bluuebunny/crossref_metadata_2025 huggingface dataset:
Neurogenic fever due to injury of the hypothalamus in a stroke patient
Authors: Jang Sung Ho , Seo You Sung
Published: March 2021

Rationale:

Neurogenic fever is a non-infectious source of fever in a patient with brain injury, especially hypothalamic injury. We report on a stroke patient with neurogenic fever due to injury of hypothalamus, demonstrated by using diffusion tensor imaging (DTI).

Patient concerns:

A 28-year-old male patient was admitted to the rehabilitation department of university hospital at 30 months after onset. Brain MRI showed leukomalactic lesions in hypothalamus, bilateral medial temporal lobe, and bilateral basal ganglia. He showed intermittent high body temperature (maximum:39.5°C, range:38.5–39.2°C), but did not show any infection signs upon physical examination or after assessing his white blood cell count and inflammatory enzyme levels such as erythrocyte sedimentation rate and C-reactive protein. In addition, 8 age-matched normal (control) subjects (4 male, mean age: 26.6 years, range: 21–29years) were enrolled in the study.

Diagnosis:

Intraventricular hemorrhage and intracerebral hemorrhage in the left basal ganglia.

Interventions:

He underwent extraventricular drainage and ventriculoperitoneal shunting for hydrocephalus.

Outcomes:

DTI was performed at 30 months after onset, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained for hypothalamus. The FA and ADC values of patient were lower and higher, respectively, by more than two standard deviations from control values. Injury of hypothalamus was demonstrated in a stroke patient with neurogenic fever.

Lessions:

Our results suggest that evaluation of hypothalamus using DTI would be helpful in patients show unexplained fever following brain injury.
The psychometric measures to assess aggressive dimension following traumatic brain injury
Authors: Corallo Francesco , Anselmo Anna , Palmeri Rosanna , Di Cara Marcella , Formica Caterina , De Salvo Simona , Todaro Antonino , Rifici Carmela , Marino Silvia , Bramanti Placido , Lo Buono Viviana
Published: March 2021

Background:

higher level of aggression and antisocial behavior are frequent following head trauma, due to specific brain alterations. Many tests are used to assess this aspect. A descriptive review was conducted on the main tests used to detect the appearance of aggressive dimensions following traumatic brain injury.

Review summary:

we searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 723 publications, only 7 met our search criteria. Findings showed that various psychometric tools are used to assess aggressiveness and its subdomains, following head trauma.

Conclusions:

further investigation are necessary to clarify whether these tools ensure a reliable diagnosis in order to make an early intervention and reduce violent behavior and its development.
Basic life support training programme in schools by school nurses
Authors: Martínez-Isasi Santiago , García-Suárez Mario , De La Peña Rodríguez Medea Aglaya , Gómez-Salgado Juan , Fernández Nélida , Méndez-Martínez Carlos , Leon-Castelao Esther , Clemente-Vivancos Alvaro , Fernández-García Daniel
Published: March 2021

Background:

Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools.

Objective:

to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school.

Methods:

62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport.

Results:

The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles.

Conclusions:

11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly.
Castleman disease and paraneoplastic pemphigus in a pregnant woman
Authors: Cui Beibei , Lin Hui
Published: March 2021

Rationale:

Orogenital ulcers can be observed in various conditions, such as Behcet disease, infection and also paraneoplastic pemphigus (PNP). Castleman disease (CD), which is a rare cause of paraneoplastic pemphigus represents a heterogenous lymphoproliferative disorder of unknown etiology. Paraneoplastic pemphigus associated with CD in pregnancy is rare and has not been reported yet.

Patient concerns:

We report a rare case of CD in a 26-year-old pregnant woman with orogenital ulcers. The patient suffered from mucosal erosions and uveitis at 23 weeks of gestation. A retroperitoneal mass (9.7×7.3×11.8 cm) was identified by CT scan.

Diagnoses:

According to histological and immunohistological findings, a diagnosis of unicentric CD, hyaline vascular type, and PNP was formulated.

Intervention:

High dose methylpredisonlone was given for the therapy. Pancreatic uncinatectomy, portal vein and superior mesenteric vein repair, pancreaticojejunostomy, and caesarean section were performed on the patient to remove the tumor and the fetus.

Outcomes:

The fetus did not survive after surgery. The patient did not achieve remission and she died from epidermolysis and sepsis several months later.

Lessons:

PNP associated with CD is a rare lymphoproliferative disorder and needs to be differentiated from other orogenital diseases by histological features.

Ethics and dissemination:

Written informed consent was obtained from the patient for publication of this case report and accompanying images. Ethical approval of this study was granted by the Ethics Committee of West China Hospital of Sichuan University. (Ethics Reference No: 2021143).
Marinacci anastomosis (reverse Martin-Gruber anastomosis)
Authors: Chang Yu-Tai , Chen Chun-Lung , Lai Chien-Hung
Published: March 2021

Rationale:

The incidence of Martin-Gruber anastomosis ranges from 5% to 34%, which is characterized by crossing over from the median to the ulnar nerve and innervating the first dorsal interosseous, thenar or hypothenar muscles. However, the reverse Martin-Gruber anastomosis, or Marinacci anastomosis, is far less discussed and appears in recent literature.

