bluuebunny/crossref_metadata_2025 huggingface dataset:
MiR-194-5p serves as a potential biomarker and regulates the proliferation and apoptosis of hippocampus neuron in children with temporal lobe epilepsy
Authors: Niu Xia , Zhu Hai-Ling , Liu Qian , Yan Jing-Fen , Li Mei-Lian
Published: March 2021

Background:

The aim of the present study is to explore the expression level and the clinical significance of miR-194-5p to the children with temporal lobe epilepsy, and investigate its functions in regulating cell behaviors of hippocampal neurons.

Methods:

The expression level of miR-194-5p was detected in the serum of 59 temporal lobe epilepsy (TLE) children and 63 healthy children. To further study the role of miR-194-5p in the development of TLE in children, the epileptiform discharge model was established in rat hippocampal neurons to mimic TLE conditions in children. Receiver operator characteristic (ROC) curves and area under the ROC curve were established to evaluate the diagnostic value of serum microRNAs to the differentiation of the TLE group and healthy group. The influence of miR-194-5p on the proliferation and apoptosis of hippocampus neurons was examined by using MTT and flow cytometric apoptosis assay. Luciferase reporter assay was performed to confirm the target gene of miR-194-5p.

Results:

The result demonstrated that miR-194-5p was significantly dysregulated in plasma of TLE patients. Analysis of ROCs showed that the miR-194-5p had high specificity and sensitivity in the diagnosis of the TLE in children. The expression of miR-194-5p was found to increase in the hippocampal cells cultured in the magnesium-free medium through quantitative real-time polymerase chain reaction. Hyper-expressed of miR-194-5p reversed TLE-induced reduction for the cell viability, and inhibited the cell apoptosis induced by TLE. Insulin-like growth factor 1 receptor (IGF1R) was proved to be a direct target gene of miR-194-5p.

Conclusion:

MiR-194-5p is a likely potential biomarker and treatment target of TLE in children. IGF1R might be involved in the regulatory role of miR-194-5p in hippocampus neuron apoptosis.
Diagnostic significance of circulating miR-485-5p in patients with lupus nephritis and its predictive value evaluation for the clinical outcomes
Authors: Wu Qinghua , Qin Yanan , Shi Mei , Yan Liping
Published: March 2021

Background:

Lupus nephritis (LN) is one of the main risk factors contributing to morbidity and mortality of systemic lupus erythematosus (SLE). This study aimed to investigate the potential role of miR-485-5p in human LN.

Methods:

Quantitative real-time polymerase chain reaction was used for the measurement of miR-485-5p levels. The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in serum were determined by enzyme-linked immunosorbent assay. The diagnostic role of miR-485-5p in LN was evaluated by the receiver operating characteristic (ROC) curve. The impact of miR-485-5p on end-stage renal disease (ESRD) was compared by Kaplan-Meier analysis and Cox regression analysis. The target gene was determined by a dual-luciferase reporter assay system.

Results:

MiR-485-5p was highly expressed in SLE and LN patients compared with the healthy controls, and LN patients had the highest level of miR-485-5p. The expression level of miR-485-5p in active LN patients was significantly increased compared with that in nonactive cases. MiR-485-5p expression showed a positive correlation with the levels of estimated glomerular filtration rate, serum creatinine, proteinuria, SLE disease activity index score, and inflammatory cytokines. The ROC analysis results indicated that serum miR-485-5p was a promising biomarker for the early diagnosis of LN, and it can distinguish active LN patients from nonactive ones. Phosphatase and tensin homolog was a direct target of miR-485-5p, and negatively associated with serum miR-485-5p levels. More ESRD events were observed in cases with high miR-485-5p expression, miR-485-5p was an independent factor for the risk of ESRD in LN patients.

Conclusion:

Serum miR-485-5p might be a novel promising diagnostic marker for LN and has potential predictive value for ESRD risk in LN patients.
Benchmarking SARS CoV-2 Infection in the Workplace to Support Continuity of Operations
Authors: Iddins Bart O. , Waugh Mark H. , Buck Brandon , Cato Tracey , Graham David E. , Attia Kareem , Jones Dan , Partin Adam , Shourbaji Rania , Wesh Christopher
Published: March 2021

Objective:

The COVID-19 pandemic jeopardizes continuity of operations of workplaces and the health and safety of workers. Exemplar workplace-related SARS-CoV-2 benchmarks are described and illustrated with empirical data.

Methods:

Benchmarks were collected over a 9-month period on a large workplace (N = 5500+). These ranged from quantitative indices associated with RT-qPCR targeted testing and random surveillance screening, surveillance for new variants of SARS-CoV-2, intensive contact tracing, case management, return to work procedures, to monitoring of antibody seropositive status.

Results:

Data and analyses substantiated effectiveness of interventions. This was evidenced in suppressed infection rates, rapid case identification and isolation, acceptance of the program by employees, documentation of presumptive immunity, and working relationships with senior management.

Conclusions:

These SARS-CoV-2 exemplar benchmarks provided an evidence-base for practice and contributed strategically to organizational decisions.
The Effect of Global DNA Methylation on PDCD5 Expression in the PBMC of Occupational Chromate Exposed Workers
Authors: Ha Feizai , Li Na , Long Changmao , Zheng Pai , Hu Guiping , Jia Guang , Wang Tiancheng
Published: March 2021

Objectives:

To evaluate the alteration of protein of programmed cell death 5 (PDCD5) in peripheral blood mononuclear cells (PBMC) and DNA methylation caused by hexavalent chromium exposure.

