bluuebunny/crossref_metadata_2025 huggingface dataset:
Transvaginal subfascial synthetic sling – “A novel technique” versus trans-obturator mid-urethral sling in female stress urinary incontinence: A comparative study
Authors: Khawaja Abdul Rouf , Rouf Malik Abdul , Khan Farzana Bashir , Bhat Arif Hamid , Dar Yaser Ahmad , Malik Sajad Ahmad , Wani Mohammad Saleem
Published: August 2021

Background:

To assess the treatment outcome and overall efficacy of the novel technique of a transvaginal subfascial synthetic sling (TVSS) in comparison to the standard trans-obturator tape (TOT-O) mid-urethral sling for female stress urinary incontinence (SUI).

Materials and methods:

The study included 206 female SUI patients managed at our institution between March 2015 and December 2019. The patients were randomly distributed into 2 comparable groups (Group A as TOT-O and Group B as TVSS) with respect to age, trouble due to SUI assessed with respect to degree of incontinence (number of episodes and diapers used per day), and body mass index (≤40 kg/m2), with 100 patients in the TOT-O group as group A and 106 patients in TVSS as group B. Preoperative variables related to the number of incontinent episodes and diapers usage were equal in both groups. The procedure was done under spinal anesthesia and results were assessed in terms of improvement in SUI as the primary outcome, any sexual dysfunction, complications, and overall satisfaction as secondary outcomes.

Results:

Symptomatic improvement after the procedure was seen in all patients with complete resolution of symptoms in 91 patients (91.%) in the TOT-O group (group A) versus 96 patients (90.56%) in the TVSS (group B). Postoperative complications included urinary retention in 6% versus 5.6%, increased day time urinary frequency in 8% versus 6.6%, urge incontinence in 4% versus 2.8%, and groin/thigh pain in 12% versus 0.9%, respectively. Mesh incision was done in 1 (1%) versus none (0%), and local mesh excision for mesh erosion in 2 (2%) versus 1 (0.9%) at 3 months after the procedure in the TOT-O group and the TVSS group, respectively. The p value and Chi-Square test with respect to the clinical profile and satisfaction with respect to complete resolution of symptoms was calculated using Open EPI software which were insignificant. Sexual function (SF) was assessed using the Brief Index of SF for Women questionnaire. All the patients were satisfied with respect to SF at 6 months of follow-up.

Conclusions:

The TVSS as a novel technique for female SUI is less invasive, simpler to learn, with less postoperative pain with resolution of SUI, rapid recovery, and good personal satisfaction compared to the standard TOT-O in procedure.
Rapid Review of Social Contact Patterns During the COVID-19 Pandemic
Authors: Liu Carol Y. , Berlin Juliette , Kiti Moses C. , Del Fava Emanuele , Grow André , Zagheni Emilio , Melegaro Alessia , Jenness Samuel M. , Omer Saad B. , Lopman Benjamin , Nelson Kristin
Published: August 2021

Background:

Physical distancing measures aim to reduce person-to-person contact, a key driver of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. In response to unprecedented restrictions on human contact during the coronavirus disease 2019 (COVID-19) pandemic, studies measured social contact patterns under the implementation of physical distancing measures. This rapid review synthesizes empirical data on the changing social contact patterns during the COVID-19 pandemic.

Method:

We conducted a systematic review using PubMed, Medline, Embase, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We descriptively compared the distribution of contacts observed during the pandemic to pre-COVID data across countries to explore changes in contact patterns during physical distancing measures.

Results:

We identified 12 studies reporting social contact patterns during the COVID-19 pandemic. Eight studies were conducted in European countries and eleven collected data during the initial mitigation period in the spring of 2020 marked by government-declared lockdowns. Some studies collected additional data after relaxation of initial mitigation. Most study settings reported a mean of between 2 and 5 contacts per person per day, a substantial reduction compared to pre-COVID rates, which ranged from 7 to 26 contacts per day. This reduction was pronounced for contacts outside of the home. Consequently, levels of assortative mixing by age substantially declined. After relaxation of initial mitigation, mean contact rates increased but did not return to pre-COVID levels. Increases in contacts post-relaxation were driven by working-age adults.

Conclusion:

Information on changes in contact patterns during physical distancing measures can guide more realistic representations of contact patterns in mathematical models for SARS-CoV-2 transmission.
Radiation Protection Evaluation of Medical X-ray Imaging Centers in Qazvin, Iran
Authors: Esfahani Azam Janati , Cheraghi Susan
Published: August 2021

Given the potential risks of x rays in imaging, it is necessary to evaluate the radiation safety of medical x-ray imaging rooms and radiation information of radiographers. A descriptive study has been carried out in Qazvin, Iran, in the form of a questionnaire answered by radiography technologists in private and public imaging centers to assess the level of knowledge, attitude, and performance about x-ray exposure and safety against it. Afterward, the radiation doses of public areas of the radiography centers were measured by a survey meter. A checklist was also completed, containing items about availability of ventilation facilities in x-ray rooms, radiation warning signs, radiation work schedules, documents of periodic blood test monitoring, exposure history of radiographers by film badge, and documents of the quality control of x-ray devices. The data analysis was performed by SPSS 16 using descriptive study, t-test, ANOVA, and Pearson’s correlation coefficient test. The mean attitude and knowledge scores were 6.65 ± 1.63 out of 9 and 4.82 ± 2.06 out of 15, respectively. Sex, age, and workplace had no significant effect on the radiographers’ knowledge and attitude, while occupational experience had a negative relationship, and level of education had a significant direct association with knowledge of the participants (p-value<0.05). The performance of the staff was somewhat good. Almost all x-ray imaging centers had good radiation protection conditions. The annual quality control of x-ray imaging devices was ensured. The radiation protection awareness among the medical radiographers in Qazvin city needs to be improved, especially among the experienced staff.
Pu-239 Accumulation in E. Coli and P. Putida Grown in Liquid Cultures
Authors: Manglass Lisa , Wintenberg Molly , Blenner Mark , Martinez Nicole
Published: August 2021

