bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study of Correlation Between Tympanic Membrane Perforation Size With Hearing Loss in Patients With Inactive Mucosal Chronic Otitis Media
Authors: Kolluru Kartik , Kumar Sunil , Upadhyay Prabhakar 
Published: October 2020

Purpose:
This study is directed towards establishing a correlation between the objective measurement of tympanic membrane (TM) perforation size with hearing loss in patients with inactive mucosal chronic otitis media (COM), and to compare the otoscopic findings of the TM perforation vis-a-vis the results obtained by image analysis of the endoscopic image of the perforation.

Materials and methods:
An observational, prospective and hospital based study was performed on 107 ears (78 patients) with inactive mucosal chronic otitis media. Objective measurement of the TM perforation size was done by capturing the images of the perforation on ImageJ analysis software. A correlation was established between the hearing loss and the perforation with respect to its size and location. The accuracy of the otoscopic finding of the perforation was established with respect to the endoscopic image of the perforation.

Results:
The extent of the hearing loss was seen to increase with increasing size of the TM perforation (r = 0.435, p < 0.0001). Posterior perforations had a 12% greater hearing loss than anterior perforations but this was significant only at the frequency of 500 Hz (p = 0.02). There was a positive correlation between the otoscopic estimation of the size of the perforation with the endoscopically obtained image.

Conclusion:
Hearing loss in chronic otitis media is directly proportional to the size of the TM perforation and posteriorly based perforations have worse audiometric thresholds at lower frequencies (500 Hz).
The role of endocrine-disrupting chemicals in uterine fibroid pathogenesis
Authors: Bariani Maria Victoria , Rangaswamy Roshni , Siblini Hiba , Yang Qiwei , Al-Hendy Ayman , Zota Ami R. 
Published: October 2020

Purpose of review
Uterine leiomyoma (fibroids) is a gynecologic disorder impacting the majority of women in the United States. When symptomatic, these noncancerous tumors can cause severe morbidity including pelvic pain, menorrhagia, and infertility. Endocrine-disrupting chemicals (EDCs) may represent a modifiable risk factor. The aim of this review is to summarize recent human and experimental evidence on EDCs exposures and fibroids.

Recent findings
Multiple EDCs are associated with fibroid outcomes and/or processes including phthalates, parabens, environmental phenols, alternate plasticizers, Diethylstilbestrol, organophosphate esters, and tributyltin. Epidemiologic studies suggest exposure to certain EDCs, such as di-(2-ethylhxyl)-phthalate (DEHP), are associated with increased fibroid risk and severity. Both human and experimental studies indicate that epigenetic processes may play an important role in linking EDCs to fibroid pathogenesis. In-vitro and in-vivo studies show that DEHP, bisphenol A, and diethylstilbestrol can impact biological pathways critical to fibroid pathogenesis.

Summary
While research on EDCs and fibroids is still evolving, recent evidence suggests EDC exposures may contribute to fibroid risk and progression. Further research is needed to examine the impacts of EDC mixtures and to identify critical biological pathways and windows of exposure. These results could open the door to new prevention strategies for fibroids.
Testosterone therapy: where do the latest guidelines agree and differ?
Authors: Pelzman Daniel L. , Hwang Kathleen 
Published: October 2020

Purpose of review
The incidence of testosterone deficiency and number of men on testosterone therapy (TTh) has increased significantly over the past 3 decades. This rise has been accompanied by controversies surrounding the indications and possible adverse effects of therapy. To better inform prescribing habits among providers, many major medical associations have devised guidelines regarding the diagnosis and management of testosterone deficiency. While these guidelines agree in many areas, there are some key differences that should be identified. This review will explore the similarities, differences, and rationale for these guidelines.

Recent findings
Over the past 7 years, much attention has been devoted to the implications of TTh on cardiac health. All reviewed guidelines include dedicated sections discussing these implications and the society's position on prescribing testosterone considering recent findings, however, differ on specific contraindications to TTh and when to initiate therapy after a cardiovascular event. In addition, the American College of Physicians released its first guideline earlier this year which may impact prescribing habits among primary care physicians.

Summary
The differences between testosterone deficiency guidelines may indicate gaps in our knowledge of testosterone deficiency and focuses of future research efforts. Prescribers should be aware of these differences and discuss all treatment options with their patients.
Hypogonadism and metabolic syndrome: review and update
Authors: Berg William T. , Miner Martin 
Published: October 2020

Purpose of review
The prevalence of metabolic syndrome and hypogonadism continues to rise in the United States and around the world. These two conditions are inexorably linked, and understanding their relationship with each other is key to treating men with either of these conditions.

