3, n = 30). Globe akinesia was recorded after the injection of anesthetic at 2, 5, and 10 minute time intervals. Patients were asked to rate the pain during administration of anesthesia, during surgery, and postoperatively using the visual analog pain scale.

Results:

For a perfect block, at 10 minutes, retrobulbar outperformed both sub-Tenon and medial canthus episcleral anesthesia which seemed quite similar. During administration, the three techniques did not show statistically different effects on pain. Regarding perioperative pain, retrobulbar outperformed medial canthus episcleral anesthesia.

Conclusion:

All three techniques allowed for safe surgery. Retrobulbar obtained the best results, although sub-Tenon proved to be a valid alternative. Medial canthus episcleral anesthesia obtained mostly good and fair blocks and acceptable pain levels during surgery. Further studies should investigate whether optimal anesthetic efficacy can be obtained with sub-Tenon and medial canthus episcleral techniques when higher volumes are used.
Eosinophilic Dermatosis of Malignancy Involving the Eyelid
Authors: Ho Tiffany C. , Compton Leigh , Sheinbein David , Custer Philip L.
Published: July 2021

A 72-year-old man with history of chronic lymphocytic lymphoma presented with a tender, ulcerated cutaneous eyelid lesion. Excisional biopsy revealed a diagnosis of eosinophilic dermatosis of malignancy. This rare paraneoplastic eruption is associated with hematologic malignancies and characterized histopathologically by lymphocytic infiltration accompanied by numerous eosinophils. To our knowledge, eosinophilic dermatosis of malignancy involving the eyelid has not been previously reported.
Right anterior insula is associated with pain generalization in patients with fibromyalgia
Authors: Liu Hung-Yu , Chou Kun-Hsien , Lee Pei-Lin , Wang Yen-Feng , Chen Shih-Pin , Lai Kuan-Lin , Lin Ching-Po , Wang Shuu-Jiun , Chen Wei-Ta
Published: July 2021

Despite diffuse tenderness, patients with fibromyalgia (FM) have reported a wide range of areas with musculoskeletal pain. This study investigated the neural structures and neuroanatomical networks associated with self-reported widespread pain in FM using magnetic resonance imaging. We collected clinical profiles and brain magnetic resonance imaging data of newly diagnosed patients with FM. A total of 138 patients with FM were divided into 3 subgroups based on the number of pain areas, with 3 to 8, 9 to 12, and 13 to 19 areas, respectively. Using voxel-based morphometry analysis, we first identified the neural structure that showed a trend of volumetric change across the 3 subgroups. We then used it as a candidate seed of interest with a seed-to-voxel analytical approach to explore the structural covariance (SC) networks of the whole brain. Finally, we studied the trend of changes in the distribution and strength of SC networks across subgroups of patients. We found a decreasing trend in the volumes of the right anterior insular cortex (rAIC) across the 3 subgroups that had an increased number of pain areas. An increasing trend in the number of neural substrates over the subcortical regions, especially the basal ganglion, showed SC to the rAIC, and a decreasing trend of SC strength was shown between the rAIC and the precuneus, frontal cortex, anterior and posterior cingulate, and lingual gyri, across the patient subgroups with increased pain areas. The rAIC and its altered connection with specific brain regions indicates widespread pain in patients with FM.
Functional outcomes following critical illness: epidemiology, current management strategies and the future priorities
Authors: McPeake Joanne , Sevin Carla M. , Mikkelsen Mark E.
Published: July 2021

Purpose of review

Intensive care unit (ICU) survivorship has gained significant attention over the course of the COVID-19 pandemic. In this review, we summarize the contemporary literature in relation to the epidemiology and management of post-ICU problems.

Recent findings

Survivors of critical illness can have complex physical, social, emotional and cognitive needs in the months following hospital discharge. Emerging evidence has shown that pre-ICU characteristics such as educational attainment, alongside in-ICU factors such as delirium, may contribute to worsening outcomes. Evidence regarding the impact of post-ICU recovery services is evolving, but models such as post-ICU clinics and peer support programs are gaining rapid momentum.

