bluuebunny/crossref_metadata_2025_split huggingface dataset:
18F-FDG PET/CT for staging and response assessment of primary parotid MALT lymphoma with multiple sites involvement
Authors: Ren Yixuan , Huang Lele , Han Yuping , Cui Zhencun , Li Jicheng , Dong Chi , Liu Jiangyan 
Published: January 2019

Abstract

Rationale:
Mucosa-associated lymphoid tissue (MALT) lymphoma is an extranodal low-grade B cell lymphoma that generally exhibits an indolent clinical course. Currently, the application of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in MALT lymphoma is still controversial. Herein, we reported a case of using 18F-FDG PET/CT for staging and response assessment of primary parotid MALT lymphoma with multiple sites involvement. As far as we know, there are no similar case reports have been published before.

Patient concerns:
A 71-year-old woman, who received mass resection twice during the past 2 years due to the repeatedly relapse of facial painless masses and diagnosed as reactive lymphoid hyperplasia by pathologic tests. However, the pathological diagnosis was then changed to primary parotid MALT lymphoma after left parotidectomy operation because of a new mass found in her left parotid. Four months later, the right eyelid of the patient swelled with a blurred vision. Then, 18F-FDG PET/CT scan was performed for staging, and the imaging results showed an abnormal increase of 18F-FDG uptake in multiple sites including bilateral ocular adnexal, lungs, pleura, occipital subcutaneous tissue, left kidney, and lymph nodes.

Diagnoses:
The patient was diagnosed as primary parotid MALT lymphoma with Ann Arbor stage of IVA based on the 18F-FDG PET/CT findings.

Interventions:
The patient received 4 cycles of chemotherapy, followed by a partial metabolic remission (PMR), which was determined by interim 18F-FDG PET/CT, and finally additional 2 cycles of chemotherapy.

Outcomes:
The follow-up study illustrated that the patient had been alive and doing well at 12 months after chemotherapy.

Lessons:
Although MALT lymphoma normally localizes in the primary organs, the involvement of multiple organs and lymph nodes is possible. The use of PET/CT demonstrated significant clinical values in the accurate staging and response assessment of 18F-FDG-avid MALT lymphoma. It is potentially useful for indicating the progress and transformation of MALT lymphoma, and guidance in localization of pathological biopsy. It is also helpful for clinicians to choose reasonable treatment strategy and improve the prognosis of patients.
Immediate extubation after heart transplantation in a child by remifentanil-based ultra-fast anesthesia
Authors: Yao Yong-Xing , Wu Jia-Teng , Zhu Wei-Liu , Zhu Sheng-Mei 
Published: January 2019

Abstract

Rationale:
Ventilator-associated complications comprise important fatal aetiologies during heart transplantation. Ultra-fast anesthesia might provide the most effective measure to prevent this type of complication. Immediate extubation after heart transplantation (IEAHT) has recently been reported in adult patients. However, IEAHT in children is much more challenging due to limitations in anesthesia protocols. Recently, we managed to perform an ultra-fast anesthesia protocol combined with IEAHT during a heart transplant operation in a child, who had an excellent postoperative outcome.

Patient concerns:
A 13-year-old girl had been diagnosed with dilated cardiomyopathy 5 years before this case, due to intractable dyspnoea and cough. She received multiple medical treatments after diagnosis, with minimal effects. Physical examination findings included a bulge in her left chest and pitting edema over both legs. Moist rales could be heard in the lung. Echocardiography revealed very large heart chambers, with an ejection fraction of 17%.

Diagnosis:
The patient was diagnosed with dilated cardiomyopathy and scheduled to undergo an emergent operation for heart transplantation.

Interventions:
The patient underwent an ultra-fast anesthesia protocol and ultra-fast reversal during heart transplantation. General anesthesia was induced with etomidate, fentanyl, and vecuronium; it was then maintained with remifentanil-based total intravenous anesthesia.

Outcomes:
Immediately after the end of the operation, the patient was brought to consciousness with stable breathing and haemodynamics. The patient was successfully extubated on the operating table and transferred to the intensive care unit with spontaneous breathing, without postoperative mechanical ventilation. The recovery period was uneventful and the patient was discharged 1 month later without complications.

