bluuebunny/crossref_metadata_2025 huggingface dataset:
Acoustic- Versus Intelligibility-Based Assessment of Subjective Listening Difficulty Measured With the Repeat-Recall Test
Authors: Slugocki Christopher , Kuk Francis , Korhonen Petri
Published: October 2024

Objectives:

To contrast interpretations of listening effort ratings when judged against acoustic- versus intelligibility-based normative references.

Design:

Existing data collected from 66 normal-hearing adult listeners, comprising 2730 trials of the Repeat-Recall Test, were used to establish norms of subjective listening effort ratings for six ranges of intelligibility. Data from 21 aided hearing-impaired listeners were then used to contrast intelligibility-based norms against acoustic-based norms when interpreting listening effort ratings measured in omnidirectional and directional microphone conditions.

Results:

Whereas acoustic-based norms effectively demonstrated reduced effort for directional versus omnidirectional microphone modes, intelligibility-based references controlled for listeners’ performance biases and improved the consistency with which subjective ratings were ranked across the two microphone conditions.

Conclusions:

The choice of normative reference should be carefully considered when judging listening effort ratings from hearing-impaired individuals against those of their normal-hearing peers. Whereas acoustic-based references may be more useful for evaluating the benefits of hearing aid technology, intelligibility-based references may be better suited to identifying listeners with poor subjective experiences for speech-in-noise related to factors beyond intelligibility.
Association between different patterns of obesity and the short-term outcomes of gastric cancer surgery
Authors: Shi Guoqing , Gao Tianyu , Du Peng , Guo Jiwu , Dong Yan , Mao Jie
Published: October 2024

Previous studies have shown that general and central obesity are each linked to adverse outcomes in gastrointestinal cancers. However, their combined effect on gastrointestinal cancers surgery outcomes were less understood. This study aims to integrate both general and central obesity to examine the outcomes of gastric cancer surgery in different obesity patterns. We retrospectively analyzed 248 patients who underwent gastric cancer surgery between 2021 and 2023 in a single institute. The Inbody720 body composition analyzer measured body composition. We evaluated the relationship between obesity patterns – combining BMI with central obesity measures (waist circumference, waist-to-hip ratio, visceral fat area) – and postoperative complications and 30-day readmission. Central-only obesity were more likely to induce fistula (P = 0.025), while non-obesity was more likely to develop postoperative abdominal effusion (P = 0.049) and bleeding (P = 0.042). Central-only obesity was significantly associated with severe postoperative complications after adjustment for hypertension, diabetes, abdominal surgery history, preoperative albumin levels, age, sex, and surgical types. This remains significant even after adjusting for muscle mass. However, we did not find the same results for significant complications. Regarding 30-day readmission, there are no differences between different patterns of obesity. Central-only obesity is an independent risk factor for severe postoperative complications in gastric cancer, while a high BMI appears to be associated with a lower risk compared to non-obese patients, but not significant postoperative complications. The likelihood of readmission within 30 days post-surgery may not be related to the patient’s pattern of obesity.
Midface Projection Using Biostimulatory Poly-l-Lactic Acid Injectable Implant: A Subgroup Analysis of the Cheek Wrinkle Trial
Authors: Fabi Sabrina G. , Le Jennifer HTD. , Prygova Inna , Bråsäter Daniel
Published: October 2024

BACKGROUND

Correction of cheek wrinkles using poly-l-lactic acid (PLLA-SCA) was demonstrated in a 12-month study.

OBJECTIVE

This analysis assessed change from baseline in lifting effect of PLLA-SCA using a 3D camera to provide additional quantified data.

METHODS

Subjects received PLLA-SCA (reconstituted in 8 mL of sterile water + 1 mL of 2% lidocaine) in both cheeks or no treatment (control). Assessments included the Galderma Cheek Wrinkle Scale (GCWS), aesthetic improvement, and 3D photography. In subjects with severe GCWS at baseline, Canfield software analyzed 3D images for change from baseline in midface volume projection and volume change of both cheeks at Month 9.

RESULTS

The primary study showed a statistically significant higher at-rest GCWS responder rate at Month 12 for PLLA-SCA, 71.6%, versus control, 26.1% (p < .0001). In this Month 9 analysis, mean midface volume projection demonstrated a positive volume shift for PLLA-SCA (left: 0.45 mm; right: 0.34 mm; n = 46) versus control (left: 0.25 mm; right: −0.01 mm; n = 21). Midface volume and max projection changes for PLLA-SCA were +4.88 mL/+1.62 mm (left), +2.84 mL/+1.12 mm (right) versus +0.26 mL/+0.34 mm (left), +0.68 mL/+0.37 mm (right) for control.

CONCLUSION

Poly-l-lactic acid-treatment of subjects with severe GCWS had a clinically meaningful lifting effect in both cheeks (positive volume shift, positive volume change, and max projection) in the midface.

