Hornervelez2919

BACKGROUND AND AIM To differentiate solid-pseudopapillary tumors (SPTs) of the pancreas from pancreatic neuroendocrine tumors (pNETs) by endoscopic ultrasound. METHODS We retrospectively reviewed all patients with SPTs and pNETs who underwent endoscopic ultrasound (EUS) from May 2012 to August 2018 at the Fudan University Shanghai Cancer Center. We included patients confirmed pathologically with a surgical biopsy or with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The demographic data of the patients, characteristics of the lesions and overall survival data of patients with these two diseases were further compared. RESULTS A total of 147 pNET patients and 21 SPT patients were included in our study. The mean ages of the patients in the SPT and pNET groups were 35.95years and 54.30years, respectively. There were more females in the SPT group than in the pNET group (71.43% vs. 40.82%). The patients in the pNET group had significantly more lymphatic metastases and visceral organ metastases than the patients in the SPT group. A larger proportion of pNET lesions than SPT lesions had homogeneous echo patterns and were hypervascular. Cystic components and calcification components were more often observed in the SPT lesions than in the pNET lesions. In the multivariate logistic regression analysis, the hypervascularization (OR 6.528, 95% CI 1.562-27.285, P=0.010) and cystic component (OR 0.106, 95% CI 0.019-0.597, P=0.011) variables resulted in the best discrimination of patients with SPTs from patients with pNETs. Survival among patients with SPTs was higher than that among patients with pNETs at all points in the follow-up period. CONCLUSIONS SPTs tended to occur in younger people and were more common in women. Pancreatic neuroendocrine tumors tended to form metastases more often than SPTs. The blood supply and cystic components of the lesions may have novel potential diagnostic utility for differentiating SPTs from pNETs. OBJECTIVES Over 40% of individuals in the United States with end-stage kidney disease have obesity. Little is known about renal dietitian perspectives on obesity management in the setting of dialysis dependence. DESIGN AND METHODS An online 21-item survey was distributed to 118 renal dietitians via individual outreach and a professional organization e-mail listserv. Four themes were explored the burden of obesity among dialysis patients, concepts of healthy weight loss, weight loss approaches, and challenges of obesity management in dialysis settings. Respondents were asked to rank approaches and biomarkers for obesity management from 0 (least important or not used) to 100 (most important). Free text fields were provided in each category for additional comments. RESULTS Thirty-one renal dietitians responded to the survey (26% response rate). The majority of respondents (90%) indicated that access to kidney transplantation was the main reason that dialysis patients with obesity desired weight loss. Calorie res loss. BACKGROUND Noncontrast enhanced computed tomography (NCCT) remains the most common method for brain imaging patients who present acutely with ischaemic stroke. Computational methods may improve NCCT analysis in this context. We systematically reviewed current research. METHODS We searched 7 medical and computer engineering databases for studies testing computational methods for analysing NCCT in acute ischaemic stroke. Two independent reviewers extracted the following data; computational method, imaging features investigated, test dataset, ground truth comparison, and performance. We critically evaluated studies for risk of bias and applicability using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). RESULTS From 11,235 nonduplicated articles, we full-text reviewed 200 and selected 68 for inclusion. We identified three dominant study types testing a large range of computational methods for (1) identifying acute ischaemic stroke (n = 42); (2) ischaemic lesion segmentation (n = 6); and (3) automated Alberta Stroke Program Early CT Score (n = 20). Most articles presented small test datasets, poorly documented patient populations, and did not specify the acuity of the CT scans used in development. There was limited validation or clinical testing of computational methods. Automated Alberta Stroke Program Early CT Score methods were the only software systems presented in multiple publications. Critical evaluation was often limited by lack of data. Ipatasertib manufacturer CONCLUSIONS Computational techniques for analysing NCCT in patients with acute ischaemic stroke have not been adequately clinically validated. Further research with larger and more relevant datasets, in addition to better collaboration between clinicians and researchers, is needed to aid more widespread clinical adoption and implementation. OBJECTIVE The value of a simplified, focused intraoperative transesophageal echocardiography (TEE) protocol in patients undergoing liver transplantation (LT) is unknown. We sought to create and assess a 5-view LT TEE examination focused on 5 prespecified common causes of hypotension during LT. DESIGN Retrospective cohort study. SETTING Single-center tertiary academic hospital. PARTICIPANTS All patients undergoing LT with TEE from January 2010 through May 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A 5-view LT TEE protocol adapted from a published rescue TEE protocol was assessed retrospectively in a cohort of 106 patients. The primary outcome was the frequency with which the protocol would have detected a composite of 5 prespecified causes of hypotension if the TEE exam had been limited to those views. To assess potential influence on intraoperative care, management changes associated with TEE images were extracted from the medical record. The prespecified diagnoses occurred 24 times; the LT TEE protocol would have detected 22 of 24 of these (92%, 95% confidence interval [CI] 74%-98%). Intraoperative management changes occurred in 15 of 16 patients (94%) with 1 of the prespecified TEE findings, compared with 1 of 27 patients (3.7%) with TEE findings outside those diagnoses (p less then 0.0001). CONCLUSIONS In a retrospective cohort study, a simplified LT TEE protocol would have detected 92% of prespecified TEE findings. Management changes occurred in 94% of those patients, while changes rarely occurred in patients with other TEE findings. A focused LT TEE protocol may diagnose critical pathology adequately and guide management during LT when standard monitors are insufficient.