bluuebunny/crossref_metadata_2025 huggingface dataset:
The significance of the small adenoma: a longitudinal study of surveillance colonoscopy in an Australian population
Authors: Symonds Erin L. , Cole Stephen R. , Lau Su Yin , Steele Simon , Meng Rosie , Woodman Richard J. , Young Graeme P. , Cock Charles , Fraser Robert , Bampton Peter
Published: January 2019

Background

The international guidelines for surveillance following the finding of a small tubular adenoma vary between no surveillance or colonoscopy at 5 or 10 years, whereas surveillance after an advanced adenoma is 3 years. Optimization of surveillance reduces the risk of colorectal cancer (CRC) with efficient use of colonoscopy resources. We assessed the risks of advanced colorectal neoplasia following a baseline finding of a small adenoma compared with advanced adenoma.

Patients and methods

A retrospective audit was undertaken of patients enrolled in a CRC surveillance program, wherein regular colonoscopies and screening with faecal immunochemical test (FIT) were provided. Patients diagnosed with either small or advanced adenoma followed by at least one surveillance colonoscopy were included. Advanced adenoma included adenomas with features of villous change, size of at least 10 mm, high-grade dysplasia, three or more small tubular adenomas and traditional and sessile serrated adenomas. Subdistribution hazard ratios were calculated for advanced neoplasia (CRC or advanced adenoma).

Results

Overall, 378 patients (62.6±11.2 years, 57.9% male) were included, with 44.2% diagnosed with small adenoma and 55.5% with advanced adenoma at baseline. The crude cumulative incidence of advanced neoplasia at first surveillance was 13.2 and 18.5% after small and advanced adenoma (P=0.16) (at 45.9 and 35.6 months, respectively), which became significant for advanced adenoma after adjustment (subdistribution hazard ratio=2.55, 95% confidence interval=1.49–4.35, P<001). A positive FIT was the only independent predictor of advanced neoplasia after a small adenoma at baseline colonoscopy (odds ratio=5.05, 95% confidence interval=1.27–20.02, P=0.02).

Conclusions

The risk of advanced neoplasia following a small adenoma was lower than that following an advanced adenoma, but was strongly predicted by a positive FIT. Reducing frequency of colonoscopy while providing regular FIT might be a more efficient use of resources for this population.
Senior NCLEX-RN Coaching Model
Authors: Schlairet Maura C. , Rubenstein Cynthia
Published: January 2019

Background

A host of interventions have been used to improve NCLEX outcomes, yet scant evidence exists to show the influence of academic coaching on pass rates.

Purpose

To improve NCLEX confidence/readiness and pass rates in a baccalaureate nursing program, an NCLEX Coaching Model was developed and implemented.

Method

Senior students were paired with faculty for 6 weeks of NCLEX coaching. Students self-assessed strengths, risk factors, and challenges related to NCLEX preparation. Coaches and students co-developed the NCLEX Preparation and Success Plan using standardized NCLEX predictor scores. Success plans represented individualized preparation strategies focused on specific NCLEX Client Needs categories.

Result

National Council Licensure Examination confidence/readiness scores improved significantly, and first-time NCLEX pass rates improved slightly after coaching.

Conclusion

An NCLEX Coaching Model can build student confidence/readiness and promote NCLEX success among nursing students. Peplau's Theory of Interpersonal Relations was useful in guiding development and implementation of a coaching model.
Teaching Nursing Students How to Decrease the Stigma Against People Who Use Drugs
Authors: Dion Kimberly
Published: January 2019

Background

People who use drugs (PWUD) experience bias and stigmatization from their health care providers at higher rates than do people with other health conditions.

Problem

Nursing students are ill-prepared to care for PWUD.

Approach

Nursing students received 2 educational sessions targeted at caring for PWUD. One hour focused on identifying and intervening in the case of an opioid overdose. The other was about stigmatization experienced by PWUD, harm reduction, nonstigmatizing language, and ways in which nurses can improve care for PWUD.

Outcomes

Students demonstrated the use of destigmatizing language, applied learned harm reduction concepts, and incorporated referral to area resources for counseling or treatment during care of PWUD.

Conclusions

By using the reflective learning taught in the classroom, nursing students were able to establish the human connection needed to improve care for this vulnerable population.
Human Factors Associated With the Use of Manual Bulb Suction Devices
Authors: O'Neal Pamela V. , Black Caroline Bryson , Adams Ellise D. , Armentrout Daniel L.
Published: January 2019

Background

Manual bulb suction is commonly used to promote naso-oropharyngeal airway clearance. Human factors of hand placement (radial vs. axial) and relative negative pressure generated are not known. This study is the first step in developing clinical guidelines for safe and effective mechanical use of manual bulb suction to reduce and prevent upper airway injury.

Objective

The aim of this study was to determine the negative pressure generated when a 2-oz. manual bulb suction device is compressed and released, and hand placement is either in a radial or axial position.

Methods

A total of 87 subjects were recruited using a convenience sampling method to identify hand placement and predicted negative pressures emitted during bulb compression and release. A pressure transmitter system was developed and tested with 666 negative pressure measurements to verify internal consistency and reliability in predicting negative pressure.

