bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of 18-fluorodeoxyglucose PET/computed tomography parameters and clinical features to predict outcome for diffuse large B-cell lymphoma
Authors: Baratto Lucia , Wu Fengyu , Minamimoto Ryogo , Hatami Negin , Liang Tie , Sabile Jean , Advani Ranjana H. , Mittra Erik
Published: March 2021

Purpose

To determine if the correlation between different metabolic parameters along with clinical features can create an improved model of prognostication for diffuse large B-cell lymphoma (DLBCL) patients.

Methods

We retrospectively evaluated 89 patients with DLBCL. All patients had a baseline and an interim 18F-FDG PET/CT. Seventy-nine also had an end-of-treatment PET/CT (EOT-PET). For each scan, we collected standardized uptake value (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUVmaxsum, SUVmeansum, MTVsum, and TLGsum. These metabolic parameters were combined with clinical features in order to identify a new prognostic model. The predictive value of interim PET and EOT-PET using Deauville score was also determined.

Results

Baseline SUVmaxsum and SUVmeansum were significantly correlated to overall survival (OS) (P value = 0.012 and 0.011, respectively). The percentage change of MTV and TLG sum from baseline to EOT was predictive of progression-free survival (PFS) (P value = 0.003 and 0.022, respectively). The combination of either Deauville score at the EOT and SUVmaxsum at baseline significantly predicted OS (P value <0.001); Eastern Cooperative Oncology Group performance status, presence of extranodal disease and percentage change of MTVsum from baseline to EOT were significant predictors of PFS (P value = 0.001).

Conclusions

SUVmaxsum and SUVmeansum at baseline and percentage change in MTV and TLG sum from baseline to EOT are predictors of outcome in DLBCL patients. These metabolic parameters combined to Deauville score and some clinical features could be used together to stratify patients.
Dual-tracer approach vs. dual time-point approach in leukocyte scintigraphy in treatment evaluation of persistent chronic prosthetic joint infection
Authors: Teiler Johan , Åkerlund Börje , Brismar Harald , Savitcheva Irina , Ahl Marcus , Bjäreback Annie , Hedlund Håkan , Holstensson Maria , Axelsson Rimma
Published: March 2021

Background

Both dual time-point 99mTc-hexamethylpropylene amine oxime (HMPAO)-leukocyte scintigraphy and dual-tracer 99mTc-HMPAO-leukocyte scintigraphy (with the addition of 99mTc-nanocolloid bone marrow scintigraphy) have been used to diagnose prosthetic joint infection (PJI). A treatment evaluation of persistent PJI using these imaging protocols has yet to be presented.

Objective

The purpose of this study was to compare the accuracy of dual time-point 99mTc-HMPAO-leukocyte scintigraphy to the dual-tracer alternative of single time-point 99mTc-HMPAO-leukocyte scintigraphy or single-photon emission computed tomography/computed tomography (SPECT/CT) combined with a 99mTc-nanocolloid bone marrow scintigraphy or SPECT/CT, for treatment evaluation of PJI.

Material and methods

Thirty-one PJI patients under antibiotic treatment were included in this retrospective study. Examinations were organized into three settings. Setting one used dual time-point approach with delayed (2 h) and late (24 h) planar 99mTc-HMPAO-leukocyte scintigraphy, including both visual and semiquantitative analysis. Setting two used delayed (2 h) planar 99mTc-HMPAO-leukocyte scintigraphy combined with 99mTc-nanocolloid bone marrow scintigraphy and for setting three SPECT/CT replaced planar imaging.

Results

Accuracy was 0.68 for visual evaluation and 0.55 for semiquantitative evaluation of setting one; 0.71 for setting two; and 0.68 for setting three. Sensitivity was 0.54 for visual evaluation and 0.31 for semiquantitative evaluation of setting one; 0.38 for setting two; and 0.46 for setting three. Specificity was 0.78 for visual evaluation and 0.72 for semiquantitative evaluation of setting one; 0.94 for setting two; and 0.83 for setting three.

Conclusion

No significant difference in accuracy, sensitivity, or specificity between the approaches for treatment evaluation of suspected persistent PJI in the hip or knee was observed.
18F-FDG PET/CT imaging features of patients with multicentric Castleman disease
Authors: Jiang Yuanyuan , Hou Guozhu , Zhu Zhaohui , Huo Li , Li Fang , Cheng Wuying
Published: March 2021

Objective

The aim of this study is to investigate the role of 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) in the evaluation of multicentric Castleman disease (MCD).

Methods

Thirty-five patients with pathologically confirmed MCD who underwent 18F-FDG PET/CT were retrospectively included. The FDG uptake and CT findings of lymph nodes, pulmonary involvement, spleen, and bone marrow were assessed and the maximum standardized uptake value (SUVmax) of each lesion was measured. The locations of lymph nodes were also evaluated.

Results

18F-FDG PET/CT showed increased uptake in multiple nodal regions in 34 out of 35 MCD patients. The most frequently involved nodal sites were the cervical, iliac, axillary, and inguinal areas, and the least common was paraaortic and abdominal nodes. The involved lymph nodes were not confluent and presented a relatively symmetric pattern on PET/CT images. The highest SUVmax of lymph nodes per patient ranged from 2 to 19 with a mean value of 5.61 ± 3.12. Pulmonary manifestation including cysts, nodules, and interstitial lung disease were found in 10 patients, eight of whom demonstrated mild to moderate uptake in the lungs. 18F-FDG PET/CT also revealed other findings including hypermetabolic spleen (n = 8) and bone marrow (n = 23), elevated uptake in salivary glands (n = 8). Four patients also underwent follow-up PET/CT scans after therapy, and three of them displayed decreased metabolism.