Methods:

There were 112 workers and 56 controls in this study. The chromium in RBC and urine, PBMC with PDCD5+, DNA methylation, urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) and score of DNA damage were measured.

Results:

In chromate exposed workers, the percent of PBMC with PDCD5+, urine 8-OHdG, and score of DNA damage were significantly higher, whereas global DNA methylation was significantly lower. The binary logistic regression and generalized linear mixed model analysis showed that the percent of PBMC with PDCD5+ was significantly associated with global DNA hypomethylation.

Conclusions:

The aberrant DNA hypomethylation plays an important role in PBMC apoptosis of occupational hexavalent chromium exposure.
Actions Speak Louder Than Words
Authors: van der Put Anne C. , Mandemakers Jornt J. , de Wit John B.F. , van der Lippe Tanja
Published: March 2021

Objective:

To study whether workplace social relations explain use of worksite health promotion (WHP), by examining colleagues’ and team managers’ WHP encouragement of a healthy lifestyle, and colleague WHP uptake.

Methods:

Multilevel data came from the second wave of the European Sustainable Workforce Survey (4345 employees of 402 team in 9 countries). Linear probability models were used to test use of two types of WHP: healthy menus and sport facilities.

Results:

Employees are more likely to use healthy menus and sport facilities when more colleagues do so too and when colleagues encourage a healthy lifestyle. Surprisingly, encouragement by one's manager plays no role.

Conclusions:

Social contact among colleagues can facilitate WHP use, and WHP initiatives should pay attention to the influential role of colleagues.
Predictors of Work Efficiency in Structural Firefighters
Authors: Norris Maxwell S. , McAllister Matt , Gonzalez Andrew E. , Best Stuart A. , Pettitt Robert , Keeler Jason M. , Abel Mark G.
Published: March 2021

Objective:

Develop a novel work efficiency (WE) metric to quantify firefighter physical ability and identify correlates of WE.

Methods:

Physical fitness and anthropometric measurements were taken on 19 male firefighters. Firefighters performed a timed maximal effort simulated fireground test (SFGT). WE was quantified as: (1/[Air depletion × SFGT completion time]) × 10,000. Regression analyses were used to identify predictors of WE.

Results:

WE was significantly correlated to age, relative body fat, fat mass, occupational experience, jump height, inverted row repetitions, relative bench press and squat strength, treadmill time to exhaustion, relative ventilatory threshold, and relative peak oxygen consumption. Treadmill time to exhaustion and relative lower body strength accounted for the greatest variance in WE (R
2 = 0.72, root mean square error = 0.07).

Conclusion:

Aerobic endurance and relative lower body strength were related to an occupationally-specific assessment of firefighter physical ability.
Preliminary Safety and Efficacy of Head and Neck Cooling Therapy After Concussion in Adolescent Athletes: A Randomized Pilot Trial
Authors: Congeni Joseph , Murray Tamara , Kline Peyton , Bouhenni Rachida , Morgan Danielle , Liebig Christopher , Lesak Alexandria , McNinch Neil L.
Published: March 2021

Objective:

To determine the safety and efficacy of head and neck cooling when applied up to 8 days after concussion among adolescent athletes.

Design:

A randomized nonblinded pilot trial.

Setting:

Sports Medicine Clinic in a tertiary hospital.

Patients:

Adolescent athletes aged 12 to 17 years diagnosed with a concussion within 1 week of injury.

Interventions and Main Outcome Measures:

The control group (n = 27) received standard treatment (short term brain rest), whereas the treatment group (n = 28) received standard treatment and head and neck cooling. Head and neck cooling treatment was applied to patients at the postinjury assessment visit and at 72 hours post-injury. The SCAT5 (Sport Concussion Assessment Tool) total symptom severity score was collected at postinjury assessment visit, pre- and post-treatment at 72 hours, and at 10 days, and 4 weeks post-treatment.

Results:

Athletes who received head and neck cooling had a faster symptom recovery (P = 0.003) and experienced significant reduction in symptom severity scores after treatment (P < 0.001). Sport type and gender did not influence the treatment outcome (P = 0.447 and 0.940, respectively).

Conclusions:

This pilot study demonstrates feasibility of head and neck cooling for the management of acute concussion in adolescent athletes.
Dizziness, Psychosocial Function, and Postural Stability Following Sport-Related Concussion
Authors: Hunt Danielle L. , Oldham Jessie , Aaron Stacey E. , Tan Can Ozan , Meehan William P. , Howell David R.
Published: March 2021

Objective:

To examine if self-reported dizziness is associated with concussion symptoms, depression and/or anxiety symptoms, or gait performance within 2 weeks of postconcussion.

Design:

Cross-sectional study.

Setting:

Research laboratory.

Participants:

Participants were diagnosed with a concussion within 14 days of initial testing (N = 40). Participants were divided into 2 groups based on their Dizziness Handicap Inventory (DHI) score: 36 to 100 = moderate/severe dizziness and 0 to 35 = mild/no dizziness.

Interventions:

Participants were tested on a single occasion and completed the DHI, hospital anxiety and depression scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and Post-Concussion Symptom Inventory (PCSI). Three different postural control tests were use: modified Balance Error Scoring System, single-/dual-task tandem gait, and a single-/dual-task instrumented steady-state gait analysis.

Main Outcome Measures:

Comparison of patient-reported outcomes and postural control outcomes between moderate/severe (DHI ≥ 36) and mild/no (DHI < 36) dizziness groups.

