bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning Curves in Open, Laparoscopic, and Robotic Pancreatic Surgery
Authors: Müller P. C. , Kuemmerli C. , Cizmic A. , Sinz S. , Probst P. , de Santibanes M. , Shrikhande S. V. , Tschuor C. , Loos M. , Mehrabi A. , Z’graggen K. , Müller-Stich B. P. , Hackert T. , Büchler M. W. , Nickel F.
Published: January 2022

Objective:

To depict and analyze learning curves for open, laparoscopic, and robotic pancreatoduodenectomy (PD) and distal pancreatectomy (DP).

Background:

Formal training is recommended for safe introduction of pancreatic surgery but definitions of learning curves vary and have not been standardized.

Methods:

A systematic search on PubMed, Web of Science, and CENTRAL databases identified studies on learning curves in pancreatic surgery. Primary outcome was the number needed to reach the learning curve as defined by the included studies. Secondary outcomes included endpoints defining learning curves, methods of analysis (statistical/arbitrary), and classification of learning phases.

Results:

Out of 1115 articles, 66 studies with 14,206 patients were included. Thirty-five studies (53%) based the learning curve analysis on statistical calculations. Most often used parameters to define learning curves were operative time (n = 51), blood loss (n = 17), and complications (n = 10). The number of procedures to surpass a first phase of learning curve was 30 (20–50) for open PD, 39 (11–60) for laparoscopic PD, 25 (8–100) for robotic PD (P = 0.521), 16 (3–17) for laparoscopic DP, and 15 (5–37) for robotic DP (P = 0.914). In a three-phase model, intraoperative parameters improved earlier (first to second phase: operating time –15%, blood loss –29%) whereas postoperative parameters improved later (second to third phase: complications –46%, postoperative pancreatic fistula –48%). Studies with higher sample sizes showed higher numbers of procedures needed to overcome the learning curve (rho = 0.64, P < 0.001).

Conclusions:

This study summarizes learning curves for open-, laparoscopic-, and robotic pancreatic surgery with different definitions, analysis methods, and confounding factors. A standardized reporting of learning curves and definition of phases (competency, proficiency, mastery) is desirable and proposed.
Challenging the Subcostal Incision Scar with the Two-staged Abdominoplasty: An Innovative Approach
Authors: Mahabbat Nehal A. , Shah Mardan Qutaiba N.M. , Mohamed Abbas O. , Almarshad Felwa A. , Mrad Mohamed Amir , Al-Qattan Mohammad M. , Hashem Fuad K.
Published: January 2022

Abdominoplasty is a commonly sought-after procedure due to its life-transforming results, but is limited, as in any other operation, by a number of contraindications. One of these contraindications is a subcostal scar, which may jeopardize blood supply to the upper flap of the abdominoplasty, resulting in skin necrosis. Herein, we challenge this dogma by introducing the two-staged abdominoplasty with the utilization of a delayed flap in a 48-year-old multiparous woman presenting with a Kocher incision of open cholecystectomy, with good results and a complication-free course of 3 postoperative months. We recommend this approach in patients with subcostal scars. However, more research into the utilization of delayed flaps in abdominoplasty should be done to have a more well-founded conclusion.
A Modified Rhomboid Flap for Medial Canthal Reconstruction
Authors: Tasch Christoph , Pattiss Alexander , Lanthaler Monika , Pierer Gerhard
Published: January 2022

Background:

The reconstruction of medial canthal defects is often challenging in achieving continuity of color and texture, obtaining adequate tissue for large defects, and the reproduction of natural external appearance with inconspicuous scars. We describe a technique for reconstruction of the medial canthal area, using a modified rhomboid flap.

Methods:

The technique is based on the use of a modified rhomboid flap for medial canthal defects—superiorly based on the root of the nose for defects mostly above the medial canthal tendon, inferiorly based on the cheek for defects mostly below the medial canthal tendon, and in cases of large defects, using a combination of the two flaps. We present a case series of five patients successfully reconstructed with the mentioned technique after resection of medial canthal basal cell carcinoma.

Results:

Of the five patients with a mean age of 76.2 years (range 62–84 years), reconstruction was performed in three patients with a superiorly based rhomboid flap, in one patient with an inferiorly based rhomboid flap, and in another patient with a large defect using a combination of the two flaps. Mean follow-up was 374.4 days (range 30–1247 days). All patients achieved a complete primary closure with no further surgery and satisfactory cosmetic and functional results.

Conclusion:

The modified rhomboid flap is a simple and reliable technique for all defects of the medial canthal area.
Severe Cherubism Treated with Curettage, Osteotomy, and Bony Repositioning: A Case Series of Three Patients
Authors: Moss Whitney , Pires Giovanna , Zahid Rehan , Tyrell Richard , Rhemtulla Irfan , Gociman Barbu
Published: January 2022

Cherubism is a rare, autosomal dominant condition characterized by the replacement of medullary bone by fibro-osseous lesions, predominantly in the bilateral maxillae and/or mandibles. The clinical presentation of cherubism can vary widely, from clinically undetectable to severe facial disfigurement. Although there are no established management guidelines for this condition, conservative management with observation is typically favored in most cases due to the possibility of spontaneous regression following puberty. In this article, we present three cases of moderate to severe cherubism managed with early surgical intervention utilizing curettage and osteotomy followed by bony repositioning. We aimed to show the feasibility and safety of this minimally invasive surgical technique in the management of moderate to severe cases of cherubism to provide improvement in patient quality of life, aesthetics, and function while also possibly mitigating the need for later reconstructive surgery.
Role of Skin Stretch on Local Vascular Permeability in Murine and Cell Culture Models
Authors: Demir Tuna , Takada Hiroya , Furuya Kishio , Sokabe Masahiro , Ogawa Rei
Published: January 2022

Background:

Excessive mechanical forces, particularly skin stretch, have been implicated in pathological cutaneous scarring. We hypothesize that this reflects, in part, stretch-induced vessel leakage that provokes prolonged wound/scar inflammation. However, this has never been observed directly. Here, a mouse model was used to examine the effect of skin flap stretching on vascular permeability. An in vitro model with pseudocapillaries grown in a stretchable chamber was also used to determine the effect of stretching on endothelial cell morphology and ion channel activity.

