Primary sarcoma of the liver: A nationwide analysis of a rare mesenchymal tumor.

BACKGROUND AND OBJECTIVES: Primary liver sarcomas are rare malignancies. Prognostic factors associated with long-term survival remain poorly understood. The objective of this study is to determine factors associated with long-term survival. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with visceral sarcoma arising from the liver. Demographic factors, tumor characteristics, resection status, and survival were evaluated. Multivariate Cox regression analysis was performed to determine predictors of survival. RESULTS: A total of 743 patients with primary hepatic sarcoma were identified. The median tumor size was 10 cm. Only 30% (n = 221) of patients in the cohort underwent surgery. The 5-year overall survival rates were 47.9% for localized disease, 29.5% for regional disease, and 16.5% for distant disease, p < 0.001. Among patients who underwent surgical resection, patients with embryonal sarcoma had better 5-year survival compared with angiosarcoma and other histologic subtypes. On multivariate analysis, surgery was associated with improved survival, while older age, higher stage, and angiosarcoma histology were the strongest independent predictors of poor survival. CONCLUSIONS: Surgery remains the mainstay of treatment for this rare malignancy but is performed in less than one-third of patients. Angiosarcoma histology is associated with worse overall survival, while surgical resection remains the strongest predictor of improved overall survival.

Characterizing Chronic Pain and Adverse Childhood Experiences in the Lesbian, Gay, Bisexual, Transgender, or Queer Community.

BACKGROUND: Childhood adversity is associated with chronic pain in adulthood. Additionally, individuals identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report a greater prevalence of chronic pain and increased adverse childhood experiences (ACEs). While the LGTBQ+ community has a disproportionately high chronic disease burden, limited research has been conducted on the associations between chronic pain conditions or intensity and childhood adversity in this population. METHODS: In this cross-sectional study, participants were 18 years or older, LGBTQ+ identifying, and reported chronic pain. Surveys were electronically distributed from August to November 2022 via LGBTQ+ organization email listservs and social media platforms. The survey included demographics and validated questionnaires measuring chronic pain (The Chronic Pain Questionnaire) and childhood adversity (ACE score). In analysis, ACE scores of 4 or more were defined as high. RESULTS: Responses from 136 individuals (average age of 29 ± 7.4 years) were analyzed. The mean for participants' average pain rating in the last 6 months was 5.9 of 10. Participants' worst pain was rated at least a 7 of 10 for 80% of respondents. Half (47%) had high ACE scores, and high ACE scores were significantly associated with higher average pain scores (6.27 ± 1.79, mean difference = -2.22, P = .028, 95% confidence interval [CI], -1.2 to -0.0), and higher perceived current pain ratings (4.53 ± 2.16, mean difference = -2.78, P = .007, 95% CI, -1.9 to -0.3). Transgender and gender diverse (TGD) participants (n = 75) had higher ACE scores (3.91 ± 1.78) and current pain scores compared to cisgender individuals (3.9 ± 1.8 vs 3.0 ± 1.9, P = .009, 95% CI, 0.0-0.3). History of any sexual trauma was prevalent in 36.7% and was associated with chronic pain located in the pelvic region (P = .016, effect size estimate 0.21). Specific histories of forced sexual and touch encounters were associated with a specific diagnosis of fibromyalgia (P = .008, effect size estimate 0.31 and P = .037, effect size estimate 0.31, respectively). CONCLUSIONS: Childhood adversity and chronic pain's dose-dependent relationship among our LGBTQ+ sample indicates a need to explore trauma's role in perceived pain. Given sexual trauma's association with pain location and diagnosis, type of trauma may also be crucial in understanding chronic pain development. Research into the relationships between childhood adversity, sexuality, gender identity, and chronic pain could improve chronic pain prevention and management for the LGBTQ+ community.

The Continued Rise of Syphilis: A Case Report to Aid in Identification of the Great Imitator.