Conclusion

18F-FDG PET/CT is a useful tool in the diagnosis, evaluation, and follow-up of MCD by providing systemic manifestations of lymphadenopathy, pulmonary involvement, and hypermetabolic spleen or bone marrow. Furthermore, the lymphadenopathy in MCD presented a predominantly peripheral distribution, relatively symmetric, moderately hypermetabolic, and not confluent pattern on 18F-FDG PET/CT.
Impact of fluorine-18-fluorodeoxyglucose PET/computed tomography in staging of patients with gallbladder cancer: a systematic review and meta-analysis
Authors: Parida Girish Kumar , Panda Raj Abhisek , Agrawal Kanhaiyalal
Published: March 2021

Background

Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) has proven its efficacy in various malignancies; however, currently it is not used routinely for the management of gallbladder carcinoma (GBCa). So, we tried to review and analyze the impact of FDG PET/CT in the staging workup of gallbladder carcinoma.

Methods

Databases like PubMed, SCOPUS, and EMBASE were searched for published original studies on F-18 FDG PET/CT in staging workup gallbladder carcinoma till December 2020. The included studies were assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist. A random-effect model was used for calculating pooled estimates of sensitivity and specificity. They were demonstrated in Forest plots. I
2 statistic was used to assess heterogeneity in the studies.

Results

There is a paucity of literature with respect to the role of FDG PET/CT in GBCa. With the available data, the pooled sensitivity and specificity of 18F-FDG PET/CT for detection of local disease estimates of 96% [95% confidence interval (CI), 90–99%] and 91% (95% CI, 77–98%), respectively. Pooled sensitivity and specificity for detection of metastatic disease are 95% (95% CI, 88–98%) and 97% (95% CI, 90–100%), respectively. For nodal disease, these values are 75% (95% CI, 53–90%) and 91% (95% CI, 77–98%), respectively. Besides this, FDG PET/CT findings have changed the management in significant proportion of patients.

Conclusion

With the limited data available currently, we found that 18F-FDG PET/CT is a quite accurate noninvasive tool in staging the workup of GBCa. However, further large multicentre trials are necessary for the generation of stronger evidence in this regard.
18F-fluciclovine PET/CT detection of biochemical recurrent prostate cancer in patients with PSA levels <2.00 ng/mL
Authors: Garza Daniel , Kandathil Asha , Xi Yin , Subramaniam Rathan M.
Published: March 2021

Objective

To establish the detection rate of prostate cancer recurrence following definitive therapy by 18F-fluciclovine PET/computed tomography (CT) in patients with biochemical recurrence (BCR) and prostate-specific antigen (PSA) levels less than 2.00 ng/mL.

Methods

In this retrospective study, 78 patients with a PSA level of less than 2.00 ng/mL were selected from the 211 patients who underwent at least one 18F-fluciclovine PET/CT scan at our institution for the detection of biochemical recurrent prostate cancer between April 2017 and December 2018. Inherent differences in the characteristics of patients with and without a positive scan were investigated for possible associations using multivariable analysis.

Results

One or more positive sites of recurrence were identified in 44 out of 78 patients (56.4%). Patients with a Gleason score between 8 and 10 were more likely to have a positive scan compared to patients with Gleason scores of 6–7 [adjusted odds ratio: 3.53, 95% confidence interval (1.13–10.99), P = 0.03]. No other significant association was found between PSA, T classification, and detection rate.

Conclusion

18F-fluciclovine PET/CT demonstrated a detection rate of 56.4% among patients with a PSA below 2.0 ng/mL. The results of this study support the use of 18F-fluciclovine PET/CT for the detection of recurrent prostate cancer at lower PSA levels, even at PSA levels less than 0.5 ng/mL.
Characterisation of 99mTc EDDA/HYNIC-TOC (Tektrotyd) physiological and neuroendocrine tumour uptake using SPECT/CT standardised uptake values: initial experience
Authors: Reilly Caitlin , Gemmell Alastair J. , McLaughlin Ian M , Fleming Robert , Reed Nicholas , McIntosh David , Nicol Alice
Published: March 2021

99mTc Ethylene diamine N,N'-diacetic acid hydrazinonicotinamide-conjugated Tyr3-octreotide (99mTc EDDA/HYNIC-TOC) single photon emission tomography/computed tomography (SPECT/CT) imaging of somatostatin receptors is used in the assessment of neuroendocrine tumours (NETs). The objective of this study was to characterise quantitative standardised uptake value (SUV) SPECT/CT of normal physiological uptake and NET disease. Forty-four patients (22 female and 22 male) referred for 99mTc EDDA/HYNIC-TOC SPECT/CT imaging for diagnosis/primary staging (n = 28) or the assessment of residual/recurrent disease (n = 16) were included. SPECT/CT SUVmax values were determined for normal physiological uptake (spleen, kidney, liver and bone) and NET disease (liver metastases, metastatic lymph nodes, bone metastases and intrapulmonary lesions). Statistical testing was performed to compare normal uptake and NET disease uptake in liver and bone (Student’s t-test).