Patient concerns:

A 56-year-old man presented to the clinic of a university hospital because of left neck soreness with numbness radiating to the left lateral shoulder. The neck discomfort was aggravated while the neck rotated or tilted to the right.

Diagnosis:

Higher compound muscle action potential over the abductor pollicis brevis on elbow stimulation than on the wrist was found during upper limb nerve conduction velocity study. Ulnar to median anastomosis was identified.

Intervention:

We performed cervical spine X-ray and electrophysiological examinations and monitored the patient.

Outcomes:

We identified that this patient had left C5 and C6 subacute radiculopathy with active denervation and left subclinical ulnar sensory neuropathy, and verified the existence of ulnar-to-median anastomosis.

Lessons:

We demonstrated a pure motor ulnar-to-median anastomosis without sensory correspondence and higher CMAP over the abductor pollicis brevis on elbow stimulation of the ulnar nerve than on the wrist. The prevalence might be underestimated in a Chinese population-based published study.
Refusal of cancer-directed surgery in male breast cancer
Authors: Wang Shipei , Chen Sichao , Huang Yihui , Hu Di , Zeng Wen , Zhou Ling , Zhou Wei , Chen Danyang , Feng Haifeng , Wei Wei , Zhang Chao , Liu Zeming , Wang Min , Guo Liang
Published: March 2021

It has been reported that some male breast cancer patients may refuse the recommended surgery, but the incidence rate in the United States is not clear. The purpose of this study was to identify the incidence, trends, risk factors, and eventual survival outcomes associated with the rejection of such cancer-directed surgery.

We collected data on 5860 patients with male breast cancer (MBC) from the Surveillance, Epidemiology, and End Results database, including 50 patients refusing surgery as recommended. Kaplan–Meier survival analysis and Cox proportional hazard regression were used to identify the effects of refusing surgery on cancer-specific survival (CSS) and overall survival (OS). The association between acceptance or rejection of surgery and mortality were estimated by nested Cox proportional hazards regression models with adjustment for age, race, clinical characteristics, and radiation.

Of the 5860 patients identified, 50 (0.9%) refused surgery. Old age (≥65: hazard ratio [HR]: 3.056, 95% confidence interval [CI]: 1.738–5.374, P < .0001), higher AJCC stage (III: HR: 3.283, 95% CI: 2.134–5.050, P < .0001, IV: HR: 14.237, 95% CI: 8.367–24.226, P < .0001), progesterone receptor status (negative: HR: 1.633, 95% CI: 1.007–2.648, P = .047) were considered risk factors. Compared with the surgery group, the refusal group was associated with a poorer prognosis in both OS and CSS (χ2 = 94.81, P < .001, χ2 = 140.4, P < .001). Moreover, significant differences were also observed in OS and CSS among 1:3 matched groups (P = .0002, P < .001).

Compared with the patients undergoing surgery, the patients who refused the cancer-directed surgery had poor prognosis in the total survival period, particularly in stage II and III. The survival benefit for undergoing surgery remained even after adjustment, which indicates the importance of surgical treatment before an advanced stage for male breast cancer patients.
Analysis of clinical characteristics and prognosis of patients with peripheral T-cell lymphoma
Authors: Liang Xiao , Guo Li , Hu Xin , Li Shan , Wen Shujuan
Published: March 2021

Background:

This study aimed to explore the clinical characteristics, therapeutic efficacy and prognostic factors of peripheral T-cell lymphoma (PTCL).

Methods:

The clinical data of 119 PTCL patients who were admitted to the Xinjiang Medical University Affiliated Tumor Hospital from January 2010 to December 2017 were retrospectively analyzed, including the clinical characteristics, therapeutic efficacy, prognosis-related factors and treatments. Among the patients, 98 patients received antharcyclines-based therapeutic protocols, including Cyclophosphamide, Pirarubicin, Vincristine, Prednisone (CHOP) protocol and Cyclophosphamide, Pirarubicin, Vincristine, Prednisone, Etoposide (CHOPE) protocol, with median follow-up time of 32.5 months (2–166 months). The patients’ clinical characteristics were analyzed, and COX ratio risk regression model was adopted to analyze the prognostic factors related with the survival rate of PTCL patients.

Results:

The 5-year overall survival (OS) rate was 46.4% and progression-free survival (PFS) rate was 42.7% in the 98 patients, and there were insignificant differences between patients with CHOP protocol and those with CHOPE protocol in the 5-year OS and PFS rates (OS:P = 0.197, PFS:P = 0.663). The univariate analysis results showed that different pathological types, Ann Arbor stage, Eastern Cooperative Oncology Group (ECOG) score ≥ 2, the number of extranodal lymphomas involved, Lactic dehydrogenase (LDH) level, presence/absence of bone marrow involved, international prognostic index (IPI) score, β2microglobulin (β2-MG) level and hemoglobin (Hb) level were poor prognosis factors influencing patients’ OS and PFS rates (Pall < .05). Multivariate analysis demonstrated that different pathological types, Ann Arbor stage, presence/absence of bone marrow involved and Hb level were independent prognostic indicators influencing patients’ OS and PFS rates (Pall < .05).