Results:

Participants with moderate/severe dizziness (n = 19; age = 17.1 ± 2.4 years; 63% female) reported significantly higher symptom burden (PSCI: 43.0 ± 20.6 vs 22.8 ± 15.7; P = 0.001) and had higher median HADS anxiety (6 vs 2; P < 0.001) and depression (6 vs 1; P = 0.001) symptom severity than those with no/minimal dizziness (n = 21; age = 16.5 ± 1.9; 38% female). During steady-state gait, moderate/severe dizziness group walked with significantly slower single-task cadence (mean difference = 4.8 steps/minute; 95% confidence interval = 0.8, 8.8; P = 0.02) and dual-task cadence (mean difference = 7.4 steps/minute; 95% confidence interval = 0.7, 14.0; P = 0.04) than no/mild dizziness group.

Conclusion:

Participants who reported moderate/severe dizziness reported higher concussion symptom burden, higher anxiety scores, and higher depression scores than those with no/mild dizziness. Cadence during gait was also associated with the level of dizziness reported.
The Position of the Heart During Normothermic Ex Situ Heart Perfusion is an Important Factor in Preservation and Recovery of Myocardial Function
Authors: Hatami Sanaz , Qi Xiao , White Christopher W. , Bozso Sabin J. , Himmat Sayed , Sergi Consolato , Nagendran Jayan , Chung Hyun-Joong , Nobes David S. , Freed Darren H.
Published: March 2021

Ex situ heart perfusion (ESHP) is being investigated as a method for the continuous preservation of the myocardium in a semiphysiologic state for subsequent transplantation. Most methods of ESHP position the isolated heart in a hanging (H) state, representing a considerable departure from the in vivo anatomical positioning of the heart and may negatively affect the functional preservation of the heart. In the current study, cardiac functional and metabolic parameters were assessed in healthy pig hearts, perfused for 12 hours, in either an H, or supported (S) position, either in nonworking mode (NWM) or working mode (WM). The cardiac function was best preserved in the S position hearts in WM (median 11 hour cardiac index (CI)/1 hour CI%: working mode perfusion in supported position = 94.77% versus nonworking mode perfusion in supported position = 62.80%, working mode perfusion in H position = 36.18%, nonworking mode perfusion in H position = 9.75%; p < 0.001). Delivery of pyruvate bolus significantly improved the function in S groups, however, only partially reversed myocardial dysfunction in the H heart groups. The hearts perfused ex situ in a semianatomical S position and in physiologic WM had better functional preservation and recovery than the H hearts in non-S position. Optimizing the positional support for the ex situ–perfused hearts may improve myocardial preservation during ESHP.
Unfractionated and Low-Molecular-Weight Heparin for Bridging Patients with Left Ventricular Assist Device: An Event-Based Analysis
Authors: Rabon Alyssa D. , Taber David J. , Uber Walter E. , Houston Brian A. , Meadows Holly
Published: March 2021

The relative efficacy of bridging with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) in left ventricular assist device (LVAD) patients has not been established. We performed a retrospective, longitudinal cohort study to evaluate safety and efficacy of bridging strategies including all adult LVAD patients implanted at the Medical University of South Carolina from August 2014 to July 2017. In addition to LMWH and UFH exposure, we recorded any time period a patient did not receive a bridging agent for a subtherapeutic international normalized ratio (INR) value as a control group; these events were defined as nonbridging (NB) events. Multivariable Cox regression survival models were utilized for analysis. There were 563 episodes evaluated in 50 patients. Compared with NB events, UFH (adjusted hazard ratio [aHR], 3.75; 95% CI, 1.45–9.73; p = 0.007) and LMWH (aHR, 2.25; 95% CI, 1.03–4.94; p = 0.043) were both associated with an increased risk of bleeding. Compared with NB events, LMWH was not associated with a decreased risk of clotting events (aHR, 1.56; 95% CI, 0.28–8.73; p = 0.616). In the 381 NB events, a nonsignificant signal was noted toward increased risk of thrombotic events in those with an INR ≤ 1.5 (aHR, 2.99; 95% CI, 0.57–15.8; p = 0.2). Among all 563 episodes, those with a baseline INR ≥ 2.0 demonstrated an increased risk of bleeding events (aHR, 2.35; 95% CI, 1.18–5.69; p = 0.016). Our data suggest that the efficacy of LMWH bridging in LVAD patients warrants further investigation.
Transcarotid Approach to Placement of an Impella 5.0
Authors: Ramamurthi Adhitya , Cain Michael T. , Smith Nathan , Espinal Angelia , Joyce David L. , Mohammed Asim , Joyce Lyle D. , Durham Lucian A.
Published: March 2021

Microaxial left ventricular assist devices (mLVADs) have traditionally been placed through a transfemoral or transaxillary arterial approach. Transfemoral access is restrictive, significantly limiting postoperative patient ambulation. Transaxillary placement is preferred but not feasible in a subset of patients due to small arterial diameter or tight angulation of the thoracic outlet. Transcarotid delivery has been utilized for other cardiovascular device deployment with good success; however, this approach has not been described for mLVAD support. We present a case series of transcarotid placement of mLVADs in cases where a transaxillary and transfemoral approach was not feasible. From May 2017 to April 2019, six patients in cardiogenic shock required mLVAD support achieved via a transcarotid approach. Technical success was achieved in all patients. One patient was directly weaned from mLVAD support and two patients died on mLVAD support. Escalation to venoarterial extracorporeal membrane oxygenation (VA-ECMO) was required for three patients, two of whom subsequently died. There were no bleeding or valvular complications related to device placement, and no obvious or known neurologic complications related to mLVAD support. Transcarotid placement of mLVADs expands the utility of these devices as an alternative to traditional support strategies or prohibitive arterial anatomy; however, further study is needed to determine its efficacy.
Extracorporeal Membrane Oxygenation Complicated by an Interrupted Inferior Vena Cava
Authors: Johnson Aric J. , Srour Habib
Published: March 2021

