Medicine and Health Sciences Commons^™

Evaluation Of A Multidisciplinary Lipid Clinic To Improve The Care Of Individuals With Severe Lipid Conditions: A Re-Aim Framework Analysis, Laney K Jones, Megan Mcminn, David Kann, Michael Lesko, Amy C Sturm, Nicole Walters, Nan Chen, Kerrianne Fry, Ross C Brownson, Samuel S Gidding, Marc S Williams, Alanna Kulchak Rahm

2020-Current year OA Pubs

BACKGROUND: Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability.

METHODS: The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC …

Clustering Of Patients With Overactive Bladder Syndrome, James Gross, Joel M Vetter, H Henry Lai

2020-Current year OA Pubs

BACKGROUND: Overactive bladder is a heterogenous condition with poorly characterized clinical phenotypes. To discover potential patient subtypes in patients with overactive bladder (OAB), we used consensus clustering of their urinary symptoms and other non-urologic factors.

METHODS: Clinical variables included in the k-means consensus clustering included OAB symptoms, urinary incontinence, anxiety, depression, psychological stress, somatic symptom burden, reported childhood traumatic exposure, and bladder pain.

RESULTS: 48 OAB patients seeking care of their symptoms were included. k-means consensus clustering identified two clusters of OAB patients: a urinary cluster and a systemic cluster. The systemic cluster, which consisted of about half of the …

P97/Vcp Is Highly Expressed In The Stem-Like Cells Of Breast Cancer And Controls Cancer Stemness Partly Through The Unfolded Protein Response, Chuang Li, Yongsheng Huang, Qianqian Fan, Hongyang Quan, Yeqing Dong, Meng Nie, Jiaqi Wang, Fucun Xie, Jiang Ji, Lan Zhou, Zhi Zheng, Lin Wang

2020-Current year OA Pubs

p97/VCP, an evolutionarily concerned ATPase, partakes in multiple cellular proteostatic processes, including the endoplasmic reticulum (ER)-associated protein degradation (ERAD). Elevated expression of p97 is common in many cancers and is often associated with poor survival. Here we report that the levels of p97 positively correlated with the histological grade, tumor size, and lymph node metastasis in breast cancers. We further examined p97 expression in the stem-like cancer cells or cancer stem cells (CSCs), a cell population that purportedly underscores cancer initiation, therapeutic resistance, and recurrence. We found that p97 was consistently at a higher level in the CD44

Impact Of Spinal Deformity Characteristics On Patient-Reported Outcome Measurement Information System Scores In Patients With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion, Scott J. Luhmann, Mike P. Kelly, Nichelle H. Enata, Kirsten Brouillet, Ernst Etienne, Brian A. Kelly

2020-Current year OA Pubs

INTRODUCTION: The impact of posterior spinal fusion (PSF) on physical function and pain and mental health in pediatric patients as quantified by the Patient-Reported Outcomes Measurement Information System (PROMIS), developed by the National Institute of Health, is largely unknown. The purpose of this study is to report the changes of PROMIS scores for upper extremity (UE), pain interference (PI), mobility (MOB), and peer relationships (PR) after PSF in patients with idiopathic scoliosis (IS), compare postoperative changes in PROMIS PI and Scoliosis Research Society-30 pain scores, and evaluate associations between curve characteristics and PROMIS scores.

METHODS: A retrospective cohort of 122 …

The Predictive Value Of Absolute Lymphocyte Counts On Tumor Progression And Pseudoprogression In Patients With Glioblastoma, Jing Xi, Bilal Hassan, Ruth G N Katumba, Karam Khaddour, Akshay Govindan, Jingqin Luo, Jiayi Huang, Jian L Campian

2020-Current year OA Pubs

BACKGROUND: Differentiating true glioblastoma multiforme (GBM) from pseudoprogression (PsP) remains a challenge with current standard magnetic resonance imaging (MRI). The objective of this study was to explore whether patients' absolute lymphocyte count (ALC) levels can be utilized to predict true tumor progression and PsP.

