bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated 68Ga-FAPI Accumulation in a Recurrent Angiomyolipoma
Authors: Qin Chunxia , Gai Yongkang , Liu Qingyao , Shao Fuqiang , Lan Xiaoli 
Published: October 2020

Abstract

68Ga-FAPI (68Ga-labeled fibroblast activation protein inhibitor) PET imaging has been recently introduced for the diagnosis and staging in various malignant tumors. However, the reports about the utility of FAPI imaging in benign tumor are relatively rare. Here we report a case of pathologically proven recurrent angiomyolipoma in the left retroperitoneal area with low 18F-FDG uptake but diffuse heterogeneous intense 68Ga-FAPI uptake together with suspected lung metastases in a 53-year-old woman. Our case illustrates FAPI imaging could be helpful not only for detecting various malignant tumors but also for benign tumor like this case due to fibrotic activity in the disease.
Recurrent Malignant Pheochromocytoma With Unusual Peritoneal Carcinomatosis Detected on 131I-MIBG SPECT/CT
Authors: Wang Hui , Cheng Junjun , Ou Xiaohong 
Published: October 2020

Abstract
The most common sites of metastasis for pheochromocytoma are the lymph nodes, bones, lungs, and liver. Peritoneal metastasis or implantation is very rare. We present a case of recurrent malignant pheochromocytoma with unusual multiple peritoneal carcinomatosis on 131I-MIBG SPECT/CT after laparoscopic adrenalectomy.
Tooth Development Following Mandibular Distraction Osteogenesis in Neonates With Pierre Robin Sequence
Authors: Shuman Irene , Cardo Vito A. 
Published: October 2020

Background:
Mandibular distraction osteogenesis is a widely utilized surgical procedure in the pediatric population for the treatment of mandibular retrognathia. Patients with congenital abnormalities may display severe mandibular hypoplasia and associated functional problems. Distraction osteogenesis is effective in alleviating airway obstruction for these patients and is performed early in life, often during the neonatal period and during infancy. However, problems in tooth development may arise as a surgical complication.

Evidence Review:
A systematic search was conducted in PubMed and EMBASE to identify retrospective studies describing long term outcomes of mandibular distraction osteogenesis on tooth development. Each article was reviewed and relevant data were extracted, collected, and examined according to the type of dental injury, specific tooth effected, and frequency of occurrence.

Results:
Tooth injuries include positional change (35%), shape alteration/fracture (24%), missing tooth (15%), root injury/malformation (14%), follicle/bud perforation (9%), delayed eruption (2%), and dentigerous cyst (1%). The most commonly affected tooth is the permanent first molar, followed by the primary second molar. The least common tooth affected is the third molar.

Conclusions:
Although tooth injuries exist following mandibular distraction osteogenesis in the pediatric population, the risk of pathology and major complications remain relatively low. Technological advancements in presurgical planning can be expected to continue reducing the risk of adverse effects to primary and permanent tooth development.
Early Elective Surgery After Colon Cancer Diagnosis has Higher Risk of Readmission and Death
Authors: Gleason Frank , Chu Daniel I. , Kennedy Gregory D. , Kenzik Kelly M. 
Published: October 2020

Objective:
We hypothesized colon resection within 30 days of diagnosis of cancer would have higher rates of readmission and cancer specific mortality, unless there was demonstrated evidence of preoperative workup.

Summary Background Data:
Few studies have examined if negative consequences exist with expedited elective surgery after diagnosis of colon cancer. Surgery in a shorter time frame may result in a lack of appropriate preoperative care.

Methods:
Retrospective analysis of 25,407 patients in the Surveillance Epidemiology and End Results registry who underwent elective surgical resection for colon cancer from 2010 to 2015. Cohort stratified by age (66–75 vs >75 years). Primary outcomes of interest were 30-day readmission and 5-year colon cancer specific mortality. Relationships between timing of surgery and outcomes were assessed.

Results:
On unadjusted analysis, surgery before 20 days of diagnosis was associated with higher risk of 30-day readmission and colon cancer specific mortality in both age groups. Among those age 66 to 75 years old, adjusting for patient factors and preoperative workup eliminated the risk of 30-day readmission (risk ratio 1.5–0.9 for 0–10 days, risk ratio 1.3–0.9 for 11–20 days). However, the risk for colon cancer specific mortality, although reduced, persisted (hazard ratio 2.2–1.3 for 0–10 days, hazard ratio 2.0–1.2 for 11–20 days). In the cohort older than 75 years, adjusting for patient level factors and preoperative workup eliminated risk of surgery 20 days postop or sooner.