Future research should focus on modifiable risk factors and how identification and treatment of these can improve outcomes. Furthermore, rigorous evaluation of postacute critical care recovery services is necessary.
Fixation of intertrochanteric femur fractures using the SIGN intramedullary nail augmented by a lateral plate in a resource-limited setting without intraoperative fluoroscopy: assessment of functional outcomes at one-year follow-up at Juba Teaching Hospital
Authors: Areu Mapuor M.M. , von Kaeppler Ericka P. , Madison Brian Billy , Aguto Akau A. , Alphones James , Zirkle Lewis G. , Morshed Saam , Shearer David W.
Published: July 2021

Objectives:

The incidence of hip fracture is high and increasing globally due to an aging population. Morbidity and mortality from these injuries are high at baseline and worse without prompt surgical treatment to facilitate early mobilization. Due to resource constraints, surgeons in low-income countries often must adapt available materials to meet these surgical needs. The objective of this study is to assess functional outcomes after surgical fixation of intertrochanteric femur fractures with the Surgical Implant Generation Network (SIGN) intramedullary nail augmented by a lateral SIGN plate.

Design:

Prospective case series

Setting:

Juba Teaching Hospital, Tertiary Referral Hospital for South Sudan

Participants:

Adult patients with intertrochanteric hip fractures

Intervention:

SIGN nail augmented by a lateral plate

Main Outcome Measurements:

Primary outcome was hip function as measured by a modified Harris Hip Score (mHHS) at 1-year after surgery. Secondary endpoints were the occurrence of reoperation or infection at 1-year after surgery.

Results:

Thirty patients were included, 16 (53%) men and 14 (47%) women, with a mean age of 62 years. Fractures were classified as AO/OTA Type 31A1 in 12 (40%) patients, 31A2 in 15 (50%) patients, and 31A3 in 3 (10%) patients. Mean mHHS at 1-year was 75.10 ± 21.2 with 76% categorized as excellent or good scores. There was 1 (3%) infection and 2 (7%) reoperations.

Conclusions:

The SIGN nail augmented by a lateral plate achieved good or excellent hip function in the majority of patients with intertrochanteric hip fractures. This may be a suitable alternative to conventional implants for hip fracture patients in low-resource settings to allow mobilization.
Review: Head and Eye Movements and Gaze Tracking in Baseball Batting
Authors: Toole Andrew J. , Fogt Nick
Published: July 2021

SIGNIFICANCE

After a 30-year gap, several studies on head and eye movements and gaze tracking in baseball batting have been performed in the last decade. These baseball studies may lead to training protocols for batting. Here we review these studies and compare the tracking behaviors with those in other sports.

Baseball batters are often instructed to “keep your eye on the ball.” Until recently, the evidence regarding whether batters follow this instruction and if there are benefits to following this instruction was limited. Baseball batting studies demonstrate that batters tend to move the head more than the eyes in the direction of the ball at least until a saccade occurs. Foveal gaze tracking is often maintained on the ball through the early portion of the pitch, so it can be said that baseball batters do keep the eyes on the ball. While batters place gaze at or near the point of bat-ball contact, the way this is accomplished varies. In some studies, foveal gaze tracking continues late in the pitch trajectory, whereas in other studies, anticipatory saccades occur. The relative advantages of these discrepant gaze strategies on perceptual processing and motor planning speed and accuracy are discussed, and other variables that may influence anticipatory saccades including the predictability of the pitch and the level of batter expertise are described. Further studies involving larger groups with different levels of expertise under game conditions are required to determine which gaze tracking strategies are most beneficial for baseball batting.
Association between Clinical Vision Measures and Visual Perception and Soccer Referees' On-field Performance
Authors: Baptista Antonio M. G. , Serra Pedro M. , Faisal Muhammad , Barrett Brendan T.
Published: July 2021

SIGNIFICANCE

The decisions taken by soccer officials are critically important to game management. Understanding the underlying processes that mediate expert performance in soccer refereeing may lead to a better standard of officiating. Vision is the dominant source of incoming information upon which officials rely to make their on-field decisions.

PURPOSE

We tested the hypothesis that performance on generic tests of vision and visual perception predicts domain-specific performance in elite-level soccer referees (R) and assistant referees (AR).

METHODS

We assessed the vision of R and AR who officiate at the highest level in Portugal. To be eligible for inclusion, R and AR had to have officiated for at least two consecutive seasons across the 2014/2015, 2015/2016, and 2016/2017 seasons. A single, rank-order list of the performance of eligible officials was created based on the rank-order list for each season that was made by the Portuguese Soccer Federation. Clinical vision measures included visual acuity and stereoacuity, and visual perception measures were gathered using the Test of Visual Perceptual Skills, Third Edition.

RESULTS

A total of 59 officials participated (21 R, 38 AR), 17 of whom officiated at the international level. The R and AR groups did not differ in vision or visual perception measures. We found that better stereoacuity (P < .001) and visual memory (P = .001) are associated with a higher rank order of on-field performance after adjusting for the age, experience, the national/international status, and the regional affiliation of the officials. Together, these two measures explain 22% of the variance in rank-order performance.