Clinical trial registry number

NCT04124692.
Intraneural Topography and Branching Patterns of the Common Peroneal Nerve: Studying the Feasibility of Distal Nerve Transfers
Authors: Le Elliot L.H. , Allenby Taylor H. , Fisher Marlie , Constantine Ryan S. , McNamara Colin T. , Barnhill Caleb , Engemann Anne , Merced-O’Neill Orlando , Iorio Matthew L.
Published: October 2024

Background:

Common peroneal nerve (CPN) disruption is the most common lower extremity nerve injury and results in gait disturbances and sensory paresthesias. The goal of this study is to describe branching patterns and the intraneural topography of the CPN to facilitate operative planning in CPN reconstruction.

Methods:

The CPN and its distal motor and sensory branches were dissected in 6 lower leg cadavers. Branching patterns and distances were recorded with the fibular head as the landmark. Histological review of the nerve cross sections helped characterize the intraneural topography within the fibular tunnel.

Results:

The CPN distal branching patterns were highly variable. The tibialis anterior motor branch was found on average 9.6 cm distal to the fibular head. Despite the variable branching patterns, the fascicular topography of the CPN within the fibular tunnel was consistent. Proximal to the tunnel, the nerve has 3 major fascicles, which include the superficial peroneal motor, common sensory, and deep peroneal motor (DPN) fascicles from lateral to medial. Within the tunnel, the topography consolidates into the superficial peroneal motor and DPN major divisions—motor axons anteriorly and sensory axons posteriorly.

Conclusions:

The data presented provide clinically relevant information for the peripheral nerve surgeon where fascicular reconstruction of the nerve and neurolysis should focus on the anterior half of the nerve to restore ankle dorsiflexion. The nerve proximally is divided into 3 major fascicles compared with 2 distally. Surgeons may consider distal nerve transfers from the tibial nerve motor branches to the DPN or tibialis anterior motor branch.
Modulating intestinal neuroimmune VIPergic signaling attenuates the reduction in ILC3-derived IL-22 and hepatic steatosis in MASLD
Authors: Nguyen Henry H. , Talbot Jhimmy , Li Dayi , Raghavan Varsha , Littman Dan R.
Published: October 2024

Background:

Metabolic dysfunction–associated steatotic liver disease (MASLD, formerly known as NAFLD) is a major driver of cirrhosis and liver-related mortality. However, therapeutic options for MASLD, including prevention of liver steatosis, are limited. We previously described that vasoactive intestinal peptide–producing neurons (VIP-neurons) regulate the efficiency of intestinal dietary fat absorption and IL-22 production by type 3 innate lymphoid cells (ILC3) in the intestine. Given the described hepatoprotective role of IL-22, we hypothesize that modulation of this neuroimmune circuit could potentially be an innovative approach for the control of liver steatosis.

Methods:

We used a model of diet-induced MASLD by exposing mice to a high-fat diet (HFD) for 16 weeks, when the development of liver steatosis was first observed in our animals. We characterized IL-22 production by intestinal ILC3 at this dietary endpoint. We then evaluated whether communication between VIP-neurons and ILC3 affected IL-22 production and MASLD development by exposing mice with a conditional genetic deletion of Vipr2 in ILC3 (Rorc(t)

Cre

Vipr2

fl/fl
) to the HFD. We also performed intermittent global inhibition of VIP-neurons using a chemogenetic inhibitory approach (Vip

Ires-Cre

hM4Di

LSL
) in HFD-fed mice.

Results:

Production of IL-22 by intestinal ILC3 is reduced in steatotic mice that were exposed to an HFD for 16 weeks. Targeted deletion of VIP receptor 2 in ILC3 resulted in higher production of IL-22 in ILC3 and was associated with a significant reduction in liver steatosis in mice under HFD. Global inhibition of VIP-producing neurons also resulted in a significant reduction in liver steatosis.

Conclusions:

Modulating VIPergic neuroimmune signaling can ameliorate the development of hepatic steatosis induced by a surplus of fat ingestion in the diet. This neuroimmune pathway should be further investigated as a potential therapeutic avenue in MASLD.
FAK inhibition delays liver repair after acetaminophen-induced acute liver injury by suppressing hepatocyte proliferation and macrophage recruitment
Authors: Li Qing , Xu Qi , Shi Jialin , Dong Wei , Jin Junfei , Zhang Chong
Published: October 2024

Background:

Overdose of acetaminophen (APAP), a commonly used antipyretic analgesic, can lead to severe liver injury and failure. Current treatments are only effective in the early stages of APAP-induced acute liver injury (ALI). Therefore, a detailed examination of the mechanisms involved in liver repair following APAP-induced ALI could provide valuable insights for clinical interventions.

Methods:

4D-label-free proteomics analysis was used to identify dysregulated proteins in the liver of APAP-treated mice. RNA-Seq, hematoxylin-eosin staining, immunohistochemical staining, immunofluorescence staining, quantitative PCR, western blotting, transwell were used to explore the underlying mechanisms.

