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Rationale and Objectives: To evaluate whether parathyroid adenomas can be detected by thoracic radiologists on routine chest CT., Materials/methods: This retrospective study included patients with hyperparathyroidism evaluated by parathyroid scans and a control group with normal calcium. All had enhanced chest CT within 36 months prior to parathyroid imaging. Chest CTs were reviewed by 3 blinded thoracic radiologists. We report diagnostic accuracy for all positive findings and findings > 8 mm., Results: Our sample comprised 126 patients, 63 with confirmed hyperparathyroidism and 63 control patients; 6 parathyroid cases were excluded for being out of the field of view. Readers 1, 2, and 3 had sensitivity of 95%, 60%, and 35%, and specificity of 88%, 89%, and 97%, respectively. Specificity increased to 95%, 97%, and 98% when considering only findings larger than 8 mm. Review of false negative studies for reader 1 revealed 3 parathyroid adenomas visualized in retrospect. Review of the 7 false positive studies for reader 1 revealed candidate lesions in all of them attributed to exophytic thyroid nodules or lymph nodes. 90%, 67%, and 40% of the parathyroid adenoma patients had at least 1, 2, and 3 complications respectively. Most prevalent complications were nephrolithiasis (48%) and osteopenia (46%)., Conclusions: Routine contrast-enhanced chest CT can detect the majority of parathyroid adenomas with high specificity., Clinical Relevance/application: Increasing awareness of parathyroid adenomas by chest radiologists allow for detection of enlarged parathyroid glands, diagnosing hyperparathyroidism before clinical presentation., Competing Interests: Declaration of Competing Interest The authors report no relevant financial disclosures., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: Delays to biopsy and surgery after lung nodule detection can impact survival from lung cancer. The aim of this study was to identify factors associated with delay in a lung cancer screening (LCS) program., Materials and Methods: We evaluated patients in an LCS program from May 2015 through October 2021 with a malignant lung nodule classified as lung CT screening reporting and data system (Lung-RADS) 4B/4X. A cutoff of more than 30 days between screening computed tomography (CT) and first tissue sampling and a cutoff of more than 60 days between screening CT and surgery were considered delayed. We evaluated the relationship between delays to first tissue sampling and surgery and patient sex, age, race, smoking status, median income by zip code, language, Lung-RADS category, and site of surgery (academic vs community hospital)., Results: A total of 185 lung cancers met the inclusion criteria, of which 150 underwent surgical resection. The median time from LCS CT to first tissue sampling was 42 days, and the median time from CT to surgery was 52 days. 127 (69%) patients experienced a first tissue sampling delay and 60 (40%) had a surgical delay. In multivariable analysis, active smoking status was associated with delay to first tissue sampling (odds ratio: 3.0, CI: 1.4-6.6, P = 0.005). Only performing enhanced diagnostic CT of the chest before surgery was associated with delayed lung cancer surgery (odds ratio: 30, CI: 3.6-252, P = 0.02). There was no statistically significant difference in delays with patients' sex, age, race, language, or Lung-RADS category., Conclusion: Delays to first tissue sampling and surgery in a LCS program were associated with current smoking and performing diagnostic CT before surgery., Competing Interests: M.M.H. was supported by the National Cancer Institute (R01CA260889). The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: ERBB2-amplified colorectal cancer is a distinct molecular subtype with expanding treatments. Implications of concurrent oncogenic RAS/RAF alterations are not known., Experimental Design: Dana-Farber and Foundation Medicine Inc. Colorectal cancer cohorts with genomic profiling were used to identify ERBB2-amplified cases [Dana-Farber, n = 47/2,729 (1.7%); FMI, n = 1857/49,839 (3.7%)]. Outcomes of patients receiving HER2-directed therapies are reported (Dana-Farber, n = 9; Flatiron Health-Foundation Medicine clinicogenomic database, FH-FMI CGDB, n = 38). Multisite HER2 IHC and genomic profiling were performed to understand HER2 intratumoral and interlesional heterogeneity. The impact of concurrent RAS comutations on the effectiveness of HER2-directed therapies were studied in isogenic colorectal cancer cell lines and xenografts., Results: ERBB2 amplifications are enriched in left-sided colorectal cancer. Twenty percent of ERBB2-amplified colorectal cancers have co-occurring oncogenic RAS/RAF alterations. While RAS/RAF WT colorectal cancers typically have clonal ERBB2 amplification, colorectal cancers with co-occurring RAS/RAF alterations have lower level ERRB2 amplification, higher intratumoral heterogeneity, and interlesional ERBB2 discordance. These distinct genomic patterns lead to differential responsiveness and patterns of resistance to HER2-directed therapy. ERBB2-amplified colorectal cancer with RAS/RAF alterations are resistant to trastuzumab-based combinations, such as trastuzumab/tucatinib, but retain sensitivity to trastuzumab deruxtecan in in vitro and murine models. Trastuzumab deruxtecan shows clinical efficacy in cases with high-level ERBB2-amplified RAS/RAF coaltered colorectal cancer., Conclusions: Co-occurring RAS/RAF alterations define a unique subtype of ERBB2-amplified colorectal cancer that has increased intratumoral heterogeneity, interlesional discordance, and resistance to trastuzumab-based combinations. Further examination of trastuzumab deruxtecan in this previously understudied cohort of ERBB2-amplified colorectal cancer is warranted., (©2024 American Association for Cancer Research.)