Results

The majority of subjects compressed the bulb radially (55%). Suction pressures ranged from −42 mm Hg to −81 mm Hg, with a standard deviation of −7 mm Hg. Males tended to have statistically significant higher negative pressures (U = 170, p = .021) when radially compressing the bulb. Females generated statistically significant higher negatives pressures (U = 71.50, p = .001) when axially compressing the bulb.

Discussion

A 2-oz. manual bulb suction device creates negative pressures less than 85 mm Hg when using moderate compression regardless of hand placement (radial or axial placement). Further studies are needed to explore additional healthcare provider and patient human factor variables related to the mechanical use of manual bulb suction.
Are Pediatric Critical Personnel Satisfied With Their Lives? Prediction of Satisfaction With Life From Burnout, Posttraumatic Stress, and Posttraumatic Growth, and Comparison With Noncritical Pediatric Staff
Authors: Rodríguez-Rey Rocío , Palacios Alba , Alonso-Tapia Jesús , Pérez Elena , Álvarez Elena , Coca Ana , Mencía Santiago , Marcos Ana , Mayordomo-Colunga Juan , Fernández Francisco , Gómez Fernando , Cruz Jaime , Ramos Victoria , Olmedilla Marta
Published: January 2019

Objectives:

Staff in PICUs shows high burnout, posttraumatic stress disorder symptoms, and posttraumatic growth levels. However, their levels of satisfaction with life and how positive and negative posttrauma outcomes relate to each other and contribute to predict satisfaction with life remain unknown. Thus, we attempted to explore these aspects and to compare the findings with data from pediatric professionals working in noncritical units.

Design:

This is an observational multicentric, cross-sectional study.

Setting:

The PICU of nine hospitals in Spain, and other pediatric units in the same hospitals.

Subjects:

Two hundred ninety-eight PICU workers (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in noncritical pediatric units (53 physicians, 104 nurses, and 32 nursing assistants).

Intervention:

Participants completed the Maslach Burnout Inventory, the Trauma Screening Questionnaire, the Posttraumatic Growth Inventory, and the Satisfaction With Life Scale.

Measurements and Main Results:

Of PICU staff, 16.4% were very satisfied with their lives, 34.2% were satisfied, 34.6% showed average satisfaction with life, and 14.8% were below average. No differences were found between PICU and non-PICU workers. Women reported lower satisfaction with life than men, and physicians reported higher satisfaction with life than other professional groups. The correlation between posttraumatic stress disorder and posttraumatic growth was low, but significant and positive. According to the path analysis with latent variables, 20% of the variance satisfaction with life could be predicted from burnout, posttraumatic stress disorder symptoms, and posttraumatic growth. Higher distress was inversely associated to satisfaction with life, whereas posttraumatic growth contributed to higher satisfaction with life.

Conclusions:

Posttraumatic growth can moderate the negative effect of traumatic work-related experiences in satisfaction with life. PICU and non-PICU workers were equally satisfied with their lives. Positive and negative impact of work-related potentially traumatic events can coexist in the same person. Interventions aimed at reducing distress and fostering posttraumatic growth could impact in an improvement in pediatric health professionals’ satisfaction with life.
Bridging the Stressful Gap Between ICU and Home: Medical Simulation for Pediatric Patients and Their Families*
Authors: Graham Robert J. , Amar-Dolan Laura R. , Roussin Christopher J. , Weinstock Peter H.
Published: January 2019

Objectives:

Introduce an expanding role for pediatric critical care and medical simulation to optimize the care for children with technology dependence.

Data Sources:

Limited review of literature and practice for current teaching paradigms, vulnerability of the patient population, and efficacy of simulation as a medical educational tool.

Conclusions:

In accordance with new care models and patient need, critical care requires parallel evolution of care practices, including new educational and care models, in order to maximally reduce risk, fear, and anxiety and to insure quality and consistent care in the community for patients and families transitioning between the ICU and home environments.
Population Pharmacokinetics and Dosing of Milrinone After Patent Ductus Arteriosus Ligation in Preterm Infants
Authors: Hallik Maarja , Ilmoja Mari-Liis , Tasa Tõnis , Standing Joseph F. , Takkis Kalev , Veigure Rūta , Kipper Karin , Jalas Tiiu , Raidmäe Maila , Uibo Karin , Starkopf Joel , Metsvaht Tuuli
Published: January 2019

Objectives:

The postoperative course of patent ductus arteriosus ligation is often complicated by postligation cardiac syndrome, occurring in 10–45% of operated infants. Milrinone might prevent profound hemodynamic instability and improve the recovery of cardiac function in this setting. The present study aimed to describe the population pharmacokinetics of milrinone in premature neonates at risk of postligation cardiac syndrome and give dosing recommendations.

Design:

A prospective single group open-label pharmacokinetics study.

Settings:

Two tertiary care neonatal ICUs: Tallinn Children’s Hospital and Tartu University Hospital, Estonia.

Patients:

Ten neonates with postmenstrual age of 24.6–30.1 weeks and postnatal age of 5–27 days undergoing patent ductus arteriosus ligation and at risk of postligation cardiac syndrome, based on echocardiographic assessment of left ventricular output of less than 200 mL/kg/min 1 hour after the surgery.

