bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Utility of Different Approaches for Detection of Late Pseudoprogression in Glioblastoma With O-(2-[18F]Fluoroethyl)-l-Tyrosine PET
Authors: Kertels Olivia , Mihovilovic Milena I. , Linsenmann Thomas , Kessler Almuth F. , Tran-Gia Johannes , Kircher Malte , Brumberg Joachim , Monoranu Camelia Maria , Samnick Samuel , Ernestus Ralf-Ingo , Löhr Mario , Meyer Philipp T. , Lapa Constantin
Published: July 2019

Purpose

PET/CT using O-(2-[18F]fluoroethyl)-l-tyrosine (18F-FET) has proven valuable in differentiating tumor recurrence and progression from therapy-induced changes. This study aimed to investigate the diagnostic performance of several analytic approaches in the setting of suspected late pseudoprogression (PsP) in glioblastoma multiforme (GBM).

Methods

Retrospective analysis of tumor recurrence was performed in 36 patients with histopathologically confirmed GBM and suspicion of recurrence/disease progression more than 12 weeks from cessation of irradiation based on MRI and Response Assessment in Neuro-Oncology working group criteria. For differentiation of late PsP from true tumor recurrence, images were analyzed semiquantitatively employing tumor-to-brain ratios using 5 different approaches for tumor and normal brain reference region definition, respectively. Histopathology and/or clinical and imaging follow-up served as reference. Respective areas under the receiver operating characteristic curve were compared.

Results

18F-FET PET was able to reliably differentiate PsP from true tumor progression with areas under the receiver operating characteristic curve ranging from 0.80 to 0.88 (all P < 0.01). Irrespective of the approach chosen, the classification differences between the applied methods were not significant (all P > 0.05), albeit approaches focusing on voxels with the highest uptake tended to perform superior.

Conclusions

Irrespective of the analytical approach, 18F-FET PET is a robust tool for detection of late PsP with only minor differences between different analytical approaches. However, methodological standardization and harmonization are needed to ensure comparability between different centers.
18F-FDG PET/MR in an Atypical Pediatric Solid Pseudopapillary Pancreatic Tumor
Authors: Cavaliere Annachiara , Giraudo Chiara , Zuliani Monica , Cecchin Diego , Quaia Emilio
Published: July 2019

MR and 18F-FDG PET/MR images of a 15-year-old boy with recurrent mild abdominal pain and hyperamylasemia demonstrating a pancreatic head lesion hypointense on the T1-weighted and slightly hyperintense on the T2-weighted images, with very small pseudocystic areas, restricted diffusion on the apparent diffusion coefficient map, and focal FDG uptake. No other pathologic findings such as enlarged lymph nodes, vascular invasion, metastases, dilatation of the main pancreatic duct, or pathologic uptake of the parotid glands were detected. The MR features, even if atypical, together with the focal uptake, allowed the diagnosis of pediatric solid pseudopapillary pancreatic tumor, which was then confirmed by histology.
18F-FDG PET/CT in Lymphomatoid Papulosis Mimicking Primary Cutaneous Anaplastic Large Cell Lymphoma
Authors: Senthil Raja , Gangadharan V. P. , Visakh R. Arun , Mahadevan Pushpa , Pratap Thara , Jayasree M. G.
Published: July 2019

Lymphomatoid papulosis is a benign self-healing condition, presenting as papulonodular skin eruptions and mimicking malignant cutaneous lymphomas histopathologically. 18F-FDG PET/CT findings in this benign condition have not been described in detail in the literature. We present a case of lymphomatoid papulosis mimicking primary cutaneous anaplastic large cell lymphoma histopathologically and demonstrating intensely FDG-avid cutaneous lesions on 18F-FDG PET/CT, which disappear spontaneously in the follow-up scan.
Low 68Ga–PSMA PET/CT Uptake in Chronic Intramuscular Nodular Fasciitis
Authors: Plouznikoff Nicolas , Artigas Carlos , Karfis Ioannis , Flamen Patrick
Published: July 2019

Nodular fasciitis is an uncommon benign mass-forming myofibroblastic proliferation, most frequently found in the upper limbs, with only rare intramuscular cases. We describe herein a case of chronic nodular fasciitis of the left triceps muscle with a low 68Ga-labeled prostate-specific membrane antigen (PSMA) ligand uptake on PET/CT. 68Ga-PSMA ligands bind to PSMA-expressing prostate cancer cells, but uptake has also been demonstrated in other solid neoplasms and various benign lesions. Nodular fasciitis should be included in the differential diagnosis of soft tissue lesions with variable 68Ga-PSMA uptake.
Multiple Solitary Plasmacytomas With Multifocal Bone Involvement Diagnosed With 68Ga–Prostate-Specific Membrane Antigen PET/CT
Authors: Alabed Yazan Z.
Published: July 2019

A 63-year-old man with elevated prostate-specific antigen serum levels and enlarged prostate gland underwent ultrasound-guided transrectal biopsy, which did not reveal any evidence of malignancy. In order to help guidance of repeat biopsy, 68Ga–prostate-specific membrane antigen–targeted ligand PET (PSMA PET/CT) was ordered. PET/CT scan showed no abnormal PSMA expression within the prostate gland. There were, however, multiple PSMA-expressing osteolytic lesions throughout the axial skeleton. Bone lesion biopsy obtained for final workup revealed multiple solitary plasmacytomas with multifocal bone involvement. This rare case highlights the utility of PSMA PET/CT in diagnosing nonprostate malignancies.
Ileal Neuroendocrine Tumor With Bilateral Breast and Ovarian Metastases
Authors: Tripathy Sarthak , Naswa Niraj , Jha Pragati , Reddy Sreenivasa , Parida Girish Kumar
Published: July 2019