Conclusion:

PTCL is poor in therapeutic efficacy and prognosis, and different pathological types, Ann Arbor stage, presence/absence of bone marrow involved and Hb level are related with the prognosis of PTCL patients. Anemia occurring before the treatment is an important predictive indicator influencing the prognosis of PTCL patients and patients who experience anemia will be poor in prognosis.
Comparison of the efficacy and safety of acupuncture and acupotomy for patients with cervical spondylotic radiculopathy
Authors: Zhou Shiming , Liu Biao , Guo Jinwei
Published: March 2021

Background:

There is no systematic review to compare the efficacy of acupuncture and acupotomy in patients with cervical spondylotic radiculopathy. It is worthy to critically review the evidence of the comparison of these 2 therapies to inform clinical practice. Therefore, the purpose of this study was to compare the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy and to provide evidence for clinical practice.

Methods:

Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library were searched in March 2021 by 2 independent reviewers. Data extraction was performed independently, and any conflict was resolved before final analysis. Only randomized clinical trials were included in this study. Outcomes included pain intensity, symptom score, neck disability index, total effective rate, and curative rate. The Cochrane risk of bias tool is used to evaluate the risk of bias of included randomized controlled trials by 2 independent reviewers.

Results:

We hypothesized that these 2 methods would provide similar therapeutic benefits. The results of this research will be delivered in a peer-reviewed journal.

Conclusion:

This study expects to provide credible and scientific clinical evidence for the efficacy and safety of acupuncture and acupotomy in the treatment of cervical spondylotic radiculopathy.

OSF registration number:

10.17605/OSF.IO/U7T6A.
Disseminated gonococcal infection in a Japanese man with complement 7 deficiency with compound heterozygous variants
Authors: Kageyama Misaki , Hagiya Hideharu , Ueda Yasutaka , Ohtani Katsuki , Fukumori Yasuo , Inoue Norimitsu , Wakamiya Nobutaka , Yoneda Nanoka , Kimura Keigo , Nagasawa Motonori , Nakagami Futoshi , Nishi Isao , Sugimoto Ken , Rakugi Hiromi
Published: March 2021

Rationale:

Complement deficiency are known to be predisposed to disseminated gonococcal infection (DGI). We herein present a case of DGI involving a Japanese man who latently had a complement 7 deficiency with compound heterozygous variants.

Patient concerns:

A previously healthy 51-year-old Japanese man complained of sudden-onset high fever. Physical examination revealed various skin lesions including red papules on his trunk and extremities, an impetigo-like pustule on left forearm, and tendinitis of his right forefinger.

Diagnosis:

Blood culture testing detected gram-negative cocci, which was confirmed to be Neisseria gonorrhoeae based on mass spectrometry and a pathogen-specific PCR test.

Interventions:

Screening tests for underlying immunocompromised factors uncovered that complement activities (CH50) was undetectable. With a suspicion of a congenital complement deficiency, genetic analysis revealed rare single nucleotide variants in complement 7 (C7), including c.281-1G>T and a novel variant c.1454C>T (p.A485V). CH50 was normally recovered by adding purified human C7 to the patient's serum, supporting that the patient has C7 deficiency with compound heterozygous variants.

Outcomes:

Under a diagnosis of DGI, the patient underwent an antibiotic treatment with cefotaxime for a week and was discharged without any sequela.

Lessons:

DGI is a rare sexually-transmitted infection that potentially induces systemic complications. Complement immunity usually defeats N. gonorrhoeae and prevents the organism from causing DGI. This case highlighted the importance of suspecting a complement deficiency when a person develops DGI.
The relationship between mean platelet volume and metabolic syndrome in patients with type 2 diabetes mellitus
Authors: Ding Qinpei , Wang Fangwei , Guo Xintong , Liang Min
Published: March 2021

This study aimed to investigate the association between mean platelet volume (MPV) and metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM). Data for 1240 patients with T2DM admitted to the Department of Endocrinology at the First Affiliated Hospital of Guangxi Medical University between January 1, 2017 and June 1, 2020 were collected retrospectively via electronic medical records, including demographic information, complete blood count, lipid profile, and glucose metabolism indexes. MetS was defined according to the Chinese Diabetes Society. Among the 1240 patients enrolled, 873 (70.40%) had MetS. MPV was significantly higher in patients with MetS (P < .001). For individual MetS components, MPV was significantly higher in the presence of abdominal obesity (P = .013) and hypertriglyceridemia (P = .026), but did not differ in the presence of elevated blood pressure (P = .330) or low high-density lipoprotein cholesterol (P = .790). Moreover, MPV was independently associated with MetS after adjustment for sex, smoking, alcohol drinking, white blood cell count, fasting C-peptide, and body mass index (odds ratio 1.174, 95% confidence interval 1.059–1.302). The odds ratio for MetS in the highest tertile, compared with the lowest MPV tertile, was 1.724 (95% confidence interval 1.199–2.479, P for trend = .003) after multiple adjustment. In stratified analyses, the positive correlation of MPV with MetS was significant only in patients who were older, male, or overweight, or who had poor glycemic control. In conclusion, high MPV was positively associated with the presence of MetS in patients with T2DM, particularly older, male, or overweight patients, or those with poor glycemic control.
Glioblastoma in a female neurofibromatosis 1 patient without IDH1, BRAF V600E, and TERT promoter mutations
Authors: Cai Jia-Wei , Chen Xiao-Yong , Chen Jin-Yuan , Wu Zan-Yi , Wu Xi-Yue , Yu Liang-Hong , You Hong-Hai
Published: March 2021

Rationale:

Glioblastoma is the most lethal and common malignant brain tumor but rare in patients with neurofibromatosis type 1. The clinical findings and pathological findings with gene signatures in female patients have not been well clarified.

