bluuebunny/crossref_metadata_2025_split huggingface dataset:
Testicular Pain Pathway in Children
Authors: Bastianpillai Christopher , Ryan Kate , Hamid Sami , Li Chi-Ying , Green James S.A. 
Published: January 2020

Objectives
Acute scrotal pain in children is a common presenting complaint in hospital, and it is imperative that cases of testicular torsion are identified and managed promptly. We aim to identify the most influential points in the pathway in determining whether patients are managed in the appropriate time frame, so these areas can be targeted to improve salvage rates.

Methods
Using quality improvement principles, the pediatric scrotal pain pathway was mapped out, commencing with initial symptom onset and ending with definitive surgical management. We retrospectively reviewed data on all patients between 0 and 18 years of age attending the emergency department at Whipps Cross University Hospital with acute scrotal pain between October 2010 and October 2013.

Results
Over the 3-year period, 238 patients 18 years or younger presented to casualty with scrotal pain. Of the patients assessed initially by an emergency department physician, 52.8% (n = 67) were discharged without referral. To our knowledge, none of these patients presented later with a missed torsion. Torsion was diagnosed in 23.2% of the patients operated on (n = 22), of which 5 required orchidectomy, comprising 2.1% of all patients presenting with scrotal pain. In this group, 4 were due to late presentation by the patient.

Conclusions
We demonstrate the value of different stages of the pathway, as more than half of patients seen in A&E were correctly discharged without referral. In the context of our study, late presentation to hospital appears to be the most significant factor leading to orchidectomy. To target this issue, awareness among both children and parents must be improved.
Internationally Acquired Severe Systemic Infections in Febrile Pediatric Travelers Presenting to the Emergency Department
Authors: Khan Masrur A. , Rosenberg Michael G. , Fein Daniel M. , Quezada Xavier H. , Reingold Rachel E. , Tadros Farid K. , Wolnerman Yonatan Y. , Yao Jennifer Y. , Schneider Carisa , Meltzer James A. 
Published: January 2020

Objectives
Most children in the United States who visit the emergency department (ED) with fever have minor illnesses not requiring treatment or hospitalization. However, when a child has recently immigrated or traveled abroad, internationally acquired severe systemic infections (ISSIs) must be considered. We sought to describe children who have traveled internationally and present to the ED with a complaint of fever and to determine risk factors associated with ISSIs in these patients.

Methods
We conducted a retrospective study of children younger than 18 years who presented to 2 pediatric EDs in Bronx, NY (June 2007 to May 2017). Patients were included if they had both fever within 24 hours and international travel within 30 days. We compared groups using bivariate analyses and created a prediction model for ISSIs using multivariable logistic regression.

Results
Of the 353 children included, 44 (12%) had ISSI: 25 (57%), malaria; 6 (14%), dengue; and 13 (30%), bacteremia. Eight (18%) of those with ISSI presented with fever to another medical provider in the week prior but did not receive bloodwork. Four variables were independently associated with ISSIs: headache (odds ratio [OR], 21.7; 95% confidence interval [CI], 6.8–69.3), travel to Africa or Asia (OR, 18.8; 95% CI, 4.8–73.2), platelets of 150,000/μL or less (OR, 15.1; 95% CI, 4.7–48.6), and alanine aminotransferase level of 30 IU/L or greater (OR, 8.9; 95% CI, 3.1–25.3).

Conclusions
Children who travel internationally and present with fever upon return are at substantial risk for developing ISSIs. The diagnosis of ISSIs is often overlooked, but certain risk factors have the potential to aid clinicians.
Metastatic Hormone-Sensitive Prostate Cancer
Authors: Kinsey Emily N. , Zhang Tian , Armstrong Andrew J. 
Published: January 2020

Purpose
In recent years, the treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have expanded significantly. In addition to androgen deprivation therapy, the systemic treatments now include docetaxel, abiraterone, enzalutamide, and apalutamide. Radiation to the primary is also an option for select low-volume patients.

Methods
We conducted a review of the pivotal trials that have changed the practice of mHSPC.

Results
We describe an overview of the trials that investigated docetaxel (CHAARTED and STAMPEDE-Docetaxel), abiraterone (LATTITUDE and STAMPEDE-Abiraterone), enzalutamide (ARCHES, ENZAMET), apalutamide (TITAN), and radiation to the primary (STAMPEDE-Radiation).

