bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Usefulness of Short-Interval Sequential FDG PET/CT Studies in Defining the Benignity of Hypermetabolic Lipomatous Tumor
Authors: Hod Nir , Nalbandyan Karen , Lantsberg Sophie 
Published: February 2023

Abstract
We present an interesting case of incidentally detected lipomatous tumor in an oncological patient that could result in a false-positive interpretation by exhibiting intense FDG activity similar to that of a malignant neoplasm. Careful evaluation of FDG uptake changes on sequential short-interval PET/CT studies was helpful in defining the benign nature of the tumor as the hypermetabolism was gradually disappearing obviating the need for a major surgery.
Complete Remission Upon Peptide Receptor Radionuclide Therapy in a G2 Pancreatic Neuroendocrine Tumor
Authors: Weich Alexander , Serfling Sebastian E. , Yi Heqing , Buck Andreas K. , Higuchi Takahiro , Werner Rudolf A. 
Published: February 2023

Abstract
We report the case of a 52-year-old man affected with a metastasized neuroendocrine tumor (G2) of the pancreas. After surgical removal, follow-up imaging 36 months later revealed somatostatin receptor–positive liver lesions. Because of disease progression under cold somatostatin analogs 6 months later, peptide receptor radionuclide therapy was performed, that induced complete remission (CR), supporting the notion that “hot” somatostatin analogs can achieve CR even in patients affected with pancreatic G2 neuroendocrine tumor. Of note, such cases exhibiting CR upon peptide receptor radionuclide therapy are extremely rare and further investigations may pool those exceptional treatment responders.
Nodular Fasciitis
Authors: Pitot Marika A. , Broski Stephen M. , Thompson Scott M. , Woodrum David A. , Powell Garret M. 
Published: February 2023

Abstract
PET/CT plays a crucial role in the management of prostate cancer with several emerging and established radiopharmaceuticals, including 18F-piflufolastat and 11C-choline. These radiotracers are thought to be relatively specific to prostate cancer; however, uptake has also been demonstrated in other benign and malignant lesions. Nodular fasciitis is a rapidly growing benign soft tissue neoplasm that is typically self-limiting. Although a few case reports describe 68Ga-PSMA uptake in nodular fasciitis, uptake of 11C-choline and other PSMA-targeted PET probes, including 18F-piflufolastat, have not previously been reported. We present a novel case of nodular fasciitis demonstrating both 18F-piflufolastat and 11C-choline avidity.
Asymptomatic Prostate Cancer Metastasis in Rectal Mucosa Revealed by 18F-PSMA-1007 PET/CT
Authors: Wang Shu , Cheng Zhiming , Du Bulin , Li Yaming , Li Xuena 
Published: February 2023

Abstract
Prostate cancer metastasis to the rectal mucosa, a relatively rare metastatic site, leads to a higher clinical stage and poorer prognosis. A 65-year-old man with prostate cancer underwent 18F–prostate-specific membrane antigen (PSMA) PET/CT for staging. Intense 18F-PSMA uptake occurred at the primary lesion, bladder, adjacent seminal vesicle, and rectum. PET/CT imaging revealed increased homogeneous round activity of the rectal wall. The final diagnosis was prostate cancer metastasis to the rectal mucosa. This case suggested that 18F-PSMA PET/CT may assist in locating rare metastases of prostate cancer, with potential value for early staging.
Complete Metabolic Response by 18F-FDG PET/CT to Atezolizumab Plus Bevacizumab in Patients With Advanced Hepatocellular Carcinoma
Authors: Uchida Yoichiro , Yoh Tomoaki , Fukui Ayaka , Takai Atsushi , Hatano Etsuro 
Published: February 2023

Abstract
Nowadays, atezolizumab plus bevacizumab is recommended for advanced hepatocellular carcinoma (HCC) as the first-line systemic chemotherapy. Nevertheless, the data with regard to the tumor response still remain limited. We report a complete metabolic response assessed by 18F-FDG PET/CT in a 74-year-old man with advanced HCC who underwent atezolizumab plus bevacizumab followed by radical hepatectomy. Furthermore, pathological examination revealed that the tumor showed complete response for this therapy. This case suggests that 18F-FDG PET/CT represents clinical relevance as a useful approach for therapeutic assessment of immune-oncology drugs in HCC.
Role of Quantitative Plaque Analysis and Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography to Assess Plaque Progression
Authors: Qiao Hong Yan , Wu Yong , Li Hai Cheng , Zhang Hai Yan , Wu Qing Hua , You Qing Jun , Ma Xin , Hu Shu Dong 
Published: February 2023

Purpose:
To explore the role of quantitative plaque analysis and fractional flow reserve (CT-FFR) derived from coronary computed angiography (CCTA) in evaluating plaque progression (PP).

