bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing the Efficiency, Radiation Exposure, and Accuracy Using C-Arm versus O-Arm With 3D Navigation in Placement of Transiliac–Transsacral and Iliosacral Screws: A Cadaveric Study Evaluating an Early Career Surgeon
Authors: Araiza Edgar T. , Medda Suman , Plate Johannes F. , Marquez-Lara Alejandro , Trammell Amy P. , Aran Fernando S. , Lara Daniel , Danelson Kerry , Halvorson Jason J. , Carroll Eben A. , Pilson Holly T.
Published: May 2020

Objectives:

To compare the efficiency, radiation exposure to surgeon and patient, and accuracy of C-arm versus O-arm with navigation in the placement of transiliac–transsacral and iliosacral screws by an orthopaedic trauma fellow, for a surgeon early in practice.

Methods:

Twelve fresh frozen cadavers were obtained. Preoperative computed tomography scans were reviewed to assess for safe corridors in the S1 and S2 segments. Iliosacral screws were assigned to the S1 segment in dysmorphic pelvises. Screws were randomized to modality and laterality. An orthopaedic trauma fellow placed all screws. Time of procedure and radiation exposure to the cadaver and surgeon were recorded. Three fellowship-trained orthopaedic trauma surgeons rated the safety of each screw on postoperative computed tomography scan.

Results:

Six normal and 6 dysmorphic pelvises were identified. Eighteen transiliac–transsacral screws and 6 iliosacral screws were distributed evenly between C-arm and O-arm. Average operative duration per screw was significantly shorter using C-arm compared with O-arm (15.7 minutes ± 6.1 vs. 23.7 ± 8.5, P = 0.014). Screw placement with C-arm exposed the surgeon to a significantly greater amount of radiation (3.87 × 10−3 rads vs. 0.32 × 10−3, P < 0.001) while O-arm exposed the cadaver to a significantly greater amount of radiation (0.03 vs. 2.76 rads, P < 0.001). Two S2 transiliac–transsacral screws (1 C-arm and 1 O-arm) were categorized as unsafe based on scoring. There was no difference in screw accuracy between modalities.

Conclusions:

A difference in accuracy between modalities could not be elucidated, whereas efficiency was improved with utilization of C-arm, with statistical significance. A statistically significant increase in radiation exposure to the surgeon using C-arm was found, which may be clinically significant over a career. The results of this study can be extrapolated to a fellow or surgeon early in practice. The decision between use of these modalities will vary depending on surgeon preference and hospital resources.
Minimally Invasive Revision Forefoot Surgery
Authors: Redfern David , Vernois Joel
Published: May 2020

Broadly speaking minimally invasive surgical techniques are well suited to the revision situation. Previous surgical scars/approaches can easily be accommodated without concerns regarding skin vascularity that might apply to open approaches with open surgery in such situations. The vascular supply to bones is also likely to be preserved to a greater degree than would be possible with open surgery. This article examines forefoot minimally invasive surgery principles and techniques in the revision situation.
The Human Touch
Authors: Arcega Jennifer , Autman Iman , De Guzman Brian , Isidienu Linda , Olivar Jemimah , O'Neal Michele , Surdilla Bianca
Published: May 2020

The art of nursing care is rarely a black or white concept. Within the art of caring for and saving lives, lies many paradoxical concepts, such as nurses' codependent relationship with technology. A literature review was completed with the purpose of answering the question of whether or not technology has decreased the value of humanity in patient care. Robotic care was a concept that was identified in this review, which may devalue the human touch component of nursing care. In addition, the adoption of technological advancements to assess patients and its impact on direct nursing care was another concept explored. The aim of this study is to answer the question that lies in the relationship between nursing care and technological advancements. How can advanced technologies, which have numerous benefits to saving lives, be utilized effectively without compromising the importance of human touch?
A Needs Assessment and Educational Intervention Addressing the Care of Sexual Assault Patients in the Emergency Department
Authors: Chandramani Ayushi , Dussault Nicole , Parameswaran Ramya , Rodriguez Jaclyn , Novack Jared , Ahn James , Oyola Sonia , Carter Keme
Published: May 2020

Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault but are often ill-prepared to address their unique treatment needs. Sexual assault nurse examiners (SANEs) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by (a) conducting a needs assessment of ED providers' self-reported knowledge of, and comfort with, sexual assault patient care at an urban academic adult ED and, (b) using these results to create and implement a SANE-led educational intervention to improve emergency medicine residents' ability to provide sexual assault patient care. From the needs assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic examinations, or understanding hospital policies or state laws. Less than half of the respondents felt confident in their ability to avoid retraumatizing sexual assault patients, and only 29% felt comfortable conducting a forensic examination. On the basis of these results, a SANE-led educational intervention was developed for emergency medicine residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic examination simulation. Preintervention and postintervention surveys showed an increase in respondents' self-perceived ability to avoid retraumatizing patients, comfort with conducting forensic examinations, and understanding of laws and policies. These results show the value of an interprofessional collaboration between physicians and SANEs to train ED providers on sexual assault patient care.
Report on the Short Endoscopic Exocrine Pancreatic Function Test in Children and Young Adults
Authors: Mehta Devendra I. , He Zhaoping , Bornstein Jeffrey , Molle-Rios Zarela , Conwell Darwin L. , Horvath Karoly
Published: May 2020

Objectives

Endoscopic pancreatic function test (ePFT) has been in use for exocrine function testing since the 1990s. In patients, short ePFT assesses acinar function, unlike the longer version for ductal function in adults. The present study summarizes characteristics of 1913 short ePFTs (S-ePFT) performed at 2 centers since 2001.

