bluuebunny/crossref_metadata_2025 huggingface dataset:
Incremental Value of 18F-PSMA-1007 PET/CT in Detection of Metastatic Renal Cell Carcinoma to the Brain
Authors: Sadeq Alyaa , Usmani Sharjeel , Esmail Abdulredha A. , Fathallah Wael , Alfeeli Mahmoud A. , Marafi Fahad
Published: April 2022

18F-PSMA PET/CT is an emerging standard of care in staging prostate cancer, evaluating biochemical recurrence and response to therapy. Despite the nomenclature, PSMA expression is also documented at the tumor-associated neovasculature of other malignant solid tumors including renal cell carcinoma. We report a case of 44-year-old man known to have renal cell carcinoma who underwent 18F-PSMA and 18F-FDG PET/CT for restaging after radical nephrectomy. A well-defined solitary cerebellar lesion with marked PSMA expression and equivocal FDG uptake was noted. MRI brain confirmed a matching cerebellar metastatic lesion. 18F-PSMA expression in the metastatic RCC raises a prospective guide to futuristic theragnostic uses.
First-in-Human Experience With 177Lu-DOTAGA.(SA.FAPi)2 Therapy in an Uncommon Case of Aggressive Medullary Thyroid Carcinoma Clinically Mimicking as Anaplastic Thyroid Cancer
Authors: Ballal Sanjana , Yadav Madhav Prasad , Moon Euy Sung , Rösch Frank , ArunRaj Sreedharan Thankarajan , Agarwal Shipra , Tripathi Madhavi , Sahoo Ranjit Kumar , Bal Chandrasekhar
Published: April 2022

A 56-year-old man was diagnosed with calcitonin negative, plasma chromogranin A–positive, immunohistochemistry-negative, high-grade MTC (medullary thyroid cancer) behaving clinically like anaplastic thyroid cancer and presented with progressive disease after conventional therapies. A theranostic approach of 68Ga-DOTA.SA.FAPi–guided 177Lu-DOTAGA.(SA.FAPi)2 radionuclide therapy was administered on compassionate grounds as per the Declaration of Helsinki because known standard lines of treatment were ineffective. Treatment with a single cycle of 1.65 GBq 177Lu-DOTAGA.(SA.FAPi)2 demonstrated a sustainable reduction in the neck mass with significant improvement in the quality of life of the patient. 177Lu-DOTAGA.(SA.FAPi)2 is a potential theranostic option for high-grade MTC refractory to standard therapeutic options.
FDG PET/CT in a Patient With Syphilis Suspected of Having Penile Cancer
Authors: Jakobsen Jakob Kristian , Szumniak Joanna , Stilling Christina , Fledelius Joan , Bouchelouche Kirsten
Published: April 2022

A 58-year-old man with large penile wound and enlarged regional lymph node was suspected of having disseminated penile cancer. FDG PET/CT for primary staging showed high FDG uptake on penis and in several enlarged lymph nodes. However, biopsies revealed no signs of malignancy, but ulceration, inflammation, fibrosis, and spirochetes. Furthermore, Wassermann test was positive. The patient was then treated for syphilis. To our knowledge, this is the first report on FDG PET/CT in a patient suspected of having penile cancer that turned out to be syphilis. Thus, syphilis can be added to the list of benign pitfalls in FDG PET/CT.
Comparison of 18F-FDG and 68Ga-FAPI PET/CT in Gastric Kaposi Sarcoma
Authors: Tatar Gamze , Beyhan Ediz , Erol Fenercioğlu Özge , Arslan Esra , Çermik Tevfik Fikret
Published: April 2022

Herein, we present the results of 18F-FDG PET/CT and 68Ga-FAPI-4 PET/CT of a patient with metastatic Kaposi sarcoma. A 47-year-old man with suspected gastric cancer was referred to 18F-FDG PET/CT for diagnosis and staging. PET/CT detected increased 18F-FDG uptake in metastatic lymphadenopathies and liver lesions. 68Ga-FAPI-4 PET/CT was performed for ongoing clinical trial. Although 68Ga-FAPI-4 PET/CT may be a better alternative than 18F-FDG for the imaging of primary tumoral infiltrations in the stomach, 18F-FDG seems to be a more useful agent for the Kaposi sarcoma in determining the extent of the disease and the localization of metastatic lesions.
FDG PET/CT in Metastatic Spindle Cell Sarcoma of Penile Origin
Authors: Kale Shubham Anil , Agrawal Archi , Menon Santosh , Joshi Amit , Murthy Vedang , Bakshi Ganesh , Prakash Gagan , Purandare Nilendu , Shah Sneha , Puranik Ameya , Rangarajan Venkatesh
Published: April 2022

Spindle cell sarcoma is a connective tissue tumor usually involving bone or muscle. Penis is an unusual and very rare site for the primary involvement of the tumor, especially mesenchymal tumor. We here present a case of a 27-year-old man diagnosed with spindle cell sarcoma of penile origin in which FDG PET/CT was done as part of workup.
Vaccine-Related Lymph Nodes
Authors: Ah-Thiane Loic , Ferrer Ludovic , Maucherat Bruno , Fleury Vincent , Le Thiec Maelle , Rusu Daniela , Rousseau Caroline
Published: April 2022

Purpose

Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18F-FDG PET/CT.