Results:

Utilizing high throughput 4D-label-free proteomics analysis, we observed a notable increase in proteins related to the “focal adhesion” pathway in the livers of APAP-treated mice. Inhibiting focal adhesion kinase (FAK) activation with a specific inhibitor, 1,2,4,5-Benzenetetraamine tetrahydrochloride (also called Y15), resulted in reduced macrophage numbers, delayed necrotic cell clearance, and inhibited liver cell proliferation in the necrotic regions of APAP-treated mice. RNA-Seq analysis demonstrated that Y15 downregulated genes associated with “cell cycle” and “phagosome” pathways in the livers of APAP-treated mice. Furthermore, blocking extracellular matrix (ECM)-integrin activation with a competitive peptide inhibitor, Gly-Arg-Gly-Asp-Ser (GRGDS), suppressed FAK activation and liver cell proliferation without affecting macrophage recruitment to necrotic areas. Mechanistically, ECM-induced FAK activation upregulated growth-promoting cell cycle genes, leading to hepatocyte proliferation, while CCL2 enhanced FAK activation and subsequent macrophage recruitment via F-actin rearrangement.

Conclusions:

Overall, these findings underscore the pivotal role of FAK activation in liver repair post-APAP overdose by promoting liver cell proliferation and macrophage recruitment.
The tyrosine kinase Yes1 is a druggable host factor of HEV
Authors: Haase Jil Alexandra , Baheerathan Abarna , Zhang Xin , Fu Rebecca Menhua , Nocke Maximilian Klaus , Decker Charlotte , Dao Thi Viet Loan , Todt Daniel , Neyts Johan , Kaptein Suzanne J.F. , Steinmann Eike , Kinast Volker
Published: October 2024

Background:

HEV is a positive-sense, single-stranded RNA virus of the Hepeviridae family. Although HEV accounts for more than 3 million symptomatic cases of viral hepatitis per year, specific anti-HEV therapy and knowledge about HEV pathogenesis are scarce.

Methods:

To gain a deeper understanding of the HEV infectious cycle and guide the development of novel antiviral strategies, we here used an RNAi mini screen targeting a selection of kinases, including mitogen-activated protein kinases, receptor tyrosine kinases, and Src-family kinases. Further, we used state-of-the-art HEV infection models, including primary human hepatocytes and athymic nude rats.

Results:

Upon knockdown of the Src-family kinase Yes1, a significant reduction of HEV susceptibility could be observed, suggesting an important role of Yes1 in the HEV infectious cycle. Selective inhibition of Yes1 kinase activity resulted in significant inhibition of HEV infection in hepatoma cells and primary human hepatocytes, as well as in a rat HEV in vivo model system. Subsequent analysis of Y1KI during the HEV infectious life cycle indicated a role of Yes1 kinase activity in the early onset of HEV infection.

Conclusions:

We identified the dependence of HEV on Yes1 signaling, which may contribute to the so far scarce knowledge of HEV’s pathogenesis in the future. Moreover, we provide Y1KI as a novel antiviral drug candidate specifically targeting an HEV host factor.
Serum amyloid P (PTX2) attenuates hepatic fibrosis in mice by inhibiting the activation of fibrocytes and HSCs
Authors: Cong Min , Carvalho Gontijo Weber Raquel , Sakane Sadatsugu , Zhang Vivian , Jiang Chunyan , Taura Kojiro , Kodama Yuzo , DeMinicis Samuele , Ganguly Souradipta , Brafman David , Chien Shu , Kramer Michael , Lupher Mark , Brenner David A. , Xu Jun , Kisseleva Tatiana
Published: October 2024

Background:

Liver fibrosis is caused by chronic toxic or cholestatic liver injury. Fibrosis results from the recruitment of myeloid cells into the injured liver, the release of inflammatory and fibrogenic cytokines, and the activation of myofibroblasts, which secrete extracellular matrix, mostly collagen type I. Hepatic myofibroblasts originate from liver-resident mesenchymal cells, including HSCs and bone marrow–derived CD45+ collagen type I+ expressing fibrocytes. Recombinant human serum amyloid P (hSAP), a natural inhibitor of fibrocyte activation into myofibroblasts, was shown to ameliorate experimental renal, lung, skin, and cardiac fibrosis. We investigated if hSAP can ameliorate the development of liver fibrosis of different etiologies.

Methods:

Reporter Collagen-α(1)I-GFP mice were subjected to cholestatic liver injury (by ligation of the common bile duct) or toxic liver injury (by carbon tetrachloride administration) and treated prophylactically or therapeutically with hSAP (12.5 μg/g). Primary cultures of mouse fibrocytes and HSCs were stimulated to activate with or without incubation with hSAP.

Results:

We demonstrate that treatment with hSAP suppressed hepatic fibrosis by ≈50% through dual mechanisms. hSAP prevented the recruitment of fibrocytes into the injured liver and their differentiation into myofibroblasts. Remarkably, hSAP also inhibited the activation of HSCs into myofibroblasts.

Conclusions:

Since HSCs serve as a major source of collagen type I–producing myofibroblasts and fibrocytes stimulate fibrosis, hSAP may become part of the therapy of liver fibrosis of different etiologies.
Advancements in automated external and wearable cardiac defibrillators
Authors: Aldaas Omar M. , Birgersdotter-Green Ulrika
Published: October 2024

Purpose of review

Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is crucial for improving survival. Automated external defibrillators (AEDs) and wearable cardiac defibrillators (WCDs) seek to improve the survival rates following out-of-hospital cardiac arrests. We aim to review the indications, utility, advancements, and limitations of AEDs and WCDs, as well as their role in contemporary and future clinical practice.

