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To evaluate ablation zone sizes in patients undergoing pulmonary tumor cryoablation with 14-gauge cryoablation probes.A single-center retrospective analysis of all consecutive patients who underwent cryoablation of pulmonary tumors with 1 or more 14-gauge probes (August 2017 to June 2020) was performed. Intraprocedural and 1-2-month postprocedural chest computed tomography (CT) scans were evaluated to characterize pulmonary lesions, ice balls, and ablation zones. Single-probe 14-gauge ablation zone volumes were compared with manufacturer reference isotherms and single- and 2-probe ablation zones from a prior investigation of 17-gauge probes. Overall survival and local recurrence-free survival were calculated to 3 years.Forty-seven pulmonary malignancies in 42 patients (women, 50%; mean age, 75.2 years ± 11.5) underwent cryoablation with 1 (n = 35), 2 (n = 10), or 3 (n = 2) cryoablation probes. One- to 2-month follow-up CT images were available for 30 of the 42 patients. The mean cryoablation zone volumes at 1-2 months when 1 (n = 21), 2 (n = 8), and 3 (n = 1) probes were used were 5.0 cmFourteen-gauge probes generate larger ablation volumes than those generated by 17-gauge probes. Manufacturer-reported isotherms are significantly larger than actual cryoablation zones. Cryoablation can attain low rates of local recurrence.

Quality improvement efforts within pediatric trauma centers (PTCs) are robust, but the majority of children do not receive initial postinjury care at PTCs. Disparities in access to quality trauma care remain, particularly for children who initially access the trauma system outside of a PTC. The purpose of this project was to identify unmet needs for injured children within the pediatric emergency care system and to determine national priorities for quality improvement across the continuum of pediatric trauma care.A panel of delegates representing patients and families, prehospital providers, federal funding partners, nurses, and physicians was recruited from 10 national stakeholder organizations. Potential targets were identified using an initial stakeholder meeting followed by a free text response survey. Free text items were coded and condensed as themes and then ranked by the panel using a modified Delphi approach to determine consensus priorities. Items not achieving35% prioritization on a given iteration were dropped from subsequent iterations. Consensus was defined as 75% of members designating an item as a top-four priority.Nineteen themes were identified as potential targets for QI initiatives. Four iterations of panel ranking were used to achieve consensus, with four priorities identified: (1) creation of a toolkit and standard provider training for pediatric trauma triage, shock recognition, and early recognition for need to transfer to higher level of care; (2) development of minimum standards for pediatric trauma resuscitation and stabilization capability in nonpediatric centers; (3) facilitating creation of local nursing and physician champions for pediatric trauma; and (4) development and dissemination of best-practice guidelines to improve imaging practices for injured children.System-level quality improvement priorities for pediatric trauma care should focus resources on developing and implementing minimum pediatric standards for injury care, frontline provider training, stabilization protocols, imaging guidelines, and local pediatric champions.Therapeutic/Care Management; Level IV.

Custom pathway and substrate-kinase libraries for tumor-specific pathway enrichment analyses.

Tyrosine phosphorylation (pTyr) plays a pivotal role in signal transduction and is commonly dysregulated in cancer. As a result, profiling tumor pTyr levels may reveal therapeutic insights critical to combating disease. Existing discovery and targeted mass spectrometry–based methods used to monitor pTyr networks involve a tradeoff between broad coverage of the pTyr network, reproducibility in target identification across analyses, and accurate quantification. To address these limitations, we developed a targeted approach, termed “SureQuant pTyr,” coupling low input pTyr enrichment with a panel of isotopically labeled internal standard peptides to guide data acquisition of low-abundance tyrosine phosphopeptides. SureQuant pTyr allowed for reliable quantification of several hundred commonly dysregulated pTyr targets with high quantitative accuracy, improving the robustness and usability of targeted mass spectrometry assays. We established the clinical applicability of SureQuant pTyr by profiling pTyr signaling levels in human colorectal tumors using minimal sample input, characterizing patient-specific oncogenic-driving mechanisms. While in some cases pTyr profiles aligned with previously reported proteomic, genomic, and transcriptomic molecular characterizations, we highlighted instances of new insights gained using pTyr characterization and emphasized the complementary nature of pTyr measurements with traditional biomarkers for improving patient stratification and identifying therapeutic targets. The turn-key nature of this approach opens the door to rapid and reproducible pTyr profiling in research and clinical settings alike and enables pTyr-based measurements for applications in precision medicine.Significance:SureQuant pTyr is a mass spectrometry–based targeted method that enables sensitive and selective targeted quantitation of several hundred low-abundance tyrosine phosphorylated peptides commonly dysregulated in cancer, including oncogenic signaling networks.