METHODS: Patients were considered eligible for the study if they had 1) GBM diagnosis, 2) a series of blood cell counts and clinical follow-ups, and 3) tumor progression documented by both MRI and pathology. Data analysis results include descriptive statistics, median (IQR) for continuous variables and count (%) for categorical variables, p values from Wilcoxon rank …

Postoperative Complications Are Associated With Long-Term Changes In The Gut Microbiota Following Colorectal Cancer Surgery, Felix C F Schmitt, Martin Schneider, William Mathejczyk, Markus A Weigand, Jane C Figueiredo, Christopher I Li, David Shibata, Erin M Siegel, Adetunji T Toriola, Cornelia M Ulrich, Alexis B Ulrich, Sébastien Boutin, Biljana Gigic

2020-Current year OA Pubs

Changes in the gut microbiome have already been associated with postoperative complications in major abdominal surgery. However, it is still unclear whether these changes are transient or a long-lasting effect. Therefore, the aim of this prospective clinical pilot study was to examine long-term changes in the gut microbiota and to correlate these changes with the clinical course of the patient. Methods: In total, stool samples of 62 newly diagnosed colorectal cancer patients undergoing primary tumor resection were analyzed by 16S-rDNA next-generation sequencing. Stool samples were collected preoperatively in order to determine the gut microbiome at baseline as well as at …

Obstetric Anesthesia Services In Israel Snapshot (Oasis) Study: A 72 Hour Cross-Sectional Observational Study Of Workforce Supply And Demand, Gal Schtrechman-Levi, Alexander Ioscovich, Jacob Hart, Jacob Bar, Ronit Calderon-Margalit, Eshel A Nir, Yehuda Ginosar

2020-Current year OA Pubs

BACKGROUND: We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care.

METHODS: Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were …

Severity Of Parkinsonism Associated With Environmental Manganese Exposure, Brad A Racette, Gill Nelson, Wendy W Dlamini, Pradeep Prathibha, Jay R Turner, Mwiza Ushe, Harvey Checkoway, Lianne Sheppard, Susan Searles Nielsen

2020-Current year OA Pubs

BACKGROUND: Exposure to occupational manganese (Mn) is associated with neurotoxic brain injury, manifesting primarily as parkinsonism. The association between environmental Mn exposure and parkinsonism is unclear. To characterize the association between environmental Mn exposure and parkinsonism, we performed population-based sampling of residents older than 40 in Meyerton, South Africa (N = 621) in residential settlements adjacent to a large Mn smelter and in a comparable non-exposed settlement in Ethembalethu, South Africa (N = 95) in 2016-2020.

METHODS: A movement disorders specialist examined all participants using the Unified Parkinson Disease Rating Scale motor subsection part 3 (UPDRS3). Participants also completed an …

A Conserved Role For Sleep In Supporting Spatial Learning In Drosophila, Krishna Melnattur, Leonie Kirszenblat, Ellen Morgan, Valentin Militchin, Blake Sakran, Denis English, Rushi Patel, Dorothy Chan, Bruno Van Swinderen, Paul J Shaw

2020-Current year OA Pubs

Sleep loss and aging impair hippocampus-dependent Spatial Learning in mammalian systems. Here we use the fly Drosophila melanogaster to investigate the relationship between sleep and Spatial Learning in healthy and impaired flies. The Spatial Learning assay is modeled after the Morris Water Maze. The assay uses a "thermal maze" consisting of a 5 × 5 grid of Peltier plates maintained at 36-37°C and a visual panorama. The first trial begins when a single tile that is associated with a specific visual cue is cooled to 25°C. For subsequent trials, the cold tile is heated, the visual panorama is rotated and …

Application Fever: Reviewing The Causes, Costs, And Cures For Residency Application Inflation, J. Bryan Carmody, Ilana S. Rosman, John C. Carlson

2020-Current year OA Pubs

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of "Application Fever" is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of Application Fever, with a focus on contributing factors and costs of this behavior. Application Fever has its origins in the early 1990s. At that time, the number of residency applicants began to outpace the number of available positions. Because an applicant who applies to more residency programs has a greater probability of securing a residency position than …