Interventions:

Milrinone at a dose of 0.73 μg/kg/min for 3 hours followed by 0.16 μg/kg/min for 21 hours. Four blood samples from each patient for milrinone plasma concentration measurements were collected.

Measurements and Main Results:

Concentration-time data of milrinone were analyzed with nonlinear mixed-effects modeling software (NONMEM Version 7.3 [ICON Development Solutions, Ellicott City, MD]). Probability of target attainment simulations gave a dosing schedule that maximally attains concentration targets of 150–250 μg/L. Milrinone pharmacokinetics was described by a one-compartmental linear model with allometric scaling to bodyweight and an age maturation function of glomerular filtration rate. Parameter estimates for a patient with the median weight were 0.350 (L/hr) for clearance and 0.329 (L) for volume of distribution. The best probability of target attainment was achieved with a loading dose of 0.50 μg/kg/min for 3 hours followed by 0.15 μg/kg/min (postmenstrual age < 27 wk) or 0.20 μg/kg/min (postmenstrual age ≥ 27 wk).

Conclusions:

Population pharmacokinetic modeling and simulations suggest a slow loading dose followed by maintenance infusion to reach therapeutic milrinone plasma concentrations within the timeframe of the postligation cardiac syndrome.
Use of Capnography and Cardiopulmonary Resuscitation Feedback Devices Among Prehospital Advanced Life Support Providers
Authors: Sahyoun Cyril , Siliciano Christina , Kessler David
Published: January 2019

Background

Capnography and cardiopulmonary resuscitation (CPR) feedback devices have been shown to improve resuscitation outcomes, with the American Heart Association recommending their use during advanced life support (ALS). Little is known about the availability of these devices, their protocoled use, and the attitudes toward them in the prehospital setting.

Objectives

The objectives of this study were to assess the availability of capnography and CPR feedback devices among prehospital ALS agencies in New York State (NYS), to describe the protocoled use of these devices, and to evaluate the attitudes of providers toward the use of these devices.

Methods

Prehospital agencies that provide ALS services in NYS were identified using an online registry. Managers in these agencies were contacted by electronic mail and asked to complete a questionnaire regarding their agency's experience with capnography and CPR feedback devices. The questionnaire included questions on the availability of capnography and CPR feedback devices, the existence of clinical protocols for using capnography, and provider opinion on the utility of capnography and CPR feedback devices for improving pediatric resuscitation.

Results

Of 710 ALS agencies, 238 (33.5%) completed the survey. Ninety-five percent and 24% of agencies reported having capnography and CPR feedback devices available aboard ambulances, respectively. Ninety-seven percent of agencies reported having capnography clinical protocols for endotracheal intubation, 63% for return of spontaneous circulation, and 54% for guiding CPR. Forty-seven percent agreed that capnography improves outcomes in the resuscitation of pediatric patients, whereas 51% of providers were neutral and 2% disagreed.

Conclusions

Capnography is available in most NYS ALS agencies surveyed. Cardiopulmonary resuscitation feedback devices are less common. Protocols for the use of capnography mainly focused on endotracheal intubation and less for the recognition of return of spontaneous circulation and for guiding CPR. Half of the providers surveyed were neutral on whether capnography improves outcomes in the resuscitation of pediatric patients.
Hospital-Based Emergency Department Visits With Pediatric Burns
Authors: Abramowicz Shelly , Allareddy Veerasathpurush , Lee Min Kyeong , Nalliah Romesh P. , Rampa Sankeerth , Allareddy Veerajalandhar
Published: January 2019

Objective

The objective of this study was to examine the characteristics and outcomes in children presenting to emergency departments (EDs) with burn injuries.

Methods

The Nationwide Emergency Department Sample (NEDS) for the years 2008 to 2013 was used. All patients younger than 18 years who visited a hospital-based ED with a burn injury were selected. The study focused on (1) demographics (age, sex, insurance status), (2) characteristics of burns (types, causes), (3) disposition status after ED/hospitalization, (4) charges (ED and hospital), and (5) patient outcomes. Inclusion criteria were a visit to ED in the United States with a burn. Descriptive statistics were used to summarize the findings.

Results

During the study period, there were 746,593 ED visits due to burn injuries. Majority were insured by Medicaid (52.8%). Most frequent injuries were burns of wrists/hands (39.5%), lower limbs (24.1%), and upper limb—except wrist/hand (20.1%). The most common causes of burns were heat from electric appliances (37.1%) or hot liquids and vapors (24.8%). Following the ED visit, 89.1% were discharged routinely, and 4.3% were admitted. Mean charge per patient per ED visit was $1117. Total ED charges across the United States was $708.7 million. When admitted, mean length of stay was 5.7 days. Total hospitalization charge across the United States was $1.7 billion.

Conclusions

Pediatric burn injuries require significant resources for stabilization and treatment by EDs. The present study highlights the burden and impact of pediatric burn injuries in the United States.
Lung Ultrasound Findings and Bronchiolitis Ultrasound Score for Predicting Hospital Admission in Children With Acute Bronchiolitis
Authors: Özkaya Ahmet Kağan , Yilmaz Hayri Levent , Kendir Özlem Tolu , Gökay Sinem Sari , Eyüboğlu İlker
Published: January 2019

Objectives

The purposes of this study were to determine the benefit of the bronchiolitis ultrasound score (BUS) in predicting hospital admission in children with acute bronchiolitis and to characterize lung sonography findings.

