bluuebunny/crossref_metadata_2025 huggingface dataset:
Financial Relationships Between Pharmaceutical Companies and Rheumatologists in Japan Between 2016 and 2019
Authors: Murayama Anju , Mamada Hanano , Shigeta Haruki , Yoshinaga Takamichi , Saito Hiroaki , Yamashita Erika , Tanimoto Tetsuya , Ozaki Akihiko
Published: February 2023

Backgrounds

Given the increasing number of novel and expensive drugs for rheumatoid diseases, the financial relationships between pharmaceutical companies and rheumatologists could be prevalent and substantial. However, little was known about the information in Japan.

Methods

Using payment data publicly disclosed by 92 major pharmaceutical companies, we evaluated the financial relationships between pharmaceutical companies and rheumatologists who were board certified by the Japan College of Rheumatology between 2016 and 2019. The trends in payments were estimated by the generalized estimating equations with 4-year payment data. Differences in payments between general and leading rheumatologists including the board members, clinical practice guideline authors, and medical journal editors were assessed.

Results

Of the board-certified rheumatologists, 70.7% (3563 of 5038) received a total of $55,246,485 in personal payments for lecturing, writing, and consulting from 79 pharmaceutical companies between 2016 and 2019. The median payments per rheumatologist receiving payments were $3447 (interquartile range, $1124–$11,974) in payment amounts. There were increasing trends in the payments per rheumatologist and the number of rheumatologists with payments, with average yearly change rates of 5.9% (95% confidence interval, 3.9%–7.9%; p < 0.001) and 1.2% (95% CI, 0.3%–2.0%; p = 0.008). The leading rheumatologists such as the society board members, clinical practice guideline authors, and medical journal editors received much more payments than other rheumatologists.

Conclusion

Most rheumatologists increasingly received personal payments for lecturing, consulting, and writing reimbursements from pharmaceutical companies in Japan. These payments were significantly concentrated on rheumatologists in authoritative and influential positions.
Late Pseudoprogression
Authors: Li Ling , Tian Yueli , He Yong
Published: February 2023

Recognition of pseudoprogression in malignant glioma is one of the major challenges in the Response Assessment in Neuro-Oncology criteria. Somatostatin receptors were overexpressed on the surface of the most high-grade glioma. The corresponding PET imaging is used for planning radiation and radionuclide therapy. However, the heterogeneity of somatostatin receptors distribution is mainly responsible for the lack of specificity. Here we reported a case of a 35-year-old man with mesenchymal oligodendroglioma operation and radiotherapy 19 months ago. 68Ga-DOTATATE PET showed intense uptake near the operation region, which has been misinterpreted as tumor recurrence.
Retroperitoneal Inflammation Detected on FDG PET/CT in Patient on Long-Term Immunotherapy
Authors: Khessib Tasnim , Franc Benjamin , Yang Eric , Moradi Farshad
Published: February 2023

A 68-year-old man with a history of pulmonary adenocarcinoma on maintenance pembrolizumab presented for surveillance imaging. 18F-FDG PET/CT demonstrated new ill-defined right retroperitoneal and presacral soft tissue stranding with associated FDG uptake suggestive of inflammation. Biopsy results revealed fibroadipose tissue with extensive lymphoplasmacytic inflammation concerning for immunotherapy-related toxicity. The patient was subsequently taken off pembrolizumab, which he had been on for approximately 3 years. Recognition of immunotherapy-related adverse effects and how they can manifest on 18F-FDG PET/CT is important for prompt cessation of treatment.
Dual-Time-Point 18F-FDG PET/CT for Differentiating a Chest Wall Hemangioma From a Malignant Metastasis
Authors: Lu Hsi-Huei , Chiu Nan-Tsing
Published: February 2023

Dual-time-point18F-flluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can be used to differentiate benign vascular tumors from other malignant growths. We present the case of a 70-year-old woman with a history of cervical carcinoma who was referred for PET/CT to examine a left chest wall tumor noted on CT, which involved the adjacent rib and pleura, thus raising the suspicion of metastasis. The chest wall tumor demonstrated moderate FDG uptake and further decreased uptake at the delayed-phase scanning, corresponding to biodistribution of FDG in the blood pool. These findings indicated a benign hemangioma rather than a metastasis.
68Ga-FAPI-04 PET/CT In Primary Signet Ring–Like Cell Carcinoma of Prostate With Bone Metastases
Authors: Tatar Gamze , Baykal Koca Sevim , Sevindir İsa , Ergül Nurhan , Çermik Tevfik Fikret
Published: February 2023

We presented a 69-year-old man with liver cirrhosis who underwent 68Ga–fibroblast activation protein (FAPI)-04 PET/CT imaging for an ongoing study. In addition to the significant activity in liver cirrhosis on FAPI PET, a primary prostate tumor was incidentally detected with bone metastases. Further, FAPI-negative metastases were not observed on CT evaluation. In this context, we think that FAPI may be helpful with the potential theranostic aspect, especially in selected patients when current treatment options are not applicable or unresponsive. However, we should await the results of prospective studies investigating both prognostic and theranostic use of FAPI and demonstrating its effectiveness in cancer therapy.
A Case of Metastatic Thymoma Responsive to Treatment With 177Lu-DOTATATE
Authors: Halperin Reut , Urban Damien , Tirosh Amit
Published: February 2023