Background: Primary cardiac soft tissue sarcomas (CSTS) affect young adults, with dismal outcomes., Objectives: The aim of this study was to investigate the clinical outcomes of patients with CSTS receiving immune checkpoint inhibitors (ICIs)., Methods: A retrospective, multi-institutional cohort study was conducted among patients with CSTS between 2015 and 2022. The patients were treated with ICI-based regimens. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates were determined according to Response Evaluation Criteria in Solid Tumors version 1.1. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events version 5.0., Results: Among 24 patients with CSTS, 17 (70.8%) were White, and 13 (54.2%) were male. Eight patients (33.3%) had angiosarcoma. At the time of ICI treatment, 18 patients (75.0%) had metastatic CSTS, and 4 (16.7%) had locally advanced disease. ICIs were administered as the first-line therapy in 6 patients (25.0%) and as the second-line therapy or beyond in 18 patients (75.0%). For the 18 patients with available response data, objective response rate was 11.1% (n = 2 of 18). The median PFS and median OS in advanced and metastatic CSTS (n = 22) were 5.7 months (95% CI: 2.8-13.3 months) and 14.9 months (95% CI: 5.7-23.7 months), respectively. The median PFS and OS were significantly shorter in patients with cardiac angiosarcomas than in those with nonangiosarcoma CSTS: median PFS was 1.7 vs 11 months, respectively ( P  < 0.0001), and median OS was 3.0 vs 24.0 months, respectively ( P  = 0.008). Any grade treatment-related adverse events occurred exclusively in the 15 patients with nonangiosarcoma CSTS (n = 7 [46.7%]), of which 6 (40.0%) were grade ≥3., Conclusions: Although ICIs demonstrate modest activity in CSTS, durable benefit was observed in a subset of patients with nonangiosarcoma, albeit with higher toxicity., Competing Interests: Dr Abdel-Wahab is supported by a K01 Mentored Research Scientist Development Award from the National Institute of Allergy and Infectious Diseases (grant K01AI163412) and has received the University of Texas MD Anderson Cancer Center Institutional Research Grant, Division of Internal Medicine Development Award, Survivorship Seed Money Award, Prioritizing Research Innovation and Mentoring Excellence Award, and Melanoma SPORE Career Enhancement Program Award. Dr Nassar has received honoraria from OncLive, TEMPUS, and the Korean Society for Medical Oncology; and has received consulting fees from Guidepoint Global. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Purpose: Screening with low dose computed tomography (CT) can reduce lung cancer related death at the expense of unavoidable false positive results. The purpose of this study is to measure the rate of surgery for benign nodules, and evaluate characteristics of those nodules., Materials and Methods: In this study, we evaluated patients in the Lung Cancer Screening (LCS) program across a large tertiary healthcare network from 5/2015 through 10/2021 who underwent surgical resection for a lung nodule. We reviewed the pathology reports and subsequent follow-up to establish whether the nodule was benign or malignant. Imaging characteristics of the nodules were evaluated by a radiology fellow, and we recorded Lung-RADS category, nodule status (baseline, stable, new, growing), FDG uptake on PET/CT, and calculated the risk from the Brock model., Results: During this time period, a total of 21,366 LCS CT was performed in 9050 patients, and 260 patients underwent a following surgical resection. Review of the pathology results revealed: 220 lung cancer (85%), 2 other malignancies (1%), and 38 benign findings (15%). Pathology of the benign nodules was as follows: 12 with scarring/fibrosis, 5 with benign neoplasms, 14 with infection/inflammation, and 7 with other diagnoses. Lung-RADS category was as follows: 4 (11%) Lung-RADS 2, 2 (5%) Lung-Rad 3, 11 (29%) Lung-RADS 4A, 13 (34%) Lung-RADS 4B, and 8 (21%) Lung-RADS 4X. The size of the nodules ranged from 4 to 41 mm with a median of 13 mm. 2 (5%) were ground glass, 10 (26%) were part-solid, and 26 (68%) were solid. FDG-PET/CT was performed in 19 out of 38 cases, of which: 2 (11%) had no uptake, 10 (53%) had mild uptake, 3 (16%) had moderate uptake, and 4 (21%) had intense uptake. Risk assessment by Brock calculator revealed that 9 (24) had <5% (very low) risk; 27 (71%) had 5-65% (low-intermediate) risk, and 2 (5%) had >65% (high) risk., Conclusion: Surgical resection of benign nodules is unavoidable despite application of Lung-RADS guidelines in a modern screening program, with approximately 15% of surgeries being done for benign lesions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mark Hammer reports financial support was provided by NIH R01CA260889. Mark Hammer reports a relationship with NIH R01CA260889 that includes: funding grants., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