Conclusions:
The risk associated with short time to surgery (within 30 days) may be mitigated if full oncologic workups are provided.
Complications and Failure to Rescue After Inpatient Pediatric Surgery
Authors: Portuondo Jorge I. , Shah Sohail R. , Raval Mehul V. , Pan I-wen E. , Zhu Huirong , Fallon Sara C. , Harris Alex H. S. , Singh Hardeep , Massarweh Nader N. 
Published: October 2020

Objective:
To describe the frequency and patterns of postoperative complications and FTR after inpatient pediatric surgical procedures and to evaluate the association between number of complications and FTR.

Summary and Background:
FTR, or a postoperative death after a complication, is currently a nationally endorsed quality measure for adults. Although it is a contributing factor to variation in mortality, relatively little is known about FTR after pediatric surgery.

Methods:
Cohort study of 200,554 patients within the National Surgical Quality Improvement Program-Pediatric database (2012–2016) who underwent a high (≥ 1%) or low (< 1%) mortality risk inpatient surgical procedures. Patients were stratified based on number of postoperative complications (0, 1, 2, or ≥3) and further categorized as having undergone either a low- or high-risk procedure. The association between the number of postoperative complications and FTR was evaluated with multivariable logistic regression.

Results:
Among patients who underwent a low- (89.4%) or high-risk (10.6%) procedures, 14.0% and 12.5% had at least 1 postoperative complication, respectively. FTR rates after low- and high-risk procedures demonstrated step-wise increases as the number of complications accrued (eg, low-risk— 9.2% in patients with ≥3 complications; high-risk—36.9% in patients with ≥ 3 complications). Relative to patients who had no complications, there was a dose-response relationship between mortality and the number of complications after low-risk [1 complication – odds ratio (OR) 3.34 (95% CI 2.62–4.27); 2 – OR 10.15 (95% CI 7.40–13.92); ≥3-27.48 (95% CI 19.06-39.62)] and high-risk operations [1 – OR 3.29 (2.61–4.16); 2–7.24 (5.14–10.19); ≥3–20.73 (12.62–34.04)].

Conclusions:
There is a dose-response relationship between the number of postoperative complications after inpatient surgery and FTR, ever after common, “minor” surgical procedures. These findings suggest FTR may be a potential quality measure for pediatric surgical care.
Policies Restricting Overlapping Surgeries Negatively Impact Access to Care, Clinical Efficiency, and Hospital Revenue
Authors: Brandon Cameron , Ghenbot Yohannes , Buch Vivek , Contreras-Hernandez Enrique , Tooker John , Dimentberg Ryan , Richardson Andrew G. , Lucas Timothy H. 
Published: October 2020

Objective:
To model the financial impact of policies governing the scheduling of overlapping surgeries, and to identify optimal solutions that maximize operating efficiency that satisfy the fiduciary duty to patients.

Background:
Hospitals depend on procedural revenue to maintain financial health as the recent pandemic has revealed. Proposed policies governing the scheduling of overlapping surgeries may dramatically impact hospital revenue. To date, the potential financial impact has not been modeled.

Methods:
A linear forecasting model based on a logic matrix decision tree enabled an analysis of surgeon productivity annualized over a fiscal year. The model applies procedural and operational variables to policy constraints limiting surgical scheduling. Model outputs included case and financial metrics modeled over 1000-surgeon-year simulations. case metrics included annual case volume, case mix, operating room (OR) utilization, surgeon utilization, idle time, and staff overtime hours. Financial outputs included annual revenue, expenses, and contribution margin.

Results:
The model was validated against surgical data. case and financial metrics decreased as a function of increasingly restrictive scheduling scenarios, with the greatest contribution margin loses ($1,650,000 per surgeon-year) realized with the introduction of policies mandating that a second patient could not enter the OR until the critical portion of the first surgery was completed. We identify an optimal scheduling scenario that maximizes surgeon efficiency, minimizes OR idle time and revenue loses, and satisfies ethical obligations to patients.

