bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hybrid magnetic resonance and PET imaging for prostate cancer recurrence
Authors: Rednam Nikita , Kundra Vikas 
Published: March 2023

Purpose of review
Recurrence post definitive local therapy by prostatectomy or radiation therapy is often detected via rise in serum prostate-specific antigen (PSA) levels; however, PSA rise does not localize the disease. Distinguishing local versus distant recurrence guides whether to choose subsequent local versus systemic therapy. The purpose of this article is to review imaging for prostate cancer recurrence post local therapy.

Recent findings
Among imaging modalities, multiparametric MRI (mpMRI) is commonly used to assess for local recurrence. New radiopharmaceuticals target prostate cancer cells and enable whole-body imaging. These tend to be more sensitive for lymph node metastases than MRI or computed tomography (CT) and for bone lesions than bone scan at lower PSA levels but can be limited for local prostate cancer recurrence. Given greater soft tissue contrast, similar criteria for lymph nodes, and greater sensitivity for prostate bone metastases, MRI is advantageous to CT. MRI of the whole body and mpMRI are now feasible within a reasonable time frame and complementary to PET imaging, enabling whole-body and pelvis-focused PET-MRI, which should be advantageous in the setting of recurrent prostate cancer.

Summary
Hybrid PET-MRI with prostate cancer targeted radiopharmaceuticals and whole body with local multiparametric MRI can be complementary for detecting local and distant recurrence to guide treatment planning.
Window-of-opportunity clinical trials for biomarker discovery in head and neck squamous cell carcinoma
Authors: Marret Grégoire , Borcoman Edith , Le Tourneau Christophe 
Published: March 2023

Purpose of review
We review the window-of-opportunity clinical trials that have been reported in head and neck squamous cell carcinoma (HNSCC), and discuss their challenges.

Recent findings
Limited treatment options exist in HNSCC. Cetuximab, an mAb targeting epidermal growth factor receptor, and the PD-1 inhibitors nivolumab and pembrolizumab, are the only drugs that improved overall survival in the recurrent and/or metastatic setting. Both cetuximab and nivolumab improve overall survival by less than 3 months, potentially because of the lack of predictive biomarkers. The only validated predictive biomarker to date is protein ligand PD-L1 expression that predicts the efficacy of pembrolizumab in first-line, nonplatinum refractory recurrent and/or metastatic HNSCC. The identification of biomarkers of efficacy of new drugs is key to avoid administering toxic drugs to patients who will not benefit from them, and to expect increased drug efficacy in the biomarker-positive group of patients. One way of identifying such biomarkers are the window-of-opportunity trials in which drugs are given for a short period of time before the definitive treatment, with the aim to collect samples for translational research. These trials differ from neoadjuvant strategies where efficacy is the primary endpoint.

Summary
We show that these trials were safe and successful in identifying biomarkers.
Stereotactic body irradiation for metastasis from renal carcinoma: A retrospective study
Authors: Rida Hanan , Zaine Hind , Jouhadi Hassan , Benider Abdellatif , Samlali Hamza , Samlali Redouane 
Published: March 2023

Abstract

Background
Renal cell carcinoma (RCC) has traditionally been considered to be radioresistant. Response rates are believed to be improved by a high dose of stereotactic body radiotherapy (SBRT). A retrospective analysis was conducted of patients treated with SBRT for metastatic disease from RCC.

Material and methods
We reviewed records from 20 patients who underwent SBRT for a total of 30 RCC metastases from 2015 to 2020. Patients were included who had a confirmed primary RCC and radiographic evidence of metastasis, either synchronous or metachronous. The most common SBRT fractionation was 30 Gy in 3 fractions.

Results
Median age was 60 years (range, 40–77 years) and 60% were male. After a median follow-up of 18 months (range, 3–36 months), overall survival was estimated to be 85% and 70%, at 1 and 2 years, respectively, and local control at 2 years was 83.33%. Only 5 patients had documented progression of disease, all of whom received biologically effective dose inferior to 100 Gy, and no patients treated with a higher biologically effective dose had disease, which progressed. The most common acute toxicity was grade 1 fatigue (20%). No grade 3 or higher acute toxicity occurred.