Discussion
The treatment of mHSPC is a complex topic, and treatment choice should be individualized. Patient preferences, cost, volume of disease, and side effect profiles are important in determining which option is the best for an individual patient.
Stereotactic Ablative Body Radiotherapy for Intermediate- or High-Risk Prostate Cancer
Authors: Loblaw Andrew 
Published: January 2020

Abstract
Stereotactic ablative radiotherapy (SABR) is a relatively novel form of high precision radiotherapy. For low- and intermediate risk patients, ultrahypofractionation (UHF - more than 5 Gy per day) has been compared to conventionally fractionated or moderately hypofractionated radiotherapy in two large randomized studies. A third smaller randomized study examined the question of the optimal frequency of treatments. The results of these studies will be reviewed. SABR for high risk prostate cancer has been shown to be feasible and is well tolerated with careful planning and setup techniques. However, there is currently insufficient data supporting its use for high-risk patients to offer SABR outside of a clinical trial. SABR costs less to the radiotherapydepartments and, the patient, as well as increasing system capacity. Therefore, it has the potential to be widely adopted in the next few years.
Induced oscillatory signaling in the beta frequency of top-down pain modulation
Authors: Diers Martin , de Vos Cecile C. , Gandhi Wiebke , Hoeppli Marie E. , Becker Susanne , Bock Elisabeth , Baillet Sylvain , Schweinhardt Petra 
Published: January 2020

AbstractBackground:Induced synchronized brain activity, particularly in the beta-frequency range, has rarely been investigated in human electrophysiological studies of attentional modulation of the perception of nociceptive stimuli.Methods:We measured time-resolved brain responses to nociceptive stimuli in healthy subjects (final data set: n = 17) using magnetoencephalography (MEG). In addition to investigating evoked responses as previous studies, we tested whether synchronized beta activity induced by nociceptive stimuli differs between 2 attentional conditions. Subjects were presented simultaneously with 2 stimulus modalities (pain-producing intraepidermal electrical stimuli and visual stimuli) in 2 different experimental conditions, ie, “attention to pain” and “attention to color.” Pain ratings between conditions were compared using a 2-sided paired-samplettest; MEG data were analyzed with Brainstorm.Results:Pain ratings were significantly higher in the “attention to pain” compared with the “attention to color” condition. Peak amplitudes of the evoked responses were significantly larger in the “attention to pain” condition bilaterally in the insula and secondary somatosensory cortex, and in the primary somatosensory cortex (SI) contralateral to stimulation. Induced responses to painful stimuli were significantly stronger in contralateral SI in the beta-frequency range in the “attention to pain” condition.Conclusions:This study replicates previous reports w.r.t. the attentional modulation of evoked responses and suggests a functional role of induced oscillatory activity in the beta frequency in top-down modulation of nociceptive stimuli.
Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems
Authors: Gilligan Leah A. , Trout Andrew T. , Bennett Paula , Dillman Jonathan R. 
Published: January 2020

Objectives
Ultrasound shear wave elastography (SWE) is an imaging technique that quantifies liver stiffness. However, comparison data across newest ultrasound systems are sparse. The purpose of this study was to assess repeatability and agreement of shear wave speeds (SWSs) across 6 ultrasound 2-dimensional (2D) SWE systems.

Materials and Methods
This cross-sectional, Health Insurance Portability and Accountability Act–compliant study received institutional review board approval. Written informed consent was obtained. Serial 2D SWE examinations were performed with 6 ultrasound systems (Aplio i800, Canon Medical Systems; LOGIQ E10, GE Healthcare; Resona 7, Mindray North America; EPIQ Elite, Philips Healthcare; ACUSON Sequoia, Siemens Medical Solutions; and Aixplorer MACH 30, SuperSonic Imagine) on 4 elastic phantoms (SWS range, 0.82–3.51 m/s) and on livers of 24 adults (healthy volunteers and patients with known liver stiffening). Participants were imaged 2 times per ultrasound system, with 90 to 120 minutes between examinations. Median SWS was calculated from separately acquired SWS measurements per examination (40 phantom measurements and 10 liver measurements per examination).

Results
Overall intraclass correlation coefficient (ICC) for intersystem agreement of median SWS across systems was 0.99 (95% confidence interval, 0.96–1.0) in phantoms and 0.66 to 0.69 (95% confidence interval, 0.47–0.84) in humans across systems. Means of median SWS measurements in humans ranged from 1.24 to 1.56 m/s. Average individual subject-level variance (interquartile range/median SWS) across all examinations was 0.07, with an average coefficient of variation of 6.0%. Pairwise ICCs for intersystem agreement in subjects across systems ranged from 0.41 to 0.91; test-retest repeatability in subjects was excellent for all systems, with ICCs ranging from 0.87 to 0.97.