The highest normal physiological uptake was observed in the spleen (mean SUVmax 29.8, SD 13.7), with lower uptake in the kidneys (16.7, 3.2) and liver (7.3, 2.1). Increased SUVmax values were observed in primary tumour and metastatic disease, greatest in liver metastases (21.8, 13.3), with lower, similar values obtained for metastatic lymph nodes (16.3, 7.5) and intrapulmonary lesions (17.5, 16.8). SUVmax in bone metastases averaged 12.9 (7.0). Significant differences were observed between normal and metastatic SUVmax in the liver and bone (P < 0.01). SPECT/CT SUV quantification is feasible in a manner similar to PET/CT. 99mTc EDDA/HYNIC-TOC SPECT/CT SUVmax has been characterised in NET disease, demonstrating high target to non-target ratios for primary tumours and metastatic lesions.
Targeted PET/CT imaging for clear cell renal cell carcinoma with radiolabeled antibodies: recent developments using girentuximab
Authors: van Oostenbrugge Tim , Mulders Peter
Published: March 2021

Purpose of review

Conventional imaging is unable to differentiate clear cell renal cell carcinoma (ccRCC) from other more indolent and benign renal tumors. Positron emission tomography/computed tomography (PET/CT) using radiolabeled antibodies may aid in detecting both localized and metastatic ccRCC. The purpose of this review is to summarize recent literature regarding the use of radiolabeled antibodies for imaging of ccRCC.

Recent findings

Two recent studies evaluated the use of radiolabeled anticarbonic anhydrase IX antibody girentuximab for the imaging of ccRCC. PET/CT with 89zirconium-labeled girentuximab (89Zr-girentuximab PET/CT) was used to guide clinical decision making in 16 patients with localized disease. It had a high specificity for detecting ccRCC with 6/6 resected lesions with uptake proven to be ccRCC, all lesion without uptake showed to be indolent during follow-up. Clinical management was changed in 36% (5/14) of patients with the metastatic disease based on outcomes of the scan. Furthermore, in 42 patients 89Zr-girentuximab PET/CT combined with CT outperformed CT alone or combined with 18F fludeoxyglucose PET for detection of metastasis.

89Zr-girentuximab PET/CT has the ability to diagnose ccRCC in localized disease. In metastatic disease, it enables the differentiation of ccRCC from non-ccRCC cancers and the evaluation of disease extent. 89Zr-girentuximab PET/CT diagnostic accuracy is currently evaluated in a multicenter phase III trial.
Salvage radical prostatectomy after local radiotherapy in prostate cancer
Authors: Pfister David , Kokx Ruud , Hartmann Florian , Heidenreich Axel
Published: March 2021

Purpose of review

Salvage surgeries are rarely offered and performed in prostate cancer except for isolated lymph node metastases. Meanwhile, data are sufficient that salvage radical prostatectomy is recommended by the guidelines. In the following review, we focus on different treatment strategies comparing open and DaVinci laparoscopic approach with regard to functional and oncologic outcome. Of further interest are palliative surgeries.

Recent findings

Salvage radical prostatectomy is mainly performed in high volume centres. Data are increasing on minimal invasive surgery, although data on functional outcome are conflicting. As patients with prostate cancer have longer life expectancy even in metastasized disease, the possibility of developing symptomatic progression increases as well. We need to be aware that the confrontation with symptomatic prostate cancer patients will be more frequent in the future and that there are surgical approaches to palliate these patients sufficiently.

Data on minimal invasive salvage radical prostatectomy are getting more valid and are an option in experienced centres. Salvage radical prostatectomy is a definitive curative option for the patients. To avoid local progression, palliative local surgeries need to be discussed with the patients.
Ovarian Clear Cell Tumors Associated With Seromucinous Borderline Tumor: A Case Series
Authors: Vroobel Katherine M. , McCluggage W. Glenn
Published: March 2021

Ovarian seromucinous borderline tumors (SMBT) and clear cell tumors are both closely associated with endometriosis and share, in a proportion of cases, a molecular pathway involving ARID1A mutations, but they have been rarely described in association. We report a case series of 4 clear cell tumors (3 carcinomas, 1 borderline adenofibroma) coexisting in the same ovary with SMBT. In all cases, the SMBT was the predominant component and we highlight that adequate sampling of these tumors is important to detect small clear cell carcinomas, thus potentially altering the treatment and prognosis.
Coping Strategies and Their Impact on Emotional Distress and Fatigue Among Breast Cancer Survivors
Authors: Levkovich Inbar
Published: March 2021

Objectives

This study examined the relations between subjective stress and strategies for coping with stress (emotion control strategies and self-compassion), as well as the relations between emotional distress and fatigue.

Methods

The study used a cross-sectional survey design. Participants were 170 women aged 24 to 82 years with diagnoses of breast cancer stages I to III who were 1 to 12 months postchemotherapy, with no current evidence of disease and no previous cancer diagnosis. Participants were recruited by consecutive sampling, and the overall response rate was 85%.

Results

Higher subjective stress was associated with higher emotional control (r = 0.23, P < 0.01), and both were associated with higher emotional distress (r = 0.63, P < 0.001; r = 0.20, P < 0.05). Lower self-compassion was associated with higher emotional distress (r = −0.20, P < 0.05). Fatigue exhibited a high association with emotional distress (r = 0.67, P < 0.001), which increased as subjective stress increased. Older age was associated with emotional control (r = 0.16, P < 0.05), whereas younger age was associated with emotional distress. Time elapsed since chemotherapy was negatively associated with both emotional distress (r = −0.19, P < 0.05) and fatigue (r = −0.18, P < 0.05). A strong positive association emerged between fatigue and emotional distress (r = 0.67, P < 0.001).