Understanding of the behavior and effects of plutonium (Pu) in the environment is an important aspect of developing responsible and effective strategies for remediation and environmental stewardship. This work studies the sorption and uptake of 239Pu by common environmental bacteria, Escherichia coli DH10β and Pseudomonas putida KT-2440. Plutonium was directly incorporated into growth media prior to inoculation (0.12 kBq mL−1), and samples from the liquid cultures of E. coli and P. putida were analyzed over a 15-d growth period through liquid scintillation counting (LSC) of plutonium in cell pellets and cell culture media following centrifugation. To improve its solubility in the liquid cultures, Pu was complexed with citrate prior to inoculation. P. putida cultures were also grown without citrate to examine potential impact of P. putida’s ability to use citrate as a food source. The accumulation of Pu in P. putida cells was found to increase both with and without citrate complexation for the first 5 d and then plateau until the end of the study period (15 d). A higher activity concentration of Pu was found in P. putida cells grown with citrate complexation than without. The activity concentration of plutonium in E. coli cells was greater than that in P. putida cells, which may be the result of a stronger complexing agent made by E. coli for the purpose of iron uptake. There are a variety of factors that influence Pu behavior in bacterial systems, and results confirm that even in a simple system, multiple mechanisms are at play.
The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak
Authors: Castro Maria Gabriela , Sloane Philip D.
Published: August 2021

Federally Qualified Health Centers (FQHCs) have been essential in response to COVID-19 outbreaks among vulnerable populations. Our rural FQHC had a primary role in early detection of and response to a poultry plant-related outbreak at the outset of the pandemic that disproportionately and gravely affected the local Hispanic community. The health center activated a rapid local response that included the community's first mass testing event and first acute respiratory treatment clinic, both of which were central to abatement. Lessons learned from this experience provide important guidance for the potential role of FQHCs in infection outbreak preparedness in marginalized communities.
Enhancing occupational safety in the X-ray laboratory
Authors: Bansal Priya , Luna Michael , Dutton Margaret , Maini Aneel , Banerjee Subhash , Brilakis Emmanouil S. , Maini Brijeshwar , Khalili Houman
Published: August 2021

Despite more than 80% of interventional operators reporting one or more orthopedic injuries attributed to the X-ray laboratory, there has been limited adoption of various strategies and equipment to minimize these injuries. A comprehensive review of these methods to reduce musculoskeletal strain is lacking in the current literature, and is essential in order to ensure a long, healthy, and productive interventional career.
Tonic pupil secondary to varicella-zoster-virus (VZV) keratouveitis in a child
Authors: Tsokolas Georgios , Tyradellis Straton , Islam Tahir
Published: August 2021

Introduction:

An unusual case of tonic pupil in a 4-year-old male child secondary to Varicella-Zoster-Virus (VZV) keratouveitis is described in this case report. To the best of our knowledge, our report is the thirtieth case of tonic pupil following chickenpox infection in the literature.

Patient concerns:

A 4-year-old male child presented at our department in June 2019 with anisocoria and feeling generally unwell. The right pupil was noted by his mother to be larger than the left in normal, bright and dim illumination conditions. Of note, the child at the same time was suffering from chickenpox and the symptoms started approximately 4 days prior to the attendance at Accident and Emergency with a generalized vesicular rash. The mother also reported that the right eye was mildly red and uncomfortable and her son was complaining of photophobia.

Diagnosis:

Tonic pupil secondary to VZV keratouveitis.

Interventions:

Full past medical and ocular history was obtained. The patient underwent full ophthalmic examination including dilated fundoscopy. Visual acuity was recorded with Snellen Chart and Keeler chart of Minimum Angle of Resolution chart. Patient had Magnetic Resonance Imaging due to anisocoria to exclude intracranial pathology. The child was treated with intravenous Acyclovir and had a good recovery, though the anisocoria persisted.

Outcomes:

During the follow-ups in the Paediatric Ophthalmology Clinic, 0.125% pilocarpine test revealed profound miosis of the affected right pupil and normal response from the healthy left pupil. In addition, the range of accommodation was reduced in the affected right eye. The child was closely observed to prevent right eye amblyopia and the plan was to issue bifocals to maximize both near and distant visual acuity. Nevertheless, during close follow-up the accommodation reflex in the right eye recovered on its own and the child was eventually discharged from the clinic without executive bifocals.

Conclusion:

VZV keratouveitis leading to tonic pupil is a rare complication. The proposed pathophysiological mechanism is retrograde dissemination of the infection through the parasympathetic nerve fibers from the iris via the inferior branch of the third nerve to the ciliary ganglion. Our case emphasizes the potential amblyogenic consequences of tonic pupil.
Carbohydrate-restricted diets and Type 1 diabetes mellitus: research considerations
Authors: Dikeman David T. , Westman Eric C.
Published: August 2021

Purpose of review

Type 1 diabetes mellitus (T1DM) is managed via careful control of blood glucose, exogenous insulin, diet, exercise, and other physiologic factors. Interestingly, the dietary recommendations for T1DM have had very little systematic research. Many clinical observations, as well as emerging research studies, have noted that a carbohydrate-restricted diet can lead to normalization of blood glucoses with reduction in hypoglycemic reactions among motivated individuals.