Patient concerns:

A 51-year-old female patient complained of headache and left limb weakness lasting for 20 days. The patient underwent a cesarean section 20 years ago and hysterectomy 1 year ago because of uterine leiomyomas. Multiple café-au-lait spots and neurofibromas were found over patient's chest, neck, back, and arms. The myodynamia of left distant and proximate epipodite were grade 0 and grade 1 respectively. The myodynamia of lower left limb was grade 3.

Diagnoses:

Magnetic resonance imaging revealed a malignant lesion which was most likely a glioblastoma in the right temporo-parietal lobe, approximately 5.6 × 5.9 × 6.9 cm in size with a rounded boundary.

Interventions:

A right temporo-parietal craniotomy was performed to resect the space-occupying lesion for gross total removal. Then, the patient received concurrent chemoradiotherapy. Histological examination confirmed a glioblastoma without v-RAF murine sarcoma viral oncogene homolog B1 gene, isocitrate dehydrogenase 1 gene, and telomerase reverse transcriptase gene promoter mutations.

Outcomes:

After surgery, the headache was relieved and the muscular strength of left limbs did improve. After receiving the standard treatment regimen, the patient was alive at 13 months follow-up.

Lessons:

This is the first reported glioblastoma in female neurofibromatosis type 1 patient without v-RAF murine sarcoma viral oncogene homolog B1 gene, isocitrate dehydrogenase 1 gene, and telomerase reverse transcriptase gene promoter mutations. Tumors in adult patients with these signatures were less aggressive with well-circumscribed border and had long-term survivals which strengthened the evidence that these patients may comprise a unique subset in glioblastoma.
Symptomatic bilateral massive pulmonary embolism and proximal and distal deep vein thrombosis following arthroscopic meniscus surgery
Authors: Jeon Sang Hyun , Kwon Geon Ho , Kim Man Soo
Published: March 2021

Rationale:

The incidence of venous thromboembolism (VTE) after knee arthroscopy is remarkably lower than that of arthroplasty. We describe a patient with symptomatic bilateral massive pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) in the femoral and popliteal veins after arthroscopic meniscus repair surgery.

Patient concerns:

The patient underwent arthroscopic meniscus repair with no intraoperative complication. There were no underlying diseases such as hypertension or diabetes. On day 5 postoperative, the patient complained of dyspnea, chest discomfort, and nausea after standing.

Diagnosis:

On DVT and PTE computed tomography, there were multifocal PTEs in the distal portion of the main and segmental branches of both pulmonary arteries. There was a focal thrombosis in the left deep femoral vein, as well as small DVTs in the left popliteal and calf veins.

Interventions:

After 3 days of low-molecular-weight heparin 1 mg/kg every 12 hours, treatment was changed to an oral drug, dabigatran, for 6 months.

Outcomes:

There were no PTE or DVT findings on computed tomography at 6 months postoperative. The patient did not complain of symptoms related to PTE or DVT at 6 months after the operation, has returned to work, and is living without discomfort.

Lessions:

The frequency of VTE is very low after arthroscopic meniscus surgery, but it represents a life-threatening event. Our patient had risk factors for VTE including obesity, surgery time of ∼60 minutes, and immobilization. Although arthroscopic meniscus surgery is relatively safe, evaluation of risk factors for VTE should be performed before and after surgery, and appropriate thromboprophylaxis should be provided when necessary.
Advancing African otolaryngology and head & neck surgery education and training through virtual academic platforms and multidisciplinary teams
Authors: Din Taseer F. , Macharia Chege , Harris Tashneem
Published: March 2021

Purpose of review

To overview the rise of virtual tools to propagate academia and clinical service within Africa, in the field of otolaryngology, propelled by the coronavirus disease 2019 (COVID-19) pandemic.

Recent findings

The rise of the COVID-19 virus saw a dramatic reduction in elective surgery and outpatient services with a subsequent reduction in experiential learning for trainees. This has spurred the rising trend to maintain the mission of education and clinical service, virtually. There have been unprecedented levels of international collaboration in the ‘pandemic year of 2020’ that has seen various platforms conceived to harmonize varying practices from global experts towards the ultimate goal of education propagation and improved patient care. The continent of Africa, amidst its own unique challenges, has boldly stepped into the virtual realm in form of a resident-centred platform coined University Of Cape Town-Africa Virtual ENT, and two multidisciplinary team (MDT) meetings: the African Head and Neck Society Virtual Tumour Board and the African Virtual Cochlear Implant Meeting.

The COVID-19 pandemic will have long-lasting effects on clinical practice and training programs globally. This has demanded academicians to re-imagine novel ways to buoy academia and maintain international collaboration in an inexpensive and convenient way to nourish the sacred mission of education and clinical service within our spirited continent.
Tolerance, immunosuppression, and immune modulation: impacts on lung allograft survival
Authors: Shepherd Hailey M. , Gauthier Jason M. , Kreisel Daniel
Published: March 2021

Purpose of review

Immune responses following lung transplantation continue to result in high rates of allograft failure and rejection, and current immunosuppression does not address the unique immunologic properties of the lung. Here, we review recent studies on lung allograft tolerance and alloimmunity and discuss implications for immunosuppression.