Conclusions:
Hospitals may expect significant financial loses with the introduction of policies restricting OR scheduling. We identify an optimal solution that maximizes efficiency while satisfying ethical duty to patients. This forecast is immediately relevant to any hospital system that depends upon procedural revenue.
Prospective Phase II Trials Validate the Effect of Neoadjuvant Chemotherapy on Pattern of Recurrence in Pancreatic Adenocarcinoma
Authors: Chawla Akhil , Qadan Motaz , Castillo Carlos Fernandez-del , Wo Jennifer Y. , Allen Jill N. , Clark Jeffrey W. , Murphy Janet E. , Catalano Onofrio A. , Ryan David P. , Ting David T. , Deshpande Vikram , Weekes Colin D. , Parikh Aparna , Lillemoe Keith D. , Hong Theodore S. , Ferrone Cristina R. 
Published: October 2020

Objective:
The objective of this study was to characterize the patterns of first recurrence after curative-intent resection for pancreatic adenocarcinoma (PDAC).

Summary of Background Data:
We evaluated the first site of recurrence after neoadjuvant treatment as locoregional (LR) or distant metastasis (DM). To validate our findings, we evaluated the pattern from 2 phase II clinical trials evaluating neoadjuvant chemotherapy (NAC) in PDAC.

Methods:
We identified site of first recurrence from a retrospective cohort of patients from 2011 to 2017 treated with NAC followed by chemoradiation and then an operation or an operation first followed by adjuvant therapy, and 2 separate prospective cohorts of patients derived from 2 phase II clinical trials evaluating patients treated with NAC in borderline-resectable and locally advanced PDAC

Results:
In the retrospective cohorts, 160 out of 285 patients (56.1%) recurred after a median disease-free survival (mDFS) of 17.2 months. The pattern of recurrence was DM in 81.9% of patients, versus LR in 11.1%. This pattern was consistent in patients treated with upfront resection and adjuvant chemotherapy (DM 83.0%, LR 16.9%) regardless of margin-involvement (DM 80.1%, LR 19.4%). The use of NAC did not alter pattern of recurrence; 81.7% had DM and 18.3% had LR. This pattern also remained consistent regardless of margin-involvement (DM 94.1%, LR 5.9%). In the Phase II borderline-resectable trial (NCI# 01591733) cohort of 32 patients, the mDFS was 34.2 months. Pattern of recurrence remained predominantly DM (88.9%) versus LR (11.1%). In the Phase II locally-advanced trial (NCI# 01821729) cohort of 34 patients, the mDFS was 30.7 months. Although there was a higher rate of local recurrence in this cohort, pattern of first recurrence remained predominantly DM (66.6%) versus LR (33.3%) and remained consistent independent of margin-status.

Conclusions:
The pattern of recurrence in PDAC is predominantly DM rather than LR, and is consistent regardless of the use of NAC and margin involvement.
Acute Toxicity and Triphasic Waves—The Example of Cefepime
Authors: Husari Khalil S. , Ritzl Eva K. , Kaplan Peter W. 
Published: October 2020

Purpose:
Triphasic waves (TWs) have been associated with a host of medication toxicities, and cefepime has emerged recently as a frequently encountered offending agent. This investigation aims to evaluate cefepime-induced encephalopathy and to report the associated clinical, EEG expression with TWs, and the radiologic findings.

Methods:
A retrospective multicenter observational study examining adult patients with cefepime-induced encephalopathy with generalized periodic discharges on either routine or continuous EEG between January 2014 and January 2020. Clinical, electrographic, and radiologic data were collected. Patients in whom cefepime was not the sole causative factor for their encephalopathy were excluded.

Results:
Twenty-seven patients with cefepime-induced encephalopathy marked by generalized periodic discharges with triphasic morphology were identified at both centers, whereas no patients were presenting with generalized periodic discharges without TWs. Patients had a median age of 63 years (interquartile range, 56–73). Fifty-six percent of the cohort (15 patients) were <65 years of age. Eighteen patients (67%) had either acute or chronic kidney impairment (either acute kidney injury or chronic kidney disease or both), whereas 81% had preexisting white matter disease on brain imaging. Of these, 14 patients (51%) were classified as either moderate or severe. In the majority of the patients, TWs were either state-dependent or stimulus-sensitive, and in one third of them presented only as stimulus-induced pattern. All patients improved with discontinuation of cefepime.