We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18F-FDG.

Patients and Methods

Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs.

Results

Of the 226 patients in our cohort study, 120 patients underwent an 18F-fluorocholine PET/CT, 79 a 68Ga-PSMA-11 PET/CT, 6 an 18F-FDOPA PET/CT, and 21 a 68Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18F-fluorocholine and 12.7% (10/79 patients) with 68Ga-PSMA-11. None of our patients undergoing 18F-FDOPA or 68Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical (P < 10−4), with the number of vaccine doses received (P = 0.041), with a short delay between vaccination and PET/CT realization (P < 10−5), and with a higher prostate-specific antigen level for patients with PCa (P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area.

Conclusions

Detecting positive LNs after COVID-19 vaccination is not an exclusive 18F-FDG PET/CT pattern but is common on 18F-fluorocholine and possible on 68Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18F-FDOPA or 68Ga-DOTATOC PET/CT, this seems to have a lesser impact.
Double Trap Escape
Authors: Wang Sisi , Huang Qifeng , Dong Ke , Qin Chunxia , Wen Guanghua
Published: April 2022

A 55-year-old man was diagnosed with gastric adenocarcinoma. 18F-FDG PET/CT was performed, which detected an enlarged nodule with increased uptake located in the omentum between the transverse colon and liver, thus lymph node metastasis was under suspicion. The patient subsequently underwent 68Ga-FAPI PET/MRI clinical trial after signing the informed consent, which also revealed the abnormal focus with intense uptake. However, the histopathology of the nodule was unexpectedly diagnosed as fibrous hyperplasia after lymphadenectomy.
68Ga-PSMA Uptake in Brain Metastasis of Gastric Carcinoma
Authors: Kesim Selin , Oksuzoglu Kevser
Published: April 2022

A 69-year-old man with a known history of gastric and prostate adenocarcinoma was referred to 68Ga–prostate-specific membrane antigen (PSMA) PET/CT for restaging due to biochemical recurrence of prostate cancer. 68Ga-PSMA PET/CT revealed tracer accumulation in the primary prostatic lesion, lymph node, bone metastases, and brain lesion, which was later confirmed on biopsy to be metastasis of gastric carcinoma. This case reminds us of the variable spectrum of 68Ga-PSMA uptake in prostatic and nonprostatic metastatic lesions, the potential pitfalls on PET/CT images in the workup of patients with concomitant malignancies.
A Challenge for Emphysema Quantification Using a Deep Learning Algorithm With Low-dose Chest Computed Tomography
Authors: Choi Hyewon , Kim Hyungjin , Jin Kwang Nam , Jeong Yeon Joo , Chae Kum Ju , Lee Kyung Hee , Yong Hwan Seok , Gil Bomi , Lee Hye-Jeong , Lee Ki Yeol , Jeon Kyung Nyeo , Yi Jaeyoun , Seo Sola , Ahn Chulkyun , Lee Joonhyung , Oh Kyuhyup , Goo Jin Mo
Published: April 2022

Purpose:

We aimed to identify clinically relevant deep learning algorithms for emphysema quantification using low-dose chest computed tomography (LDCT) through an invitation-based competition.

Materials and Methods:

The Korean Society of Imaging Informatics in Medicine (KSIIM) organized a challenge for emphysema quantification between November 24, 2020 and January 26, 2021. Seven invited research teams participated in this challenge. In total, 558 pairs of computed tomography (CT) scans (468 pairs for the training set, and 90 pairs for the test set) from 9 hospitals were collected retrospectively or prospectively. CT acquisition followed the hospitals’ protocols to reflect the real-world clinical setting. Using the training set, each team developed an algorithm that generated converted LDCT by changing the pixel values of LDCT to simulate those of standard-dose CT (SDCT). The agreement between SDCT and LDCT was evaluated using the intraclass correlation coefficient (ICC; 2-way random effects, absolute agreement, and single rater) for the percentage of low-attenuated area below −950 HU (LAA−950 HU), κ value for emphysema categorization (LAA−950 HU, <5%, 5% to 10%, and ≥10%) and cosine similarity of LAA−950 HU.

Results:

The mean LAA−950 HU of the test set was 14.2%±10.5% for SDCT, 25.4%±10.2% for unconverted LDCT, and 12.9%±10.4%, 11.7%±10.8%, and 12.4%±10.5% for converted LDCT (top 3 teams). The agreement between the SDCT and converted LDCT of the first-place team was 0.94 (95% confidence interval: 0.90, 0.97) for ICC, 0.71 (95% confidence interval: 0.58, 0.84) for categorical agreement, and 0.97 (interquartile range: 0.94 to 0.99) for cosine similarity.