Metastasis to the breast is a rare occurrence and constitutes less than 2% of all breast tumors. Similarly, ovarian metastases from neuroendocrine tumors are also uncommon, and if the adnexal masses are bilateral, then the chances of it being metastatic rather than being primary range from 88% to 94%. We present a case of 61-year-old woman who in the course of workup for abdominal pain and diarrhea was eventually diagnosed as ileal neuroendocrine tumor with breast, ovarian, and lymph nodal metastases on 68Ga-DOTANOC PET/CT scan.
A Stepwise Approach to Identify the Clinical Role of 18F-FDG PET/CT in Patients With Suspicious Bone Metastasis From an Unknown Primary Site
Authors: Chowdhury Md. Sunny Anam , Jeon Subin , Bom Hee-Seung , Min Jung-Joon , Kwon Seong Young
Published: July 2019

In patients with suspicious bone metastasis, the clinical impact of PET/CT for differential diagnosis and primary lesion identification could differ according to 18F-FDG uptake patterns. We report the findings in patients with suspicious bone metastasis who underwent PET/CT for the evaluation of the primary lesion site and were classified in a stepwise manner, first based on the multiplicity of positive bone uptake and then the presence of extraskeletal uptake.
High-Resolution PET Cisternography With 64Cu-DOTA for CSF Leak Detection
Authors: Freesmeyer Martin , Schwab Matthias , Besteher Bianca , Gröber Sebastian , Waschke Albrecht , Drescher Robert
Published: July 2019

Intracranial hypotension may lead to chronic, debilitating symptoms, and severe complications. The underlying CSF leak may be difficult to localize. To establish a new diagnostic option for the detection of CSF leaks, 64Cu-DOTA was developed as a tracer for PET imaging. PET/CT imaging was possible with high resolution and without complications. In one patient, the exact site of a dural tear was identified, enabling successful surgical treatment. PET cisternography with 64Cu-DOTA appears to be safe and able to locate a CSF leak. It has the potential to be a problem-solving modality in cases with inconclusive CT, MR, and/or scintigraphic findings.
Implementation of a Modified Enhanced Recovery Protocol in Cleft Palate Repairs
Authors: Hush Stefanie E. , Chen Jenny T. , Brady Colin M. , Soldanska Magdalena , Nusz David J. , Rhinehart Darren L. , Heiss Kurt , Crowley Connor , Williams Joseph K.
Published: July 2019

Aims:

Enhanced Recovery after Surgery (ERAS) protocols have been shown to improve patient outcomes in numerous adult surgical populations, but there are few known standards for their use in pediatric patients. To assess the effectiveness in pediatric craniofacial surgery, we present our results following the application of a modified ERAS protocol for patients undergoing primary palatoplasty.

Methods:

A modified ERAS program was developed and implemented in a multidisciplinary manner. The primary components of the protocol included: (1) administration of gabapentinoids, (2) minimal perioperative narcotic use, and (3) post-operative pain control using nonnarcotic first-line agents. Fifty patients were collected prospectively, assigned to the modified ERAS protocol and compared to historic controls. We reviewed patient demographics, narcotic use, length of stay (LOS), oral intake, and complication rates.

Results:

Between April 2017 and June 2018, 50 patients underwent palatoplasty under the modified ERAS protocol. The mean age (control: 9.7 ± 2.3 months; ERAS: 9.9 ± 1.6 months), weight (8.8 ± 1.3 kg; 8.6 ± 1.3 kg), and comorbidities did not vary between the groups. ERAS patients evidenced an increase in oral intake normalized per LOS (22.3 mL/h vs 15.4 mL/h). Total narcotic usage (morphine equivalents) during each phase of care was greater in the controls compared with ERAS (Intraop: 3.71 mg vs 0.12 mg; PACU: 0.51 mg vs 0.05 mg; Postop: 2.6 mg vs 0.07 mg). The implementation of this protocol led to a 36.6% decrease in LOS (1.83 days vs 1.16 days) without an increase in perioperative complications.

Conclusions:

Implementation of a modified ERAS protocol provided effective perioperative pain control allowing narcotic minimization, increased post-operative oral intake, and a shorter LOS without an increased complication rate.
Timing of Tracheotomy in Patients With Severe Traumatic Brain Injury
Authors: Lu Wenchao , Wu Tao , Cui Ping , Zhang Junfeng , Sheng Xudong , Ding Zhibin
Published: July 2019

Background:

Tracheotomy has played an important role in the treatment of patients with severe traumatic brain injury (TBI), the appropriate tracheotomy time will affect the prognosis of patients. However, the timing of tracheostomy after severe TBI remains controversial. To find the optimal time for tracheostomy, the authors compared the effects of early tracheostomy (ET) versus late tracheostomy (LT) on TBI-related outcomes and prognosis.

Methods:

The clinical data of 98 patients with severe TBI treated by tracheotomy at NICU, First Affiliated Hospital of Xi’an Medical University, January 2017 to January 2018, were analyzed retrospectively. According to the time of the tracheotomy during the treatment, the patients were divided into ET group (after admission <3 days) and LT group (>3 days after admission). The NICU stay, hospital stay, long duration of antibiotic use, pneumonia rates, mortality rates, improvement of nerve function, complications of tracheotomy, and treatment cost were compared between the 2 groups.

Results:

The NICU stay, hospitalization stay, and antibiotic use time of patients in the ET group were shorter than those in the LT group (P < 0.05). The pneumonia rates and the cost of hospitalization in the ET group were lower than those in the LT group (P < 0.05). The complications of the tracheostomy, mortality, and neurologic function improvements were not statistically significant in the 2 groups (P > 0.05).