CONCLUSIONS

This is the first study to show a link between the vision of officials and their on-field performance. The origin and significance of these findings remain to be established, and further work is required to establish whether they are component skills in the domain of soccer refereeing.
Plasticity of Mature B Cells Between Follicular and Classic Hodgkin Lymphomas
Authors: Trecourt Alexis , Mauduit Claire , Szablewski Vanessa , Fontaine Juliette , Balme Brigitte , Donzel Marie , Laurent Camille , Sesques Pierre , Ghesquières Hervé , Bachy Emmanuel , Salles Gilles , Emile Jean-François , Chassagne-Clément Catherine , Genestier Laurent , Copie-Bergman Christiane , Traverse-Glehen Alexandra
Published: July 2021

Follicular lymphoma and classic Hodgkin lymphoma can be associated in composite and/or sequential lymphomas. Common IGH and BCL2 rearrangements have already been identified between both contingents of these entities, but mutation profiles have not yet been investigated. The main objective of this study was to analyze the transdifferentiation process that may occur between Hodgkin and follicular contingents in sequential and composite lymphomas to better characterize these entities. From 2004 to 2020, a retrospective multicentric study was performed, including 9 composite and 13 sequential lymphomas. Clinical data were retrospectively collected. Fluorescent in situ hybridization of BCL2 and BCL6 rearrangements, polymerase chain reaction of IGH and IGK rearrangements, next-generation sequencing of IGK rearrangement, and targeted next-generation sequencing (TNGS) on a panel of genes frequently mutated in lymphomas were performed on each contingent of composite and sequential lymphomas. For TNGS, each contingent was isolated by laser capture microdissection. Clinical presentation and evolution were more aggressive in sequential than composite lymphomas. By fluorescent in situ hybridization, common rearrangements of BCL6 and BCL2 were identified between both contingents. Similarly, a common clonal relationship was established by evaluating IGH and IGK rearrangement by polymerase chain reaction or next-generation sequencing. By TNGS, the same pathogenic variants were identified in both contingents in the following genes: CREBBP, KMT2D, BCL2, EP300, SF3B1, SOCS1, ARID1A, and BCOR. Specific pathogenic variants for each contingent were also identified: XPO1 for Hodgkin lymphoma contingent and FOXO1, TNFRSF14 for follicular lymphoma contingent. This study reinforces the hypothesis of a transdifferentiation process between Hodgkin and follicular contingent of sequential/composite lymphomas.
Eliminating Lumbar Puncture for Low-Risk Febrile Infants
Authors: Gala Payal K. , Scarfone Richard J. , Murray Ashlee , Balamuth Fran
Published: July 2021

Background

Bacterial meningitis in low-risk febrile young infants (FYIs) aged >28 days has become increasingly rare. Routine performance of lumbar puncture (LP) in these infants is associated with adverse consequences and may be unnecessary. We modified our clinical practice guideline (CPG) to reduce the number of FYIs 29 to 56 days old who receive LP.

Methods

This quality improvement project sought to modify a preexisting CPG to diagnose and manage FYIs 0 to 56 days old that eliminated routine performance of LP in children 29 to 56 days old who were considered low-risk for serious bacterial infection. The change was implemented by making adjustments to the online CPG. A statistical process control chart was used to assess the affect of the initiative on our primary outcome of LP rate in this population of FYIs.

Results

Postimplementation of the CPG initiative, 71% of FYIs 29 to 56 days old did not receive LP, compared with 42% preimplementation. This practice change was also associated with fewer hospitalizations, lower median emergency department (ED) length of stay, and fewer 72-hour ED revisits. Over 3 years of sustained practice, 1/713 (0.1%; 95% confidence interval, 0%–0.8%) low-risk FYI returned within 72 hours and was subsequently treated for probable bacterial meningitis, although cerebrospinal fluid culture was negative for bacterial growth.

Conclusions

A change in CPG reduced the number of LPs performed in febrile infants 29 to 56 days old. This change resulted in fewer LPs, hospitalizations, ED revisits, and a lower ED length of stay for FYIs 29 to 56 days old.
A Comparison of Surgical Complications in Patients Undergoing Delayed versus Staged Tissue-Expander and Free-Flap Breast Reconstruction
Authors: Shammas Ronnie L. , Cason Roger W. , Sergesketter Amanda R. , Glener Adam D. , Broadwater Gloria , Hollins Andrew , Le Elliot , Marks Caitlin , Atia Andrew N. , Orr Jonah P. , Hollenbeck Scott T.
Published: July 2021

Background:

Patients undergoing mastectomy may not be candidates for immediate free-flap breast reconstruction because of medical comorbidities or postmastectomy radiation therapy. In this setting, flap reconstruction may be intentionally delayed or staged with tissue expander placement (“delayed-immediate” reconstruction). The optimal reconstructive choice and incidence of complications for these approaches remain unclear.

