bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early-Phase 18F-Florbetaben PET as an Alternative Modality for 18F-FDG PET
Authors: Son Seung Hyun , Kang Kyunghun , Ko Pan-Woo , Lee Ho-Won , Lee Sang-Woo , Ahn Byeong-Cheol , Lee Jaetae , Yoon Uicheul , Jeong Shin Young 
Published: September 2019

Purpose
Based on the possibility that early-phase florbetaben (E-FBB) brain PET can be a surrogate for brain perfusion imaging, we conducted this study to investigate the clinical utility of E-FBB PET instead of 18F-FDG brain PET.

Materials and Methods
This prospective study included 35 patients with clinical suspicion of cognitive decline or dementia and 5 healthy controls. Brain MRI, E-FBB PET, late-phase FBB PET, and FDG PET were acquired. The regional SUV ratios (SUVRs) were calculated by cortical surface region of interest analysis using individual MRI, and relationship between E-FBB and FDG PET was analyzed. All PET scans were scored and analyzed as per visual scoring system, which represent tracer uptake abnormality. Moreover, uptake patterns were analyzed to determine the disease.

Results
Among the 40 subjects, 19 were amyloid-positive and 21 were amyloid-negative on late-phase FBB PET. Cortical surface region of interest analysis conducted for comparing between E-FBB and FDG PET revealed significant correlations (P < 0.0001) for regional SUVR among all brain regions; however, the SUVR values of FDG PET were statistically higher than those of E-FBB PET. Similarly, although the visually rated scores for E-FBB and FDG PET showed significant correlation (P < 0.0001), it was considered that the tracer uptake was more severely decreased for FDG PET. The disease types, specified by E-FBB and FDG PET, were statistically correlated.

Conclusions
E-FBB PET could potentially be a useful biomarker for the diagnosis of dementia in place of FDG PET. Nevertheless, the severity of the disease was more accurately determined by FDG PET.
Increased FDG Uptake in the Center of the Gallbladder Stone
Authors: Ji Xia , Dong Aisheng 
Published: September 2019

Abstract
We present a case with a large gallbladder stone showing central hypermetabolism detected incidentally by an FDG PET/CT scan. However, the same gallbladder stone did not showed any FDG activity on the FDG PET/CT scan performed 2 years ago. The mechanism of variable FDG uptake in the same gallbladder stone is unclear, which needs further investigation.
Scrotal Fibroepithelial Polyp With Acute and Chronic Inflammation Mimics Malignancy on 18F-FDG PET/CT Imaging
Authors: Chuang Tzyy-Ling , Tseng Chih-En , Huang Shih-Wen , Wang Yuh-Feng 
Published: September 2019

Abstract
Computed tomography (CT) of a 68-year-old man showed multiple small nodules in the bilateral lungs (maximum 14 mm in the left upper lobe). CT-guided biopsy of left upper lobe lesion showed no tumor or granuloma. Fluorodeoxyglucose (FDG) PET/CT showed multiple nodules with background-to-mild FDG-avid activity, and an incidental left scrotal skin lesion with intensely increased accumulation of 18F-FDG (SUVmax, 11.7), suspected malignant. After urologist consultation, local dermatological findings suggested a huge wart. Excision was done, and pathology concluded nodular papillary fibroepithelial polyp with acute and chronic inflammation.
Orbital Adult T-Cell Leukemia/lymphoma With Skin Involvement Demonstrated on FDG PET/CT
Authors: Hotta Masatoshi , Minamimoto Ryogo 
Published: September 2019

Abstract
An 85-year-old woman presented with decreased visual acuity. MRI of the brain revealed bilateral orbital masses, and FDG-PET/CT demonstrated moderate to intense uptake in the orbital tumors and thickened skin on the left lower leg. Biopsies of the orbital and cutaneous lesions revealed infiltration by T-cell lymphoma, and the presence of human T-cell lymphotropic virus type 1 antigens confirmed the diagnosis of adult T-cell leukemia/lymphoma (ATLL). Although orbital ATLL is rare, the skin is a common site of extranodal involvement of T-cell lymphomas, including ATLL, and FDG uptake by a cutaneous lesion can facilitate early diagnosis.
Decrease in 18F-Florbetapir Accumulation in the Cerebral Hemisphere With Hypoperfusion and Misery Perfusion Due to Chronic Atherosclerotic Occlusion of the Internal Carotid Artery
Authors: Takahashi Tatsuhiko , Kobayashi Masakazu , Fujiwara Shunrou , Kubo Yoshitaka , Terasaki Kazunori , Ogasawara Kuniaki 
Published: September 2019