Lessons:
Our experience, in this case, revealed that IEAHT in children is achievable if the ultra-fast protocol is performed properly and carefully, in order to prevent ventilator-associated complications.
Are newer insulins always the better option?
Authors: Malkani Samir 
Published: January 2019

Purpose of review
Since its discovery almost a century ago, there have been numerous advancements in the formulations of insulin. The newer insulin analogs have structural modifications with the goal of altering pharmacokinetics to achieve either quick onset and offset of action (mealtime bolus analogs), or a prolonged steady action (basal analogs). These analogs offer many advantages over older human insulins but are several-fold more expensive. The aim of this review is to evaluate reasons for the exorbitant price of the newer insulins, to examine the evidence regarding their clinical advantages and to make value-based prescribing recommendations.

Recent findings
The higher cost of newer insulins cannot be justified based on drug development or manufacturing costs. Compared with older insulins, newer analogs do not offer significant advantage in achieving hemoglobin A1c targets, but they reduce risk of hypoglycemia. The reductions in hypoglycemia are relatively modest and most apparent in those with type 1 diabetes, possibly because these individuals are more prone to hypoglycemia.

Summary
When cost considerations are important, the older insulins (regular and NPH insulin) can be used safely and effectively for most individuals with type 2 diabetes who have a low risk of hypoglycemia.
Why are hypomethylating agents or low-dose cytarabine and venetoclax so effective?
Authors: Pollyea Daniel A. , Jordan Craig T. 
Published: January 2019

Purpose of review
Venetoclax with backbone therapies have shown promising efficacy for newly diagnosed, previously untreated, older, unfit acute myeloid leukemia patients. This review discusses this data and potential reasons for the efficacy of these venetoclax-based combinations.

Recent findings
Venetoclax with hypomethylators and low-dose cytarabine have resulted in high response rates, promising response durations, and significant overall survival in relatively small, uncontrolled studies. There is emerging data that these responses are due to the effective targeting of leukemia stem cells through an alteration of the metabolic environment that is poorly tolerated by this population.

Summary
Venetoclax with a backbone therapy in older, untreated patients with acute myeloid leukemia has shown promising efficacy in preliminary clinical trials, and at least partially works through a novel mechanism that can target the leukemia stem cell population. Future investigations will help elucidate the mechanism and the contributions being made by each agent in the regimen.
Diagnostic Performance of Apparent Diffusion Coefficient for Prediction of Grading of Pancreatic Neuroendocrine Tumors
Authors: Zong Rui Long , Geng Li , Wang Xiaohong , Xie Daohai 
Published: January 2019

Objectives
The aim of this study was to evaluate the diagnostic value of apparent diffusion coefficient (ADC) for the World Health Organization grade of pancreatic neuroendocrine tumors (pNETs).

Methods
The MEDLINE, Google Scholar, PubMed, and Embase databases were searched to identify relevant original articles investigating the ADC value in predicting the grade of pNETs. The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated by using random effects models. Subgroup analysis was performed to discover heterogeneity effects.

Results
Nine studies with 386 patients met our inclusion criteria. For identifying G1 from G2/3, the pooled SE, SP, PLR, NLR, and area under the curve of the summary receiver operating characteristic curve were 0.84 (95% confidence interval [95% CI], 0.73–0.91), 0.87 (95% CI, 0.72–0.94), 6.3 (95% CI, 2.7–14.6), 0.19 (95% CI, 0.10–0.34), and 0.91 (95% CI, 0.89–0.94), respectively. The summary estimates for ADC in distinguishing G3 from G1/2 were as follows: SE, 0.93 (95% CI, 0.66–0.99); SP, 0.92 (95% CI, 0.86–0.95); PLR, 11.1 (95% CI, 6.6–18.6); NLR, 0.08 (95% CI, 0.01–0.45); and area under the curve, 0.92 (95% CI, 0.85–0.96).