Methods:

Murine skin flaps were stretched with a biaxial stretching device, after which FITC-conjugated-dextran was injected and imaged with fluorescence stereomicroscopy. Endothelial cells were induced to form pseudocapillary networks in an elastic chamber. The chamber was stretched and differential interference contrast microscopy was used to assess cell morphology. In other experiments, markers for Ca2+ influx and K+ efflux were added before a single stretch was conducted. Histamine served as a positive-control in all experiments.

Results:

Cyclic stretching (20%) increased the vascular permeability of skin flaps almost as strongly as histamine. Both stimuli also partially disrupted the pseudocapillary networks, induced cell contraction, and created gaps between the cells. Both stimuli caused sustained K+ efflux; stretching had a milder effect on Ca2+ influx.

Conclusions:

Excessive cyclical stretching strongly increased the vascular permeability of skin vessels and in vitro pseudocapillaries. This effect associated with increased K+ efflux and some Ca2+ influx. Inhibiting such early stretch-induced signaling events may be an effective strategy for treating and preventing hypertrophic scars and keloids.
Aortic diastolic pressure decay explains sex-related differences in the subendocardial viability ratio: the Wakuya study
Authors: Tagawa Kaname , Tsuru Yusuke , Yokoi Katsumi , Aonuma Takanori , Hashimoto Junichiro
Published: January 2022

Objective:

Coronary heart disease is the leading cause of mortality in women. Despite a higher risk of heart failure after the first myocardial infarction in women compared with men, the sex-specific mechanisms are unknown. We hypothesized that myocardial ischemia is attributable to sex-related diastolic alterations in the central hemodynamics.

Methods:

We investigated the subendocardial viability ratio (myocardial oxygen supply/demand) and aortic diastolic pressure decay index in 962 apparently healthy adults (mean age, 56 ± 10 years). Using noninvasive applanation tonometry, the subendocardial viability ratio, aortic diastolic pressure decay index, and aortic augmentation index were estimated in all participants. The aortic diastolic pressure decay index was quantified by fitting an exponential curve: P(t) = P
0e−λt (λ, decay index; P
0, end-systolic pressure; t, time from end-systole).

Results:

Women showed a significantly higher aortic diastolic pressure decay index, even after adjusting for age, hypercholesterolemia, and diabetes, and a significantly lower subendocardial viability ratio than men (P < 0.001). Analysis demonstrated a mediating effect of the aortic decay index on the sex-related differences in the subendocardial viability ratio (71%), despite different effects of the augmentation index (5%).

Conclusion:

These results suggest that the predisposition of women to coronary heart disease is more likely attributable to impaired myocardial perfusion caused by accelerated aortic diastolic pressure decay, rather than increased myocardial load due to augmented aortic systolic pressure.
Mapping of corneal birefringence in thin and asymmetric keratoconus corneas with ultrahigh-resolution polarization-sensitive OCT
Authors: Patil Rahul , Shetty Rohit , Narasimhan Raghav , Patel Yash , Khamar Pooja , Pircher Michael , Hitzenberger Christoph K. , Nuijts Rudy M.M.A. , Sinha Roy Abhijit
Published: January 2022

Purpose:

To evaluate phase retardation (PR) across healthy eyes and eyes with thin corneas (<500 μm) and with asymmetric and bilateral keratoconus (KC).

Setting:

Narayana Nethralaya Eye Hospital, Bangalore, India.

Design:

Observational cross-sectional.

Methods:

There were 4 eye groups: healthy eyes (Group 1; n = 10 eyes), eyes with thin corneas and no clinical disease (Group 2; n = 10 eyes), eyes with asymmetric KC (Group 3; n = 5 eyes), and eyes with clinical KC (Group 4; n = 15 eyes). All eyes were imaged with polarization-sensitive optical coherence tomography (PS-OCT), MS-39, and Corvis-ST. Using PS-OCT, PR was analyzed in annular regions. The anterior (A-E) and Bowman (E-B) wavefront aberrations, epithelial Zernike indices (EZI), total corneal thickness, Corvis biomechanical index (CBI), total biomechanical index (TBI), and Belin-Ambrósio overall deviation index (BAD-D) were analyzed.

Results:

Only CBI, TBI, BAD-D, A-E and E-B aberrations, EZI, and total corneal thickness distributions of Groups 1 (n =10), 2 (n =10), and 3 (n =5) were similar (P > .05) but not CCT (P < .05). PR distributions clearly showed that the eyes in Groups 1, 2, and 3 had a normal corneal birefringence unlike Group 4 (n = 10) eyes (P < .05). The PR map was similar to the preferred orientations of collagen fibers seen in X-ray diffraction ex vivo studies of corneal stroma.