We describe a case of a 74-year-old woman with germline BRCA2 mutation, with an incidental diagnosis of metastatic thymoma presenting as a mediastinal mass with cardiac muscle and lymph node involvement. Despite surgical and radiotherapy treatment, there was marked advancement with new lung and liver metastases. All lesions demonstrated 68Ga-DOTATATE PET/CT uptake, and the patient received 4 peptide receptor radionuclide therapy cycles with 177Lu-DOTATATE, with pronounced reduction in the size of the liver, cardiac, and pleural lesions. This is the first case to demonstrate partial response to peptide receptor radionuclide therapy in metastatic thymoma, thus suggesting possible treatment option to refractory and advancing metastatic thymoma.
Hepatic Small Vessel Neoplasm Mimics Prostate Cancer on 18F-DCFPyl PET/CT
Authors: Spinali Keith L. , Papke David J. , Shah Hina J.
Published: February 2023

18F-DCFPyl is a Food and Drug Administration–approved radiotracer that targets prostate-specific membrane antigen and is used in the detection of recurrent or metastatic prostate cancer. As its use has increased, a growing number of nonprostatic disease entities have been identified that express prostate-specific membrane antigen and can mimic prostate cancer. Thus, the interpreting physician must also consider other variables such as serum prostate-specific antigen levels and the distribution of uptake to avoid an inappropriate diagnosis of metastatic prostate cancer. We describe 18F-DCFPyl uptake associated with a hepatic small vessel neoplasm, an association previously undescribed in the literature.
A Discordant Pattern of Uptake on 68Ga-PSMA PET/CT Versus 18F-Fluciclovine PET/CT in Radiation-Induced Hepatitis
Authors: Adediran Omotayo A. , Lawal Ismaheel O. , Muzahir Saima , Bhave Manali A. , Friend Sarah , Fielder Bridget , Meisel Jane , Torres Mylin A. , Styblo Toncred M. , Graham Cathy , Holbrook Anna , Kalinsky Kevin , Crowe Ronald J. , Ulaner Gary A. , Schuster David M.
Published: February 2023

A 62-year-old woman with right-sided invasive lobular breast carcinoma completed external beam radiotherapy 6 weeks before undergoing a 68Ga-PSMA PET/CT and 18F-fluciclovine PET/CT scan as part of an ongoing clinical trial (NCT04750473) assessing the performance of these molecular imaging modalities in invasive lobular breast carcinoma. The 68Ga-PSMA PET/CT demonstrated a band-like area of increased radiotracer uptake in the dome of the right lobe of the liver anteriorly, whereas 18F-fluciclovine PET/CT done a day later revealed photopenia in the corresponding area of the liver. The external beam radiotherapy plan confirmed that the radiotherapy field overlaid the region of the hepatic discordant radiotracer uptake on the PET/CT scans.
Bone Scan With Pulmonary Uptake in Scleroderma
Authors: Farahmandfar Fatemeh , Moradian Sadegh , Pournazari Mehran , Salimi Mehdi , Shakeri Sara
Published: February 2023

We present a 61-year-old woman with a history of scleroderma and suspicion of osteomyelitis in her left wrist. She underwent a 3-phase bone scan for evaluation of osteomyelitis. Incidentally, the scan showed bilateral pulmonary MDP uptake, especially in lower lobes, which was proven to be due to the nonfibrotic form of nonspecific interstitial pneumonia.
Prediction of Complication Risk in Computed Tomography-guided Thoracic Biopsy
Authors: Lee Hwan , Murphy Christina , Mortani Barbosa Eduardo J.
Published: February 2023

Purpose:

Computed tomography-guided transthoracic biopsy (CTTB) is a minimally invasive procedure with a high diagnostic yield for a variety of thoracic diseases. We comprehensively assessed a large CTTB cohort to predict procedural and patient factors associated with the risk of complications.

Materials and Methods:

The medical record and computed tomography images of 1430 patients who underwent CTTB were reviewed individually to obtain clinical information and technical procedure factors. Statistical analyses included descriptive and summary statistics, univariate analysis with the Fisher test, and multivariate logistic regression.

Results:

The most common type of complication was pneumothorax (17.4%), followed by bleeding (5.9%). Only 26 patients (1.8%) developed a major complication. Lung lesions carried a higher risk of complications than nonlung lesions. For lung lesions, the nondependent position of the lesion, vertical needle approach, trespassing aerated lung, and involvement of a trainee increased the risk of complication, whereas the use of the coaxial technique was a protective factor. The time with the needle in the lung, the number of biopsy samples, and the distance crossing the aerated lung were identified as additional risk factors in multivariate analysis. For nonlung lesions, trespassing the pleural space was the single best predictor of complications. A logistic regression-based model achieved an area under the receiver operating characteristic curve of 0.975, 0.699, and 0.722 for the prediction of major, minor, and no complications, respectively.

Conclusions:

Technical procedural factors that can be modified by the operator are highly predictive of the risk of complications in CTTB.
Nontuberculosis Mycobacteria Infection After Liposuction and Fat Grafting for Augmentation Mammoplasty
Authors: Yeh Jui-Po , Tsai Yueh-Ju
Published: February 2023

Background

Nontuberculosis mycobacteria (NTM) commonly occur in nature. Although the infection rate is low, soft tissue infection with NTM after surgical procedures is possible in both immunocompromised and normal populations. For cosmetic surgery, NTM infection has emerged as a common infection in the recent years, and this indicates the need to pay more attention, especially to those with prolonged atypical uncertain wound problems.

Aim and Objectives

We aimed to report a case of NTM infection after breast augmentation to share our experience on clinical appearance and process of diagnosis and treatment, and to review the existing literature.