Conclusions:
Cefepime toxicity should be considered in the differential diagnosis in encephalopathic patients with TWs. The presence of preexisting white matter disease in these patients should heighten the degree of suspicion, especially in younger patients and patients without renal dysfunction.
AbnormalTP53predicts risk of progression in patients with Barrett’s esophagus regardless of a diagnosis of dysplasia
Authors: Redston Mark , Noffsinger Amy , Kim Anthony , Akarca Fahire G , Stapleton Diane , Nowden Laurel , Lash Richard , Bass Adam J , Stachler Matthew D 
Published: October 2020

ABSTRACTBarrett’s esophagus is the precursor to esophageal adenocarcinomas, which are deadly cancers with a rapidly rising incidence. A major challenge is identifying the small group with Barrett’s esophagus who will progress to advanced disease from the many who will not. Assessment of p53 status has promise as a predictive biomarker, but analytic limitations and lack of validation in large, definitive studies have precluded its use. In this study, criteria for abnormal immunohistochemical expression of p53 were developed in non-dysplastic Barrett’s biopsies and validated with sequencing to assessTP53mutations. The utility of p53 expression as a biomarker for progression of Barrett’s esophagus was tested retrospectively in 561 Barrett’s patients with or without known progression. The findings were prospectively validated in a clinical practice setting in 1487 Barrett’s patients. Abnormal p53 expression highly correlated withTP53mutation status (90.6% agreement) and strongly associated with neoplastic progression in the retrospective cohorts, regardless of histologic diagnosis (P<0.001). In patients with non-dysplastic Barrett’s esophagus at baseline, 89/179 (49.7%) of those with subsequent progression to high grade dysplasia/cancer and 3/179 (1.7%) of non-progressors had abnormal p53 (sensitivity: 49.7,% specificity: 98.3%, Odds ratio: 58 (95% CI 17.9-188.5, P<0.0001) for identifying progressors). In the prospective validation cohort, p53 immunohistochemistry predicted progression among non-dysplastic Barrett’s, indefinite for dysplasia, and low-grade dysplasia (P<0.001). p53 immunohistochemistry can successfully identify Barrett’s esophagus patients at high risk of progression, including in patients without evidence of dysplasia. p53 immunohistochemistry is inexpensive, easily integrated into routine practice, and should be considered in biopsies from all Barrett’s patients without high grade dysplasia or cancer.
Hepatic resection versus transarterial chemoembolization for the intermediate stage hepatocellular carcinoma: A cohort study
Authors: Lu Linbin , Zheng Peichan , Wu Zhixian , Chen Xiong 
Published: October 2020

AbstractBackgroundThe selection criterion for hepatic resection(HR) in intermediate-stage(IM) hepatocellular carcinoma(HCC) is still controversial. We used real-world data to evaluate the overall survival (OS) treated with HR or TACE.MethodsIn all, 942 patients with IM-HCC were categorized in HR and TACE groups. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score- matched (PSM) analyses. The smooth curve was performed through the generalized additive model. The interaction test was performed to evaluate the HR impact on OS concerning risk factors. Also, we used multiple imputation to deal with the missing data.ResultsTotally, 23.0% (n=225) of patients received HR. At a median overall survival of 23.7 months, HR was associated with the improved OS on multivariate analysis (hazard ratio, 0.45; 95%CI: 0.35, 0.58; after PSM: 0.56; 95%CI: 0.41, 0.77). Landmark analyses limited to long-term survivors of ≥ 6 months, ≥ 1, and ≥ 2 years demonstrated better OS with HR in all subsets (all P<0.05). After PSM analysis, however, HR increased 20% risk of death (HR, 1.20; 95%CI: 0.67, 2.15) in the subgroup of LDH ≤192 U/L (P for interaction = 0.037). Furthermore, the significant interaction was robust between the LDH and the HR with respect to 1-, 3-, and 5-year observed survival rate (all P<0.05).ConclusionHepatic resection was superior to TACE for intermediate-stage HCC in the range of LDH level > 192 U/L. Moreover, TACE might be suitable for patients with LDH level ≤ 192 U/L.SynopsisHepatectomy was superior to TACE for BCLC-B HCC.Hepatectomy increased 20% risk of death for LDH < 192 U/L after matching.A significant interaction was robust between LDH and with respect to hepatectomy the 1-, 3-, and 5-year observed survival rate.
Graph theory analysis of induced neural plasticity post-Acceptance and Commitment Therapy for chronic pain
Authors: Meier Sarah K. , Ray Kimberly L. , Waller Noah C. , Gendron Barry C. , Aytur Semra A. , Robin Donald A. 
Published: October 2020