Conclusions:

PR distributions may eliminate the uncertainty associated with the stromal status of thin and asymmetric KC corneas. Group 2 and 3 eyes appeared as healthy because of normal corneal birefringence at the time of imaging, but a longitudinal follow-up of these eyes with PS-OCT may assist in early detection of onset of disease.
Are objective measures of sleep and sedentary behaviours related to low back pain flares?
Authors: Costa Nathalia , Smits Esther J. , Kasza Jessica , Salomoni Sauro , Rodriguez-Romero Beatriz , Ferreira Manuela L. , Hodges Paul W.
Published: January 2022

Risk factors for low back pain (LBP) flares have been considered about self-reported measures. This case–crossover study aimed to investigate whether (1) objective measures of physical activity and sleep were associated with the risk of experiencing LBP flares and (2) these associations differed for flares defined as pain 2 or more points greater than average pain over the period using an 11-point Numerical rating scale (0-no pain and 10-worst pain imaginable) (pain-defined flare: PDF) and flares identified by participants according to a broader definition that considered emotions or coping (self-reported flare [SRF]). We included 126 participants who had experienced LBP for >3 months. Physical activity and sleep were monitored for 28 days using wearable sensors. Occurrence of flares (PDF or SRF) was assessed daily using a smartphone application. Data on exposure to risk factors 1, 2, and 3 days preceding PDF or SRF were compared with nonflare control periods. Conditional logistic regression determined association between each factor and flares. Data show that day-to-day variation in physical activity and in-bed time are associated with the risk of LBP flares, but associations differ depending on how flare is defined. Longer in-bed time increased the risk of PDF but not SRF. Although physical activity was not associated with the risk of PDF, greater sedentary behaviour increased the risk of SRF and being more physically active decreased the risk for SRF. These results highlight the potential role of targeting sleep and physical activity in interventions to prevent LBP flares and indicate that risk factors differ depending on how LBP flares are defined.
Joint effects of back pain and mental health conditions on healthcare utilization and costs in Ontario, Canada: a population-based cohort study
Authors: Wong Jessica J. , Côté Pierre , Tricco Andrea C. , Watson Tristan , Rosella Laura C.
Published: January 2022

We assessed the joint effects of back pain and mental health conditions on healthcare utilization and costs in a population-based sample of adults in Ontario. We included Ontario adult respondents of the Canadian Community Health Survey between 2003 and 2012, followed up to 2018 by linking survey data to administrative databases. Joint exposures were self-reported back pain and mental health conditions (fair/poor mental health, mood, and anxiety disorder). We built negative binomial, modified Poisson and linear (log-transformed) models to assess joint effects (effects of 2 exposures in combination) of comorbid back pain and mental health condition on healthcare utilization, opioid prescription, and costs. The models were adjusted for sociodemographic, health-related, and behavioural factors. We evaluated positive additive and multiplicative interaction (synergism) between back pain and mental health conditions with relative excess risk due to interaction (RERI) and ratio of rate ratios (RRs). The cohort (n = 147,486) had a mean age of 46 years (SD = 17), and 51% were female. We found positive additive and multiplicative interaction between back pain and fair/poor mental health (RERI = 0.40; ratio of RR = 1.12) and mood disorder (RERI = 0.41; ratio of RR = 1.04) but not anxiety for back pain–specific utilization. For opioid prescription, we found positive additive and multiplicative interaction between back pain and fair/poor mental health (RERI = 2.71; ratio of risk ratio = 3.20) and anxiety (RERI = 1.60; ratio of risk ratio = 1.80) and positive additive interaction with mood disorder (RERI = 0.74). There was no evidence of synergism for all-cause utilization or costs. Combined effects of back pain and mental health conditions on back pain–specific utilization or opioid prescription were greater than expected, with evidence of synergism. Health services targeting back pain and mental health conditions together may provide greater improvements in outcomes.
Association of Adverse Events in Opioid Addiction Treatment With Quality Measure for Continuity of Pharmacotherapy
Authors: Liu Ying , Becker Andrew , Mattke Soeren
Published: January 2022

Several quality measures for continuity of substance use care are being used in accountability programs, but it is not known whether they are predictive of better patient outcomes. We analyzed whether opioid use disorder (OUD) patients in the care of clinicians and practices with higher rates on one of these measures—continuity of pharmacotherapy for OUD—have a lower risk of overdose and detox events using Medicare data. For a 10-percentage point increase in an individual clinician's measure rate, the estimated odds ratios of a patient experiencing each of these two events were 0.92 (95% confidence interval [CI] 0.85 to 0.99) for overdose and 0.83 (95% CI 0.75 to 0.92) for detox. The corresponding estimates at the practice level were 0.90 (95% CI 0.85 to 0.95) for overdose and 0.83 (95% CI 0.77 to 0.89) for detox. These results suggest that a clinician's or practice's higher measure rate for continuity of pharmacotherapy for OUD is predictive of their patients' lower likelihood of having an adverse event. The findings contribute to a growing body of evidence on the importance of treatment continuity for OUD and support the validity of measuring continuity in provider-level accountability programs.
Improving Mortality Through a Multihospital, Collaborative Quality Improvement Project
Authors: Geskey Joseph M. , Foreman Joann K. , Witkowski Molly E. , Huerta Susan M. , Berkland Diana , Hohmann Samuel F. , Meurer Steve
Published: January 2022