Heterotaxy refers to a congenital disorder in which there is a disruption of the normal left-right axis, resulting in duplication of one laterality, and can affect all of the thoracic and abdominal organs. Findings include atrial isomerism, vascular abnormalities affecting the great vessels, ciliary dyskinesia, polysplenia or asplenia, biliary atresia, and gut malrotation. These anomalies can present unique challenges in the critical care setting, particularly in those requiring mechanical circulatory support. Here, we present a patient with acute respiratory distress syndrome requiring venovenous extracorporeal oxygenation which was complicated by a persistent impedance of flow. She was subsequently discovered to have an interrupted inferior vena cava, where lower limb venous drainage returned to the heart via the azygos and hemiazygos systems. We use this case to also highlight other manifestations of heterotaxy which may affect critical care.
Ventricular Assist Device Driveline Infection and Development of Intracranial Hemorrhage: A Case Series
Authors: Prince Adam J. , Domenico Christopher M. , Shore Supriya , Urgo Kimberly A. , Atluri Pavan , Wald Joyce W. , Birati Edo Y.
Published: March 2021

Durable left ventricular assist devices (LVAD) are frequently complicated by driveline infection. The objective of this case series was to examine whether an association exists between driveline infection and intracranial hemorrhage. This retrospective case series included patients at a single tertiary care hospital on durable LVAD support who developed intracranial hemorrhage. Physical examination data, vital signs, and laboratory markers of sepsis including blood cultures and imaging of driveline sites were reviewed. A total of nine patients were included in the case series. At the time of hemorrhagic event, five patients had active driveline infection, and five patients were found to be bacteremic. All bacteremic patients were found to have supratherapeutic INR at the time of presentation. Although five patients experienced subarachnoid hemorrhage, only one patient was found to have a cerebral aneurysm. This case series highlights a possible association between LVAD driveline infection and intracranial hemorrhage, and the need for further research to better understand the pathophysiology driving this association.
Assessment of an Automatic Hot Water Sterilizing System-Equipped Dialysis Supply Device’s Circuit Degradation, 7 Years Postinstallment
Authors: Ogawa Tomonari , Kanayama Yuki , Sasaki Yusuke , Tokui Kenta , Yasuda Kunihiko , Hara Hiroaki , Iwashita Takatsugu , Shimizu Taisuke , Hasegawa Hajime
Published: March 2021

At most dialysis clinics in Japan, a central dialysis fluid delivery system (CDDS) is used primarily to provide consistent treatment to patients. We incorporated hot water disinfection to a CDDS over a 7 year period, after which we assessed the dialysis purification levels. We observed that adequate levels had been maintained. We rated the internal circuits of the device at the 7 year mark, comparing the insides of both the used and unused new Synflex tubing, silicone blades, Teflon tubing, silicone rubber tubing, and stainless steel parts. No bacteria or contamination (such as endotoxins) was detected, and no degradation or damage were observed. Even after the auto-hot water disinfection system was installed, no internal tubing degradation due to hot water or mechanical issues have occurred, and the system’s dialysis fluid purification levels have been maintained.
The effect of glucagon-like peptide-1 receptor agonists on 24-hour ambulatory blood pressure: a confirmatory meta-analysis
Authors: Patoulias Dimitrios , Papadopoulos Christodoulos , Siskos Fotios , Stavropoulos Konstantinos , Doumas Michael
Published: March 2021

Objective

Hypertension augments overall cardiovascular risk in patients with type 2 diabetes mellitus (T2DM); however, control rates remain suboptimal. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have revolutionized the field of T2DM therapeutic management due to their multiple pleiotropic effects. Therefore, we sought to determine the effect of this class on ambulatory blood pressure monitoring (ABPM), pooling data from relevant randomized controlled trials (RCTs).

Methods

We searched major electronic databases, namely PubMed and Cochrane Library, along with gray literature sources, for RCTs assessing the effect of various GLP-1RAs on ambulatory BP in patients with T2DM.

Results

We pooled data from seven RCTs in total. GLP-1RA treatment compared to placebo or active control resulted in a nonsignificant decrease in 24-h SBP (mean difference = −1.57 mm Hg; 95% CI,−4.12 to 0.98; I
2 = 63%) and in 24-h DBP (mean difference = 1.28 mmHg; 95% CI,−0.31 to 2.87; I
2 = 49%). No subgroup differences between the various GLP-1RAs were detected.