Methods:
A total of 248 consecutive patients who underwent serial CCTA examinations were enrolled. All patients’ images were analyzed quantitatively by plaque analysis software. The quantitative analysis indexes included diameter stenosis (%DS), plaque length, plaque volume (PV), calcified PV, noncalcified PV, minimum lumen area (MLA), and remodeling index (RI). PP is defined as PAV (percentage atheroma volume) change rate >1%. CT-FFR analysis was performed using the cFFR software.

Results:
A total of 76 patients (30.6%) and 172 patients (69.4%) were included in the PP group and non-PP group, respectively. Compared with the non-PP group, the PP group showed greater %DS, smaller MLA, larger PV and non-calcified PV, larger RI, and lower CT-FFR on baseline CCTA (all P<0.05). Logistic regression analysis showed that RI≥1.10 (odds ratio [OR]: 2.709, 95% CI: 1.447-5.072), and CT-FFR≤0.85 (OR: 5.079, 95% CI: 2.626-9.283) were independent predictors of PP. The model based on %DS, quantitative plaque features, and CT-FFR (area under the receiver-operating characteristics curve [AUC]=0.80, P<0.001) was significantly better than that based rarely on %DS (AUC=0.61, P=0.007) and that based on %DS and quantitative plaque characteristics (AUC=0.72, P<0.001).

Conclusions:
Quantitative plaque analysis and CT-FFR are helpful to identify PP. RI and CT-FFR are important predictors of PP. Compared with the prediction model only depending on %DS, plaque quantitative markers and CT-FFR can further improve the predictive performance of PP.
The Usage of Intravenous Tranexamic Acid in Reduction Mammaplasty Safely Reduces Hematoma Rates
Authors: Om Anjali , Marxen Troy , Kebede Sara , Losken Albert 
Published: February 2023

Background
Bleeding complications are not uncommon after breast reduction surgery, and recently, tranexamic acid (TXA) as an antifibrinolytic agent has been used in various surgical specialties as a way to minimizes such adverse outcomes. We elected to evaluate the effectiveness of intravenous (IV) intraoperative TXA in reduction mammoplasty patients.

Methods
This is a retrospective chart review of clinical charts of all patients who received reduction mammoplasty by a single surgeon at Emory University Hospital or its affiliated Aesthetic Center from January 1, 2020, to March 1, 2022. Seventy-four consecutive breast reduction patients received 1-g IV TXA intraoperatively compared with 117 consecutive controls. The outcome of interest included 30-day postoperative bleeding complications.

Results
There was no significant difference in age (P = 0.92), body mass index (P = 0.98), percentage of smokers (P = 0.56), operating time (P = 0.87), estimated blood loss (P = 0.90), or weight removed (P = 0.98) between patients in each arm. There were 19 bleeding events (16.2%) in the non-TXA arm compared with 1 bleeding event (1.4%) in the TXA arm (P = 0.0143). Of the 19, 6 (5.1%) were major events, and 13 were minor events (11.1%); the only bleeding event in the TXA arm was minor. Number needed to treat all bleeding events with use of TXA was 7, and the number needed to treat minor hematomas was 11. There was no significant difference in the rate of seroma, wound healing complications, infection, or nipple necrosis between the 2 arms (P > 0.05).