Conclusions:

Emphysema quantification with LDCT was feasible through deep learning-based CT conversion strategies.
Atrial Impairment as a Marker in Discriminating Between Takotsubo and Acute Myocarditis Using Cardiac Magnetic Resonance
Authors: Cau Riccardo , Loewe Christian , Cherchi Valeria , Porcu Michele , Ciet Pierluigi , Suri Jasjit S. , Saba Luca
Published: April 2022

Purpose:

The purpose of this study was to comprehensively compare the left and right atrium strain and strain rate (SR) parameters by cardiac magnetic resonance (CMR) between patients with Takotsubo (TS) and patients with acute myocarditis (AM).

Materials and Methods:

We retrospectively enrolled 3 groups of patients: TS (n=18), AM (n=14), and 11 healthy subjects. All the patients had complete CMR data for features tracking assessment.

Differences in reservoir, conduit strain (εe), conduit strain rate (SRe), and booster phase of biatrial strain were analyzed between the groups using analysis of variance and multivariate analysis of covariance analyses. Intraobserver and interobserver reproducibility was assessed for all strain and SR parameters using intraclass correlation coefficients and Bland-Altman analysis.

Results:

Atrial strain was feasible in all patients and controls. In TS, left atrium (LA) reservoir strain (εs), reservoir SR, εe, and SRe were significantly lower compared with the other groups (P=0,001 for all). multivariate analysis of covariance analysis showed association of these parameters after correction for age and sex, while LA booster deformation (εa and SRa) strain parameters were preserved. LA SRe proved to have excellent sensitivity in differentiating patients with TS from those with AM (areas under the curves of 0.903, 95% confidence interval: 0.81-0.99).

Biatrial strain and SR parameters showed good (excellent) intraobserver and interobserver reproducibility (ranged between 0.61 to 0.96 and 0.50 to 0.90, respectively).

Conclusion:

Compared with AM, patients with TS showed significantly decreased LA reservoir, conduit strain, and SR parameters. Therefore, LA strain assessment may have a role in discriminating between TS and AM.
The “Sickness” Memory
Authors: El Haj Mohamad , Allain Philippe , Antoine Pascal , Chapelet Guillaume , Kapogiannis Dimitrios , Boutoleau-Bretonnière Claire , Gallouj Karim
Published: April 2022

Background:

Diagnosis of Alzheimer disease (AD) can cause substantial psychological distress in patients. We thus assessed how patients with AD remember the announcement of diagnosis.

Methods:

We recruited 47 participants with mild AD (26 women; M age=68.89 y, SD=7.37; M years of formal education=9.74, SD=3.00). We invited the participants to remember the moment when their clinicians announced their diagnosis, within 6 months of the event, as well as a control memory, over the same period. We analyzed memory retrieval regarding specificity, as well as the subjective experience of retrieval (ie, regarding mental time travel, visual imagery, emotion and importance).

Results:

No significant differences were observed between memory of diagnosis and control memory regarding specificity, mental time travel and visual imagery. However, memory of diagnosis triggered a more intense emotional experience and feeling of importance than control memory.

Discussion:

Retrieval of the diagnosis announcement can activate a strong emotional and personally important experience in patients with AD. When remembering the diagnosis announcement, patients with AD may re-experience some features of that turning point in which they shift from “person” to “patient.”
Swimming exercise reverses chronic unpredictable mild stress–induced depression-like behaviors and alleviates neuroinflammation and collapsing response mediator protein-2–mediated neuroplasticity injury in adult male mice
Authors: Xie Yumeng , Wu Zuotian , Sun Limin , Zhou Lin , Xiao Ling , Wang Huiling , Wang Gaohua
Published: April 2022

Objective

Impaired neuroplasticity and neuroinflammation are vital in the mechanisms of depression. Exercise alleviates depressive symptoms and ameliorates body functions. Swimming is one of the most common exercises; however, whether swimming alters depressive behaviors and the underlying mechanism has not been fully elucidated.

Methods

Male C57/BL6J mice were exposed to chronic unpredictable mild stress (CUMS) for 6 weeks and then were subjected to a 5-week swimming program. Behavioral test, including sucrose preference test (SPT), open field test (OFT), elevated plus-maze (EPM) test, and tail suspension test (TST), was conducted to assess the anxiety-like and depressive behaviors. Western blotting and immunofluorescence staining were carried out after tissue collection.

Results

This study showed that CUMS-induced depressive behaviors but swimming exercise increased sucrose preference in SPT, increased time and velocity in the center on OFT, decreased time in the closed arm, increased time in the open arm in EPM, and decreased immobility time in TST. We further found swimming exercise increased hippocampal collapsing response mediator protein-2 (CRMP2) expression and decreased p-CRMP2 expression in CUMS mice. CUMS inhibited the levels of α-tubulin and CRMP2, and the expression of ionized calcium-binding adaptor molecule 1 and caspase-1, whereas swimming reversed them in CUMS-exercised mice.

