bluuebunny/crossref_metadata_2025 huggingface dataset:
Underneath the White Coat
Authors: Maffoni Marina , Argentero Piergiorgio , Giorgi Ines , Giardini Anna
Published: January 2020

Palliative care practice is associated with risk factors linked to end-of-life, chronicity, personal, interpersonal, and work characteristics, as well as with protective factors, but how these are perceived by the health care providers themselves is not clear. This article aims to elaborate a theoretical framework explaining the risk and protective factors for palliative care providers in their daily practice. Nineteen providers (16 nurses, 3 physicians) working in a palliative care unit of a clinical-research institute in Northern Italy were interviewed. A Grounded Theory qualitative approach guided the data collection and analysis. From the interviews, 28 codes, subsequently organized into 11 interconnected categories, emerged. They described both stressors (emotion management regarding death/dying, conflicts, communication and relationship with patients/caregivers, discrepancies between patients' and caregivers' needs, communication of poor diagnosis/prognosis, decision making about treatment, and real-life and work interference) and protective factors (social support, positive approach and value of past experience, recognized value of/passion toward professional work, work-family balance). Experiencing these elements as positive or negative depends on the professionals' point of view, as well as their past and present experience.

Understanding what dealing with life-limiting illnesses means may suggest tailored interventions to improve professionals' well-being by fostering the protective elements and combatting the risk factors.
Cognitive and Emotional Empathy in Anorexia Nervosa
Authors: Doba Karyn , Nandrino Jean-Louis
Published: January 2020

The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.
Evaluating Changes in Caring Behaviors of Caritas Coaches Pre and Post the Caritas Coach Education Program
Authors: Brewer Barbara B. , Anderson Jan , Watson Jean
Published: January 2020

OBJECTIVE

The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP).

BACKGROUND

The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory.

METHODS

A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP.

RESULTS

The mean scores of all measures improved significantly.

CONCLUSIONS

After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.
Transition From Acute to Chronic Pain in Lower Extremity Fracture Patients
Authors: Griffioen Mari A. , Glutting Joseph , O’Toole Robert V. , Starkweather Angela R. , Lyon Debra , Dorsey Susan G. , Renn Cynthia L.
Published: January 2020

Background

Traumatic injury is a major source of chronic pain, particularly for individuals with traumatic fracture of the fibula and/or tibia (lower extremity fracture [LEFx]). Although several factors (e.g., older age, being female, high pain intensity at time of initial injury) have been identified as risk factors for chronic pain associated with LEFx. Comprehensive biopsychosical models to predict the odds of transitioning from acute to chronic pain after LEFx are needed to better understand the underlying processes, predict risk for chronic pain, and develop personalized therapies for individuals at higher risk for developing chronic pain.

Objective

The aim of the study was to outline the study design that will be used to examine the physiological, psychological, and genetic/genomic variables—models that predict the transition from acute to chronic pain after LEFx.

Method

This prospective descriptive cohort study will enroll 240 participants with a fibula and/or tibia fracture and 40 controls with no LEFx. Data will be collected during an in-hospital baseline visit, five in-person clinic visits (6 weeks, 12 weeks, 24 weeks, 52 weeks, and 24 months), and seven online between-visit surveys (2 weeks, 4 weeks, 8 weeks, 10 weeks, 16 weeks, 20 weeks, and 18 months) from participants with LEFx and at concordant intervals from controls. Measures will consist of 19 questionnaires characterizing pain and psychological status, neurophysiological testing for peripheral sensory nerve function, and peripheral blood samples collections for RNA sequencing. Illumina standard protocols will be used to sequence RNA, and read counts will be used to measure gene expression.

Analysis

Direct-entry, multiple logistic regression will be used to produce odds ratios expressing the relative risk on each explanatory variable when controlling for other predictors/covariates in the model.

Conclusion

This study is one of the first to longitudinally characterize the biopsychosocial variables associated with a clinically relevant problem of the transition from acute to chronic posttraumatic fracture pain in individuals with LEFx. Results from this study will be used to construct predictive risk models of physiological, psychological, and genetic/genomic variables associated with increased risk for transitioning from acute to chronic pain status after LEFx. This work will lead to a better understanding of the trajectory of pain and relevant variables over time; initiate a better understanding of variables associated with risk for transitioning from acute to chronic pain; and, in the future, could provide a foundation for the identification of novel therapeutic targets to improve the outcomes of individuals with LEFx.
Newly Approved Antimicrobials
Authors: Cottreau Jessica M. , Christensen Alyssa B.
Published: January 2020

In recent years, government-backed policies have promoted the development of new antimicrobials to combat increases in antibiotic-resistant organisms. This article summarizes the 10 new antibacterial agents to be approved in the last 5 years.
Management Considerations for Recalcitrant Hyperemesis
Authors: Spinosa Daniel , Post Annalisa , Kuller Jeffrey A. , Dotters-Katz Sarah
Published: January 2020

Importance

Hyperemesis gravidarum (HEG) affects 0.3% to 3% of pregnancies and requires additional therapies beyond those commonly used for less severe instances of nausea and vomiting of pregnancy (NVP). Differentiating between NVP and HEG is a vital yet challenging function for any obstetrician. The literature for management of HEG is lacking compared with that of NVP.