Methods

The main indications in patients presenting at ages infancy to 24.3 years, for the S-ePFT were failure to thrive, weight loss, diarrhea, and abdominal pain with bloating. Secretin was administered as bolus, and 4 aliquots of fluid were collected between 4 and 10 minutes after administration. Amylase, lipase, trypsin, and chymotrypsin activities were measured in the laboratory.

Results

The pH of consecutive samples increased by 0.3 to 0.7. Overall, 36.7% had abnormal S-ePFT with selective amylase deficiency (9.5%) and generalized enzyme deficiency (8.9%) being the most frequent. Retest reproducibility, repeatability, and clinical validity were high. By adding S-ePFT to endoscopy for the suspicion of malabsorption, the abnormal findings increased by 36.9%.

Conclusions

Short ePFT assesses pancreatic acinar function in a reliable and clinically meaningful way in patients. Diagnostic yield of endoscopy increased substantially albeit with increased sedation time. By S-ePFT ductal function, cytokines and proteomics can also be assessed.
Establishment of a 7-miRNA–Based Risk Score System for Predicting Prognosis of Pancreatic Cancer
Authors: Zhuang Hongkai , Ma Zuyi , Huang Kaijun , Zhou Zixuan , Huang Bowen , Sun Zhonghai , Hou Baohua , Zhang Chuanzhao
Published: May 2020

Objective

This study developed a prognosis-associated miRNA (PAM)-based risk score system to predict overall survival for pancreatic cancer.

Methods

We screened potential PAMs using bioinformatics technology. A risk score system integrating the PAMs was established, and the predictive value was evaluated. The targets of these PAMs were identified and functional enrichment analysis was performed.

Results

Seven PAMs (hsa-mir-188, hsa-mir-1301, hsa-mir-424, hsa-mir-5010, hsa-mir-584, hsa-mir-5091, and hsa-mir-3613) were identified. We also developed a risk score system, which showed a high Harrell concordance index (C-index, 0.723) for overall survival in the Cancer Genome Atlas data sets. The areas under the curve of the receiver operating characteristic curve at the 1-, 2-, and 3-year survival points were 0.718, 0.832, and 0.903, respectively. In addition, both the C-index and the areas under the curve for recurrence-free survival showed a good outcome, indicating that the system had a satisfactory predictive power. Furthermore, 49 target genes of PAMs were identified. Functional enrichment analysis revealed that these targets may be involved in various biological pathways, including the transforming growth factor β signaling pathway, Notch signaling, and downregulation of SMAD2/3.

Conclusions

The findings of this study suggest that the 7-miRNA–based risk score system is a promising prognostic model for pancreatic cancer.
Extrapancreatic Nerve Plexus Invasion on Imaging Predicts Poor Survival After Upfront Surgery for Anatomically Resectable Pancreatic Cancer
Authors: Sugimoto Motokazu , Kobayashi Tatsushi , Kobayashi Shin , Takahashi Shinichiro , Konishi Masaru , Mitsunaga Shuichi , Ikeda Masafumi , Gotohda Naoto
Published: May 2020

Objectives

This study aimed to analyze the risk factors for poor survival of the patients with anatomically resectable pancreatic ductal adenocarcinoma (PDAC), focusing on detailed computed tomography (CT) findings of tumor extent to the peripancreatic tissue.

Methods

The study included 192 patients who underwent upfront pancreaticoduodenectomy for anatomically resectable PDAC. Preoperative CT images were rereviewed by an experienced radiologist for the pattern of tumor extension to the surrounding tissue: biliary, duodenal, serosal, retroperitoneal, portal venous, arterial, extrapancreatic nerve plexus, and other-organ invasion. Imaging findings and other clinical data that could be obtained before surgery were evaluated for their association with a shorter disease-specific survival (DSS) and recurrence-free survival (RFS).

Results

Of the 192 anatomically resectable PDAC patients, extrapancreatic nerve plexus invasion was observed on CT in 38 patients (20%), and this finding was independently associated with a shorter DSS (hazard ratio, 2.258; P < 0.001) and RFS (hazard ratio, 2.665; P < 0.001). The median survival of patients with and without extrapancreatic nerve plexus invasion on CT was 19.7 versus 38.5 months (P < 0.001).

Conclusions

Extrapancreatic nerve plexus invasion was shown as an only CT finding associated with a shorter DSS and RFS after upfront surgery for the patients with anatomically resectable PDAC.
Adenosquamous Carcinoma of the Pancreas Comprise a Heterogeneous Group of Tumors With the Worst Outcome
Authors: Boecker Joerg , Feyerabend Bernd , Tiemann Katharina , Buchwalow Igor , Wagner Kim C. , Oldhafer Karl J. , Andruszkow Julia , Daniels Thies , Boessow Dorthe , Boecker Werner , Neumann Ulf Peter
Published: May 2020

Objectives

Information of the clinicopathological characteristics and outcome data of patients with adenosquamous carcinoma of the pancreas (ASCAP) remains limited. This study's aim is to describe the clinical, pathological, and molecular characteristics of 25 resected ASCAPs.

Methods

Of all 25 cases, patient characteristics, follow-up data, and pathological/immunohistological features were reviewed and analyzed.