Recent findings

Processes governing tolerance and alloimmunity in lung allografts differ from other solid organs. Recent studies have suggested that allorecognition is regulated at the level of the lung graft. Furthermore, certain cell populations essential for lung allograft tolerance may facilitate rejection in other organs. Induction of lung allograft tolerance is associated with the formation of tertiary lymphoid organs, which are enriched in regulatory T cells and play an important role in preventing rejection.

Recent discoveries regarding alloactivation and the regulation of tolerance following lung transplantation have introduced exciting potential avenues for the development of lung-specific immunosuppression.
The evolving role of ECMO in liver transplantation
Authors: Hogen Rachel , Sedra Ashraf H. , Motamed Arash , Emamaullee Juliet
Published: March 2021

Purpose of review

To review the indications for extra-corporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients and their optimal management on ECMO.

Recent findings

Recent studies have reported a 30–40% survival rate among LT recipients that receive ECMO. Increasingly, case reports have documented successful outcomes of LT performed for patients on preoperative ECMO. Outcomes appear to be superior with patients in the immediate peri-LT period with reversible causes of severe, acute respiratory, and/or cardiovascular collapse. Mortality is most commonly secondary to infection. Volume optimization with CRRT may improve outcomes and perfusion to the graft, especially for patients on veno-arterial ECMO. There is little consensus on management of anticoagulation in these patients, but it can likely be held temporarily when the patient is coagulopathic and/or experiencing bleeding complications.

ECMO should be considered in the peri-LT period for patients with severe, acute, and reversible causes of respiratory and/or cardiovascular collapse, with acceptable outcomes in patients that would otherwise not be expected to survive. Management of the post-LT patient on ECMO is challenging with a slowly enlarging body of literature to inform decision making.
Delirium Education in Hospice Care
Authors: Sinchak Cynthia , DeGuzman Pamela B.
Published: March 2021

Diagnosing delirium in hospice patients is challenging owing to the multifactorial causes and symptoms of delirium that can mimic natural end-of-life processes. When delirium goes unrecognized in hospice patients, preventable causes can be left untreated, leading to sequelae that are misaligned with the principles of hospice care. We conducted an evidence-based quality improvement project on a 10-bed inpatient hospice unit aimed at increasing nursing staff knowledge about assessing delirium, with a focus on preventable causes. Nurses were trained in use of the Nursing Delirium Screening Scale, which was implemented over a 5-week period. Increases in knowledge were evaluated with a pretest and posttest. We used a paired t test to determine knowledge improvement. Use of the tool was evaluated using a survey. Nurses demonstrated significantly improved knowledge after the educational session (P = .009). Survey results indicated overwhelmingly that nurses valued having an easy-to-use tool to assess delirium in their patients. Because we used a paper-based tool during the project, which was found to be cumbersome by staff, our next steps are to determine the feasibility of implementing the tool into the electronic medical record.
When Crisis Strikes, Handle With CARE
Authors: Sites Christine S. , Templin Casey M.
Published: March 2021

The decision to continue a career advancement program in midst of our health system’s response to the COVID-19 pandemic was made after weighing the pros and cons. At a time when high priority was placed on educating the frontline nurses on rapidly changing protocols and supporting mental health, our organization reallocated resources and ways of doing things in order to maintain some form of normalcy. By doing so, we were able to demonstrate our commitment to professional development even in the face of adversity and highlight the resourcefulness of nursing professional development practitioners. As the COVID-19 crisis has laid bare, we live in an increasingly complex and interconnected world, and agility will be essential to future nursing professional development practice.
A Fatal Case of Rickettsiosis From South Africa
Authors: Blumenthal Ryan , Hoosen Anwar , Skosana Lebogang Busisiwe , Weyer Jacqueline
Published: March 2021

We present a case of fatal Rickettsiosis from South Africa.
Key Renal Neoplasms With a Female Predominance
Authors: Baniak Nicholas , Barletta Justine A. , Hirsch Michelle S.
Published: March 2021

Renal neoplasms largely favor male patients; however, there is a growing list of tumors that are more frequently diagnosed in females. These tumors include metanephric adenoma, mixed epithelial and stromal tumor, juxtaglomerular cell tumor, mucinous tubular and spindle cell carcinoma, Xp11.2 (TFE3) translocation-associated renal cell carcinoma, and tuberous sclerosis complex (somatic or germline) associated renal neoplasms. The latter category is a heterogenous group with entities still being delineated. Eosinophilic solid and cystic renal cell carcinoma is the best-described entity, whereas, eosinophilic vacuolated tumor is a proposed entity, and the remaining tumors are currently grouped together under the umbrella of tuberous sclerosis complex/mammalian target of rapamycin–related renal neoplasms. The entities described in this review are often diagnostic considerations when evaluating renal mass tissue on biopsy or resection. For example, Xp11.2 translocation renal cell carcinoma is in the differential when a tumor has clear cell cytology and papillary architecture and occurs in a young or middle-aged patient. In contrast, tuberous sclerosis complex–related neoplasms often enter the differential for tumors with eosinophilic cytology. This review provides an overview of the clinical, gross, microscopic, immunohistochemical, genetic, and molecular alterations in key renal neoplasms occurring more commonly in females; differential diagnoses are also discussed regardless of sex predilection.
Prevalence of Drinking Within Low-Risk Guidelines During the First 2 Years After Inpatient Rehabilitation for Moderate or Severe Traumatic Brain Injury
Authors: Adams Rachel Sayko , Ketchum Jessica M. , Nakase-Richardson Risa , Katz Douglas I. , Corrigan John D.
Published: March 2021