Conclusion

Our study confirmed that swimming exercise reverses CUMS-induced depressive behaviors, and neuroinflammation and CRMP2-mediated neuroplasticity are involved, which may provide a new insight into the antidepression therapy of exercise.
Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival
Authors: Mobley Erin M , Tfirn Ian , Guerrier Christina , Gutter Michael S , Vigal Kim , Pather Keouna , Baskovich Brett , Awad Ziad T , Parker Alexander S
Published: April 2022

BACKGROUND:

This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival.

STUDY DESIGN:

We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non–early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival.

RESULTS:

In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (–2.0 ppt). Those who were insured (–0.1 ppt) or uninsured (–2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt).

CONCLUSIONS:

Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods
Authors: Eruchalu Chukwuma N , Bergmark Regan W , Smink Douglas S , Tavakkoli Ali , Nguyen Louis L , Bates David W , Cooper Zara , Ortega Gezzer
Published: April 2022

BACKGROUND:

Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic.

STUDY DESIGN:

Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality.

RESULTS:

During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22–0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12–2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use.

CONCLUSION:

Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.
Residents as Leaders: Using a Delphi Process to Conduct an Institutional Preoperative Patient Optimization Quality Improvement Initiative
Authors: Kane William J , Lynch Kevin T , Squeo Gabriella C , Haywood Nathan S , Cramer Christopher L , Chancellor William Z , Cohee Amy S , Thames Matthew R , Friel Charles M , Hedrick Traci L
Published: April 2022

BACKGROUND:

Many residency programs struggle to meet the ACGME requirement for resident participation in quality improvement initiatives.

STUDY DESIGN:

As part of an institutional quality improvement effort, trainees from the Departments of Surgery and Anesthesiology at a single academic medical center were teamed with institutional content experts in 7 key risk factor areas within preoperative patient optimization. A systematic review of each subject matter area was performed using the MEDLINE database. Institutional recommendations for the screening and management of each risk factor were developed and approved using modified Delphi consensus methodology. Upon project completion, an electronic survey was administered to all individuals who participated in the process to assess the perceived value of participation.

RESULTS:

Fifty-one perioperative stakeholders participated in recommendation development: 26 trainees and 25 content experts. Residents led 6 out of 7 groups specific to a subject area within preoperative optimization. A total of 4,649 abstracts were identified, of which 456 full-text articles were selected for inclusion in recommendation development. Seventeen out of 26 (65.4%) trainees completed the survey. The vast majority of trainees reported increased understanding of their preoperative optimization subject area (15/17 [88.2%]) as well as the Delphi consensus method (14/17 [82.4%]) after participation in the project. Fourteen out of 17 (82.4%) trainees stated that they would participate in a similar quality improvement initiative again.

CONCLUSIONS:

We demonstrate a novel way to involve trainees in an institutional quality initiative that served to educate trainees in quality improvement, the systematic review process, Delphi methodology, and preoperative optimization. This study provides a framework that other residency programs can use to engage residents in institutional quality improvement efforts.
Investigation into the Cost-Effectiveness of Extended Posttraumatic Thromboprophylaxis
Authors: Nicholson Kristina J , Rosengart Matthew R , Smith Kenneth J , Neal Matthew D , Myers Sara P
Published: April 2022

BACKGROUND:

Severely injured patients are at particularly high risk for venous thromboembolism (VTE). Although thromboprophylaxis (PPX) is employed during the inpatient period, patients may continue to be at high risk after discharge. Comparative evidence from surgical subspecialities (eg oncology) reveals benefits of postdischarge (ie extended) PPX. We hypothesized that an extended, postinjury oral thromboprophylaxis regimen would be cost-effective.

STUDY DESIGN:

A cost-utility model compared no PPX with a 30-day course of apixaban, dabigatran, enoxaparin, fondaparinux, or rivaroxaban in trauma patients. Immediate events including deep venous thrombosis, pulmonary embolus, or bleeding within 30 days of injury were modeled in a decision tree with patients entering a Markov process to account for sequelae of VTE, including postthrombotic syndrome and chronic thromboembolic pulmonary hypertension. Effectiveness was measured in quality-adjusted life years. One-way and probabilistic sensitivity analyses were performed to identify conditions under which the preferred PPX strategy changed.

RESULTS:

Rivaroxaban was the dominant strategy (ie less costly and more effective) compared with no PPX or alternative regimens, delivering 30.21 quality-adjusted life years for $404,546.38. One-way sensitivity analyses demonstrated robust preference for rivaroxaban. When examining only patients with moderate-high or high VTE Risk Assessment Profile scores, rivaroxaban remained the preferred strategy. Probabilistic sensitivity analysis demonstrated a preference for rivaroxaban in 100% of cases at a standard willingness-to-pay threshold of $100,000/quality-adjusted life year.

