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Objectives: To determine the feasibility of sentinel node radiolocalization in stage N0 in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel node could be prognostic of regional micrometastatic disease. Study Design: A prospective report on the application sentinel node radiolocalization in eight patients with N0 squamous cell carcinoma of the head and neck region. Methods: For each patient a peritumoral submucosal injection of filtered technetium (99mTc) prepared with sulfur colloid was performed immediately following intubation. After at least 30 minutes, focal areas of accumulation corresponding to a sentinel node were marked on the skin surface. Complete neck dissections were performed, and the sentinel nodes were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen. Results: Sentinel node radiolocalization accurately identified two or more sentinel lymph nodes in all eight cases. In one patient, two of the three lymph nodes containing micrometastatic disease were sentinel lymph nodes. There was no instance in which sentinel node was negative for micrometastatic disease while being positive in a nonsentinel lymph node. Conclusions: Accurate localization of the sentinel lymph node using radiolabeled sulfur-colloid is feasible in patients with squamous cell carcinoma of the head and neck region. Although sentinel node radiolocalization in head and neck squamous cell cancer may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined. [ABSTRACT FROM AUTHOR]

Although the concept of the sentinel node has existed for most of the twentieth century, it was only in the last decade that methods were developed which allowed practical application to cancer patients. Sentinel nodes (SN) are a highly variable but limited set of lymph nodes first to receive drainage from any given location. Cancer metastasizes to these nodes before other nodes. Radioactive tracers and blue dyes are used to guide the surgeon to the SNs for resection. Two large clinical trials of SN surgery in breast cancer patients are actively underway in the United States. Until the impact of this very promising technology is confirmed to provide the same staging and prognosis, regional control, and survival as conventional surgery, it is considered an experimental procedure. [ABSTRACT FROM AUTHOR]

Background: Literature regarding opioid use disorder (OUD) is often difficult for nonscientific communities to access. The OUD database on RefBin categorizes scientific findings and may facilitate access to information regarding OUD. Objectives: To evaluate if the RefBin OUD database improves access to information about OUD for policymakers and medical students. Methods: 31 medical students and 13 individual policymakers completed this study. Using a cross-over method, participants answered questions about OUD. Speed, accuracy, confidence, and satisfaction metrics were collected and compared between searches that used RefBin vs other resources chosen by participants. Results: At baseline, medical students reported being comfortable with scientific literature and familiar with OUD. Policymakers reported low comfort levels with scientific literature and variable familiarity with OUD. Within the medical student sample, the odds of answering correctly were 2.43 times higher for RefBin searches than for searches using resources other than RefBin (non-RefBin searches) ( p  = .005; 95% CI: (1.31, 4.51)). For policymakers, the odds of answering correctly were 3.65 times higher for RefBin vs non-RefBin searches ( p  = .0496; 95% CI: [1.002, 13.279]). Medical students reported feeling confident in their results 50.7% of the time when using RefBin, compared to 28.3% with non-RefBin searches ( p  = .006). Conclusion: When compared with searching using non-RefBin sources, searches performed using RefBin resulted in improved accuracy and efficiency for both medical students and policymakers. This demonstrates the potential utility of the RefBin OUD database in improving access to reliable information about OUD.

Background: Pregnant and post-partum women with opioid dependence are an extremely vulnerable population within correctional facilities. A significant number of maternal inmates, however, still lack adequate provision of medications for opioid use disorder (OUD) and are subsequently forced into withdrawal. Currently, there exist no comprehensive reviews on the scope of literature regarding the management of this population. We aimed to provide a review on the research surrounding these women., Design: A systematic search of PubMed Central was conducted to identify studies evaluating OUD among pregnant and post-partum incarcerated women. Citations from only the last 20 years were included to ensure both relevance and scope of information., Results: The topics that emerged from this review included medications for OUD (MOUD) administration vs detoxification practices, treatment upon incarceration and upon release, and maternal and fetal outcomes. Across all articles, current care management of this population appeared inadequate. We further compiled all author recommendations and perspectives into a framework that can inform potential improvements in care coordination., Conclusions: This review identifies significant gaps in current management-particularly regarding administration of MOUDs-and emphasizes the need for standardization of addiction-related and perinatal healthcare. We also highlight gaps in the literature and potential areas for future research.