Conclusions
Diffusion-weighted imaging is a reliable tool for predicting the grade of pNETs, especially for G3. Moreover, the combination of 3.0-T device and higher b value can slightly help improve SE and SP.
Comparative Study Between Gemcitabine-Based and Gemcitabine Plus S1–Based Preoperative Chemoradiotherapy for Localized Pancreatic Ductal Adenocarcinoma, With Special Attention to Initially Locally Advanced Unresectable Tumor
Authors: Takeuchi Taijiro , Mizuno Shugo , Murata Yasuhiro , Hayasaki Aoi , Kishiwada Masashi , Fujii Takehiro , Iizawa Yusuke , Kato Hiroyuki , Tanemura Akihiro , Kuriyama Naohisa , Azumi Yoshinori , Usui Masanobu , Sakurai Hiroyuki , Isaji Shuji 
Published: January 2019

Objectives
To evaluate clinical/histological response and prognosis between preoperative gemcitabine-based chemoradiation therapy (G-CRT) and gemcitabine plus S1–based CRT (GS-CRT) for localized pancreatic ductal adenocarcinoma patients according to the 3 resectability groups.

Methods
Among 199 patients who had 90% or more relative dose intensity of chemotherapy and completion of radiotherapy preoperatively (G-CRT: 98 and GS-CRT: 101), the subjects were 113 patients (G-CRT: 60 and GS-CRT: 53) who underwent curative-intent resection, and we compared clinical and histological effects between the 2 regimens.

Results
There is a significant improvement in clinical and histological responses as assessed by reduction rate in tumor size, post-CRT serum level of carbohydrate antigen 19-9, and the ratio of histological high responder according to the Evans grading system in GS-CRT, as compared with G-CRT, which in turn significantly increased R0 resection rate (P = 0.013). These effects of GS-CRT resulted in significant improvement of disease-specific survival (median survival time, 36.0 vs 27.2 months; P = 0.042), especially in patients with unresectable locally advanced disease (36.0 vs 18.1 months, P = 0.014).

Conclusions
For localized pancreatic ductal adenocarcinoma patients, GS-CRT, as compared with G-CRT, provides significant improvement in clinical and histological response as well as long-time survival, especially in patients with unresectable locally advanced disease.
Cellular Immunotherapy for Multiple Myeloma
Authors: Rosenblatt Jacalyn , Avigan David 
Published: January 2019

Abstract
Cellular immunotherapy for myeloma has the unique potential both to potently kill the malignant clone and to evoke a memory response to protect from relapse. Understanding the complex interactions between the malignant clone and the microenvironment that promote immune escape is critical to evoke effective antimyeloma immunity. Tremendous progress has been made in the area of cancer vaccines and adoptive T-cell therapy in recent years. Careful study of the mechanisms of response and of immune escape will be critical to developing novel combination therapies and ultimately to improve outcomes for patients with myeloma.
Patient-Reported Outcome Measures for Toe-to-Hand Transfer: A Prospective Longitudinal Study
Authors: Tsai Tzong-Yun , Fries C. Anton , Hsiao Jo-Chun , Hsu Chung-Chen , Lin Yu-Te , Chen Shih-Heng , Lin Chih-Hung , Wei Fu-Chan , Lin Cheng-Hung 
Published: January 2019

Background:
Patient-reported outcome measures are an important metric in evaluating treatment efficacy of reconstructive surgery. Toe-to-hand transfer can restore vital prehensile function; however, this surgery is complex, extensive rehabilitation is required, and there are concerns about donor-site morbidity. This study longitudinally explores the benefits of this procedure, from the patient’s perspective, using patient-reported outcome measures.

Methods:
Twenty-three patients who underwent free toe-to-hand transfers from 2012 to 2015 were evaluated preoperatively and postoperatively using the following validated questionnaires: the Michigan Hand Outcomes Questionnaire, the 36-Item Short-Form Health Survey, and the Lower Limb Outcomes Questionnaire. Subgroup analysis was performed between dominant and nondominant reconstructed hands.