Recent findings

Recent advancements in these technologies, such as smartphone applications and drone delivery of AEDs and less inappropriate shocks and decreased size of WCDs, have increased their ubiquity and efficacy. However, implementation of this technology remains limited due to lack of resources and suboptimal patient adherence.

Out of hospital cardiac arrests continue to pose a significant public health challenge. Advancements in AEDs and WCDs aim to facilitate prompt defibrillation of shockable rhythms with the goal of improving survival rates. However, they remain underutilized due to limited resources and suboptimal patient adherence. As these technologies continue to evolve to become smaller, lighter and more affordable, their utilization and accessibility are expected to improve.
The continuous erector spinae plane block can provide effective analgesia in polytrauma patients: A case report
Authors: Petrucci Emiliano , Pizzi Barbara , Ciccozzi Alessandra , Lupi Ettore , Marinangeli Franco , Piroli Alba
Published: October 2024

The choice of an effective analgesic and anesthetic technique usually poses a challenge in polytrauma patients requiring satisfactory pain control and emergency surgery. In this case report, we describe a patient under anticoagulant therapy who presented to the emergency department with multiple fractures of the thoracic and lumbar area and needed emergency splenectomy and thoracic drainage placement. The use of the bilateral continuous erector spinae plane block, a novel interfascial plane block, ensured satisfactory analgesic efficacy, without side effects and was helpful in avoiding the use of opioids.
Postoperative complication rates in intraocular lens placement and fixation methods for inadequate capsular bag support: review and meta-analysis
Authors: Kanclerz Piotr , Radomski Szymon Adam , Hecht Idan , Tuuminen Raimo
Published: October 2024

Topic:

To evaluate the complication rates of different intraocular lens (IOL) placement methods in adults with inadequate capsular bag support.

Clinical Relevance:

The surgical correction of inadequate capsular bag support for the IOL harbors several challenges, and there is a wide range of surgical procedures.

Methods:

For the purpose of this meta-analysis, surgical methods were grouped based on the location of IOL placement: (1) anterior chamber (AC) placement; (2) iris fixation, which included prepupillary or retropupillary placement of an iris-claw IOL, or iris suturing of an IOL; and (3) scleral fixation, which included scleral sutured and sutureless techniques. Only studies comparing the results of 2 or more different placement methods were analyzed. The study protocol has been registered in the PROSPERO database (CRD42023458557).

Results:

15 studies were included in the final analysis, which reported results of 1247 eyes. The overall complication rate was nonsignificantly lower in iris fixation (4.4%; 95% CI, 3.6%-5.4%, P = .150) than in AC placement (7.4%; 95% CI, 6.4%-7.9%) and scleral fixation (7.4%; 95% CI, 6.5%-8.4%). Transient corneal edema was the most common complication in AC placement (29.9%; 95% CI, 2.4%-57.5%, P < .001), compared with scleral fixation (11.9%; 95% CI, 2.6%-21.2%) and iris fixation (4.1%; 95% CI, 0.8%-7.3%). Vitreous hemorrhages were more frequently reported after scleral fixation (8.5%; 95% CI, 6.3%-11.2%, P = .006) than in AC placement (5.4%; 95% CI, 3.4%-8.5%) and iris fixation (1.4%; 95% CI, 0.4%-4.2%), and so was IOL decentration/dislocation (8.9%; 95% CI, 6.7%-11.8%, P = .047 compared with 1.1%; 95% CI, 0.4%-3.4% and 4.0%; 95% CI, 2.2%-7.3%, respectively).

Conclusions:

The risks associated with particular techniques should be taken into account in preoperative counseling and planning postoperative treatment.
Preoperative low skeletal muscle mass index assessed using L3-CT as a prognostic marker of clinical outcomes in pancreatic cancer patients undergoing surgery: a systematic review and meta-analysis
Authors: Raoul Pauline , Cintoni Marco , Coppola Alessandro , Alfieri Sergio , Tortora Giampaolo , Gasbarrini Antonio , Mele Maria Cristina , Rinninella Emanuele
Published: October 2024

Background:

Reduction in muscle mass can be routinely quantified using computed tomography (CT) of the third lumbar vertebra (L3) during a curative pancreatic cancer (PC) course. This systematic review and meta-analysis aimed to assess the association between preoperative low skeletal muscle index (SMI) measured by L3-CT and postoperative clinical outcomes in PC resectable patients.

Methods:

Three electronic databases (PubMed, Web of Science, and Scopus) were searched for articles published through May 2023. Duplicate titles and abstracts, full-text screening, and data extraction were performed. A meta-analysis was performed for overall survival (OS), recurrence-free survival (RFS), postoperative pancreatic fistula (POPF), morbidity, and postoperative length of stay (P-LOS). The risk of bias was assessed.

Results:

A total of 2942 patients with PC from 11 studies were identified. Preoperative low SMI was found in 50.9% of PC resectable patients. Preoperative low SMI was significantly associated with adjusted OS (adjusted hazard ratio, 1.52; 95% CI 1.25–1.86, P< 0.0001). No significant associations were found between preoperative low SMI and RFS, number of POPF, significant morbidity, and P-LOS (P>0.05).