The objective of this retrospective, longitudinal study was to investigate the prevalence of drinking within the recommended limits (i.e., low-risk drinking) after moderate/severe traumatic brain injury (TBI). Data were drawn from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems National Database, a longitudinal dataset closely representative of the US adult population requiring inpatient rehabilitation for TBI. The sample included 6348 adults with moderate or severe TBI (injured October 2006–May 2016) who received inpatient rehabilitation at a civilian TBI Model Systems center and completed the alcohol consumption items preinjury and 1 and 2 yrs postinjury. National Institute on Alcohol Abuse and Alcoholism guidelines define low-risk drinking as no more than 4 drinks per day for men or 3 drinks per day for women and no more than 14 drinks per week for men or no more than 7 drinks per week for women. Low-risk drinking was common both before and after TBI, with more than 30% drinking in the low-risk level preinjury and more than 25% at 1 and 2 yrs postinjury. Postinjury, most drinkers consumed alcohol in the low-risk level regardless of preinjury drinking level. Definitive research on the long-term outcomes of low-risk alcohol consumption after more severe TBI should be a high priority.
Tensiomyographic changes of muscle contractile properties in individuals with lower-limb amputation: A pilot study
Authors: Fujishita Hironori , Maeda Noriaki , Urabe Yukio , Komiya Makoto , Sakai Shogo , Fukuhara Kouki , Kimura Hiroaki , Adachi Nobuo
Published: March 2021

Background:

Individuals with a unilateral lower-limb amputation (LLA) rely heavily on their intact limb during daily physical activities. However, there is limited research on the resultant effects of this over-reliance on contractile properties of muscles in the intact limb.

Objective:

To compare the muscle contractile properties of the intact limb among individuals with a unilateral LLA to those of age-matched able-bodied individuals, using tensiomyography.

Study Design:

This is a cross-sectional, observational study.

Methods:

Nine men with a unilateral LLA and 10 able-bodied men (control) were included. Tensiomyography measures were obtained for 5 muscles: gastrocnemius lateralis (GL) and medialis (GM), rectus femoris, vastus lateralis (VL), and vastus medialis. Contraction time (Tc), delay time (Td), maximal displacement (Dm), and velocity of deformation (Vd) for each muscle were compared between groups.

Results:

Tc and Td for the GL and GM muscles were lower for the LLA than the control group (GL: P = .03, r = −0.51, P < .01, r = 0.67; GM: P = .02, r = 0.53, P = .07, r = 0.54, respectively). Dm and Vd of the VL were significantly smaller in the LLA than the control group (P < .01, r = 0.73, P < .01, r = 0.23, respectively).

Conclusions:

Men with a unilateral LLA seem to have slower deformation of the gastrocnemius muscles and higher stiffness of the VL than able-bodied controls. These findings may be indicative of an overuse of the intact limb as a compensation for the unilateral LLA. The confirmation of these findings in a larger sample size is required to translate these findings to practice.
Hepatic Radiofrequency Ablation
Authors: Collettini Federico , Brangsch Julia , Reimann Carolin , Chapiro Julius , Savic Lynn Jeanette , Buchholz Rebecca , Keller Sarah , Hamm Bernd , Goldberg S. Nahum , Makowski Marcus R.
Published: March 2021

Objectives

Macrophages accumulating in the periablational rim play a pivotal role in initiating and sustaining the perifocal inflammatory reaction, which has been shown to be at least 1 of the mechanisms responsible for the systemic pro-oncogenic effects of focal hepatic radiofrequency ablation (RFA). Herein, we tested the hypothesis to use superparamagnetic iron oxide nanoparticle (SPION)–enhanced magnetic resonance imaging (MRI) for noninvasive quantification of iron-loaded macrophages in the periablational rim of VX2 tumor-bearing rabbits.

Materials and Methods

Twelve VX2 tumor-bearing rabbits underwent MRI immediately after and up to 3 weeks after focal hepatic RFA. For noninvasive quantification of macrophage accumulation in the periablational rim, animals were scanned before and 24 hours after SPION injection. T2*-weighted images were analyzed and correlated with histopathological and immunohistochemical findings. Furthermore, correlations with quantitative measurements (ICP-MS [inductively coupled plasma–mass spectrometry] and LA-ICP-MS [laser ablation–ICP-MS]) were performed.

Results

SPION-enhanced T2*-weighted MRI scans displayed a progressive increase in the areas of signal intensity (SI) loss within the periablational rim peaking 3 weeks after RFA. Accordingly, quantitative analysis of SI changes demonstrated a significant decline in the relative SI ratio reflecting a growing accumulation of iron-loaded macrophages in the rim. Histological analyses confirmed a progressive accumulation of iron-loaded macrophages in the periablational rim. The ICP-MS and LA-ICP-MS confirmed a progressive increase of iron concentration in the periablational rim.