Supplementary figures, table legends, and methods.

Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer, especially breast, gastrointestinal, respiratory, urinary tract, and hematological malignancies. Catheter ablation (CA) is a well-established, safe treatment option in healthy patients; however, literature regarding safety of CA for AF in patients with cancer is limited and confined to single centers. We aimed to assess the outcomes and peri-procedural safety of CA for AF in patients with certain types of cancer. The NIS database was queried between 2016 and 2019 to identify primary hospitalizations with AF and CA. Hospitalizations with secondary diagnosis of atrial flutter and other arrhythmias were excluded. Propensity score matching was used to balance the covariates between cancer and non-cancer groups. Logistic regression was used to analyze the association. During this period, 47,765 CA procedures were identified, out of which 750 (1.6%) hospitalizations had a diagnosis of cancer. After propensity matching, hospitalizations with cancer diagnosis had higher in-hospital mortality (OR 3.0, 95% CI 1.5–6.2, p = 0.001), lower home discharge rates (OR 0.7, 95% CI 0.6–0.9, p < 0.001) as well as other complications such as major bleeding (OR 1.8, 95% CI 1.3–2.7, p = 0.001) and pulmonary embolism (OR 6.1, 95% CI 2.1–17.8, p < 0.001) but not associated with any major cardiac complications (OR 1.2, 95% CI 0.7–1.8, p = 0.53). Patients with cancer who underwent CA for AF had significantly higher odds of in-hospital mortality, major bleeding, and pulmonary embolism. Further larger prospective observational studies are needed to validate these findings.

Tumoral calcinosis is a rare lobulated soft tissue mass in periarticular soft tissues, Also called as calcium hydroxyappetite deposition in soft tissue. Here is a case of a 35-year-old male, came with a large swelling in sacrococcygeal region since 2 years. The CT scan showed large lobulated mass showing heterogenous iso to hyperdense lesion with no obvious destruction of bones with multiple calcifications and fatty tissue within. Clinically the provisional diagnosis was made as sacrococcygeal teratoma. The mass was excised and the histopathology examination revealed multiple large foci of amorphous calcified material surrounded by foreign body giant cell reaction and fibrosis. Diagnosis of Tuomral calcinosis was given. Huge tumoral calcinosis requiring surgical treatment are rare and should be remembered in the differential diagnosis of recurrent calcified soft tissue lesions mimicking malignancy in sacrococcygeal region. Also, correlation with biochemical parameters helps in classifying the lesions thereby helping the correct management.

Learning manual small-incision cataract surgery (SICS) is essential for ophthalmic surgeons as it provides an alternative to phaco-emulsification in complicated cases. Nearly 10% of ophthalmic surgeons are left-handed. Left-handed surgeons do face more difficulties because of their laterality, which have been highlighted in various surveys even in other surgical specialities. Surgical training programs, residency programs, and fellowships have traditionally been designed considering the right hand as the dominant hand. Left-handed surgeons (LHSs) are at disadvantage as they are trained by right-handed surgeons (RHSs), which may result in more initial intra-operative errors. Intra-ocular lenses are also designed such that dialing into the bag is relatively difficult for LHSs. Developing customized training modules for LHSs can help them overcome the laterality challenges and enhance their surgical capabilities. In this article, we herein present a brief description of the SICS technique for LHSs, elaborating the crucial steps and customized maneuvers that, if performed differently, may make surgeries easier for them.