Methods:

The authors retrospectively identified patients who underwent delayed [n = 140 (72 percent)] or staged [n = 54 (28 percent)] abdominal free-flap breast reconstruction between 2010 and 2018 and compared the incidence of postoperative complications.

Results:

Patients undergoing staged reconstruction had a higher overall incidence of perioperative complications, including surgical-site infection (40.7 percent versus 6.5 percent; p < 0.001), wound healing complications (29.6 percent versus 12.3 percent; p = 0.004), hematoma (11.1 percent versus 0.7 percent; p < 0.001), and return to the operating room (27.8 percent versus 4.4 percent; p < 0.0001). These complications occurred predominately during the expansion stage, resulting in an 18.5 percent (n = 10) rate of tissue expander failure. Mean time from mastectomy to flap reconstruction was 476.8 days (delayed, 536.4 days; staged, 322.4 days; p < 0.001). At the time of flap reconstruction, there was no significant difference in the incidence of complications between the staged cohort versus the delayed cohort, including microsurgical complications (1.9 percent versus 4.3 percent; p = 0.415), total flap loss (0 percent versus 2.1 percent; p = 0.278), or fat necrosis (5.6 percent versus 5.0 percent; p = 0.875).

Conclusions:

The aesthetic and psychosocial benefits of staged free-flap breast reconstruction should be balanced with the increased risk of perioperative complications as compared to a delayed approach. Complications related to definitive flap reconstruction do not appear to be affected by the approach taken at the time of mastectomy. 

Clinical Question/Level of Evidence:

Therapeutic, III.
Relationship between level of daily activity and upper-body aerobic capacity in adults with a lower limb amputation
Authors: Mellema Mirjam , Mirtaheri Peyman , Gjøvaag Terje
Published: July 2021

Background:

Previous studies show that people with lower limb amputation (LLA) have a sedentary lifestyle, reduced walking capacity, and low cardiorespiratory fitness (VO2peak). There is, however, no knowledge on the relationship between cardiorespiratory fitness and objectively measured level of physical activity in daily life.

Objectives:

To investigate the relationship between upper-body VO2peak, physical activity levels, and walking capacity in persons with LLA.

Study design:

Correlational and descriptive study.

Methods:

Fourteen participants with LLA performed an assessment of VO2peak on an arm-crank ergometer and walking capacity (preferred walking speed and 2-minute walking test). Level of physical activity was measured over 7 days with a step activity monitor (number of steps; sedentary time; and proportion of low-intensity, moderate-intensity, high-intensity, and peak-intensity activity level).

Results:

VO2peak correlated significantly with number of steps per day (r = 0.696, p = 0.006), sedentary time (r = −0.618, p = 0.019), high-intensity activity level (r = 0.769, p = 0.001), and peak-intensity activity level (r = 0.674, p = 0.008). After correcting for age, correlations were still large and significant. Large correlations were also found between VO2peak, preferred walking speed (r = 0.586, p = 0.027), and 2-minute walking test (r = 0.649, p = 0.012).

Conclusions:

We provide the first evidence of the strong relationships between upper-body VO2peak, sedentary behavior, high-intensity activity level, and walking capacity in persons with LLA. Further research is needed to investigate the potential effect of upper-body cardiorespiratory fitness on the level of activity in daily life, or vice versa.
Spindle Cell Lipoma Revisited: Common and Unusual Magnetic Resonance Imaging Findings in 54 Patients With New Observations
Authors: Kumar Rajendra , Lefkowitz Robert A. , Agaram Narasimhan P. , Amini Behrang , Satcher Robert L. , Wang Wei-Lien
Published: July 2021

The aims of the study were to study demographic data of patients with spindle cell lipoma and describe a spectrum of magnetic resonance imaging features of the tumor.
Radiomics-Based Machine Learning Classification for Glioma Grading Using Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging
Authors: Hashido Takashi , Saito Shigeyoshi , Ishida Takayuki
Published: July 2021

Objective

The aim of this study was to evaluate various radiomics-based machine learning classification models using the apparent diffusion coefficient (ADC) and cerebral blood flow (CBF) maps for differentiating between low-grade gliomas (LGGs) and high-grade gliomas (HGGs).

