bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of gamma probe-assisted intraoperative sentinel lymph node evaluation in predicting axillary breast cancer metastasis after neoadjuvant chemotherapy
Authors: Berberoglu Kezban , Erdemir Ayhan , Rasa Kemal , Baloglu Huseyin , Cakmakci Metin 
Published: November 2019

Objective
Intraoperative sentinel lymph node biopsy is a universally accepted technique to identify patients who are candidates for axillary lymph node dissection during breast cancer surgery. However, there is controversy over its use in patients who underwent preoperative neoadjuvant chemotherapy. This study aimed to examine the diagnostic value of gamma probe-assisted intraoperative sentinel lymph node examination with frozen section in breast cancer patients who had undergone preoperative neoadjuvant chemotherapy.

Methods
This retrospective study included 94 tumors diagnosed with stage IIA, IIB or IIIA invasive breast cancer with locoregional lymph node metastasis who underwent surgical treatment after neoadjuvant chemotherapy. Intraoperatively, axillary sentinel lymph node sampling was done using radioactive colloid and gamma probe and materials were examined with frozen section method. Patients with positive sentinel nodes underwent axillary resection. Histopathological examination of all surgical samples was done postoperatively.

Results
In 87 of 94 tumors (92.6%), a sentinel lymph node could be identified using the method. The sensitivity, specificity and accuracy of the method for predicting axillary macro metastasis were 85.7, 86.5 and 86.2%, respectively, with 5.7% false negative rate.

Conclusions
Sentinel lymph node identification using preoperative scintigraphy and intraoperative use of gamma probe seems to be a feasible and efficient method in terms of differentiating patients that require axillary lymph node dissection during breast cancer surgery, even when they have received neoadjuvant chemotherapy. Further large prospective studies allowing subgroup analyses are warranted.
A microdosimetry model of kidney by GATE Monte Carlo simulation using a nonuniform activity distribution in digital phantom of nephron
Authors: Jabari Masoud , Rajabi Hossein , Dadashzadeh Simin 
Published: November 2019

Objectives
As the main pathway for the clearance of radiopharmaceutical from the body, kidney is a dose-limiting organ in medical application of radionuclides. Because of its unique physiology, radioactivity is seen to concentrate on kidney nonuniformly. This nonuniformity can be considered in nephron microstructures. A microdosimetry model of kidney is necessary to include the nonuniform distribution in internal radiation dosimetry.

Method
Implementing the microdosimetry model requires, first, a geometry phantom of nephrons. Stylized phantoms cannot distribute activities inside nephron compartments nonuniformly. A phantom of nephron was generated by a preliminary three-dimensional graphic model and was converted to a proper format of digital phantom. The phantom was fed to GATE Monte Carlo toolkits. Simulations were performed and S-values for five radionuclides (Tc-99m, In-111, Lu-177, Ac-225 and Bi-212) were calculated and compared with corresponding results published in the literature derived with a stylized phantom of nephron. Activity was distributed nonuniformly according to the kinetics of two mainly used diagnostic tracers (diethylenetriaminepetaacetate and ethylenedicysteine) and absorbed dose of nephron cells were calculated.

Results
A good correlation was shown between the generated phantom microdosimetry model and stylized model and revealed the phantom can be used for future microdosimetry studies of kidney to evaluate radiobiological effects of internal radiation from various diagnostic and therapeutic radiopharmaceuticals. Absorbed dose of cells for nonuniform distribution showed that some cells in a nephron compartment receive higher dose than (more than two-fold) that of compartment average dose.

Conclusion
Average dose of nephron is not a reliable parameter for nephrotoxicity evaluation.
Predicting large-volume lymph node metastasis in the clinically node-negative papillary thyroid microcarcinoma: a retrospective study
Authors: Shen Guohua , Ma Huan , Huang Rui , Kuang Anren 
Published: November 2019

Objective
Large-volume lymph node metastasis (LNM) has been believed to be an important predictor for recurrence in papillary thyroid microcarcinoma (PTMC). However, the clinical predictors for large-volume LNM have yet to be established. This study aimed to determine clinical predictors for large-volume LNM in clinically node-negative PTMC.