Materials and Methods

We retrospectively review a patient who suffered from NTM infection after liposuction and fat grafting for breast augmentation between 2019 and 2021 in our hospital. The baseline characteristics, operations, bacterial culture report, medications, and outpatient information were collected from medical records.

Results

The patient suffered from purulent skin lesions after breast augmentation and was diagnosed with NTM infection according to the culture report. The NTM infection was resolved after a long-term course of treatment for around a year, including surgical debridement, serial aspirations, and prescriptions of antituberculosis medications.

Conclusions

The results of our study suggest that NTM must be considered when facing refractory infections after surgeries or invasive procedures without bacterial growth on routine cultures. Acid-fast stain and mycobacterial culture are strongly recommended. Treatment modalities include localized aspiration, surgical debridement, and multidrug antibiotics based on the sensitivity of the microorganism.
Flap Coverage of Infected Ventricular Assist Devices Influences Patient Outcomes
Authors: Sweitzer Keith , Butterfield James , Hubert Jessica , Park Won , Tomtschik Julia , Carter Mathew , Gosev Igor , Bell Derek
Published: February 2023

Background

The use of left ventricular assist devices (LVADs) for patients with end-stage cardiac failure awaiting heart transplantation has become increasingly common. However, ventricular assist device–related infections remain a major problem complicating their long-term use. Poor data exist to determine how to manage these infections after operative debridement.

Methods

Patients who underwent insertion of a ventricular assist device and had a subsequent readmission for LVAD infection at the University of Rochester Medical Center from 2012 to 2022 were identified through accessing the medical records archives of the hospital. Patients were followed retrospectively for an average of 3.2 years. Patient demographics, preoperative diagnosis/disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, infectious organism identified at initial washout, infectious organism identified at time of definitive device coverage, timing of coverage procedure after the initial washout for infection, type of flap used for coverage, 90-day complications after definitive coverage, and lifetime return to operating room for infection were reviewed. Comparison analysis with a χ2 test was used to analyze outcomes.

Results

Of 568 patients admitted with an LVAD-related infection 117 underwent operative debridement. Of these, 34 underwent primary closure, 31 underwent closure with secondary intention (negative pressure wound therapy with split thickness skin grafting), and 52 were closed with a flap (pectoralis, omental, latissimus, or vertical rectus abdominus musculocutaneous flap). There was a statistically significant higher incidence of return to the operating room (RTOR) for infection over a lifetime with primary closure compared with secondary intention and flap reconstruction (P = 0.01, 0.02), but no difference in 90-day complications (P = 0.76, P = 0.58). Eighty-three patients had a positive culture upon definitive coverage with 24 having a postsurgical complication, 15 of which required lifetime RTOR for infection. Thirty four were closed with negative cultures with 9 having a complication and 4 requiring RTOR for infection. This was not statistically significant for complications or RTOR (P = 0.79, 0.40). Culture data were further substratified into bacterial cultures (n = 73) versus fungal cultures (n = 10), and there was no statistically significant difference between these compared with complications or RTOR (P = 0.40, 0.39).

Conclusions

Coverage of infected LVADs with locoregional flaps or allowing to granulate using wound vac therapy has a decreased lifetime RTOR for future infections for these patients without increase in 90-day complications. Timing of RTOR should not be impacted by positive cultures provided there is healthy granulation tissue in the wound.
Introduction of Spring-Assisted Cranioplasty for Sagittal Craniosynostosis in a Craniofacial Service: A Report of Early Experience
Authors: Bakri Sherif , Mazeed Ahmed S. , Saied Samia , Abdelhamied Ahmed Kamal , Kenawy Karam , Aly Haitham M. , Ahmed Islam Mokhtar , Sadek Abdelrahim Abdrabou , Othman Amr Ahmed , Kolby Lars , Elsherbiny Ahmed
Published: February 2023

Spring-assisted cranioplasty (SAC) for the treatment of craniosynostosis uses internal springs to produce dynamic changes in cranial shape over several months before its removal. The purpose of this study was to report the first Egyptian experiences with SAC in the treatment of children with sagittal synostosis and evaluate the preliminary outcome. A total of 17 consecutive patients with scaphocephaly underwent SAC with a midline osteotomy along the fused sagittal suture and insertion of 3 springs with bayonet-shaped ends across the opened suture. Operative time, blood transfusion requirements and length of ICU, total hospital stay, and complications graded according to Oxford protocol classification were recorded. Spring removal was performed once re-ossification of the cranial defect occurred. All patients successfully underwent SAC without significant complications. The mean age at surgery was 6.8 months. The mean time of the spring insertion surgery was 63 minutes (SD 9.7). Blood transfusion was needed in less than half of the patients (41.2%).The mean duration of hospital stay was 3.2 days. The mean timing of spring removal was 5.5 months (SD 0.4). The mean time of the second surgery (spring removal) was 22.8 minutes (SD 3.6). In conclusion, SAC can easily be incorporated into the treatment armamentarium of craniofacial surgeons. The technique offers a safe and minimally invasive option for the treatment of sagittal craniosynostosis with the benefit of limited dural undermining, minimal blood loss, operative time, anesthetic time, ICU stay, and hospital stay.
Surgical Margins in 3D Planned Mandibular Resections for Squamous Cell Carcinomas of the Oral Cavity
Authors: Lamy Mona , La Rosa Stefano , May Laurence , Broome Martin
Published: February 2023

Purpose:

Three-dimensional (3D) planned mandibular resections using cutting guides and preplanned plates are now widely used in oncological surgery. The main advantages are the gain of time, precision, and esthetic outcomes. The drawbacks include costs, time for planning, and printing the surgical tools. This time between the radiological data and the surgery may allow tumor progression, rendering the custom-made guides useless. There is no consensus regarding surgical margins that should be planned to ensure a safe oncologic outcome. The purpose of this retrospective study is to evaluate if the planned bony margins are adequate.