Methods

Fifty-two glioma patients, including 18 LGGs (grade II) and 34 HGGs (grade III/IV), were examined using a 3.0-T magnetic resonance scanner. The ADC and CBF maps were obtained from diffusion-weighted imaging and pseudo-continuous arterial spin labeling perfusion-weighted imaging, respectively. A total of 91 radiomic features were extracted from each of the tumor volume on the ADC and CBF maps. We constructed 4 types of machine learning classifiers based on (1) least absolute shrinkage and selection operator regularized logistic regression (LASSO-LR), (2) random forest (RF), (3) support vector machine (SVM) with the radial basis function kernel (SVM-RBF), and (4) SVM with the linear kernel (SVM-L). A training set with 36 gliomas (70%) was used to select the important radiomic features and train each model using 5-fold cross-validation. The remaining 16 gliomas (30%) were used as a test set. Receiver operating characteristic analysis was performed to evaluate the model performance.

Results

A radiomic feature, ADC first-order-based skewness, was selected as an important variable in all classification models. According to the receiver operating characteristic analysis, the areas under the curve of the LASSO-LR, RF, SVM-RBF, and SVM-L models for the training set were 0.965, 1.000, 0.979, and 0.969, respectively. For the test set, the areas under the curve of the LASSO-LR, RF, SVM-RBF, and SVM-L models were 0.883, 0.917, 0.717, and 0.917, respectively. All classification models showed sufficient diagnostic performance on the test set.

Conclusions

Radiomics-based machine learning classifiers using the quantitative ADC and CBF maps are useful for differentiating HGGs from LGGs.
Collaborative Writing Projects: Set Yourself up for Success
Authors: Catanzano Tara , Robbins Jessica B. , Schwartz Fides R. , Rajiah Prabhakar , Wang Sherry S. , Nandwana Sadhna , Soloff Erik V. , Folio Les R.
Published: July 2021

This article will review critical components for the successful completion of a multi-institution, multiauthor collaborative paper. Best practices for the creation and publication of a collaborative paper will be addressed.
Usefulness of Virtual Monochromatic Images and Iodine Maps Derived from Dual-Energy Computed Tomography for Diagnosing Deep Neck Abscesses
Authors: Hattori Youhei , Azuma Minako , Nakada Hiroshi , Kimura Aya , Khant Zaw Aung , Tono Tetsuya , Hirai Toshinori
Published: July 2021

Objective

We aimed to determine whether dual-energy computed tomography (CT) is useful for evaluating deep neck abscesses.

Methods

This study included 22 consecutive patients who were clinically suspected of having a deep neck abscess and underwent dual-energy CT. Conventional 120-kVp images, 70- and 40-keV virtual monochromatic images (VMIs), and iodine maps were inspected to calculate the contrast ratio of the abscess rim (AR) to the abscess center (AC) or to the adjacent muscle (M). The diagnostic certainty of abscesses was assessed on these images.

Results

Twenty (91%) of 22 patients had a definitive diagnosis. The contrast ratio for AR/AC and AR/M was significantly higher on 40-keV VMIs and iodine maps than on 120-kVp images and 70-keV VMIs (P < 0.05). On both 40-keV VMIs and iodine maps, the diagnostic certainty of abscess improved in 3 (15%) cases compared with 120-kVp images and 70-keV VMIs.

Conclusions

Dual-energy CT-based 40-keV VMIs and iodine maps are useful for evaluating deep neck abscesses and may improve diagnostic certainty.
Therapeutic Computed Tomography–Guided Pericardiocentesis: Lessons Learned Based on a 7-Year Single-Center Experience
Authors: Khashper Alla , Shelef Ilan , Taragin Benjamin Hyatt , Smolikov Alexander
Published: July 2021

Objective

Pericardiocentesis is a well-known procedure commonly performed by either image-guided intervention or surgical approaches. Computed tomography (CT)–guided pericardiocentesis is not widely used, but provides certain advantages. In the article we will discuss our technique of CT-guided therapeutic pericardiocentesis, including advantages and disadvantages, patient selection, possible approaches, and complications.

Methods

The retrospective study included 121 therapeutic pericardial drainages performed under CT guidance. Demographic data of the patients, entry site, and needle orientation were recorded. Procedure complications and their significance were analyzed.

Results

One hundred and twenty-one pericardial drainages with catheter insertion were performed under CT guidance on 119 patients presenting with clinically significant pericardial effusion. The most common approach was at the left anterior chest wall. The rate of minor complications was 5.8%, no major complications occurred.