Methods
A total of 947 clinically N0 PTMC patients who received total thyroidectomy with lymph node dissection and radioiodine therapy were included. Based on the LNM status, they were divided into two groups: large-volume LNM and small-volume LNM including those patients without LNM. The association between age, gender and other clinical factors and large-volume LNM were investigated. The recurrence-free survival was also compared among these groups.

Results
We found that male gender [odds ratio (OR) = 1.865, P = 0.015], young age (OR = 2.743, P < 0.001) and extrathyroid extension (OR = 5.352, P < 0.001) were independent predictors for high prevalence of large-volume LNM. Young (<40 years) and male patients tended to have large-volume LNM with the highest prevalence of 17.20%, whereas old (≥55 years) and female patients had the lowest prevalence of 2.02%. After median follow-up of 71 months, the recurrence rate was significantly higher for large-volume LNM compared with small-volume LNM (15.48 vs 0.72%, P < 0.05). Large-volume LNM status was significantly associated with decreased recurrence-free probability, while small-volume LNM had little effect on the recurrence-free survival.

Conclusions
This study showed that in clinically node-negative PTMC, young male patients had a greater incidence of large-volume LNM.
Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair
Authors: Ngo Peter D. , Kamran Ali , Clark Susannah J. , Jennings Russell W. , Hamilton Thomas E. , Smithers Charles J. , Zendejas Benjamin , Yasuda Jessica L. , Zurakowski David , Manfredi Michael A. 
Published: November 2019

ABSTRACTObjectives:The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in patients with esophageal atresia remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI.Methods:A total of 158 patients with esophageal atresia with at least 1 ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI−) and dilation with steroid injection (ISI+).Results:A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1 mm (interquartile range [IQR] 0, 3) versus 0 mm (IQR −1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved diameter (P < 0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P = 0.0009, P = 0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% confidence interval: 2.15–4.88) (P < 0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR−1.25, 2) (P = 0.001). There was no difference in perforation incidence between ISI+ and ISI− groups (P = 0.82).Conclusions:ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.
Role of Thiopurines in Pediatric Inflammatory Bowel Diseases
Authors: Atia Ohad , Ledder Oren , Ben‐Moshe Tehila , Lev‐Tzion Raffi , Rachmen Yelana , Meyer Esther O. , Beeri Rachel , Renbaum Pinhas , Shamasneh Ibrahim , Shteyer Eyal , Turner Dan 
Published: November 2019

ABSTRACTObjectives:Use of thiopurines for inflammatory bowel diseases (IBDs) is declining in some parts of the world. We aimed to explore outcomes of thiopurines and predictors of response in a real‐world prospective cohort of children with dose optimization.Methods:Children with IBD treated with thiopurines without biologics were enrolled. Dosing was guided by thiopurine S‐methyltransferase‐activity at baseline and by clinical response and toxicity at 4 months; 1 year into the study, therapeutic drug monitoring at 4 months was also considered in the decision making. The primary outcome was steroid‐free remission without treatment escalation by 12 months (SFR), using the intention‐to‐treat approach.Results:A total of 129 children were included (74% Crohn disease [CD] and 26% ulcerative colitis [UC]). SFR was achieved in 37 (39%) CD and 13 (39%) UC patients, and SFR with normal erythrocyte sedimentation rate/C‐reactive protein in 20 (21%) and 9 (27%), respectively. At 4 months, mean corpuscular volume/white blood cell ratio and Δ absolute neutrophil count weakly correlated with 6‐thioguanine (r = 0.33, P = 0.02 and r = 0.32, P = 0.02, respectively). In CD, SFR was associated with 4‐month median weighted Pediatric Crohn Disease Activity Index (2.5 [IQR 0–7.5] in responders vs 5 in nonresponders [0–12.5], P = 0.048) and Δabsolute neutrophil count (1.7 [IQR 0.7–4.1] vs 0.05 [−2.3–0.9]; P = 0.03). Mild drug‐related adverse events were recorded in 30 children (22%), 3 required stopping the drug.Conclusions:In this real‐life prospective cohort using dose optimization, thiopurines were safe and effective in 21% of CD and 27% of UC patients, including normalization of C‐reactive protein and erythrocyte sedimentation rate. Thiopurines remain a viable option in the treatment algorithm of mild‐moderate pediatric IBD, especially in girls whose risk for lymphoma is lower.
Infantile Myofibromatosis: 32 Patients and Review of Literature
Authors: Zhao Guoqiang , Zhu Ming , Qin Chaojin , Liu Xiwang , Zhao Xufei 
Published: November 2019