Methods

This prospective observational study was performed in an academic pediatric emergency department. Children younger than 24 months presenting to the emergency department, diagnosed with acute bronchiolitis by 2 independent pediatricians were included in the study. Lung ultrasound was performed by a single sonographer, who was blinded to as much clinical information as possible. In addition, the treating physicians were blinded to the lung ultrasound findings. Logistic regression analysis models were used to identify admission predictors. Receiver operating characteristic analysis was used to evaluate the predictive value for effects of the BUS and the modified Bronchiolitis Severity Score on admission.

Results

The median age of the 76 patients diagnosed with acute bronchiolitis was 6 months (interquartile range, 3.6–10 months). Forty-two (55.3%) of the 76 patients enrolled were admitted. Lung ultrasound was compatible with acute bronchiolitis in 74 patients (97%). A significant correlation was determined between modified Bronchiolitis Severity Score and BUS in children with acute bronchiolitis (r = 0.698, P < 0.001). The most effective parameter in determining admission on logistic regression analysis, independently of other variables, was BUS (P = 0.044; adjusted odds ratio, 1.859; 95% confidence interval, 1.016–3.404). Bronchiolitis ultrasound score values of 3 or greater exhibited 73.81% sensitivity and 73.53% specificity, whereas BUS values of 4 or greater exhibited 50% sensitivity and 91.18% specificity.

Conclusions

Point-of-care lung ultrasound can accurately detect pulmonary anomalies in children with acute bronchiolitis, has a close correlation with clinical findings, and is a useful tool in predicting hospital admission.
The Reliability of Computerized Physician Order Entry Data for Research Studies
Authors: Dexheimer Judith W. , Taylor Regina G. , Kachelmeyer Andrea M. , Reed Jennifer L.
Published: January 2019

Objectives

In the United States, adolescents account for nearly half of the newly diagnosed sexually transmitted infections annually, and many of these infections are asymptomatic. Adolescents often seek care in pediatric emergency departments; thus, the emergency department is an important setting to implement adolescent sexually transmitted infection screening. Before implementation, baseline data reflecting current screening rates of symptomatic and asymptomatic patients were needed. This study aimed to evaluate the accuracy of provider-reported rates of symptomatic and asymptomatic chlamydia (CT) and gonorrhea (GC) testing in adolescents overall and pre–electronic health record (EHR) and post-EHR order modification in preparation for a research intervention.

Methods

This was a 1-year prospective, observational study. Provider reason for CT/GC testing was added to the existing EHR order. Chart reviews were performed to ensure the accuracy of clinician CT/GC testing choices (symptomatic vs asymptomatic). Frequencies of testing choices were obtained. Order modifications were made to further clarify the definitions. A Student t test was used to compare data preorder and postorder modification.

Results

When relying on providers to report reasons for CT/GC testing (symptomatic vs asymptomatic), many patients were misclassified based on a priori defined testing reasons. After order modification, rates of provider-reported symptomatic testing remained unchanged (P = 0.16). Provider-reported asymptomatic testing significantly declined (P = 0.004); however, 23.2% of those tested continued to be misclassified.

Conclusions

Provider-entered EHR data are increasingly being used in research studies; thus, it is important to ensure its accuracy and reliability before study implementation.
Teaching of chronic pain management in a low- and middle-income setting: a needs assessment survey
Authors: Moyo Nomaqhawe , Madzimbamuto Farai
Published: January 2019

Introduction:

Pain is the most common reason for patients to see their physicians. For this reason, every physician should be able to diagnose and manage pain correctly.

Objectives:

The objective of this survey was to identify gaps in the teaching on chronic pain and its management in the current training programs at the University of Zimbabwe College of Health Sciences (UZCHS).

Methods:

A focused needs assessment using a self-administered questionnaire to collect data from participants was performed. A copy of the English Version of the International Association for the Study of Pain (IASP) curriculum on Pain for Medicine was attached for participants to refer to. Faculty and final-year postgraduate students were eligible. Questions were on the current teaching practice on chronic pain at the UZCHS.

Results:

Faculty members and postgraduates from 15 of 19 departments in the college participated in the study. Only 2 departments have written chronic pain teaching curriculum. Most faculty members, 68% had no knowledge of the IASP curriculum or its existence. Seventy-seven percent of the respondents were strongly dissatisfied with the current pain-related content, teaching or learning strategies in their programs. Most respondents suggested the need for the adoption of an interprofessional education learning strategy and adopting the IASP curriculum.

Conclusion:

The current teaching practice on chronic pain at the UZCHS is inadequate to prepare the health care professionals to independently care for chronic pain patients.
Assessment of Public Perception Regarding Patient Engagement for Patient Safety in Korea
Authors: Lee Hyeon-Jeong , Jang Seung Gyeong , Choi Ji Eun , Lee Won , Pyo Jeehee , Ock Minsu , Lee Sang-Il
Published: January 2019

Objectives

This study conducted a survey to examine how the general public in Korea perceives patient engagement for patient safety and to identify vulnerable groups and contents priorities of patient engagement education for the general public.