Conclusions

Therapeutic pericardiocentesis can be obtained under CT guidance in a safe and effective manner. Recommendations for building a patient-centered protocol with an interdisciplinary team are discussed. Patient selection, procedural guidance, and lessons to avoid complications are reviewed.
Increased 68Ga-FAPI Uptake in Ankylosing Spondylitis in a Patient With Rectal Cancer
Authors: Yao Lanlin , Zhao Long , Pang Yizhen , Shang Qihang , Chen Haojun
Published: July 2021

Ankylosing spondylitis represents an inflammatory arthropathy with a predilection for the axial skeleton. We reported 68Ga-FAPI PET/CT finding of ankylosing spondylitis in a 65-year-old patient with rectal cancer. In addition to accumulating in primary tumor and metastatic lymph nodes, increased 68Ga-FAPI uptake was also observed in the sacroiliac and costovertebral joints, indicating sacroiliitis and spondylitis. However, no abnormal 18F-FDG uptake was observed in the inflammatory lesions. This case highlighted that 68Ga-FAPI PET/CT is useful for the evaluation of inflammatory conditions in ankylosing spondylitis.
Feasibility and Therapeutic Potential of 177Lu–Fibroblast Activation Protein Inhibitor–46 for Patients With Relapsed or Refractory Cancers
Authors: Assadi Majid , Rekabpour Seyed Javad , Jafari Esmail , Divband GhasemAli , Nikkholgh Babak , Amini Hamidreza , Kamali Hassan , Ebrahimi Sakineh , Shakibazad Nader , Jokar Narges , Nabipour Iraj , Ahmadzadehfar Hojjat
Published: July 2021

Introduction

Fibroblast activation protein (FAP) is a member of the serine protease family and has a high expression in the stroma of approximately 90% of epithelial malignancies. The present investigation aimed to assess the feasibility, safety, and dosimetry data of 177Lu-FAPI-46 in diverse malignancies.

Patients and Methods

Patients with advanced cancers with nonoperable tumors, or tumors refractory to conventional therapies, were enrolled. Treatment included escalating doses of 177Lu-FAPI-46 (1.85–4.44 GBq) per cycle using a combination of clinical and statistical expertise design, and intervals of 4 to 6 weeks were considered between the cycles. Biodistribution and dosimetry were examined by whole-body scans. We applied the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 to measure peptide-targeted radionuclide therapy (PTRT)–associated toxicity.

Results

A total of 21 patients (11 females and 10 males) with a median age of 50 years (range, 6–79 years) were investigated. Of 21 participants, 18 cases were selected for PTRT. Overall, 36 PTRT cycles were performed. The median number of PTRT cycles and the median injected amount of activity in each cycle were 2 and 3.7 GBq, respectively. The dosimetric analysis revealed median absorbed doses of 0.026, 0.136, 0.886, and 0.02 with ranges of 0.023–0.034, 0.001–0.2, 0.076–1.39, and 0.002–0.2 mGy/MBq for the whole body, liver, kidneys, and spleen, respectively. The therapy was well tolerated in almost all patients.

Conclusions

The findings of this preliminary investigation might indicate the potential feasibility and safety of PTRT using 177Lu-FAPI-46 for different aggressive tumors. Moreover, the current study could be beneficial in determining the suitable amount of activity for a phase 2 study.
Portal Biliopathy and Cavernous Transformation of the Portal Vein Revealed by 68Ga-FAPI PET/CT
Authors: Wang Rongxi , Gao Xuehan , Han Xianlin , Zhu Zhaohui , He Xiaodong
Published: July 2021

A 47-year-old man presented with right upper abdominal pain for 1 month. Contrast-enhanced CT revealed hilar bile duct stenosis with dilatation of the intrahepatic bile ducts, and his serum CA19-9 and CA242 levels were significantly elevated. 18F-FDG and 68Ga-FAPI PET/CT were performed for differential diagnosis. 18F-FDG PET/CT showed only mild FDG uptake in the hepatic hilum. Astonishingly, in 68Ga-FAPI PET/CT, intense radioactivity was presented on the same region, which indicated massive fibroblasts aggregation in hepatic hilum. The patient was finally diagnosed as portal biliopathy caused by cavernous transformation of the portal vein.
CXCR4 Expression Demonstrated by 68Ga-Pentixafor PET/CT Imaging in a Case of Systemic Mastocytosis Mimicking Lymphoma
Authors: Kiran Murat Yilmaz , Apaydin Arikan Evsen , Sanli Yasemin , Yegen Gulcin , Kuyumcu Serkan
Published: July 2021