Recent findings
Testosterone has been shown to be a key regulator in the maintenance of metabolic homeostasis. A large volume of research has found that testosterone deficiency is closely linked to metabolic syndrome through complex physiologic mechanisms of endothelial dysfunction, inflammation, and glucose metabolism.

Summary
Interventions through lifestyle modification and testosterone replacement in hypogonadal men may reduce the morbidity and mortality risks associated with metabolic syndrome.
The value of 4D fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis of lung lesions
Authors: Zhang Lixia , Chen Jinyan , Xu Caiyun , Zhang Yin , Qi Lili , Zhang Xiyan 
Published: October 2020

Objective
This study aimed to assess the clinical value of 4D fluorine-18-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) in the differential diagnosis for lung lesions.

Patients and methods
Fifty-eight patients with lung lesions including lung cancer, pneumonia nodules, and benign pulmonary nodules were enrolled. The PET/CT scan was performed immediately (15 min of dynamic scan), at 60 min (early scan), and at 120 min (delayed scan) after the injection of 18F-FDG. The time-activity curves (TACs) were generated from the dynamic PET. The maximum standardized uptake value (SUVmax) of each lesion at early and delayed scans was measured, and the retention index of SUVmax (RI-SUVmax) was calculated. The cutoff values for SUVmax were determined.

Results
Lung cancer lesions (27/31, 87.1%) exhibited a continuously rising slope of TAC, whereas pneumonia lesions (13/15, 86.66%) and benign pulmonary nodules (12/12, 100%) exhibited a continuously decreasing slope of TAC. The early-SUVmax and delayed-SUVmax in the pneumonia group were significantly lower than those in the lung cancer group, whereas notably higher than those in the benign pulmonary nodules group. The diagnostic accuracy was: delayed-SUVmax > early-SUVmax > RI-SUVmax.

Conclusion
The 4D 18F-FDG PET/CT exhibited excellent performance with high accuracy in the dynamic PET/CT.
Predictive value of sentinel lymph node imaging and biopsy in early cervical cancers: correlation with scintigraphic uptake patterns and histology
Authors: Subramanyam Padma , Palaniswamy Shanmuga Sundaram 
Published: October 2020

Aim
This study was designed to 1) assess the feasibility, standardization of sentinel lymph node imaging (SLNI) and biopsy in early cervical cancers and also to determine the detection rates. 2) To analyze the SLN uptake pattern and correlate the findings with the histological grades of tumor.

Materials and methods
52 early cervical cancer patients underwent same-day 99mTc sulfur colloid (filtered) SLNI and biopsy with gamma probing. Patients underwent radical hysterectomy, para-aortic and pelvic lymphadenectomy irrespective of sentinel lymph node biopsy (SLNB) findings. We analyzed the colloid transit times, uptake pattern, lymphatic groups involved and histology.

Results
A total of 203 hot nodes (100% detection rate) were detected and harvested. Study showed 100% sensitivity, specificity, and negative predictive value. Internal iliac nodes were predominantly involved. Lymphatic uptake patterns were graded and correlated with tumor histology (Ki index). Transit time was relatively prolonged in patients with aggressive tumors.

Conclusion
SLNI and biopsy in early cervical malignancies are feasible with high detection rate. Scintigraphic patterns of nodal uptake were relevant and found to correlate with the tumor histological grades. We found that nonfocal nodal uptake patterns were mainly encountered in patients with tumors having higher Ki index. Immunohistochemistry further facilitated identification of lymph nodal metastases. The visual grading system, implemented in this study provides a good indication of the degree of impairment of lymphatic drainage. Higher visual scintigraphic grade denotes greater lymphatic tumor burden.
The frequency and malignancy rate of incidental focal breast lesions identified by 18F-fluorodeoxyglucose positron emission tomography
Authors: Andersen Jeannette D. , Zacho Helle D. , Petersen Lars J. 
Published: October 2020

Objective
To evaluate the frequency and malignancy rate of incidental focal uptake of 18F-fluorodeoxyglucose (FDG) in the breast on PET/computed tomography (CT).

Material and methods
All PET/CT scan reports from a single institution from 2010 to 2017 were electronically searched for words or phrases related to FDG uptake in the breast. Potentially eligible PET/CT scans were manually reviewed for the presence of focal incidental findings in the breast, and a final diagnosis was established based on pathology, clinical examinations, and clinical follow-up.