High-Frequency Alternating Current Block Using Macro-Sieve Electrodes: A Pilot Study, Soumyajit Ray, Saad Javeed, Jawad M. Khalifeh, Nikhil Chandra, Nathan Birenbaum, John M. Felder, Daniel Moran, Wilson Z. Ray, Matthew R. Macewan

2020-Current year OA Pubs

Background and objective High-frequency alternating current (HFAC) can yield a rapid-acting and reversible nerve conduction block. The present study aimed to demonstrate the successful implementation of HFAC block delivery via regenerative macro-sieve electrodes (MSEs). Methods Dual-electrode assemblies in two configurations [dual macro-sieve electrode-1 (DMSE-I), DMSE-II] were fabricated from pairs of MSEs and implanted in the transected and subsequently repaired sciatic nerves of two male Lewis rats. After four months of postoperative nerve regeneration through the MSEs' transit zones, the efficacy of acute HFAC block was tested for both configurations. Frequencies ranging from 10 kHz to 42 kHz, and stimulus amplitudes …

Whole-Genome Sequencing Of African Americans Implicates Differential Genetic Architecture In Inflammatory Bowel Disease, Hari K Somineni, Rodney D Newberry, Et Al.

2020-Current year OA Pubs

Whether or not populations diverge with respect to the genetic contribution to risk of specific complex diseases is relevant to understanding the evolution of susceptibility and origins of health disparities. Here, we describe a large-scale whole-genome sequencing study of inflammatory bowel disease encompassing 1,774 affected individuals and 1,644 healthy control Americans with African ancestry (African Americans). Although no new loci for inflammatory bowel disease are discovered at genome-wide significance levels, we identify numerous instances of differential effect sizes in combination with divergent allele frequencies. For example, the major effect at PTGER4 fine maps to a single credible interval of 22 …

Unwillingness Of Patients In Ghana To Interrupt Antiretroviral Therapy For Hiv Cure Research, Evelyn Y Bonney, Helena Lamptey, James O Aboagye, Christopher Zaab-Yen Abana, Anthony T Boateng, Darius N K Quansah, Adjoa Obo-Akwa, Vincent J Ganu, Peter Puplampu, George B Kyei, H-Cris Massive Action Team

2020-Current year OA Pubs

OBJECTIVES: Though antiretroviral therapy (ART) has reduced HIV infection into a manageable chronic disease, it does not provide for a cure. HIV cure trials may carry risks for patients who are generally doing well on ART, making it imperative that their input is sought as various types of cure methods and trials are designed. Few studies have sought the views of African patients on HIV cure studies. The objective of this study was to determine the views and preferences of people living with HIV (PLWH) in Ghana on cure research.

METHODS: We used a questionnaire to interview 251 PLWH in …

The Structure And Diversity Of Strain-Level Variation In Vaginal Bacteria, Brett A Tortelli, Amanda L Lewis, Justin C Fay

2020-Current year OA Pubs

The vaginal microbiome plays an important role in human health and species of vaginal bacteria have been associated with reproductive disease. Strain-level variation is also thought to be important, but the diversity, structure and evolutionary history of vaginal strains is not as well characterized. We developed and validated an approach to measure strain variation from metagenomic data based on SNPs within the core genomes for six species of vaginal bacteria:

Pattern Recognition In Lymphoid Malignancies Using Cytogps And Mercator, Zachary B Abrams, Dwayne G Tally, Lin Zhang, Caitlin E Coombes, Philip R O Payne, Lynne V Abruzzo, Kevin R Coombes

2020-Current year OA Pubs

BACKGROUND: There have been many recent breakthroughs in processing and analyzing large-scale data sets in biomedical informatics. For example, the CytoGPS algorithm has enabled the use of text-based karyotypes by transforming them into a binary model. However, such advances are accompanied by new problems of data sparsity, heterogeneity, and noisiness that are magnified by the large-scale multidimensional nature of the data. To address these problems, we developed the Mercator R package, which processes and visualizes binary biomedical data. We use Mercator to address biomedical questions of cytogenetic patterns relating to lymphoid hematologic malignancies, which include a broad set of leukemias …

Cardiac Magnetic Resonance For Early Detection Of Radiation Therapy-Induced Cardiotoxicity In A Small Animal Model, El-Sayed H Ibrahim, Chieh-Yu Lin, Zhiqiang Xu, Amanda Klaas, Carmen Bergom, Et Al.