Materials and Methods:

Inclusion criteria were: Squamous cell carcinomas of the anterior and lateral floor of mouth with mandibular invasion (T4); mandibular resection using 3D planning and cutting guides. Between June 2015 to December 2019, 16 patients met the criteria. The time between the planning and the surgery was recorded. The authors decided to use a margin of at least 1 cm on the preoperative computerized tomography scans on each side of the tumors in our planning for all patients. The authors then measured the distance of the bone resection on the pathological specimen.

Results:

All 16 patients had safe bone surgical margins (R0). The average time from the scanners used for the planning to the surgery was 33 days.

Discussion:

All the cutting guides could be used. The pathology examination showed safe oncological margins and no patients required further resection. A 1 cm margin during 3D planning for mandibular resections with 3D printed cutting guides, in patients with T4 Squamous Cell Carcinomas can therefore be considered safe.
Long-Term Update: Free Fibula Flap Growth After Pediatric Mandibular Reconstruction
Authors: Yim Nicholas H. , Montgomery Ashley , Upadhyaya Raghave M. , Buchanan Edward P.
Published: February 2023

A free fibular flap is commonly used in adult mandibular reconstruction; however, its use in the pediatric population is not strongly supported. The authors are reporting the long-term update of a case of a pediatric patient who underwent a mandibular reconstruction using a free fibular flap after a resection of mandibular desmoid fibromatosis. Greatest growth was objectively measured and demonstrated at the condyle using a 3-dimensional model generated from Materialise software. This is 1 case and subsequent studies should be observed to further elucidate the full growth potential of the mandible in pediatric patients undergoing mandibular reconstruction.
Osseointegration Levels of Implants Placed With Allogenic and Xenogenic Bone Ring: An Experimental Biomechanical Analysis
Authors: Gul Mehmet , Bozoglan Alihan , Dundar Serkan , Bingul Muhammet Bahattin , Kirtay Mustafa , Ozupek Muhammet Fatih , Habek Osman , Ozcan Erhan Cahit , Tasdemir Ismail
Published: February 2023

This in vivo study aimed to do a biomechanical analysis of the early period bone-implant connection of titanium implants simultaneously inserted with xsenogenic and allogenic bone ring. In this study, 28 Sprague Dawley female rats were used. Four rats were killed to obtain an allogenic bone ring, and after this, the remaining rats were divided into control (n=8), xsenogenic (n=8), and allogenic (n=8) bone ring groups. Titanium-machined surfaced implants were integrated right tibias of the rats. In controls, only implants were integrated into right tibias. In the greft groups, the implants were integrated simultaneously with bone rings. After 2 weeks of the experimental period, the rats were killed ,and titanium implants and surrounding bone tissues were removed for biomechanic analysis. After biomechanical reverse torque analysis bone-implant connection was determined as Newton/cm2; in controls 3.26 (1.2 to 4.5), in allogenic ring group 3.37 (2 to 4.4), in xsenogenic ring group 5.93 (2.8 to 10). Statistically significant differences were not detected between the groups (P>0.05). Within the limitation of this study, both allogenic and xsenogenic bone grafts could be successfully used in bone augmentation in implant surgery.
Characteristics and Outcomes of Electric Bicycle-Related Open-Globe Injuries in a Tertiary Hospital in North China
Authors: Han Shaolei , Wang Lifei , Fan Yiming , Wang Tingting , Jia Jinchen , Huo Tao , Xin Liuqing
Published: February 2023

Background:

The aim was to describe the characteristics and outcomes of patients treated for electric bicycle-related open-globe injuries (OGIs).

Methods:

A retrospective chart review of all patients who presented with electric bicycle-related OGIs was performed at the Hebei Eye Hospital in North China between January 2012 and December 2018. Demographic data, injury type, presenting clinical examination findings, best-corrected visual acuity (BCVA), secondary ocular complications, necessary surgical procedures and long-term outcome data were recorded.

Results:

Twenty-six patients with electric bicycle-related OGIs met the inclusion criteria and were enrolled in the study. Eighteen of the 26 patients (69.2%) were males. the average age of these patients was 44.0 years old. The injuries peaked in winter in the hour between 15:00 and 20:00. Among the patients, 23 (88.5%) were farm workers, 2 (7.7%) were industrial workers, 1 (3.8%) was student. The types of OGIs were 23 ruptures (88.5%), 3 penetrating injuries (11.5%). Data on zone of injuries included 1 zone I injuries (3.8%), 12 zone II injuries (46.2%), 13 zone III injuries (50.0%). Nine eyes (34.6%) had traumatic cataract, 24 eyes (92.3%) had vitreous hemorrhage, 20 eyes (79.9%) had retinal detachment, 19 eyes (73.1%) had choroidal detachment. Ten eyes (38.4%) had hand motion or worse vision at final follow-up. four eyes (15.4%) which had injuries involving all 3 zones resulted in enucleation or evisceration. With respect to BCVA, the initial BCVA was 2.7±0.3 and the final BCVA was 2.0±0.7, indicating that the patients’ BCVA was significantly improved by surgery (t=4.3, P<0.001).