Results:
Mechanism of injury was crush in 83 percent; the remainder sustained cutting, avulsion, and burn injuries. Thirty-four toes were transferred: nine great toes, 20 second toes, and five third toes. Michigan Hand Outcomes Questionnaire results showed significant improvement in overall activities of daily living, work, aesthetics, and patient satisfaction (p < 0.05). The results of the 36-Item Short-Form Health Survey showed significant improvements in physical and emotional roles (p < 0.05). The Lower Limb Outcomes Questionnaire showed no deterioration of foot function (p = 0.55). Subgroup analysis showed significant improvement in patient-reported outcome measures for patients undergoing dominant hand reconstruction but no difference between thumb reconstruction and finger-only reconstruction.

Conclusions:
Patient-reported outcome measures demonstrate the significant utility of toe-to-hand transfer procedures in both functional and psychosocial domains in that there are relatively greater benefits in reconstructing the dominant hand, and that donor-site morbidity is well tolerated.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung
Authors: Neill Sarah , Dean Nathan 
Published: January 2019

Purpose of review
Our purpose is to describe aspiration pneumonia/pneumonitis as a spectrum of infectious/noninfectious diseases affecting the lung. We summarize diagnosis, risk factors, treatment, and strategies for prevention of aspiration.

Recent findings
Aspiration is present in normal individuals, and disease manifestation depends on the chemical characteristics, frequency, and volume of inoculum. Anaerobes, though present, are no longer the predominant microbes isolated in aspiration pneumonia. Targets for preventing aspiration including improved oral hygiene and positional feeding have had mixed results. Patients diagnosed by clinicians with aspiration pneumonia experience greater morbidity and mortality than patients with community-acquired pneumonia.

Summary
Aspiration pneumonia and pneumonitis are part of the pneumonia continuum and share similarities in pathophysiology, microbiology, and treatment. Modern microbiology demonstrates that the lung is not sterile, and isolates in aspiration pneumonia frequently include aerobes or mixed cultures. Treatment for aspiration pneumonia should include antibiotic coverage for oral anaerobes, aerobes associated with community-acquired pneumonia, and resistant organisms depending on appropriate clinical context. Additional studies targeting prevention of aspiration and investigating the increased morbidity and mortality associated with aspiration pneumonia are warranted.
Why have trials of inhaled antibiotics for ventilator-associated infections failed?
Authors: Palmer Lucy B. 
Published: January 2019

Purpose of review
Two recent large randomized placebo-controlled clinical trials of adjunctive inhaled therapy for the treatment of ventilator-associated pneumonia failed to show a mortality effect or more rapid resolution of pneumonia symptoms. Does the failure of these studies to reach their endpoints suggest the end of inhaled therapy? This review will explain why inhaled therapy may still have an important role in the treatment of ventilated patients.

Recent findings
The recent interest in inhaled antimicrobial therapy is driven by the global emergence of increasingly resistant bacteria to systemic therapy. As fast as the pharmaceutical pipeline delivers more powerful systemic antibiotics to the ICU, the bacteria evolve and develop resistance to them. The hypothesis of recent trials has been that adjunctive inhaled therapy will make systemic treatment more effective. This review summarizes the available data from the two recent multisite randomized Phase 2 and Phase 3 trials of inhaled antimicrobials as adjunctive therapy and suggests why they failed to achieve their endpoints. When given properly, these drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. The results of these trials and the data from many other smaller trials are compelling us to re-examine the indications for inhaled therapy as well as what clinical outcomes are most important.

Summary
This review summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated infections. Future investigations need to reevaluate the design and the outcomes that are most important in this era of multidrug-resistant bacteria.
Recovery of Severe Aphasia After Cranioplasty: Considerations on a Case Study
Authors: Corallo Francesco , De Cola Maria Cristina , Lo Buono Viviana , Cammaroto Simona , Marra Angela , Manuli Alfredo , Calabrò Rocco Salvatore 
Published: January 2019