Abstract
A 67-year-old man had a slowly progressing impairment of recent memory. Cerebral angiography showed atherosclerotic occlusion of the right internal carotid artery with insufficient collateral circulation. Positron emission tomography (PET) using 15O2 gas showed reduced cerebral blood flow, reduced cerebral metabolic rate of oxygen, and elevated oxygen extraction fraction in the precentral region of the right cerebral hemisphere. Use of 18F-florbetapir PET depicted amyloid β deposition as decreased tracer uptake in the precentral region in the right cerebral hemisphere when compared with the contralateral hemisphere.
Pituitary Adenoma on 18F-Fluciclovine PET/CT
Authors: Wang Jiaqiong , Foley Mark , Kuker Russ 
Published: September 2019

Abstract
A 69-year-old man presented with lower urinary tract symptoms and prostate biopsy showed prostate cancer. 18F-Fluciclovine PET/CT revealed abnormal increased radiotracer uptake within the prostate gland, and multiple osseous structures, suspicious for tumoral involvement. Incidentally, an expansile soft tissue density mass arising from sella turcica demonstrated increased radiotracer activity. MRI showed a lobulated enhancing mass centered in the sella and eroding into the sphenoid sinus. The differential diagnosis includes pituitary macroadenoma versus prostate cancer metastasis. The tumor was resected and the pathological diagnosis was pituitary adenoma.
Risk Factors Associated With Postoperative Recurrence in Patients With Tenosynovial Giant Cell Tumor of the Hand
Authors: Shi Jialu , Zheng Jingwei , Zhou Xijie , Li Zhijie , Chen Xinglong , Gao Weiyang , Yan Hede 
Published: September 2019

Abstract
Identification of risk factors for recurrence of tenosynovial giant cell tumors of the hand is crucial to provide adequate preoperative counseling and tailor surgical treatment. However, the risk factors are still controversial, which are the subject of this research.
Recently, we conducted a retrospective cohort study of 135 consecutive patients with giant cell tumors of the tendon sheath of the hand from January 2010 to July 2016. All patients underwent surgical excision, received necessary imaging examinations, and had routine follow-up and thus were identified as those who had recurrence by confirmation of reoperation, and the duration ranged from 24 to 103 months (mean, 53.5 ± 21.4 months). There were 14 local recurrences (10.4%) within 6 to 24 months, respectively, after surgery. Data pertaining to sex, age, tumor sites, tumor size, tumor number, course of disease, bone erosion, tumor growth patterns, anesthesia mode, and the surgeon's experience were all extracted, and Cox regression models were used to estimate recurrence rate with adjustment for potential confounders.
According to the Cox regression analysis, the recurrence rate after surgery was significantly higher in patients with a diffused form than in those with a localized one (P = 0.001); in addition, patients with 2 or more tumors had a much higher postoperative recurrence rate than did those with only 1 tumor (P = 0.023).
This study suggested that the recurrence rate of tenosynovial giant cell tumors of the hand was closely related to the tumor number and tumor growth patterns.
Intercostal Nerve Transfer in Management of Biceps and Triceps Cocontraction in Spontaneously Recovered Obstetric Brachial Plexus Palsy
Authors: Semaya Ahmad Elsayed , El-Nakeeb Ramy , Hasan Mohammad , Shams Ahmed 
Published: September 2019

Background
Obstetric brachial plexus palsy is caused by traction during birth. Most patients regain useful function with spontaneous recovery. In some cases, cross reinnervation occurs between the biceps and triceps muscles. In these cases, smooth active motion of the elbow joint is impaired by simultaneous biceps and triceps muscle contraction. The biceps and triceps muscle cocontraction could be treated by botulinum toxin type A injection, tendon transfer of the triceps to biceps, and intercostal nerves transfer to the musculocutaneous nerve (MCN) or to the motor branch of the radial nerve to the triceps muscle.

Patients and Methods
We present 16 cases (10 males and 6 females) with biceps and triceps cocontraction in spontaneously recovered obstetric brachial plexus palsy patients. They were treated by 3 intercostal nerves transfer to MCN without exploration of the remaining plexus. The mean age at surgery was 40.6 months (range, 24–65 months). Preoperative electromyography was done in all cases to confirm biceps and triceps cocontraction and to assess the contractile status of both muscles.