Conclusion:

For severe TBI, ET can reduce the NICU stay, hospitalization stay, length of antibiotic use, and reduce the incidence rates of pneumonia and the cost of hospitalization compared with LT, but there is no significant improvement in the mortality rates and neurologic function of patients during hospitalization.
Use of Unsintered Hydroxyapatite and Poly-l-lactic Acid Composite Sheets for Management of Orbital Wall Fracture
Authors: Tsumiyama Shinya , Umeda Go , Ninomiya Kunitoshi , Miyawaki Takeshi
Published: July 2019

Although unsintered hydroxyapatite and poly-l-lactic acid (u-HA/PLLA) composite sheets have various applications, such as in craniomaxillofacial fractures, orthognathic surgery, and orthopedic surgery, and have been proven to be safe and effective, no studies have reported the use of u-HA/PLLA composite sheets for orbital wall reconstruction with long-term follow-up. This study reports our preliminary results using the u-HA/PLLA composite sheet for orbital wall fractures. The SuperFIXSORB MX sheet (u-HA/PLLA composite sheet; Takiron, Tokyo, Japan), with size of 30 × 50 mm and thickness of 0.5 mm, was used in all cases of hard reconstruction of the orbital bone defect. Seventy-two patients with acute orbital wall fractures (within 2 weeks after sustaining the injury) treated at the Jikei University between January 2014 and August 2016 were included. The authors evaluated the postoperative complications and the operability of the material. The authors did not observe any postoperative complications, such as infection, postoperative diplopia, or enophthalmos, due to the use of the u-HA/PLLA composite sheet. In pure orbital fractures (orbital fractures only), the mean (±standard deviation) operation time was significantly longer with combined inferior and medial wall fractures (201.1 ± 36.6 minutes; n = 11) than with inferior wall or medial wall fractures only (135.0 ± 54.4 minutes; n = 51) (Mann–Whitney U test, P < 0.001). The U-HA/PLLA composite sheet is safe and can be used for orbital wall fracture reconstruction. Further long-term functional and aesthetic assessments for infection, ocular movement disorder, enophthalmos, and any other complication are necessary.
Water-Filled Vesicles of Choroid Plexus Tumors
Authors: Aydin Mehmet Dumlu , Kanat Ayhan , Karaavci Nuh Cagri , Sahin Hakan , Ozmen Sevilay
Published: July 2019

Objective:

Choroid plexus cysts are the most common neuro-epithelial cysts.

Methods:

The authors describe 2 cases. The first case is a 1-year-old child presenting with hydrocephalus and cyst of the choroid plexus. The child was treated with endoscopic fenestration of the cysts.

Results:

The histological examination of the cyst wall was consistent with choroid epithelium and water-filled vesicles. The second case is a 63 year old male with a highly vascularized tumor extending to choroid plexus. A quaductus Silvius was obstructed by the tumor. The histopathologic examination of choroid plexus showed a low number, water-vesicles.

Conclusions:

According to our knowledge, there are no previous reports of water-filled vesicles with choroid plexus cyst causing hydrocephalus. The first case is a good example of over secretion of cerebrospinal fluid (CSF) with the water-filled vesicle. The second case with low number of water filled vesicle shows that the cause of hydrocephalus is not over production of CSF, it is blockage of the CSF pathway in Aquaductus Silvius by the tumor itself. These 2 cases are illustrative and more importantly highlight the need to study for water-filled vesicles in these kind of cases.
Inguinal Vascular Surgical Wound Protection by Incisional Negative Pressure Wound Therapy
Authors: Hasselmann Julien , Björk Jonas , Svensson-Björk Robert , Acosta Stefan
Published: July 2019

Objective:

A randomized controlled trial (RCT) was undertaken to determine the effect of negative pressure wound therapy (NPWT) on closed incisions after inguinal vascular surgery regarding surgical site infections (SSIs) and other wound complications.

Background:

SSIs are a major concern in open vascular procedures involving the inguinal region. Prophylactic NPWT on closed incisions has shown promising results, but the quality of evidence can be debated. This study aims to objectively evaluate whether NPWT on sutured inguinal incisions after elective vascular surgery can decrease the incidence of surgical site complications.

Methods:

One hundred thirty-nine patients undergoing elective open vascular surgery with inguinal incisions received either NPWT or a standard dressing. Patients with bilateral incisions randomly received a dressing on one incision and the opposite dressing on the other. The primary endpoints were SSI or other wound complications at 3 months, assessed by wound care experts blinded to the treatment arm and using objective wound assessment criteria (ASEPSIS-score). Statistical analysis was performed on an intention-to-treat basis and obtained P values from analyses in the uni- and bilateral groups were combined to an overall P value using Fisher's method for combining P values.

Results:

The incidence of SSI was reduced in the NPWT group compared with the control group [11.9% vs 29.5% in the unilateral group (n = 120), 5.3% vs 26.3% in the bilateral group (n = 19), respectively; combined P = 0.02]. No differences regarding other surgical site complications were observed between the groups.

Conclusion:

NPWT on closed inguinal vascular surgical incisions in elective patients reduces the incidence of SSI.
Radiographic and Serologic Predictors of Pathologic Major Response to Preoperative Therapy for Pancreatic Cancer
Authors: Perri Giampaolo , Prakash Laura , Wang Huamin , Bhosale Priya , Varadhachary Gauri R. , Wolff Robert , Fogelman David , Overman Michael , Pant Shubham , Javle Milind , Koay Eugene , Herman Joseph , Kim Michael , Ikoma Naruhiko , Tzeng Ching-Wei , Lee Jeffrey E. , Katz Matthew H. G.
Published: July 2019

Objective:

We sought to identify potential radiologic and serologic markers of pancreatic tumor response to therapy, using pathologic major response (pMR) as the objective endpoint.

Background:

We previously demonstrated that a pMR to preoperative therapy, defined as detection of <5% viable cancer cells in the surgical specimen on histopathological analysis, is an important prognostic factor for patients with pancreatic ductal adenocarcinoma (PDAC).