Introduction: Menopause means permanent cessation of menstruation at the end of reproductive life. With the increase in life expectancy, women spend one-third of their life in menopausal period. Menopausal women face problems like hot flushes, feeling accomplished, poor memory, tiredness, joint pain, weak physical strength, lack of energy, avoiding intimacy, and vaginal dryness. Due to these the physical, psychosocial, and sexual health-related aspects get deteriorated. Aim: To assess the effect of postmenopausal symptoms on health-related quality of life among women. Materials and Methods: A cross-sectional research design was used, and 168 postmenopausal women, were selected following home visits at selected rural areas of Central Gujarat and Saurashtra, India. Women in the age group of 40-60 years, who had completed seven years of natural menopausal period were eligible for the study. The Menopause Specific Quality of Life Questionnaire was used and statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20.0. Results: Mean age of the postmenopausal women was 76.93 years. The majority 85 (50.6%) had completed their primary education. The most commonly found postmenopausal symptoms were feeling tired 153 (91.07%), loss of physical strength 153 (91.07%), and lack of energy 153 (91.07%). The mean score for vasomotor domain was 5.34±1.91, sexual domain 4.31±1.69, psychosocial domain 4.07±1.44, and physical domain was 3.85±1.10. The majority of the postmenopausal symptoms were related to the vasomotor domain. Conclusion: The present study findings concluded that all domains’ symptoms negatively impacted a women’s quality of life.The majorly affected domain was vasomotor, while least affected was physical domain.

ObjectivesThe Field Triage Guidelines (FTG) support emergency medical service (EMS) decisions regarding the most appropriate transport destination for injured patients. While the components of the algorithm are largely evidenced-based, the stepwise approach was developed with limited input from EMS providers. FTG are only useful if they can easily be applied by the field practitioner. We sought to gather end-user input on the current guidelines from a broad group of EMS stakeholders to inform the next revision of the FTG.MethodsAn expert panel composed an end-user feedback tool. Data collected included: demographics, EMS agency type, geographic area of respondents, use of the current FTG, perceived utility, and importance of each step in the algorithm (1: physiologic, 2: anatomic, 3 mechanistic, 4: special populations). The American College of Surgeons Committee on Trauma (ACS COT), in partnership with several key organizations, distributed the tool to reach as many providers as possible.Results3958 responses were received (82% paramedics/emergency medical technicians, 9% physicians, 9% other). 94% responded directly to scene emergency calls and 4% were aeromedical providers. Steps 2 and 3 were used in 95% of local protocols, steps 1 and 4 in 90%. Step 3 was used equally in protocols across all demographics; however, step 1 was used significantly more in the air medical services than ground EMS (96% vs 88%, pConclusionThe FTG are widely used by EMS in the USA. The stepwise approach is useful; however, mechanism (not physiological criteria) drives most of the decisions and is evaluated first . Revision of the FTG should consider the experience of the end-users.Level of evidenceV.

Background: The etiologies for cervical lymphadenopathy fall under a wide range spectrum and usually, history and physical examination alone may lead to a diagnosis. Posterior cervical LAP may occur with Epstein-Barr virus (EBV) infection, tuberculosis, lymphoma, or head and neck malignancy (either lymphomas or metastatic squamous cell carcinoma). However, a stepwise methodological approach to LAP can lead to an accurate diagnosis with minimal discomfort to the patient and also less time-consuming for the clinician.Methods: In this series, 320 cases were studied with taking a detailed clinical history, physical examination, and investigations. After a physical examination and reaching a clinical diagnosis, confirmation was done by fine needle aspiration cytology (FNAC) and biopsy.Results: Incidence of tuberculous LAP is much higher in lower socioeconomic class groups people versus middle or higher socioeconomic class groups. Incidence of tuberculous LAP is higher in urban areas compared to rural areas due to overcrowding, and poor sanitation.Conclusions: Tuberculosis is a potentially serious infectious disease, one of the commonest diseases affecting lymph nodes. It is curable with anti-tubercular drugs if administered as per the accepted regimen.

This cohort study uses a longitudinal access and adjudication data set to evaluate prescription out-of-pocket costs and filling behaviors of commercially insured individuals with chronic obstructive pulmonary disease (COPD).