Conclusions:

SMI should be evaluated in a timely manner as a predictor of OS in PC resectable patients. Studies assessing nutritional protocols for maintaining/increasing skeletal muscle mass are required to develop a personalized nutritional approach to improve clinical outcomes.
Validation of mitochondrial FMN as a predictor for early allograft dysfunction and patient survival measured during hypothermic oxygenated perfusion
Authors: Dingfelder Jule , Kollmann Dagmar , Rauter Laurin , Pereyra David , Kacar Sertac , Weijler Anna M. , Saffarian Zadeh Tina , Tortopis Chiara , Silberhumer Gerd , Salat Andreas , Soliman Thomas , Berlakovich Gabriela , Györi Georg P.
Published: October 2024

Hypothermic oxygenated machine perfusion (HOPE) preconditions liver grafts before transplantation. While beneficial effects on patient outcomes were demonstrated, biomarkers for viability assessment during HOPE are scarce and lack validation. This study aims to validate the predictive potential of perfusate flavin mononucleotide (FMN) during HOPE to enable the implementation of FMN-based assessment into clinical routine and to identify safe organ acceptance thresholds. FMN was measured in perfusate samples of 50 liver grafts at multiple time points. After transplantation, patients were followed up for development of early allograft dysfunction (EAD), transplantation, and 1-year survival. FMN concentrations were significantly higher for grafts that developed EAD at 5 and 60 minutes into HOPE (p = 0.008, p = 0.026). The strongest predictive potential of FMN for EAD was observed at 5 minutes of HOPE with an AUC of 0.744. Similarly, 5-minute FMN was predictive for 1-year mortality (p < 0.001), reaching a remarkable AUC of 0.890. Cutoffs for prediction of EAD (10.6 ng/mL) and early mortality (23.5 ng/mL) were determined and allowed risk stratification of grafts. Particularly, patients receiving low-risk grafts developed EAD in 9% of cases, while all patients survived the first postoperative year. In contrast, high-risk organs developed an incidence of EAD at 62%, accompanied by the necessity of retransplantation in 38% of cases. One-year mortality in the high-risk cohort was 62%. Evaluation of FMN as early as 5 minutes during HOPE allows for risk stratification of liver grafts. Low-risk grafts, according to FMN, display a negligible risk for patients. Yet, high-risk grafts are associated with increased risk for EAD, transplantation, and early mortality and should not be used for transplantation without further assessment.
Characterization of exclusive rib lesions detected by [68Ga]Ga-PSMA-11 PET/CT
Authors: Stoffels Marine , Cousin François , Lamande Maréva , Denis Chloé , Waltregny David , Hustinx Roland , Sautois Brieuc , Withofs Nadia
Published: October 2024

Objective

The objective of this study was to characterize exclusive costal lesions detected by 68Gallium-labelled prostate-specific membrane antigen ([68Ga]Ga-PSMA-11) PET/computed tomography (CT) at initial staging or biochemical recurrence (BCR) in prostate cancer (PCa) patients, and to identify clinical and/or PET/CT criteria associated with benign and malignant lesions.

Methods

We retrospectively identified 54 patients with PCa who underwent [68Ga]Ga-PSMA-11 PET/CT for initial staging (N = 39) or BCR (N = 15) and whose reports described rib lesions, at the exclusion of any other lesions, whether doubtful, suspicious, or established. Posttherapy prostate-specific antigen (PSA) levels were used to determine whether those lesions were benign or malignant. Each patient’s prostate-specific membrane antigen PET/CT report was classified as true positive, true negative, false positive, or false negative based on the posttherapy PSA level. We then assessed whether any clinical and/or PET/CT criteria could help differentiate benign from malignant lesions, and if any criteria were misleading.

Results

Among the 54 patients, 46 (85.2%) had 64 benign costal lesions, and eight (14.8%) had 10 malignant lesions. PET/CT reports indicated rib lesions as benign/equivocal in 38/54 (55.6%) patients and malignant in 16/54 (29.6%). Benign features on CT were the only parameter significantly associated with the final diagnosis. Factors such as patient age, maximum standardized uptake value of lesions, lesion dispersion, and malignant features described on CT were found to be misleading when deciding the malignant or benign status.

Conclusion

Most exclusive costal lesions detected by [68Ga]Ga-PSMA-11 PET/CT are benign. Apart from specific benign CT features, no clinical or PET/CT criteria reliably differentiate benign from malignant costal lesions.
Lutetium-177-prostate-specific membrane antigen therapy for prostate cancer: current status and future prospects
Authors: Wong Chris Ho-Ming , Nicoletti Rossella , Mazzone Elio , Eapen Renu S.
Published: October 2024

Purpose of review

Lutetium-177-prostate-specific membrane antigen (Lu 177-PSMA) radioligand therapy has emerged as a promising novel strategy for advanced prostate cancer. With its increasing importance alongside with a plethora of exciting results from latest trials, we would like to summarize current evidence and advancements in Lu 177-PSMA therapy across different stages of prostate cancer.