Methods

We developed a questionnaire based on previous studies and conducted one-on-one interviews with 600 individuals from the public. Then, we conducted descriptive statistical analyses (i.e., frequency, percentage, and averages) on the questionnaire items. Furthermore, we examined the individual differences of participants’ sociodemographic characteristics in their responses to the questionnaire.

Results

The general public’s awareness regarding accreditation programs for healthcare organizations was still low (47.4%). Nearly 60% of participants said that they did not agree with the practice of telling their own names and dates of birth before treatment. Approximately 80% of the participants would not ask medical staff to confirm washing their hands. Only half of the participants were aware of medical dispute mediation and arbitration programs. Nearly 90% of the participants agreed that patient safety is important. However, on participants’ confidence in making the correct choice and safety in their treatment, the average score was 68.7 of 100 points. Participants tended to be less confident about engaging in patient safety activities if they were older, less educated, or had poor health status.

Conclusions

Participants in this study believed that patient safety is an important issue, but they were not confident about choosing the correct medical institution or about receiving safe treatment.
Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China
Authors: Wang Yuanyuan , Fan Yanjun , Wang Xiaoli , Ma Yuanying , Wu Chunmei , Shi Huifeng , Han Hui , Liu Weiwei , Liu Chaojie
Published: January 2019

Objectives

The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations.

Methods

Using the PSC survey for MCH institutions (PSCS-MCHI), 2021 valid respondents from 25 participating institutions were investigated in three regions (Beijing, Zhejiang, and Jiangxi) of China. Patient safety culture and its subscale scores (1–5) and factors associated with PSC as revealed by multilevel modeling.

Results

The respondents had an average PSC score of 3.55 (SD = 0.35), with subscale scores ranging between 2.46 (“staffing and workload”) and 4.02 (“work commitment”). There were limited regional differences in PSC: a three-level regression model was only confirmed for the subscale “staff empowerment” (P = 0.006). However, significant organizational variations in PSC were evident: a two-level regression model was assumed for the PSC scale and nine subscales (P < 0.001). The fixed-effect models showed that male respondents, frontline workers, those who were in their mid-career (11–20 y), overloaded (≥9 hours), and had a masters or higher degree reported worse PSC. Frontline workers were less positive than managers in ratings on “managerial response to risks” (−0.11 [−0.20 to −0.02]), “management support” (−0.18 [−0.28 to −0.07]), and “staff empowerment” (−0.23[−0.35 to −0.11]).

Conclusions

Patient safety culture in MCH institutions is shaped by organizational and individual characteristics. We observed a gap in perceived PSC between frontline worker, who are less positive, and managers. Actions for improving PSC should consider interventions on organizational management (such as appropriate staffing and workload management) and engagement of frontline workers in the development of management and training activities.
Artificial Intelligence–Based Classification of Breast Lesions Imaged With a Multiparametric Breast MRI Protocol With Ultrafast DCE-MRI, T2, and DWI
Authors: Dalmiş Mehmet U. , Gubern-Mérida Albert , Vreemann Suzan , Bult Peter , Karssemeijer Nico , Mann Ritse , Teuwen Jonas
Published: January 2019

Objectives

We investigated artificial intelligence (AI)–based classification of benign and malignant breast lesions imaged with a multiparametric breast magnetic resonance imaging (MRI) protocol with ultrafast dynamic contrast-enhanced MRI, T2-weighted, and diffusion-weighted imaging with apparent diffusion coefficient mapping.

Materials and Methods

We analyzed 576 lesions imaged with MRI, including a consecutive set of biopsied malignant (368) and benign (149) lesions, and an additional set of 59 benign lesions proven by follow-up. We used deep learning methods to interpret ultrafast dynamic contrast-enhanced MRI and T2-weighted information. A random forests classifier combined the output with patient information (PI; age and BRCA status) and apparent diffusion coefficient values obtained from diffusion-weighted imaging to perform the final lesion classification. We used receiver operating characteristic (ROC) analysis to evaluate our results. Sensitivity and specificity were compared with the results of the prospective clinical evaluation by radiologists.

Results

The area under the ROC curve was 0.811 when only ultrafast dynamics was used. The final AI system that combined all imaging information with PI resulted in an area under the ROC curve of 0.852, significantly higher than the ultrafast dynamics alone (P = 0.002). When operating at the same sensitivity level of radiologists in this dataset, this system produced 19 less false-positives than the number of biopsied benign lesions in our dataset.

Conclusions

Use of adjunct imaging and PI has a significant contribution in diagnostic performance of ultrafast breast MRI. The developed AI system for interpretation of multiparametric ultrafast breast MRI may improve specificity.
18F-FDG PET/CT for Prognostic Stratification of Patients With Extranodal Natural Killer/T-Cell Lymphoma
Authors: Qin Chunxia , Yang Shirui , Sun Xun , Xia Xiaotian , Li Chunyan , Lan Xiaoli
Published: January 2019

Purpose

The prognostic value of PET/CT for extranodal natural killer/T-cell lymphoma (ENKTL) patients is controversial. We sought to investigate the use of pretreatment and interim PET/CT in this disease.