Conclusions
There is good to excellent intersystem agreement of measured SWS in elastic phantoms and in vivo livers across 6 ultrasound 2D SWE systems. Test-retest repeatability was excellent for all systems.
Deep Learning Approach for Generating MRA Images From 3D Quantitative Synthetic MRI Without Additional Scans
Authors: Fujita Shohei , Hagiwara Akifumi , Otsuka Yujiro , Hori Masaaki , Takei Naoyuki , Hwang Ken-Pin , Irie Ryusuke , Andica Christina , Kamagata Koji , Akashi Toshiaki , Kunishima Kumamaru Kanako , Suzuki Michimasa , Wada Akihiko , Abe Osamu , Aoki Shigeki 
Published: January 2020

Objectives
Quantitative synthetic magnetic resonance imaging (MRI) enables synthesis of various contrast-weighted images as well as simultaneous quantification of T1 and T2 relaxation times and proton density. However, to date, it has been challenging to generate magnetic resonance angiography (MRA) images with synthetic MRI. The purpose of this study was to develop a deep learning algorithm to generate MRA images based on 3D synthetic MRI raw data.

Materials and Methods
Eleven healthy volunteers and 4 patients with intracranial aneurysms were included in this study. All participants underwent a time-of-flight (TOF) MRA sequence and a 3D-QALAS synthetic MRI sequence. The 3D-QALAS sequence acquires 5 raw images, which were used as the input for a deep learning network. The input was converted to its corresponding MRA images by a combination of a single-convolution and a U-net model with a 5-fold cross-validation, which were then compared with a simple linear combination model. Image quality was evaluated by calculating the peak signal-to-noise ratio (PSNR), structural similarity index measurements (SSIMs), and high frequency error norm (HFEN). These calculations were performed for deep learning MRA (DL-MRA) and linear combination MRA (linear-MR), relative to TOF-MRA, and compared with each other using a nonparametric Wilcoxon signed-rank test. Overall image quality and branch visualization, each scored on a 5-point Likert scale, were blindly and independently rated by 2 board-certified radiologists.

Results
Deep learning MRA was successfully obtained in all subjects. The mean PSNR, SSIM, and HFEN of the DL-MRA were significantly higher, higher, and lower, respectively, than those of the linear-MRA (PSNR, 35.3 ± 0.5 vs 34.0 ± 0.5, P < 0.001; SSIM, 0.93 ± 0.02 vs 0.82 ± 0.02, P < 0.001; HFEN, 0.61 ± 0.08 vs 0.86 ± 0.05, P < 0.001). The overall image quality of the DL-MRA was comparable to that of TOF-MRA (4.2 ± 0.7 vs 4.4 ± 0.7, P = 0.99), and both types of images were superior to that of linear-MRA (1.5 ± 0.6, for both P < 0.001). No significant differences were identified between DL-MRA and TOF-MRA in the branch visibility of intracranial arteries, except for ophthalmic artery (1.2 ± 0.5 vs 2.3 ± 1.2, P < 0.001).

Conclusions
Magnetic resonance angiography generated by deep learning from 3D synthetic MRI data visualized major intracranial arteries as effectively as TOF-MRA, with inherently aligned quantitative maps and multiple contrast-weighted images. Our proposed algorithm may be useful as a screening tool for intracranial aneurysms without requiring additional scanning time.
99mTc-HDP Bone Scintigraphy, SPECT/CT, and 18F-FDG PET/CT Diagnosis Imaging of Incidental Pleural Mesothelioma in a Patient With Biochemical Recurrences of Prostate Cancer
Authors: Fernández-Rodríguez Paula , Martín-Marcuartu Juan José , Acevedo Báñez Irene , Masero Carretero José Manuel , Jiménez-Hoyuela García José Manuel 
Published: January 2020

