bluuebunny/crossref_metadata_2025_split huggingface dataset:
National Survey of Feeding Tube Verification Practices
Authors: Bourgault Annette M. , Powers Jan , Aguirre Lillian , Hines Robert B. , Sebastian Ansu T. , Upvall Michele J. 
Published: September 2020

Background
Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used.

Objectives
Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices.

Methods
A national survey of 408 critical care nurses was performed.

Results
The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed.

Discussion
Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems.

Conclusions
Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.
Uptake Within Achilles Tendon on Posttherapy Radioiodine Whole-Body Scan Related to Gouty Tophus
Authors: Ehrhart Mark , Tulchinsky Mark , Blacklock Lisa C. , Elojeimy Saeed 
Published: September 2020

Abstract
A 66-year-old man with history of papillary thyroid cancer status post total thyroidectomy underwent 131I-radioiodine ablation. Posttherapy 131I whole-body scan revealed unexpected activity within the left posterior ankle. SPECT/CT localized the radioiodine uptake to a gouty tophus in the Achilles tendon.
Lenograstim-Induced Nodal Extramedullary Hematopoiesis
Authors: Leroy-Freschini Benjamin , Nicolae Alina , Iltis-Roux Aurore 
Published: September 2020

Abstract
We report the case of a 23-year-old man with nodal EMH (extramedullary hematopoiesis) occurring during treatment for a stage IIA “gray-zone” lymphoma. Although it is often related to myeloproliferative bone marrow disease, benign etiologies such as lenograstim treatment after chemotherapy can also induce EMH and be responsible for false-positive 18F-FDG PET/CT examinations. In this respect, GLUT overexpression in hematopoietic lineages and macrophages of the inflammatory environment are responsible for increased 18F-FDG uptake. Histopathologic confirmation of new hypermetabolic lesions on follow-up PET/CT may be required when the new lesions do not conform with the treatment responses in the preexisting lesions.
PET/CT-Guided Tissue Sampling in Patients With a Failed or Inconclusive CT-Guided Procedure
Authors: Kumar Rakesh , Sharma Anshul , Thulkar Sanjay , Iyer Venkateswaran K. , Sharma Atul 
Published: September 2020

Background
CT-guided tissue sampling is a very effective tool. However, false-negative results are obtained when regions such as necrotic core or surrounding reactive fibrosis and inflammation are sampled. PET/CT-guided sampling can circumvent these limitations.

Purpose
The aim of this study was to analyze the effectiveness of PET/CT-guided sampling in patients with at least 1 instance of failed or inconclusive CT-guided procedure and factors determining the accurate sampling and complications.

Methods
One hundred eleven patients were prospectively included. After feasibility analysis in a diagnostic 18F-FDG PET/CT, sampling was performed in 106 patients (45 women, 61 men; mean age, 48.09 ± 15.42 years; biopsy in 80 and fine-needle aspiration cytology [FNAC] in 26 patients), using robotic arm and a lower IV injection dose of 74 to 111 MBq (2–3 mCi) 18F-FDG. In all patients, final check scans revealed needle at the target site. Using planned needle path as reference, deviations in first check scan were measured. Patient (n = 30) and respiratory motion (n = 57) were also recorded.

Results
Accurate lesion targeting was achieved in 81 cases (63 positive lesions, 12 confounding lesions, and 7 inadequate samples). Lesion was missed in 5 instances, and blood/necrotic tissue sampled in 19. Overall 18F-FDG–avid lesions were accurately targeted in 77.36% of patients (86.25% [biopsy] + 50% [FNAC]). Significant variables affecting targeting were needle gauge, deviation from intended entry point, procedure duration, procedure type, and patient movement. Using binomial regression, the significant parameters were procedure type (biopsy vs FNAC; odds ratio [OR], 5.916; P = 0.002), patient movement (OR, 0.275; P = 0.023), and procedure duration (OR, 1.195; P = 0.011). Overall complication rate was 21.70%, with 4.71% major complications. It was dependent on target depth (mean depth, 69.74 ± 20.29 mm [complications] vs 47.18 ± 22.60 mm; P < 0.001). Positive correlation was seen between the target depth and distance of needle from the intended target (Spearman ρ = 0.307; P = 0.001). In 28 procedures, the physician was asked to wear a pocket dosimeter, who received a mean dose of 2.52 (SD, 3.10) μSv.