Results

In this 3-institutional retrospective analysis of 562 pancreatic cancer patients, we identified 25 cases with histologically confirmed ASCAP (4.4%). Follow-up was available in 21 ASCAP and 50 pancreatic ductal adenocarcinoma control patients with a median overall survival of 8.2 and 21 months, respectively. Age, tumor size, localization in the tail, lymph node status, and resection margin seem to be the most significant factors of survival in our ASCAP cohort. In contrast to pancreatic ductal adenocarcinoma, positive expression of p63, keratins K5/14, and the epidermal growth factor receptor are a robust marker profile of these tumors.

Conclusions

Adenosquamous carcinoma of the pancreas comprises a group of neoplasms in which stage and adverse morphological features contribute to its bad prognosis. Further work must be pursued to improve detection and treatment options to reduce mortality. Specifically, differences in biology might become a target for the development of possible therapies.
Pancreatoduodenectomy With Arterial Resection for Locally Advanced Pancreatic Cancer of the Head
Authors: Haines Morgan , Chua Terence C. , Jamieson Nigel B. , Mittal Anubhav , Gill Anthony J. , Samra Jaswinder S.
Published: May 2020

The development of increasingly effective chemotherapy regimens and increasing tumor necrosis is allowing radical pancreatectomy to be re-evaluated. This systematic review examines the outcome of patients with locally advanced cancer of the pancreatic head after pancreatectomy with arterial resection. Electronic searches were performed on PubMed and Medline databases between January 2000 and December 2018. The end points were to determine the safety and overall survival after arterial resection in pancreatectomy. Thirteen studies with 467 patients were included. Celiac, hepatic, mesenteric, and splenic arteries were resected across all studies. The median overall morbidity was 52% (range, 37%–100%) and with major complications occurring in a median of 25% (range, 12%–54%) of patients. The median 90-day mortality was 5% (range, 0%–17%). R0 was achieved in 66% (range, 43%–100%) and R1 in 31% (range, 0%–74%). The median survival was 17 (range, 7–29) months with a 1- and 3-year survival of 59% (range, 16%–92%) and 17% (range, 0%–13%), respectively. Pancreatectomy with arterial resection may be safely performed in high-volume centers with acceptable survival results in highly selected patients. Pooling of data through a multi-institutional registry will allow a more accurate assessment of the safety and efficacy of this treatment strategy.
Characteristics of Lung Metastasis as an Initial Recurrence Pattern After Curative Resection of Pancreatic Cancer
Authors: Morimoto Daishi , Yamada Suguru , Sonohara Fuminori , Takami Hideki , Hayashi Masamichi , Kanda Mitsuro , Tanaka Chie , Kobayashi Daisuke , Nakayama Goro , Koike Masahiko , Fujiwara Michitaka , Fujii Tsutomu , Kodera Yasuhiro
Published: May 2020

Objectives

Understanding the disparity in clinical course because of differences in initial recurrence patterns could lead to a more accurate estimation of prognosis and optimal treatment.

Methods

Patients who underwent resection for pancreatic cancer between January 2003 and December 2016 were identified from a prospective database. We analyzed the association between clinicopathological information or survival outcomes and initial recurrence patterns.

Results

The most frequent recurrence pattern was locoregional recurrence (n = 84, 31.3%), followed by simultaneous multiple recurrences (n = 65, 24.2%), liver metastasis (n = 53, 19.8%), peritoneal dissemination (n = 41, 15.3%), and lung metastasis (n = 20, 7.5%). In addition, survival outcomes were significantly longer in the lung metastasis group than in the other recurrence pattern group (recurrence-free survival, 18.2 vs 8.2 months, P < 0.001; overall survival, 86.4 vs 21.0 months, P < 0.001; and survival after recurrence, 37.1 vs 9.3 months, P < 0.001). The lung metastasis group had a significantly higher proportion of pancreatic body and tail cancer (P < 0.002) and arterial invasion (P = 0.006) than the other recurrence pattern group.

Conclusions

Lung metastasis as an initial recurrence pattern frequently occurred in patients with body and tail cancer and patients with arterial invasion.
The Effect of Cognitive Impairment on the Prognosis of Major Depressive Disorder
Authors: Zhang Bao-Hua , Feng Lei , Feng Yuan , Xin Li-Min , Zhu Xiao-Yu , Tan Yun-Long , Wang Gang
Published: May 2020

The study recruited 168 patients diagnosed with major depressive disorder (MDD). The nine-item Patient Health Questionnaire (PHQ-9) and Perceived Deficits Questionnaire for Depression (PDQ-D) were lower and the Digit Symbol Substitution Test (DSST) was higher in the community volunteers than those in MDD patients. Depression-related scores (17-item Hamilton Depression Rating Scale [HAMD-17], Clinical Global Impressions–Severity of Illness Scale [CGI-S], and PHQ-9), functioning-related scores (Sheehan Disability Scale [SDS]), and Work Efficiency and Activity Damage–Specific Health Problems questionnaire work productivity loss were decreased, and the quality of life–related scores (European Quality of life–5 Dimensions [EQ-5D] utility score) were increased in the MDD patients. PDQ-D was decreased and DSST was increased with the increase of follow-up time. Linear regression indicated that cognitive symptoms (PDQ-D and DSST) improved more slowly than depressive symptoms (PHQ-9). At baseline, PDQ-D was related with functioning (SDS and work productivity loss). PDQ-D and DSST were related with EQ-5D utility score. In addition, at month 6, PDQ-D was related with functioning (SDS and work productivity loss) and EQ-5D utility score. Cognitive impairment might be a risk for MDD and MDD-related changes in the functioning and quality of life.
Creating and Implementing a Nurse Mentoring Program
Authors: Miller Cortney , Wagenberg Charlotte , Loney Erica , Porinchak MaryPat , Ramrup Natasha
Published: May 2020