Abstract
We present the case of a 69-year-old man with history of prostate carcinoma treated with prostatectomy and subsequently with external beam radiotherapy and hormone therapy because of biochemical recurrences. More than 10 years after the diagnosis, follow-up 99mTc-HDP bone scans and SPECT/CT images demonstrated an incidental diagnosis of osteoblastic pleural plaques that quickly evolve to mesothelioma. PET/CT achieved the definitive diagnosis by guiding the biopsy to the highest and most accessible focus of glucidic hypermetabolism. Our case report raises the association between prostate cancer patients treated with external beam radiotherapy and the development of pleural mesothelioma despite having no history of exposure to asbestos.
Remember the Pitfall
Authors: Rosar Florian , Ries Martin , Khreish Fadi , Ezziddin Samer 
Published: January 2020

Abstract
We report of a 71-year-old woman with a 2-cm somatostatin receptor–positive intrapancreatic lesion almost misdiagnosed as neuroendocrine neoplasm. By additional red blood cell scintigraphy with heat-damaged erythrocytes, the lesion was identified as an intrapancreatic accessory spleen, and unnecessary operation (which was already planned) could be avoided. This case report reminds colleagues to consider accessory spleen as differential diagnosis for somatostatin receptor–positive lesions even when located inside the pancreas. In doubtful cases, a scintigraphy with heat-damaged erythrocytes is a very useful and complementary imaging method and should be performed before any planning of surgery.
Surgical Management of Primary Chronic Osteomyelitis of the Jaws: The Use of Computer-Aided-Design/Computer-Aided Manufacturing Technology for Segmental Mandibular Resection
Authors: Bolognesi Federico , Tarsitano Achille , Cicciù Marco , Marchetti Claudio , Bianchi Alberto , Crimi Salvatore 
Published: January 2020

Abstract
The term osteomyelitis of the jaws identifies different pathological patterns characterized by the involvement of the cortical bone and bone marrow in osteoarticular infections.
At the head and neck level, the segment most affected by osteomyelitis is the mandible and in most of the cases the cause of the infection is bacterial, as a result of pulp or periodontal infections, post-extraction alveolitis, foreign bodies and fractures. The mandibular PCO often presents with an insidious onset, without a striking acute phase, and it is characterized by recurrent episodes of pain, swelling, lockjaw, latero-cervical lymphadenopathy, without signs of suppuration.
Three patients have been collected and recorded for the study.
The authors believe that in the more advanced cases of PCO in adult patients, in which the mandibular bone appears almost entirely sclerotic and deformed, and that are not responsive to pharmacological therapy or to conservative surgical therapies such as decortication, it is necessary to perform a complete removal of the portion affected by osteomyelitis, with lower alveolar nerve preservation and contextual reconstruction with free microvascular bone flap.
Our review aims to describe the clinico-pathological features of a rare pathological entity, propose a surgical treatment algorithm using computer-aided-design/computer-aided manufacturing technology and review the existing literature.
Local Injection of Botulinum Toxin Type A to Prevent Postoperative Scar
Authors: Chen Sen , Yang Yan , Zhang Dong , Liu Yun , Li Yangqun 
Published: January 2020

Background:
Physical scars, especially those in the head and neck area, can cause emotional and psychological distress. Recent studies, have suggested that botulinum toxin type A (BTX-A), also known as Botox, may improve surgical scars by speeding up the wound healing process. Injection of BTX-A is generally considered a less invasive approach.

Objectives:
The purpose of this meta-analysis was to assess the efficacy and safety of BTX-A in the prevention of postoperative scars compared to placebo or no treatment.

Materials and methods:
Following databases were searched from inception to March 2019: Cochrane Library, EMBASE, Web of Science, PubMed, and Open grey. Five trials registers were searched for potentially related trials. The authors also searched reference lists of relevant articles and contacted the investigators to identify additional published and unpublished studies.

Data collection and analysis:
Two authors independently evaluated all potential studies that met the selection criteria. Two authors independently extracted and analyzed the data.

Results:
Analysis was conducted on 267 patients who were enrolled in trials and randomly assigned to receive local injection of BTX-A (184 patients) and placebo (182 patients). Improved Vancouver scar scale scores were noted among patients treated with BTX-A injections compared with the control group (P = .000). The visual analogue scale scores revealed a significant improvement in appearance for the BTX-A-treated scars (P = .000). In addition, lower increase in width of the wound was observed in the experimental group compared to the control group (P = .000).

Recommendation:
This systematic review provided preliminary evidence that supports the efficacy and safety of BTX-A for the prevention of postoperative scar.
Comparison of the Clinical Efficacy of Boston Keratoprosthesis Type I and Repetitive Penetrating Keratoplasty for Refractory Keratopathy
Authors: Chen Yingxin , Wang Cuiyu , Liu Qiming , Wang Ziyue , Gao Minghong 
Published: January 2020

Objective:
To compare the clinical efficacy of Boston Keratoprosthesis type I (B-KProI) and penetrating keratoplasty (PKP) for patients with refractory keratopathy after 1failed PKP in China.