Conclusions
Treatment with SBRT in patients with RCC metastases yielded a high local control rate, promising survival rate, and low toxicity.
The spectrum and etiologies of lower urinary tract symptoms in postmenopausal women
Authors: Bharti Vishrut , Tiwari Rajesh K. , Gupta Sanjay , Upadhyay Rohit , Singh Manoj K. , Singh Deelip K. 
Published: March 2023

Abstract

Background
Although the prevalence of lower urinary tract symptoms (LUTS) is high in the female population, it is even higher in postmenopausal females. The frequency, severity, and etiology of LUTS vary among populations and individuals. This study aimed to define the characteristics of LUTS in postmenopausal women and their underlying etiologies.

Material and methods
Overall, 74 postmenopausal patients presenting with LUTS in the urological outpatient department were included in the study. A detailed evaluation of LUTS and their underlying etiologies was performed. Patients were divided into 2 groups based on age (<65 and ≥65 years), and the variation in different factors was compared across the groups. Variables were compared using the t test and 1-way analysis of variance.

Results
Nocturia was the most common symptom (89.2%) followed by frequency (83.8%). Among voiding LUTS, the most common was a weak stream (63.5%). Frequency, nocturia, urgency, urge urinary incontinence (UI), stress UI, and nocturnal enuresis were more common in patients older than 65 years. Urgency and urge UI were recognized to be the most bothersome symptoms by 37% of the study population followed by straining (32%). The mean storage scores, incontinence scores, and quality of life (QoL) scores for patients younger than 65 years and 65 years or older were 6.9 and 8.5 (p < 0.01), 1.8 and 4.1 (p ≤ 0.01), 4.9 and 6.1, respectively. The most common diagnosis was bladder outlet obstruction due to urethral/meatal stenosis (40.5%) followed by an overactive bladder (32.4%), urinary tract infection (10.8%), cystocele (8.1%), urethral prolapse (4.1%), and urethral caruncle (4.1%).

Conclusions
Storage LUTS were the most common and increased in both frequency and severity with age. The QoL was also more severely affected in older postmenopausal women. Bladder outlet obstruction due to meatal with or without distal urethral stenosis was the most common underlying cause of LUTS followed by an overactive bladder. Overactive bladder had the most severe impact on patients’ QoL among all the etiologies.
Preoperative renal insufficiency predicts postoperative adverse outcomes in a mixed surgical population: a retrospective matched cohort study using the NSQIP database
Authors: Liao Yu-Chen , Chang Chuen-Chau , Chen Chien-Yu , Liu Chih-Chung , Liao Chien-Chang , Shih Yu-Ru Vernon , Lin Chao-Shun 
Published: March 2023

Background:
The incidence of chronic kidney disease is increasing, but most cases are not diagnosed until the accidental finding of abnormal laboratory data or the presentation of severe symptoms. Patients with chronic kidney disease are reported to have an increased risk of postoperative mortality and morbidities, but previous studies mainly targeted populations undergoing cardiovascular surgery. The authors aimed to evaluate the risk of postoperative mortality and complications in a surgical population with preoperative renal insufficiency (RI).

Materials and Methods:
This retrospective cohort study used data from the National Surgical Quality Improvement Program database between 2013 and 2018 to evaluate the risk of postoperative morbidity and mortality in the surgical population. Patients with estimated glomerular filtration rate less than 60 ml/min/1.73 m2 were defined as the RI group. Propensity score matching methods and multivariate logistic regression were used to calculate the risk of postoperative morbidity and mortality.

Results:
After propensity score matching, 502 281 patients were included in the RI and non-RI groups. The RI group had a higher risk of 30-day in-hospital mortality (odds ratio: 1.54, 95% CI: 1.49–1.58) than the non-RI group. The RI group was associated with a higher risk of postoperative complications, including myocardial infarction, stroke, pneumonia, septic shock, and postoperative bleeding. The RI group was also associated with an increased risk of prolonged ventilator use for over 48 h, readmission, and reoperation.

Conclusion:
Patients with preoperative RI have an increased risk of postoperative 30-day mortality and complications. RI group patients with current dialysis, estimated glomerular filtration rate less than or equal to 30 ml/min/1.73 m2 or concomitant anemia had an elevated risk of postoperative mortality.
Association of severity in the grading of microvascular invasion with long-term oncological prognosis after liver resection for early-stage hepatocellular carcinoma: a multicenter retrospective cohort study from a hepatitis B virus-endemic area
Authors: Xu Xin-Fei , Diao Yong-Kang , Zeng Yong-Yi , Li Chao , Li Feng-Wei , Sun Li-Yang , Wu Han , Lin Kong-Ying , Yao Lan-Qing , Wang Ming-Da , Zhang Cheng-Wu , Lau Wan Yee , Shen Feng , Yang Tian 
Published: March 2023

Background:
The presence of microvascular invasion (MVI) is a significant malignant pathological feature related to recurrence and survival after liver resection for hepatocellular carcinoma (HCC). This study aimed to investigate the relationship between the severity in the grading of MVI and long-term oncological outcomes in patients with early-stage HCC.