Background:
Infantile myofibromatiosis (IM) is a rare benign tumor in the infants, but it has a bad prognosis if IM erncroaches on the viscera. Multiple tissues can be invaded by IM, including the subcutaneous tissue, the muscle of the neck, back, and head, but seldom in the bones and the viscera. The histopathologic and immunohistochemical examinations are necessary in daigonosis of IM as it might be misdiagnosed as the malignant tumor.

Materials and Method:
Thirty-two consecutive patients with IM in our hospital (2003-2013) were enrolled and the clinical date were analyzed to understand IM better, such as the feature of clinical manifestations, pathology, imaging tests, and treatment.

Results:
All of them underwent excision operations, 4 of them with invasion in the bones, 2 with invasion in the craniums, and the rest in the ulna and the humerus. The immunohistiochemical analysis shown that the tumor cells were positive to vimentin and smooth muscle actin while negative to the S100 protein and desmin. Twenty-five patients were in follow-up, 2 cases recurred.

Conclusions:
IM is a benign tumor, but IM with the viscera involvement has a bad prognosis. The strategy of waiting and observation for IM without visceral involvement could be selected.
Cost-effectiveness of New Targeted Agents in the Treatment of Chronic Lymphocytic Leukemia
Authors: Harkins R. Andrew , Patel Sharvil P. , Flowers Christopher R. 
Published: November 2019

Abstract
Chronic lymphocytic leukemia (CLL) is the most common adult leukemia and is clinically heterogeneous. Integration of oral targeted therapies (OTTs) in the management of CLL has fundamentally altered CLL treatment pathways and improved outcomes for patients with CLL.
We review the cost-effectiveness of OTTs in the treatment of CLL. We used MeSH (Medical Subject Heading) terms and keywords to search the National Library of Medicine online MEDLINE database (PubMed) for articles related to cost-effectiveness of OTTs in CLL care.
Oral targeted therapies add considerable expense to the treatment of CLL for patients and the health care system. Cost-effectiveness analyses of OTTs are not uniform in their conclusions and depend on patient groups selected for analysis. Given the substantial increase in expense associated with integration of OTTs in CLL treatment, cost reduction methods are needed to ensure equitable access to novel therapies for all patients with CLL.
Developing a Lymphatic Surgery Program: A First-Year Review
Authors: Johnson Anna Rose , Fleishman Aaron , Tran Bao Ngoc N. , Shillue Kathy , Carroll Brett , Tsai Leo L. , Donohoe Kevin J. , James Ted A. , Lee Bernard T. , Singhal Dhruv 
Published: November 2019

Background:
Lymphedema is a chronic condition that carries a significant physical, psychosocial, and economic burden. The authors’ program was established in 2017 with the aims of providing immediate lymphatic reconstruction in high-risk patients undergoing lymphadenectomy and performing delayed lymphatic reconstruction in patients with chronic lymphedema. The purpose of this study was to describe the authors’ clinical experience in the first year.

Methods:
A retrospective review of our clinical database was performed on all individuals presenting to the authors’ institution for lymphatic surgery consideration. Patient demographics, clinical characteristics, and surgical management were reviewed.

Results:
A total of 142 patients presented for lymphatic surgery evaluation. Patients had a mean age of 54.8 years and an average body mass index of 30.4 kg/m2. Patients with lymphedema were more likely to be referred from an outside facility compared to patients seeking immediate lymphatic reconstruction (p < 0.001). For patients with lymphedema, the most common cause was breast cancer related. Thirty-two percent of all patients evaluated underwent a lymphatic procedure. Of these, 32 were immediate lymphatic reconstructions and 13 were delayed lymphatic reconstructions. In the authors’ first year, 94 percent of eligible patients presenting for immediate lymphatic reconstruction underwent an intervention versus only 38 percent of eligible lymphedema patients presenting for delayed lymphatic reconstruction (p < 0.001).