Conclusions:

Electric bicycle-related OGIs may have severe consequences. Modern surgical techniques can increase the rate of globe salvage although final vision remains poor. Therefore, increased awareness, proposed policies and suggestions should focus on regulating the use of electric bicycles and reinforcing laws and regulations to improve safety and prevent injuries.
Transfer Patterns and Clinical Applications of the Forehead Flaps Based on the Supratrochlear Artery and Supraorbital Artery
Authors: Yang Ruomeng , Zang Mengqing , Zhu Shan , Li Shanshan , Chen Zixiang , Liu Yuanbo
Published: February 2023

This study aimed to describe the application of transferring preexpanded forehead flaps based on the supratrochlear and supraorbital arteries in 3 patterns for facial reconstruction: Pattern I, interpolated flap; Pattern II, island flap; and Pattern III, propeller flap, which was subdivided into direct propeller flap (Pattern IIIa) and indirect propeller flap (Pattern IIIb). During the first stage, a tissue expander was inserted underneath the forehead. After sufficient inflation of the expander, a forehead flap based on the supratrochlear or supraorbital artery was elevated and transferred to reconstruct the facial defects. Three weeks after the surgery, pedicle division was performed, in which Pattern I and Pattern IIIb flaps were used. Twenty-four patients underwent facial reconstruction. Twenty-three flaps survived without any perfusion-related complications. Venous congestion developed in an island flap. All patients were followed up after surgery, ranging from 2 to 156 (mean, 19) months. The color and texture of the flap matched those of the adjacent skin. The patients and their families were satisfied with the final functional and esthetic outcomes. The forehead flap based on the supratrochlear and supraorbital arteries provides reliable coverage of facial defects. The conventional interpolated flap continues to be the most dependable. Single-stage reconstruction using the island flap and direct propeller flap is applicable to patients who decline the pedicle division procedure. The novel technique of using the indirect propeller flap is safe for cheek reconstruction with minimal donor-site morbidity and esthetically pleasing results.
Three-dimensional Printing Technologies in Craniofacial Plastic Surgery: An Institutional Experience
Authors: Zhang Ziwei , Han Wenqing , Kim Byeong Seop , Chen Xiaojun , Yan Yingjie , Sun Mengzhe , Lin Li , Xu Haisong , Chai Gang
Published: February 2023

Rapid developments in 3-dimensional(3D) printing technologies in craniofacial plastic surgery have provided a new treatment modality for patients. In this article, we intend to share our institution’s experience using 3D printing in 3 modes-namely, 3-dimensional printing for manufacturing contour models, guides, and implants. Fifty-nine patients were enrolled in our study between September 2009 and September 2021. Among the 3D printing-assisted technologies, 41 cases were used for congenital malformations, 82 for trauma repair, and 112 for cosmetic surgery. Preoperative design and postoperative data were compared and analyzed based on imaging data. In craniofacial plastic surgery, all patients had excellent postoperative objective bone measurements close to the preoperative design and improved esthetic appearance. Our survey of postoperative satisfaction showed that patients were quite satisfied with the surgery, especially concerning congenital deformities. Rapid prototyping 3-dimensional printing technology provides a practical and anatomically accurate means to produce patient-specific and disease-specific translational tools. These models can be used for surgical planning, simulation, and clinical evaluation. Expanding this technology in craniofacial plastic surgery will provide adequate assistance to practitioners and patients.
Intracranial Dermoid in Patients With Fibrous Dysplasia
Authors: Song Xiaowen , Li Zhi
Published: February 2023

Objectives:

Intracranial epidermoid cyst (EC) and craniofacial fibrous dysplasia (CFD) were histogenetically different rare congenital benign diseases. The coexistence of intracranial EC and CFD was extremely rare and had not been reported yet.

Materials and Methods:

We retrospectively reviewed the clinical and radiologic information of 3 patients diagnosed with concomitant EC and CFD at Beijing Tiantan Hospital from January 2003 to January 2021 and summarized their clinicopathological features, treatment modalities, and outcomes. In addition, we performed a systematic review of cases of the coexisting intracranial EC and other intracranial abnormalities to explore the potential connections.

Results:

There were 2 women and 1 man with the mean age of 31 years old. Satisfactory resection was fulfilled for all the 3 ECs. CFD, however, was managed with watchful waiting. During the mean follow-up time of 58 months, all the ECs showed no sign of recurrence, and all the CFD lesions remained stable. Two EC specimens underwent genetic study, showing no GNAS mutations and negative Gsα protein expression. In the literature review of concomitant intracranial EC and other intracranial abnormalities, 23 studies were included. With 5 reported cases, the intracranial aneurysm was found to be the most common intracranial disease that coexisted with EC.

Conclusions:

The coexistence of intracranial EC and CFD was extremely rare. However, no convincing mechanism and evidence underlying such coexistence had been found. To provide more profound understanding about these 2 diseases and improve diagnosis and treatment strategy, further research and verification should be considered.
Influence of Obesity on Vascular Dysfunction Following Traumatic Hemorrhage
Authors: Walker Ashley E. , Cole Jazmin A. , Kumaran Sahana Krishna , Kato Jonathan I. , Zhuang Xinhao , Wolf Julia R. , Henson Grant D. , McCully Belinda H.
Published: February 2023

Background

Obesity increases the risk for morbidity and mortality following trauma. These complications are associated with profound vascular damage. Traumatic hemorrhage acutely attenuates vascular responsiveness, but the impact of obesity on this dysfunction is not known. The local inflammatory response in vascular cells is also unknown. We hypothesized that obesity potentiates trauma-induced vascular inflammation and dysfunction.