Objective

Review etiology of NVP/HEG highlights key considerations in the workup of HEG as they compare to NVP and explore management options for recalcitrant HEG focusing principally on how they affect maternal and fetal outcomes and secondarily on where data are nonprescriptive.

Evidence Acquisition

This was a literature review primarily using PubMed and Google Scholar.

Results

Short-course corticosteroids and treatment for Helicobacter pylori have the most favorable risk-reward profiles of the 4 pharmacologic therapies evaluated. Mirtazapine and diazepam may have a place in highly selected patients. If nutritional supplementation is required, enteral nutrition is strictly preferred to parenteral nutrition. Postpyloric feeding approaches are less likely to induce vomiting. Surgically placed feeding tubes are less likely to be dislodged and may be worth the invasive insertion procedure if nasogastric or nasojejunal tubes are not tolerated.

Conclusions and Relevance

Hyperemesis gravidarum is a diagnosis reserved for refractory cases of NVP and therefore by definition poses treatment challenges. Any clinical presentation that lent itself to prescriptive, algorithmic management would likely fall short of the diagnostic criteria for HEG. However, data can inform management on a patient-by-patient basis or at least help patient and provider understand risks and benefits of therapies reserved for refractory cases.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to evaluate the epidemiology and pathophysiology of HEG, especially as compared with NVP; assess second-line pharmacologic therapies for HEG, with particular focus on the data available for those interventions; and compare different options for nutritional support.
A CRISPR Focus on Attitudes and Beliefs Toward Somatic Genome Editing From Stakeholders Within the Sickle Cell Disease Community
Authors: Persaud Anitra , Desine Stacy , Blizinsky Katherine , Bonham Vence L.
Published: January 2020

(Abstracted from Genetics Med 2019;21:1726–1734.
Rapid Testing Algorithm Performance in a Low-Prevalence Environment
Authors: Martin Eugene G. , Cornett Julia , Mohammed Debbie Y. , Salaru Gratian
Published: January 2020

Background

The performance of a statewide HIV rapid test algorithm (RTA) in a low-prevalence setting (0.71%) was examined for 3 years.

Methods

An initial rapid screening by HIV-1/2 Ag/Ab Combo test (RT#1) with Ab verification using a second, different rapid test (RT#2) was conducted. Clinic referral was immediate for antigen-only–positive screens. Antibody-positive screens were confirmed by RT#2. Specimens were collected following discordant RTA results (initially Ab-POS by RT#1, but negative on RT#2) and tested in accordance with the current Centers for Disease Control and Prevention/Association of Public Health Laboratories–based HIV diagnostic algorithm supplemented by a quantitative viral load whenever possible.

Results

Of 310,785 tests performed, 2400 preliminary positive screens were identified; 2191 (91.8%) confirmed by RT#2. Of 13 Determine Combo AG-POS results identified, only 1 confirmed positive. Of the remaining 196 discordant results, 182 (92.9%) were uninfected, including 13 with AG-POS/AB-POS results. Of 14 true positives (7.1%) identified after discordant RTA results, the average quantitative HIV-1 viral load was 277,385 copies/mL, but 5 (35.7%) of 14 had viral loads <1000 copies/mL. Among the 2191 “presumptive positive” by RTA, 3 false-positive (FP) RTAs were reported (both rapid tests having positive results, while the HIV-1/2 Ag/Ab assay and quantitative HIV-1 viral load showed negative results).

Conclusions

The RTA was effective in predicting true-positive HIV test results and facilitating linkage to care. Discordant results were infrequent. Fingerstick DC Ag detection identified a single early infection. Many discordant cases that were subsequently positive were associated with viral loads <1000 copies/mL.
Death Certification in Northern Alberta
Authors: Wood Kimberly A. , Weinberg Seth H. , Weinberg Mitchell L.
Published: January 2020

Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.
Parents' Perspectives on Communication and Shared Decision Making for Febrile Infants ≤60 Days Old
Authors: Aronson Paul L. , Schaeffer Paula , Niccolai Linda M. , Shapiro Eugene D. , Fraenkel Liana
Published: January 2020

Objectives

Decisions about the management of febrile infants ≤60 days old may be well suited for shared decision making (SDM). Our objectives were to learn about parents' experiences with receiving and understanding information in the emergency department (ED) and their perspectives on SDM, including for decisions about lumbar puncture (LP).

Methods

We conducted semistructured interviews with 23 parents of febrile infants ≤60 days old evaluated in the pediatric ED at an urban, academic medical center. Interviews assessed parents' experiences in the ED and their perspectives on communication and SDM. Two investigators coded the interview transcripts, refined codes, and identified themes using the constant comparative method.

Results

Parents' unmet need for information negatively impacted parents' understanding, stress, and trust in the physician. Themes for parents' perspectives on SDM included the following: (1) giving parents the opportunity to express their opinions and concerns builds confidence in the decision making process, (2) parents' preferences for participation in decision making vary considerably, and (3) different perceptions about risks influence parents' preferences about having their infant undergo an LP. Although some parents would defer decision making to the physician, they still wanted to be able to express their opinions. Other parents wanted to have the final say in decision making. Parents valued risks and benefits of having their child undergo an LP differently, which influenced their preferences.