Conclusions:
First-year review of our lymphatic surgery experience has demonstrated clinical need evidenced by the number of patients and high percentage of outside referrals. As a program develops, lymphatic surgeons should expect to perform more time-sensitive immediate lymphatic reconstructions, as evaluation of chronic lymphedema requires development of a robust team for workup and review.
Endoscopic Temporal Brow Lift: Surgical Indications, Technique, and 10-Year Outcome Analysis
Authors: Rohrich Rod J. , Cho Min-Jeong 
Published: November 2019

Background:
Brow-lift techniques have evolved from the most invasive approach, such as a coronal brow lift, to a minimally invasive technique, such as an endoscopic brow lift over the past century. Although an endoscopic brow lift offers the advantage of being minimally invasive, it suffers from a high recurrence rate. The authors present their experience of combining an endoscopic and temporal brow lift approach for long-lasting results, and discuss the surgical indication, techniques, and outcome of an endoscopic temporal brow lift.

Methods:
A retrospective review was performed of patients who underwent brow rejuvenation from 2008 to 2018. Demographic, surgical procedure, complication, and outcome data were collected.

Results:
Of the 159 patients who underwent a brow lift from 2008 to 2018, the mean patient age was 59.1 years, and 96 percent were women. Of the 159 patients, 71 underwent endoscopic temporal brow lift; their average age was 56.6 years, with an average body mass index of 22.9 kg/m2, and 99 percent were women. The average brow elevation was 1.8 ± 1.7 mm at the midpupil, 1.9 ± 1.8 mm at the medial canthus, and 1.8 ± 1.7 mm at the lateral canthus. There was no difference in the amount of brow elevation at the three locations (p = 0.48). The complication rate for endoscopic temporal brow lift was 1.4 percent, with a mean postoperative follow-up of 231.7 days; one relapse required a repeated procedure.

Conclusions:
The authors’ study reveals that an endoscopic temporal brow lift can elevate the medial and lateral brow effectively, with a low complication rate of 1.4 percent. This technique is an evolution from the more aggressive coronal brow lift and combines the strength of endoscopic and temporal techniques with less invasive incisions. The authors recommend this technique for patients with mild to moderate brow ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Cutting Edge of Headache Surgery: A Systematic Review on the Value of Extracranial Surgery in the Treatment of Chronic Headache
Authors: Bink Thijs , Duraku Liron S. , Ter Louw Ryan P. , Zuidam J. Michiel , Mathijssen Irene M. J. , Driessen Caroline 
Published: November 2019

Background:
Migraine is a debilitating neurologic condition, with a large socioeconomic impact. There is a subgroup of patients that does not adequately respond to pharmacologic management and may have underlying neuralgia. Surgical decompression of extracranial sensory nerves has been proposed as an alternative therapy. The aim of this article is to review the evidence for the surgical treatment of neuralgias.

Methods:
A systematic review was conducted to study the efficacy of decompression of extracranial sensory nerves as a treatment for neuralgia. Clinical studies were included that studied patients, aged 18 years or older, diagnosed with any definition of headache and were treated with extracranial nerve decompression surgery. Outcome parameters included intensity (on a 10-point scale), duration (in days), and frequency (of headaches per month).

Results:
Thirty-eight articles were found describing extracranial nerve decompression in patients with headaches. Postoperative decrease in headache intensity ranged from 2 to 8.2, reduction of duration ranged from 0.04 to 1.04 days, and reduction in frequency ranged between 4 and 14.8 headaches per month. Total elimination of symptoms was achieved in 8.3 to 83 percent of cases. A detailed summary of the outcome of single-site decompression is described. Statistical pooling and therefore meta-analysis was not possible, because of articles having the same surgeon and an overlapping patient database.