Methods:
A retrospective study was conducted on a prospectively maintained multicenter database on patients who underwent curative resection for Barcelona Clinic Liver Cancer stage 0/A HCC between 2017 and 2020. Patients were classified into three groups according to the severity in the grading of MVI: M0 (no MVI), M1 (1–5 sites of MVI occurring ≤1 cm away from the tumor), and M2 (>5 sites occurring ≤1 cm and/or any site occurring >1 cm away from the tumor). Recurrence-free survival (RFS) and overall survival (OS) were compared among the groups.

Results:
Of 388 patients, M0, M1, and M2 of the MVI gradings were present in 223 (57.5%), 118 (30.4%), and 47 (12.1%) patients, respectively. The median OS and RFS in patients with M0, M1, and M2 were 61.1, 52.7, and 27.4 months; and 43.0, 29.1, and 13.1 months (both P<0.001), respectively. Multivariable analyses identified both M1 and M2 to be independent risk factors for OS [hazard ratio (HR): 1.682, P=0.003; and HR: 3.570, P<0.001] and RFS (HR: 1.550, P=0.037; and HR: 2.256, P<0.001).

Conclusion:
The severity in the grading of MVI was independently associated with recurrence and survival after HCC resection. Patients with the presence of MVI, especially those with a more severe MVI grading (M2), require more stringent recurrence surveillance and/or active adjuvant therapy against recurrence.
The effectiveness and safety of oral medications, onabotulinumtoxinA (three doses) and transcutaneous tibial nerve stimulation as non or minimally invasive treatment for the management of neurogenic detrusor overactivity in adults: a systematic review and network meta-analysis
Authors: Chen Yuanzhuo , Peng Liao , Zhang Chi , Chen Jiawei , Chen Jiahui , Shen Hong , Luo Deyi 
Published: March 2023

Background:
Oral medications, onabotulinumtoxinA injections, and transcutaneous tibial nerve stimulation (TTNS) are recommended by the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines as non or minimally invasive treatments for patients with neurogenic detrusor overactivity (NDO) without treatment hierarchy.

Objective:
The objective was to compare and rank the effectiveness and safety of oral medications, three doses of onabotulinumtoxinA, and TTNS on improving urodynamic outcomes in patient-reported outcomes and safety outcomes in patients with NDO.

Methods:
The authors searched PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov, from their inception to October 2022 and included randomized controlled studies on the drug, onabotulinumtoxinA, and TTNS for the treatment of patients with NDO. Outcomes included urodynamic parameters, voiding diary, quality of life changes, adverse event rate and postvoid residual.

Results:
A total of 26 articles and 2938 patients were included in the statistics. Regarding effectiveness, all interventions except TTNS and α-blockers were statistically different for the placebo group. The urodynamic outcome and patient-reported outcome suggested that onabotulinumtoxinA injection (urodynamic outcome: onabotulinumtoxinA 200 U, the mean surface under the cumulative ranking curve (SUCRA): 87.4; patient-reported outcome: onabotulinumtoxinA 100 U, mean SUCRA: 89.8) was the most effective treatment, and the safety outcome suggested that TTNS (SUCRA: 83.3) was the safest. Cluster analysis found that antimuscarinics and β3-adrenoceptor-agonists possessed good effectiveness and safety.

Conclusion:
OnabotulinumtoxinA injection is probably the most effective way to treat patients with NDO, with increasing effectiveness but decreasing safety as the dose rises. The effectiveness of α-blockers and TTNS was not statistically different from the placebo group. Antimuscarinics and β3-adrenoceptor-agonists have good effectiveness and safety.
Balloon-occluded retrograde transvenous obliteration for treatment of portal hypertensive related varices
Authors: Stoleru Gianna , Henry Zachary 
Published: March 2023

Purpose of review
Balloon-occluded retrograde transvenous obliteration (BRTO) is becoming a more commonly used procedure to manage various complications of liver disease. It is important to understand the technique of the procedure, the indications for its use, and also potential associated complications.