Conclusion

GLP-1RAs treatment does not influence either systolic or diastolic ambulatory BP in patients with T2DM.
Helicobacter pylori eradication following first-line treatment failure in Europe: What, how and when chose among different standard regimens? A systematic review
Authors: De Francesco Vincenzo , Zullo Angelo , Manta Raffaele , Gatta Luigi , Fiorini Giulia , Saracino Ilaria M. , Vaira Dino
Published: March 2021

Cure rate following standard first-line regimens for Helicobacter pylori eradication is decreasing so several patients require two or more treatments. Antibiotic susceptibility-based therapy, advised in current guidelines, is largely impracticable in clinical practice. Some ‘standard’ regimens (triple therapies based on either levofloxacin or rifabutin, bismuth-based quadruple therapies, sequential, concomitant and hybrid therapies) were empirically used as rescue therapies. We performed a systematic review on recent studies carried out in European countries dealing with these regimens. A total of 24 studies, with 3804 patients, were identified. As second-line therapy, Pylera (89.2%) and sequential therapy (92.5%) achieved significantly higher cure rates as compared to all the other regimens. As third-line therapy, levofloxacin-based therapy (84.1%) and Pylera (83.6%) achieved similarly high cure rates, whereas standard, bismuth-based quadruple therapy (64.1%) achieved the lowest. As a rescue therapy, the success rate was close to 75% following all therapies used, with data on rifabutin-based regimen consolidated in the larger sample size. Overall, levofloxacin–amoxicillin triple therapy achieved higher eradication rates when the 14- rather than 10-day regimen was used (87.1 vs. 72.2%; P = 0.003). Among bismuth-based therapies, Pylera achieved a significantly higher eradication rate than standard quadruple therapy (88 vs. 67%; P < 0.0001). These data suggest that a wise ‘therapeutic package’ following first-line therapy could be Pylera, levofloxacin- and rifabutin-based therapy, as long as Pylera therapy was not used as a first-line regimen and levofloxacin-based regimen was administered for 14 days.
Acute-on-chronic liver failure in Egypt: an underestimated complication of liver cirrhosis
Authors: Medhat Mohammed A. , Gushken Fernanda , Khaled Tasneem , Hassan Elham , El-Rehim Abeer Abd , Kamel Sherif
Published: March 2021

Background

Acute-on-chronic liver failure (ACLF) is a severe liver cirrhosis complication with high mortality rates. Despite that chronic liver diseases are prevalent in Egypt, there is no available data about patients with ACLF. We aimed to evaluate the pattern of ACLF in Egypt.

Methods

This prospective cohort study included all patients with ACLF, according to the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver, admitted to Al-Rajhi liver Hospital, Egypt, between November 2018 and October 2019. We recorded data at admission, days 3, 7, 14 and 28, and calculated ACLF grades and Chronic Liver Failure Consortium scores until discharge or death. Kaplan–Meier survival analysis was used for survival analysis.

Results

We analyzed 52 patients with ACLF. Liver cirrhosis was secondary to hepatitis C virus in 46 patients (88.9%), and hepatitis B virus in 4 (7.4%). The main ACLF precipitating factors were infection in 38 (73.1%) and variceal bleeding in 9 (17.3%). The most common infections were spontaneous bacterial peritonitis (44.7%) and chest infection (31.6%). The 28 and 90-day mortality rates were 86.5 and 96.2%. None of the patients who survived >28 days had ACLF 3 at admission or day 7. Among those who died <28 days, ACLF 3 was reported in 7 at admission and 19 on day 7. Living donor liver transplantation was not offered in any case.

Conclusion

In this study, the 28-day mortality rate was higher than in the literature. Egypt urgently needs to develop specific protocols for the proper management of ACLF.
Rate of incidental central nervous system meningioma detected in patients undergoing 18F-fluciclovine PET/CT imaging for evaluation of prostate cancer
Authors: Baiomy Ali , Schellingerhout Dawid , Chapin Brian F. , Weinberg Jeffrey S. , Raza Shaan M. , Macapinlac Homer , Ravizzini Gregory
Published: March 2021

Objective

To evaluate the rate of incidental detection of central nervous system (CNS) meningioma in patients undergoing 18F-fluciclovine PET/computed tomography (CT) imaging for the evaluation of prostate cancer.

Methods

The reports of 850 18F-fluciclovine PET/CT scans in 566 patients with pathologically proven prostate cancer performed from April 2017 to July 2019, were retrospectively reviewed for the presence of CNS meningioma.

Results

A total of 14 patients (2.8%) (age range: 54–82 years old) had abnormal focal intracranial 18F-fluciclovine uptake, all extra-axial in location (SUVmax range: 3.2–19.3). Two cases out of 14 (0.35%) were diagnosed as metastatic lesions. Twelve out of the 14 patients, had 18F-fluciclovine PET/CT imaging findings suspicious for CNS meningioma, 2 of them received another diagnosis on further imaging, and only 10 cases (2%) had the diagnosis of meningioma according to follow-up MRI and 18F-fluciclovine PET/CT.

Conclusion

Focal 18F-fluciclovine avid intracranial lesions incidentally detected in patients undergoing PET/CT imaging for prostate cancer are most often CNS meningiomas.
Performance of SwiftScan planar and SPECT technology using low-energy high-resolution and sensitivity collimator compared with Siemens SPECT system
Authors: Shibutani Takayuki , Onoguchi Masahisa , Yoneyama Hiroto , Konishi Takahiro , Nakajima Kenichi
Published: March 2021

Purpose

A new low-energy high-resolution-sensitivity (LEHRS) collimator was developed by General Electric (GE) Healthcare. SwiftScan planar and single photon emission computed tomography (SPECT) systems using LEHRS collimator were developed to achieve the low-dose and/or short-time acquisition. We demonstrated the performance of SwiftScan planar and SPECT system with LEHRS collimator using phantoms.

Methods

Line source, cylindrical and flat plastic dish phantoms were used to evaluate the performance of planar and SPECT images for four patterns of Siemens LEHR, GE LEHR, GE LEHRS and SwiftScan using two SPECT-CT scanners. Each phantom was filled with 99mTc solution, and the spatial resolution, sensitivity and image uniformity were calculated from the planar and SPECT data.