Recent findings

In this paper, we review observations of carbohydrate restriction and propose a series of studies to test two levels of dietary carbohydrate intake for the management of individuals affected by T1DM. We recommend that the studies start in otherwise healthy adults with hemoglobin A1c > 8%, and then progress to more complicated populations including children, those with secondary complications and/or good glycemic control. Larger, long-term studies would then address growth in children, and diabetic complications including cardiovascular outcomes.

Due to the clinical observations of improvements using carbohydrate-restricted nutrition for T1DM, we recommend that these types of studies addressing the level of dietary carbohydrate be urgently conducted.
Retrospective cohort study of changes in estimated glomerular filtration rate for patients prescribed a low carb diet
Authors: Mitchell Nia S. , Batch Bryan C. , Tyson Crystal C.
Published: August 2021

Purpose of review

Obesity and diabetes contribute to chronic kidney disease (CKD) and accelerate the loss of kidney function. Low carbohydrate diets (LCDs) are associated with weight loss and improved diabetes control. Compared to the typical Western diet, LCDs contain more protein, so individuals with CKD are not included in studies of LCDs. Therefore, there are no studies of LCDs for weight loss and their effects on kidney function.

Recent findings

Obesity, hyperglycemia, and hyperinsulinemia can be detrimental to kidney function. LCDs may improve kidney function in patients with obesity and diabetes because they are associated with weight loss, improve blood sugar control, and decrease endogenous insulin production and exogenous insulin requirements.

In this study, for patients with mildly reduced and moderately to severely reduced kidney function who were prescribed an LCD, their estimated glomerular filtration rate (eGFR) was either unchanged or improved. For those with normal or elevated eGFR, their kidney function was slightly decreased. For those without diabetes, greater weight loss was associated with improved eGFR. Future studies should prospectively measure low carbohydrate dietary adherence and physical activity and directly measure changes in GFR and albuminuria for participants with CKD before and during that diet.
The new perspective of PET/CT for axillary nodal staging in early breast cancer patients according to ACOSOG Z0011 trial PET/CT axillary staging according to Z0011
Authors: Kong Eunjung , Choi Jungeun
Published: August 2021

Objective

Post Z0011 trial, axillary lymph node dissections (ALNDs) can be performed in patients with ≥3 positive axillary lymph nodes (ALNs). We investigated the diagnostic performance of 18F-fluorodeoxyglucose PET/computed tomography (FDG PET/CT) to predict ≥3 metastasis [high nodal burden (HNB)].

Methods

We retrospectively analyzed preoperative FDG PET/CT from January 2010 to June 2012. Patients had clinical T1-2N0 primary invasive breast cancer and underwent breast-conserving surgery with sentinel lymph node biopsy ± ALND. All suspicious ALNs were counted considering FDG-avidity with morphologic changes. Images were considered positive if the axillary basin took up more FDG than the surrounding tissue. On CT, abnormal ALNs were round/ovoid or had cortical thickening with contrast enhancement. PET/CT results were compared with the histology and follow-up findings.

Results

In total, 221 females with 224 axillae were enrolled; 161 had negative, 53 had 1–2 metastasis [low nodal burden (LNB)] and 10 had HNB. The sensitivity, specificity, negative predictive value and positive predictive value of PET/CT for HNB were 70, 100, 98.6 and 100%, respectively. There was a correlation between the number of suspicious ALNs on PET/CT and the metastatic nodes on final histology. There were no significant differences in age, tumor size and FDG-avidity between patients with negative or LNB and HNB. During follow-up, 25 patients had a recurrence. The three false-negative patients did not show recurrence.

Conclusion

Preoperative PET/CT predicts HNB with high accuracy and is useful for evaluating clinical T1-2N0 invasive breast cancer.
Exploring the potential utilities of 99mTc-labeled RBC-equilibrium radionuclide angiocardiography in transfusion-dependent β-thalassemia major patients
Authors: Vadi Shelvin Kumar , Sood Ashwani , Khadwal Alka , Parmar Madan , Bhatia Anmol , Kashyap Sonia , Bahl Ajay , Mittal Bhagwant Rai
Published: August 2021

Aims

99mTc-labeled RBC-equilibrium radionuclide angiocardiography (ERNA) is done in transfusion-dependent beta-thalassemia major (β-TM) patients routinely for cardiac dysfunction. This prospective study aimed at evaluating the potential of ERNA in demonstrating the bone marrow hyperplasia as an adjunct biomarker for monitoring the adequacy of blood transfusions in transfusion-dependent β-TM patients.

Materials and methods

One hundred and twenty-six patients of β-TM (study group) and 30 nonthalassemic patients (control) underwent ERNA study with an additional whole-body imaging. We quantitated the normalized bone marrow tracer uptake (due to marrow hyperplasia) and hepatic tracer uptake (indicator of hepatic perfusion) in both the groups on whole-body imaging. Liver and myocardial iron deposition were evaluated with T2* MRI in the thalassemic group.

Results

β-TM group showed significantly increased mean normalized marrow count (MN) compared to the control group (P < 0.001) reflecting peripheral marrow hyperplasia (indirect marker for blood transfusion inadequacy). The hematological parameters in the study group showed a negative correlation with MN, without such correlation in the control group. The study group showed greater derangement in hepatic perfusion with significantly less mean normalized hepatic tracer uptake (HN) compared to the control group. Hepatic iron deposition (evaluated with T2* MRI) also showed a negative correlation with hepatic perfusion parameter (HN) assessed by ERNA, though myocardial iron deposition did not show any significant correlation with cardiac systolic/diastolic parameters evaluated by ERNA in the study group.