Methods:

Pretreatment and posttreatment computed tomography scans of consecutive patients who received preoperative chemotherapy and/or (chemo)radiation before pancreatectomy for PDAC between January 2010 and December 2018 were rereviewed. Response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, other radiographic changes in tumor size and anatomic extent, and posttreatment CA 19-9 levels were compared between patients who did and did not have a pMR on final histopathologic analysis of their surgical specimens.

Results:

A total of 290 patients with localized PDAC underwent pancreatectomy between 2010 and 2018 after receiving preoperative chemotherapy (n = 36; 12%), (chemo)radiation (n = 87; 30%), or both (n = 167; 58%). Among them, 28 (10%) experienced pMR, including 9 (3.1%) who experienced pathologic complete response. On multivariable logistic regression, low posttreatment CA 19-9 level, RECIST partial response, and reduction in tumor volume were confirmed to be independently associated with pMR (P < 0.01).

Conclusions:

We identified serologic and radiographic indicators of pMR that could help inform the delivery of preoperative therapy to patients with PDAC.
Long-term Reintervention After Endovascular Abdominal Aortic Aneurysm Repair
Authors: Columbo Jesse A. , Martinez-Camblor Pablo , O’Malley Alistair James , Suckow Bjoern D. , Hoel Andrew W. , Stone David H. , Schanzer Andres , Schermerhorn Marc L. , Sedrakyan Art , Goodney Philip P.
Published: July 2019

Objective:

To describe the long-term reintervention rate after endovascular abdominal aortic aneurysm repair (EVR), and identify factors predicting reintervention.

Summary of Background Data:

EVR is the most common method of aneurysm repair in America, and reintervention after EVR is common. Clinical factors predicting reintervention have not been described in large datasets with long-term follow-up.

Methods:

We studied patients who underwent EVR using the Vascular Quality Initiative registry linked to Medicare claims. Our primary outcome was reintervention, defined as any procedure related to the EVR after discharge from the index hospitalization. We used classification and regression tree modeling to inform a multivariable Cox-regression model predicting reintervention after EVR.

Results:

We studied 12,911 patients treated from 2003 to 2015. Mean age was 75.5 ± 7.3 years, 79.9% were male, and 89.1% of operations were elective. The 3-year reintervention rate was 15%, and the 10-year rate was 33%. Five factors predicted reintervention: operative time ≥3.0 hours, aneurysm diameter ≥6.0 cm, an iliac artery aneurysm ≥2.0 cm, emergency surgery, and a history of prior aortic surgery. Patients with no risk factors had a 3-year reintervention rate of 12%, and 10-year rate of 26% (n = 7310). Patients with multiple risk factors, such as prior aortic surgery and emergent surgery, had a 3-year reintervention rate 72%, (n = 32). Modifiable factors including EVR graft manufacturer or supra-renal fixation were not associated with reintervention (P = 0.76 and 0.79 respectively).

Conclusions:

All patients retain a high likelihood of reintervention after EVR, but clinical factors at the time of repair can predict those at highest risk.
Histologic Subtype Defines the Risk and Kinetics of Recurrence and Death for Primary Extremity/Truncal Liposarcoma
Authors: Bartlett Edmund K. , Curtin Christina E. , Seier Kenneth , Qin Li-Xuan , Hameed Meera , Yoon Sam S. , Crago Aimee M. , Brennan Murray F. , Singer Samuel
Published: July 2019

Objective:

We sought to define the prognostic significance of histologic subtype for extremity/truncal liposarcoma (LPS).

Background:

LPS, the most common sarcoma, is comprised of 5 histologic subtypes. Despite their distinct behaviors, LPS outcomes are frequently reported as a single entity.

Methods:

We analyzed data on all patients from a single-institution prospective database treated from July 1982 to September 2017 for primary, nonmetastatic, extremity or truncal LPS of known subtype. Clinicopathologic variables were tested using competing risk analyses for association with disease-specific death (DSD), distant recurrence (DR), and local recurrence (LR).

Results:

Among 1001 patients, median follow-up in survivors was 5.4 years. Tumor size and subtype were independently associated with DSD and DR. Size, subtype, and R1 resection were independently associated with LR. DR was most frequent among pleomorphic and round cell LPS; the former recurred early (43% by 3 years), and the latter over a longer period (23%, 3 years; 37%, 10 years). LR was most common in dedifferentiated LPS, in which it occurred early (24%, 3 years; 33%, 5 years), followed by pleomorphic LPS (18%, 3 years; 25%, 10 years).

Conclusions:

Histologic subtype is the factor most strongly associated with DSD, DR, and LR in extremity/truncal LPS. Both risk and timing of adverse outcomes vary by subtype. These data may guide selective use of systemic therapy for patients with round cell and pleomorphic LPS, which carry a high risk of DR, and radiotherapy for LPS subtypes at high risk of LR when treated with surgery alone.
Metabolic Surgery Reduces the Risk of Progression From Chronic Kidney Disease to Kidney Failure
Authors: Funes David Romero , Blanco David Gutierrez , Gómez Camila Ortiz , Frieder Joel S. , Menzo Emanuele Lo , Szomstein Samuel , White Kevin P. , Rosenthal Raul J.
Published: July 2019

Introduction:

According to the Chronic Kidney Disease Prognosis Consortium (CKD-PC), 1 in 4 patients age ≥ 65 in North America has some form of chronic kidney disease (CKD), while 3 in 100 will progress to kidney failure. The aim of this study was to evaluate whether bariatric surgery alters the progression of CKD to kidney failure in patients who are severely obese.