Improving hospital mortality is a key focus of quality and safety efforts at both the local and national level. Structured interventions can assist organizations in determining whether interventional efforts have led to sustained improvement. The PARiHS framework (Promoting Action on Research Implementation in Health Services) can assist organizations in implementing research into practice. This study investigates the use of the PARiHS framework in implementing a multihospital quality improvement project aimed at improving observed-to-expected mortality as measured by Vizient’s Clinical Data Base (CDB). Structured interventions during the study period included mortality reviews, clinical documentation improvement opportunities, educational webinars, training and support in the use of CDB to explore ongoing opportunities for mortality improvement and quarterly reports to each participating hospital’s leadership team on their performance. Data were gathered from an improvement collaborative in the Upper Midwest, which comprised 34 hospitals, of which 17 participated in the intervention. Measurement occurred from Quarter 4 2016 through Quarter 3 2020 and consisted of a preintervention, intervention, and postintervention period. Although both participating and nonparticipating hospitals achieved a significant reduction in their mortality observed-to-expected ratio from the preintervention period through the postintervention period, the participating hospitals achieved a greater reduction in their observed-to-expected mortality ratio (P < 0.0004). In addition, the participating hospitals achieved a relative 21% improvement in the mortality domain rank of the Vizient Quality & Accountability Study.
High Number of Medical Conditions Detected in Elite Athlete Periodic Health Evaluations, But Only Mild Consequences
Authors: de Vries Jesse T. , Wiggers Tom G. H. , Goedegebuure Simon , Reurink Guus
Published: January 2022

Objective:

To evaluate the number of medical conditions detected by periodic health evaluations (PHEs) in elite athletes, and their consequences for management and medical clearance.

Design:

Retrospective design.

Participants:

Elite athletes of various sports in a high-performance program in The Netherlands, in the period between 2009 and 2020.

Interventions:

The PHEs consisted of a questionnaire, general and musculoskeletal physical examination, laboratory blood test, electrocardiogram, pulmonary function testing, and (cardiopulmonary) exercise test.

Main Outcome Measures:

We extracted and analyzed the medical conditions that led to advice, clinical follow-up, further diagnostic investigation or treatment, and the medical clearance status of the athlete (clearance, temporarily no clearance, or permanently no clearance).

Results:

We included 721 PHEs of 451 elite athletes. We found 1389 medical conditions that led to advice (n = 923, 66%), clinical follow-up (n = 124, 9%), further diagnostic investigation (n = 190, 14%), treatment (n = 132, 10%), or sports restriction (n = 20, 1%). Only 20 cases (3%) led to temporarily no medical clearance. After further investigation or treatment, no permanent sports restriction was imposed on any of the athletes.

Conclusions:

We found a high number of medical conditions detected with a PHE in elite athletes. However, the vast majority of detected conditions were mild, with consequences limited to preventive advice and follow-up. The yield of PHE to detect (potentially) severe pathological conditions seems low. Clinical relevance of PHE in elite athletes and potential future health benefits remain unclear.
Age, sex and racial differences in fibrin formation and fibrinolysis within the healthy population
Authors: Wang Julie , Lim Hui Y. , Nandurkar Harshal , Ho Prahlad
Published: January 2022

Increased fibrin generation and reduced fibrinolytic potential have been detected using global coagulation assays in several hypercoagulable states including cardiovascular disease and venous thromboembolism. We aimed in this study to define the impact of age, sex and race on fibrin generation and lysis using the Overall Haemostatic Potential (OHP) assay in a group of stringently defined healthy adults. Healthy adult patients not receiving anticoagulation and without a history of thrombotic disease were prospectively recruited. Iindividuals with cardiovascular risk factors (e.g. hypertension, diabetes, smoking), receiving hormonal therapy, antiplatelet agents or with abnormal routine blood tests were also excluded. Platelet-poor plasma was obtained and the OHP assay, which evaluates fibrin formation with and without tissue plasminogen activator, was performed on all plasma samples. 144 healthy subjects (34.7% male) with median age 42 years (interquartile range 20, 77) were recruited. After multivariate analysis, age at least 50 years and female sex were associated with significantly increased fibrin generation parameters (overall coagulation potential, OHP, maximum optical density, fibrin) as well as reduced markers of fibrinolysis (overall fibrinolytic potential and time-to-50% lysis). There were no significant differences in OHP parameters between whites, East Asians and South Asians after accounting for age and sex. This study defines age, sex and racial differences of fibrin generation and fibrinolysis as measured by the OHP assay in a sample of healthy subjects. Further studies are warranted in diseased populations, where there is growing awareness of the role of global coagulation assay in defining prothrombotic and hypofibrinolytic states.
Quantification of Maternal Microchimeric Cells in the Liver of Children With Biliary Atresia
Authors: Tamaoka Satoshi , Fukuda Akinari , Katoh‐Fukui Yuko , Hattori Atsushi , Uchida Hajime , Shimizu Seiichi , Yanagi Yusuke , Kanaan Sami B. , Sakamoto Seisuke , Kasahara Mureo , Yoshioka Takako , Fukami Maki
Published: January 2022

Biliary atresia (BA) is a rare disorder of unknown etiology. There is a debate as to whether maternal microchimerism plays a significant role in the development of BA or in graft tolerance after liver transplantation. Here, we performed quantitative‐PCR‐based assays for liver tissues of children with BA and other diseases. Maternal cells were detected in 4/13 and 1/3 of the BA and control groups, respectively. The estimated number of maternal cells ranged between 0 and 34.7 per 106 total cells. The frequency and severity of maternal microchimerism were similar between the BA and control groups, and between patients with and without acute rejection of maternal grafts. These results highlight the high frequency of maternal microchimerism in the liver. This study provides no evidence for roles of microchimerism in the etiology of BA or in graft tolerance. Thus, the biological consequences of maternal microchimerism need to be clarified in future studies.
Prenatal Symptom Cluster of Psychopathology and Associations With Mindfulness and Rumination
Authors: Sun Yaoyao , Chen Qingyi , Li Yanyan , Wang Juan , Bazzano Alessandra N. , Cao Fenglin
Published: January 2022