CONCLUSIONS:

A 30-day course of rivaroxaban is a cost-effective extended thromboprophylaxis strategy in trauma patients in this theoretical study. Prospective studies of postdischarge thromboprophylaxis to prevent postinjury VTE are warranted.
Preoperative Nutritional Optimization of the Oncology Patient: A Scoping Review
Authors: Brajcich Brian C , Stigall Kyle , Walsh Danielle S , Varghese Thomas K , Barber Annabel E , Kralovich Kurt A , Wescott Annie B , Pockaj Barbara A , Ko Clifford Y , Laronga Christine
Published: April 2022

BACKGROUND

Malnutrition is common among patients with cancer and is a known risk factor for poor postoperative outcomes; however, preoperative nutritional optimization guidelines are lacking in this high-risk population. The objective of this study was to review the evidence regarding preoperative nutritional optimization of patients undergoing general surgical operations for the treatment of cancer.

METHODS

A literature search was performed across the Ovid (MEDLINE), Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCOhost), and Web of Science (Clarivate) databases. Eligible studies included randomized clinical trials, observational studies, reviews, and meta-analyses published between 2010 and 2020. Included studies evaluated clinical outcomes after preoperative nutritional interventions among adult patients undergoing surgery for gastrointestinal cancer. Data extraction was performed using a template developed and tested by the study team.

RESULTS

A total of 5,505 publications were identified, of which 69 studies were included for data synthesis after screening and full text review. These studies evaluated preoperative nutritional counseling, protein-calorie supplementation, immunonutrition supplementation, and probiotic or symbiotic supplementation.

CONCLUSIONS

Preoperative nutritional counseling and immunonutrition supplementation should be considered for patients undergoing surgical treatment of gastrointestinal malignancy. For malnourished patients, protein-calorie supplementation should be considered, and for patients undergoing colorectal cancer surgery, probiotics or symbiotic supplementation should be considered.
Comparative Accuracy of ICD-9 vs ICD-10 Codes for Acute Appendicitis
Authors: Duraiswamy Swetha , Ignacio Amanda , Weinberg Janice , Sanchez Sabrina E , Flum David R , Paasche-Orlow Michael K , Kenzik Kelly M , Tseng Jennifer F , Drake Frederick Thurston
Published: April 2022

BACKGROUND

ICD codes are used to identify patients with appendicitis and to classify disease severity for reimbursement and research purposes. We sought to compare the accuracy of ICD-9 vs ICD-10 codes in classifying appendicitis as uncomplicated vs complicated (defined as perforated, necrotic, or abscess) compared with the clinical gold standard: surgeon characterization of the appendix in the operative report.

STUDY DESIGN

This is a retrospective review of operative reports and discharge ICD-9/10 codes for patients 18 years or older who underwent noninterval, nonincidental appendectomy from January 2012 to December 2019 at a tertiary referral center. Sensitivity, specificity, and positive predictive value were calculated for ICD-9/10 codes to classify appendicitis as complicated when compared with surgeon description. Chi-square testing was used to compare agreement between ICD-9/10 codes and surgeon description.

RESULTS

A total of 1,585 patients underwent appendectomy. ICD-9 codes had higher sensitivity than ICD-10 codes for complicated appendicitis (sensitivity 0.84 and 0.54, respectively) and a similar positive predictive value (0.77 and 0.76, respectively). Overall, 91% of ICD-9 codes agreed with surgical description of disease, but 84.4% of ICD-10 codes agreed with surgical description (p < 0.01). Among cases classified as complicated by the surgeon, 84% (79/94) had an accurate ICD-9 code for complicated disease, but only 53.8% (57/106) of cases had an accurate ICD-10 code (p < 0.01).

CONCLUSIONS

Compared with ICD-9 codes, ICD-10 codes were less accurate in characterizing severity of appendicitis. The ICD-10 coding schema does not provide an accurate representation of disease severity. Until this system is improved, significant caution is needed for people who rely on these data for billing, quality improvement, and research purposes.
Improving Outcomes after Allograft Nephrectomy through Use of Preoperative Angiographic Kidney Embolization
Authors: Jacobs Marie L , Stratta Robert J , Miller Michael J , Durrani Raisa , Harriman David , Kiger David , Farney Alan , Rogers Jeffrey , Orlando Giuseppe , Jay Colleen L
Published: April 2022

BACKGROUND:

Allograft nephrectomy (AN) has been associated with considerable perioperative morbidity. We aimed to determine if preoperative angiographic kidney embolization (PAKE) to induce graft thrombosis before AN improves outcomes.

STUDY DESIGN:

We reviewed adult kidney transplant alone patients who underwent AN at a single center from 2002 to 2020 and compared perioperative outcomes for patients with and without PAKE.

RESULTS:

Eighty patients underwent AN, including 54 (67.5%) with PAKE before AN and 26 (32.5%) with AN alone. PAKE was associated with significantly reduced blood loss (PAKE: mean 266 ± 292 mL vs AN alone: 495 ± 689 mL; p = 0.04) and reduced transfusion requirements (PAKE: mean 0.5 ± 0.8 packed red blood cell units vs AN alone: 1.6 ± 2.6 units; p = 0.004) despite similar preoperative hemoglobin levels. Mean operating time (PAKE: 142 ± 43 minutes vs AN alone: 202 ± 111 minutes; p = 0.001) and length of hospital stay (PAKE: 4.3 ± 2.0 days vs AN alone: 9.3 ± 9.4 days; p = 0.0003) also favored PAKE, as did the surgical complication rate (PAKE: 6/54 [11%] vs AN alone: 9/26 [35%], p = 0.02). Long-term patient survival after AN was comparable in both groups.