Conclusion

ERNA study with these novel parameters (MN and HN) may have the potential to assess peripheral marrow hyperplasia and derangement in hepatic perfusion in transfusion-dependent β-TM.
Haralick texture features extracted from Ga-68 PSMA PET/CT to differentiate normal prostate from prostate cancer: a feasibility study
Authors: Sharma Akshima , Kumar Sanjay , Pandey Anil Kumar , Arora Geetanjali , Sharma Anshul , Seth Amlesh , Kumar Rakesh
Published: August 2021

Objective

Role of texture parameters on the basis of Ga-68 PSMA PET/CT in prostate cancer (Pca) is largely unexplored. Present work done is a preliminary study that aims to evaluate the role of Haralick texture features on the basis of Ga-68 PSMA PET/CT in Pca in which texture features were used to differentiate between normal prostate and Pca tissue.

Methods

The study retrospectively enrolled patients in two groups: group 1 included 30 patients with biopsy-proven adenocarcinoma prostate and median age 64 years (range: 50–82 years) who underwent baseline Ga-68 PSMA PET/CT prior to therapy; group 2 included 24 patients with pathologies other than Pca and median age 53.5 years (range: 18–80 years) who underwent Ga-68 PSMA PET/CT as part of another study in our department. Patients in group 2 did not have any prostate pathology and served as controls for the study. The segmented images of prostate (3-D image) were used to calculate 11 Haralick texture features in MATLAB. SUVmax was also evaluated. All parameters were compared among the two groups using appropriate statistical analysis and P value <0.05 was considered significant.

Results

All 11 Haralick texture features, as well as SUVmax, were significantly different among Pca and controls (P < 0.05). Among the texture features, contrast was most significant (P value of Mann–Whitney U <0.001) in differentiating Pca from normal prostate with AUROC curve of 82.9% with sensitivity and specificity 83.30% and 73.30%, respectively at cut-off 0.640. SUVmax was also significant with AUROC curve 94.0% and sensitivity and specificity 62.5% and 90%, respectively at cut-off 5.7. A significant negative correlation of SUVmax was observed with contrast.

Conclusion

Haralick texture features have a significant role in differentiating Pca and normal prostate.
Efficacy of voxel-based dosimetry map for predicting response to trans-arterial radioembolization therapy for hepatocellular carcinoma: a pilot study
Authors: Yoo Min Young , Paeng Jin Chul , Kim Hyo-Cheol , Lee Min Sun , Lee Jae Sung , Lee Dong Soo , Kang Keon Wook , Cheon Gi Jeong
Published: August 2021

Objective

Typical clinical dosimetry models for trans-arterial radioembolization (TARE) assume uniform dose distribution in each tissue compartment. We performed simple voxel-based dosimetry using post-treatment 90Y PET following TARE with 90Y-resin microspheres and investigated its prognostic value in a pilot cohort.

Method

Ten patients with 14 hepatocellular carcinoma lesions who underwent TARE with 90Y-resin microspheres were retrospectively included. The partition model-based expected target tumor dose (TDp) was calculated using a pretreatment 99mTc-macroaggregated albumin scan. From post-treatment 90Y-microsphere PET and voxel-wise S-value kernels, voxel-based dose maps were produced and the absorbed dose of each lesion (TDv) was calculated. Heterogeneity of intratumoral absorbed doses was assessed using the SD and coefficient of variation of voxel doses. The response of each lesion was determined based on contrast-enhanced MRI or CT, or both. Lesion responses were classified as local control success or failure. Prognostic values of dosimetry parameters and clinicopathological factors were evaluated in terms of progression-free survival (PFS) of each lesion.

Results

TDv was significantly different between local control success and failure groups, whereas tumor size, TDp and intratumoral dose heterogeneity were not. Univariate survival analysis identified serum aspartate transaminase level ≥40 IU/L, tumor size ≥66 mm and TDv <81 Gy as significant prognostic factors for PFS. However, only TDv was an independent predictive factor in the multivariate analysis (P = 0.022). There was a significant correlation between TDv and PFS (P = 0.009; r = 0.669).

Conclusions

In TARE, voxel-based dose index TDv can be estimated on post-treatment 90Y PET using a simple method. TDv was a more effective prognostic factor for TARE than TDp and clinicopathologic factors in this pilot study. Further studies are warranted on the role of voxel-based dose and dose distribution in TARE.
Electric nerve stimulation for overactive bladder: an umbrella review
Authors: Li Min , Zhang Ningning , Wu Di , Jiang Meina , You Simiao , Jia Yong
Published: August 2021

Numerous systematic reviews and meta-analyses have reported the effect of electrical nerve stimulation (ENS) on overactive bladder (OAB). However, these results are contradictory. We conducted an umbrella review to summarize the evidence and evaluate the effectiveness of ENS for OAB by using an umbrella review methodology from multiple perspectives with sufficient methodological quality. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and PsycINFO databases and two Chinese databases (CNKI and CBM) to identify articles written in English or Chinese that were published up to 15 February 2021. Two authors of this review independently selected the studies, assessed their quality, and extracted the data from all the included studies. We performed a quality assessment of eligible reviews using the AMSTAR 2.0 tool and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals and heterogeneity. Ten systematic reviews and meta-analyses covering 89 randomized controlled trials and 16 prospective cohort studies with a total population of 5004 participants that investigated the effect of ENS for OAB in terms of 17 different outcomes were identified. ENS seems effective and safety for OAB, with our results showing weak evidence of clinical efficacy and no evidence of side effects. To recommend ENS as a practical treatment option for OAB, however, more high-quality research is needed.
Increasing the Efficiency of Critical Care Orientation
Authors: Weiss Rebecca L. , Hayden Margaret , Petras Denise , Ren Dianxu , Fennimore Laura
Published: August 2021