Methods:

We conducted a retrospective review of all patients who underwent bariatric surgery at our institution over the last 16 years. Kidney function and injury were assessed using the average estimated glomerular filtration rate and urinary albumin-to-creatinine ratio (uACR) over 3 months preoperatively and postoperative at 12-month follow-up. The risk of progression from CKD to kidney failure was assessed using the Chronic Kidney Disease Prognosis Consortium (CKD-PC) equation.

Results:

Out of 2924 patients reviewed over this period of time, 69 (2.4%) had the recorded data necessary to assess kidney injury and the risk of disease progression to kidney failure. Patients within moderate and severe stages of CKD-related albuminuria improved the most at 12-month follow-up (by 48% and 79%; P = 0.0001 and P = 0.025, respectively). This translated to a relative risk reduction for progression to kidney failure in CKD ≥ stage 3 patients of 70% at 2 years and 60% at 5 years (both P = 0.001).

Conclusions:

Bariatric surgery seems to improve kidney injury, especially among patients with the most severe stages of CKD. Marked 2- and 5-year risk reduction in the progression from CKD to kidney failure was observed.
Computer Vision Analysis of Intraoperative Video
Authors: Hashimoto Daniel A. , Rosman Guy , Witkowski Elan R. , Stafford Caitlin , Navarette-Welton Allison J. , Rattner David W. , Lillemoe Keith D. , Rus Daniela L. , Meireles Ozanan R.
Published: July 2019

Objective(s):

To develop and assess AI algorithms to identify operative steps in laparoscopic sleeve gastrectomy (LSG).

Background:

Computer vision, a form of artificial intelligence (AI), allows for quantitative analysis of video by computers for identification of objects and patterns, such as in autonomous driving.

Methods:

Intraoperative video from LSG from an academic institution was annotated by 2 fellowship-trained, board-certified bariatric surgeons. Videos were segmented into the following steps: 1) port placement, 2) liver retraction, 3) liver biopsy, 4) gastrocolic ligament dissection, 5) stapling of the stomach, 6) bagging specimen, and 7) final inspection of staple line. Deep neural networks were used to analyze videos. Accuracy of operative step identification by the AI was determined by comparing to surgeon annotations.

Results:

Eighty-eight cases of LSG were analyzed. A random 70% sample of these clips was used to train the AI and 30% to test the AI's performance. Mean concordance correlation coefficient for human annotators was 0.862, suggesting excellent agreement. Mean (±SD) accuracy of the AI in identifying operative steps in the test set was 82% ± 4% with a maximum of 85.6%.

Conclusions:

AI can extract quantitative surgical data from video with 85.6% accuracy. This suggests operative video could be used as a quantitative data source for research in intraoperative clinical decision support, risk prediction, or outcomes studies.
A Novel Validated Recurrence Risk Score to Guide a Pragmatic Surveillance Strategy After Resection of Pancreatic Neuroendocrine Tumors
Authors: Zaidi Mohammad Y. , Lopez-Aguiar Alexandra G. , Switchenko Jeffrey M. , Lipscomb Joseph , Andreasi Valentina , Partelli Stefano , Gamboa Adriana C. , Lee Rachel M. , Poultsides George A. , Dillhoff Mary , Rocha Flavio G. , Idrees Kamran , Cho Clifford S. , Weber Sharon M. , Fields Ryan C. , Staley Charles A. , Falconi Massimo , Maithel Shishir K.
Published: July 2019

Objective:

Despite heterogeneous biology, similar surveillance schemas are utilized after resection of all pancreatic neuroendocrine tumors (PanNETs). Given concerns regarding excess radiation exposure and financial burden, our aim was to develop a prognostic score for disease recurrence to guide individually tailored surveillance strategies.

Methods:

All patients with primary nonfunctioning, nonmetastatic well/moderately differentiated PanNETs who underwent curative-intent resection at 9-institutions from 2000 to 2016 were included (n = 1006). A Recurrence Risk Score (RRS) was developed from a randomly selected derivation cohort comprised of 67% of patients and verified on the validation-cohort comprised of the remaining 33%.

Results:

On multivariable analysis, patients within the derivation cohort (n = 681) with symptomatic tumors (jaundice, pain, bleeding), tumors >2 cm, Ki67 >3%, and lymph node (LN) (+) disease had increased recurrence. Each factor was assigned a score based on their weighted odds ratio that formed a RRS of 0 to 10: symptomatic = 1, tumor >2 cm = 2, Ki67 3% to 20% = 1, Ki67 >20% = 6, LN (+) = 1. Patients were grouped into low- (RRS = 0–2; n = 247), intermediate-(RRS = 3–5; n = 204), or high (RRS = 6–10; n = 9)-risk groups. At 24 months, 33% of high RRS recurred, whereas only 2% of low and 14% of intermediate RRS recurred. This persisted in the validation cohort (n = 325).

Conclusions:

This international, novel, internally validated RRS accurately stratifies recurrence-free survival for patients with resected PanNETs. Given their unique recurrence patterns, surveillance intervals of 12, 6, and 3 months are proposed for low, intermediate, and high RRS patients, respectively, to minimize radiation exposure and optimize cost/resource utilization.
Trends in Treatment of T1N0 Esophageal Cancer
Authors: Semenkovich Tara R. , Hudson Jessica L. , Subramanian Melanie , Mullady Daniel K. , Meyers Bryan F. , Puri Varun , Kozower Benjamin D.
Published: July 2019

Objective:

The purpose of this study was to explore nationwide trends in treatment and outcomes of T1N0 esophageal cancer.

Background:

Endoscopic treatment has become an accepted option for early-stage esophageal cancer, but nationwide utilization rates and outcomes are unknown.

Methods:

T1N0 esophageal cancers were identified in the National Cancer Database from 2004 to 2014. We assessed trends in treatment; compared endoscopic therapy, esophagectomy, chemoradiation, and no treatment; and performed a subgroup analysis of T1a and T1b patients from 2010 to 2014 (AJCC 7).