Conclusions

The results of this study underline the importance of self-compassion as a coping strategy to decrease emotional distress among breast cancer survivors.
Chimeric Antigen Receptor T Cells for Multiple Myeloma
Authors: Cowan Andrew J. , Tuazon Sherilyn A. , Portuguese Andrew J. , Green Damian J.
Published: March 2021

Despite improvements in effective therapy, multiple myeloma remains incurable, and virtually all patients will face relapsed disease at some point after diagnosis. The prognosis for relapsed myeloma after developing resistance to anti-CD38 monoclonal antibodies, proteasome inhibitors, immunomodulatory agents, and autologous stem cell transplantation has been poor; however, the development of immune effector cell therapy with chimeric antigen receptor (CAR) T cells may dramatically improve the outlook for patients, although none of these therapies are approved for MM to date. Herein, we review the development and history of CAR T-cell therapy for multiple myeloma, mechanisms of resistance, and strategies to improve outcomes with CAR T therapy.
Chimeric Antigen Receptor T-Cell Therapy for B-Cell Acute Lymphoblastic Leukemia
Authors: Gauthier Jordan , Turtle Cameron J.
Published: March 2021

Immunotherapy with T cells engineered to express a chimeric antigen receptor (CAR T cells) is reshaping the management of patients with relapsed or refractory B-cell malignancies. High efficacy of CD19-targeted CAR T cells has been reported in children and adults with B-cell acute lymphoblastic leukemia (B-ALL), with complete responses without detectable minimal residual disease occurring in approximately 80% to 90% of patients. This led to the approval of tisagenlecleucel (Kymriah) by the Food and Drug Administration based on the results of the ELIANA trial. Although CD19 CAR T-cell therapy may be curative in children, responses are short-lived in most adult B-ALL patients. In addition, CAR T-cell therapy can be associated with severe, potentially life-threatening, toxicities, such as cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome. Here, we review the recent advances in CAR T-cell therapy for R/R B-ALL and discuss strategies to improve its efficacy while minimizing toxicities.
Off-the-Shelf Chimeric Antigen Receptor T Cells
Authors: Watanabe Norihiro , Mamonkin Maksim
Published: March 2021

Banked chimeric antigen receptor (CAR) T cells immediately available for off-the-shelf (OTS) application can solve key limitations of patient-specific CAR T-cell products while retaining their potency. The allogeneic nature of OTS cell therapies requires additional measures to minimize graft-versus-host disease and host-versus-graft immune rejection in immunocompetent recipients. In this review, we discuss engineering and manufacturing strategies aimed at minimizing unwanted interactions between allogeneic CAR T cells and the host. Overcoming these limitations will improve safety and antitumor potency of OTS CAR T cells and facilitate their wider use in cancer therapy.
Central nervous system infections after solid organ transplantation
Authors: Kunnathu Puthanveedu Nitin das , Lum Jessica
Published: March 2021

Purpose of review

Significant advances to our understanding of several neuroinfectious complications after a solid organ transplant (SOT) have occurred in the last few years. Here, we review the central nervous system (CNS) infections that are relevant to SOT via a syndromic approach with a particular emphasis on recent updates in the field.

Recent findings

A few key studies have advanced our understanding of the epidemiology and clinical characteristics of several CNS infections in SOT recipients. Risk factors for poor prognosis and protective effects of standard posttransplant prophylactic strategies have been better elucidated. Newer diagnostic modalities which have broad clinical applications like metagenomic next-generation sequencing, as well as those that help us better understand esoteric concepts of disease pathogenesis have been studied. Finally, several studies have provided newer insights into the treatment of these diseases.

Recent findings reflect the steady progress in our understanding of CNS infections post SOT. They provide several avenues for improvement in the prevention, early recognition, and therapeutic outcomes of these diseases.
Early Pediatric Multiple Facial Fractures Treatment With Resorbable Fixation
Authors: Santos Déborah Laurindo Pereira , Miranda Marina Lins , Jacob Eduardo Santana , Guerra Raphael Capelli , Monnazzi Marcelo Silva , Vieira Eduardo Hochuli
Published: March 2021

The facial skeleton in pediatric patients can undergo several changes during development, according to their growth zones and the traumas they suffer. Thus, some of these traumas can lead to multiple complications if not treated properly. Epidemiology can vary according to the social, cultural, and environmental aspects of each individual. Therefore, each case must be treated individually, and it is important to consider age-specific aspects, such as the high osteogenic potential, which leads to faster bone healing. The use of resorbable fixation materials in facial fractures of pediatric patients is widespread, with good acceptance and great advantages over conventional titanium materials, mainly for the elimination of a second surgery to remove the materials. The present study aims to report a series of clinical cases of infants, who suffered trauma and evolved with fractures in the facial bones. Surgical treatment was instituted to reduce and fix fractures, using the resorbable system. Patients are followed up with periodic outpatient follow-up visits and have a good case evolution.
A Review of Frontal Orbital and Frontal Sinus Fractures and Associated Ocular Injuries - Level I Trauma Center - University Hospital Experience
Authors: Viezel-Mathieu Alex , Galli Rafael , Lessard Lucie
Published: March 2021

Background:

Traumatic frontal fractures result from high force injuries and can result in significant morbidity and mortality. The purpose of the current study is to evaluate our Montreal General Hospital (MGH) experience with frontal bone fractures.