Conclusions

SPION-enhanced MRI enables noninvasive monitoring and quantification of ablation-induced macrophage recruitment in the periablational rim. Given the close interplay between ablation-induced perifocal inflammation and potential unwanted tumorigenic effects of RFA, SPION-enhanced MRI may serve as a valuable tool to guide and modulate adjuvant therapies after hepatic RFA.
A Novel Deep Learning Based Computer-Aided Diagnosis System Improves the Accuracy and Efficiency of Radiologists in Reading Biparametric Magnetic Resonance Images of the Prostate
Authors: Winkel David J. , Tong Angela , Lou Bin , Kamen Ali , Comaniciu Dorin , Disselhorst Jonathan A. , Rodríguez-Ruiz Alejandro , Huisman Henkjan , Szolar Dieter , Shabunin Ivan , Choi Moon Hyung , Xing Pengyi , Penzkofer Tobias , Grimm Robert , von Busch Heinrich , Boll Daniel T.
Published: March 2021

Objective

The aim of this study was to evaluate the effect of a deep learning based computer-aided diagnosis (DL-CAD) system on radiologists' interpretation accuracy and efficiency in reading biparametric prostate magnetic resonance imaging scans.

Materials and Methods

We selected 100 consecutive prostate magnetic resonance imaging cases from a publicly available data set (PROSTATEx Challenge) with and without histopathologically confirmed prostate cancer. Seven board-certified radiologists were tasked to read each case twice in 2 reading blocks (with and without the assistance of a DL-CAD), with a separation between the 2 reading sessions of at least 2 weeks. Reading tasks were to localize and classify lesions according to Prostate Imaging Reporting and Data System (PI-RADS) v2.0 and to assign a radiologist's level of suspicion score (scale from 1–5 in 0.5 increments; 1, benign; 5, malignant). Ground truth was established by consensus readings of 3 experienced radiologists. The detection performance (receiver operating characteristic curves), variability (Fleiss κ), and average reading time without DL-CAD assistance were evaluated.

Results

The average accuracy of radiologists in terms of area under the curve in detecting clinically significant cases (PI-RADS ≥4) was 0.84 (95% confidence interval [CI], 0.79–0.89), whereas the same using DL-CAD was 0.88 (95% CI, 0.83–0.94) with an improvement of 4.4% (95% CI, 1.1%–7.7%; P = 0.010). Interreader concordance (in terms of Fleiss κ) increased from 0.22 to 0.36 (P = 0.003). Accuracy of radiologists in detecting cases with PI-RADS ≥3 was improved by 2.9% (P = 0.10). The median reading time in the unaided/aided scenario was reduced by 21% from 103 to 81 seconds (P < 0.001).

Conclusions

Using a DL-CAD system increased the diagnostic accuracy in detecting highly suspicious prostate lesions and reduced both the interreader variability and the reading time.
Prospective Comparison of Angiogenesis-Specific 68Ga-RGD2 PET/CT Imaging Parameters and DAS28-ESR in Rheumatoid Arthritis
Authors: Kavanal Anwin Joseph , Bhattacharya Anish , Sharma Aman , Shukla Jaya , Chattopadhyay Arghya , M B Adarsh , Sharma Vikas , Vatsa Rakhee , Rana Nivedita , Kaur Gurvinder , Mittal Bhagwant Rai
Published: March 2021

Objective

The aim of this study was to compare the performance of angiogenesis-specific 68Ga-RGD2 PET/CT with Disease Activity Score 28–erythrocyte sedimentation rate (DAS28-ESR) in assessing disease activity and treatment response in rheumatoid arthritis (RA).

Methods

This was a prospective study comparing the performance of 68Ga-RGD2 PET/CT and DAS28-ESR in 30 RA patients. All of them underwent 68Ga-RGD2 PET/CT scan from head to toe and clinical examination at the baseline. A repeat scan and clinical examination were done in 27 patients after 3 months of treatment with disease-modifying antirheumatic drugs ± steroids. Three PET parameters, that is, PJC (PET-positive joint count), aSUVmax (average SUVmax), and hSUVmax (highest SUVmax), of positive joints were compared with the DAS28-ESR for disease activity assessment and response evaluation.

Results

Among the 3 PET parameters, PJC showed a significant correlation with the DAS28-ESR (0.64, P < 0.01). A significant change was observed with treatment in the DAS28-ESR and PET parameters of 27 patients at follow-up. There was significant correlation between percentage changes in DAS28-ESR and scan parameters such as PJC (0.689, P < 0.001), aSUVmax (0.712, P < 0.001), and hSUVmax (0.555, P = 0.003) values. The absolute change in aSUVmax value could accurately discriminate (area under the curve, 0.98; P = 0.001) European League Against Rheumatism responders from nonresponders.