Results

The full-width at half maximum (FWHM) values as a system spatial resolution of Siemens LEHR, GE LEHR and GE LEHRS were approximately 7.4 mm. GE LEHRS showed a lower FWHM value by increasing the blend ratio in Clarity2D processing. The system sensitivity of GE LEHRS increased by approximately 30% compared with that of GE LEHR and was similar to that of Siemens LEHR. The FWHM values of SPECT with an filtered back projection (FBP) method were approximately 10.3 mm. The FWHM values of the ordered subset expectation maximization (OSEM) method were better with an increase in iteration values. The differential uniformities of Siemens LEHR, GE LEHR, GE LEHRS and GE SwiftScan using the FBP method were approximately 15.1%. The differential uniformity of OSEM method was higher with an increase in the iteration value.

Conclusion

The SwiftScan planar and SPECT have a high sensitivity while maintaining the spatial resolution compared with the conventional system.
Automated classification of increased uptake regions in bone single-photon emission computed tomography/computed tomography images using three-dimensional deep convolutional neural network
Authors: Tsujimoto Masakazu , Teramoto Atsushi , Dosho Masakazu , Tanahashi Shingo , Fukushima Ayami , Ota Seiichiro , Inui Yoshitaka , Matsukiyo Ryo , Obama Yuuki , Toyama Hiroshi
Published: March 2021

Objective

This study proposes an automated classification of benign and malignant in highly integrated regions in bone single-photon emission computed tomography/computed tomography (SPECT/CT) using a three-dimensional deep convolutional neural network (3D-DCNN).

Methods

We examined 100 regions of 35 patients with bone SPECT/CT classified as benign and malignant by other examinations and follow-ups. First, SPECT and CT images were extracted at the same coordinates in a cube, with a long side two times the diameter of a high concentration in SPECT images. Next, we inputted the extracted image to DCNN and obtained the probability of benignity and malignancy. Integrating the output from DCNN of each SPECT and CT image provided the overall result. To validate the efficacy of the proposed method, the malignancy of all images was assessed using the leave-one-out cross-validation method; besides, the overall classification accuracy was evaluated. Furthermore, we compared the analysis results of SPECT/CT, SPECT alone, CT alone, and whole-body planar scintigraphy in the highly integrated region of the same site.

Results

The extracted volume of interest was 50 benign and malignant regions, respectively. The overall classification accuracy of SPECT alone and CT alone was 73% and 68%, respectively, while that of the whole-body planar analysis at the same site was 74%. When SPECT/CT images were used, the overall classification accuracy was the highest (80%), while the classification accuracy of malignant and benign was 82 and 78%, respectively.

Conclusions

This study suggests that DCNN could be used for the direct classification of benign and malignant regions without extracting the features of SPECT/CT accumulation patterns.
Enhancing cardiovascular research with whole-organ imaging
Authors: Rios Coronado Pamela E. , Red-Horse Kristy
Published: March 2021

Purpose of review

There have been tremendous advances in the tools available for surveying blood vessels within whole organs and tissues. Here, we summarize some of the recent developments in methods for immunolabeling and imaging whole organs and provide a protocol optimized for the heart.

Recent findings

Multiple protocols have been established for chemically clearing large organs and variations are compatible with cell type-specific labeling. Heart tissue can be successfully cleared to reveal the three-dimensional structure of the entire coronary vasculature in neonatal and adult mice. Obtaining vascular reconstructions requires exceptionally large imaging files and new computational methods to process the data for accurate vascular quantifications. This is a continually advancing field that has revolutionized our ability to acquire data on larger samples as a faster rate.

Historically, cardiovascular research has relied heavily on histological analyses that use tissue sections, which usually sample cellular phenotypes in small regions and lack information on whole tissue-level organization. This approach can be modified to survey whole organs but image acquisition and analysis time can become unreasonable. In recent years, whole-organ immunolabeling and clearing methods have emerged as a workable solution, and new microscopy modalities, such as light-sheet microscopy, significantly improve image acquisition times. These innovations make studying the vasculature in the context of the whole organ widely available and promise to reveal fascinating new cellular behaviors in adult tissues and during repair.
Oligometastatic prostatic cancer recurrence: role of salvage lymph node dissection (sLND) and radiation therapy-stereotactic body radiation therapy (RT-SBRT)
Authors: Ahmed Mohamed E. , Phillips Ryan M. , Sharma Vidit , Davis Brian J. , Karnes R. Jeffrey
Published: March 2021

Purpose of review

Metastases directed therapy (MDT) is an increasingly utilized modality in patients with oligometastatic prostate cancer (OMPC) recurrence. The purpose of our review is to discuss the recent literature on the safety and oncologic outcomes of this treatment approach.

Recent findings

Metastases directed therapy, in particular, stereotactic body radiation therapy (SBRT) and salvage lymph node dissection (sLND), has shown promising efficacy in patients with OMPC. Many case series report favorable outcomes with MDT as compared to hormonal deprivation therapy alone or surveillance. Of the few case series investigating the use of MDT as part of a multimodality approach in castrate-resistant OMPC, more favorable outcomes in comparison to the use of systemic treatment alone are reported.