Results
A total of 19 551 PET/CT scans were reviewed, from which 66 patients (0.3%) presented with unexpected focal FDG-avid lesions of the breast. Fifty-three patients (80.3%) had follow-up evaluations. The final diagnosis showed malignancies in 38 patients. Thirty-four patients had biopsy-verified cancer (primary breast cancers, n = 30; metastasis, n = 4), and four patients with known lymphoma showed a tumour response in the breast after chemotherapy. The malignancy rate was 85.0% among patients who underwent biopsy (34 of 40 patients). The SUVmax was significantly higher in patients with a final malignant diagnosis (n = 38) than in those with a benign diagnosis (n = 15) (4.5 ± 2.9 vs. 2.7 ± 1.3, P = 0.03).

Conclusion
Incidental uptake of FDG in the breast was rare. However, the malignancy rate was high among these patients, particularly among patients who had a follow-up biopsy. We recommend biopsy or thorough follow-up in patients with incidental focal uptake of FDG in the breast.
The value of skeletal standardized uptake values obtained by quantitative single-photon emission computed tomography-computed tomography in differential diagnosis of bone metastases
Authors: Zhang Yiqiu , Li Beilei , Yu Haojun , Song Junyi , Zhou Yuhong , Shi Hongcheng 
Published: October 2020

Purpose
The aim of this study was to explore the value of skeletal standardized uptake value (SUV) obtained by quantitative single-photon emission computed tomography-computed tomography (SPECT/CT) in differential diagnosis of bone metastases from benign lesions.

Materials and methods
Retrospective analysis has been conducted to 51 patients with extraskeletal malignant tumors who underwent whole-body bone scan with quantitative SPECT/CT imaging, and there are no more than three hotspots that were visually detected in the SPECT/CT imaging range. Fifty-one patients were enrolled, including 28 men and 23 women with an average age of 58.8 ± 9.5 (37–77) years. A total of 88 hotspots, including 40 benign lesions and 48 metastatic lesions, and corresponding normal sites were obtained. The region of interest (ROI) of the hotspots was sketched. The ROI of the normal bone of the spinal vertebral body adjacent to the lesions or normal bone of the symmetric side of the lesions of other locations was delineated to obtain the maximum SUV (SUVmax) and the average SUV (SUVave).

Results
The SUVmax value of all lesions was 20.73 ± 14.01 (3.90–92.61), and the SUVmax value of the corresponding normal parts was 5.88 ± 2.36 (2.08–12.52). The difference between the two groups was statistically significant (t = 10.343, P < 0.01). The SUVave of all lesions was 8.42 ± 4.81 (37–77), and the SUVave of the corresponding normal sites was 3.10 ± 1.51 (0.65–7.54). The difference between the two groups was statistically significant (t = 11.342, P < 0.01). The SUVmax of metastases was 24.77 ± 16.32 (3.90–92.61), and the SUVmax of benign lesions was 15.89 ± 8.51 (4.68–42.32). The difference between the two groups was statistically significant (t = 3.273, P = 0.002). The SUVave of metastases was 9.09 ± 5.59 (0.81–29.08), and the SUVave of benign lesions was 7.61 ± 3.57 (1.66–17.48). There was no significant difference between the two groups (t = 1.44, P = 0.154). The area under the curve (AUC) values of the SUVmax curves was greater than that of the SUVave curve. AUCs of the SUVmax and SUVave were 0.687 (P = 0.03) and 0.576 (P = 0.223), respectively. SUVmax had greater accuracy for discriminating bone metastasis from benign lesions. Hotspots of the patients with malignant neoplasms in bone SPECT/CT may be discriminated using SUVmax with certain accuracy, and the optimal cutoff value was 17.705.

Conclusion
The SUVmax of bone metastases was significantly larger than that of benign lesions, and there was no significant difference in SUVave between the two groups. Therefore, the SUVmax has a certain value for the differential diagnosis of metastases from benign lesions.
Candidemia Diagnosis With T2 Nuclear Magnetic Resonance in a PICU: A New Approach
Authors: Cendejas-Bueno Emilio , Falces-Romero Iker , Laplaza-González María , Escosa-García Luis , Schuffelmann-Gutierrez Cristina , Romero-Gómez María P. , Verdú-Sánchez Cristina , Calderón-Llopis Belén , Amores-Hernández Irene , Pemán Javier , Gómez-Zamora Ana , Río-García Miguel , Menéndez-Suso Juan José , Rodríguez-Álvarez Diego , Durán-Lorenzo Iría , Pérez-Acosta Elena , Rubio Miguel Rodríguez , Álvarez-Rojas Elena , Martínez-Romillo Paloma Dorao , Goded-Rambaud Federico , de Lorenzo Abelardo García , Maseda Emilio , Mingorance Jesús , de la Oliva Pedro , García-Rodríguez Julio 
Published: October 2020