This article describes a team approach to developing an evidence-based mentoring program for nurses at a major academic medical center. The center's nursing leadership empowered nurses to design and implement a program that supports staff engagement and professional development. This structured, collaborative process resulted in an innovative mentoring program that is aligned with the organizational culture and practices.
Incorporating a Microlearning Wellness Intervention Into Nursing Student Curricula
Authors: Gawlik Kate , Guo Jinghong , Tan Alai , Overcash Janine
Published: May 2020

Background

Cultivating healthy lifestyle beliefs (HLBs) can result in positive health outcomes for students during their nursing program.

Purpose

The purpose of the study was to determine the effectiveness of short wellness interventions (microlearning) in nursing courses on reducing stress and anxiety and enhancing HLB.

Methods

Microlearning wellness interventions were offered to graduate and undergraduate nursing students in this cluster randomized intervention study. The Perceived Stress Scale 4, Generalized Anxiety Disorder 7, and Healthy Lifestyle Beliefs Scales were administered. Student perceptions were evaluated using a short answer narrative.

Results

The intervention group reported higher HLB (P = .15), lower anxiety (P = .06), and lower stress (P = .06) compared with the control group after adjusting for baseline differences. Student comments were favorable and included enjoying the activities, weight loss success, and mindfulness strategies.

Conclusions

Incorporating wellness interventions into nursing curricula demonstrates a positive trend toward reducing anxiety and stress and improving HLB.
Rewriting the Microaggression Narrative
Authors: Carter Brigit M. , McMillian-Bohler Jacquelyn
Published: May 2020

Background

It is recognized that expanding the number of racial/ethnic minority nurses is key to addressing the challenges of health disparities. However, some schools of nursing have not typically experienced diversity.

Problem

Diverse nursing students experience increasingly high rates of exposure to microaggression, discrimination, and bias in the clinical and classroom settings. Providing nursing students with strategies to respond to microaggressions can reduce barriers to nursing education.

Approach

An interactive workshop based on the Theater of the Oppressed performance technique was developed to increase students' ability to recognize/respond to microaggressions.

Outcomes

Students (n = 97) completed a preworkshop-postworkshop evaluation. After participation, students indicated an improved ability to recognize microaggressions with intent to respond when they occur.

Conclusions

Race was the most common microaggression addressed in the skits, followed by gender and ability. The interactive nature of the workshop allowed students to practice strategies to address microaggressions.
The Role of Obesity in the Development and Management of Gynecologic Cancer
Authors: Staley S. Allison , Tucker Katherine R. , Clark Leslie H.
Published: May 2020

Importance

Endometrial cancer is the most common gynecologic malignancy, with an estimated 54,000 new cases and 10,000 deaths in the United States in 2015. The obesity epidemic directly contributes to the escalating prevalence of chronic diseases, including obesity-related cancers. Patient body weight and nutritional status markedly impact perioperative oncologic care, chemotherapy administration, recurrence risk, and survivorship goals.

Objective

The objective of this review is to explore the association between obesity and the development, treatment, and survival outcomes of gynecologic cancers.

Evidence Acquisition

A systematic literature review was performed utilizing PubMed and ClinicalTrials.gov.

Conclusions and Relevance

Caring for obese women with gynecologic cancers presents unique challenges. A coordinated multidisciplinary and system effort is required to address the prevention and treatment of obesity, as the sequela of this disease is a clear risk factor for the development of gynecologic malignancy and other comorbidities. Health care providers must be ready to address this worldwide health problem.

Target Audience

Obstetricians, gynecologists, family physicians, midwives, nurse practitioners, and dietitians

Learning Objectives

After completion of this activity, the learner should be better able to describe the pathophysiologic correlation between obesity and common gynecologic malignancies; identify limitations in cancer care due to obesity and associated comorbidities; and counsel patients regarding management strategies for treatment of obesity.
Association of Powder Use in the Genital Area With Risk of Ovarian Cancer
Authors: O'Brien Katie M. , Tworoger Shelley S. , Harris Holly R. , Anderson Garnet L. , Weinberg Clarice R. , Trabert Britton , Kaunitz Andrew M. , D'Aloisio Aimee A. , Sandler Dale P. , Wentzensen Nicolas
Published: May 2020

(Abstracted from JAMA 2020;323(1):49–59)

The International Agency for Research on Cancer has concluded that use of mineral talc-containing powders, sometimes used by women on their genitals, has “possible” evidence of carcinogenic risk. Case-control studies have demonstrated a significant association between the ever use of powder in the genital area and ovarian cancer; however, these studies may have been limited by recall bias and a surge in media coverage.
Prolapse Recurrence After Sacrocolpopexy Mesh Removal: A Retrospective Cohort Study
Authors: Sassani Jessica C. , Ross James H. , Lopa Samia , Handzel Robert M. , Bradley Megan S. , Bonidie Michael
Published: May 2020

(Abstracted from Female Pelvic Med Reconstr Surg 2020;26:92–96)