Methods:

A comprehensive review of our trauma database was performed. All adult patients (>18 years) presenting with a diagnosis of frontal sinus fracture were identified. A thorough retrospective electronic medical records search was performed and relevant data extracted. Specifically, all cases of ocular injury or sequelae were identified and an in-depth review was performed.

Results:

Between 2008 and 2014, 10,189 trauma patients presented to the MUHC Level 1 trauma center. A total of 1277 patients presented with a facial fracture and 140 had a frontal sinus fracture. The mean age was 43.5 years, 90% were male and the mean hospitalization time was 16.2 days. A significant proportion of patients suffered concomitant craniomaxillofacial fractures including orbital (79%), maxillary (66%), nasal (64%), zygomaticomaxillary complex (34%), nasoorbitoethmoid (31%), Lefort types I-III (18%), and mandibular (8%). Associated cervical spine injuries were documented in 16% of patients. Ocular injuries were present in 30% of subjects. 26% of patients had some form of permanent sequelae from their trauma, mainly neurological.

Conclusions:

Due to the intimate association of the frontal bones with the brain and the orbits, frontal sinus fractures demand a sophisticated multidisciplinary craniofacial surgical approach. Given the high rate of ocular injury of 30% as well as severe systemic injuries, the authors propose a modified treatment algorithm for these complex cases.
Nodular Pseudogout of the Skull Base Arising From the Temporomandibular Joint
Authors: Morita Yuhei , Yamamoto Naoto , Uchiyama Taku
Published: March 2021

The authors report a case of a rare, large, nodular pseudogout which developed from the temporomandibular joint (TMJ).

An 83-year-old female was referred to the hospital with swelling on her left cheek. Imaging studies revealed a large calcified mass surrounding the left mandibular condyle, partially destroying the adjoining bone and extending to the skull base. Magnetic resonance imaging (MRI) revealed soft tissue masses with low signal intensity on T1- and T2-weighted images and were enhanced after intravenous gadolinium injection.

The mass was clinically and radiologically suspected to be a neoplastic lesion, such as chondrosarcoma or fibrous dysplasia. However, histological analysis showed that the mass contained granulomatous lesions with numerous multiple nodular rod-shaped and diamond-shaped crystal deposits, which validated the diagnosis of pseudogout. X-ray diffraction (XRD) was performed to identify the tumor's deposited materials and revealed that these were calcium pyrophosphate dihydrate (CPPD) crystals. This result confirmed the histopathological diagnosis of “tophaceous pseudogout.”
Change of the Inclination Angle in a Greenstick Fracture of the Mandibular Subcondyle Treated With Intermaxillary Fixation in a Child
Authors: Hwang Kun , Ma Sung Hwan
Published: March 2021

This paper presents the outcomes of a conservative approach to greenstick condylar fracture treatment in a child. Serial changes of the inclination angle were measured in a greenstick fracture of the mandibular subcondyle treated with intermaxillary fixation (IMF).

A 7-year-old girl presented with the complaint of pain on her chin. She had fallen from a 3-m height and hit her face on the floor. She had limited mouth-opening of one finger breadth. Panoramic radiography and computed tomography confirmed a green-stick (incomplete) fracture of the right condyle, in which the lateral side of the bone was fractured and the medial side was bent. The medial inclination was approximately 67.9°. On the second posttrauma day, IMF was performed using arch-bars and a prefabricated occlusal stop. Serial Town's views were taken. The inclination of the fractured condyle was measured and compared with the contralateral side. The difference in inclination angles (DI) between the fractured and contralateral sides was plotted over time. In SPSS version 19.0, an exponential regression model was constructed.

In this child, a green-stick (incomplete) fracture of the condyle (68.0° inclination) was treated with IMF and a prefabricated occlusal stop. On day 321 post-IMF, the inclination angle had decreased to 31.1°, only 6.8° greater than the contralateral side. The DI was fitted to an exponential regression model (y = 37.019e−0.006x, R2 = 0.703, P < 0.001).

This case shows that even in children, a greenstick fracture of the mandibular condyle can be treated by vertical lengthening using an occlusal stop and IMF.
A Novel Trapezoid Concept of Fibula Cutting Guide for Mandible Angle Reconstruction
Authors: Sharma Shagun , Gaba Sunil , Nair Suraj
Published: March 2021

Virtual surgical planning (VSP) has revolutionized the planning process in the reconstruction of the mandible with a free fibula flap. The traditional planning and design use a triangular osteotomy guide with a closing wedge movement at the angle. With virtual surgical planning, the authors found an additional lateral mandibular tilt angle and tried to incorporate it in our design of osteotomy guide. The authors have proposed a novel design in a trapezoid shape to accommodate the lateral tilt angle in our osteotomy design. Incorporating the two angles in one angle design improves the aesthesis of the reconstructive procedure and saves operative time.
Pediatric Craniofacial Fractures From Canine Bites
Authors: Parent Brodie , Bykowski Michael R. , Marji Fady Paul , Ramgopal Sriram , Goldstein Jesse A. , Losee Joseph E.
Published: March 2021