2020-Current year OA Pubs

BACKGROUND: Over half of all cancer patients receive radiation therapy (RT). However, radiation exposure to the heart can cause cardiotoxicity. Nevertheless, there is a paucity of data on RT-induced cardiac damage, with limited understanding of safe regional RT doses, early detection, prevention and management. A common initial feature of cardiotoxicity is asymptomatic dysfunction, which if left untreated may progress to heart failure. The current paradigm for cardiotoxicity detection and management relies primarily upon assessment of ejection fraction (EF). However, cardiac injury can occur without a clear change in EF.

OBJECTIVES: To identify magnetic resonance imaging (MRI) markers of early RT-induced …

The National Covid Cohort Collaborative (N3c): Rationale, Design, Infrastructure, And Deployment, Melissa A Haendel, Philip R O Payne, Et Al.

2020-Current year OA Pubs

OBJECTIVE: Coronavirus disease 2019 (COVID-19) poses societal challenges that require expeditious data and knowledge sharing. Though organizational clinical data are abundant, these are largely inaccessible to outside researchers. Statistical, machine learning, and causal analyses are most successful with large-scale data beyond what is available in any given organization. Here, we introduce the National COVID Cohort Collaborative (N3C), an open science community focused on analyzing patient-level data from many centers.

MATERIALS AND METHODS: The Clinical and Translational Science Award Program and scientific community created N3C to overcome technical, regulatory, policy, and governance barriers to sharing and harmonizing individual-level clinical data. We …

Expanding Controlled Donation After The Circulatory Determination Of Death: Statement From An International Collaborative, Beatriz Domínguez-Gil, James Dubois, Et Al.

2020-Current year OA Pubs

A decision to withdraw life-sustaining treatment (WLST) is derived by a conclusion that further treatment will not enable a patient to survive or will not produce a functional outcome with acceptable quality of life that the patient and the treating team regard as beneficial. Although many hospitalized patients die under such circumstances, controlled donation after the circulatory determination of death (cDCDD) programs have been developed only in a reduced number of countries. This International Collaborative Statement aims at expanding cDCDD in the world to help countries progress towards self-sufficiency in transplantation and offer more patients the opportunity of organ donation. …

Effect Of Aspirin On Cancer Incidence And Mortality In Older Adults, John J Mcneil, Yin Cao, Et Al.

2020-Current year OA Pubs

BACKGROUND: ASPirin in Reducing Events in the Elderly, a randomized, double-blind, placebo-controlled trial of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast, prior randomized controlled trials, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality.

METHODS: 19 114 Australian and US community-dwelling participants aged 70 years and older (US minorities 65 years and older) without cardiovascular disease, dementia, or physical disability were randomly assigned and followed for a median of 4.7 years. Fatal and nonfatal …

Genome-Wide Association Study Of Circulating Interleukin 6 Levels Identifies Novel Loci, Tarunveer S. Ahluwalia, Mary F. Feitosa, Et Al.

2020-Current year OA Pubs

No abstract provided.