Results:

A total of 12,383 patients with clinical T1N0 esophageal cancer were analyzed. Over a decade, use of endoscopic therapy increased from 12.7% to 33.6%, whereas chemoradiation and esophagectomy decreased, P < 0.01. The rise in endoscopic treatment of T1a disease from 42.7% to 50.6% was accompanied by a decrease in esophagectomies from 21.7% to 12.8% (P < 0.01). For T1b disease, the rise in endoscopic treatment from 16.9% to 25.1% (P = 0.03) was accompanied by decreases in no treatment and chemoradiation, whereas the rate of esophagectomies remained approximately 50%. Unadjusted median survival was longer for patients undergoing resection: esophagectomy, 98.6 months; endoscopic therapy, 77.7 months; chemoradiation, 17.3 months; no treatment, 8.2 months; P < 0.01. Risk-adjusted Cox modeling showed esophagectomy was associated with improved survival [hazard ratio (HR): 0.85], and chemoradiation (HR: 1.79) and no treatment (HR: 3.57) with decreased survival, compared to endoscopic therapy (P < 0.01).

Conclusions:

Use of endoscopic therapy for T1 esophageal cancer has increased significantly: for T1a, as an alternative to esophagectomy; and for T1b, as an alternative to no treatment or chemoradiation. Despite upfront risks, long-term survival is highest for patients who can undergo esophagectomy.
Induction Therapy in Elderly Kidney Transplant Recipients With Low Immunological Risk
Authors: Masset Christophe , Boucquemont Julie , Garandeau Claire , Buron Fanny , Morelon Emmanuel , Girerd Sophie , Ladrière Marc , Mourad Georges , Garrigue Valérie , Cassuto Elisabeth , Albano Laetitia , Foucher Yohann , Dantal Jacques
Published: July 2019

Background.

In nonimmunized patients, similar rejection rates are observed for patients who have undergone thymoglobulin (antithymocyte globulins [ATG]) or basiliximab (BSX) therapy. While ATG may improve delayed graft function, it may also be associated with higher infection rates and malignancy risk. We compared survival and clinical outcomes in elderly recipients with low immunological risk according to their induction therapy.

Methods.

We conducted a multicentric study on nonimmunized patients ≥65 years of age receiving a first kidney transplant between 2010 and 2017. The principal outcome was patient and graft survival. Secondary outcomes were cumulative probabilities of infection, first acute rejection episode, malignancy, de novo donor specific antibody, posttransplant diabetes (PTD), cardiac complications, estimated glomerular filtration rate, and occurrence of delayed graft function. Cox, logistic, or linear statistical models were used depending on the outcome studied, and models were weighted on the propensity scores.

Results.

Two hundred and four patients were included in the BSX group and 179 in the ATG group with the average age of 71.0 and 70.5 years, respectively. Patient and graft survival at 3 years posttransplantation were 74% (95% CI, 65%-84%) and 68% (95% CI, 60%-78%) in ATG and BSX group, respectively, without significant difference. Occurrence of PTD was significatively higher in BSX group (23% versus 15%, P = 0.04) due to higher trough levels of Tacrolimus on month 3 (9.48 versus 7.30 ng/mL, P = 0.023). There was no difference in other evaluated outcomes.

Conclusions.

In elderly recipients, ATG does not lead to poorer outcomes compared with BSX and could permit lower trough levels of Tacrolimus, thus reducing occurrence of PTD.
Prediction of Perioperative Mortality of Cadaveric Liver Transplant Recipients During Their Evaluations
Authors: Molinari Michele , Ayloo Subhashini , Tsung Allan , Jorgensen Dana , Tevar Amit , Rahman Sheikh Hasibur , Jonassaint Naudia
Published: July 2019

Background.

There are no instruments that can identify patients at an increased risk of poor outcomes after liver transplantation (LT) based only on their preoperative characteristics. The primary aim of this study was to develop such a scoring system. Secondary outcomes were to assess the discriminative performance of the predictive model for 90-day mortality, 1-year mortality, and 5-year patient survival.

Methods.

The study population was represented by 30 458 adults who underwent LT in the United States between January 2002 and June 2013. Machine learning techniques identified recipient age, Model for End-Stage Liver Disease score, body mass index, diabetes, and dialysis before LT as the strongest predictors for 90-day postoperative mortality. A weighted scoring system (minimum of 0 to a maximum of 6 points) was subsequently developed.

Results.

Recipients with 0, 1, 2, 3, 4, 5, and 6 points had an observed 90-day mortality of 6.0%, 8.7%, 10.4%, 11.9%, 15.7%, 16.0%, and 19.7%, respectively (P ≤ 0.001). One-year mortality was 9.8%, 13.4%, 15.8%, 17.2%, 23.0%, 25.2%, and 35.8% (P ≤ 0.001) and five-year survival was 78%, 73%, 72%, 71%, 65%, 59%, and 48%, respectively (P = 0.001). The mean 90-day mortality for the cohort was 9%. The area under the curve of the model was 0.952 for the discrimination of patients with 90-day mortality risk ≥10%.

Conclusions.

Short- and long-term outcomes of patients undergoing cadaveric LT can be predicted using a scoring system based on recipients’ preoperative characteristics. This tool could assist clinicians and researchers in identifying patients at increased risks of postoperative death.
Bilateral Lung Transplantation Provides Better Long-term Survival and Pulmonary Function Than Single Lung Transplantation: A Systematic Review and Meta-analysis
Authors: Yu Haoda , Bian Tao , Yu Zhen , Wei Yiping , Xu Jianjun , Zhu JianRong , Zhang Wenxiong
Published: July 2019

Background.

Both bilateral lung transplantation (BLT) and single lung transplantation (SLT) are commonly used, but which method is better remains controversial. This meta-analysis was conducted to compare the 2 surgical procedures to identify a better clinical choice.