Conclusions
The use of IV TXA is a safe and effective way to reduce hematoma rates in patients receiving reduction mammoplasty.
INTERLEUKIN-35 DOWNREGULATES THE IMMUNE RESPONSE OF EFFECTOR CD4+ T CELLS VIA RESTRICTING HIGH MOBILITY GROUP BOX-1 PROTEIN-DEPENDENT AUTOPHAGY IN SEPSIS
Authors: Wu Tiantian , Ren Chao , Dou Xiaowei , Wu Yao , Dong Ning , Zhang Hui , Yao Yongming 
Published: February 2023

ABSTRACT

Background: Immunosuppression is critically involved in the development of sepsis and is closely associated with poor outcomes. The novel role of the anti-inflammatory cytokine IL-35 in sepsis was examined. Methods: Sepsis was induced by in C57BL/6 mice cecal ligation and puncture (CLP). The impacts of IL-35 on effector CD4+ T cells were investigated by examining cell proliferation and the Th1/Th2 ratio in the presence of recombinant IL-35 (rIL-35) or anti–IL-35 (EBI3). The regulatory effect of IL-35 on autophagy was evaluated by measuring autophagy markers and autophagic flux in CLP mice in vivo and in activated effector CD4+ T cells in vitro. Results: IL-35 levels were significantly increased in the serum and spleens of septic mice. rIL-35 administration after CLP further decreased proliferation and the Th1/Th2 ratio in effector CD4+ T cells and significantly shortened the survival time. Sepsis-induced autophagy activation was protective in effector CD4+ T cells and was blocked by rIL-35. The inhibitory effect of IL-35 on autophagy was observed in activated effector CD4+ T cells in vitro, and this effect was mediated by restricting high mobility group box-1 protein (HMGB1) translocation. Conclusion: IL-35 is an immunosuppressive cytokine that impairs CD4+ T-cell proliferation and differentiation in sepsis, and the effect might be mediated by reducing HMGB1-dependent autophagy.
CELLULAR SENESCENCE IMPLICATED IN SEPSIS-INDUCED MUSCLE WEAKNESS AND AMELIORATED WITH METFORMIN
Authors: Chen Juan , Chen Xin Yi , Cong Xiao Xia , Wang Shen , Xu Shui Bo , Sun Yu Ting , Zhou Yi Ting , Zheng Li Ling , Huang Man 
Published: January 2023

ABSTRACT

Background: Sepsis is a life-threatening medical emergency, frequently complicated with intensive care unit–acquired weakness syndrome (ICU-AW). ICU-AW patients display flaccid weakness of the limbs, especially in the proximal limb muscles. However, little is known regarding its pathogenesis. Here, we aimed to identify the potential signaling pathway involved in ICU-AW regulation and identify a potential therapeutic drug for intervention. Methods: Both in vivo and in vitro septic mice were used. For the in vivo septic mice, either cecum ligation and puncture or intraperitoneal injection of LPS was conducted in mice. The body weight and muscle mass were then measured and recorded. Muscle strength was evaluated by limb grip strength test. The expression of proteins extracted from cells and muscles was checked through Western blot analysis. Quantitative reverse transcription-polymerase chain reaction was carried out to test the transcriptional level of genes. Senescence-associated β-galactosidase (SA-β-gal) staining and Sirius red for collagen staining were conducted. Metformin, as an antiaging agent, was then tested for any attenuation of sepsis-related symptoms. For in vitro sepsis modeling, myoblasts were treated with LPS, analyzed for senescence-related protein expression, and subsequently retested upon metformin treatment. Results: We found that both the weight and strength of muscle were dramatically reduced in cecum ligation and puncture– or LPS-induced septic mice. RNA-seq analysis revealed that various cellular senescent genes were involved in sepsis. In line with this, expression of senescence-related genes, p53 and p21 were both upregulated. Both SA-β-gal and Sirius red for collagen staining were enhanced in tibialis anterior muscles. Notably, inhibition of p53 expression by siRNA prominently reduced the number of SA-β-gal–positive myoblasts upon LPS treatment. This indicated sepsis-induced cellular senescence to be dependent on p53. Consistent with the function of metformin in antiaging, metformin attenuated cellular senescence in both murine myoblasts and skeletal muscles during sepsis. Muscle strength of septic mice was improved upon metformin treatment. Metformin intervention is therefore proposed as a potential therapeutic strategy for ICU-AW. Conclusion: Taken together, we revealed a previously unappreciated linkage between cellular senescence and sepsis-induced muscle weakness and propose metformin as a potential therapeutic drug for the treatment of ICU-AW.
A Delphi-Style Evaluation of a Skin Assessment Simulation Using Clinical Vignettes and a Breast Health Training Tool
Authors: Greene Tatiana M. , Chuisano Samantha A. , Quiroza Sofia A. , Sadovnikova Anna 
Published: February 2023

Introduction
Breast and skin assessment are both required clinical skills across health professional training programs. The breast is an ideal “canvas” for the development of a simulation exercise focused on the identification and diagnosis of skin conditions that could present anywhere on the body alongside unique conditions specific to the breast and nipple-areolar complex. A skin assessment simulation on a breast model has not been described.