Recent findings
BRTO is superior to endoscopic cyanoacrylate injection and transjugular intrahepatic portosystemic shunt for bleeding gastric varices associated with a portosystemic shunt and should be considered a first line therapy in these patients. In addition, it has been shown to be useful in controlling ectopic variceal bleeding, improving portosystemic encephalopathy, and also in modulating blood flow in the post liver transplant setting. Modified versions of BRTO, plug assisted retrograde transvenous obliteration and coil assisted retrograde transvenous obliteration, have been developed to reduce procedure time and improve complication rates.

Summary
As the use of BRTO expands in clinical practice it will be important for gastroenterologists and hepatologists to better understand the procedure. There are still many research questions left to answer regarding the use of BRTO in specific situations and for specific patient populations.
Unintentional overdoses: understanding the fentanyl landscape and reducing harm
Authors: Bell Lauren A. , Hadland Scott E. 
Published: March 2023

Purpose of review
Adolescent and young adult overdoses and overdose fatalities continue to increase despite reductions in self-reported substance use. This review aims to explore factors contributing to this overdose epidemic, highlight signs of overdose and the role of the overdose reversal medication naloxone, and provide recommendations for practice change to support patients and decrease their risk of unintentional overdose.

Recent findings
The potent opioid fentanyl is a common contaminant in nonopioid substances, as well as in heroin and counterfeit pills, heightening risk of fatal overdose. Adolescents and young adults who die of overdose are rarely engaged in substance use disorder treatment. Medications for opioid use disorder are effective at reducing risk of fatal overdose but are underutilized, as is the opioid reversal medication naloxone.

Summary
Pediatric clinician engagement in harm reduction with adolescents and young adults, starting with screening through a confidential interview, may enhance pathways to care and reduce the risk of overdose.
How resources affect management of periprosthetic fractures of the distal femur: perspectives from Israel, South Sudan, and South Africa
Authors: Bernstein Brian P. , Rivkin Gurion , Weil Yoram A. , Greenberg Alexander , Madison Brian B. , Areu Mapour M. , Joda Omojowk B. , Berry Kirsty Leigh , Nortje Marc 
Published: March 2023

Summary:
Periprosthetic fractures of the distal femur have significant morbidity in both total hip and total knee arthroplasty (THA and TKA, respectively). The incidence of these fractures is growing, with the predominant mechanism of injury being a fall from a standing height and therefore considered fragility fractures. In many countries, improved public funding and a flourishing private health care sector, when coupled with increased life expectancy, translates to more older patients receiving both TKA and THA and therefore an increased prevalence of periprosthetic fractures and their associated complications. These fractures may occur below a long stem THA, above a TKA, or between the two (so-called “interprosthetic fracture”). We will outline fracture classification, risk factors, diagnosis, and treatment options, highlighting perspectives on treating these fractures in Israel, South Africa, and South Sudan. These countries represent differing access to resources, varied comorbidity factors, and differing health care systems. The points of difference and the points of similarity will be considered.
The Isolated Humeral Metastasis as the Initial Presentation of Renal Cell Carcinoma Revealed by 18F-FDG PET/CT
Authors: Hou Guozhu , Zhang Wenjie , Zheng Rong 
Published: March 2023

Abstract
Renal cell carcinoma (RCC) with isolated humeral metastasis as the initial presentation is rare. We reported FDG PET/CT findings of isolated humeral metastasis from RCC in a 63-year-old man with right upper arm pain as the initial presentation. The bone scanning in an outside hospital showed that the focus with increased uptake of the right humerus was possibly malignant. FDG PET/CT showed that the right humeral mass had intense activity, and there was an additional FDG lesion in the lower pole of the right kidney. The mass of the right humerus was later confirmed as humeral metastasis from RCC by pathological examination.
FDG PET/CT in a Case of Pure Ductal Adenocarcinoma of the Prostate With Osteolytic Metastases and Normal PSA Level
Authors: Dong Aisheng , Lin Xumiao , Bai Yushu , Yang Bo , Xu Shengming 
Published: March 2023