Craniofacial fractures from canine bites are rare, but can be devastating events that lead to complex surgical management, long-term functional deficits, and psychological sequelae. The objective of this case-control study was to identify risks associated with craniofacial fractures in pediatric dog bite victims. From 2008 to 2019 at our quaternary center, all children with craniofacial fractures from dog bites were included in this study. Controls were obtained in a 2:1 ratio via a random sample of all dog bite encounters. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Of 3602 dog bite encounters, 114 children were included in the study with an average age of 4.8 years (interquartile range = 2.4–9.1 years) and 51 patients (45%) were female. Seventy-four children (65%) were bitten by a family-owned dog. Thirty-eight patients with 60 craniofacial fractures were identified. The following factors were significantly associated with increased risk for craniofacial fractures: Caucasian race (OR 7.3, CI 1.6–16.7), age under five (OR 4.1, CI 1.6–10.7), rural location (OR 3.9, CI 1.3–12.3), child location on the floor (OR 6.2, CI 2.4–16.2), and dogs weighing over 30 pounds (OR 19.6, CI 5.8–82.3). Nine patients (12%) required multiple reconstructive operations, and four patients (5%) developed post-traumatic stress disorder. In conclusion, toddlers in rural households with large dogs are at high risk for sustaining craniofacial fractures from bite injuries. Craniofacial surgeons, pediatricians, and emergency department physicians should use these data to lead prevention efforts in the community.
Characterizing Epidemiology and Associated-Factors of Adolescent Sports-Related Traumas Using Trauma Quality Improvement Program
Authors: Bourdillon Alexandra , Salehi Parsa P. , Steren Benjamin , Pei Kevin Y. , Lee Yan Ho
Published: March 2021

Sports-related injuries contribute to a considerable proportion of pediatric and adolescent craniofacial trauma, which can have severe and longstanding consequences on physical and mental health. The growing popularity of sports within this at-risk group warrants further characterization of such injuries in order to enhance management and prevention strategies. In this study, the authors summarized key trends in 1452 sports-related injuries among individuals aged 16 to 19 using the American College of Surgeon's Trauma Quality Improvement Program database from 2014 to 2016. The authors observed a preponderance of injuries associated with skateboarding, snowboarding, and skiing, with significantly higher percentages of traumatic brain injuries among skateboarding-related traumas. Notably, we observed that traumatic brain injurie rates were slightly higher among subjects who wore helmets. Intensive care unit durations and hospital stays appeared to vary by sport and craniofacial fracture. Altogether, this study contributes to the adolescent sports-related injuries and craniofacial trauma literature.
Advances in Kidney Preservation Techniques and Their Application in Clinical Practice
Authors: Hosgood Sarah A. , Brown Rachel J. , Nicholson Michael L.
Published: March 2021

The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage in ice has been the standard kidney preservation technique for the last 50 y. Nonetheless, changing donor demographics that include organs from extended criteria donors and donation after circulatory death donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion and static cold storage techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of hypothermic machine perfusion techniques with the addition of oxygen or perfusion at subnormothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion to resuscitate abdominal organs of donation after circulatory death donors in situ before cold flushing is also increasingly being utilized. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.
Three-dimensional Vascularized β-cell Spheroid Tissue Derived From Human Induced Pluripotent Stem Cells for Subcutaneous Islet Transplantation in a Mouse Model of Type 1 Diabetes
Authors: Takaichi Shohei , Tomimaru Yoshito , Akagi Takami , Kobayashi Shogo , Fukuda Yasunari , Toya Keisuke , Asaoka Tadafumi , Iwagami Yoshifumi , Yamada Daisaku , Akita Hirofumi , Noda Takehiro , Gotoh Kunihito , Doki Yuichiro , Akashi Mitsuru , Eguchi Hidetoshi
Published: March 2021

Background.

Islet transplantation is an effective replacement therapy for type 1 diabetes (T1D) patients. However, shortage of donor organ for allograft is obstacle for further development of the treatment. Subcutaneous transplantation with stem cell-derived β-cells might overcome this, but poor vascularity in the site is burden for success in the transplantation. We investigated the effect of subcutaneous transplantation of vascularized β-cell spheroid tissue constructed 3-dimensionally using a layer-by-layer (LbL) cell-coating technique in a T1D model mouse.

Methods.

We used MIN6 cells to determine optimal conditions for the coculture of β-cell spheroids, normal human dermal fibroblasts, and human umbilical vein endothelial cells, and then, under those conditions, we constructed vascularized spheroid tissue using human induced pluripotent stem cell-derived β-cells (hiPS β cells). The function of insulin secretion of the vascularized hiPS β-cell spheroid tissue was evaluated in vitro. Furthermore, the function was investigated in T1D model NOD/SCID mice subcutaneously transplanted with the tissue.

Results.

In vitro, the vascularized hiPS β-cell spheroid tissue exhibited enhanced insulin secretion. The vascularized hiPS β-cell spheroid tissue also significantly decreased blood glucose levels in diabetic immunodeficient mice when transplanted subcutaneously. Furthermore, host mouse vessels were observed in the explanted vascularized hiPS β-cell spheroid tissue.

Conclusions.

Vascularized hiPS β-cell spheroid tissue decreased blood glucose levels in the diabetic mice. This therapeutic effect was suggested due to host angiogenesis in the graft. This method could lead to a promising regenerative treatment for T1D patients.
Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation
Authors: Elgharably Haytham , Ayyat Kamal S. , Okamoto Toshihiro , Thuita Lucy , Unai Shinya , Bribriesco Alejandro C. , Yun James J. , Johnston Douglas R. , Ahmad Usman , Murthy Sudish C. , Budev Marie M. , Pettersson Gosta B. , McCurry Kenneth R.
Published: March 2021

Background.

Lung transplantation (LTx) is a definitive treatment for end-stage lung disease. Herein, we reviewed our center experience over 3 decades to examine the evolution of recipient characteristics and contemporary predictors of survival for LTx.