Methods
Investigators developed 20 clinical vignettes for breast and skin conditions (ie, features) depicted on a set of 10 single silicone breast models in 4 skin tones. A modified Delphi approach was used to evaluate the appropriateness of the clinical vignettes and realism of features. A convenience sample of 136 licensed physicians was recruited online. In round 1, participants rated the realism of features and suggested descriptors for each feature. In round 2, participants rated their agreement with descriptors from round 1, selected a diagnosis based on clinical vignettes, and assessed the utility of the Breast Health Training Tool for health professionals.

Results
In round 1, participants (n = 38) agreed (5.1/6) that the features were realistic. In round 2, participants (n = 24) agreed (4.6/6) with the descriptors. Most (>50%) participants agreed on a diagnosis for each feature. Participants (n = 27) agreed (5.3/6) that this tool is useful for health professional education.

Conclusions
This is the first evaluation of a simulation tool for teaching breast examination and identification of skin conditions on the nipple-areolar complex and breast tissue in multiple skin tones, simultaneously filling the gap in women's breast, lactation, and skin health education.
Reducing Hemorrhage-Related Maternal Morbidity Using Interdisciplinary Simulation Training
Authors: Gerard Jessica L. , Turrentine Mark A. , Leong-Kee Susan 
Published: February 2023

Introduction
Postpartum hemorrhage (PPH) remains a major cause of preventable maternal morbidity in the United States. Postpartum hemorrhage simulations were developed to improve provider recognition and treatment; however, there exist few studies that investigate their effects on individual outcomes. Our objective is to estimate the effect of a simulation-based educational intervention on PPH-related maternal morbidity outcomes.

Methods
We conducted a retrospective cohort analysis of hemorrhage outcomes at a single institution between March 2012 and January 2016 during the implementation of a high-fidelity PPH simulation. Women with PPH defined as an estimated blood loss greater than 500 mL for vaginal delivery and 1000 mL for cesarean delivery were included. The primary outcome was a composite of hemorrhage-related maternal morbidity (maternal death, hysterectomy, intensive care unit admission, blood transfusion, or unanticipated procedures to treat postpartum bleeding). Multivariable logistic regression adjusted for confounding variables between presimulation and postsimulation outcomes.

Results
During the study period, 19,927 deliveries occurred with 4.5% of patients (888) experiencing hemorrhage. Women in the presimulation (n = 278) versus postsimulation groups (n = 610) had similar demographics. Although the PPH rate increased after simulation [2.8% pre vs. 6.1% post, odds ratio (OR), 2.25; 95% confidence interval (CI), 1.95–2.60], composite hemorrhage-related morbidity was lower after simulation training (44% pre vs. 35% post; OR, 0.70; 95% CI, 0.52–0.93). This reduction persisted after adjusting for confounding variables of mode of delivery and time from delivery to first uterotonic use (adjusted OR, 0.66; 95%, CI 0.49–0.89).

Conclusions
Despite an increased PPH rate, simulation education was associated with a reduction in a hemorrhage-related maternal composite morbidity.
Exploring the Frameworks, Needs, and Barriers of Interprofessional Education and Simulation in Emergency Medicine
Authors: Rutherford-Hemming Tonya , Linder Gary 
Published: February 2023

Summary Statement
This manuscript focuses on interprofessional education (IPE) using simulation and its use between emergency department and emergency medical services personnel. It explores the theoretical frameworks behind IPE and applies them to simulation-based emergency medical services education. There is a notable lack of research on the use of IPE using simulation between these 2 professions. The need for IPE using simulation as well as barriers and recommendations to remove the barriers are discussed.
Long-Term Outcomes of Exercise Therapy Versus Revascularization in Patients With Intermittent Claudication
Authors: Shirasu Takuro , Takagi Hisato , Yasuhara Jun , Kuno Toshiki , Kent K. Craig , Farivar Behzad S. , Tracci Margaret C. , Clouse W. Darrin 
Published: February 2023

Objective:
The aim was to analyze the risk of progression to chronic limb-threatening ischemia (CLTI), amputation and subsequent interventions after revascularization versus noninvasive therapy in patients with intermittent claudication (IC).