Ten Principles For Data Sharing And Commercialization, Curtis L Cole, Soumitra Sengupta, Sarah Rossetti Née Collins, David K Vawdrey, Michael Halaas, Thomas M Maddox, Geoff Gordon, Trushna Dave, Philip R O Payne, Andrew E Williams, Deborah Estrin

2020-Current year OA Pubs

Digital medical records have enabled us to employ clinical data in many new and innovative ways. However, these advances have brought with them a complex set of demands for healthcare institutions regarding data sharing with topics such as data ownership, the loss of privacy, and the protection of the intellectual property. The lack of clear guidance from government entities often creates conflicting messages about data policy, leaving institutions to develop guidelines themselves. Through discussions with multiple stakeholders at various institutions, we have generated a set of guidelines with 10 key principles to guide the responsible and appropriate use and sharing …

Hepatotoxicity Following Administration Of Onasemnogene Abeparvovec (Avxs-101) For The Treatment Of Spinal Muscular Atrophy, Deepa Chand, Franziska Mohr, Hugh Mcmillan, Francis Fonyuy Tukov, Kyle Montgomery, Aaron Kleyn, Rui Sun, Sitra Tauscher-Wisniewski, Petra Kaufmann, Gerd Kullak-Ublick

2020-Current year OA Pubs

BACKGROUND & AIMS: Spinal muscular atrophy (SMA) is an autosomal recessive, childhood-onset motor neuron disease. Onasemnogene abeparvovec (OA) is a gene therapy designed to address SMA's root cause. In pivotal mouse toxicology studies, the liver was identified as a major site of OA toxicity. Clinical data reflect elevations in serum aminotransferase concentrations, with some reports of serious acute liver injury. Prophylactic prednisolone mitigates these effects. Herein, we aim to provide pragmatic, supportive guidance for identification, management, and risk mitigation of potential drug-induced liver injury.

METHODS: Data from 325 patients with SMA who had received OA through 31 December 2019, in …

Abaloparatide Real-World Patient Experience Study, Deborah T Gold, Richard Weiss, Tammy Beckett, Chad Deal, Robert S Epstein, Andrew L James, Jacqueline M Kernaghan, Mahshid Mohseni, Michael Spiegel, Tamara Vokes, Jenna Roberts, Tom Bailey, Yamei Wang, Setareh A Williams

2020-Current year OA Pubs

Despite the availability of various osteoporosis treatments, adherence remains suboptimal. One contributing factor may be patient experience with therapy. This US, multicenter, combined retrospective chart review and patient questionnaire study included postmenopausal women at high risk for fracture and is the first study to describe real-world patient experience with abaloparatide (ABL) injection. Eight geographically diverse secondary care sites in the United States participated (

Impact Of Obesity On Day-Night Differences In Cardiac Metabolism, Sobuj Mia, Ravi Sonkar, Lamario Williams, Mary N Latimer, Isabelle Frayne Robillard, Abhinav Diwan, Stuart J Frank, Christine Des Rosiers, Martin E Young

2020-Current year OA Pubs

An intrinsic property of the heart is an ability to rapidly and coordinately adjust flux through metabolic pathways in response to physiologic stimuli (termed metabolic flexibility). Cardiac metabolism also fluctuates across the 24-hours day, in association with diurnal sleep-wake and fasting-feeding cycles. Although loss of metabolic flexibility has been proposed to play a causal role in the pathogenesis of cardiac disease, it is currently unknown whether day-night variations in cardiac metabolism are altered during disease states. Here, we tested the hypothesis that diet-induced obesity disrupts cardiac "diurnal metabolic flexibility", which is normalized by time-of-day-restricted feeding. Chronic high fat feeding (20-wk)-induced …

Genome-Wide Association Study Of Phenotypes Measuring Progression From First Cocaine Or Opioid Use To Dependence Reveals Novel Risk Genes, Richard Sherva, Congcong Zhu, Leah Wetherill, Howard J Edenberg, Emma Johnson, Louisa Degenhardt, Arpana Agrawal, Nicholas G Martin, Elliot Nelson, Henry R Kranzler, Joel Gelernter, Lindsay A Farrer

2020-Current year OA Pubs

AIM: Substance use disorders (SUD) result in substantial morbidity and mortality worldwide. Opioids, and to a lesser extent cocaine, contribute to a large percentage of this health burden. Despite their high heritability, few genetic risk loci have been identified for either opioid or cocaine dependence (OD or CD, respectively). A genome-wide association study of OD and CD related phenotypes reflecting the time between first self-reported use of these substances and a first DSM-IV dependence diagnosis was conducted.