68Ga-Pentixafor is a novel radiotracer for imaging chemokine receptor subtype 4 (CXCR4) receptors, which are expressed exceptionally high in several hematologic malignancies, including various types of lymphoma. Herein we report a case of a 64-year-old man patient with suspected hematologic malignancy who underwent 18F-FDG and 68Ga-pentixafor PET/CT. Both scans demonstrated diffusely increased activity related to bone marrow involvement. 68Ga-Pentixafor PET/CT demonstrated CXCR4-expressing intra-abdominal lymph nodes that were not detected by 18F-FDG PET/CT. The patient was highly suspicious of lymphoma; however, histopathological examination of the bone marrow revealed systemic mastocytosis with associated myelofibrosis.
A Systematic Review and Meta-analysis on the Incidence of Patients With Lower-Limb Amputations Who Developed Symptomatic Neuromata in the Residual Limb
Authors: Huang Yongxu J. , Assi Patrick E. , Drolet Brian C. , Al Kassis Salam , Bastas Gerasimos , Chaker Sara , Manzanera Esteve Isaac V. , Perdikis Galen , Thayer Wesley P.
Published: July 2021

Background

Neuromata developed after major extremity amputation can cause pain, limit the use of prosthetics, and negatively affect the quality of life. The frequency of postamputation neuroma varies widely. The objective of this study was to determine the incidence of patients who developed symptomatic neuromata after lower-limb amputation through a systematic review and meta-analysis.

Methods

A systematic review of the literature was performed on 4 major databases. Studies that reported the incidence of symptomatic neuroma in lower-limb amputees were included. A meta-analysis was performed to calculate the pooled incidence of neuromata.

Results

Thirteen studies consisting of 1329 patients were included in this meta-analysis. The reported incidence of patients who developed symptomatic neuromata ranged between 4% and 49%. The median duration of follow-up was 8.6 years (interquartile range, 2.0–17.4 years). The pooled percentage (95% confidence interval [CI]) of lower-limb amputees who developed symptomatic neuromata was 19% (12%–29%). In studies with a duration of follow-up at least 3 years, the pooled percentage (95% CI) of lower-limb amputees who developed symptomatic neuromata was 30% (22%–40%). In studies with a follow-up period of fewer than 3 years, the pooled percentage (95% CI) of neuroma incidence was 3% (2%–6%).

Conclusions

In summary, the overall incidence of patients who developed symptomatic neuromata was 19% or approximately 1 in 5 lower-limb amputees. Symptomatic neuromata are more commonly diagnosed when the follow-up period is longer than 3 years. These findings suggest that neuroma after amputation might be underestimated in studies with a short duration of follow-up.
Anatomical Variations of Anterior Ethmoidal Foramen and Cribriform Plate: Relations With Sex
Authors: Gibelli Daniele , Cellina Michaela , Gibelli Stefano , Floridi Chiara , Termine Giovanni , Sforza Chiarella
Published: July 2021

Position of anterior ethmoidal artery and height of lateral lamella of cribriform plate (LLCP) represent critical variants in endoscopy.

In 200 maxillofacial computed tomography scans of patients the position of anterior ethmoidal foramen (AEF) in relation to ethmoid roof was recorded. The height of LLCP was measured and classified according to Keros classification.

Differences in AEF position and distribution of Keros types, and LLCP height according to sex were assessed through chi-square test (P < 0.05) and 1-way analysis of covariance (ANCOVA) test, respectively (P < 0.05). Differences in LLCP height according to different AEF position were assessed through Mann–Whitney test (P < 0.05).

No differences were observed in prevalence of AEF exposure according to sex (P > 0.05); LLCP height was higher in males than in females, with a higher frequency of Keros type 3 (P < 0.05). Moreover, subjects with AEF exposure had a significantly higher LLCP height (P < 0.01).

Results highlighted innovative data useful for improving the knowledge of these sensitive variants.
Single-Session Evidence-Based Intervention and Fall Risk Awareness in Community-Dwelling Older Adults
Authors: Howard Brenda S. , Brown Jones Fiona , Sellers Steenblock Aundrea , Ham Butler Kiersten , Thomas Laub Ellen , Winters Crull Meghan , Zaborowicz Grant Katherine
Published: July 2021

Purpose:

To determine effects of a fall risk educational program on fall risk awareness.

Methods:

Twenty-five community-dwelling older adults 65 years and older attended a single-session intervention. Investigators held focus groups 1 month post-intervention. Investigators administered the Short Falls Efficacy Scale-International (S-FES-I) pre- and post-intervention.