More than 20% of the adult female population have symptomatic pelvic organ prolapse (POP) and other pelvic floor disorders. Currently, recommended surgical repair procedures for pelvic floor disorders include native tissue repair and mesh sacrocolpopexy.
Single-Cell Transcriptomic Atlas of Primate Ovarian Aging
Authors: Wang Si , Zheng Yuxuan , Li Jingyi , Yu Yang , Zhang Weiqi , Song Moshi , Liu Zunpeng , Min Zheying , Hu Huifang , Jing Ying , He Xiaojuan , Sun Liang , Ma Lifang , Esteban Concepcion Rodriguez , Chan Piu , Qiao Jie , Zhou Qi , Belmonte Juan Carlos Izpisua , Qu Jing , Tang Fuchou , Liu Guang-Hui
Published: May 2020

(Abstracted from Cell 2020;180(3):585–600.e19)

Age-associated declines in female fertility evident after only 30 years of age involve a decrease in total follicle number and oocyte quality. In addition, physiologic age–related changes include increased fibrosis, expanded stromal cell compartment, and changed ovarian medullary and cortex volume.
Acute Ataxia in Childhood
Authors: Kirik Serkan , Aslan Mahmut , Özgör Bilge , Güngör Serdal , Aslan Neslihan
Published: May 2020

Background

Acute ataxia is a common reason for presentation to the pediatric emergency department and the pediatric neurology clinic in childhood. Its incidence is between 1/100,000 and 1/500,000. Its most common reason is infections.

Objective

The aim of this study was to examine the clinical presentation, etiological factors, and prognosis of patients presenting to our regional tertiary pediatric neurology clinic with a diagnosis of acute ataxia.

Methods

An evaluation was made of patients younger than 18 years diagnosed with acute ataxia in our tertiary pediatric neurology clinic between 2009 and 2016.

Results

Thirty-nine children were included in the analysis. Sex, age, diagnoses, treatment options, and clinical and radiological findings were evaluated. Acute postinfectious cerebellar ataxia was the most common diagnosis (21/39 [51.2%]). No agent could be identified in viral serological examination in 34 patients (87.2%). Rotavirus was identified in 2 (10.5%) of the acute postinfectious cerebellar ataxia cases, and varicella-zoster virus, herpes simplex virus, and hepatitis A positivities were each identified in 1 case. In 20 (51.2%) of 39 patients, varying treatments were applied according to the primary etiology.

Conclusions

Acute ataxia is a significant neurological problem in childhood. In this study, Rotavirus was the most common infectious agent. It may be related to vaccination. This study can be considered of value as the most comprehensive study conducted to date on this subject in the eastern region of Turkey.
Quality Assurance and Performance Improvement Project for Suspected Appendicitis
Authors: AlFraih Yasser , Robinson Tessa , Stein Nina , Kam April , Flageole Helene
Published: May 2020

Introduction:

Considerable variability exists in the diagnosis and management of acute appendicitis, affecting both quality and costs of care. This prospective cohort study aimed to decrease unnecessary radiological investigations, standardize radiological imaging, avoid unnecessary hospital admissions, and decrease our institution rate of negative appendectomy.

Methods:

A multidisciplinary appendicitis care pathway was implemented. This pathway involved the use of the Pediatric Appendicitis Score, standardization of ultrasound reporting, and risk stratification to determine patient disposition. Patients were prospectively enrolled in the pathway and compared a preimplementation retrospective cohort.

Results:

We included 235 patients in this study that took place between February 2017 and January 2018. An 88.5% pathway adherence rate for appropriate referral for ultrasounds, an 84% compliance rate for correct risk stratification, and the need for a surgical consult were achieved. After implementation, standardization of ultrasound (U/S) reporting increased from 0% to 78%. The rate of computed tomography utilization decreased from 7.3% to 4.7%. An appendectomy was completed in 68 (29%) of patients. There was only 1 (1.5%) negative appendectomy, compared to the prepathway institutional negative appendectomy rate of 4%.

Conclusion:

The implementation of a standardized, evidence-based, appendicitis care pathway has the potential to improve quality of care by reducing negative appendectomies, unnecessary computed tomography scans, and unnecessary hospital admissions. The participation of the emergency and diagnostic imaging departments is critical to the successful implementation of this quality improvement measure. This simple, effective model can be easily implemented at other centers to improve the care of children.
Disseminated Bacillus Calmette-Guérin Infection Detected on FDG PET/CT Following Intravesical Bacillus Calmette-Guérin Therapy
Authors: Curley Michael , Bhardwaj Hemant
Published: May 2020

We report the case of a 64-year-old man who presented with back pain, anorexia, and weight loss 9 months following bacillus Calmette-Guérin immunotherapy for high-grade transitional cell carcinoma of the bladder. A FDG PET/CT was performed, which demonstrated osteolysis and intense FDG avidity of the T6/T7 and T8/T9 vertebral endplates. In addition, an aneurysm with FDG-avid soft tissue was present of the distal left common iliac artery. The provisional diagnosis was disseminated bacillus Calmette-Guérin infection, resulting in spondylodiscitis and a mycotic aneurysm. A CT-guided vertebral biopsy confirmed the presence of Mycobacterium tuberculosis DNA on polymerase chain reaction testing.
Posttreatment FDG-Avid Splenic Lesions in DLBCL and HD
Authors: Nachmias Boaz , Godefroy Jeremy , Rozenbach Eyal , Ganzel Chezi , Bar-Shalom Rachel , Goldschmidt Neta , Vainstein Vladimir
Published: May 2020