Abstract
Cranioplasty is the main surgical intervention for repairing cranial defects performed in about 80% of the patients following cancer surgery or decompressive craniectomy. Although some works have shown recovery of motor and cognitive function, including memory, attention, and executive functions, until today no studies have focused on language recovery after cranioplasty. A 68-year-old woman came to the Neurorehabilitation Unit of the IRCCS Neurolesi (Messina, Italy) because of a fluent aphasia due to a severe left nucleocapsular hemorrhage and greatly improved her motor and neuropsychological status after cranioplasty. Results confirmed that cranioplasty might significantly improve motor and neuropsychological function, besides aphasia. Healthcare professionals involved in rehabilitation should be aware of the potential role of cranioplasty in improving rehabilitative outcomes to better plan a more personalized rehabilitative program. Moreover, rehabilitation nurses can play a pivotal role within the rehabilitation process, as they are educated to interact and communicate with the patient suffering from aphasia.
A Multimetric Evaluation of Online Spanish Health Resources for Lymphedema
Authors: Johnson Anna Rose , Doval Andres F. , Egeler Sabine A. , Lin Samuel J. , Lee Bernard T. , Singhal Dhruv 
Published: January 2019

BackgroundBreast cancer is a leading cause of death in US Hispanic females. This demographic is more likely to present with later-stage disease and require more extensive surgical treatment, including axillary lymph node dissection, which increases risk of lymphedema. The Spanish-speaking Hispanic population has a lower health literacy level and requires materials contoured to their unique needs. The aim of this study was to evaluate online Spanish lymphedema resources.MethodsA web search using the Spanish term “linfedema” was performed, and the top 10 websites were identified. Each was analyzed using validated metrics to assess readability, understandability, actionability, and cultural sensitivity using the SOL (Simplified Measure of Gobbledygook, Spanish), Patient Education and Materials Assessment for Understandability and Actionability (Patient Education and Assessment Tool), and Cultural Sensitivity and Assessment Tool (CSAT), respectively. Online materials were assessed by 2 independent evaluators, and interrater reliability was determined.ResultsOnline lymphedema material in Spanish had a mean reading grade level of 9.8 (SOL). Average understandability and actionability scores were low at 52% and 36%, respectively. The mean CSAT was 2.27, below the recommended value of 2.5. Cohen κ for interrater reliability was greater than 0.81 for the Patient Education and Assessment Tool and CSAT, suggesting excellent agreement between raters.ConclusionsAvailable online Spanish lymphedema resources are written at an elevated reading level and are inappropriate for a population with lower health literacy levels. As patients continue to use the internet as their primary source for health information, health care entities must improve the quality of provided Spanish resources in order to optimize patient comprehension.
Behavioral interventions in epilepsy
Authors: Haut Sheryl R. , Gursky Jonathan M. , Privitera Michael 
Published: January 2019

Purpose of review
Behavioral intervention describes multiple modalities of treatments which are of increasing interest in epilepsy. This review addresses recent behavioral clinical trials in epilepsy including cognitive behavioral therapy (CBT), mindfulness, progressive muscle relaxation (PMR), and self-management. Results and conclusions from updated Cochrane reviews and the recent International League Against Epilepsy Psychology task force are presented.

Recent findings
Two recent large randomized controlled trials (mindfulness and progressive muscle relaxation) reported improved seizure frequency with behavioral treatments. In both studies, participants in both the active and the attentional control arms showed significant seizure reduction, whereas quality of life and stress reduction were better noted in the active arms. Additional behavioral modalities have reported improved seizure control including yoga, bio/neurofeedback, and music therapy.
Significant improvements in multiple quality of life, cognitive domains, and medication adherence have been reported from randomized and open label trials of cognitive behavioral therapy, and self-management programs. Multiple promising self-management programs have been recently reported, often utilizing the power of web-based apps, and digitally delivered group therapy. In 2018, the International League Against Epilepsy Psychology task force recommended that ‘psychological interventions should be incorporated into comprehensive epilepsy care.’

Summary
Behavioral treatments are successful and likely underutilized in the treatment of epilepsy. Given the challenge of conducting randomized clinical trials of behavioral therapy, much remains to be studied. However, for motivated and interested patients, appropriately chosen behavioral therapies appear to be important adjuncts to standard therapy. The timing is currently optimal to take best advantage of smartphone apps and web-based delivery systems, both for research and therapeutic purposes.