More nurses without critical care experience are being hired by intensive care units. Eleven newly hired nurses participated in a phased program designed to improve the efficiency of intensive care unit orientation. A pre–post implementation design demonstrated that although there was a 14% reduction in orientation time, there were no statistically significant changes in new hire or preceptor satisfaction nor in first-year registered nurse turnover rates. Expansion of the program is needed to demonstrate its impact.
Compelling Voices of Diversity, Equity, and Inclusion in Prelicensure Nursing Students
Authors: Wright Rebecca , Baptiste Diana-Lyn , Booth Ashley , Addison Helena , Abshire Martha , Alvarez Daisy , Barrett Megan , Hansen Bryan , Jenkins Emerald , Scarborough Sabrina , Wright Erin , Davidson Patricia M. , Ramsey Gloria C.
Published: August 2021

Background

Diversity, equity, and inclusion are increasingly recognized as core values for guiding nursing education, practice, and research. The conceptual framework of cultural humility has been adapted in a variety of health care settings, fostering a culture of diversity, equity, and inclusion through openness, supportive interaction, self-awareness, self-reflection, and critique.

Problem

Nurse educators have the opportunity, but may find it challenging, to teach students about the changing landscape of health care and the populations we serve.

Approach

This article describes the integration of the cultural humility framework into nursing curricula to teach principles of diversity, equity, and inclusivity. We provide a practical example of a diversity panel, with student and panelist reflections, exploring the intersectionality of experiences in health care and integration of personal accounts and perspectives.

Conclusion

Dialogue about diversity, equity, and inclusion is essential for preparing future nurses to deliver culturally competent care and promote health equity.
Mutational Landscape of TdT+ Large B-cell Lymphomas Supports Their Distinction From B-lymphoblastic Neoplasms
Authors: Bhavsar Shweta , Liu Yen-Chun , Gibson Sarah E. , Moore Erika M. , Swerdlow Steven H.
Published: August 2021

In the current World Health Organization classification, terminal deoxynucleotidyl transferase (TdT) expression in a high grade/large cell B-cell lymphoma (LBCL) indicates a B-lymphoblastic lymphoma/leukemia (B-LBL), although TdT expression in what appear to be mature LBCL or following mature B-cell neoplasms is reported. The frequency of TdT+ LBCL, how to best categorize these cases, and their clinicopathologic features, molecular landscape, and relationship to classic B-LBL remain to be better defined. TdT expression was therefore assessed in 258 LBCL and the results correlated with the cytologic, phenotypic, and cytogenetic findings. Targeted mutational analysis, review of prior biopsies, and assessment of clinical associations was performed in the 6 cases with >10% TdT+ cells. All 6 TdT+ LBCL were blastoid-appearing, CD34−, MYC+, BCL2+, and had MYC rearrangements (R) (5/6 with BCL2 and/or BCL6-R). 5/6 had a prior TdT− LBCL and/or follicular lymphoma and all had an aggressive course. Fifteen nonsynonymous variants in 11 genes were seen in the 4/5 tested cases with mutations. TdT+ and TdT− areas in 1 case showed identical mutations. The mutational profiles were more like those reported in germinal center B-cell type-diffuse LBCL rather than B-LBL. Evolution from preceding TdT− lymphomas was nondivergent in 1/3 tested cases and partially divergent in 2. The clinicopathologic and cytogenetic features of these 6 cases were similar to those found in a meta-analysis that included additional cases of TdT+ LBCL or B-LBL following follicular lymphoma. Thus, TdT+, CD34− large B-cell neoplasms with MYC rearrangements and often a “double hit” are rare, frequently a transformational event and aggressive but are distinct from classic B-LBL.
Substantial Lymphovascular Space Invasion Is an Adverse Prognostic Factor in High-Risk Endometrial Cancer
Authors: Peters Elke E.M. , Léon-Castillo Alicia , Hogdall Estrid , Boennelycke Marie , Smit Vincent T.H.B.M. , Hogdall Claus , Creutzberg Carien L. , Bosse Tjalling , Nout Remi A. , Ørtoft Gitte
Published: August 2021

Approximately 15% of patients with endometrial cancer present with high-risk disease (HREC). Moreover, assessing the extent of lymphovascular space invasion (LVSI) may provide prognostic insight among patients with HREC. The aim of this study was to determine whether the extent of LVSI can serve as a prognostic factor in HREC. All cases of ESMO-ESGO-ESTRO 2016 classified HREC in the Danish Gynecological Cancer Database (DGCD) diagnosed from 2005 to 2012 were reviewed for the presence and extent of LVSI (categorized using a 3-tiered definition). We used the Kaplan-Meier analysis to calculate actuarial survival rates, both adjusted and unadjusted Cox regression analyses were used to calculate the proportional hazard ratio (HR). A total of 376 patients were included in our analysis. Among 305 patients with stage I/II HREC, 8.2% and 6.2% had focal or substantial LVSI, respectively, compared with 12.7% and 38.0% of 71 patients with stage III/IV HREC, respectively. Moreover, the estimated 5-yr recurrence-free survival rate was significantly lower among patients with substantial LVSI compared with patients with no LVSI for both stage I/II (HR: 2.8; P=0.011) and stage III/IV (HR: 2.9; P=0.003) patients. Similarly, overall survival was significantly lower among patients with substantial LVSI for both stage I/II (HR: 3.1; P<0.001) and stage III/IV (HR: 3.2; P=0.020) patients. In patients with HREC, substantial LVSI is an independent adverse prognostic factor for lymph node and distant metastases, leading to reduced survival. Thus, the extent of LVSI should be incorporated into routine pathology reports in order to guide the appropriate choice of adjuvant treatment.
Perceptions of Stakeholders Toward “Hospital at Home” Program in Singapore: A Descriptive Qualitative Study
Authors: Chua Crystal Min Siu , Ko Stephanie Qianwen , Lai Yi Feng , Lim Yee Wei , Shorey Shefaly
Published: August 2021