CONCLUSIONS:

PAKE was associated with lower intraoperative blood loss, fewer transfusions, reduced operating time, shorter length of stay, and fewer surgical complications compared with AN alone at our center.
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Management of Colorectal Cancer with Peritoneal Dissemination: 30 Years of Experience at a Single Institution
Authors: Lundy Megan E , Moaven Omeed , Perry Kathleen C , Mangieri Christopher W , Valenzuela Cristian D , Russell Gregory B , Bordelon Rachel , Shen Perry , Votanopoulos Konstantinos I , Levine Edward A
Published: April 2022

BACKGROUND:

Cytoreductive surgery (CRS) is at the forefront of treatment for colorectal cancer with peritoneal metastasis or “carcinomatosis” (CRC-PC). We report outcomes of the operative management of CRC-PC at a single center.

STUDY DESIGN:

We retrospectively reviewed our database from 1992 through 2021. The Kaplan-Meier method was used to estimate survival. Proportional hazards regression and multivariable models were used for assessments.

RESULTS:

This study included 345 patients with mean age 53.5 years. Multivariate analysis revealed performance and resection status were associated with overall survival (OS; p < 0.001). Within the R0/R1 group, adverse impact on OS was found with increasing Peritoneal Cancer Index (PCI) score starting at 9 (hazard ratio [HR] = 1.98, CI 1.39–2.82, p = 0.0001) with the most significant hazard noted at PCI >14 (HR = 2.35, CI 1.52–3.63, p = 0.0001). Incomplete resection (R2) had significantly worse OS compared with complete CRS 33.4 (n = 206) vs R2: 12.7 months (n = 139; p < 0.0001. When stratified by PCI for the R0/R1 group, median OS for PCI less than 10, 10 to 15, and greater than 15 was 38.2, 19.7, and 22.2 m, respectively (p = 0.0007 comparing PCI less than 10 and greater than 15). Ten-year increments—1991 through 2000, 2001 through 2010, 2011 through 2020—revealed improvement in median OS (13.4 [n = 66], 19.3 [n = 139], and 29.1 months [n = 140]). However, by resection status, median OS remained stable for R0/R1 (32.3 [n = 23], 31.1 [n = 76], and 34.1 months [n = 107]) and improved for R2 (5.2 [n = 43], 14.4 [n = 63], and 14.6 months [n = 33]). Clavien-Dindo complication rate (greater than or equal to grade III) was 29.4%.

CONCLUSION:

CRS improves outcomes for CRC-PC compared with historic outcomes with nonoperative management. This benefit is greatest with complete resection and lower disease burden. Results of CRS (with or without heated intraperitoneal chemotherapy) are improving, and surgery for CRC-PC should be routinely considered.
Early Assessment of National Kidney Allocation Policy Change
Authors: Rohan Vinayak S , Pilch Nicole , McGillicuddy John , White Jared , Lin Angello , Dubay Derek , Taber David J , Baliga Prabhakar K
Published: April 2022

BACKGROUND:

The new kidney allocation changes with elimination of donor service areas (DSAs) and Organ Procurement and Transplantation Network regions were initiated to improve equity in organ allocation. The aim of this evaluation was to determine the operational, financial, and recipient-related effect of the new allocation system on a large rural transplantation program.

STUDY DESIGN:

A retrospective, cross-sectional analysis of organ offers, allograft outcomes, and attributed costs in a comparative time cohort, before (December 16, 2020 to March 14, 2021) and after (March 15, 2021 to June 13, 2021) the allocation change was performed. Outcomes were limited to adult, solitary, deceased donor kidney transplantations.

RESULTS:

We received 198,881 organ offers from 3,886 organ donors at our transplantation center from December 16, 2020 to June 31, 2021: 87,643 (1,792 organ donors) before the change and 111,238 (2094 organ donors) after the change, for a difference of +23,595 more offers (+302 organ donors). This resulted in 6.5 more organs transplanted vs a predicted loss of 4.9 per month. Local organ offers dropped from 70% to 23%. There was a statistically significantly increase in donor terminal serum creatinine (1.2 ± 0.86 mg/dL vs 2.2 ± 2.3 mg/dL, p < 0.001), kidney donor profile index (KDPI) (39 ± 20 vs 48 ± 22, p = 0.017), cold ischemia time (16 ± 7 hours vs 21 ± 6 hours, p < 0.001), and delayed graft function rates (23% vs 40%, p = 0.020).