Methods

Sixty-five patients diagnosed with ENKTL who underwent pretreatment (n = 53) and/or interim PET/CT scans (after 2–4 cycles of chemotherapy and/or radiotherapy, n = 33) were retrospectively enrolled. Interim PET/CT images were interpreted according to the Deauville 5-point scale. PET/CT results were assessed for their predictive value of progression-free survival (PFS) and overall survival (OS). Kaplan-Meier estimates were generated to evaluate the predictive value of clinical parameters and PET/CT scans for prognosis evaluation. The Cox proportional hazards model was performed to assess the potential independent predictors for PFS and OS.

Results

Patients with a high score (4/5) according to the Deauville scale had heavier tumor burdens and tended to have elevated serum LDH and β2-microglobulin (β2-MG). In univariate analysis, the following parameters were predictive of PFS: age (≤60 vs > 60 years), stage (I/II vs III/IV), lesion location (nasal vs extranasal), LDH (normal vs elevated), β2-MG (normal vs elevated), SUVmax before treatment (≤8.3 vs > 8.3), and interim PET/CT results. For OS, the predictive factors were composed of stage, lesion location, LDH, β2-MG, and interim PET/CT results. However, in multivariate analysis, only interim PET/CT scan interpreted by the Deauville scale remained as an independent predictor for both PFS and OS.

Conclusions

Interim PET/CT scan displayed potential predictive value for ENKTL patients. Response assessment according to the Deauville 5-point scale may help to improve the accuracy of prediction. Patients with advanced stage (III/IV), elevated LDH or β2-MG, and a high Deauville score of 4 to 5 on the interim PET/CT scan were more likely to have reduced PFS and OS.
Diffuse Skeletal Hemangiomatosis Mimicking Metastastic Disease on 18F-FDG PET/CT
Authors: Huang Dong , Ou Xiaohong , Ye Yunxia , Zhang Wenjie
Published: January 2019

Diffuse skeletal hemangiomatosis is a rare vascular proliferation disorder involving multiple bones and may be confused with metastatic bone malignancy. We present a case of a 53-year-old man suffering back and proximal right femur pain underwent 18F-FDG PET/CT scan. Multiple hypermetabolic lesions of bone were concerning for metastatic carcinoma. Since no primary malignancy was found, open biopsy was performed and histologic examination led to a diagnosis of diffuse skeletal angiomatosis. This case highlighted the importance of including diffuse skeletal hemangiomatosis in the differential diagnosis of multiple hypermetabolic skeletal lesions on 18F-FDG PET/CT.
Gummatous Syphilis Mimicking Malignant Bone Tumor on FDG PET/CT
Authors: Wang Li-juan , Wu Hu-bing , Zhou Wen-lan , Yu Si-rui , Wang Quan-shi
Published: January 2019

A 47-year-old woman suffered worsening pain in the waist and numbness in the right thigh for 1 month. MRI was performed to determine the cause, which detected an osteolytic lesion in the T12 vertebral body, suggestive of possible bone metastasis. FDG PET/CT scan was undertaken to detect the primary tumor, which only showed the same isolated lesion in the T12 without any other abnormal hypermetabolic lesion. The pathology following vertebrectomy revealed granulomatous infection. The diagnosis of osseous syphilis was eventually made following a subsequent positive Treponema pallidum serological test.
Diffuse-Type Tenosynovial Giant Cell Tumor of the Shoulder Evaluated by FDG PET/CT
Authors: Tang Kun , Zheng Xiangwu , Lin Jie , Wang Ling
Published: January 2019

Diffuse-type tenosynovial giant cell tumor is a locally aggressive neoplasm that typically involves the knee and hip but rarely involves the shoulder. In this case, a 74-year-old woman presented a painless mass in the right shoulder. FDG PET/CT demonstrated intense FDG uptake with an SUVmax of 19.2 in the lesion. The mass was dissected and confirmed as diffuse-type tenosynovial giant cell tumor by pathology. Follow-up FDG PET/CT assessment revealed more extensive soft tissue infiltration and adjacent bone erosion 3 years after surgery. Thus, FDG PET/CT well demonstrated the hypermetabolic and local aggressive characteristics of the lesion.
Delayed Response (Partial Remission) 3 Years After Peptide Receptor Radionuclide Therapy in a Patient Participating in the NETTER-1 Trial
Authors: Zhang Jingjing , Kulkarni Harshad R. , Singh Aviral , Baum Richard P.
Published: January 2019

Peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogues has been shown to be highly efficacious concerning progression-free survival and response rates in patients with advanced, progressive, well-differentiated, somatostatin-receptor–positive neuroendocrine neoplasm. We report here delayed response of a midgut neuroendocrine neoplasm patient, who had stable disease after 4 cycles of PRRT and over a long period of 5 restaging admissions with excellent quality of life (full working hours), persisting for 3 years of follow-up, and presented as further partial remission according to both Response Evaluation Criteria in Solid Tumors and EORTC criteria, respectively, 36 months after the last PRRT cycle.
Spontaneous Regression of Clinically Indolent Lymphomas Revealed by 18F-FDG PET/CT
Authors: Pan Qingqing , Luo Yaping , Cao Xinxin , Zhang Yan , Li Fang
Published: January 2019