Methods

Male Sprague-Dawley rats (~250 g) were fed normal chow (NC; 13.5% kcal fat, n = 20) or high-fat (HF; 60% kcal fat, n = 20) diets for 6-8 weeks. Under anesthesia, hemorrhage was induced by a mesenteric artery laceration, a Grade V splenic injury, and hypotension (MAP = 30–40 mmHg) for 30 minutes. Vascular responsiveness was assessed ex vivo in isolated mesenteric arteries pre- and post-hemorrhage. Gene expression for interleukin (IL)-1β, and IL-6, pro-oxidant NADPH oxidase 2 (NOX2), and α-adrenergic receptor were assessed in carotid artery endothelial cells (ECs) and non-ECs (media + adventitia).

Results

In NC rats, hemorrhage attenuated norepinephrine-induced vasoconstriction and endothelium-dependent vasodilation to acetylcholine. In HF rats, baseline norepinephrine-induced vasoconstriction was attenuated compared to NC, but vasoconstriction and endothelium-dependent vasodilation did not change pre- to post-hemorrhage. Hemorrhage led to elevated IL-1β gene expression in ECs, and elevated IL1β, IL-6, NOX2, and α-adrenergic receptor gene expression in the media + adventitia compared with sham. HF rats had greater EC IL-1 β and NOX2 gene expression compared with NC rats. The hemorrhage-induced elevation of IL-1β in the media + adventitia was greatest in HF rats.

Conclusion

Traumatic hemorrhage attenuates vascular responsiveness and induces vascular inflammation. The attenuated vascular responsiveness following hemorrhage is absent in obese rats, while the elevated vascular inflammation persists. A HF diet amplifies the arterial inflammation after hemorrhage. Altered vascular responsiveness and vascular inflammation may contribute to worse outcomes in obese trauma patients.
CARDIOMYOCYTE REPROGRAMMING IN ANIMAL MODELS OF SEPTIC SHOCK
Authors: Hobai Ion A.
Published: February 2023

Cardiomyocyte reprogramming plays a pivotal role in sepsis-induced cardiomyopathy through the induction or overexpression of several factors and enzymes, ultimately leading to the characteristic decrease in cardiac contractility. The initial trigger is the binding of LPS to TLR-2, -3, -4, and -9 and of proinflammatory cytokines, such as TNF, IL-1, and IL-6, to their respective receptors. This induces the nuclear translocation of nuclear factors, such as NF-κB, via activation of MyD88, TRIF, IRAK, and MAPKs. Among the latter, ROS- and estrogen-dependent p38 and ERK 1/2 are proinflammatory, whereas JNK may play antagonistic, anti-inflammatory roles. Nuclear factors induce the synthesis of cytokines, which can amplify the inflammatory signal in a paracrine fashion, and of several effector enzymes, such as NOS-2, NOX-1, and others, which are ultimately responsible for the degradation of cardiomyocyte contractility. In parallel, the downregulation of enzymes involved in oxidative phosphorylation causes metabolic reprogramming, followed by a decrease in ATP production and the release of fragmented mitochondrial DNA, which may augment the process in a positive feedback loop. Other mediators, such as NO, ROS, the enzymes PI3K and Akt, and adrenergic stimulation may play regulatory roles, but not all signaling pathways that mediate cardiac dysfunction of sepsis do that by regulating reprogramming. Transcription may be globally modulated by miRs, which exert protective or amplifying effects. For all these mechanisms, differentiating between modulation of cardiomyocyte reprogramming versus systemic inflammation has been an ongoing but worthwhile experimental challenge.
DIAGNOSTIC VALUE OF MITOCHONDRIAL DNA AND PERIPHERAL BLOOD MONONUCLEAR CELL RESPIROMETRY FOR BURN-RELATED SEPSIS
Authors: Robles Maria Cielito , Heard Tiffany C. , Chao Tony , Alcover Karl , Wagner Amanda , Akers Kevin S. , Burmeister David M.
Published: February 2023

Background: Sepsis is the leading cause of mortality among burn patients that survive acute resuscitation. Clinical criteria have poor diagnostic value for burn-induced sepsis, making it difficult to diagnose. Protein biomarkers (e.g., procalcitonin) have been examined with limited success. We aimed to explore other biomarkers related to mitochondria (mitochondrial DNA [mtDNA]) and mitochondrial function of peripheral blood mononuclear cells (PBMCs) for sepsis diagnosis in burn patients. Methods: We conducted a follow-up analysis of a single center, prospective observational study of subjects (n = 10 healthy volunteers, n = 24 burn patients) to examine the diagnostic value of mtDNA and PBMC respirometry. Patients were enrolled regardless of sepsis status and followed longitudinally. Patient samples were classified as septic or not based on empiric clinical criteria. Isolated PBMCs were loaded into a high-resolution respirometer, and circulating mtDNA was measured with a PCR-based assay. Sequential Organ Failure Assessment (SOFA) criteria were also compared. Results: The SOFA criteria comparing septic versus before/nonseptic patients revealed significantly higher heart rate (P = 0.012) and lower mean arterial pressure (P = 0.039) in burn sepsis. MtDNA was significantly elevated in septic burn patients compared with healthy volunteers (P < 0.0001) and nonseptic patients (P < 0.0001), with no significant difference between healthy volunteers and nonseptic burn patients (P = 0.187). The area under the ROC curve (AUC) for mtDNA was 0.685 (95% confidence interval = 0.50–0.86). For PBMC respirometry, burn patients exhibited increased routine and maximal respiration potential compared with healthy volunteers. However, no difference was found between nonseptic and septic patient samples. A subanalysis revealed a significant mortality difference in PBMC respirometry after sepsis diagnosis, wherein survivors had higher routine respiration (P = 0.003) and maximal respiration (P = 0.011) compared with nonsurvivors. Conclusion: Our findings reveal that mtDNA may have diagnostic value for burn sepsis, whereas PBMC respirometry is nonspecifically elevated in burns, but may have value in mortality prognosis. A larger, multisite study is warranted for further validity of the diagnostic value of mtDNA and PBMC respirometry as biomarkers for prognosis of sepsis and outcomes in burn patients.
IMPORTANCE OF THE INNATE IMMUNE RESPONSE IN SKELETAL MUSCLE TO SEPSIS-INDUCED ALTERATIONS IN PROTEIN BALANCE
Authors: Lang Charles H.
Published: February 2023