Residual end of treatment (EOT) FDG-avid lesions are often due to infectious or inflammatory process and not due to refractory lymphoma. Nonetheless, such lesions prompt diagnostic and therapeutic interventions. We evaluate clinical and radiological characteristics of patients with EOT FDG-avid splenic lesions. Comparing metabolic volume (MV) ratio between EOT to interim, showed a marked difference between false positive and true positive lesions (0.5 vs 3.6, P = 0.02). EOT SUVmax was also significantly different between the groups (7 vs. 19, P = 0.02). We suggest EOT/interim-MV ratio as a tool to identify patients at low risk of refractory disease allowing non-invasive surveillance.
Radioiodine Retention Within Dilated Common Biliary Duct Mimicking Metastatic Thyroid Cancer Diagnosed by the Combination of SPECT/CT and MRI
Authors: Dai Hongyuan , Huang Rui
Published: May 2020

A 55-year-old woman with papillary thyroid carcinoma under total thyroidectomy and cervical lymph node dissection was referred for 131I radioiodine therapy. Posttherapeutic whole-body scintigraphy revealed increased focal uptake in the right upper abdomen, which localized to the region of the head of the pancreas on SPECT/CT fusion images. Further evaluation with MRI affirmed the radioiodine retention corresponded to bile duct dilation.
18F-FDG PET/CT Imaging of Vasculitis Complicated With Relapsing Polychondritis
Authors: Kamada Hiroki , Takanami Kentaro , Toyama Yoshitaka , Saito Mioko , Takase Kei
Published: May 2020

We present a case of a 38-year-old woman who complained with cough, fever, and back pain with a weight loss. 18F-FDG PET/CT to search fever origin revealed uptake in the tracheobronchial and the left auricular cartilage and wall of the thoracic aorta. She underwent biopsy of the left auricle and was diagnosed with relapsing polychondritis (RP) complicating vasculitis. After steroid therapy, FDG PET/CT demonstrated regression of inflammation, showing decreases in the uptakes. Vasculitis should be considered in case of RP with systemic manifestations. Our case demonstrated the utility of FDG PET/CT in evaluation of RP lesions including aortitis.
A Case of Coronavirus Infection Incidentally Found on FDG PET/CT Scan
Authors: Doroudinia Abtin , Tavakoli Mehrdad
Published: May 2020

We present a highly suspicious case of COVID-19 infection, incidentally found on 18F-FDG PET/CT images. Patient was scanned on February, 25, 2020, when COVID-19 outbreak was unrecognized in our country. She admitted having recent occasional dry cough and fever. A retrospective review of her clinical and laboratory data was strongly suggestive for diagnosis of COVID-19 infection. PET/CT images demonstrated hypermetabolic diffuse ground glass opacities in both lungs with bilateral nodules. There was no evidence of pleural effusion or prominent mediastinal or hilar lymphadenopathy. Radiologists must be aware of COVID-19 presentations on PET/CT scan images during COVID-19 outbreak.
FDG PET/CT in Diagnosing COVID-19 Infection in a Cancer Patient With Exposure History But Minimal Symptoms
Authors: Chuang Hubert H. , Emery Dustin J. , Campbell Richelle Millican , Lu Yang
Published: May 2020

A 56-year-old woman with high-grade neuroendocrine small cell carcinoma had known contact history of COVID-19 about 16 days prior to the restaging PET/CT. The patient was instructed to self-quarantine for 14 days, and no COVID-19 test was performed. Upon arrival, the patient had low-grade fever of 37.1°C, but did not meet infection control criteria for COVID-19 testing, and it was approved to proceed with PET/CT. The FDG PET/CT images revealed new multifocal hypermetabolic bilateral pulmonary ground-glass opacities that are suggestive of COVID-19 pneumonia. Meanwhile, the patient’s symptoms worsened, and a blood test later confirmed COVID-19 infection.
Three-Dimensional Visualization for Extended Deep Inferior Epigastric Perforator Flaps
Authors: Cui HuaiRui , Ding MaoCao , Mao YiHua , Zhou Peng , Sun ChenYou , Tang MaoLin , Xu DaChuan
Published: May 2020

Purpose

The aim of the study was to provide an applied and digital anatomical basis of acquiring extended deep inferior epigastric perforator (DIEP) flaps for clinical use.

Methods

Five formalin-soaked specimens were received red latex injection and dissected by layers. The arteriography using the modified mixture of lead oxide-gelatin was performed on 10 adult cadavers that were serially scanned by a spiral computed tomography. The DIEPs were 3 dimensionally reconstructed by Mimics.

Results

The medial row perforators of DIEP arteries are located in the medial 1/third of rectus abdominis muscle, and lateral row perforators in the lateral 1/third of the muscle. The perforators distribute mainly from the upper tendinous intersection of umbilicus to below umbilicus within 8.0 cm, especially 4.0 cm. There are constant diameter 0.8-mm perforators or greater accompanied with nerveswithin this region. The main perforators are shown by fast direct volume rendering (VR) reconstruction method, and 3-dimensional images of DIEPs are acquired by dynamic reconstruction (DR) method. Consecutively, the adjacent perforators can be combined freely and the position and anastomosis of extended branches can be easily observed. The extended DIEP flaps were designed by VR and DR methods.