Methods.

We retrospectively reviewed the data of LTx procedures performed at our institution from January 1990 to January 2019 (n = 1819). The cohort is divided into 3 eras; I: 1990–1998 (n = 152), II: 1999–2008 (n = 521), and III: 2009–2018 (n = 1146). Univariate and multivariate analyses of survival in era III were performed.

Results.

Pulmonary fibrosis has become the leading indication for LTx (13% in era I, 57% in era III). Median recipient age increased (era I: 46 y–era III: 61 y) as well as intraoperative mechanical circulatory support (era I: 0%–era III: 6%). Higher lung allocation score was associated with primary graft dysfunction (P < 0.0001), postoperative extracorporeal mechanical support (P < 0.0001), and in-hospital mortality (P = 0.002). In era III, hypoalbuminemia, thrombocytopenia, and high primary graft dysfunction grade were multivariate predictors of early mortality. The 5-y survival in eras II (55%) and III (55%) were superior to era I (40%, P < 0.001). Risk factors for late mortality in era III included recipient age, chronic allograft dysfunction, renal dysfunction, high model for end-stage liver disease score, and single LTx.

Conclusions.

In this longitudinal single-center study, recipient characteristics have evolved to include sicker patients with greater complexity of procedures and risk for postoperative complications but without significant impact on hospital mortality or long-term survival. With advancing surgical techniques and perioperative management, there is room for further progress in the field.
Preemptive Kidney Transplantation Is Associated With Transplantation Outcomes in Children: Results From the French Kidney Replacement Therapy Registry
Authors: Prezelin-Reydit Mathilde , Madden Iona , Macher Marie-Alice , Salomon Rémi , Sellier-Leclerc Anne-Laure , Roussey Gwenaelle , Lahoche Annie , Garaix Florentine , Decramer Stéphane , Ulinski Tim , Fila Marc , Dunand Olivier , Merieau Elodie , Pongas Marios , Zaloszyc Ariane , Baudouin Véronique , Bérard Etienne , Couchoud Cécile , Leffondré Karen , Harambat Jérôme
Published: March 2021

Background.

Kidney transplantation (KT) is the optimal treatment for children with end-stage kidney disease. The aim of this study was to evaluate the impact of preemptive kidney transplantation (PKT) and of pretransplant dialysis duration on graft survival among French pediatric kidney transplant recipients.

Methods.

We analyzed all first pediatric kidney-only transplantations performed in France between 1993 and 2012. A Cox multivariable model was used to investigate the association of PKT and pretransplant dialysis time with the hazard of graft failure defined as death, return to dialysis, or retransplant, whichever occurred first.

Results.

Patients (n = 1911) were included, of which 380 (19.8%) received a PKT. Median time of follow-up was 7.0 y. PKT was associated with a 55% reduction of the hazard of graft failure at any time after KT compared with patients transplanted after dialysis (hazard ratio, 0.45; 95% confidence interval, 0.33-0.62), after adjustment for recipient sex and age, primary kidney disease, donor age and type (living or deceased donor), number of HLA mismatches, cold ischemia time, and year of transplantation. A reduction of the hazard of graft failure was found in PKT whatever the compared duration of dialysis, even when <6 mo and whatever the dialysis modality. Results were similar in multiple sensitivity analyses.

Conclusions.

In France, PKT among pediatric patients is associated with a better graft survival when compared with KT after dialysis, even when <6 mo. Based on these findings, we suggest that PKT should be considered as the treatment of choice for children with end-stage kidney disease.
Renal Cell Carcinoma and Kidney Transplantation: A Narrative Review
Authors: Dahle Dag Olav , Skauby Morten , Langberg Carl Wilhelm , Brabrand Knut , Wessel Nicolai , Midtvedt Karsten
Published: March 2021

Kidney transplant recipients (KTRs) are at increased risk of developing renal cell carcinoma (RCC). The cancer can be encountered at different steps in the transplant process. RCC found during work-up of a transplant candidate needs treatment and to limit the risk of recurrence usually a mandatory observation period before transplantation is recommended. An observation period may be omitted for candidates with incidentally discovered and excised small RCCs (<3 cm). Likewise, RCC in the donor organ may not always preclude usage if tumor is small (<2 to 4 cm) and removed with clear margins before transplantation. After transplantation, 90% of RCCs are detected in the native kidneys, particularly if acquired cystic kidney disease has developed during prolonged dialysis. Screening for RCC after transplantation has not been found cost-effective. Treatment of RCC in KTRs poses challenges with adjustments of immunosuppression and oncologic treatments. For localized RCC, excision or nephrectomy is often curative. For metastatic RCC, recent landmark trials in the nontransplanted population demonstrate that immunotherapy combinations improve survival. Dedicated trials in KTRs are lacking. Case series on immune checkpoint inhibitors in solid organ recipients with a range of cancer types indicate partial or complete tumor response in approximately one-third of the patients at the cost of rejection developing in ~40%.
Updates on management of headache in women and transgender women
Authors: Ailani Jessica
Published: March 2021

Purpose of review

Gender differences exist in headache disorders. A greater understanding of the role of hormones in headache can help the clinician better approach and manage common primary headache disorders.

Recent findings

Recent studies highlight differences in how migraine and cluster headache present in women and men. Updates to the ongoing debate of how to manage the use of hormones in women with migraine, especially with aura, have been well reviewed in the last 18 months. A new meta-analysis evaluates gender differences in response to triptans.