Conclusions:
Nerve decompression surgery is an effective way of treating headaches in a specific population of patients with neuralgia. Although a meta-analysis of the current data was not possible, the extracranial decompression of peripheral head and neck sensory nerves has a high success rate.
Does fibrosis really regress in HIV/hepatitis C virus co-infected patients after treatment with direct antiviral agents?
Authors: Rial-Crestelo David , Sepúlveda María Antonia , González-Gasca Francisco Javier , Geijo-Martínez Paloma , Martínez-Alfaro Elisa , Barberá José Ramón , Yzusqui Miguel , Casallo Sonia , García María , Hornero Constanza Muñoz , Espinosa-Gimeno Alfredo , Torralba Miguel 
Published: November 2019

Objective:
To evaluate the progression of liver stiffness after treatment with direct antiviral agents (DAAs), to identify predictive factors of fibrosis regression and to analyze the changes of scores AST-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) after treatment.

Design:
Multicenter prospective cohort study of HIV/HCV co-infected patients conducted within the GECMEI cohort, Spain.

Methods:
Individuals were eligible if they were willing to start DAAs and underwent two transient elastographies: at baseline and after the end of treatment (EOT). All patients with detectable HCV RNA naïve to DAAs were consecutively enrolled from nine medical hospitals. Liver stiffness results were categorized in four Metavir stages (F1: <7.1; F2 : 7.1--9.5; F3 : 9.5--2.4; F4: >12.4 kPa). The APRI and FIB-4 scores were calculated at baseline, EOT and 12 weeks after EOT.

Results:
One hundred and seventy-eight patients were examined throughout a follow-up of 16.3 months (IQR: 12.5–25). The median of liver stiffness decrease was 2.6 kPa (IQR: 0–6.3). A greater improvement was observed in F3–F4 compared with F1–F2, (6.4 vs. 0.91 kPa, P < 0.001; P = 0.001, respectively). A decline between baseline and EOT measures was observed in APRI and FIB-4 (P < 0.001). Sustained virological response (SVR12) achievement was the only predictor of fibrosis regression [OR:17.4 (95% CI: 1.8–164.6; P = 0.013)].

Conclusion:
Most patients experienced a significant reduction of liver stiffness and APRI and FIB-4 scores. This improvement was greater in those with advanced liver disease. SVR12 was the only predictor of fibrosis regression. The significance of this reduction is unclear and could reflect a decline in inflammation rather than true fibrosis regression.
Applying the Exploration Preparation Implementation Sustainment (EPIS) Framework to the Kigali Imbereheza Project for Rwandan Adolescents Living With HIV
Authors: Donenberg Geri R. , Cohen Mardge H. , Ingabire Charles , Fabri Mary , Emerson Erin , Kendall Ashley D. , Remera Eric , Manzi Olivier , Nsanzimana Sabin 
Published: November 2019

Background:
Sub-Saharan African adolescents living with HIV face challenges to antiretroviral therapy (ART) adherence. Poor mental health drives nonadherence but can be improved with cognitive behavioral therapy (CBT). CBT delivered by peers may strengthen effects while building capacity for sustainment in low-income countries. This case study retrospectively applied the Exploration Preparation Implementation Sustainment framework to characterize the execution of the Kigali Imbereheza Project, a 2-arm individually randomized group controlled trial of Trauma-Informed Adherence-Enhanced CBT (TI-CBTe) delivered by Rwandan youth leaders (YLs) to adolescents living with HIV.

Methods:
YL (n = 14, 43% female, M = 22.71 years) had confirmed HIV and self-reported ART adherence >95%. Participants (n = 356, 51% female, M = 16.78 years) living with HIV were randomized to TI-CBTe or usual care. Two YLs co-led TI-CBTe sessions over 2 months for a total of 12 hours, while other YL observed and rated fidelity. Participants reported on YL competence. Additional data evaluated feasibility, acceptability, uptake, and fidelity.

Results:
In the Exploration phase, focus groups, stakeholder meetings, and individual interviews revealed strong consensus for delivering TI-CBT to reduce adolescent depression and trauma and improve ART adherence. In the Preparation phase, curriculum revisions were made, YLs were successfully trained, and a cascading supervision model was established. In the Implementation phase, YL delivered TI-CBTe with close monitoring and supervision. Findings revealed strong feasibility, acceptability, uptake, and fidelity, increasing the likelihood of Sustainment.

Conclusions:
Exploration Preparation Implementation Sustainment can guide implementation planning and delivery and evaluate implementation outcomes.