Conclusions

The DIEPs can obtain large extended perforator flaps accompanied with nerves. The perforator close to the umbilicus should be selected while designing the DIEP flap. The 3-dimensional model of extended DIEP flaps can be established conveniently and intuitively by VR and DR methods of Mimics.
Positron Emission Tomography Imaging of Long-Term Expression of the 18 kDa Translocator Protein After Sudden Cardiac Arrest in Rats
Authors: Schroeder Daniel C. , Popp Erik , Rohleder Cathrin , Vus Stefanie , Bethencourt David de la Puente , Finke Simon R. , Zlatopolskiy Boris D. , Zischler Johannes , Drzezga Alexander , Herff Holger , Annecke Thorsten , Hucho Tim , Neumaier Bernd , Böttiger Bernd W. , Endepols Heike
Published: May 2020

Background:

Knowledge about the neuroinflammatory state during months after sudden cardiac arrest is scarce. Neuroinflammation is mediated by cells that express the 18 kDa translocator protein (TSPO). We determined the time course of TSPO-expressing cells in a rat model of sudden cardiac arrest using longitudinal in vivo positron emission tomography (PET) imaging with the TSPO-specific tracer [18F]DAA1106 over a period of 6 months.

Methods:

Five male Sprague Dawley rats were resuscitated from 6 min sudden cardiac arrest due to ventricular fibrillation, three animals served as shams. PET measurements were performed on day 5, 8, 14, 90, and 180 after intervention. Magnetic resonance imaging was performed on day 140. Imaging was preceded by Barnes Maze spatial memory testing on day 3, 13, 90, and 180. Specificity of [18F]DAA1106 binding was confirmed by Iba-1 immunohistochemistry.

Results:

[18F]DAA1106 accumulated bilaterally in the dorsal hippocampus of all sudden cardiac arrest animals on all measured time points. Immunohistochemistry confirmed Iba-1 expressing cells in the hippocampal CA1 region. The number of Iba-1-immunoreactive objects per mm2 was significantly correlated with [18F]DAA1106 uptake. Additionally, two of the five sudden cardiac arrest rats showed bilateral TSPO-expression in the striatum that persisted until day 180. In Barnes Maze, the relative time spent in the target quadrant negatively correlates with dorsal hippocampal [18F]DAA1106 uptake on day 14 and 180.

Conclusions:

After sudden cardiac arrest, TSPO remains expressed over the long-term. Sustainable treatment options for neuroinflammation may be considered to improve cognitive functions after sudden cardiac arrest.
Bone Marrow Mesenchymal Stem Cell-Derived Exosomes Attenuate LPS-Induced ARDS by Modulating Macrophage Polarization Through Inhibiting Glycolysis in Macrophages
Authors: Deng Huimin , Wu Lingmin , Liu Meiyun , Zhu Lina , Chen Yuanli , Zhou Huanping , Shi Xuan , Wei Juan , Zheng Li , Hu Xiaoting , Wang Mansi , He Zhengyu , Lv Xin , Yang Hao
Published: May 2020

Macrophages play a key role in the development of sepsis-induced acute respiratory distress syndrome (ARDS). Recent evidence has proved that glycolysis plays an important role in regulating macrophage polarization through metabolic reprogramming. Bone marrow mesenchymal stem cells (BMSCs) can alleviate sepsis-induced lung injury and possess potent immunomodulatory and immunosuppressive properties via secreting exosomes. However, it is unknown whether BMSCs-derived exosomes exert their therapeutic effect against sepsis-induced lung injury by inhibiting glycolysis in macrophages. Therefore, the present study aimed to evaluate the anti-inflammatory effects of exosomes released from BMSCs on acute lung injury induced by lipopolysaccharide (LPS) in mice and explored the possible underlying mechanisms in vitro and in vivo. We found that BMSCs inhibited M1 polarization and promoted M2 polarization in MH-S cells (a murine alveolar macrophage cell line) by releasing exosomes. Further experiments showed that exosomes secreted by BMSCs modulated LPS-treated MH-S cells polarization by inhibiting cellular glycolysis. Moreover, our results showed that BMSCs-derived exosomes down-regulated the expression of several essential proteins of glycolysis via inhibition of hypoxia-inducible factor 1 (HIF-1)α. Finally, a model of LPS-induced ARDS in mice was established, we found that BMSCs-derived exosomes ameliorated the LPS-induced inflammation and lung pathological damage. Meanwhile, we found that intratracheal delivery of BMSCs-derived exosomes effectively down-regulated LPS-induced glycolysis in mice lung tissue. These findings reveal new mechanisms of BMSCs-derived exosomes in regulating macrophage polarization which may provide novel strategies for the prevention and treatment of LPS-induced ARDS.
Targeted Temperature Management in Cardiac Arrest Patients With an Initial Non-Shockable Rhythm: A Systematic Review and Meta-Analysis
Authors: Barbarawi Mahmoud , Alabdouh Ahmad , Barbarawi Owais , Lakshman Harini , Alkasasbeh Mariam , Rizk Fatima , Bachuwa Ghassan , Alkotob Mohammad L.
Published: May 2020

Background:

Targeted temperature management (TTM) is now recommended for patients presenting with an out-of-hospital cardiac arrest. However, there are limited data that support its use in patients with an initial non-shockable rhythm (NSR).

Methods:

A literature search of PubMed/MEDLINE, Cochrane Library, and Embase was conducted by two independent authors for studies that compared TTM along with standard care versus standard care alone in treating cardiac arrest with initial NSR. Outcomes were short-term and long-term survival, and a Cerebral Performance Category (CPC) score of 1 to 2 at the longest follow-up period. The Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Trial sequential analysis (TSA) was performed on the randomized controlled trials (RCTs).