Conclusions

68Ga-RGD2 PET/CT is a promising tool for objective assessment of disease activity and treatment response in patients with RA.
Uncommon Testicular Germ Cell Tumor Thrombus in Azygos Vein Detected by FDG PET/CT
Authors: Peker Abdusselim Adil , Toprak Huseyin , Yasin Ayse Irem , Aydin Mehmet
Published: March 2021

A 40-year old man admitted to the nuclear medicine department to undergo PET/CT for restaging of known testicular germ cell tumor. The patient had a history of orchiectomy for left testis and left nephrectomy with retroperitoneal lymph node dissection. Histopathology revealed testicular germ cell tumor. During the follow-up period, there is a rapidly expanding mass in posterior mediastinum. PET reveals increased FDG activity in the azygos vein. Contrast-enhanced CT of the thorax showed distended azygos vein with heterogeneously enhancing thrombus and peripheral fat stranding. Findings are consistent with azygos vein tumor thrombosis related to testicular germ cell tumor.
18F-FDG PET/CT Monitoring of Tumor Response to Tyrosine Kinase Inhibitors and Alkylating Drugs in an SDH-Deficient GIST
Authors: Somme François , Bender Laura , Kurtz Jean-Emmanuel , Gantzer Justine , Imperiale Alessio
Published: March 2021

Succinate dehydrogenase (SDH)–deficient gastrointestinal stromal tumors (GISTs) are associated with loss of function of SDH complex and represent 5% to 7.5% of GISTs. SDH-deficient GISTs usually develop in the stomach of children and young adults, and could be part of Carney triad or Carney-Stratakis syndromes including paraganglioma. SDH-deficient GISTs are often indolent despite the high rate of distant metastasis, and overall unresponsive to tyrosine kinase inhibitors. However, epigenetic inactivation of MGMT leads to potential effectiveness of alkylating agents. We report the 18F-FDG PET/CT results for monitoring response to TKI and alkylating drugs in a patient with refractory SDHB-deficient GIST.
18F-FDG–Avid Lymph Nodes After COVID-19 Vaccination on 18F-FDG PET/CT
Authors: Ulaner Gary A. , Giuliano Peter
Published: March 2021

A 68-year-old man with right cheek melanoma after resection underwent 18F-FDG PET/CT, which was unremarkable except for multiple FDG-avid subcentimeter but rounded lymph nodes in the left axilla. The patient had undergone a COVID-19 vaccination in the left arm 3 weeks prior. As under vaccinations have been documented to cause reactive FDG-avid lymph nodes, the nodes in our patient were considered benign, reactive to the COVID-19 vaccination. Although FDG-avid benign, reactive nodes have been an uncommon finding in the past, the upcoming surge in COVID-19 vaccinations makes this an important finding for the interpreting physician to consider and recognize.
Patient Preparedness for Pelvic Organ Prolapse Surgery: A Randomized Equivalence Trial of Preoperative Counseling
Authors: Sassani Jessica C. , Grosse Philip J. , Kunkle Lauren , Baranski Lindsey , Ackenbom Mary F.
Published: March 2021

Objective

Preoperative counseling can affect postoperative outcomes and satisfaction. We hypothesized that patient preparedness would be equivalent after preoperative counseling phone calls versus preoperative counseling office visits before prolapse surgery.

Methods

This was an equivalence randomized controlled trial of women undergoing pelvic organ prolapse surgery. Participants were randomized to receive standardized counseling via a preoperative phone call or office visit. The primary outcome was patient preparedness measured on a 5-point Likert scale by the Patient Preparedness Questionnaire at the postoperative visit. A predetermined equivalence margin of 20% was used. Two 1-sided tests for equivalence were used for the primary outcome.

Results

We randomized 120 women. The study was concluded early because of COVID-19 and subsequent surgery cancellations. There were 85 participants with primary outcome data (43 offices, 42 phones). Mean age was 62.0 years (±1.0) and 64 (75.3%) had stage III or stage IV prolapse. The primary outcome, patient preparedness measured at the postoperative visit, was equivalent between groups (office, n = 43 [97.7%]; phone, n = 42 [97.6%], P < 0.001). Most women reported they would have preferred a phone call (n = 66, 65.5%) with more women in the phone group expressing this preference than the office group (office 40.5% vs phone 90.5%, P < 0.001). Ultimately, nearly all women (96.5%) were satisfied with their method of counseling.

Conclusions

Preoperative counseling phone calls were equivalent to office visits for patient preparedness for pelvic organ prolapse surgery. This study demonstrates patient acceptance of phone calls for preoperative counseling. Telehealth modalities should be considered as an option for preoperative patient counseling.
The case for formal methodology in scientific reform
Authors: Devezer Berna , Navarro Danielle J. , Vandekerckhove Joachim , Ozge Buzbas Erkan
Published: March 2021

Current attempts at methodological reform in sciences come in response to an overall lack of rigor in methodological and scientific practices in experimental sciences. However, most methodological reform attempts suffer from similar mistakes and over-generalizations to the ones they aim to address. We argue that this can be attributed in part to lack of formalism and first principles. Considering the costs of allowing false claims to become canonized, we argue for formal statistical rigor and scientific nuance in methodological reform. To attain this rigor and nuance, we propose a five-step formal approach for solving methodological problems. To illustrate the use and benefits of such formalism, we present a formal statistical analysis of three popular claims in the metascientific literature: (i) that reproducibility is the cornerstone of science; (ii) that data must not be used twice in any analysis; and (iii) that exploratory projects imply poor statistical practice. We show how our formal approach can inform and shape debates about such methodological claims.