There is growing appreciation that skeletal muscle is a fully functional component of the body's innate immune system with the potential to actively participate in the host response to invading bacteria as opposed to being a passive target. In this regard, skeletal muscle in general and myocytes specifically possess an afferent limb that recognizes a wide variety of host pathogens via their interaction with multiple classes of cell membrane–bound and intracellular receptors, including toll-like receptors, cytokine receptors, NOD-like receptors, and the NLRP inflammasome. The efferent limb of the innate immune system in muscle is equally robust and with an increased synthesis and secretion of a variety of myocyte-derived cytokines (i.e., myokines), including TNF-α, IL-1, IL-6, and NO as well as multiple chemokines in response to appropriate stimulation. Herein, the current narrative review focuses primarily on the immune response of myocytes per se as opposed to other cell types within whole muscle. Moreover, because there are important differences, this review focuses specifically on systemic infection and inflammation as opposed to the response of muscle to direct injury and various types of muscular dystrophies. To date, however, there are few definitive muscle-specific studies that are necessary to directly address the relative importance of muscle-derived immune activation as a contributor to either the systemic immune response or the local immune microenvironment within muscle during sepsis and the resultant downstream metabolic disturbances.
Long-term Outcomes After Laparoscopic, Robotic, and Open Pancreatoduodenectomy for Distal Cholangiocarcinoma
Authors: Uijterwijk Bas A. , Lemmers Daniël H.L. , Bolm Louisa , Luyer Misha , Koh Ye Xin , Mazzola Michele , Webber Laurence , Kazemier Geert , Bannone Elisa , Ramaekers Mark , Ielpo Benedetto , Wellner Ulrich , Koek Sharnice , Giani Alessandro , Besselink Marc G. , Abu Hilal Mohammed ,   for the ISGACA consortium, the International study group on non-pancreatic periampullary cancer
Published: February 2023

Objective:

This study aimed to compare surgical and oncological outcomes after minimally invasive pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) for distal cholangiocarcinoma (dCCA).

Background:

A dCCA might be a good indication for MIPD, as it is often diagnosed as primary resectable disease. However, multicenter series on MIPD for dCCA are lacking.

Methods:

This is an international multicenter propensity score-matched cohort study including patients after MIPD or OPD for dCCA in 8 centers from 5 countries (2010-2021). Primary outcomes included overall survival (OS) and disease-free interval (DFI). Secondary outcomes included perioperative and postoperative complications and predictors for OS or DFI. Subgroup analyses included robotic pancreatoduodenectomy (RPD) and laparoscopic pancreatoduodenectomy (LPD).

Results:

Overall, 478 patients after pancreatoduodenectomy for dCCA were included of which 97 after MIPD (37 RPD, 60 LPD) and 381 after OPD. MIPD was associated with less blood loss (300 vs 420 mL, P=0.025), longer operation time (453 vs 340 min; P<0.001), and less surgical site infections (7.8% vs 19.3%; P=0.042) compared with OPD. The median OS (30 vs 25 mo) and DFI (29 vs 18) for MIPD did not differ significantly between MIPD and OPD. Tumor stage (Hazard ratio: 2.939, P<0.001) and administration of adjuvant chemotherapy (Hazard ratio: 0.640, P=0.033) were individual predictors for OS. RPD was associated with a higher lymph node yield (18.0 vs 13.5; P=0.008) and less major morbidity (Clavien-Dindo 3b-5; 8.1% vs 32.1%; P=0.005) compared with LPD.

Discussion:

Both surgical and oncological outcomes of MIPD for dCCA are acceptable as compared with OPD. Surgical outcomes seem to favor RPD as compared with LPD but more data are needed. Randomized controlled trials should be performed to confirm these findings.
Health-related Quality of Life of Patients With Non–Intra-abdominal Desmoid-Type Fibromatosis During Active Surveillance
Authors: Schut Anne-Rose W. , Timbergen Milea J.M. , Nasserinejad Kazem , van Dalen Thijs , van Houdt Winan J. , Bonenkamp Johannes J. , Sleijfer Stefan , Grünhagen Dirk J. , Verhoef Cornelis , Husson Olga ,   on behalf of the Dutch Grafiti Group
Published: February 2023

Objective:

To examine the impact of an active surveillance (AS) approach on the health-related quality of life (HRQoL) of patients with desmoid-type fibromatosis (DTF).

Background Data:

AS is recommended as initial approach in DTF patients. AS might however negatively affect HRQoL due to physical symptoms or stress and anxiety.