Results
The mean postoperative follow-up period was 51.7 months (range, 27–64 months). At the final follow-up, elbow flexion was graded 3 in 1 patient, grade 4 in 3 patients, grade 6 in 9 patients, and grade 7 in 3 patients using the 7-point Toronto scale. The mean active range of motion of the elbow (against gravity) increased from 38 degrees preoperatively (range, 0–75 degrees) to 96.8 °̊ at the final follow-up (range, 60–140 degrees).

Conclusions
Intercostal nerves transfer to MCN for management of biceps, and triceps cocontraction in spontaneously recovered obstetric brachial plexus injury is a good option with minimal morbidity and high success rate.
Qualitative Assessment of Columella Scar Quality After Extended Mohler Unilateral Cleft Lip Repair
Authors: Eisemann Bradley S. , Kantar Rami S. , Ramly Elie P. , Alfonso Allyson R. , Wang Maxime , Flores Roberto L. 
Published: September 2019

Background:
The Extended Mohler cleft lip repair restores upper lip form using a columellar flap to fill the defect created by the downward rotation of Cupid's bow. The resulting columella incision is mentioned as a potential drawback. This study seeks to evaluate the morbidity of the resulting scar.

Materials and methods:
This retrospective study enrolled 50 unilateral cleft lip patients treated using the Extended Mohler repair. 5 reviewers examined post-operative images. Three validated scar assessment scales were utilized: Manchester Scar Scale (MSS), Modified Scar-Rating Scale (MSRS), and Stony Brook Scar Evaluation Scale (SBSES). A scar score for the lip and columellar portion of each patient was determined.

Results:
Three different scar scales demonstrated significantly better scar quality for the columellar portion of the scar compared to the lip portion. The average score for the lip and columella using the MSS was 7.0 ± 1.4 and 5.7 ± 1.1 (P <0.001). The average score for the lip and columella using the MSRS was 5.5 ± 1.4 and 4.3 ± 0.9 (P <0.001). The average score for the lip and columella using the SBSES was 3.5 ± 1.1 and 3.9 ± 0.7 (P = 0.014). The intraclass correlation coefficient for lip scar assessments was 0.901 (MSS), 0.91 (MSRS), and 0.873 (Stony Brook Evaluation Scale [SBES]). The intraclass correlation coefficient for columellar scar assessment was 0.786 (MSS), 0.761 (MSRS), and 0.726 (SBES).

Conclusion:
The Extended Mohler unilateral cleft lip columellar scar is of superior quality compared to the lip portion. This analysis ameliorates one of the major concerns regarding the Extended Mohler cleft lip repair.
Long-Term Outcomes for Adult Patients With Cleft Lip and Palate
Authors: Connolly Katharine A. , Kurnik Nicole M. , Truong Tuan A. , Muller Cristiane , Beals Patricia H. , Singh Davinder J. , Beals Stephen P. 
Published: September 2019

Abstract
The purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years of age and who had a history of clefts of the lip or palate, or both, from January 1, 2013, to June 30, 2014. The authors compared the concerns of the patients who received cleft-team–based care by a single, multidisciplinary cleft team; multiple multidisciplinary cleft teams; or no formal cleft team. The authors analyzed data for 142 patients. The most common patient concerns were lip aesthetics (64%), nose aesthetics (61%), septal deviations (47%), nasal obstruction (44%), malocclusion (32%), oronasal fistulas (29%), and speech (21%). Oronasal fistulas were more commonly reported in the group of patients who had care by multiple teams (42.9%; P < .001). Malocclusion was more commonly reported in the group of patients who had care by multiple teams (50%; P = .001). The authors found that adult patients who have undergone rehabilitation for cleft lip and palate appear to have a common set of long-term needs. Multidisciplinary cleft-team–based care appears to be the most effective way to address these needs.
Coordination of the Fetal Medicine Institute and the Cleft and Craniofacial Center: Application to Early Management of Infants With Cleft Lip and Palate
Authors: Fan Kenneth L. , Black Cara K. , Mantilla-Rivas Esperanza , Bulas Dorothy I. , Rubio Eva , Blask Anna R. , Robinson Chelsea , Oh Albert K. 
Published: September 2019

Background/Purpose:
The primary objective of this study is to describe the authors’ experience at the Children's National Health System with the coordination of the Fetal Medicine Institute and the Cleft and Craniofacial Center. This collaboration highlights the accuracy and completeness of prenatal diagnosis of cleft abnormalities with expedient postnatal management.