With the recent advances in imaging techniques, particularly molecular imaging, management of OMPC has progressed rapidly in the last few years. The feasibility and benefits of MDT in OMPC have been demonstrated in prospective and retrospective series. Further prospective studies investigating the role of MDT to define optimal patient subgroups and management strategies are warranted.
What is next in second- and later-line treatment of metastatic renal cell carcinoma? review of the recent literature
Authors: Mori Keiichiro , Schmidinger Manuela , Quhal Fahad , Egawa Shin , Shariat Shahrokh F. , Grünwald Viktor
Published: March 2021

Purpose of review

The current treatment landscape of metastatic renal cell carcinoma has changed dramatically from the dominance of single-agent tyrosine kinase inhibitor (TKI) therapy to immune-checkpoint inhibitor (ICI)-based combinations in recent years. However, the optimal subsequent therapy remains ill-defined owing to the novelty of this approach.

Recent findings

Treatment with TKIs after failure of single or dual ICI therapies may result in robust clinical efficacy. Nonetheless, there is a trend toward lower efficacy of TKIs after previous ICI–TKI combination therapy. Currently, tivozanib is the only drug whose third- and later-line use after failure of TKI and ICI is supported by evidence, with significantly longer progression-free survival and higher objective response rates than sorafenib. Data from retrospective studies highlight the safety and clinical activity of ICI rechallenge.

Overall, the level of evidence remains low. Treatment after failure of dual ICI therapy is not well defined and may consist of any available TKI. Although first-line use of TKI is less common, strong evidence suggests cabozantinib or nivolumab as standard options in that setting. The recommendations after first-line TKI–ICI therapy failure mirror this recommendation, although the data are less robust.
Metastatic nonclear renal cell carcinoma current review in evolving treatment strategies
Authors: Suárez Cristina , Díaz-Mejía Nely , Morales-Barrera Rafael , González Macarena , Mateo Joaquin , Carles Joan
Published: March 2021

Purpose of review

Renal cell carcinoma (RCC) is the 6th most often diagnosed cancer in men and the 10th in women. Nearly 75% of the renal cancer cases are clear cell histologic subtype, whereas nonclear cell histologies represent the remaining 25%. Treatment options for clear renal type are well established. However, as nonclear RCC represents a heterogenous and less frequent group. Current treatment options for these tumors are limited and mostly based on evidence derived from small phase II clinical trials. The present review aims to provide an update of the available treatment options for nonclear RCC.

Recent findings

In the past decade, the vascular endothelial growth factor tyrosine kinase inhibitor, sunitinib, and mammalian target of rapamycin inhibitors, everolimus, and temsirolimus, have demonstrated limited efficacy in nonclear RCC. Recent studies with MET inhibitors and immunotherapy-based combinations have proven promising activity, especially in certain subgroups of patients, such as patients with MET-driven disease or patients with sarcomatoid features RCC.

Here, we report currently available data about biology and treatment of nonclear cell RCC.
Individualizing renal cell carcinoma treatment through biomarkers discovery in the era of immune checkpoint inhibitors: where do we stand?
Authors: Porta Camillo , Cosmai Laura , Rizzo Mimma
Published: March 2021

Purpose of review

The treatment landscape of metastatic renal cell carcinoma has greatly evolved over the past fifteen years, leading to a significant improvement in the outcome of our patients. However, there is still an urgent need for predictive biomarkers that could guide our treatment selection, especially in the present era of immune-based treatments.

Recent findings

A number of putative biomarkers of immunotherapy activity have been proposed over the past few years, including PD-L1 immunohistochemical expression, tumor mutational burden, neoantigens load, insertions and deletions, complex gene signatures, as well as lymphocytic subpopulations (either circulating or tumor-infiltrating). However, despite preliminary intriguing findings, no biomarker for immune checkpoint activity has emerged so far, that could be used in everyday clinical practice, mainly due to preliminary, or frankly, conflicting results.

The quest for an ‘ideal’ biomarker, which should be characterized by adequate specificity, sensibility, predictive (and not just prognostic) value, robustness, reproducibility, ease of evaluation and low cost, is still ongoing.
Salvage therapy for localized recurrences of penile cancer
Authors: Saidian Ava , Ceballos Brian , Necchi Andrea , Baumgarten Adam S. , Spiess Philippe E.
Published: March 2021

Purpose of review

To review the current literature and guidelines regarding salvage therapy for local and regional recurrence of primary penile cancer.

Recent findings

While invasive surgical management has not significantly changed, penile sparing treatments (PSTs) may have a promising role in the management of local recurrence. Penile sparing surgeries do appear to have higher rates of recurrence. However, the overall survival rate is comparable to that of partial and total penectomies. Additionally, a combination of therapies may have a more profound effect on management of penile cancer.

Clinicians must discuss the role of each type of therapy for penile cancer with their patients, and tailor their management to the extent of disease in each patient. While it is important to discuss the balance between quality of life and rates of relapse, one must also emphasize the rates of overall survival in patients with local recurrence who are treated with PSTs.
Dedifferentiation in Breast Metastasis of Endometrial Carcinoma: A Diagnostic Dilemma
Authors: Shah Varsha I. , Morgan Sian E. , Köbel Martin , Lee Cheng-Han , McCluggage W. Glenn
Published: March 2021