Objective

Hospital at Home (HaH) programs have been shown to improve quality of care and patient satisfaction, and reduce bed occupancy rate in hospitals. Despite the prevalence of HaH in Western countries, studies in Asia are limited and the perception of HaH remains underexplored in Asian context. Understanding the perceptions of stakeholders is vital before implementing HaH in any new settings. Thus, the aim of this study is to explore the perceptions of referring physicians, care providers, patients, and caregivers on HaH programs in a multiracial country such as in Singapore.

Methods

This study used a descriptive qualitative design. Participants from 2 tertiary hospitals in Singapore, including 13 referring physicians, 10 care providers, 15 patients, and 3 caregivers, were interviewed between June 2020 and September 2020. Data were analyzed using inductive thematic analysis.

Results

The overarching theme titled “The stakeholders’ perception on HaH” was pillared by 4 main themes: (1) patients suitable for HaH; (2) perceived advantages and benefits of HaH; (3) perceived risks, anxiety, and concerns about HaH; and (4) potential enablers of HaH. Overall, the findings reported that most of the stakeholders embraced HaH. Timely medical interventions and support from care providers were reportedly important factors to maintain patient safety and quality of care. The importance of having adequate resources and sound financing mechanisms to develop a successful HaH program was also highlighted.

Conclusions

This study offered insights into HaH from the perspectives of stakeholders in Singapore and facilitate the planning of future HaH pilot programs in multiracial Singapore and other Asian countries.
Incidental 68Ga-DOTATOC PET/CT Uptake in Hemorrhagic Transformation of Stroke in a Patient With Cervical Paraganglioma
Authors: Valhondo-Rama Raquel , Rodríguez Gómez José Carlos , Couto Caro Rosa , Cabrera-Martín María Nieves , Carreras Delgado José Luis
Published: August 2021

We present a case of a 75-year-old woman with clinical suspicion of stroke whose cranial CT showed ischemic changes in right precentral region, without visible vascular occlusion, and a right vagal lesion suggestive of paraganglioma. Two weeks later, 68Ga-DOTATOC PET/CT with IV iodine-based contrast administration (Biograph 6 True Point equipment; Siemens) was performed for characterization of this lesion and staging. Intraparenchymal 68Ga-DOTATOC uptake was visualized in right frontal lobe suggestive of hemorrhagic transformation of the previous stroke.
Incidentally Detected High SSTR Expression in Uterine Leiomyoma on DOTANOC PET/CT
Authors: Datta Gupta Shreya , Kaushik Prateek , Ramteke Prashant , Mallik Abhishek Kumar , Krishna Asuri , Sharma J.B. , Damle Nishikant Avinash
Published: August 2021

A 38-year-old woman with a 2-month history of per vaginal bleeding and episodes of palpitations, headache, and vomiting underwent 68Ga-DOTANOC PET/CT for evaluation, which revealed a left suprarenal mass and a large uterine mass, both of which were intensely tracer avid. Histopathology of the masses after surgery revealed a left pheochromocytoma and uterine leiomyoma. SSTR-expressing leiomyoma is an uncommon finding and must be kept in mind as a differential diagnosis of DOTANOC-avid uterine mass.
Quality and Safety in Healthcare, Part XC
Authors: Harolds Jay A.
Published: August 2021

The A3 form is a structured way of solving problems using a detailed step-by-step methodology using the principles of the Plan-Do-Check-Act cycle. The A3 form supports efforts to organize the thinking of workers about new ways to improve. The form is used as a guide for many project teams to find answers, and then the team arrives at decisions through consensus. Sometimes process mapping, driver diagrams, and gap analysis are included in A3 problem solving. The A3 form is just one of numerous healthcare applications for the Toyota Production System and Lean.
The “Ultimate Triple PET”
Authors: McClenathan Matthew , Peacock Justin G.
Published: August 2021

A 71-year-old man with a history of carcinoid and prostate adenocarcinoma underwent 68Ga-DOTATATE PET/CT to evaluate new mediastinal lymphadenopathy. The scan revealed new carcinoid metastases, but the mediastinal nodes were not avid. 18F-FDG PET/CT was performed to evaluate for cardiac and mediastinal sarcoidosis, revealing a lack of cardiac sarcoidosis, but probable mediastinal sarcoidosis. 18F-Fluciclovine PET/CT was then performed for possible prostate metastases, revealing the patient’s known prostate cancer. Three different PET radiopharmaceuticals revealed 3 different processes in a single patient within a 195-day period, demonstrating the power of nuclear medicine diagnostics.
68Ga-FAPI-04 PET/CT Versus 18F-FDG PET/CT in Malignant Peritoneal Mesothelioma
Authors: Gündoğan Cihan , Güzel Yunus , Kömek Halil , Etem Hülya , Kaplan İhsan
Published: August 2021