Conclusions

Physicians need to adequately inform parents to facilitate parents' understanding of information and gain their trust. Shared decision making may be warranted for decisions about whether to perform an LP, although parents' preferences for participating in decision making vary.
Pediatric Emergency Department Interventions of Pharmacy Residents
Authors: Anderson Gabrielle L. , Olson Ole J. , Mannenbach Mark S. , Rudis Maria I.
Published: January 2020

Objective

We sought to assess the frequency and types of interventions performed by pharmacy residents in a pediatric emergency department (ED).

Methods

The study was conducted in an academic ED with 77,000 annual visits, of which 17% are pediatric. Six pharmacy residents completed a total of 9 two-week rotations in the pediatric ED as part of their pharmacy residency programs from February 2016 to December 2018. Pharmacy residents recorded pharmacy intervention data in real time. We quantified the number and type of interventions and time spent making the interventions.

Results

Of 1608 pediatric patients present during the ED shifts when pharmacy residents were on service, pharmacy residents intervened on 294 patients (18.3%). A total of 400 activities and interventions were recorded. The majority (72%) of patients required 1 intervention, whereas the remaining 28% had 2 or more interventions documented. The median time spent per patient was 15 minutes (interquartile range, 10–20 minutes). Pharmacy residents were most commonly involved with medication selection and dosing.

Conclusions

The presence of a dedicated pharmacy team member in the pediatric area of the ED allows for a high level of involvement and interaction with other members of the health care team primarily through providing recommendations regarding medication selection, dosing, optimization, and answering drug information and medication administration questions.
2017 AAAEM Benchmarking Survey
Authors: Rathlev Niels K. , Holt Nate M. , Harbertson Cathi A. , Hettler Joeli , Reznek Martin A. , Tsai Shiu-Lin , Lopiano Kenny K. , Bohrmann Tommy , Scheulen James J.
Published: January 2020

Objectives

The Academy of Administrators in Academic Emergency Medicine Benchmark Survey of academic emergency departments (EDs) was conducted in 2017. We compared operational measures between pediatric and adult (defined as fewer than 5% pediatric visits) EDs based on survey data. Emergency departments in dedicated pediatric hospitals were not represented.

Methods

Measures included: (1) patient volumes, length of stay, and acuity; and 2) faculty staffing, productivity, and percent effort in academics. t Tests were used to compare continuous measures and inferences for categorical variables were made using Pearson χ2 test.

Results

The analysis included 17 pediatric and 52 adult EDs. We found a difference in the number of annual visits between adult (median, 66,275; interquartile range [IQR], 56,184–77,702) and pediatric EDs (median, 25,416; IQR, 19,840–29,349) (P < 0.0001). Mean “arrivals per faculty clinical hour” and “total arrivals per treatment space” showed no differences. The proportion of visits (1) arriving by emergency medical services and (2) for behavioral health were significantly higher in adult EDs (both P < 0.0001). The mean length of stay in hours for “all” patients was significantly longer in adult (5.4; IQR, 5.0–6.6) than in pediatric EDs (3.5; IQR, 2.9–4.3; P = 0.017). A similar difference was found for “discharged” patients (P = 0.004). Emergency severity indices, professional evaluation and management codes, and hospitalization rates all suggest higher acuity in adult EDs (all P < 0.0001). There were no differences in mean work relative value units per patient or in the distribution of full time equivalent effort dedicated to academics.

Conclusions

In this cohort, significant differences in operational measures exist between academic adult and pediatric EDs. No differences were found when considering per unit measures, such as arrivals per faculty clinical hour or per treatment space.
Does the Role of A Rapid Triage Provider Improve Pain Control in an Academic Pediatric Emergency Department?
Authors: Savage Jillian G. , DePiero Andrew D. , Attia Magdy W.
Published: January 2020

Pediatric pain control in the emergency department (ED) remains problematic. This quantifiable metric may be positively affected by the utilization of a rapid triage provider (RTP). This is a retrospective case control study of pediatric patients requiring either ketorelac intravenous (IV) or morphine IV for painful conditions. Patients in the control group were managed according to standard nursing-driven triage process. Patients in the RTP group were seen by the standard triage team as well as by the RTP.We identified 114 patients who required IV pain medications. The mean time from arrival to pain medication administration for the RTP group as compared with the control group was 47 and 64 minutes (P = 0.02). Similarly, the mean time from arrival to IV pain medication order placement was 15 and 43 minutes (P < 0.01). An RTP improves pain control in the pediatric ED via more efficient order placement and IV pain medication administration.
Increased Muscle Strength Limits Postural Sway During Daily Living Activities in Total Hip Arthroplasty Patients
Authors: Winther Siri B. , Foss Olav A. , Klaksvik Jomar , Husby Vigdis S.
Published: January 2020

Objective

The aim of the study was to investigate the effect of maximal strength training on postural sway after total hip arthroplasty, performed before and after a battery of physical performance tests that resemble daily living activities.

Design

This study is an exploratory study based on data from a 3-mo randomized controlled trial involving 54 total hip arthroplasty patients performing maximal strength training or conventional rehabilitation. At 3, 6, and 12 mos postoperatively, postural sway was evaluated in two gait tests; ie, one test before and one test after conducting a battery of physical performance tests.