Results:

Raw S-FES-I scores trended toward reduced fear of falling. Older adults reported heightened awareness of fall risks and reinforcement of fall prevention behaviors. Social support and narrative storytelling helped motivate participants.

Conclusion:

A single-session educational program reinforced existing fall risk reduction knowledge and behaviors but was limited in its ability to prompt behavioral change.
Rituximab Desensitization in Liver Transplant Recipients With Preformed Donor-specific HLA Antibodies: A Japanese Nationwide Survey
Authors: Akamatsu Nobuhisa , Hasegawa Kiyoshi , Sakamoto Seisuke , Ohdan Hideki , Nakagawa Ken , Egawa Hiroto
Published: July 2021

Background.

The significance of preformed donor-specific anti-HLA antibodies (DSAs) in liver transplant recipients is controversial. Moreover, there has been no established desensitization protocol for DSA-positive recipients.

Methods.

A Japanese nationwide survey was performed to investigate the clinical practice among preformed DSA-positive patients with special reference to rituximab desensitization.

Results.

There was a total of 47 cases, including 2 pediatric cases, in which rituximab (287 ± 159 mg [319 (50–916)/m2]) was administered to desensitize preformed DSA. The decision for the indication of rituximab desensitization was based on a single-antigen assay in the majority of cases (83%, 39/47), and the most frequent protocol was rituximab monotherapy (n = 12) followed by quadruple treatment with rituximab tacrolimus, mycophenolate mofetil, and plasmapheresis (n = 11). The overall 1-, 3-, and 5-y graft and patient survival rates among adult patients were 85%, 83%, 83%, and 81%, 77%, 74%, respectively, while neither graft loss nor death was observed in the 2 pediatric cases. The 1-, 3-, and 12-mo cumulative incidence of antibody-mediated rejection (AMR) was 11%, 13%, and 13%, respectively. The incidence of AMR was significantly higher in the lower rituximab dose group than in the higher rituximab dose group (cutoff 300 mg/m2, 4% versus 24%, P = 0.041). The rate of infusion-related adverse drug reactions (ADRs) was 4.4%, and all ADRs were mild and self-limiting. A total of 99 ADRs among 27 patients were reported, none of which were severe adverse events associated with rituximab.

Conclusions.

The rituximab induction was well tolerated among DSA-positive liver transplant recipients with a satisfactory outcome. A rituximab dose >300 mg/m2 was observed to achieve less incidence of the development of AMR.
Antibody testing in neuropathy associated with anti-Myelin-Associated Glycoprotein antibodies: where we are after 40 years
Authors: Latov Norman
Published: July 2021

Purpose of review

The diagnosis of Myelin-Associated Glycoprotein (MAG) neuropathy is based on the presence of elevated titers of IgM anti-MAG antibodies, which are typically associated with IgM monoclonal gammopathy, and a slowly progressive, distal demyelinating phenotype. The condition, however, can be under or over diagnosed in patients with mildly elevated antibody titers, absent monoclonal gammopathy, or an atypical presentation. The purpose of this paper is to examine recent advances in our understanding of the currently available anti-MAG antibody assays, their reliability, and their use in deciding treatment or monitoring the response to therapy.

Recent findings

Higher titers of anti-MAG antibodies are more likely to be associated with the typical MAG phenotype or response to therapy. Mildly elevated antibody levels can occur in patients with chronic inflammatory demyelinating polyneuropathy. Testing for cross-reactivity with HNK1 can add to the specificity of the antibody assays. Patients with MAG neuropathy can present with an atypical phenotype and in the absence of a detectable monoclonal gammopathy.

Assays for anti-MAG antibodies by Enzyme-Linked Immunosorbent Assay can be improved by testing for antibody binding at multiple serum dilutions, the inclusion of antigen-negative microwells as internal controls for each sample, testing for cross-reactivity with HNK1, and formal validation. The diagnosis needs to be considered in patients with demyelinating neuropathy, even in the absence of a monoclonal gammopathy or typical phenotype. The change in antibody levels needs to be considered in evaluating the response to therapy with B-cell depleting agents.
Opsoclonus in Uremia With Resolution After Hemodialysis
Authors: Changa Abhinav R. , Rucker Janet C. , Drummond Patrick S.
Published: July 2021

A 78-year-old man was evaluated for altered mentation in the setting of significant uremia. On examination, he was found to be encephalopathic with generalized myoclonus and spontaneous opsoclonus. He had no known risk factors for the development of opsoclonus and upon undergoing hemodialysis, experienced near resolution of his eye movement abnormalities, thus highlighting a possible link between the uremic state and opsoclonus.