AbstractChronic musculoskeletal pain affects the lives of over 50 million individuals in the United States, at a cost of more than $550 billion each year. Chronic pain leads to functional brain changes within those suffering from the condition. Not only does the primary pain network transform as the condition changes from acute to persistent pain, a state of hyper-connectivity also exists between the default mode, frontoparietal, and salience networks. Graph theory analysis has recently been used to investigate treatment-driven brain network changes. For example, current research suggests that Acceptance and Commitment Therapy (ACT) may reduce the chronic pain associated hyper-connectivity between the default mode, frontoparietal, and salience networks, as well as within the salience network. This study extended previous work by examining the associations between the three networks above and a meta-analytically derived pain network. Results indicate decreased connectivity within the pain network (including left putamen, right insula, left insula, and right thalamus) in addition to triple network connectivity changes after the four-week Acceptance and Commitment therapy intervention.
Sex differences in the genetic regulation of the blood transcriptome response to glucocorticoid receptor activation
Authors: Moore Sarah R. , Halldorsdottir Thorhildur , Martins Jade , Lucae Susanne , Müller-Myhsok Bertram , Müller Nikola S. , Piechaczek Charlotte , Feldmann Lisa , Freisleder Franz Joseph , Greimel Ellen , Schulte-Körne Gerd , Binder Elisabeth B. , Arloth Janine 
Published: October 2020

ABSTRACTSubstantial sex differences have been reported in the physiological response to stress at multiple levels, including the release of the stress hormone, cortisol. Here, we explore the genomic variants in 93 females and 196 males regulating the initial transcriptional response to cortisol via glucocorticoid receptor (GR) activation. Gene expression levels in peripheral blood were obtained before and after GR-stimulation with the selective GR agonist dexamethasone to identify differential expression following GR-activation. Sex stratified analyses revealed that while the transcripts responsive to GR-stimulation were mostly overlapping between males and females, the quantitative trait loci (eQTLs) regulation differential transcription to GR-stimulation were distinct. Sex-stratified eQTL SNPs (eSNPs) were located in different functional genomic elements and sex-stratified transcripts were enriched within postmortem brain transcriptional profiles associated with Major Depressive Disorder (MDD) specifically in males and females in the cingulate cortex. Female eSNPs were enriched among SNPs linked to MDD in genome wide association studies. Finally, transcriptional sensitive genetic profile scores derived from sex-stratified eSNPS regulating differential transcription to GR-stimulation were predictive of depression status and depressive symptoms in a sex-concordant manner in a child and adolescent cohort (n = 584). These results suggest potential of eQTLs regulating differential transcription to GR-stimulation as biomarkers of sex-specific biological risk for stress-related psychiatric disorders.
A placebo-controlled double blind trial of hydroxychloroquine in mild-to-moderate COVID-19
Authors: Dubée Vincent , Roy Pierre-Marie , Vielle Bruno , Parot-Schinkel Elsa , Blanchet Odile , Darsonval Astrid , Lefeuvre Caroline , Abbara Chadi , Boucher Sophie , Devaud Edouard , Robineau Olivier , Rispal Patrick , Guimard Thomas , d’Anglejean Emma , Diamantis Sylvain , Custaud Marc-Antoine , Pellier Isabelle , Mercat Alain ,   for the HYCOVID study group
Published: October 2020

AbstractBackgroundThe efficacy of hydroxychloroquine in coronavirus disease 2019 (COVID-19) remains controversial.MethodsWe conducted a multicentre randomized double-blind placebo-controlled trial evaluating hydroxychloroquine in COVID-19 patients with at least one of the following risk factors for worsening: age ≥75 years, age between 60 and 74 years, and presence of at least one comorbidity, or need for supplemental oxygen (≤3 L/min). Eligible patients were randomized in a 1:1 ratio to receive either 800mg hydroxychloroquine on Day 0 followed by 400mg per day for 8 days or a placebo. The primary endpoint was a composite of death or tracheal intubation within 14 days following randomization. Secondary endpoints included mortality and clinical evolution at Day 14 and 28, viral shedding at Day 5 and 10.ResultsThe trial was stopped after 250 patients were included due to a slowdown of the pandemic in France. The intention-to-treat population comprised 123 and 124 patients in the placebo and hydroxychloroquine groups, respectively. The median age was 77 years and 151 patients required oxygen therapy. The primary endpoint occurred in nine patients in the hydroxychloroquine group and eight patients in the placebo group (relative risk 1.12; 95% confidence interval 0.45– 2.80; P=0.82). No difference was observed between the two groups in any of the secondary endpoints.ConclusionIn this trial involving mainly older patients with mild-to-moderate COVID-19, patients treated with hydroxychloroquine did not experience better clinical or virological outcomes than those receiving the placebo.