An 83-year-old man presented with abdominal pain, vomiting, and bloating. His abdominal CT revealed heterogeneous peritoneal thickening in the lower quadrants, which was more prominent in the pelvic region. 18F-FDG PET/CT performed to locate the primary tumor showed irregular peritoneal and omental thickening with low to moderate FDG uptake. 68Ga–FAPI (fibroblast activation protein–specific inhibitor)–04 PET/CT of the patient, whose primary tumor could not be detected using FDG, showed high radiopharmaceutical uptake in the areas of heterogeneous thickening on peritoneal and serosal surfaces. Peritoneal Tru-Cut biopsy revealed malignant tumoral infiltration indicating mesothelioma. This case showed that 68Ga-FAPI-04 PET/CT could be a promising radiopharmaceutical in the evaluation of peritoneal mesothelioma.
Malignant Melanoma of Glans Penis
Authors: Sachani Hemant , Tripathy Sarthak , Shamim Shamim Ahmed , Rastogi Sameer , Baa Annie K.
Published: August 2021

Melanomas usually arise in the sun exposed parts of the skin. Mucosal melanoma is a rare condition. Melanoma of glans penis is even a rarer phenomenon with less than 250 cases reported in literature so far. Here we present a case of a 55-year-old man diagnosed with melanoma of glans penis with findings on 18F FDG PET/CT scan done for metastatic workup. 18F-FDG PET/CT showed primary in the glans penis with metastases in the right supraclavicular, mediastinal, and abdominal lymph nodes.
Hepatic Lesion of Mucosa-Associated Lymphoid Tissue Lymphoma Revealed by Al18F-NOTA-FAPI-04 PET/CT
Authors: Kou Ying , Yao Zhiwei , Cheng Zhuzhong
Published: August 2021

A middle-aged man was newly diagnosed with mucosa-associated lymphoid tissue lymphoma with secondary liver involvement. The hepatic lesion was not shown on FDG PET/CT but FAPI (fibroblast-activated protein inhibitor) PET/CT, which revealed abnormal FAPI accumulation. This case demonstrated that FAPI PET/CT might provide value in hepatic mucosa-associated lymphoid tissue lymphoma.
Mismatched Lesions on 18F-FDG PET and 18F-Fluciclovine PET Images in a Patient With Metastatic Prostate Small Cell Carcinoma
Authors: Gu Joshua , Lu Yang , Xu Guofan
Published: August 2021

A 65-year-old man with fluciclovine-avid metastatic prostate small cell carcinoma with prostate-specific antigen (PSA) 19.4 ng/mL at diagnosis underwent system therapy and subsequent surgery and achieved hormonal response with PSA <0.1 ng/mL. An 18F-fluciclovine PET/CT scan 3 months after surgery was negative for disease. Although PSA remained <0.1 ng/mL, the rising carcinoembryonic antigen prompted an 18F-FDG PET/CT 6 weeks later. It showed multiple hypermetabolic lesions in the prostatectomy bed, liver, and right iliac bone, suggestive of malignant disease. The FDG-avid prostatectomy lesions were further confirmed on MRI. This case demonstrates that FDG PET/CT has a role in suspected metastatic prostate small cell carcinoma with negative fluciclovine PET examination.
Ectopic Retrolaryngeal Parathyroid Adenoma Detected by 18F-Ethylcholine PET/US Fusion Imaging
Authors: Seifert Philipp , Greiser Julia , Winkens Thomas , Lorenz Kerstin , Freesmeyer Martin
Published: August 2021

A 68-year-old woman was referred with the diagnosis of symptomatic pHPT (primary hyperparathyroidism). Ultrasonography (US) and 99mTc-MIBI scintigraphy could not clearly identify a parathyroid adenoma. A primary unilateral surgical exploration remained unsuccessful to remove adenomatous parathyroid tissue and the pHPT persisted. 18F-ethylcholine PET/CT showed a left-sided retropharyngeal lesion with intense tracer uptake that could not be detected on US images at first sight. Therefore, additional 18F-ethylcholine PET/US fusion imaging was performed and revealed a poorly definable nodular structure on US that could be unambiguously correlated to the PET finding. Surgical excision confirmed an oncocytic variant of parathyroid adenoma, and parathormone and calcium levels normalized immediately.
18F-PSMA-1007 Uptake in Paget Disease of the Bone: An “Iron Man” Sign
Authors: Alfeeli Mahamoud , Marafi Fahad , Esmail Abdulredha , Fathallah Wael M.A. , Usmani Sharjeel
Published: August 2021

18F-PSMA is a promising tracer for both staging and detection of biochemical recurrence in prostate cancer. PSMA is also expressed in the benign pathological conditions. We report a case of 81-year-old man with a known case of prostate cancer who underwent 18F-PSMA for restaging. 18F-PSMA PET/CT shows intense tracer uptake in the frontal bone appearing like an “Iron Man” sign. Corresponding noncontrast CT images, pagetoid changes with thickened cortex, mixed lytic/sclerotic mottled pattern. It is important to recognize 18F-PSMA expression in the benign nonprostatic pathologies to avoid false interpretation.
18F-FDG PET/CT Findings in a Rare Case of Paraneoplastic Vestibulocerebellar Syndrome Associated With Isolated Antiamphiphysin Antibodies
Authors: Komandla Shivaram Rao , Vankadari Kousik , Milap Milap , V. Hemanth , Kandadai Rukmini Mridula
Published: August 2021