The present study aimed to examine the interrelationships of prenatal psychopathology (specifically symptom cluster), dispositional mindfulness, and rumination using network analysis. Network analysis estimates the links between symptoms and can evaluate the presence and strength of the links. A total of 1122 pregnant women were recruited from a tertiary hospital in China. Psychopathology symptoms (including anxiety, depression, stress, fatigue, sleep, fear of childbirth [FOC], and memory problems) were assessed and used along with mindfulness and rumination to construct networks of association using R. Results illustrated five communities within the network. Anxiety resulted in the highest strength of centrality followed by two symptoms: FOC and retrospective memory. Paths showed that mindfulness was directly connected to depression, prospective memory, retrospective memory, and lack of positive anticipation in FOC, whereas mindfulness was connected indirectly through rumination to anxiety, fatigue, stress, and sleep problems. The findings reinforce that anxiety is a key symptom of prenatal psychopathology and requires priority consideration. The direct associations between mindfulness and prenatal psychopathology symptoms provide potential targets for future mindfulness-based interventions, and mindfulness reducing rumination thus in turn decrease anxiety, suggesting potential mediating mechanism of mindfulness.
Meat Helps Make Every Bite Count
Authors: Hawthorne Keli M. , Castle Jill , Donovan Sharon M.
Published: January 2022

New evidence-based dietary guidelines for feeding infants from birth to 24 months old recommend meat as an ideal first complementary food. Starting at 6 months old, infants need a variety of nutrient-dense foods, including foods that are rich in bioavailable iron and zinc. Because infants and toddlers eat small quantities of foods, it is critical to make every bite count in the early years. New parents are often unsure of optimal complementary feeding practices. The goal of this article is to review the role of red meat as a potential first complementary food for infants.
Evaluating the Strength of Association of Human Papillomavirus Infection With Penile Carcinoma: A Meta-Analysis
Authors: Catalfamo Collin J. , Brown Heidi E. , Dennis Leslie K.
Published: January 2022

Background

Human papillomavirus (HPV) is a common sexually transmitted infection that is strongly associated with cervical cancer. A link to penile cancers has been suggested by case series. We sought to assess the strength of the association between HPV infection and penile cancer by meta-analysis.

Methods

A literature search to identify population-based studies evaluating the risk of HPV infection with penile cancer was conducted via PubMed and Google Scholar databases through December 2020. Studies were included in the pooled analyses if they presented relative risk (RR) estimates comparing penile cancer cases with noncases by HPV exposure status. They were stratified by (1) type of HPV, (2) test used to determine past HPV infection, and (3) the penile cancer type. Pooled analyses were conducted for stratum with at least 2 independent studies using fixed-effects and random-effects models.

Results

Fourteen articles representing 9 study populations fit the inclusion criteria and were included in the pooled analysis. Based on these studies, the pooled RRs are 2.9 (95% confidence interval [CI], 1.7–5.0; n = 4 studies) for invasive penile cancer and seropositivity to HPV16 L1, 4.5 (95% CI, 1.3–15.5; n = 2) for seropositivity to HPV18, and 8.7 for anogenital warts (95% CI, 5.1–14.8; n = 5). For the 3 studies reporting invasive and in situ penile cancer, the risk was 7.6 for anogenital warts.

Conclusions

The pooled RRs indicate up to a 4.5-fold increased risk between seropositivity for HPV infection and invasive penile cancer. This is much lower than associations seen between HPV and cervical cancer.
Distal Triceps Tendon Tears: Magnetic Resonance Imaging Patterns Using a Systematic Classification
Authors: Vicentini Joao R.T. , Hilgersom Nicolaas F.J. , Martinez-Salazar Edgar L. , Simeone F. Joseph , Bredella Miriam A. , Palmer William E. , Oh Luke S. , Torriani Martin
Published: January 2022

Objective

This study aimed to evaluate distal triceps tendon tear patterns using a systematic classification based on the tendon's layered structure.

Methods

We retrospectively identified Magnetic resonance imaging (MRI) examinations with triceps tendon tears that underwent reconstructive surgery. Magnetic resonance images were reviewed independently by 2 musculoskeletal radiologists to determine tendon layer involvement and ancillary findings, including tear size, involvement of triceps lateral expansion, and presence of olecranon bursal fluid. Surgical reports were scrutinized for level of anatomic detail and correlation with imaging findings.

Results

We identified 69 triceps tendon tears in 68 subjects (61 men, 7 women; mean age, 45 ± 12 years) who underwent surgical reconstruction. On MRI, the superficial layer was always involved with either a partial or full-thickness tear. The most common tear pattern was a combination of superficial layer full-thickness tear with deep layer partial tear (25 of 69 [36%]). Mean tear length was 24 ± 12 mm. We found no cases of isolated deep layer tears. Involvement of triceps lateral expansion and presence of bursal fluid correlated positively with tear severity of superficial and deep layers (P < 0.001). Detailed surgical correlation was limited, with only 9 of 69 (13%) of surgical reports containing information specifically addressing individual tendon layers.

Conclusions

Triceps tendon tears show tear patterns following its layered structure and can be assessed by MRI. Radiologists and surgeons are encouraged to describe tear patterns considering both superficial and deep tendon layers.
Differentiation Between Solitary Pulmonary Inflammatory Lesions and Solitary Cancer Using Gemstone Spectral Imaging
Authors: Zhu Liu-hong , Wang Fu-nan , Wang Yan-wei , Cheng Qi-hua , Zhou Jian-jun
Published: January 2022

Background

The distinction between solitary inflammatory lesion and solitary lung cancer remains a challenge because of their considerable overlapping computed tomography (CT) imaging features.