Recent findings

In metastatic castration-resistant prostate cancer (mCRPC), early studies like the LuPSMA trial and TheraP trial demonstrated promising PSA response rates. The landmark VISION trial had established the oncological efficacy of Lu 177-PSMA as salvage therapy and demonstrated its benefit on survival outcomes. Explorations into earlier treatment settings have also been encouraging. Studies like that the PSMAfore trial, Enza-P trial and the UpFrontPSMA trial explored an earlier role of Lu 177-PSMA in mCRPC, and showed benefits when used in solitary or in junction with Docetaxel or androgen receptor pathway inhibitor. Finally, the potential use of Lu 177-PSMA as neoadjuvant therapy in localized prostate cancer is also under consideration, whose safety was demonstrated in the recent LuTectomy trial.

Lu 177-PSMA therapy represents a significant advancement in prostate cancer treatment, offering selective and targeted delivery of radiation to prostate cancer cells in patients across various disease stages. Ongoing research and collaborative efforts are essential to overcome existing challenges, optimize patient selection and integrate this therapy into standard clinical practice, ultimately improving outcomes for patients with advanced prostate cancer.
Minimizing overtreatment and maximizing oncologic outcomes in upper tract urothelial carcinoma
Authors: Zahalka Ali H. , Margulis Vitaly
Published: October 2024

Purpose of review

An update on the latest advances in the management of upper tract urothelial carcinoma (UTUC), with an emphasis on strategies to optimize oncologic outcomes while minimizing overtreatment.

Recent findings

Recent high-quality trials have changed the landscape of UTUC treatment. Emerging tools including 3D histology and measurement of cell free tumor DNA may improve diagnostic accuracy of disease grading and staging, and be used in monitoring treatment response. Novel therapies show promise of reducing low-grade UTUC disease recurrence at the cost of significant side-effects. Platinum-based neoadjuvant chemotherapy in high-grade/muscle-invasive disease showed complete pathological response in a subset of patients, but difficult to predict responders. Adjuvant platinum-based chemotherapy exhibited a clear survival benefit, but immunotherapy did not, suggesting possible overtreatment with these agents. Molecularly-targeted therapies in metastatic UTUC have shown the greatest recent oncologic advances, but exhibit a high adverse event-rate.

Low-grade UTUC has the potential for overtreatment, as it exhibits low metastatic-potential and excellent survival. For high-grade and advanced-stage UTUC, these carry high mortality rates and require more aggressive treatment, but studies are limited by inaccurate grading and staging which can lead to overtreatment especially in the neoadjuvant setting. Emerging technologies will help improve diagnostic accuracy and noninvasive monitoring of treatment response.
Technology for helping people with neuromotor, intellectual, and speech disabilities engage in leisure and communication activities: a proof-of-concept study
Authors: Lancioni Giulio E. , Navarro Jorge , Mellino Antonella , Bortolozzi Elena , Singh Nirbhay N. , O’Reilly Mark F. , Sigafoos Jeff , Alberti Gloria
Published: October 2024

We extended the assessment of our recently developed technology to help people with neuromotor, intellectual, and speech disabilities access (listen to) music, communicate with distant partners, and answer questions. The technology included a tablet (1) fitted with an Internet connection, a SIM card, WhatsApp Messenger, and MacroDroid application, and (2) interfaced with different pairs of response sensors. Six participants were included in the study, which was carried out according to a nonconcurrent multiple baseline design across participants. During the baseline phase (5–8 sessions carried out over 1–2 weeks), participants were unable to access music, make video calls, or answer questions using a regular tablet. During the intervention phase (50–102 sessions carried out with the technology over 2–4 months), however, they activated means of 4.7–7.6 songs and 0.4–3.6 video calls per session. Moreover, they answered correctly a mean of 69–96% of the questions presented to them. These results suggest that our technology solution is a viable and potentially valuable resource for people with extensive disabilities.
Examination of Proprioceptive Reliance During Backward Walking in Individuals With Multiple Sclerosis
Authors: VanNostrand Michael , Monaghan Patrick G. , Fritz Nora E.
Published: October 2024

Background:

Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception’s role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers.

Methods:

Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure.

Results:

Significant correlations were seen for vibration sensation and FW comfortable (ρ = 0.35), FW fast (ρ = 0.34), BW comfortable (ρ = 0.46), and BW fast (ρ = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β = 0.57; fast β = 0.58) compared to FW (comfortable β = 0.41; fast β = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation (P = 0.04).

Discussion and Conclusions:

Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention.

Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490).
Surgical Management of 2,350 Pediatric Dermoid Cysts
Authors: Ng Jinggang J , Saikali Linda M. , Massenburg Benjamin B , Wu Meagan , Romeo Dominic J , Blum Jessica D , Swanson Jordan W , Taylor Jesse A , Kreiger Portia A , Bartlett Scott P
Published: October 2024

Background:

We examined operative and pathologic findings of a large series of dermoid cysts at a high-volume pediatric hospital over 23 years.

Methods:

A retrospective review was performed of all dermoid cysts excised from 2000 to 2023 at the Children’s Hospital of Philadelphia. Lesions were classified by location. Depth was stratified into Type 1, superficial; Type 2, subperiosteal or containing a stalk to a cranial suture; Type 3, intraosseous or intracartilaginous; Type 4, intracranial extradural; and Type 5, intracranial intradural.