A 48-year-old man and a 55-year-old woman, who were diagnosed with follicular lymphoma and small B lymphocytic cell lymphoma, respectively, underwent initial “watch-and-wait” approach against lymphoma. The initial 18F-FDG PET/CT of both patients showed multiple FDG-avid lymph nodes in the neck, mediastinum, abdomen, and inguinal regions. During their active surveillance, the follow-up PET/CT of both patients revealed spontaneous regression of lymphoma.
99mTc-HYNIC-TOC in the Evaluation of Recurrent Tumor-Induced Osteomalacia
Authors: Shi Ximin , Jing Hongli , Li Fang , Zhao Yupei , Wang Zhenghua , Huo Li
Published: January 2019

Purpose

Tumor-induced osteomalacia (TIO) is rare paraneoplastic disorder generally caused by small benign neoplasm. Somatostatin receptor imaging has emerged as imaging of the choice in the localization of the causative tumors in new patients with clinical diagnosis of TIO. An accurate localization of the causative tumor using somatostatin receptor imaging followed by successful surgical removal offers cure of the disease. In small percentage of the patients, however, there can be recurrent disease after the surgery. In this retrospective investigation, we tried to assess whether somatostatin receptor imaging using 99mTc-HYNIC-TOC (99mTc-hydrazinonicotinyl-Tyr3-octreotide) is also useful in patients with recurrent TIO after initial successful surgery.

Methods

The images of 99mTc-HYNIC-TOC images and clinical charts of total 18 patients with suspected recurrent TIO were retrospectively reviewed. The image findings were compared with the clinical chart, which include clinical follow-up and subsequent imaging and surgery.

Results

Among all 18 patients, 99mTc-HYNIC-TOC imaging results were negative in 5 of them. Among these 5 patients with negative imaging study, the causes of recurrent symptoms and hypophosphatemia in 3 patients were eventually found unrelated to TIO. 99mTc-HYNIC-TOC successfully identified either recurrent causative tumors in the same location (n = 10) or different causative tumor in other locations (n = 3) in 13 patients, which rendered a sensitivity of 86.7% (13 of 15).

Conclusions

The efficacy of 99mTc-HYNIC-TOC imaging in the evaluation of patients with potential recurrent TIO is compatible to that with new patients who never received surgical resection for the culprit tumors. It can play an important role in known TIO patients who were suspected to have recurrent disease.
Measurement of Spleen Stiffness by Shear-Wave Elastography for Prediction of Splenomegaly Etiology
Authors: Batur Abdussamet , Alagoz Sumeyra , Durmaz Fatma , Baran Ali Irfan , Ekinci Omer
Published: January 2019

Objective

The aim of this study was to evaluate the reproducibility of measurement of spleen stiffness at the time of the initial detection of splenomegaly, whether it is found incidentally or not, in determining the etiology of splenomegaly.

Methods

The pathologies that brought about the diffuse splenomegaly were evaluated in 3 main groups as follows: hepatoportal, myeloproliferative, and infectious causes. In addition, 17 healthy control patients were recruited. All patients were examined with acoustic radiation force impulse imaging with VTQ.

Results

The difference between the splenic parenchymal elasticity values in the hepatoportal group (3.27 ± 0.36 m/s), in the myeloproliferative disease group (2.98 ± 0.33 m/s), in the infectious disease group (2.44 ± 0.21 m/s), and in the control group (2.08 ± 0.19 m/s) was found to be statistically significant (P = 0.001). The intraclass correlation coefficient for shear wave velocity measurement between hepatoportal causes and myeloproliferative causes was 71.2% (95% confidence interval [CI], 54.9%–87.4%), between hepatoportal causes and infective causes was 99.7% (95% CI, 98.6%–100.0%), and between myeloproliferative causes and infective causes was 83.3% (95% CI, 68.8%–97.9%). In the same patient groups, spleen volumes were measured as 64.08 ± 9.66, 78.18 ± 18.52, and 51.57 ± 7.44 cm2, respectively; in the control group, it was 26.75 ± 6.57 cm2. The difference between spleen volumes was found to be statistically significant (P = 0.001).

Conclusions

Distinguishing the causes of splenomegaly is important because the disorders require different management strategies. In diseases that cause splenomegaly, tissue content may change according to pathogenesis. Such changes in the spleen are mechanical properties that can be quantified by elastography.
Ultrasound Elastography Evaluations in Patient Populations With Various Kidney Diseases
Authors: Gungor Ozkan , Guzel Fatma Betul , Sarica Mehmet Akif , Gungor Gulay , Ganidagli Berivan , Yurttutan Nursel , Gorgel Ahmet Fazil , Altunoren Orcun
Published: January 2019