Results

At 3 mos postoperatively, postural sway in the test after was significantly higher for the conventional rehabilitation group than the maximal strength training group (P = 0.045); however, there was no between-group difference at the test before (P = 0.670). Postural sway was also significantly higher in the test after compared with the test before in the conventional rehabilitation group (P < 0.001). No difference was found between the test before and test after in the maximal strength training group (P = 0.713). At 6 and 12 mos postoperatively, there were no statistically significant within- or between-group differences in postural sway.

Conclusions

Increased muscular strength limits postural sway 3 mos postoperatively in total hip arthroplasty patients after a demanding battery of physical performance tests simulating daily living activities.
Genomic Strategies to Personalize Use of Androgen Deprivation Therapy With Radiotherapy
Authors: Glicksman Rachel M. , Berlin Alejandro
Published: January 2020

The use of combination RT and androgen deprivation therapy in many prostate cancer curative-intent treatment scenarios is supported by level 1 evidence. However, in our current clinical paradigm, we have no ability to determine a priori which patients truly benefit from combination therapy and therefore apply the combination RT and androgen deprivation therapy intensification strategy to all patients, which results in overtreatment or undertreatment of the majority of our patients. Genomics has the ability to more deeply and objectively characterize the disease, in turn refining our prognostication capabilities and enabling the individualization of treatments. We review the commercially available prostate cancer genomic tests, focusing on those able to predict patient outcomes following radiotherapy or guide radiotherapy treatment decisions.
Next Generation of Androgen Deprivation Therapy Combined With Radiotherapy for N0 M0 Prostate Cancer
Authors: Barata Pedro , Layton Jodi , Lewis Brian , Sartor Oliver
Published: January 2020

Androgen deprivation therapy in combination with definitive radiation therapy is a standard of care for both intermediate-/high-risk localized prostate, locally advanced prostate cancer. Newer hormonal therapies have shown promising results in patients with castration-resistant disease and are now being investigated in early stages, in combination with radiation therapy. In this section, we review the body of evidence elucidating the mechanism of synergy and immune modulation effect of androgen deprivation therapy and radiation therapy, summarize the pivotal studies supporting its use in the nonmetastatic setting, and present the ongoing studies who will likely shape the management of locally advanced disease, in the upcoming years.
The feasibility and acceptability of research magnetic resonance imaging in adolescents with moderate–severe neuropathic pain
Authors: Verriotis Madeleine , Moayedi Massieh , Sorger Clarissa , Peters Judy , Seunarine Kiran , Clark Christopher A. , Walker Suellen M.
Published: January 2020

Introduction:

Multimodal characterisation with questionnaires, Quantitative Sensory Testing (QST), and neuroimaging will improve understanding of neuropathic pain (NeuP) in adolescents. Magnetic resonance imaging (MRI) data in adolescents with NeuP are limited, and the perceived practical or ethical burden of scanning may represent a barrier to research.

Objective:

To determine the feasibility of MRI scanning in adolescents with moderate–severe NeuP, with respect to consent rate, postscan acceptability, and data quality.

Methods:

This prospective cohort study evaluating questionnaires and QST recruited adolescents aged 10 to 18 years with clinically diagnosed NeuP from a tertiary clinic. Eligible adolescents aged 11 years and older could additionally agree/decline an MRI scan. After the scan, families rated discomfort, perceived risk, and acceptability of current and future MRI scans (0–10 numerical rating scales). Head motion during scanning was compared with healthy controls to assess data quality.

Results:

Thirty-four families agreed to MRI (72% recruitment), and 21 adolescents with moderate–severe pain (average last week 6.7 ± 1.7; mean ± SD) and with neuropathic QST profiles were scanned. Three adolescents reported positional or noise-related discomfort during scanning. Perceived risk was low, and acceptability of the current scan was high for parents (range [median]: 7 to 10/10 [10]) and adolescents (8–10/10 [10]). Willingness to undergo a future research scan was high for parents (7–10/10 [10]) and adolescents (5–10/10 [10]) and did not differ from future scans for clinical purposes. Mean head motion during resting state functional MRI did not differ from control adolescents.

Conclusion:

Research MRI is feasible and acceptable for many adolescents with moderate–severe NeuP.
Brief Report: Virologic Response by Baseline Viral Load With Dolutegravir Plus Lamivudine vs Dolutegravir Plus Tenofovir Disoproxil Fumarate/Emtricitabine: Pooled Analysis
Authors: Eron Joseph , Hung Chien-Ching , Baril Jean-Guy , Slim Jihad , Falcó Vicenç , Bogner Johannes , Maggiolo Franco , Mills Anthony , Sievers Jörg , Man Choy Y. , Urbaityte Rimgaile , Underwood Mark , Tenorio Allan R. , Pappa Keith A. , Wynne Brian , Koteff Justin , Gartland Martin , Smith Kimberly Y. , Aboud Michael
Published: January 2020

Background:

To investigate antiviral potency of the 2-drug regimen (2DR) dolutegravir plus lamivudine vs the 3-drug regimen (3DR) dolutegravir plus tenofovir disoproxil fumarate/emtricitabine, we performed a post-hoc analysis assessing antiviral response rates in the phase III GEMINI-1 and GEMINI-2 studies by baseline viral load (VL).

Setting:

One hundred ninety-two centers in 21 countries.