Abstract
Prostatic ductal adenocarcinoma is an uncommon aggressive subtype of prostate carcinoma. It is more likely to present with advanced stage and lower prostate-specific antigen. We describe FDG PET/CT findings in a case of pure prostatic ductal adenocarcinoma with lymph node, bone and lung metastases, normal serum prostate-specific antigen level, and elevated serum carbohydrate antigen 19-9 and carbohydrate antigen 724 levels. The primary tumor, and lymph node and bone metastases were hypermetabolic. All the bone metastases were osteolytic. The multiple lung metastases showed no significant FDG uptake, which may be due to small size.
Transumbilical Silicone Breast Augmentation
Authors: Ryan Emma , Haiavy Jacob , Patino Gabriel 
Published: March 2023

Abstract
Transumbilical silicone breast augmentation (TUSBA) is a fairly new and rapidly growing technique of endoscopically assisted placement of silicone breast implants. In comparison, the well-known transumbilical breast augmentation (TUBA) with saline has been described in the literature since 1993 (Planas J. Introduction of breast implants through the abdominal route. Plast Reconstr Surg. 1976;57:431–437). The TUBA procedure has proven to be safe, efficient, and cosmetically sound over the last 29 years (Shiffman MA, Caleel RT, Shumway R, et al. Survey of transumbilical breast augmentation (TUBA). Am J Cosmet Surg. 2011;28:5–11). Augmentation with silicone through the umbilicus is becoming more popular due to several factors: first, because the acceptance of TUBA with saline has been good with positive outcomes and, second, because patients prefer the discrete location and small size of the umbilical scar left behind. Endoscopic guidance is a critical tool for learning and visualization and for reducing complications such as hematoma or misplacement of the implant.
Breast augmentation continues to grow in popularity and acceptance, alongside cosmetic procedures in general. This author expects that, as the TUSBA technique becomes more widespread in use, surgeons will benefit from having a practical clinical publication from which to modify their own technique. This publication will present the authors' TUSBA technique and chart review of practice data from May 2021 through November 2022, wherein the TUSBA procedure was performed.
Forty women aged 21 to 61 years (mean, 35.13 years) underwent endoscopically assisted TUSBA. All patients had the implants placed in the submuscular pocket. Patient surveys and postoperative visit data were used in the generation of follow-up information. Upon inspection of the chart data at 3, 6, 9, and 12 months, there were no reports of capsular contracture. Transumbilical silicone breast augmentation is a safe and efficient method for silicone implant placement in select patients.
Primary Ear Reconstruction Using Cadaveric Costal Cartilage
Authors: Palacios Jose F. , Hazkour Nissim , Robinson Emma , Swami Pooja , Smith Lee , Grande Daniel , Bastidas Nicholas 
Published: March 2023

Objective
Allogeneic cadaveric costal cartilage is commonly used for grafts in nasal reconstruction surgery; however, limited information exists on its use in total ear reconstruction for microtia. In this case series, we describe the novel use of cadaveric cartilage for auricular framework construction in ear reconstruction and review preliminary histologic findings.

Methods
Patients requiring primary complete reconstruction of the auricle from August 2020 to December 2021 were eligible and underwent ear reconstruction using cadaveric costal cartilage. Patients were evaluated for surgical site infection, skin necrosis, cartilage resorption, and cartilage exposure during regular follow-up visits. Two cartilage samples were taken after 2 separate second-stage surgeries done 52 weeks after first-stage reconstruction. These samples were stained with hematoxylin and eosin as well as safranin-O and examined under light microscopy.

Results
A total of 12 ear reconstruction procedures using cadaveric costal cartilage were performed across 11 patients; 10 of 12 ears had type III microtia and 2 of 12 ears had type IV microtia. Patients ranged from 4 to 25 years old at the time of surgery, with an average age of 10.7 years. Follow-up time ranged from 1.6 to 25.4 months, with a mean follow-up time of 11.2 months. No patients experienced any visibly significant cartilage warping. Two patients experienced minor construct exposure, which were successfully salvaged. Two patients experienced surgical site infections, one lead to resorption requiring framework replacement. Preliminary histologic analysis of the 2 samples taken 1 year after implantation showed viable chondrocytes with no evidence of immunologic rejection or any local inflammation or host foreign body response.

Conclusions
Cadaveric costal cartilage serves as a viable alternative to autologous cartilage and other alloplastic biomaterials for construction of auricular frameworks in primary microtia reconstruction. Resorption secondary to infection and construct exposure remain potential risks. Longer follow-up times and a larger sample size are needed for assessment of long-term efficacy.