OBJECTIVES:
Early diagnosis of invasive Candida infections is a challenge for pediatricians, intensivists, and microbiologists. To fill this gap, a new nanodiagnostic method has been developed using manual application of T2 nuclear magnetic resonance to detect Candida species. The aim of this study was to evaluate, prospectively, the usefulness as a tool diagnosis of the T2Candida panel in pediatric patients admitted at the PICU compared with blood culture.

DESIGN:
This is a prospective, observational, and unicentric study to compare T2Candida results with simultaneous blood cultures for candidemia diagnose.

SETTING:
This study was carried out in a 1,300-bed tertiary care hospital with a 16-bed medical-surgical PICU.

PATIENTS:
Sixty-three patients from 0 to 17 years old were enrolled in this study, including those undergoing solid organ transplantation (kidney, liver, pulmonary, multivisceral, intestinal, and heart) and hematopoietic stem cell transplantation.

MEASUREMENTS AND MAIN RESULTS:
Seven patients were positive by the T2Candida test. Only two of them had the simultaneous positive blood culture. T2Candida yielded more positive results than blood cultures.

CONCLUSIONS:
T2Candida might be useful for the diagnosis of candidemia in PICUs. The prevalence of candidemia might be underestimated in this pediatric population. The use of this diagnostic tool in these units may help clinicians to start adequate and timely antifungal treatments.
Outcome of Early Hemostatic Intervention in Children With Sepsis and Nonovert Disseminated Intravascular Coagulation Admitted to PICU: A Randomized Controlled Trial
Authors: El-Nawawy Ahmed A. , Elshinawy Mohamed I. , Khater Doaa M. , Moustafa Azza A. , Hassanein Nehad M. , Wali Yasser A. , Nazir Hanan F. 
Published: October 2020

Objectives:
Evaluation of the outcome of early hemostatic management of disseminated intravascular coagulopathy in patients with severe sepsis/septic shock admitted to PICU, before the development of clinically overt disseminated intravascular coagulopathy.

Design:
Prospective interventional, open label randomized controlled clinical trial.

Setting:
PICU at Alexandria University Children’s Hospital.

Patients:
The study included 80 patients with proven severe sepsis/septic shock in nonovert disseminated intravascular coagulopathy stage. They were randomly assigned into two groups (group 1 and group 2).

Interventions:
Specific intervention was applied for group 1 (plasma transfusion, low-dose unfractionated heparin, and tranexamic acid).

Measurements:
All patients had assessment of Pediatric Index of Mortality 2 score, Pediatric Logistic Organ Dysfunction score, inotropic score, routine laboratory, and hemostatic tests including fibrin degradation products and d-dimers. Disseminated intravascular coagulopathy risk assessment scores were calculated on daily basis.

Results:
Mortality rate was significantly higher in group 2. Progression to overt disseminated intravascular coagulopathy was significantly more common among group 2 patients than group 1 (45% and 10%, respectively) (p < 0.0001). Disseminated intravascular coagulopathyRisk Assessment Scores were significantly higher on the second and fifth days among group 2 patients. The initial specific hemostatic intervention was the only significant predictor of survival and prevention of progression to overt disseminated intravascular coagulopathy.

Conclusions:
Our results suggest that early use of a combination of fresh frozen plasma transfusion, low-dose heparin, and tranexamic acid in children with severe sepsis/septic shock in the “window of opportunity” before the development of overt disseminated intravascular coagulopathy stage was associated with better outcome for survival and prevention of progression to overt disseminated intravascular coagulopathy, with no increase in bleeding risk. Larger multicenter studies are needed to further prove this practice.
Comparison of Prostate-Specific Membrane Antigen PET/CT and Contrast-Enhanced Magnetic Resonance Imaging in Follow-up Assessment of Juvenile Nasal Angiofibroma—A Novel Pilot Study
Authors: Thakar Alok , Sakthivel Pirabu , Arunraj Sreedharan Thankarajan , Bhalla Ashu Seith , Kakkar Aanchal , Kumar Rakesh , Kumar Rakesh 
Published: October 2020