Background:
Conflicting evidence exists regarding adverse limb outcomes after each treatment strategy.

Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. MEDLINE, Web of Science, and Google Scholar were searched aided by a health sciences librarian through August 16, 2022. Randomized control trials (RCTs) comparing invasive (endovascular or surgical revascularization) and noninvasive treatment (exercise and/or medical treatment) were included. PROSPERO registration was completed (CRD42022352831).

Results:
A total of 9 RCTs comprising 1477 patients (invasive, 765 patients; noninvasive, 712 patients) were eligible. During a mean of 3.6-year follow-up, progression to CLTI after invasive [5 (2–8) per 1000 person-years] and noninvasive treatment [6 (3–10) per 1000 person-years] were not statistically different [rate ratio (RR): 0.77; 95% CI, 0.35–1.69; P=0.51, I
2=0%]. Incidence of amputation (RR: 1.69; 95% CI, 0.54–5.26; P=0.36, I
2=0%) and all-cause mortality (hazard ratio: 1.26; 95% CI, 0.91–1.74; P=0.16, I
2=0%) also did not differ between the groups. However, the invasive treatment group underwent significantly more revascularizations (RR: 4.15; 95% CI, 2.80–6.16; P<0.00001, I
2=83%). The results were not changed by fixed effect or random-effects models, nor by sensitivity analysis.

Conclusions:
Although there is equivalent risk of progression to CLTI, major amputation and all-cause mortality compared with noninvasive treatment, invasive treatment for patients with IC led to significantly more revascularization procedures and should be used selectively in patients with major lifestyle limitation. Guideline recommendation of noninvasive treatment for first-line IC therapy is supported.
Radical Resection Combined With Intestinal Autotransplantation for Locally Advanced Pancreatic Cancer After Neoadjuvant Therapy
Authors: Liang Tingbo , Zhang Qi , Wu Guosheng , Liu Chaoxu , Bai Xueli , Gao Shunliang , Ma Tao , Sun Ke , Yan Senxiang , Xiao Wenbo , Jiang Tian’an , Lu Fangyan , Zhang Yuntao , Shen Yan , Zhang Min , Zhang Xiaochen , Shan Jianzhen 
Published: February 2023

Objective:
To achieve radical resection of locally advanced pancreatic ductal adenocarcinoma (PDAC), and tested the safety and benefits of intestinal autotransplantation in pancreatic surgery.

Background:
PDAC has an extremely dismal prognosis. Radical resection was proved to improve the prognosis of patients with PDAC; however, the locally advanced disease had a very low resection rate currently. We explored and evaluated whether the combination of modern advances in systemic treatment and this macroinvasive surgery was feasible in clinical practice.

Methods:
Patients diagnosed as PDAC with superior mesenteric artery involvement and with or without celiac trunk involvement were included. Patients were treated with modified-FOLFIRINOX chemotherapy with or without anti-PD-1 antibodies and were applied to tumor resection combined with intestinal autotransplantation. Data on operative parameters, pathologic results, mortality, morbidity, and survival were analyzed.

Results:
A total of 36 consecutive cases were applied to this strategy and underwent radical resection combined with intestinal autotransplantation. Among these patients, 24 of them received the Whipple procedure, 11 patients received total pancreatectomy, and the other 1 patient received distal pancreatectomy. The median operation time was 539 minutes. Postoperative pathology showed an R0 resection rate of 94.4%, and tumor invasion of a superior mesenteric artery or superior mesenteric vein was confirmed in 32 patients. The median number of dissected lymph nodes was 43, and 25 patients were positive for lymph node metastasis. The median time of intensive care unit stay was 4 days. Two patients died within 30 days after surgery due to multiorgan failure. The severe postoperative adverse events (equal to or higher than grade 3) were observed in 12 out of 36 patients, and diarrhea, gastroparesis, and abdominal infection were the most frequent adverse events. Postoperative hospital stay was averagely of 34 days. The recurrence-free survival is 13.6 months. The median overall survival of patients after diagnosis and after surgery was 21.4 months and 14.5 months, respectively.

Conclusions:
Our attempt suggests the safety of this modality and may be clinically beneficial for highly selected patients with PDAC. However, the experience in multidisciplinary pancreatic cancer care and intestinal transplantation is warranted.