Method:
The 42 consecutive cases with refractory keratopathy after 1 failed PKP, from July 2010 to December 2014, were divided into 2 groups according to the surgical method: KPro group (n = 21) and PKP group (n = 21). Visual acuity (LogMAR), corneal graft transparency, postoperative complications and corneal graft survival rate were observed. The follow-up time was 2 years. The Kaplan-Meier curve was used to analyze the survival rate of the two groups of corneal grafts.

Results:
The average best corrected visual acuity (BCVA) at 1, 6, 12, 18, and 24 months in KPro group were significantly lower than PKP group (P < 0.01). The best postoperative visual acuity and BCVA at postoperative 2 years in KPro group were lower than PKP group. The success rate of KPro group (86%) were significantly higher than PKP group (43%) (P < 0.01). There were no significant differences in indicate of complications in 2 groups including secondary glaucoma, secondary infectious corneal ulcer, corneal graft melting and endophthalmitis (P > 0.05).

Conclusion:
Compared with repetitive PKP, B-KProI had a higher success rate, improved postoperative visual acuity, reduced postoperative corneal transplant rejection rates and improved corneal graft survival rate.
Computational Evaluation of Potential Correction Methods for Unicoronal Craniosynostosis
Authors: Bozkurt Selim , Borghi Alessandro , Jeelani Owase , Dunaway David , Schievano Silvia 
Published: January 2020

AbstractUnicoronal craniosynostosis is the second most common type of nonsyndromic craniosynostosis: it is characterized by ipsilateral forehead and fronto-parietal region flattening with contralateral compensatory bossing. It is a complex condition; therefore, which is difficult to treat because of the asymmetry in the orbits, cranium, and face. The aim of this study is to understand optimal osteotomy locations, dimensions, and force requirements for surgical operations of unicoronal craniosynostosis using a patient-specific finite element model and — at the same time — to evaluate the potential application of a new device made from Nitinol which was developed to expand the affected side of a unicoronal craniosynostosis skull without performing osteotomies. The model geometry was reconstructed using Simpleware ScanIP. The bone and sutures were modeled using elastic properties to perform the finite element analyses in MSc Marc software. The simulation results showed that expanding the cranium without osteotomy requires a significant amount of force. Therefore, expansion of the cranium achieved by Nitinol devices may not be sufficient to correct the deformity. Moreover, the size and locations of the osteotomies are crucial for an optimal outcome from surgical operations in unicoronal craniosynostosis.
Simultaneous Surgery for Contouring the Prominent Zygoma and Mandibular Angles With Facelift in Middle-Aged Patients
Authors: Zhou Jing , Qi Zuoliang , Jin Xiaolei 
Published: January 2020

Background:As the pursuit of higher self-attractiveness grows, an increasing number of middle-aged people are unsatisfied with their facial contour and required osteotomy. However, for these patients, performing osteotomy only would accelerate the aging process. Herein, the authors put forward simultaneous surgery for contouring the prominent zygoma and mandible with facelift for elderly patients.Methods:Patients were divided into 3 groups: group A with prominent mandible, group B with protruding zygoma, and group C with prominent mandible and zygoma. By implementing intraoral incision, outer cortex grinding, mandibular angle curved osteotomy, and reduction malarplasty were performed. Through facelift incision, the zygomatic arch was reduced and facelift was conducted. Patients were followed up for at least 12 months and were asked to evaluate their experience.Results:From March 2009 to January 2018, a total of 55 patients received the surgery: 17 patients received mandibular angle osteotomy and facelift, 22 received malarplasty and facelift, and 16 underwent mandible and zygoma contouring and facelift. The recovery process was uneventful, with only 2 patients in group A and 1 patient in group C who suffered from a hematoma, which relieved without surgical intervene. The postoperative images showed smoother facial contours. Patients were satisfied with surgical outcomes. Significant improvements were seen comparing pre- and postoperative photos.Conclusion:Conducting osteotomy and rhytidectomy concurrently results in smooth facial contour and youthful appearance which improves patients’ self-image and contributes to high patients’ satisfaction. With a low complication rate and no long-term complication, the surgery is safe to perform.Level of Evidence:Level IV, the case study.