Results:

Of 2,350 lesions, 2,237 (95.2%) were in the head and neck. Most common locations were lateral brow and orbit, 892 (38%); anterior neck, 303 (12.9%); and frontal, 253 (10.8%). Among the series, 67.9% were Type 1, 10.1% were Type 2, 16.5% were Type 3, 2.3% were Type 4, and 3.2% were Type 5. Older age at surgery correlated with depth among locations demonstrating intracranial extension (r=.061, p=.016). Anterior fontanelle (59.1%), nasal (16.2%), occipital (5.6%), and temporal (4.7%) lesions had the highest intracranial extension rates. Temporal (49.4%), frontal (32.8%), nasal (29.9%), and occipital (22.2%) lesions had higher rates of osseous/cartilaginous involvement. On histopathologic examination, 403 (17.1%) were ruptured. Ruptured lesions were associated with giant cell reaction (46.4 versus 5.7%, p<.001).

Conclusions:

Anterior fontanelle, nasal, occipital, and temporal lesions are at higher risk of intracranial extension and may require preoperative imaging. Frontal and parietal lesions have a lower risk of intracranial involvement. Lateral brow and orbit, periauricular, and anterior neck lesions demonstrate a higher rate of osseous involvement without intracranial tracking.
“Legislative Impact and Persistent Disparities: Post-Mastectomy Breast Reconstruction Rates in the United States Among 224,506 Patients”
Authors: Schafer Rachel E. , Ho Isabel , Potoczak Patrick S. , Misra-Hebert Anita , Nowacki Amy S. , Schwarz Graham S.
Published: October 2024

Background:

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to impact trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking.

Methods:

We analyzed National Surgical Quality Improvement Program (NSQIP) data spanning 2005-2022 to investigate the impact of ACA on racial and ethnic diversity in immediate breast reconstruction post-mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time.

Results:

In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and Black or African American individuals underwent immediate breast reconstruction at lower rates compared to White patients (P < 0.001). Additionally, Hispanic patients were less likely to undergo breast reconstruction compared to non-Hispanic patients (28.0% vs 33.4%; P < 0.001). In the post-ACA period, this trend persisted with all racial groups undergoing immediate breast reconstruction at lower rates compared to White patients (P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared to non-Hispanic patients (53.8% vs 47.9%, P < 0.001).

Conclusions:

Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.
Brief Report: Transition Preparation and Post-Transition Evaluation Practices at Adult Clinics That Care for Young Adults With Perinatally Acquired HIV in Massachusetts, United States
Authors: Tassiopoulos Katherine , John Betsey , Khadraoui Anisa , Salomon Liz , Vergara Eduardo , Fukuda H. Dawn , Siminski Suzanne M. , Van Dyke Russell , DeMaria Alfred
Published: October 2024

Background:

Most young adults with perinatal HIV (PHIV) transition from pediatric or adolescent to adult clinical care. Although guidelines to increase transition success have been recommended, we know little about uptake of these guidelines, particularly by adult care clinics.

Methods:

We administered web-based surveys to adult care providers of young adults with PHIV in Massachusetts to evaluate transition preparation and post-transition evaluation practices. We compared transition practices and HIV care continuum outcomes by clinic setting.

Results:

Twenty-four providers submitted information on 23 adult care clinics. Ten were hospital-based and 13 were community-based clinics. Community-based clinics were more likely than hospital-based clinics to conduct pre-transition (33% vs. 10%) and post-transition (67% vs. 30%) evaluation of patients' readiness to self-manage health care, and to share health outcome information with the pediatric/adolescent care team (50% vs. 20%). Community-based clinics were also more likely to have personnel dedicated to the transition process and to facilitate communication between the patient and pediatric/adolescent care team. Engagement in care was similar for young adults with PHIV seen at community-based and hospital-based clinics (88.2% vs. 85.5%; P = 1.00), but retention in care (76.5% vs. 50.5%; P = 0.05) and viral suppression (88.2% vs. 65.1%; P = 0.08) were higher in community-based than in hospital-based clinics.

Conclusions:

In Massachusetts, transition practices vary across adult clinics that care for young adults with PHIV. Recommended practices, and HIV care continuum outcomes, were more likely to be met at community-based clinics than hospital-based clinics. Community-based adult care may provide more comprehensive transition practices and serve as a model for hospital-based clinics.
Diagnostic and Therapeutic Approach to Rare Tongue Lipoma
Authors: Guo Xin-Ran , Liu Zi-Xiu , Jia Jun , Yu Zi-Li
Published: October 2024