Methods:
With Institutional Review Board approval, the authors retrospectively reviewed 74 patients referred for potential orofacial cleft and 44 met the inclusion criteria. Follow-up fetal ultrasonography is typically performed and three-dimensional imaging was performed when feasible. If questionable anomalies or facial findings are present on these studies, the authors proceed with fetal magnetic resonance imaging. A thorough consultation is held with the cleft team, resulting in a comprehensive plan of care. Postnatal examination confirmed the correct prenatal diagnosis in nearly all patients.

Results:
Sensitivity and specificity for isolated unilateral cleft lip were 89% and 100%, respectively; for unilateral cleft lip and palate, sensitivity and specificity were 82% and 90%, respectively; for bilateral cleft lip and palate, sensitivity and specificity were 97% and 90%, respectively. Initial postnatal evaluation by the cleft surgeon occurred at an average age of 21 days after birth. All patients who were candidates for presurgical orthodontia were treated at an appropriate young age (mean: 66.5 days).

Conclusions:
Coordinated prenatal evaluation of patients with cleft lip/palate by multidisciplinary centers plays an important role in the care of these complex patients. The results of the authors’ study demonstrated high sensitivity and specificity for the prenatal diagnosis of cleft lip/palate, leading to timely postnatal evaluation and treatment.
The impact of interhospital transfer on mortality benchmarking at Level III and IV trauma centers: A step toward shared mortality attribution in a statewide system
Authors: Holena Daniel N. , Kaufman Elinore J. , Hatchimonji Justin , Smith Brian P. , Xiong Ruiying , Wasser Thomas E. , Delgado M. Kit , Wiebe Douglas J. , Carr Brendan G. , Reilly Patrick M. 
Published: September 2019

BACKGROUND
Many injured patients presenting to Level III/IV trauma centers will be transferred to Level I/II centers, but how these transfers influence benchmarking at Level III/IV centers has not been described. We hypothesized that the apparent observed to expected (O:E) mortality ratios at Level III/IV centers are influenced by the location at which mortality is measured in transferred patients.

METHODS
We conducted a retrospective study of adult patients presenting to Level III/IV trauma centers in Pennsylvania from 2008 to 2017. We used probabilistic matching to match patients transferred between centers. We used a risk-adjusted mortality model to estimate predicted mortality, which we compared with observed mortality at discharge from the Level III/IV center (O1) or observed mortality at discharge from the Level III/IV center for nontransferred patients and at discharge from the Level I/II center for transferred patients (O2).

RESULTS
In total, 9,477 patients presented to 11 Level III/IV trauma centers over the study period (90% white; 49% female; 97% blunt mechanism; median Injury Severity Score, 8; interquartile range, 4–10). Of these, 4,238 (44%) were transferred to Level I/II centers, of which 3,586 (85%) were able to be matched. Expected mortality in the overall cohort was 332 (3.8%). A total of 332 (3.8%) patients died, of which 177 (53%) died at the initial Level III/IV centers (O1). Including posttransfer mortality for transferred patients in addition to observed mortality in nontransferred patients (O2) resulted in worse apparent O:E ratios for all centers and significant differences in O:E ratios for the overall cohort (O1:E, 0.53; 95% confidence interval, 0.45–0.61 vs. O2:E, 1.00, 95% confidence interval, 0.92–1.11; p < 0.001).

CONCLUSION
Apparent O:E mortality ratios at Level III/IV centers are influenced by the timing of measurement. To provide fair and accurate benchmarking and identify opportunities across the continuum of the trauma system, a system of shared attribution for outcomes of transferred patients should be devised.
The impact of Medicaid expansion on trauma-related emergency department utilization: A national evaluation of policy implications
Authors: Knowlton Lisa Marie , Dehghan Melody S. , Arnow Katherine , Trickey Amber W. , Tennakoon Lakshika , Morris Arden M. , Spain David A. 
Published: September 2019

BACKGROUND
The impact of the 2014 Affordable Care Act (ACA) upon national trauma-related emergency department (ED) utilization is unknown. We assessed ACA-related changes in ED use and payer mix, hypothesizing that post-ACA ED visits would decline and Medicaid coverage would increase disproportionately in regions of widespread policy adoption.