CONCLUSION:

The new kidney allocation policy has led to an increase in KDPI of donors with longer cold ischemia time, leading to higher delayed graft function rates. This has resulted in increasing logistical and financial burdens on the system. Implementing large-scale changes in allocation based predominantly on predictive modeling needs to be intensely reassessed during a longer follow up.
Prospective Evaluation of Radar-Localized Reflector–Directed Targeted Axillary Dissection in Node-Positive Breast Cancer Patients after Neoadjuvant Systemic Therapy
Authors: Gallagher Kristalyn K , Iles Kathleen , Kuzmiak Cherie , Louie Raphael , McGuire Kandace P , Ollila David W
Published: April 2022

BACKGROUND:

This is a prospective, single-institution study to evaluate feasibility and accuracy of radar-localized reflector (RLR)–targeted axillary dissection (TAD) in node-positive breast cancer patients after neoadjuvant systemic therapy (NST).

METHODS:

Patients with biopsy-proven T1–2, N1–3 disease were eligible. Before NST, a marker clip and/or RLR was placed into the positive node. After NST, RLR was inserted if not placed previously. All patients underwent RLR TAD followed by axillary lymph node dissection (ALND). Primary end points of the trial were feasibility of RLR TAD and false negative rate (FNR).

RESULTS:

Between 2017 and 2021, 101 patients with N1–3 disease underwent NST. Five patients withdrew from the study, 1 was ineligible, and there were 9 technical failures, thus our final study cohort comprised 86 patients. RLR TAD was performed with probe guidance and confirmed with intraoperative specimen radiograph. After RLR TAD, ALND was performed. Median number of RLR TAD nodes removed was 2 (range 1–10), and the RLR TAD nodes remained positive in 56 patients. Median number of ALND nodes removed was 18 (range 4-46). Accounting for 9 technical failures, feasibility was 90%. All technical failures occurred with attempted placement of RLR after NST. Feasibility rate was 100% when RLR placement occurred at diagnosis. Of the evaluable 86 patients, RLR TAD accurately predicted axillary status in 83 patients, with FNR of 5.1%.

CONCLUSION:

We demonstrate high accuracy of RLR TAD, especially when RLR is placed before NST. For patients who present with N1–3 disease, this is another step towards axillary surgery de-escalation strategies.
Impact of Cryoablation on Pectus Excavatum Repair in Pediatric Patients
Authors: Clark Rachael A , Jacobson Jillian C , Singhal Amogh , Alder Adam C , Chung Dai H , Pandya Samir R
Published: April 2022

BACKGROUND:

Minimally invasive repair of pectus excavatum (MIRPE) involves placement of a transthoracic, retrosternal support bar under thoracoscopic guidance. Despite its minimally invasive technical approach, postoperative pain is a significant morbidity that often results in increased length of stay. Multi-modal pain control strategies have been used in the past with limited success. Recently, the use of intraoperative intercostal nerve cryoablation (CA) has been added. In the present study, we aim to evaluate the effects of CA on postoperative pain control, opioid requirements, and perioperative outcomes.

STUDY DESIGN:

A single-center, retrospective chart review of all patients (less than 18 years old) who underwent MIRPE from 2009 to 2020 was performed. CA was started in June 2018. Data collection included demographics, preoperative characteristics, intraoperative findings, and postoperative outcomes. We hypothesized that CA would be associated with improved pain scores, lower doses of total inpatient opioid requirement, and shorter length of stay (LOS).

RESULTS:

One hundred sixty-one patients met inclusion criteria: 75 underwent intraoperative CA and 86 underwent MIRPE without CA (NCA group). CA significantly decreased median LOS from 4 days in NCA to 2 days; the use of CA was the only significant predictor of LOS on linear regression. CA was also associated with decreased total PCA, intravenous opioid, and oral opioid dosages. There was no difference in inpatient pain scores and a slight increase in mean procedure time. However, CA was associated with significantly decreased postoperative complications.

CONCLUSIONS:

The use of cryoablation during MIRPE significantly decreases LOS, perioperative opioid requirements, and postoperative complications, with a minimal increase in operative time. Cryoablation is an effective pain control modality in the surgical management of chest wall deformities in children.
Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis
Authors: Zheng Hui , Lai Victoria , Lu Jana , Kang Jin K , Chou Jiling , Burman Kenneth D , Wartofsky Leonard , Rosen Jennifer E
Published: April 2022

BACKGROUND:

Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy.

STUDY DESIGN:

Multivariate logistic regressions were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution.

RESULTS:

Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors.

CONCLUSION:

Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach.
Effect of Antibiotic Duration in Emergency General Surgery Patients with Intra-Abdominal Infection Managed with Open vs Closed Abdomen
Authors: Diaz Jose J , Zielinski Martin D , Chipman Amanda M , O’Meara Lindsay , Schroeppel Thomas , Cullinane Daniel , Shoultz Thomas , Barnes Stephen L , May Addison K , Maung Adrian A ,   for the MERIDIAN Study Consortium
Published: April 2022

BACKGROUND:

Data on duration of antibiotics in patients managed with an open abdomen (OA) due to intra-abdominal infection (IAI) are scarce. We hypothesized that patients with IAI managed with OA rather than closed abdomen (CA) would have higher rates of secondary infections (SIs) independent of the duration of the antibiotic treatment.