Renal elastography is an ultrasonographic method that has been recently found to provide information on renal functions and fibrosis. In this study, we aimed to investigate the relationship between elastography scores and renal functions and proteinuria levels in patient populations with various kidney diseases. Seventy-five diabetic nephropathy patients, 66 kidney transplant patients, and 45 glomerulonephritis patients were included in the study. The amount of proteinuria was measured according to the protein-to-creatinine ratio in spot urine samples. The estimated glomerular filtration rate (eGFR) was calculated according to the Modification of Diet in Renal Disease formula. Ultrasound elastography scores were measured in each patient group by a radiologist. The mean age of diabetic nephropathy patients was 61 ± 10 years. The mean elastography score was 0.96 ± 0.30. Elastography score was positively correlated with serum blood urea nitrogen and creatinine levels and was negatively correlated with eGFR value. The mean age of kidney transplant patients was 42 ± 12 years. The mean elastography score was 1.10 ± 0.38. There was a significant relationship between elastography score and proteinuria level. The mean age of glomerulonephritis patients was 37 ± 13 years. The mean elastography score was 0.91 ± 0.41. Elastography score was positively correlated with serum blood urea nitrogen and creatinine levels. However, there was no relationship between elastography score and eGFR value and proteinuria level. Although renal elastography provides information on renal functions and proteinuria in patients with diabetic nephropathy, renal transplant, and glomerulonephritis, there is a need for studies with a larger number of patients on this subject.
Dynamic Compression—A New and Practical Technique for the Sonographic Diagnosis of Enteric Duplication
Authors: Kitami Masahiro
Published: January 2019

Objectives

This study aims to examine the utility of dynamic compression and other sonographic signs in diagnosing enteric duplication.

Methods

This study reviewed real-time sonographic findings from ultrasound examinations performed by the author between April 2015 and March 2017, including 4 consecutive cases of enteric duplication and 7 cases of other abdominal cysts (control group). The ability of dynamic compression to separate the lesion from the adjacent intestine was analyzed, as were other sonographic signs, including the 5-layer sign, peristalsis, and the split-wall sign.

Results

The 5-layer sign and peristalsis were seen in only 1 of 4 cases of enteric duplication. The split-wall sign was positive in all 4 cases of enteric duplication. In a case of gastric duplication, the split-wall sign was not detected during the first examination. One case showed an atypical white split wall, and 3 cases showed a pseudo–split wall; however, this pseudo–split wall was differentiated from the true split-wall sign using dynamic compression. The dynamic compression technique correctly differentiated enteric duplication from other abdominal cysts in all but 2 cases (82%).

Conclusions

The 5-layer sign and peristalsis were not sensitive for enteric duplication. The split-wall sign may have the highest sensitivity and specificity for enteric duplication, but finding this sign is technically difficult and interpretation is complicated by atypical variations. Dynamic compression differentiated enteric duplication from other abdominal cysts with 82% accuracy, and this technique was simple to perform and easier to interpret than the split-wall sign.
Lung Ultrasonography in the Diagnosis of Pneumonia in Children—A Metaanalysis and a Review of Pediatric Lung Imaging
Authors: Najgrodzka Paulina , Buda Natalia , Zamojska Anna , Marciniewicz Ewelina , Lewandowicz-Uszyńska Aleksandra
Published: January 2019

Background

Pneumonia is one of the most frequent widespread and severe infectious diseases in pediatric patients worldwide. Pneumonia is characterized by high incidence and possibility of complications in the course of the disease in pediatric patients. For this reason, there is a need to have a rapid and safe diagnostic method to recognize it. Imaging diagnostic tools, such as x-ray examinations, necessitate caution while using these methods. To date, there have been lots of studies with the aim to determine the role of lung ultrasonography (LUS) in the diagnosis of inflammatory lesions in children. Our aim was to assess the accuracy of the LUS as diagnostic method of pneumonia in children by making a systematic research of literature.

Objectives

This work is a review of available literature and studies on LUS in pneumonia in children and summary of necessary information about the usefulness of LUS and sonographic findings to diagnose pneumonia in the pediatric population.

Methods

We searched the following databases: PubMed, Scopus, MEDLINE, and Ovid. The following key words were used: pediatrics, pneumonia, ultrasound, chest x-ray, and LUS.

Results

The total search results amounted to 1987. From 1987 potentially eligible studies, 19 were included, and 3 were meta-analysis. We studied and performed the statistical analysis of the results publication.

Conclusions

As a result of the analysis, a significant advantage of the ultrasound examination in comparison with the x-ray study was demonstrated. Lung ultrasound could be a safe diagnostic method for this reason.
Ultrasonography in the Diagnosis and Monitoring of Therapy for Primary Thyroid Lymphoma
Authors: Li Peng , Zhang Hui
Published: January 2019

This study aims to evaluate the value of ultrasonography in the diagnosis, treatment, and follow-up of primary thyroid lymphoma. The clinical data of 12 patients, who were pathologically confirmed with thyroid lymphoma and treated in our hospital, were retrospectively analyzed. Ultrasonography was performed on the thyroid and neck lymph nodes, and the sonographic features of the lesions were recorded. During the course of the diagnosis and treatment of lymphoma, the patients were monitored and followed up by ultrasonography. The sonographic features of 12 patients with 20 lesions revealed hypoechoic masses, within which “strip-shaped” and “grid-shaped” high echoes were observed, and echoes behind masses were not attenuated. Furthermore, a small amount of blood flow signals were observed. Six patients received thyroidectomy. Among these patients, one patient relapsed. Six patients underwent chemotherapy. Among these patients, 2 patients relapsed and received chemotherapy again. Ultrasound can guide the biopsy of suspicious lymphoma lesions and provide accurate information on treatment effects and tumor recurrence for patients with thyroid lymphoma after treatment, especially after chemotherapy.