METHODS
We queried the National Emergency Department Sample (NEDS) for those with a primary trauma diagnosis, aged 18 to 64. Comparing pre-ACA (2012) to post-ACA (10/2014 to 09/2015), primary outcomes were change in ED visits and payer status; secondary outcomes were change in costs, discharge disposition and inpatient length of stay. Univariate and multivariate analyses were performed, including difference-in-differences analyses. We compared changes in ED trauma visits by payer in the West (91% in a Medicaid expansion state) versus the South (12%).

RESULTS
Among 21.2 million trauma-related ED visits, there was a 13.3% decrease post-ACA. Overall, there was a 7.2% decrease in uninsured ED visits (25.5% vs. 18.3%, p < 0.001) and a 6.6% increase in Medicaid coverage (17.6% vs. 24.2%, p < 0.001). Trauma patients had 40% increased odds of having Medicaid post-ACA (vs. pre-ACA: aOR 1.40, p < 0.001). Patients in the West had 31% greater odds of having Medicaid (vs. South: aOR 1.31, p < 0.001). The post-ACA increase in Medicaid was greater in the West (vs. South: aOR 1.60, p < 0.001). Post-ACA, inpatients were more likely to have Medicaid (vs. ED discharge: aOR 1.20, p < 0.001) and there was a 25% increase in inpatient discharge to rehabilitation (aOR 1.24, p < 0.001).

CONCLUSION
Post-ACA, there was a significant increase in insured trauma patients and a decrease in injury-related ED visits, possibly resulting from access to other outpatient services. Ensuring sustainability of expanded coverage will benefit injured patients and trauma systems.

LEVEL OF EVIDENCE
Economic, level III.
Quantifying the Limits of Immunotherapies in Mice and Men
Authors: Brown Liam V , Gaffney Eamonn A , Ager Ann , Wagg Jonathan , Coles Mark C 
Published: September 2019

AbstractBackgroundCART-cells have demonstrated clinical success for the treatment of multiple different lymphomas and leukaemias. However, comparable clinical efficacy has not been observed for various solid tumours in human clinical trials, despite promising data from murine cancer models. Lower effective CART-cell delivery rates to human solid tumours compared to haematological malignancies in humans and solid tumours in mice might partially explain these divergent clinical outcomes, requiring the development of quantitative methods to calculate effective dosing in the clinic and models.MethodsWe used anatomical and physiological data for human and rodent circulatory systems to calculate the typical value and expected variation of the perfusion of healthy and tumour tissues, and used these to estimate the upper limits of immune cell delivery rates (maximum possible under optimal conditions) across different organs, tumours types and species.ResultsEstimated maximum delivery rates were up to order 10,000-fold greater in mice than humans yet reported CART-cell doses are typically only 10-100-fold lower in mice, suggesting that the effective delivery rates of CART-cells into tumours in clinical trials are far lower than in corresponding mouse models. Estimated delivery rates were compared to published PET data and found to be consistent.ConclusionsThe results suggest that higher effective human doses may be needed to drive efficacy comparable to mouse solid tumour models. These increased doses raise safety and manufacturing concerns. We posit that quantitation of species and organ-specific delivery and homing of engineered T-cells will be key to unlocking their potential for solid tumours.
Most cancers carry a substantial deleterious load due to Hill-Robertson interference
Authors: Tilk Susanne , Curtis Christina , Petrov Dmitri A , McFarland Christopher D 
Published: September 2019

AbstractCancer genomes exhibit surprisingly weak signatures of negative selection1,2. This may be because selective pressures are relaxed or because genome-wide linkage prevents deleterious mutations from being removed (Hill-Robertson interference)3. By stratifying tumors by their genome-wide mutational burden, we observe negative selection (dN/dS ~ 0.47) in low mutational burden tumors, while remaining cancers exhibit dN/dS ratios ~1. This suggests that most tumors do not remove deleterious passengers. To buffer against deleterious passengers, tumors upregulate heat shock pathways as their mutational burden increases. Finally, evolutionary modeling finds that Hill-Robertson interference alone can reproduce patterns of attenuated selection and estimates the total fitness cost of passengers to be 40% per cell on average. Collectively, our findings suggest that the lack of observed negative selection in most tumors is not due to relaxed selective pressures, but rather the inability of selection to remove deleterious mutations in the presence of genome-wide linkage.