Purpose/BackgroundThe specific identification of residual/recurrent juvenile nasal angiofibroma (JNA) following surgical treatment remains difficult. Contrast MRI and CT may not enable the differentiation of tumor from postsurgical reparative tissue. Functional imaging with prostate-specific membrane antigen (PSMA) PET/CT targeting tumor-associated neovasculature has recently demonstrated universal positive uptake in primary JNA and offers promise of greater accuracy in the detection or exclusion of recurrent/residual JNA.MethodsIn this prospective study, 18 postsurgical JNA patients with high suspicion for residual disease evinced by follow-up MR scan, or nasal endoscopy, or recent epistaxis during September 2018–November 2019 were included. All patients underwent head and neck spot PSMA PET/CT imaging. Postcontrast enhancement of a definite lesion was considered as a criterion for residual/recurrent tumor in contrast-enhanced MRI (CEMRI). In PSMA PET/CT, any abnormal uptake apart from physiological sites in the head and neck was considered as residual lesions. Radiological results were categorized as negative, suspicious, and residual/recurrent tumors. Any discrepancy between CEMRI and PSMA was resolved by surgical biopsies. The sensitivity, specificity, and positive and negative predictive values were separately calculated for CEMRI and PSMA PET/CT for diagnosing residual lesions. The interrater agreement κ value was also calculated.ResultsOn CEMRI evaluation, 14 of 18 patients had residual tumors, 2 had suspicious residual lesions, and 2 had normal postoperative scans. On PSMA PET/CT, 12 of 18 patients had residual tumors, and 6 had normal negative scans. Surgical biopsy in all 4 discordant cases was negative for tumors and revealed only fibrosis. In 1 patient with residual tumor on both scans, discrepancy was noted with regard to tumor extent demonstrated by the 2 scans, and further surgical excision confirmed the imaging findings of PSMA PET/CT as accurate. The sensitivity, specificity, and positive and negative predictive values of CEMRI were 100%, 33.33%, and 75% and 100%, respectively. The sensitivity, specificity, and positive and negative predictive values of PSMA PET/CT were 100% for all parameters. The interrater agreement between the 2 tests (κ) is 0.5 (95% confidence interval, 0.19–0.81).ConclusionsThe68Ga-PSMA PET/CT is noted as more specific than the current standard of CEMRI in the identification of residual/recurrent JNA. It is the first radionuclide imaging scan that has found application in postoperative assessment of JNA.Trial registration:Clinical Trials Registry of India (CTRI/2018/08/015479).
The Impact of Performance Status on Length of Hospital Stay and Clinical Complications Following Liver Transplantation
Authors: Wallace David , Cowling Thomas E. , Walker Kate , Suddle Abid , Gimson Alex , Rowe Ian , Callaghan Chris , Heaton Nigel , van der Meulen Jan , Bernal William 
Published: October 2020

Background.
Impaired pretransplant performance status (PS) is associated with chronic liver disease (CLD). We studied its impact on hospital length of stay (LOS), complications, and readmissions in the first year after liver transplantation.

Methods.
The Standard National Liver Transplant Registry was linked to a hospital administrative dataset, and all first-time liver transplant recipients with CLD aged ≥18 years in England were identified. A modified 3-level Eastern Cooperative Oncology Group score was used to assess PS. Linear- and logistic-fixed effect regression models were used to estimate the effect of specific posttransplant complications and readmissions in the first year after transplantation.

Results.
Six thousand nine hundred sixty-eight recipients were included. Impaired PS was associated with an increased LOS in the initial posttransplant period (comparing ECOG 1–3, adjusted difference 7.2 d; 95% confidence [CI], 4.8-9.6; P < 0.001) and in time spent on the ITU (adjusted difference 1.2 d; 95% CI, 0.4-2.0; P < 0.001). There was no significant association between ECOG status and total LOS of later admissions (adjusted difference, 2.5 d; 95% CI, –0.4-5.5; P = 0.23). Those with a poorer ECOG status had an increased incidence of renal failure (odds ratio, 1.5; 95% CI, 1.1-2.0; P = 0.004) and infection (odds ratio, 1.2; 95% CI, 1.1-1.4; P = 0.02) but not an increased incidence of readmission (odds ratio, 1.2; 95% CI, 0.9-1.5; P = 0.13).

Conclusions.
In liver transplant recipients with CLD, impaired pretransplant PS is associated with prolonged LOS in the immediate posttransplant period but not with LOS of later admissions in the first year after transplantation. Impaired PS increased the risk of renal failure and infection.