Background and Objectives: Literature review using search engines results in a list of manuscripts but does not provide the content contained in the manuscripts. Our goal was to evaluate user performance-based criteria of concept retrieval accuracy and efficiency using a new database system that contained information extracted from 1000 COVID-19 articles., Methods: A sample of 17 students from the University of Vermont were randomly assigned to use the COVID-19 publication database or their usual preferred search methods to research eight prompts about COVID-19. The relevance and accuracy of the evidence found for each prompt were graded. A Cox proportional hazards' model with a sandwich estimator and Kaplan-Meier plots were used to analyse these data in a time-to-correct answer context., Results: Our findings indicate that students using the new information management system answered significantly more prompts correctly and, in less time, than students using conventional research methods. Bivariate models for demographic factors indicated that previous research experience conferred an advantage in study performance, though it was found to be independent from the assigned research method., Conclusions: The results from this pilot randomised trial present a potential tool for more quickly and thoroughly navigating the literature on expansive topics such as COVID-19., Competing Interests: Competing interests: David Krag has a significant financial interest in Plomics Inc, the developer of RefBin.com. The investigator disclosed his personal financial interest to the IRB of the University of Vermont. The IRB at the University of Vermont and the University of Vermont Medical Center determined that this pilot study qualified for an exemption from ethics review. Any potential conflicts of interest were managed. All other authors declare that they have no conflicts of interest., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The number of new biomedical manuscripts published on important topics exceeds the capacity of single persons to read. Integration of literature is an even more elusive task. This article describes a pilot study of a scalable online system to integrate data from 1000 articles on COVID-19., Methods: Articles were imported from PubMed using the query 'COVID-19'. The full text of articles reporting new data was obtained and the results extracted manually. An online software system was used to enter the results. Similar results were bundled using note fields in parent-child order. Each extracted result was linked to the source article. Each new data entry comprised at least four note fields: (1) result, (2) population or sample, (3) description of the result and (4) topic. Articles underwent iterative rounds of group review over remote sessions., Results: Screening 4126 COVID-19 articles resulted in a selection of 1000 publications presenting new data. The results were extracted and manually entered in note fields. Integration from multiple publications was achieved by sharing parent note fields by child entries. The total number of extracted primary results was 12 209. The mean number of results per article was 15.1 (SD 12.0). The average number of parent note fields for each result note field was 6.8 (SD 1.4). The total number of all note fields was 28 809. Without sharing of parent note fields, there would have been a total of 94 986 note fields., Conclusion: This pilot study demonstrates the feasibility of a scalable online system to extract results from 1000 manuscripts. Using four types of notes to describe each result provided standardisation of data entry and information integration. There was substantial reduction in complexity and reduction in total note fields by sharing of parent note fields. We conclude that this system provides a method to scale up extraction of information on very large topics., Competing Interests: Competing interests: MB and DK have ownership interest in Plomics. SL, IF, CT-L, SR and JP declare no financial or competing interests., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Breast cancer metastasizes through the lymphovascular system to the regional lymph nodes in the axilla and to both visceral and non-visceral sites. Renewed interest in the route by which tumor cells gain access to blood and lymphatic capillaries are the subject of research at mechanical, anatomic, pathologic, genetic, epidemiologic and molecular levels. Two papers presented at the 7th International Symposium on Cancer Metastasis in San Francisco showed tumor cells entering the systemic circulation through the sentinel lymph node. This information challenges the current paradigm where clinicians believe that access is gained through intra- and peri-tumoral blood vessels and that metastasis to axillary lymph nodes is an interesting epi-phenomenon. The sentinel lymph node era has changed the modern surgical approach to the axilla and the basis of this change is summarized in this paper. A new approach to the management of axillary metastases after systemic therapy relies on determining whether there is a complete pathologic response; if no tumor is found in the previously biopsied node, a complete axillary lymph node dissection may be avoided. African American women seem to inherit a trait from West African ancestors and tend to develop more lethal types of breast cancer. These tumors may have a molecular machinery that enhances their ability to metastasize to visceral sites and future research may unearth the mechanisms for this phenomenon.

Oct3/4, a transcription factor specifically expressed in mammalian totipotent embryonic stem and germ cells, has a critical role in the regulation and maintenance of pluripotency and self-renewal. However, reactivation of Oct3/4 expression is observed in several human breast cancer cell lines, but not in non‑malignant cells. To examine Oct3/4 expression in human primary breast carcinomas and normal breast tissues, we obtained breast tumor tissues from 28 patients and normal breast tissues from 9 women. According to quantitative polymerase chain reaction, all of the tumor tissues, irrespective of tumor type or clinicopathological status, expressed Oct3/4 mRNA at 10- to 100- fold higher levels than that in the normal breast tissues. Expression of the Oct3/4 protein in tumors was confirmed by western blot analysis and immunofluorescent staining. Additionally, rapid amplification of cDNA ends and DNA sequencing revealed expression of multiple Oct4 gene transcripts from chromosome 6 (POU5F1) in normal breast tissues and the non‑malignant breast epithelial cell line MCF‑10A; by contrast, the breast tumors and malignant breast cancer cell line MCF‑7 predominantly expressed transcripts of an Oct4-like gene (POU5F1B) from chromosome 8, which was termed Oct3 in the current study. The deduced amino acid sequences of full-length Oct3 and Oct4 are 96% identical. The findings of the current study indicated that Oct3, rather than Oct4, may serve as a novel clinical marker and a potential target for gene-specific therapy of breast cancer.

Background: Not all patients with non-small cell lung carcinoma (NSCLC) have mediastinal lymph node involvement and development of less invasive methods for evaluating mediastinal lymph nodes is important. Sentinel node biopsy has been used for NSCLC since 1999 to decrease the need for mediastinal lymph node dissection. In this review, we searched the literature in this regard and reported the results in a meta-analysis format., Methods: Medline, SCOPUS, and ISI web of knowledge were searched using: "(lung AND sentinel)" with no date or language limit. Any study with more than 5 patients and enough information to calculate detection rate and sensitivity was included., Results: Overall 47 and 43 studies (including subgroups) had the criteria for detection rate and sensitivity pooling respectively. Pooled detection rate was 80.6% [76.8-84%] and pooled sensitivity was 87% [83-90%]. Using radiotracers or both radiotracers and dyes had higher detection rate and sensitivity compared to dye alone. Among studies using radiotracers, highest detection rate was in intra-operative peri-tumoral injection group and highest sensitivity was in peri-tumoral pre-operative injection group. Emerging methods of sentinel node surgery including magnetic materials, fluorescent dyes, CT contrast agents, and carbon nano-particles had promising results., Conclusions: Sentinel node mapping using radiotracers is a feasible technique for mediastinal lymph node staging of N0 NSCLC patients. Alternative methods of sentinel node mapping are promising and warrant further studies., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)