Most breast tumors are primary to this site; breast metastasis of endometrial origin is extremely rare. Low-grade endometrioid endometrial carcinomas can undergo dedifferentiation to undifferentiated carcinoma but such transformation at a metastatic site has been reported previously in only 2 cases. We report a case of dedifferentiation occurring in an isolated solitary breast metastasis of a low-grade endometrioid endometrial carcinoma. A 64-yr-old woman presented with a breast mass 2 yr after initial diagnosis of a grade 1 FIGO stage IIIA endometrioid endometrial carcinoma. Ultrasound guided biopsy of the breast mass showed a grade 1 endometrioid carcinoma which was diffusely estrogen receptor and PAX8-positive, consistent with metastasis from the previous endometrial carcinoma. The tumor initially responded to Letrozole therapy but then abruptly increased in size. Mastectomy revealed a poorly differentiated malignant tumor with morphology and immunophenotype (including loss of ARID1A and ARID1B immunoreactivity) consistent with undifferentiated endometrial carcinoma with no residual low-grade component. Awareness of the phenomenon of dedifferentiation of endometrial carcinoma in a metastatic site is important to avoid misdiagnosis as a primary breast cancer or metastasis from another primary site.
How Do We Meet the Challenge of Chimeric Antigen Receptor T-Cell Therapy for Solid Tumors?
Authors: Schoenfeld Adam J. , O'Cearbhaill Roisin E.
Published: March 2021

Immune checkpoint inhibition has vastly improved the treatment of solid tumors, but most patients do not experience durable clinical benefit, so novel immunotherapeutic approaches are needed. Autologous T cells genetically engineered to express chimeric antigen receptors (CARs) have led to unprecedented clinical success in hematologic malignancies, and increasing efforts are actively being pursued to translate these benefits to the solid tumor arena. However, solid tumors present unique challenges for CAR T-cell development. In this review, we examine the potential barriers to progress and present emerging approaches to overcome these challenges with CAR therapy in solid tumors.
Central nervous system infections associated with neurologic devices
Authors: Bloch Karen , Hasbun Rodrigo
Published: March 2021

Purpose of review

To review recent data on the epidemiology, microbiology, diagnosis, and management of central nervous system (CNS) infections associated with neurologic devices.

Recent findings

The increasing use of implanted neurologic devices has led to an increase in associated infections. Cerebrospinal fluid (CSF) inflammation may be present after a neurosurgical procedure, complicating the diagnosis of CNS infection. Newer biomarkers such as CSF lactate and procalcitonin show promise in differentiating infection from other causes of CSF inflammation. Molecular diagnostic tests including next-generation or metagenomic sequencing may be superior to culture in identifying pathogens causing healthcare-associated ventriculitis and meningitis.

Neurologic device infections are serious, often life-threatening complications. Rapid recognition and initiation of antibiotics are critical in decreasing morbidity. Device removal is usually required for cure.
Neuroradiology of infectious diseases
Authors: Singh Sonia Kaur , Hasbun Rodrigo
Published: March 2021

Purpose of review

Early diagnosis of central nervous system (CNS) infections is crucial given high morbidity and mortality. Neuroimaging in CNS infections is widely used to aid in the diagnosis, treatment and to assess the response to antibiotic and neurosurgical interventions.

Recent findings

The Infectious Diseases Society of America (IDSA) guidelines have clear recommendations for obtaining a computerized tomography of the head (CTH) prior to lumbar puncture (LP) in suspected meningitis. In the absence of indications for imaging or in aseptic meningitis, cranial imaging is of low utility. In contrast, cranial imaging is of utmost importance in the setting of encephalitis, bacterial meningitis, ventriculitis, bacterial brain abscess, subdural empyema, epidural abscess, neurobrucellosis, neurocysticercosis, and CNS tuberculosis that can aid clinicians with the differential diagnosis, source of infection (e.g., otitis, sinusitis), assessing complications of meningitis (e.g., hydrocephalus, venous sinus thrombosis, strokes), need for neurosurgical interventions and to monitor for the response of therapy. Novel imaging techniques such as fast imaging employing steady-state acquisition (FIESTA), susceptibility-weighted imaging (SWI), and chemical exchange saturation transfer (CEST) contrast are briefly discussed.

Though the radiological findings in CNS infections are vast, certain patterns along with clinical clues from history and examination often pave the way to early diagnosis. This review reiterates the importance of obtaining cranial imaging when necessary, and the various radiological presentations of commonly encountered CNS infections.
Facial Nerve Paraganglioma Masquerading as Bell palsy: A Reconstructive Pitfall
Authors: Seu Michelle , Eggerstedt Michael , Ghai Ritu , Dorafshar Amir H. , Wiet R. Mark
Published: March 2021

Background:

Facial paralysis can drastically diminish satisfaction in one's social interactions and overall quality of life. Bell palsy is the most common cause of facial palsy, however, a diagnosis of “atypical” BP may originate from an entirely different pathological process. This case highlights a rare case of facial nerve paraganglioma, initially misdiagnosed as BP, that resulted in facial paralysis from neoplastic invasion of the facial nerve.

Case presentation:

A 66-year old Hispanic woman with systemic lupus erythematosus presented to the plastic surgery clinic with complaints of drooling and being unable to smile. She experienced several episodes of left facial paralysis and was diagnosed with BP at an outside institution. Each episode was only partially responsive to steroid therapy. Imaging at our institution demonstrated lobulated enhancement along the vertical and extratemporal segments of the facial nerve, which prompted surgical intervention. The patient underwent left transmastoid approach for removal of the lesion involving the facial nerve followed by facial nerve reanimation via gracilis free flap without complication.

Conclusions:

This report outlines an extraordinarily rare case of a patient with facial nerve paraganglioma. This case represents the importance of reconstructive surgeons in considering a thorough diagnostic work-up with imaging and histopathology in the setting of idiopathic facial paralysis. Successful collaboration between otolaryngology and plastic surgery made streamlined diagnosis and surgical treatment of this unique case possible.