Purpose

This study aimed to verify whether spectral CT parameters can differentiate solitary lung cancer from solitary inflammatory lesions and to find their correlations with lesion size.

Methods

A total of 78 patients with solitary lung lesions were included in our study. All of them underwent enhanced CT scans with Gemstone Spectral Imaging (GSI) mode, which was one of the dual-energy imaging technologies. According to maximum diameter (D
max) of the lesion, regions of interest were collected and divided into inflammatory (group I: <3 cm [IA], n = 17; ≥3 cm [IB], n = 14) and cancer groups (group II: <3 cm [IIA], n = 20; ≥3 cm [IIB], n = 27). Computed tomography values (HU40keV, HU70keV), effective atomic number (Z
eff), iodine concentration (IC), normalized IC (NIC), and spectral curve slopes (λ
30, λ
40) of each region of interest were calculated. The NIC was defined as the IC ratio of the lesion to the descending aorta. Mann-Whitney U test was used for intergroup (I vs II, IA vs IIA, IB vs IIB) and intragroup (IA vs IB, IIA vs IIB) comparisons, and receiver operating characteristic curve analysis was performed. Correlation analysis was applied to find the relationship between D
max and GSI parameters.

Results

No significant correlation was found between GSI parameters and D
max in the inflammatory group, whereas inverse correlations were found in the cancer group. Gemstone spectral imaging parameters (except HU70keV) of group IIA were significantly higher than those of group IIB. There were significant differences in HU40keV, IC, NIC, λ
30, and λ
40 between groups IB and IIB under both arterial and venous phase (P values < 0.05), whereas the area under the curve for λ
30 under venous phase was largest, and sensitivity and specificity were 96.32% and 85.71%, respectively. However, only HU40keV and HU70keV values under the arterial phase of IIA were significantly higher than those of IA.

Conclusions

Quantitative parameters of GSI demonstrated an inverse correlation with the lesion size of solitary lung cancer, and GSI parameters can be new ways to differentiate solitary lung cancer from solitary inflammatory lesions.
The Potential Value of 320-Row Computed Tomography Angiography in Digital Subtraction Angiography–Negative Spontaneous Subarachnoid Hemorrhage Patients
Authors: Wu Shengfeng
Published: January 2022

Objective

This study aimed to investigate the clinical value of multiphase and multiparametric 320-row computed tomography (CT) in the long-term follow-up of spontaneous subarachnoid hemorrhage (SAH) with initially negative CT angiography (CTA) and digital subtraction angiography (DSA) results.

Methods

We retrospectively analyzed the clinical data of 35 patients with nontraumatic angiographically negative SAH results from February 2012 to December 2015. Regular follow-up was performed with 320-row CTA, CT venography, and CT perfusion.

Results

All patients received 320-row CT follow-up for 0.5 to 4 years. The diagnostic yield of the follow-up examinations was 4 of 35 (11.4%), 3 of 31 (9.7%), and 1 of 28 (3.6%) for the first, second, and third time points, respectively. Two patients were admitted to the hospital because of recurrent subarachnoid hemorrhage during the follow-up period and diagnosed with ruptured aneurysms.

Conclusions

Patients with SAH with negative findings in the first DSA examination require to follow up. Follow-up using 320-row CTA, CT venography, and CT perfusion allows for a noninvasive diagnostic test for cerebrovascular diseases with higher compliance and fewer complications when compared with follow-up using DSA.
A Renal Cyst Invaded by Infiltrating Renal Cell Carcinoma With Multiple Hypermetabolic Bone Metastases as the Initial Presentation
Authors: Wang Shu , Du Bulin , Li Xuena , Li Yaming
Published: January 2022

Cystic renal cell carcinoma (RCC) refers to an indolent version of RCC composed predominantly of cysts, and it is associated with good prognosis. We showed the FDG PET/CT findings in a patient with multiple hypermetabolic bone metastases presenting with pain in the left shoulder and upper abdomen, who was later found to have cystic RCC. FDG PET/CT demonstrated hypermetabolic bone lesions and slight thickening of the renal cyst wall with light metabolism. This report indicates the risk of misdiagnosing cystic RCC as a renalcyst.
Machine Learning Quantitative Analysis of FDG PET Images of Medial Temporal Lobe Epilepsy Patients
Authors: Shih Yen-Cheng , Lee Tse-Hao , Yu Hsiang-Yu , Chou Chien-Chen , Lee Cheng-Chia , Lin Po-Tso , Peng Syu-Jyun
Published: January 2022

Purpose

18F-FDG PET is widely used in epilepsy surgery. We established a robust quantitative algorithm for the lateralization of epileptogenic foci and examined the value of machine learning of 18F-FDG PET data in medial temporal lobe epilepsy (MTLE) patients.

Patients and Methods

We retrospectively reviewed patients who underwent surgery for MTLE. Three clinicians identified the side of MTLE epileptogenesis by visual inspection. The surgical side was set as the epileptogenic side. Two parcellation paradigms and corresponding atlases (Automated Anatomical Labeling and FreeSurfer aparc + aseg) were used to extract the normalized PET uptake of the regions of interest (ROIs). The lateralization index of the MTLE-associated regions in either hemisphere was calculated. The lateralization indices of each ROI were subjected for machine learning to establish the model for classifying the side of MTLE epileptogenesis.