Methods:

Treatment-naive HIV-1–infected participants with screening VL ≤500,000 copies/mL were randomized 1:1 to once-daily dolutegravir plus lamivudine or dolutegravir plus tenofovir disoproxil fumarate/emtricitabine. Median change from baseline was determined for log10-transformed VL in the overall study population and the subpopulation with baseline VL >100,000 copies/mL. Proportion of participants achieving plasma VL <50 copies/mL (Snapshot algorithm) or <40 copies/mL (Abbott RealTime HIV-1 assay) and target not detected was assessed through week 48 by baseline VL. Time to viral suppression was determined (nonparametric Kaplan–Meier method).

Results:

For 293 participants with baseline VL >100,000 copies/mL, median change from baseline at week 4 was −3.38 and −3.40 log10 copies/mL in the 2DR and 3DR groups, respectively; reduction was sustained throughout 48 weeks. Time to VL <50 copies/mL was longer in participants with baseline VL >100,000 copies/mL than the overall study population (57 [week 8] vs 29 days [week 4]) and similar between the 2DR and 3DR groups. Proportion of participants with VL <50 or <40 copies/mL and target not detected was similar between groups, irrespective of baseline VL, at all tested visits throughout 48 weeks.

Conclusion:

Dolutegravir plus lamivudine demonstrates high antiviral potency in treatment-naive HIV-1–infected individuals across baseline VL strata.
A Family With A20 Haploinsufficiency Presenting With Novel Clinical Manifestations and Challenges for Treatment
Authors: Hautala Timo , Vähäsalo Paula , Kuismin Outi , Keskitalo Salla , Rajamäki Kristiina , Väänänen Antti , Simojoki Marja , Säily Marjaana , Pelkonen Ilpo , Tokola Heikki , Mäkinen Markus , Kaarteenaho Riitta , Jartti Airi , Hautala Nina , Kantola Saara , Jackson Päivi , Glumoff Virpi , Saarela Janna , Varjosalo Markku , Eklund Kari K. , Seppänen Mikko R. J.
Published: January 2020

Background

Tumor necrosis factor α–induced protein 3 gene (TNFAIP3, also called A20) haploinsufficiency (HA20) leads to autoinflammation and autoimmunity. We have recently shown that a p.(Lys91*) mutation in A20 disrupts nuclear factor κB signaling, impairs protein-protein interactions of A20, and leads to inflammasome activation.

Methods

We now describe the clinical presentations and drug responses in a family with HA20 p.(Lys91*) mutation, consistent with our previously reported diverse immunological and functional findings.

Results

We report for the first time that inflammasome-mediated autoinflammatory lung reaction caused by HA20 can be treated with interleukin 1 antagonist anakinra. We also describe severe anemia related to HA20 successfully treated with mycophenolate. In addition, HA20 p.(Lys91*) was found to associate with autoimmune thyroid disease, juvenile idiopathic arthritis, psoriasis, liver disease, and immunodeficiency presenting with specific antibody deficiency and genital papillomatosis.

Conclusions

We conclude that HA20 may lead to combination of inflammation, immunodeficiency, and autoimmunity. The condition may present with variable and unpredictable symptoms with atypical treatment responses.
Deep-Learning Generated Synthetic Double Inversion Recovery Images Improve Multiple Sclerosis Lesion Detection
Authors: Finck Tom , Li Hongwei , Grundl Lioba , Eichinger Paul , Bussas Matthias , Mühlau Mark , Menze Bjoern , Wiestler Benedikt
Published: January 2020

Objectives

The aim of the study was to implement a deep-learning tool to produce synthetic double inversion recovery (synthDIR) images and compare their diagnostic performance to conventional sequences in patients with multiple sclerosis (MS).

Materials and Methods

For this retrospective analysis, 100 MS patients (65 female, 37 [22–68] years) were randomly selected from a prospective observational cohort between 2014 and 2016. In a subset of 50 patients, an artificial neural network (DiamondGAN) was trained to generate a synthetic DIR (synthDIR) from standard acquisitions (T1, T2, and fluid-attenuated inversion recovery [FLAIR]). With the resulting network, synthDIR was generated for the remaining 50 subjects. These images as well as conventionally acquired DIR (trueDIR) and FLAIR images were assessed for MS lesions by 2 independent readers, blinded to the source of the DIR image. Lesion counts in the different modalities were compared using a Wilcoxon signed-rank test, and interrater analysis was performed. Contrast-to-noise ratios were compared for objective image quality.

Results

Utilization of synthDIR allowed to detect significantly more lesions compared with the use of FLAIR images (31.4 ± 20.7 vs 22.8 ± 12.7, P < 0.001). This improvement was mainly attributable to an improved depiction of juxtacortical lesions (12.3 ± 10.8 vs 7.2 ± 5.6, P < 0.001). Interrater reliability was excellent in FLAIR 0.92 (95% confidence interval [CI], 0.85–0.95), synthDIR 0.93 (95% CI, 0.87–0.96), and trueDIR 0.95 (95% CI, 0.85–0.98).

Contrast-to-noise ratio in synthDIR exceeded that of FLAIR (22.0 ± 6.4 vs 16.7 ± 3.6, P = 0.009); no significant difference was seen in comparison to trueDIR (22.0 ± 6.4 vs 22.4 ± 7.9, P = 0.87).