Syphilis is a progressive sexually transmitted infection that has a wide variety of presentations depending on the disease stage. These variable presentations can make it difficult to differentiate syphilis from other diseases. While tertiary syphilis is less common in the United States compared to primary or secondary syphilis, recognition of the varied manifestations of advanced syphilis can help providers accurately diagnose this disease to help prevent continued spread. In this case report, we present a patient with a history of bilateral palmar wounds. The patient had presented to multiple emergency departments without a diagnosis of syphilis. Upon subsequent emergency department visits, the patient was diagnosed with tertiary syphilis, started on a course of penicillin, and evaluated by dermatology. However, the patient left against medical advice prior to further evaluation and treatment. From this case report, we have learned the importance of considering tertiary syphilis gummas in the differential diagnosis of atypical skin wounds. Topics: Sexually transmitted infection (sti), syphilis, tertiary syphilis, gummas, dermatologic lesions.

Optimal Image Gain Intensity of Point-of-care Ultrasound when Screening for Ocular Abnormalities in the Emergency Department.

INTRODUCTION: Point-of-care ultrasound (POCUS) plays a pivotal role in evaluating ocular complaints in the emergency department (ED). The rapid and non-invasive nature of ocular POCUS makes it a safe and informative imaging modality. Previous studies have investigated using ocular POCUS to diagnose posterior vitreous detachment (PVD), vitreous hemorrhage (VH), and retinal detachment (RD); however, there are few studies that assess image optimization techniques and how they impact the overall accuracy of ocular POCUS. METHODS: We performed a retrospective review of ED patients who received ocular POCUS examinations and ophthalmology consultations as part of their evaluation for eye complaints at our urban, Level I trauma center ED from November 2017-January 2021. Of 706 exams, 383 qualified for the study. In this study we primarily investigated how stratified gain levels impact the accuracy of ocular POCUS for detection of any posterior chamber pathology and, secondarily, whether stratified gain levels impact the accuracy of detecting RD, VH, and PVD specifically. RESULTS: The images were found to have an overall sensitivity of 81% (76-86%), specificity of 82% (76-88%), positive predictive value (PPV) of 86% (81-91%), and negative predictive value (NPV) of 77% (70-83%). Images acquired with a gain of (25, 50] had a sensitivity of 71% (61-80%), specificity of 95% (85-99%), PPV of 96% (88-99%), and NPV of 68% (56-78%). Images acquired with a gain of (50, 75] had a sensitivity of 85% (73-93%), specificity of 85% (72-93%), PPV of 86% (75-94%), and NPV of 83% (70-92%). Images acquired with a high gain (75, 100] had a sensitivity of 91% (82-97%), specificity of 67% (53-79%), PPV of 78% (68-86%), and NPV of 86% (72-95%). CONCLUSION: In the ED setting, high (75, 100] gain on ocular POCUS scanning has a higher degree of sensitivity for detecting any posterior chamber abnormality, as compared to low (25, 50] gain levels. Thus, incorporating the use of high gain for ocular POCUS exams produces a more effective tool for ocular pathologies in acute care settings and may be particularly valuable in resource-limited settings.

Applicant Perspectives of Virtual General Surgery Residency Interviews.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic prompted drastic changes to residency recruitment. The majority of general surgery residency interviews for the 2020-2021 interview cycle were restructured into a virtual format. The goal of this study is to evaluate general surgery residency applicants' perception of virtual interviews. METHODS: A secure, anonymous, web-based survey was developed, tested, and distributed via email to all candidates who applied to the University of California Irvine general surgery residency program for Match 2021. RESULTS: 1239 general surgery applicants were invited after Match Day 2021 to take the survey, and 167 (13.5%) completed the survey and were included in the final analysis. Applicants received and accepted a median of 10 (Interquartile range [IQR], 5-18) and 9 (IQR, 5-15) interviews. Using a Likert scale, candidates revealed they were most satisfied with introduction and program overview (72.5%) and interactions with faculty (70.6%). Applicants were dissatisfied with pre-interview socials (66.9%) and hospital tours (66.2%). When evaluating programs, they had the most difficulty discerning program culture and resident autonomy. Most applicants (54%) were satisfied with the virtual format and 52% believed that virtual format should continue. DISCUSSION: The majority of applicants were satisfied with virtual interviews and could foresee the format continuing in the future.