Result

Ninety-three patients were enrolled for training and validation, and another 11 patients were used for testing. The hit rate of lateralization by visual analysis was 75.3%. Among the 23 patients whose MTLE side of epileptogenesis was incorrectly determined or for whom no conclusion was reached by visual analysis, the Automated Anatomical Labeling and aparc + aseg parcellated the associated ROIs on the correctly lateralized MTLE side in 100.0% and 82.6%. In the testing set, lateralization accuracy was 100% in the 2 paradigms.

Conclusions

Visual analysis of 18F-FDG PET to lateralize MTLE epileptogenesis showed a lower hit rate compared with machine-assisted interpretation. While reviewing 18F-FDG PET images of MTLE patients, considering the regions associated with MTLE resulted in better performance than limiting analysis to hippocampal regions.
Tumor Imaging With 68Ga-DOTA-FAPI-04 PET/CT
Authors: Çermik Tevfik Fikret , Ergül Nurhan , Yılmaz Burçak , Mercanoğlu Güldem
Published: January 2022

Introduction and Aim

Cancer-associated fibroblasts, which are densely found in tumor tissue, express high levels of fibroblast activation protein (FAP), and FAP inhibitors (FAPIs) labeled with radionuclides can be used in the diagnosis and treatment of cancer. In this study, the role of 68Ga-DOTA-FAPI-04 PET/CT in imaging of primary, metastatic, and recurrent cancers was investigated.

Patients and Methods

A total of 42 patients (16 females, 26 males; mean age, 58.5 years; range, 31–84 years) with 22 different types of malignant diseases were included in the study. 68Ga-DOTA-FAPI-04 PET/CT imaging was performed 1 to 7 days after 18F-FDG PET/CT. Pathological uptake levels in primary tumoral lesions, lymph nodes, skeletal system, liver, peritoneal surfaces, and other body parts were compared between 2 PET/CTs. In addition, physiological uptake levels of 18F-FDG and 68Ga-FAPI were defined measuring the liver, thoracic aorta, gluteal muscle activities, and uterus activity in female patients.

Results

Of the 42 patients in the study group, 33 patients were included for staging, 8 patients for restaging, and 1 patient for evaluation of treatment response. 68Ga-DOTA-FAPI-04 PET/CT showed intense uptake in 94.2% of primary tumoral lesions. In patients with multiple myeloma, 18F-FDG uptake in the bone marrow was significantly higher than 68Ga-FAPI uptake, whereas in gastric signet ring cell tumors, 68Ga-FAPI uptake was found to be significantly higher than 18F-FDG uptake. It was observed that 68Ga-DOTA-FAPI-04 PET/CT detected bone, liver, and peritoneum metastases with higher sensitivity and accuracy compared 18F-FDG PET/CT.

Conclusions

The preliminary findings of this study showed that 68Ga-DOTA-FAPI-04 PET/CT can contribute to the diagnostic process in solid tumors. Especially in malignancies with mild uptake on 18F-FDG PET/CT, it stands out in diagnosis, staging, and restaging. It is also predicted that FAPI molecules can be used for radionuclide therapy in patients with metastatic disease and unresponsive to other treatments showing intense uptake on 68Ga-DOTA-FAPI-04 PET/CT.
18F-FDG PET/CT Image Analysis of Penicilliosis Marneffei in an Immunocompetent Child Patient
Authors: Cheng You , Li Wen-Min , Huang Jian-Jiang , Wang Shu-Xia , Shao Dan
Published: January 2022

Penicilliosis marneffei is an extremely rare fungal infectious disease that often occurs in hosts with immunodeficiency or immune dysfunction. Penicilliosis marneffei has been seldom reported in children with multiple infiltrations throughout the body. We report a case of a boy with normal immune function who had multiple infiltrations of penicilliosis marneffei and was misdiagnosed with lymphoma by PET/CT.
Visualization of Tumor Heterogeneity in Advanced Medullary Thyroid Carcinoma by Dual-Tracer Molecular Imaging
Authors: Hasenauer Natalie , Higuchi Takahiro , Deschler-Baier Barbara , Hartrampf Philipp E. , Pomper Martin G. , Rowe Steven P. , Fassnacht Martin , Buck Andreas K. , Werner Rudolf A.
Published: January 2022

We present the case of a 60-year-old man with medullary thyroid carcinoma and hepatic, osseous, and lymph node metastases who underwent peptide receptor radionuclide therapy with 177Lu-DOTATOC. After 2 cycles, 68Ga-DOTATOC PET/CT revealed multiple nonavid lesions. To assess whether the patient would be eligible for prostate-specific membrane antigen (PSMA)–targeted radioligand therapy, a PSMA PET/CT was conducted. PSMA PET/CT identified increased PSMA expression in both 68Ga-DOTATOC–avid and nonavid lesions. As such, dual-radiotracer PET/CT may allow for insights into the complexities of tumor heterogeneity in patients with medullary thyroid carcinoma, which may pave the way for subsequent therapeutic algorithms.
Role of FDG PET/CT in the Evaluation of Therapy Response in Systemic Juvenile Xanthogranuloma
Authors: Mavi Mehmet Emin , Turan Basak Soydas , Salanci Bilge Volkan , Bozkurt Murat Fani
Published: January 2022

Juvenile xanthogranuloma, a rare type of non-Langerhans cell histiocytosis, is mostly seen in childhood and adolescence and generally manifests as widespread skin lesions. It rarely shows systemic involvement. Although the cutaneous form is often self-limited, systemic form is quite aggressive. Here we report the findings of FDG PET/CT scans during the course of cladribine therapy in a 6-year-old girl with systemic juvenile xanthogranuloma.
A Systematic Review of Subsurface Radiofrequency Treatments in Plastic Surgery
Authors: Swanson Eric
Published: January 2022

Background

Subsurface radiofrequency (RF) treatments produce skin contraction by causing coagulation of the underlying subcutaneous fat. This method is marketed to fill a treatment gap for patients who do not wish to have surgery. A systematic review of this subject has not been previously published.