METHODS: Cox proportional hazards regression in a discovery sample of 6,188 African-Americans (AAs) and 6,835 European-Americans (EAs) participants in a genetic study of …

Medalt: Single-Cell Copy Number Lineage Tracing Enabling Gene Discovery, Fang Wang, Qihan Wang, Vakul Mohanty, Shaoheng Liang, Jinzhuang Dou, Jincheng Han, Darlan Conterno Minussi, Ruli Gao, Li Ding, Nicholas Navin, Ken Chen

2020-Current year OA Pubs

We present a Minimal Event Distance Aneuploidy Lineage Tree (MEDALT) algorithm that infers the evolution history of a cell population based on single-cell copy number (SCCN) profiles, and a statistical routine named lineage speciation analysis (LSA), whichty facilitates discovery of fitness-associated alterations and genes from SCCN lineage trees. MEDALT appears more accurate than phylogenetics approaches in reconstructing copy number lineage. From data from 20 triple-negative breast cancer patients, our approaches effectively prioritize genes that are essential for breast cancer cell fitness and predict patient survival, including those implicating convergent evolution.The source code of our study is available at https://github.com/KChen-lab/MEDALT .

The Second Ninds/Nibib Consensus Meeting To Define Neuropathological Criteria For The Diagnosis Of Chronic Traumatic Encephalopathy, Kevin F Bieniek, Nigel J Cairns, Et Al.

2020-Current year OA Pubs

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with exposure to head trauma. In 2015, a panel of neuropathologists funded by the NINDS/NIBIB defined preliminary consensus neuropathological criteria for CTE, including the pathognomonic lesion of CTE as "an accumulation of abnormal hyperphosphorylated tau (p-tau) in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci and in an irregular pattern," based on review of 25 tauopathy cases. In 2016, the consensus panel met again to review and refine the preliminary criteria, with consideration around the minimum threshold for diagnosis and the reproducibility of a proposed …

The State Of Neuro-Oncology During The Covid-19 Pandemic: A Worldwide Assessment, Maciej M. Mrugala, Milan G. Chheda, Et Al

2020-Current year OA Pubs

No abstract provided.

Removal Of Epididymal Visceral Adipose Tissue Prevents Obesity-Induced Multi-Organ Insulin Resistance In Male Mice, Michael P Franczyk, Mai He, Jun Yoshino

2020-Current year OA Pubs

Obesity is associated with insulin resistance, an important risk factor of type 2 diabetes, atherogenic dyslipidemia, and nonalcoholic fatty liver disease. The major purpose of this study was to test hypothesize that prophylactic removal of epididymal visceral adipose tissue (VAT) prevents obesity-induced multi-organ (liver, skeletal muscle, adipose tissue) insulin resistance. Accordingly, we surgically removed epididymal VAT pads from adult C57BL/6J mice and evaluated in vivo and cellular metabolic pathways involved in glucose and lipid metabolism following chronic high-fat diet (HFD) feeding. We found that VAT removal decreases HFD-induced body weight gain while increasing subcutaneous adipose tissue (SAT) mass. Strikingly, VAT …

Photosensitivity Reaction From Operating Room Lights After Oral Administration Of 5-Aminolevulinic Acid For Fluorescence-Guided Resection Of A Malignant Glioma, Alexander T. Yahanda, Gavin P. Dunn, Michael R. Chicoine

2020-Current year OA Pubs

Orally administered 5-aminolevulinic acid (5-ALA), which was approved in the United States in 2017, is preferentially metabolized by malignant glioma cells into protoporphyrin IX and enhances tumor visualization when using a blue light filter on an operating microscope. Photosensitivity after 5-ALA administration is a known side effect, but a photosensitivity reaction from operating room lights has not yet been documented. We report the case of a 56-year-old man with a history of previous resection of a grade II astrocytoma who presented with imaging concerning for tumor recurrence and possible malignant transformation. Repeat surgical resection utilized 5-ALA. Soon after the surgery, …