Paraneoplastic cerebellar degeneration (PCD) is an immune-mediated neurological disease characterized by adaptive immune response against onconeural antigens physiologically expressed in the cerebellum. It is characterized by presence of highly specific onconeural autoantibodies such as anti-Yo, anti-Hu, anti-Ri, and anti-Ma2 in the serum and cerebrospinal fluid as diagnostic biomarkers. Antiamphiphysin autoantibody–related paraneoplastic encephalitis is a less commonly seen autoimmune neurological disorder usually presenting as stiff person syndrome. We present an unusual case of isolated antiamphiphysin antibody–related PCD presenting as vestibulocerebellar syndrome with associated sensorineural hearing loss and sensory neuropathy. FDG PET helped in topographical localization of brain lesion along with early detection of extragonadal germ cell tumor in the retroperitoneum.
Autophagy impairment by African swine fever virus
Authors: Shimmon Gareth L. , Hui Joshua Y. K. , Wileman Thomas E. , Netherton Christopher L.
Published: August 2021

African swine fever is a devastating disease of domestic swine and wild boar caused by a large double-stranded DNA virus that encodes for more than 150 open reading frames. There is no licensed vaccine for the disease and the most promising current candidates are modified live viruses that have been attenuated by deletion of virulence factors. Like many viruses African swine fever virus significantly alters the host cell machinery to benefit its replication and viral genes that modify host pathways represent promising targets for development of gene deleted vaccines. Autophagy is an important cellular pathway that is involved in cellular homeostasis, innate and adaptive immunity and therefore is manipulated by a number of different viruses. Autophagy is regulated by a complex protein cascade and here we show that African swine fever virus can block formation of autophagosomes, a critical functional step of the autophagy pathway through at least two different mechanisms. Interestingly this does not require the A179L gene that has been shown to interact with Beclin-1, an important autophagy regulator.
A third COVID-19 vaccine shot markedly boosts neutralizing antibody potency and breadth
Authors: Iketani Sho , Liu Lihong , Nair Manoj S. , Mohri Hiroshi , Wang Maple , Huang Yaoxing , Ho David D.
Published: August 2021

COVID-19 (coronavirus disease 2019) vaccines have been rapidly developed and deployed globally as a measure to combat the disease. These vaccines have been demonstrated to confer significant protection, but there have been reports of temporal decay in antibody titer. Furthermore, several variants have been identified with variable degrees of antibody resistance. These two factors suggest that a booster vaccination may be worthy of consideration. While such a booster dose has been studied as a series of three homologous vaccines in healthy individuals, to our knowledge, information on a heterologous regimen remains unreported, despite the practical benefits of such a scheme. Here, in this observational study, we investigated the serological profile of four healthy individuals who received two doses of the BNT162b2 vaccine, followed by a third booster dose with the Ad26.COV2.S vaccine. We found that while all individuals had spike-binding antibodies at each of the timepoints tested, there was an appreciable drop in titer by four months following the second vaccination. The third vaccine dose robustly increased titers beyond that of two vaccinations, and these elicited antibodies had neutralizing capability against all SARS-CoV-2 strains tested in both a recombinant vesicular stomatitis virus-based pseudovirus assay and an authentic SARS-CoV-2 assay, except for one individual against B.1.351 in the latter assay. Thus, a third COVID-19 vaccine dose in healthy individuals promoted not just neutralizing antibody potency, but also induced breadth against dominant SARS-CoV-2 variants.

Significance

COVID-19 vaccines confer protection from symptomatic disease, but the elicited antibody titer has been found to decrease with time. Furthermore, SARS-CoV-2 variants with relative resistance against antibody neutralization have been identified. To overcome such issues, a third vaccine dose applied as a booster vaccine may be necessary. We studied four healthy individuals who received a heterologous booster dose as a third vaccine. All of these individuals had heightened neutralizing antibody titer following the booster vaccination, and could neutralize nearly all variants tested. Thus, a heterologous third COVID-19 vaccine dose may be a mechanism to both heighten and broaden antibody titers, and could be an additional strategy for controlling the SARS-CoV-2 pandemic.
DECREASED BREADTH OF THE ANTIBODY RESPONSE TO THE SPIKE PROTEIN OF SARS-CoV-2 AFTER REPEATED VACCINATION
Authors: Horndler Lydia , Delgado Pilar , Romero-Pinedo Salvador , Quesada Marina , Balabanov Ivaylo , Laguna-Goya Rocío , Almendro-Vázquez Patricia , Llamas Miguel A. , Fresno Manuel , Paz-Artal Estela , van Santen Hisse M. , Álvarez Stela , Olmo Asunción , Alarcón Balbino
Published: August 2021

The rapid development of vaccines to prevent infection by SARS-CoV-2 virus causing COVID-19 makes necessary to compare the capacity of the different vaccines in terms of development of a protective humoral response. Here, we have used a highly sensitive and reliable flow cytometry method to measure the titers of antibodies of the IgG1 isotype in blood of healthy volunteers after receiving one or two doses of the vaccines being administered in Spain. We took advantage of the multiplexed capacity of the method to measure simultaneously the reactivity of antibodies with the S protein of the original strain Wuhan and the variants B.1.1.7 (Alpha), B.1.617.2 (Delta) and B.1.617.1 (Kappa). We found significant differences in the titer of anti-S antibodies produced after a first dose of the vaccines ChAdOx1 nCov-19/AstraZeneca, mRNA-1273/Moderna, BNT162b2/Pfizer-BioNTech and Ad26.COV.S/Janssen. Most important, we found a relative reduction in the reactivity of the sera with the Alpha, Delta and Kappa variants, versus the Wuhan one, after the second boosting immunization. These data allow to make a comparison of different vaccines in terms of anti-S antibody generation and cast doubts about the convenience of repeatedly immunizing with the same S protein sequence.