Methods.

Cohort studies comparing SLT and BLT were identified by conducting searches of databases and screening references of retrieved articles. Survival, pulmonary function, surgical indicators, and complications were compared between the 2 groups.

Results.

Thirty studies (1980 recipients in the SLT group and 2112 recipients in the BLT group) were pooled in the meta-analysis. The long-term overall survival rate (OSR) (OSR-4y and OSR-5y), bronchiolitis obliterans syndrome (BOS)–free survival, BOS-free survival rate (BFSR) (2–5 y), 6-minute walking distance, forced expiratory volume in 1 second (%), forced vital capacity (%), oxygenation index, pulmonary arterial pressure, Arterial partial pressure of oxygen (Pao2), diffusing capacity of the lung for carbon monoxide (Dlco), and BOS were better in the BLT group than in the SLT group. The advantages shown in the BLT group compared with the SLT group in regard to these variables increased with the prolongation of survival time. However, surgical time, ischemic time, postoperative intensive care unit days, and postoperative hospital days were shorter in the SLT group than in the BLT group. Overall survival, short-term OSR (1–3 y), BSFR-1y, in-hospital mortality, postoperative ventilator days, and postoperative complications (except BOS) were similar between the 2 groups. Bacterial pneumonia, graft failure, fungal infection, cardiac arrhythmia, and hemorrhage were the top 5 causes of in-hospital mortality.

Conclusions.

BLT appears to be associated with better long-term survival, better postoperative lung function, and less BOS compared with SLT. In-hospital mortality and postoperative complications (except BOS) were similar between the 2 groups.
The Role of miR-200b-3p in Modulating TGF-β1–induced Injury in Human Bronchial Epithelial Cells
Authors: Ladak Shameem S. , Roebuck Eliott , Powell Jason , Fisher Andrew J. , Ward Chris , Ali Simi
Published: July 2019

Background.

Dysregulation of microRNAs (miRNAs) has been implicated in airway diseases where transforming growth factor-β (TGF-β)–induced epithelial-mesenchymal transition (EMT) may contribute to pathophysiology. Our study investigated the role of miRNA-200b in TGF-β1–induced EMT in human bronchial epithelial cells.

Methods.

NanoString nCounter miRNA assay was used to profile miRNA in control versus TGF-β1 (1, 4, and 24 h) stimulated BEAS-2B cells. Immortalized primary bronchial epithelial cell line (BEAS-2B cells), human primary bronchial epithelial cells (PBECs), and PBECs derived post-lung transplant were transfected with miR-200b-3p mimics and EMT marker expression was examined at RNA and protein level. miRNA target studies were performed and validated using computational tools and luciferase assay. In situ hybridization was done on normal lung tissue to localize miR-200b-3p in airway epithelium.

Results.

miR-200b-3p was downregulated post-TGF-β1 treatment compared with control in BEAS-2B. miR-200b-3p mimic transfection before TGF-β1 stimulation maintained epithelial marker expression and downregulated mesenchymal cell markers at RNA and protein level in BEAS-2B cells and PBECs. Furthermore, miR-200b-3p mimics reversed established TGF-β1–induced EMT in BEAS-2B cells. miR-200b-3p targets, ZNF532, and ZEB2 were validated as direct targets using luciferase assay. miR-200b-3p mimics suppress TGF-β1–induced EMT via inhibition of ZNF532 and ZEB2. In situ hybridization showed that miR-200b-3p is expressed in the normal lung epithelium. Additionally, miR-200b-3p mimics inhibit EMT in the presence of TGF-β1 in PBECs derived from lung allograft.

Conclusions.

We provide proof of concept that miR-200b-3p protects airway epithelial cells from EMT. Manipulating miR-200b-3p expression may represent a novel therapeutic modulator in airway pathophysiology.
Perceptions, Barriers, and Experiences With Successful Aging Before and After Kidney Transplantation: A Focus Group Study
Authors: Van Pilsum Rasmussen Sarah E. , Warsame Fatima , Eno Ann K. , Ying Hao , Covarrubias Karina , Haugen Christine E. , Chu Nadia M. , Crews Deidra C. , Harhay Meera N. , Schoenborn Nancy L. , Segev Dorry L. , McAdams-DeMarco Mara A.
Published: July 2019

Background.

End-stage kidney disease (ESKD) patients are living longer, often into older age, and commonly pursue kidney transplantation. Successful aging, a multidimensional construct of physical and social wellbeing, has been expanded and adapted for patients with chronic disease. However, perceptions of, barriers to, and experiences with successful aging among adults with ESKD are unclear and likely differ based on whether they have received a kidney transplant.

Methods.

Ten focus groups were held with 39 total ESKD patients aged ≥50 years (19 transplant candidates, 20 transplant recipients). Transcriptions were analyzed thematically by 2 independent coders using an inductive, constant comparative approach.

Results.

The mean age was 64.8 (SD = 7.5); 51% were African American and 64% were males. Six themes were identified: familiarity with successful aging, perceptions of successful aging after ESKD diagnosis, barriers to successful aging, experiences with successful aging among transplant candidates, experiences with successful aging among transplant recipients, and suggested interventions. While all participants sought to achieve successful aging while living with ESKD, experiences with successful aging differed between candidates and recipients. Candidates struggled with the limitations of dialysis; some viewed transplantation as an opportunity to age successfully, while others were resigned to the drawbacks of dialysis. In contrast, transplant recipients were optimistic about their ability to age successfully, believing their transplant facilitated successful aging. Participants believed support groups for adults with ESKD and more thoughtful health care for aging adults would promote successful aging.

Conclusions.