Results:

Thirty studies were included in the final analysis: 25 observational and five RCTs, totalling 10,703 patients, 4,023 of whom received TTM and 6,680 received standard care alone. Compared with standard care, patients who presented with an initial NSR cardiac arrest and received TTM (target of 32°C –34°C) had a significantly higher short-term survival (OR 1.44 95% CI 1.15–1.81; P = 0.002), long-term survival (OR 1.52 95% CI 1.03–2.26; P = 0.04), and CPC score of 1 to 2 (OR 1.63 95% CI 1.22–2.17; P = 0.0010). Sensitivity analyses by including only RCTs showed a trend, although not significant, toward better short-term survival (OR 1.25 95% CI 0.82–1.89; P = 0.30), long-term survival (OR 1.15 95% CI 0.80–1.66; P = 0.46), and neurologic outcomes (OR 1.51 95% CI 0.81–2.80; P = 0.19). However, TSA performed on the RCTs revealed that the results were inconclusive.

Conclusion:

Among patients who survived cardiac arrest with an initial NSR, TTM is associated with a higher rate of survival and favorable neurological outcomes compared with no TTM. However, analyses from the included RCTs did not support this conclusion.
Effects of Different Target Temperatures on Angiogenesis and Neurogenesis Following Resuscitation in a Porcine Model After Cardiac Arrest
Authors: Cui Hao , Yang Zhengfei , Xiao Peng , Shao Fei , Zhao Shen , Tang Ziren
Published: May 2020

Objective:

The optimal effective temperature of targeted temperature management (TTM) used to prevent cerebral injury following cardiopulmonary resuscitation (CPR) is undetermined. In this study, we compared the mortality, neurologic deficits, and cerebral protein levels of two target temperatures.

Methods:

Fifty 4-month-old female domestic pigs were randomized to sham, TTM at 33°C ± 0.5°C (T33), TTM at 35°C ± 0.5°C (T35), and normothermic (NT) groups. In the NT and TTM groups, untreated ventricular fibrillation was induced electrically in animals for 10 min, followed by 6 min of CPR. Target core temperatures (Tc) of TTM groups were induced and maintained (6 h) using an endovascular hypothermia device, and rewarmed to 37.5 ± 0.5°C in the next 6 h. Tc of the NT group was maintained at 37.5 ± 0.5°C. The survival outcomes and neurological function were evaluated every 24 h for 72 h.

Results:

All animals were successfully resuscitated with no significant differences in baseline characteristics or hemodynamic indexes. Survival rates and neurological outcomes were significantly improved in the TTM groups, with T33 showing the most significant effect. Compared with NT-treated animals, TTM-treated animals had higher expressions of angiopoietin-1, transforming growth factor-alpha , vascular endothelial growth factor, metallopeptidase inhibitor (TIMP)-1, TIMP-2, and platelet-derived growth factor-BB. Macrophage migration inhibitory factor and IL-17F levels were markedly upregulated after resuscitation in the NT group but inhibited in the TTM groups. Neuron-specific enolase staining data was also consistent with our conclusion that hypothermia can reduce reperfusion-induced brain injuries.

Conclusion:

Lower target temperature showed greater protective effects against cerebral injuries after CPR, and the improved neurological outcomes after TTM may be associated with decreased expression of pro-inflammatory cytokines and increased expression of blood–brain barrier and neurogenesis regulatory factors in this porcine model of CA following resuscitation.
SARS-CoV-2/COVID-19: Evolving Reality, Global Response, Knowledge Gaps, and Opportunities
Authors: Osuchowski Marcin F. , Aletti Federico , Cavaillon Jean-Marc , Flohé Stefanie B. , Giamarellos-Bourboulis Evangelos J. , Huber-Lang Markus , Relja Borna , Skirecki Tomasz , Szabó Andrea , Maegele Marc
Published: May 2020

Approximately 3 billion people around the world have gone into some form of social separation to mitigate the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The uncontrolled influx of patients in need of emergency care has rapidly brought several national health systems to near-collapse with deadly consequences to those afflicted by Coronavirus Disease 2019 (COVID-19) and other critical diseases associated with COVID-19. Solid scientific evidence regarding SARS-CoV-2/COVID-19 remains scarce; there is an urgent need to expand our understanding of the SARS-CoV-2 pathophysiology to facilitate precise and targeted treatments. The capacity for rapid information dissemination has emerged as a double-edged sword; the existing gap of high-quality data is frequently filled by anecdotal reports, contradictory statements, and misinformation. This review addresses several important aspects unique to the SARS-CoV-2/COVID-19 pandemic highlighting the most relevant knowledge gaps and existing windows-of-opportunity. Specifically, focus is given on SARS-CoV-2 immunopathogenesis in the context of experimental therapies and preclinical evidence and their applicability in supporting efficacious clinical trial planning. The review discusses the existing challenges of SARS-CoV-2 diagnostics and the potential application of translational technology for epidemiological predictions, patient monitoring, and treatment decision-making in COVID-19. Furthermore, solutions for enhancing international strategies in translational research, cooperative networks, and regulatory partnerships are contemplated.
Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario
Authors: Jonsson Karin , Hultin Magnus , Härgestam Maria , Lindkvist Marie , Brulin Christine
Published: May 2020

Introduction

Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance.

Methods

This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist.

Results

The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = −1.30, P = 0.02) leadership performance.

Conclusions

This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.