Conclusions

Computationally generated DIR images improve lesion depiction compared with the use of standard modalities. This method demonstrates how artificial intelligence can help improving imaging in specific pathologies.
A Case of Primary Localized Small Bowel Amyloidosis Studied by 18F-Choline and Contrast-Enhanced 18F-FDG PET/CT
Authors: Minordi Laura Maria , Caldarella Carmelo , Ripani Daria , Calandriello Lucio , Manfredi Riccardo
Published: January 2020

Amyloidosis is a rare hereditary or acquired protein deposition disorder with different etiologies, characterized by pathological protein deposition essentially in nearly any organs or tissues. There are 2 major forms: primary and secondary amyloidosis. Moreover, it is possible to have systemic or localized disease. The localized form of amyloidosis affecting the small intestine is rare, and it is characterized by the formation of precursor proteins at the site of the lesion. We report a case of localized small bowel amyloidosis studied by 18F-choline and 18F-FDG–iodinated PET/CT performed for staging an aggressive prostatic cancer.
Pseudomyogenic Hemangioendothelioma
Authors: Liu Yiyan
Published: January 2020

Pseudomyogenic hemangioendothelioma is a rare vascular tumor described as a fibroma-like variant of epithelioid sarcoma. There were scant publications about FDG PET/CT findings of pseudomyogenic hemangioendothelioma. A 20-year-old man with biopsy-confirmed pseudomyogenic hemangioendothelioma of the left tibia had FDG PET/CT for evaluation of the lesion extent and metastasis, which demonstrated numerous, multilayer FDG-avid lesions of the left lower extremity below the knee. Although pathologic examination is mandatory for diagnosis, FDG PET/CT of the case showed distinctive image finding of pseudomyogenic hemangioendothelioma: multifocal and multilayer lesions in a single distal lower extremity.
Nodular Fat-Sparing Hepatic Parenchyma as 11C-Choline–Avid Finding on PET/CT
Authors: Nguyen Ba Duong , Heller Matthew T. , Roarke Michael C.
Published: January 2020

Focal nodular fat sparing of the liver may show, on PET/CT imaging, prominent tracer uptake over a background of less metabolic features of steatosis. This finding, already reported with 18F-FDG, may mimic primary or secondary neoplasms of the liver. The authors present an additional case of nodular fat-sparing hepatic parenchyma exhibiting 11C-choline avidity during PET/CT assessment for biochemical recurrence of prostate cancer.
99mTc Tamoxifen for Imaging Estrogen Receptor Expression in Metastatic Breast Cancer Patient
Authors: Chhabra Anupriya , Shukla Jaya , Kumar Rajender , Laroiya Ishita , Vatsa Rakhee , Bal Amanjit , Singh Gurpreet , Mittal Bhagwant Rai
Published: January 2020

Estrogen receptor–expressing breast cancer exhibits better prognosis due to responsiveness to antiestrogen treatment. Therefore, knowledge of the estrogen receptor status of a tumor is an important prognostic and predictive indicator in breast cancer. We present noninvasive imaging of estrogen receptors with 99mTc tamoxifen that can identify the active tumor and approachable sites for biopsy. It may help in selection of patients for hormone replacement therapy and in assessment of receptor status in recurrent disease and also in response evaluation.
Successful Intra-arterial Peptide Receptor Radionuclide Therapy of DOTATOC-Negative High-Grade Liver Metastases of a Pancreatic Neuroendocrine Neoplasm Using 177Lu-DOTA-LM3
Authors: Zhang Jingjing , Kulkarni Harshad R. , Singh Aviral , Baum Richard P.
Published: January 2020

Radiolabeled somatostatin receptor (SSTR) antagonists have shown promise for imaging neuroendocrine neoplasms and the superiority to SSTR agonists, with lower liver background especially for the sensitive detection of liver metastases, higher tumor-to-background ratio, and favorable pharmacokinetics. The clinical data of radiolabeled SSTR antagonists for therapy are still limited. We report our experience treating a young patient with DOTATOC-negative high-grade liver metastases of a pancreatic neuroendocrine neoplasm who underwent intra-arterial peptide receptor radionuclide therapy using SSTR antagonist 177Lu-DOTA-LM3, demonstrating an excellent response, nearly complete remission according to molecular imaging criteria and morphological partial remission, without any significant toxicity.
68Ga–Prostate-Specific Membrane Antigen Uptake in Cerebral Tuberculosis
Authors: Wong Veronica Chi Ken , Shen Lily , Nasser Elias , Adams David Nicholas , Mansberg Robert
Published: January 2020

A 71-year-old man with a history of high-risk prostate adenocarcinoma (Gleason score 4 + 5 = 9) treated with brachytherapy in 2016 was referred for a 68Ga–prostate-specific membrane antigen (PSMA)–HBED–CC PET/CT scan for suspected cancer recurrence on a background of slowly rising serum prostate-specific antigen (0.95 ng/mL; reference, <0.2 ng/mL). This revealed PSMA-avid dura-based hyperdense lesions in the brain, suggestive of cerebral metastases. Biopsy demonstrated the presence of acid-fast bacilli, and with further clinical and microbiological testing, a diagnosis of PSMA-avid cerebral tuberculous mycobacterium infection was made.
Limited Usefulness of 18F-FDG PET/CT in Predicting Tumor Regression After Preoperative Chemotherapy for Noncardia Gastric Cancer
Authors: Morgagni Paolo , Bencivenga Maria , Colciago Eleonora , Tringali Domenico , Giacopuzzi Simone , Framarini Massimo , Saragoni Luca , Mura Gianni , Graziosi Luigina , Marino Elisabetta , Fumagalli Romario Uberto , Baiocchi Gianluca , Moretti Andrea , Rossi Vania , Verlato Giuseppe
Published: January 2020

Background

The present study aimed to better define the usefulness of 18F-FDG PET/CT in predicting pathological tumor response (PTR) and survival in patients with noncardia gastric cancer treated with preoperative chemotherapy.