Adults with ESKD may benefit from discussions with their clinicians and caregivers about goals, barriers, and strategies regarding successful aging.
Development and Comparison of Predictive Models for Pressure Injuries in Surgical Patients
Authors: Park Seul Ki , Park Hyeoun-Ae , Hwang Hee
Published: July 2019

PURPOSE:

The purpose of this study was to develop and compare 3 predictive models for pressure injury (PI) occurrence in surgical patients.

DESIGN:

Retrospective case-control study.

SUBJECTS AND SETTING:

Data on PI risk assessment and preanesthesia evaluation records from 400 patients (80 patients who developed PIs after surgery and 320 patients who did not) in a South Korean acute care setting who underwent surgery between January 2015 and May 2016 were extracted from the electronic health record.

METHODS:

Three models were developed with items from the Braden Scale (model 1), the Scott Triggers tool (model 2), and the Scott Triggers tool in addition to type of anesthesia, laboratory test results, and comorbid conditions (model 3) using logistic regression to analyze items (factors) in each model. Predictive performance indices, which included sensitivity, specificity, positive predictive value, negative predictive value, area under the receiver operating characteristics curve, and Akaike information criterion, were compared among the 3 models.

RESULTS:

Findings showed there were no significant factors in model 1, the estimated surgery time and serum albumin level were significant in model 2, and the estimated surgery time, serum albumin level, and brain disease were significant in model 3. The model performance evaluation revealed that model 2 was the best fitting model, demonstrating the highest sensitivity (84.4%), highest negative predictive value (94.6%), and lowest Akaike information criterion (302.03).

CONCLUSIONS:

The Scott Triggers tool in model 2, which consists of simple items that are easy to extract from preanesthesia evaluation records, was the best fitting model. We recommend the Scott Triggers tool be used to predict the development of PIs in surgical patients in acute care settings.
Root Cause Analysis for Hospital-Acquired Pressure Injury
Authors: Black Joyce M.
Published: July 2019

Root cause analysis (RCA) is a systematic process for identifying the causes of an adverse occurrence or combined with an approach for a response designed to prevent recurrences. This method may be used for continuous quality improvement in a facility or health system. Root cause analysis can aid nurses and hospital risk managers to determine how the system can improve to reduce the number and severity of pressure injuries. The process of RCA begins with being certain the wound is a pressure injury using differential diagnoses of similar appearing skin disease and injury, followed by an examination of the processes of care (human roots) for missed actions or inactions that are linked to development of a particular pressure injury. The final step of RCA is a critical examination of the system (including people and processes) to look for modifiable trends or patterns are identified that are used to prevent recurrences.
Executive Summary: Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) Nursing Best Practice Recommendations
Authors: Brooke Jillian , El-Ghaname Amanda , Napier Karen , Sommerey Laureen
Published: July 2019

Enterocutaneous fistulas (ECF) and enteroatmospheric fistulas (EAF) pose significant quality-of-life concerns for patients, and management challenges for the interprofessional healthcare team. In 2009, the Canadian Association for Enterostomal The developed best practice recommendations for the management of ECF. Over time, evidence and practice evolve, and the Nurses Specialized in Wound, Ostomy and Continence Canada performed a comprehensive review of the literature and revised the practice recommendation document. The revised recommendations provide evidence-based management guidance for ECF and EAF in the adult population whether in acute care, community/home care, or long-term/residential settings, and are specifically created for nurses. The revised recommendations include organizational support, assessment, nutrition, pharmaceutical management, education, and local fistula management. This article serves as an executive summary for this clinical resource; the full guideline is available at http://nswoc.ca/ecf-best-practices/
High open-circuit voltages in lead-halide perovskite solar cells: experiment, theory and open questions
Authors: Kirchartz Thomas
Published: July 2019

One of the most significant features of lead-halide perovskites is their ability to have comparably slow recombination despite the fact that these materials are mostly processed from solution at room temperature. The slow recombination allows achieving high open-circuit voltages when the lead-halide perovskite layers are used in solar cells. This perspective discusses the state of the art of our understanding and of experimental data with regard to recombination and open-circuit voltages in lead-halide perovskites. A special focus is put onto open questions that the community has to tackle to design future photovoltaic and optoelectronic devices based on lead-halide perovskites and other semiconductors with similar properties.

This article is part of a discussion meeting issue ‘Energy materials for a low carbon future’.
Impact of the iron substitution on the thermoelectric properties of Co

1−
x

Fe

x

S
2
(
x
≤ 0.30)
Authors: Salas Ulises Acevedo , Fourati Ismail , Juraszek Jean , Richomme Fabienne , Pelloquin Denis , Maignan Antoine , Hébert Sylvie
Published: July 2019

The strong interplay between magnetism and transport can tune the thermoelectric properties in chalcogenides and oxides. In the case of ferromagnetic CoS
2
pyrite, it was previously shown that the power factor is large at room temperature, reaching 1 mW m
−1 
K
−2
and abruptly increases for temperatures below the Curie transition (
T
C
), an increase potentially due to a magnonic effect on the Seebeck (
S
) coefficient. The too large thermal conductivity approximately equal to 10.5 W m
−1 
K
−1
at room temperature prevents this pyrite from being a good thermoelectric material. In this work, samples belonging to the Co

1−
x

Fe

x

S
2
pyrite family (
x
 = 0, 0.15 and 0.30) have thus been investigated in order to modify the thermal properties by the introduction of disorder on the Co site. We show here that the thermal conductivity can indeed be reduced by such a substitution, but that this substitution predominantly induces a reduction of the electronic part of the thermal conductivity and not of the lattice part. Interestingly, the magnonic contribution to
S
below
T
C
disappears as
x
increases, while at high
T
,
S
tends to a very similar value (close to −42 µV K
−1
) for all the samples investigated.

This article is part of a discussion meeting issue ‘Energy materials for a low carbon future’.