METHODS:

This was an observational, prospective, multicenter, international study of patients with IAI requiring laparotomy for source control. Demographic and antibiotic duration values were collected. Primary outcomes were SI (surgical site, bloodstream, pneumonia, urinary tract) and mortality. Statistical analysis included ANOVA, chi-square/Fisher’s exact test, and logistic regression.

RESULTS:

Twenty-one centers contributed 752 patients. The average age was 59.6 years, 43.6% were women, and 43.9% were managed with OA. Overall mortality was 16.1%, with higher rates among OA patients (31.6% vs 4.4%, p < 0.001). OA patients had higher Sequential Organ Failure Assessment (4.7 vs 1.8, p < 0.001), American Society of Anesthesiologists Physical Status (3.6 vs 2.7, p < 0.001), and APACHE II scores (16.1 vs 9.4, p < 0.001). The mean duration of antibiotics was 6.5 days (8.0 OA vs 5.4 CA, p < 0.001). A total of 179 (23.8%) patients developed SI (33.1% OA vs 16.8% CA, p < 0.001). Longer antibiotic duration was associated with increased rates of SI: 1 to 2 days, 15.8%; 3 to 5 days, 20.4%; 6 to 14 days, 26.6%; and more than 14 days, 46.8% (p < 0.001).

CONCLUSIONS:

Patients with IAI managed with OA had higher rates of SI and increased mortality compared with CA. A prolonged duration of antibiotics was associated with increased rates of SI. Increased antibiotic duration is not associated with improved outcomes in patients with IAI and OA.
Effect of Quarantine and Reopening Measures on Pediatric Trauma Admissions During the 2019 SARS-CoV2 Virus Pandemic
Authors: Gillory Lauren , Cairo Sarah , Megison Steve , Vinson Lori , Chung Dai H , Ryan Mark L
Published: April 2022

BACKGROUND:

Several studies have reported decreased trauma admissions and increased physical abuse in children resulting from stay-at-home measures. However, these studies have focused on a limited period after the implementation of lockdown policies. The purpose of this study was to examine the effect of quarantine and reopening initiatives on admissions for varying types of injuries in pediatric patients.

STUDY DESIGN:

Registry data for an urban Level I pediatric trauma center were evaluated from April 1, 2018, to March 30, 2021. A timeline of local shutdown and reopening measures was established and used to partition the data into 6-month intervals. Data about demographics and injury characteristics were compared with similar intervals in 2018 and 2019 using appropriate statistical methodology for categorical, parametric, and nonparametric data.

RESULTS:

A total of 3,110 patients met criteria for inclusion. A total of 1,106 patients were admitted the year after the closure of schools and nonessential businesses. Decreases in overall admissions and evaluations for suspected child abuse noted early in the pandemic were not sustained during shutdown or reopening periods. However, we observed a 77% increase in all-terrain vehicle injuries, along with a 59% reduction in sports injuries (chi-square [8, N = 3,110] = 49.7; p < 0.001). Significant shifts in demographic and payor status were also noted.

CONCLUSIONS:

This is the first study to comprehensively examine the effects of quarantine and reopening policies on admission patterns for a pediatric trauma center in a metropolitan area. Total admissions and child abuse evaluations were not impacted. If shutdown measures are re-instituted, preventative efforts should be directed towards ATV use and recreational activities.
Identification of novel microcephaly-linked protein ABBA that mediates cortical progenitor cell division and corticogenesis through NEDD9-RhoA
Authors: Carabalona Aurelie , Kallo Henna , Gonzalez Maryanne , Andriichuk Liliia , Elomaa Ellinoora , Molinari Florence , Fragkou Christiana , Lappalainen Pekka , Wessels Marja W , Saarikangas Juha , Rivera Claudio
Published: April 2022

The cerebral cortex, which is responsible for higher cognitive functions, relies on the coordinated asymmetric division cycles of polarized radial glial progenitor cells for proper development. Defects in the mitotic process of neuronal stem cells have been linked to the underlying causes of microcephaly; however, the exact mechanisms involved are not fully understood. In this study, we present a new discovery regarding the role of the membrane-deforming cytoskeletal regulator protein called Abba (also known as MTSS1L/MTSS2) in cortical development. When Abba was absent in the developing brain, it led to a halt in radial glial cell proliferation, disorganized radial fibers, and abnormal migration of neuronal progenitors. During cell division, Abba localized to the cleavage furrow, where it recruited the scaffolding protein Nedd9, and positively influenced the activity of RhoA, a crucial regulator of cell division. Notably, we identified a variant of Abba (R671W) in a patient with microcephaly and intellectual disability, further highlighting its significance. The introduction of this mutant Abba protein in mice resulted in phenotypic similarities to the effects of Abba knockdown. Overall, these findings offer valuable mechanistic insights into the development of microcephaly and the cerebral cortex by identifying Abba as a novel regulator involved in ensuring the accurate progression of mitosis in neuronal progenitor cells.