This case study highlights how a looming health crisis was leveraged as drivers for positive change for the health sector, in line with the health security agenda. In Jordan, several authorities are mandated by law to manage health emergencies. Following the declaration of outbreaks of cholera in Iraq, Lebanon and Syria, health authorities in Jordan called for a series of emergency meetings during September 2022 to discuss implications around travel and trade as well as shared waters. WHO was part of the consultations and provided guidance on the application of the International Health Regulations 2005. As the risk for cholera importation persisted, the Ministry of Health assumed its leadership role for the overall health sector response while the Jordanian Center for Disease Control assumed a coordinating function. Roles and responsibilities were enshrined in the National Cholera Preparedness and Response Plan. In consideration of the vulnerability of refugee camps and settlements towards Cholera, the existing Jordan humanitarian coordination platforms such as the Health Sector Working Group were used to share information and to coordinate activities. A whole-of-government risk assessment during December 2022 was complemented by a field visit at Zaatari refugee camp. This helped assess the risk and readiness for a cholera outbreak in Jordan and informed priority activities, such as the establishment of a national risk communication and community engagement working group as well as training on case management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Bone marrow biopsy complications are rare. Our aim is to study the association of improper palpation-guided iliac biopsy tract with complications., Materials and Methods: This is a retrospective study of adult patients who underwent iliac bone marrow biopsy without image guidance at our hospital from January 2019 to January 2021, and have cross-sectional radiologic imaging of the pelvis within 30 days following the procedure. Electronic health records were reviewed for clinical data. Two radiologists reviewed images of the pelvis for assessment of biopsy tract and complications., Results: A total of 443 procedures were included in 309 patients, mean age 53.4 ± 18.1 years, 112 females (36.2%). In addition, 332 tracts were proper (75%), 97 improper (22%), and 14 unidentified (3%). All 11 complications occurred in procedures with improper tracts; nine bleeding, one fracture, and one facet joint injury. Improper tract was significantly associated with complications (p < .001). There was no statistically significant association between platelet count, international normalized ratio, antiplatelet use and anticoagulant use, and presence of complications (p > .05). Body mass index and subcutaneous fat thickness overlying posterior superior iliac spine were not associated with improper tract (p > .05). Procedures performed by providers with ≤ 12 months' experience were significantly associated with improper tract (p < .001) and hence associated with complications (p = .007)., Conclusion: Improper tracts were common in palpation-guided iliac bone marrow biopsy and significantly associated with complications. No complications were encountered in proper tract procedures. Procedures performed by providers with ≤ 12 months' experience were significantly associated with improper tract and complications., (© 2022. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Background: Invasive fungal infections (IFI) following allogeneic stem cell transplant (allo-HCT) are associated with high morbidity and mortality. Primary prophylaxis using voriconazole has been shown to decrease the incidence of IFI., Methods: We conducted a retrospective analysis at the Bone Marrow Transplant (BMT) unit of the American University of Beirut including 195 patients who underwent allo-HCT for hematological malignancies and received voriconazole as primary prophylaxis for IFI. The primary endpoints were based on the incidence of IFI at day 100 and day 180, and the secondary endpoint based on fungal-free survival., Results: For the study, 195 patients who underwent allo-HCT between January 2015 and March 2021 were included. The median age at transplant was 43 years. Of the patients, 63% were male, and the majority of patients were diagnosed with acute myeloid leukemia (AML) (60%). Voriconazole was given for a median of 90 days and was interrupted in 20 patients. The majority of IFI cases were probable invasive aspergillosis (8%). The incidence of IFI including proven, probable and possible IFI was 34%. The incidence of proven and probable IFI was 5% were 8%, respectively. The incidence of proven-probable (PP-IFI) was 5.1% at day 100 and 6.6% at day 180. The majority of PP-IFI cases were invasive aspergillosis (8%). A univariate analysis of patients, transplant characteristics and IFI showed a significant correlation between the type of donor, disease status before transplant, graft-versus-host disease prophylaxis used and incidence of IFI. Only disease status post-transplant showed a significant correlation with fungal-free survival in the multivariate analysis., Conclusion: Primary prophylaxis with voriconazole in allo-HCT is associated with a low incidence of IFI. More studies are required to compare various antifungal agents in this setting.