Lipomas are benign soft tissue tumors composed of mature adipocytes, commonly found in subcutaneous tissues. Despite their prevalence in various body regions, they are relatively rare in the oral and maxillofacial regions. This study retrospectively analyzed the clinical and imaging characteristics, as well as the treatment outcomes of 57 patients diagnosed with lipoma. Among these, 42 cases (73.7%) were located in the oral-maxillofacial and head-neck regions, predominantly in areas with relatively abundant adipose tissue, including the facial/cheek area, parotid region, submental/submandibular area, and neck. In addition, this study presents a rare case of tongue lipoma in a 57-year-old male, highlighting the clinical features, diagnostic challenges, and treatment approach. The patient presented with a painless mass on the left side of the tongue that had gradually increased in size over 5 months. Physical examination revealed a firm, well-defined, moderately mobile mass measuring ~3.0×1.5 m. Imaging, including enhanced magnetic resonance imaging, suggested a diagnosis of lipoma, leading to surgical excision. The excised mass was yellowish, encapsulated, and soft. Intraoperative frozen section biopsy confirmed it as a fat-derived tumor consistent with a lipoma, and postoperative pathological examination further identified it as a spindle cell/pleomorphic lipoma. The patient experienced a smooth recovery without complications, with normal tongue function restored. This case underscores the significance of including lipoma in the differential diagnosis of tongue masses and demonstrates the efficacy of surgical excision in managing such rare tumor.
Novel Reconstruction Method Using the Double-Arm Vascularized Fibula Flap and TriLock Bridging Plate System for Segmental Mandibulectomy Including the Anterior Border of the Mandibular Ramus
Authors: Tanaka Jumpei , Enoki Yuichiro , Sarukawa Shunji
Published: October 2024

This study aimed to develop a novel reconstruction method for segmental mandibulectomy. In the authors' opinion, reconstruction of the anterior border of the mandibular ramus using a double-arm vascularized fibular flap is important to prevent deformity due to buccal depression and the accumulation of food debris, thereby eliminating masticatory dead space that cannot be filled with prostheses such as implants or dentures. Using conventional reconstruction plates, the reconstructed bone positioned at the anterior border of the mandibular ramus required either fixing with only 1 screw or using 2 plates for stable fixation, making it difficult to position the plates stably. The TriLock Bridging Plate System (Medartis AG, Switzerland) has 2 arms on the distal side of the plate, which enables stable fixation of the reconstructed bone placed at the anterior border of the mandibular ramus. This innovation has made it possible to securely place the fibula in the ideal position.
Risk Reduction of Severe Anastomotic Leakage by Evaluation of Blood Perfusion Using Indocyanine Green After Minimally Invasive Esophagectomy Followed by Narrow Gastric Tube Reconstruction
Authors: Kitadani Junya , Hayata Keiji , Goda Taro , Tominaga Shinta , Fukuda Naoki , Nakai Tomoki , Nagano Shotaro , Ojima Toshiyasu , Kawai Manabu
Published: October 2024

Background:

Anastomotic leakage (AL) is a major complication after esophagectomy and gastric tube reconstruction. This retrospective study aims to reveal the factors in prevention of AL and in reduction of its severity.

Methods:

Enrolled in this study were the 183 patients diagnosed with esophageal cancer who underwent minimally invasive esophagectomy followed by narrow gastric tube reconstruction at Wakayama Medical University Hospital between January 2018 and March 2023. Evaluation of blood perfusion using indocyanine green began in September 2020.

Results:

AL occurred in 42 patients (22%) and did not occur in 141 patients (78%). Patient characteristics were not significantly different between patients with and without AL. Evaluation of blood perfusion of the gastric tube was performed in 69 of the 183 patients (37.7%), and after its introduction the rates of AL decreased from 28.0% to 14.4%. Blood perfusion was less evaluated in the AL group than in the non-AL group (23.8% vs. 41.8%, P=0.034). Multivariate analysis demonstrated that non-evaluation of blood perfusion using indocyanine green (odds=3.115) was an independent risk factor for AL. For the patients with AL, active interventions (eg, tube insertion into the gastric tube through the nose or fistula, embolization of cyanoacrylate) were performed significantly more often in the group without evaluation of blood perfusion than in the group with evaluation. Without evaluation of blood perfusion, there was significantly longer time from onset to resumption of diet and significantly longer postoperative hospital stays.

Conclusions:

Evaluation of qualitative blood perfusion can lead to both risk reduction and prevention of severe AL after narrow gastric tube reconstruction for esophageal cancer.
Feasibility of Using a Novel, Multimodal Motor Function Assessment Platform With Machine Learning to Identify Individuals With Mild Cognitive Impairment
Authors: Hall Jamie B. , Akter Sonia , Rao Praveen , Kiselica Andrew , Ranum Rylea , Thomas Jacob M. , Guess Trent M.
Published: October 2024

Introduction:

Early identification of clinical conditions associated with Alzheimer disease and related dementias (ADRD) is vital for intervention. One promising early detection method is the use of instrumented assessment to identify subtle motor declines associated with ADRD. This pilot study sought to establish the feasibility of building a machine learning model to identify individuals with mild cognitive impairment (MCI) using motor function data obtained from an inexpensive, portable device.

Methods:

Our novel, multimodal motor function assessment platform integrates a depth camera, forceplate, and interface board. Healthy older adults (n=28) and older adults with MCI (n=19) were assessed during static balance, gait, and sit-to-stand activities in both single- and dual-task conditions. Three machine learning models (ie, support vector machine, decision trees, and logistic regression) were trained and tested with the goal of classification of MCI.

Results:

Our best model was decision trees, which demonstrated an accuracy of 83%, a sensitivity of 0.83, a specificity of 1.00, and an F1 score of 0.83. The top features were extracted and ranked on importance.

Discussion:

This study demonstrates the feasibility of building a machine learning model capable of identifying individuals with mild cognitive impairment using motor function data obtained with a portable, inexpensive, multimodal device.