This review will focus on recent updates on the role of gender and hormones on migraine and cluster headache and how this may influence treatment.
Substance use, mental disorders and COVID-19: a volatile mix
Authors: Marel Christina , Mills Katherine L. , Teesson Maree
Published: March 2021

Purpose of review

The COVID-19 pandemic and associated restrictions have uniquely and disproportionately affected vulnerable populations. This review summarizes recent evidence on the relationship between psychiatric disorders, substance use disorders and COVID-19, highlighting acute and long-term risks, pharmacotherapy interactions and implications regarding appropriate and timely evidence-based treatment.

Recent findings

Evidence points to a complex relationship between psychiatric and substance use disorders and COVID-19. A range of risk factors associated with psychiatric and substance use disorders increases the risk of exposure to, and complications arising from, the COVID-19 virus. COVID-19 infection has been indicated as having acute and potential long-term impacts on both psychiatric and substance use disorders. Social disruption associated with restrictions imposed to curb transmission has also been identified as a risk factor for new onset of disorders and recurrence and exacerbation of existing conditions.

Early recognition and intervention are key to preventing chronic disability associated with psychiatric disorders, substance use disorders, and their co-occurrence. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. The pandemic has fast tracked the opportunity for widespread implementation of digital health interventions but ensuring these are accessible and available to all, including our most vulnerable, will be a critical task for our future health and social ecosystems.
Neurological manifestations of patients with mild-to-moderate COVID-19 attending a public hospital in Lima, Peru
Authors: Carcamo Garcia Marco H. , Garcia Choza Diego D. , Salazar Linares Brenda J. , Diaz Monica M.
Published: March 2021

Objective

To determine the prevalence and characteristics of the most common neurological manifestations in Peruvian patients with mild-to-moderate COVID-19.

Methods

We conducted a single-center prospective, cross-sectional study at an isolation center functioning as a public acute-care hospital during the COVID-19 pandemic in Lima, the capital city of Peru. This was a convenience sample of patients with acute COVID-19 infection and mild-to-moderate respiratory symptoms who presented for hospital admission between September 25 and November 25, 2020. We interviewed participants and collected demographic, medical history and clinical presentation data; all participants underwent a complete physical and neurological examination. Descriptive statistics and prevalence ratios (PR) with corresponding 95% confidence intervals and p-values were calculated to explore between-groups differences.

Results

Of 199 patients with mild-to-moderate COVID-19 enrolled in this study, 83% presented with at least one neurological symptom (mean symptom duration 8 +/-6 days). The most common neurological symptoms were headache (72%), hypogeusia or ageusia (41%), hyposmia or anosmia (40%) and dizziness (34%). Only 2.5% of the cohort had an abnormal neurological examination. The majority (42%) had no prior comorbidities. Presence of at least 1 neurological symptom was independently associated with fever, dyspnea, cough, poor appetite, sore throat, chest tightness or diarrhea, but not with comorbid conditions.

Conclusions

This cross-sectional study found that headaches, and smell and taste dysfunction are common among patients presenting with mild-to-moderate acute COVID-19 in Lima, Peru. International longitudinal studies are needed to determine the long-term neurological sequelae of COVID-19 during the acute and post-infectious period.
Predicting clinical outcomes in the Machine Learning era: The Piacenza score a purely data driven approach for mortality prediction in COVID-19 Pneumonia
Authors: Halasz Geza , Sperti Michela , Villani Matteo , Michelucci Umberto , Agostoni Piergiuseppe , Biagi Andrea , Rossi Luca , Botti Andrea , Mari Chiara , Maccarini Marco , Pura Filippo , Roveda Loris , Nardecchia Alessia , Mottola Emanuele , Nolli Massimo , Salvioni Elisabetta , Mapelli Massimo , Deriu Marco Agostino , Piga Dario , Piepoli Massimo
Published: March 2021

Background

Several models have been developed to predict mortality in patients with COVID-19 pneumonia, but only few have demonstrated enough discriminatory capacity. Machine-learning(ML) algorithms represent a novel approach for data-driven prediction of clinical outcomes with advantages over statistical modelling. We developed the Piacenza score, a ML-based score, to predict 30-day mortality in patients with COVID-19 pneumonia.

Methods

852 patients (mean age 70years, 70%males) were enrolled from February to November 2020. The dataset was randomly splitted into derivation and test. The Piacenza score was obtained through the Naïve Bayes classifier and externally validated on 86 patients. Using a forward-search algorithm the following six features were identified: age; mean corpuscular haemoglobin concentration; PaO2 /FiO2 ratio; temperature; previous stroke; gender. In case one or more of the features are not available for a patient, the model can be re-trained using only the provided features.

We also compared the Piacenza score with the 4C score and with a Naïve Bayes algorithm with 14 variables chosen a-priori.

Results

The Piacenza score showed an AUC of 0.78(95% CI 0.74-0.84, Brier-score 0.19) in the internal validation cohort and 0.79(95% CI 0.68-0.89, Brier-score 0.16) in the external validation cohort showing a comparable accuracy respect to the 4C score and to the Naïve Bayes model with a-priori chosen features, which achieved an AUC of 0.78(95% CI 0.73-0.83, Brier-score 0.26) and 0.80(95% CI 0.75-0.86, Brier-score 0.17) respectively.

Conclusion

A personalized ML-based score with a purely data driven features selection is feasible and effective to predict mortality in patients with COVID-19 pneumonia.