Methods

Seventy-one patients were recruited in 6 Italian centers. The SUV of 18F-FDG PET/CT was measured at baseline and after treatment, and the difference (dSUV) was computed. The association between PET indexes and PTR, assessed by the Becker score, was evaluated by nonparametric regression. The discriminant power of PET indexes with respect to the absence of PTR (Becker 2/3) was studied by receiver operating characteristic (ROC) curve and synthesized by the area under the curve (ROC-AUC).

Results

dSUV allowed to partially discriminate between absence/presence of PTR, when expressed as either absolute value (ROC-AUC, 0.73; 95% confidence interval, 0.59–0.87) or percentage (ROC-AUC, 0.74; 95% confidence interval, 0.59–0.89). However, only extreme values of percent dSUV were really informative. All 7 patients whose 18F-FDG uptake had increased despite preoperative treatment showed no tumor regression at pathologic examination. Seven of the 10 patients whose metabolic response had been 70% or greater had complete or nearly complete pathologic tumor regression (Becker score 1a or 1b). The metabolic response of the remaining 54 patients, which ranged between 0% and 70%, did not permit to reliably forecast pathologic tumor regression. Survival significantly decreased with increasing Becker score but was unaffected by metabolic response.

Conclusions

The present study suggests that 18F-FDG PET/CT has limited usefulness in predicting cancer regression. The lack of metabolic response in serial measurements indicates the probable ineffectiveness of preoperative treatment.
Peptide Receptor Radionuclide Therapy Using 225Ac-DOTATOC Achieves Partial Remission in a Patient With Progressive Neuroendocrine Liver Metastases After Repeated β-Emitter Peptide Receptor Radionuclide Therapy
Authors: Zhang Jingjing , Kulkarni Harshad R. , Baum Richard P.
Published: January 2020

We present here a case with β-radiation–refractory metastatic neuroendocrine tumors, who demonstrated an excellent therapy response after 1 cycle of 225Ac-DOTATOC, without any significant adverse effects even after 10 cycles of β-emitter peptide receptor radionuclide therapy followed by α-peptide receptor radionuclide therapy.
Posttreated POEMS Syndrome With Concurrent Follicular Lymphoma Revealed by 18F-FDG and 68Ga-Pentixafor PET/CT
Authors: Pan Qingqing , Luo Yaping , Cao Xinxin , Li Jian , Li Fang
Published: January 2020

A 59-year-old man with history of POEMS syndrome was found with a painless mass in the right neck for 9 months. In 18F-FDG and 68Ga-pentixafor PET/CT, there were multiple neck nodes and left inguinal nodes that showed intense 18F-FDG and 68Ga-pentixafor uptake. In addition, osteoblastic bone lesions with mild 18F-FDG and 68Ga-pentixafor uptake were noted in the pelvis, which was consistent with posttreated osseous involvement of POEMS syndrome. However, considering lymphoadenopathy with such intense 18F-FDG uptake is not usually seen in POEMS syndrome, the patient underwent biopsy of the right cervical nodes. The histopathology with immunohistochemistry confirmed follicular lymphoma.
Increased FDG Uptake on Juxtaglomerular Cell Tumor in the Left Kidney Mimicking Malignancy
Authors: Jiang Yuanyuan , Hou Guozhu , Zhu Zhaohui , Zang Jinfeng , Cheng Wuying
Published: January 2020

Juxtaglomerular cell tumor is a rare and benign tumor arising from the juxtaglomerular apparatus that overproduces renin, resulting in secondary hypertension. A 29-year-old woman was incidentally found to have a left renal mass by ultrasonography in a routine health examination. Contrast-enhanced CT results suggested renal cell carcinoma. FDG PET/CT performed for metastatic workup showed increased FDG uptake to the left renal mass and did not reveal any other abnormal FDG-avid lesions. The renal mass was surgically resected and pathological examination confirmed the juxtaglomerular cell tumor of the left kidney.
Which Is the Optimal Scan Time of 18F-DOPA PET/CT in Patients With Recurrent Medullary Thyroid Carcinoma?
Authors: Taralli Silvia , Lorusso Margherita , Capotosti Amedeo , Lanni Valerio , Indovina Luca , Rufini Vittoria
Published: January 2020

Purpose

The aim of this retrospective study was to determine, by dynamic acquisition, the optimal scan time of 18F-DOPA PET/CT in patients with recurrent medullary thyroid carcinoma (MTC).

Methods

Twenty-one patients with suspected recurrent MTC underwent dynamic 18F-DOPA PET/CT (lasting 45 minutes) followed by whole-body scan. Three different time intervals of dynamic acquisition were evaluated: ultra-early phase (2–5 minutes), early phase (5–10 minutes), and late phase (40–45 minutes). The number and SUVmax of all detected lesions among the 3 dynamic acquisition phases were compared on qualitative and semiquantitative analyses. Time-activity curves, SUVmax washout rate between ultra-early or early phase and late phase, and signal-to-noise ratio (SNR) between lesion and background activity were also calculated.