Methods:

In a prospective observational study, the GRAFITI trial (NTR4714), DTF patients were followed during an initial AS approach for 3 years. HRQoL was assessed by the EORTC QLQ-C30 at baseline, 6, 12 and 24-month follow-up. Patients who completed questionnaires at≥1-time point were included in this analysis of the secondary endpoint. A multivariable linear mixed-effects model with random intercept was conducted to assess trends of HRQoL scores over time and to explore the effect of treatment strategy on HRQoL.

Results:

All 105 patients enrolled in the GRAFITI trial were eligible for the HRQoL analyses. During 24-month follow-up, 75 patients (71%) continued AS and 30 patients (29%) started an active treatment (AT). DTF patients who continued AS demonstrated relatively stable HRQoL scores during follow-up. HRQoL scores of patients who started AT worsened compared to patients who continued AS, although no significant changes in HRQoL score over time were found in the mixed-model analyses. Overall, DTF patients who started AT scored significantly worse on pain (β=10.08, P=0.039) compared to patients who continued AS.

Conclusions:

An initial AS approach did not impair HRQoL of DTF patients who continued AS over time, therefore providing further support for AS as the frontline approach in DTF patients. Longitudinal assessment of HRQoL should be part of clinical follow-up to identify patients who may need a change in treatment strategy.
Safety and Distribution of Opioid Prescribing by U.S. Surgeons
Authors: Waljee Jennifer F. , Gunaseelan Vidhya , Bicket Mark C. , Brummett Chad M. , Chua Kao-Ping
Published: February 2023

Objective:

To estimate high-risk prescribing patterns among opioid prescriptions from U.S. surgeons; to characterize the distribution of high-risk prescribing among surgeons.

Background:

National data on the prevalence of opioid prescribing and high-risk opioid prescribing by U.S. surgeons are lacking.

Methods:

Using the IQVIA Prescription Database, which reports dispensing from 92% of U.S. pharmacies, we identified opioid prescriptions from surgeons dispensed in 2019 to patients ages ≥12 years. “High-risk” prescriptions were characterized by: days supplied >7, daily dosage ≥50 oral morphine equivalents (OMEs), opioid-benzodiazepine overlap, and extended-release/long-acting opioid. We determined the proportion of opioid prescriptions, total OMEs, and high-risk prescriptions accounted for by “high-volume surgeons” (those in the ≥95th percentile for prescription counts). We used linear regression to identify characteristics associated with being a high-volume surgeon.

Results:

Among 15,493,018 opioid prescriptions included, 7,036,481 (45.4%) were high-risk. Among 114,610 surgeons, 5753 were in the 95th percentile or above for prescription count, with ≥520 prescriptions dispensed in 2019. High-volume surgeons accounted for 33.5% of opioid prescriptions, 52.8% of total OMEs, and 44.2% of high-risk prescriptions. Among high-volume surgeons, 73.9% were orthopedic surgeons and 60.6% practiced in the South. Older age, male sex, specialty, region, and lack of affiliation with academic institutions or health systems were correlated with high-risk prescribing.

Conclusions:

The top 5% of surgeons account for 33.5% of opioid prescriptions and 45.4% of high-risk prescriptions. Quality improvement initiatives targeting these surgeons may have the greatest yield given their outsized role in high-risk prescribing.
Predictive Value of KLASS-02-QC Assessment Score on KLASS-02 Surgical Outcomes
Authors: Song Jeong Ho , Shin Hye Jung , Hyung Woo Jin , Yang Han-Kwang , Han Sang-Uk , Park Young-Kyu , Lee Hyuk-Joon , An Ji Yeong , Kim Wook , Kim Hyung-Ho , Ryu Seung Wan , Hur Hoon , Kim Min-Chan , Kong Seong-Ho , Kim Jin-Jo , Park Do Joong , Kim Young Woo , Ryu Keun Won , Kim Jong Won , Lee Joo-Ho , Kim Hyoung-Il
Published: February 2023

Objective:

The aim of this study was to audit the 22 items and assessed each item's predictive value on surgical outcomes.

Background:

The KLASS-02 trial revealed that the oncologic outcomes of laparoscopic distal gastrectomy are not inferior to open distal gastrectomy in patients with advanced gastric cancer. The surgeons participating in this trial were chosen based on the assessment scores from the KLASS-02-QC trial, which used 22 items for standardization of D2 lymphadenectomy and quality control.

Methods:

We reviewed proficiency scores (PSs) for 22 items for 20 surgeons who participated in KLASS-02. The surgeons were divided into 2 groups according to PS, and the perioperative outcomes of 924 patients enrolled in KLASS-02 were compared between groups. Each item's predictive value for perioperative outcome was then assessed using multivariable regression models.

Results:

Of the total 924 patients, 529 were operated on by high-score surgeons (high PS) and 395 were operated on by low-score surgeons (low-PS). High-PS group had less intraoperative blood loss, longer operation times, and fewer complications, major complications, reoperations, and shorter first flatus and hospital stay than low-PS group (P=0.006, P<0.001, P<0.001, P<0.001, P=0.042, P=0.013, and P<0.001, respectively). Some items used in KLASS-02-QC predicted perioperative outcomes, such as intraoperative blood loss, major complications, reoperation, and hospital stay.

Conclusions:

Although this study only analyzed data associated with qualified surgeons, the 22 items effectively assessed the surgeons based on PS. A high score was associated with longer operation times, but better perioperative outcomes.