Methods

An electronic search was performed using PubMed to identify the literature describing subsurface RF treatments.

Results

Thirty articles were evaluated. An InMode device was used in 23 studies, and a Thermi device was used in 6 studies, with or without liposuction. Treatment areas included the face, neck, body, breasts, and labia. Most studies relied on patient satisfaction scores and physician review of photographs. The most frequent complications were induration and nodules. Most patients experienced prolonged swelling and numbness. Several studies reported marginal mandibular neuropraxias. The skin response after treatment of the abdomen was poor, and seromas were common. The incidence of burns improved after modification of the InMode device. Breast treatment did not appear to be effective in treating ptosis. Patient satisfaction scores were modest. Most studies (77%) were published by authors with a known conflict of interest. In some studies, the photographs did not accurately depict the treatment result. Institutional review board approval and disclosure of off-label regulatory status were often missing.

Discussion

Thermal treatment of the subcutaneous tissue introduces extra risks without a compensatory benefit. Comparisons in terms of safety, cost, recovery time, results, and complications do not favor energy-based devices. A treatment gap may be fictitious; properly informed patients may be treated with existing surgical procedures at all ages.

Conclusions

Little evidence supports the efficacy and safety of subcutaneous RF treatments as an improvement over results that may be obtained using traditional surgical methods such as submental lipectomy, liposuction, and abdominoplasty. Photographic integrity is often lacking. Financial conflict of interest is pervasive. Marketing precedes the science. Plastic surgeons need to be aware of these serious limitations and the off-label regulatory status of these devices, before purchasing expensive equipment and recommending subsurface RF treatments to patients.
Long-term Outcomes of Persistent Postoperative Opioid Use
Authors: Aalberg Jeffrey J. , Kimball Marc D. , McIntire Timothy R. , McCullen Geoffrey M.
Published: January 2022

Objective:

To determine the association between PPOU and the long-term risk of OUD and opioid overdose.

Summary Background Data:

PPOU is a commonly used outcome in the surgical literature; its incidence and risk factors have been well described. However, its association to long term outcomes, including OUD and opioid overdose, is unknown.

Methods:

A retrospective cohort study utilizing the Veterans Health Administration corporate data warehouse. Patients undergoing any surgery between January 1, 2008 and December 31, 2018 were included and followed until December 31, 2020. Univariate and multivariate survival analysis were used to determine the association between PPOU and OUD and overdose. Sensitivity analyses were conducted to determine the impact of different definitions of persistent opioid use and the effect of preoperative opioid use.

Results:

A total of 344,745 patients undergoing surgery were included and followed for a median of 6.18 years (IQR 3.53–9.12). PPOU was associated with an increased hazard of developing both OUD (HR = 1.88, CI: 1.81–1.95, P < 0.001) and overdose (HR = 1.83, CI: 1.72–1.94, P < 0.001). This association remained consistent after adjustment for comorbidities and across all sensitivity analyses.

Conclusions:

Surgical patients who develop PPOU are at increased risk of both OUD and overdose as compared to surgical patients who do not develop persistent use.
Treatment of Surgical Scars With Combination Pulsed Dye and Fractional Nonablative Laser
Authors: Kang Bianca Y. , Ibrahim Sarah A. , Weil Alexandra , Reynolds Kelly A. , Johnson Tyler , Wilson Sarah , Lee Ming H. , Kim John Y.S. , Dirr McKenzie A. , Poon Emily , Alam Murad
Published: January 2022

Objective:

To assess the effectiveness and safety of combined pulsed-dye laser (PDL) and NAFL for treatment of surgical scars.

Summary Background Data:

PDL and NAFL have not been compared to healing by time alone.

Methods:

Randomized controlled, single-blinded clinical trial at an urban, university hospital. Healthy adults' status post skin surgery with primary closure were randomized to either 3 sessions of combination PDL and NAFL every 2 to 8 weeks, or control of no treatment. At baseline and 36-week follow-up, Patient and observer Scar Assessment Scale and Scar Cosmesis Assessment and Rating were completed by participants and blinded physicians. The primary outcome was scar improvement, as measured by the score difference over time.

Results:

Of 76 participants, 52 completed the study (July 2017 to June 2019). No severe adverse events were reported. Patient and observer Scar Assessment Scale assessments demonstrated improvement in total score in the laser group compared to controls, as reported by patients [mean difference (standard deviation), laser: 12.86 (6.91) vs control: 7.25 (6.34); P = 0.004] and blinded physicians [18.32 (8.69) vs 13.08 (9.63); P = 0.044]. Patients observed a greater improvement in scar thickness [3.68 (2.04) vs 1.88 (1.85); P = 0.002] and stiffness [3.57 (2.78) vs 1.50 (2.11); P = 0.004] with lasers, and physicians reported greater improvement in vascularity [3.71 (1.98) vs 1.71 (1.52); P = 0.0002]. The live Scar Cosmesis Assessment and Rating subscore for erythema improved significantly with lasers [1.04 (0.79) vs 0.42 (0.50); P = 0.001].

Conclusions and Relevance:

Combined PDL and NAFL resulted in scar improvement. Scar thickness, stiffness, and erythema were improved.

Trial Registration:

ClinicalTrials.gov (NCT03057964).