Results

At dynamic acquisition, 15 of 21 patients were classified as PET-positive and 6 of 21 as PET-negative, with overall 21 detected lesions. Ultra-early and early imaging provided a better lesion visualization than late phase in more than 70% of cases, as also reflected by SNR (mean SNR reduction between 2 and 45 minutes, −45% ± 19%). Time-activity curves showed a rapid tracer accumulation in MTC lesions, with an average maximum uptake at 2 minutes after injection. Mean lesion SUVmax was 2-fold higher in ultra-early frames compared with last frames (mean washout rate, −44% ± 33%). Finally, compared with whole-body imaging in the same field of view, dynamic acquisition identified 1 additional positive patient and 3 additional lesions in 2 patients.

Conclusions

Our study, showing a very fast 18F-DOPA uptake in MTC lesions, suggests the utility to obtain early PET/CT images, already at 2 to 5 minutes after tracer injection, when maximum lesion tracer uptake is reached.
Tumor SUVs on 18F-FDG PET/CT and Aggressive Pathological Features in Esophageal Squamous Cell Carcinoma
Authors: Lim Chae Hong , Park Yong-Jin , Shin Muheon , Cho Young Seok , Choi Joon Young , Lee Kyung-Han , Hyun Seung Hyup
Published: January 2020

Purpose

Considerable discrepancies are observed between clinical staging and pathological staging after surgical resection in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the relationships between tumor SUVs on FDG PET/CT and aggressive pathological features in resected ESCC patients.

Methods

A total of 220 patients with surgically resected clinical stage I–II ESCC without neoadjuvant treatment were retrospectively analyzed. SUVmax of the primary tumor was measured on pretreatment FDG PET/CT. Pathological features included depth of tumor invasion, lymph node metastasis, tumor differentiation, lymphatic vessel tumor embolus, perineural invasion, Ki-67 index, and p53 protein expression. Receiver operating characteristic curve analysis was used to determine an optimal cutoff of SUVmax to predict pathologically advanced disease. Differences in pathological features associated with SUVmax were examined by t test or χ2 test.

Results

The number of patients upstaged from clinical stage I–II to pathological stage III–IV was 43 (19.5%). Receiver operating characteristic curve analysis showed that the optimal cutoff SUVmax of 4.0 had good performance for predicting locally advanced disease (area under the receiver operating characteristic curve = 0.844, P < 0.001). Higher tumor SUVmax was significantly associated with advanced depth of tumor invasion (deeper than submucosa, P < 0.001), positive lymph node metastasis (P < 0.001), presence of lymphatic vessel tumor embolus (P < 0.001), presence of perineural invasion (P < 0.001), higher Ki-67 index (P = 0.025), and poor tumor differentiation (P = 0.039).

Conclusions

SUVmax measured on pretreatment FDG PET/CT is significantly associated with aggressive pathological features and may help clinicians identify patients at risk of advanced disease.
Prostate-Specific Membrane Antigen Expression in Primary Juvenile Nasal Angiofibroma—A Pilot Study
Authors: Sakthivel Pirabu , Thakar Alok , Prashanth Arun , Bhalla Ashu Seith , Kakkar Aanchal , Sikka Kapil , Singh Chirom Amit , Kumar Rajeev , Sharma Suresh Chandra , Kumar Rakesh
Published: January 2020

Purpose

Prostate-specific membrane antigen (PSMA) is highly expressed in prostate cancer cells and is exploited for imaging and treatment of patients with prostate cancer. Prostate-specific membrane antigen expression is also demonstrated in the tumor-associated neovasculature endothelium. Juvenile nasal angiofibroma (JNA), being a similar highly vascular tumor, may also demonstrate significant PSMA expression, which may be utilized for its imaging and treatment.

Methods

In this prospective study, 25 clinicoradiologically diagnosed primary JNA patients underwent PSMA PET/CT scan. The scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi (74–111 MBq) of 68Ga-PSMA-HBED-CC on a dedicated PET/CT scanner. Low-dose CT scan was acquired from vertex to sternoclavicular joint (100 mA, 20 kVp, 3-mm slice thickness, 0.8 pitch). Images were reconstructed with iterative reconstruction technique (4 iterations, 24 subsets). The objective was to assess the intensity and pattern of PSMA uptake in primary JNA patients.

Results

All cases (n = 25) of primary JNA showed PSMA expression in the tumor (100%). The median PSMA SUVmax ratio of tumor to background was 4.57 (range, 2.08–7.27). Intracranial extension in 14 of 25 patients was prominently visualized because of absence of background uptake in the brain. Advanced stage tumors demonstrated greater uptake than early tumors (P = 0.011). A statistically nonsignificant trend was noted for decreasing uptake with increasing age after normalizing for stage (Spearman correlation coefficient r = −0.08).

Conclusions

Assessment of PSMA expression in JNA by PSMA PET/CT opens up a new window of opportunity with respect to its radiological staging, vascularity assessment, and molecular characterization. A potential role in identification of the difficult residual-recurrent disease is anticipated and perhaps also in radioligand therapy for residual/recurrent JNA.

Clinical Trials Registry of India (CTRI/2018/08/015479).