The aims of the current study were to evaluate the bond strength of a new metallic orthodontic bracket with a laser structured base (Discovery, Dentaurum, Ispringen, Germany), and its effects on the site of bond failure and on the behavior of the enamel after debonding. One hundred and twenty recently extracted human premolars were bonded with 1 of 2 types of mechanical interlock base metal brackets: a standard system with a simple foil mesh pad (Minitrim, Dentaurum) and the Discovery bracket. A resin-based, chemically activated bonding system, No-mix (Dentaurum), was used as the adhesive system in this trial. The teeth were immersed in normal saline solution at 37 degrees C for 7 days before debonding and were randomly assigned to different subgroups. A testing machine was used to evaluate tensile and fatigue bond strengths for both brackets. After debonding, the amount of residual adhesive on the bracket and enamel detachment were assessed according to the adhesive remnant index (ARI) and the enamel detachment index (EDI) with a scanning electron microscope and an energy dispersive X-ray spectrometer. The scores obtained from the ARI and the EDI showed that the laser structured base brackets had a significantly higher bond strength (mean +/- SD: 17.1 +/- 0.7 MPa) that was 2 times higher than that observed with the simple foil mesh brackets (mean +/- SD: 8.7 +/- 1.4 MPa) (P <.001). Bond failure with the laser structured base was at the enamel-adhesive interface with an ARI score of 3 in 80% of the teeth, and bond failure with the simple foil mesh base was at the bracket-adhesive interface with an ARI score of 0 in 75% of the teeth. A small area, with less than 10% of the enamel damaged (1 on the EDI) and 1.5 microm in thickness, was observed for both brackets. The laser structured base bracket's bond strength was double that of the simple foil mesh bracket but was equally safe and did not induce significant enamel detachment.

The aim of this study was to assess the incidence on the enamel behavior of debonding two types of orthodontic brackets, bonded with two different adhesives. Ninety recently extracted human premolars were bonded with two types of brackets (30 Minitrim and 60 Discovery). Two bonding protocols were used. The first one consisted in bonding 30 Minitrim and 30 Discovery brackets on etched and dried enamel surfaces with No Mix orthodontic resin. The second one consisted in bonding 30 Discovery brackets on unetched and wet enamel surfaces with a modified glass ionomer cement, Fuji Ortho LC. Teeth were stored in hydrated ambiance at 37 degrees C for 7 days before debonding. A LLOYD (LR 30K) testing machine was used to evaluate the orthogonal tensile bond strength. The debonded base brackets were examined with a scanning electron microscope (JEOL JSM 6400) and qualitatively analyzed with an OXFORD-LINK-ISIS to assess the site of bond failure and the enamel detachments. An Enamel Detachment Index (EDI) was defined. The results showed that the types of orthodontics brackets and adhesives influenced the bond strength and the enamel detachment. The Discovery/No Mix couple presented higher bond strength (214.9 N) than observed with the Discovery/Fuji Ortho LC (98.5 N) or the Minitrim/No Mix (82.3 N) couples. The surfaces of enamel detachment were insignificant and not extended for all brackets. Nevertheless, the Discovery/No Mix couple presented 42% of an EDI score of 1, compared to the Discovery/Fuji Ortho LC and Minitrim/No Mix couples which presented, respectively, 8% an 20% of an EDI score of 1. The laser sculpted base (Discovery) bonded on unetched and wet enamel surfaces with the modified glass ionomer cement (Fuji Ortho LC) offers a good resistance to debonding forces and preserve enamel integrity.