Conclusions
PET/CT-guided sampling should be considered where CT-guided biopsy has failed or is inconclusive. The outcome is impacted by needle gauge and patient movement, and complication rate is dependent on target depth.
Dose Calculations and Dose-Effect Relationships in 177Lu-PSMA I&T Radionuclide Therapy for Metastatic Castration-Resistant Prostate Cancer
Authors: Barna Sandra , Haug Alexander R. , Hartenbach Markus , Rasul Sazan , Grubmüller Bernhard , Kramer Gero , Blaickner Matthias 
Published: September 2020

Introduction
Dose response of 22 patients experiencing mCRPC (metastatic castration-resistant prostate cancer) to 177Lu-PSMA I&T radionuclide therapy was investigated. Dosimetry calculations are used to assess correlations between dosimetric quantities and biomarker values.

Methods
The patients’ age range was 74 ± 7 years at the time of the investigated treatment cycle, and the mean injected activity was 7416 ± 218 MBq. Planar images at several time points postinjection were used for evaluation of absorbed doses to organs and lesion. 68Ga-PSMA PET/CT follow-up imaging enabled the determination of individual tumor molecular volume (TMV) shrinkage. Changes in 7 different biomarkers after the first treatment cycle were correlated with the calculated absorbed organ and TMV doses, resulting in a total number of 259 investigated correlations.

Results
Sixty-three TMVs were identified in the bone, lymph node, and liver tissue with an average reduction of 32.3%, 84.7%, and 72.9%, respectively. Absorbed doses per unit of administered activity for organs and lesions show good agreement with previous works (0.77, 0.71, and 0.27 mGy/MBq for parotid gland, kidneys, and liver as well as 4.38, 5.47, and 4.95 mGy/MBq for bone, lymph node, and liver malignancies, respectively). Only 37 of 259 possible correlations turned out to be statistically significant, 26 of which are associated with the absorbed dose of an organ and the decrease of alkaline phosphatases.

Conclusions
Although treatment with 177Lu-PSMA I&T leads to a big reduction of TMV in patients with mCRPC, the lack of correlations calls for studies using voxel-wise dosimetry based on SPECT/CTs.
Dual Thyroid Ectopia and Heterotopic Thyroid Autotransplantation
Authors: Palaniswamy Shanmuga Sundaram , Subramanyam Padma 
Published: September 2020

Abstract
Ectopic thyroid gland can be detected at any age. It is a developmental defect that results from abnormal migration of the primitive thyroid bud. Dual ectopia is very rare, and only a few cases have been reported in literature. Patients with thyroid ectopia may be either euthyroid or hypothyroid. Concept of thyroid autotransplantation is based on restoring euthyroidism and is an attempt to preserve the autoregulatory mechanism of hormone production. This is a case of dual ectopia who underwent heterotopic thyroid autotranplantation. Images demonstrate hypertrophy of the transplanted thyroid tissue with gradual restoration of thyroid trapping function.
68Ga-DOTATOC PET for Treatment Efficacy Evaluation of Cardiac Sarcoidosis
Authors: Imperiale Alessio , Poindron Vincent , Martinez Matias , Ohlmann Patrick , Schindler Thomas H. , El Ghannudi Soraya 
Published: September 2020

Abstract
Cardiac sarcoidosis (CS) has a poor prognosis related to life-threating arrhythmias and heart failure. Treatment includes anti-inflammatory therapies and implantable pacemaker and/or cardioverter defibrillator. The presence of cardiac devices and physiologic myocardial glucose uptake are major limitations of both cardiac magnetic resonance and 18F-FDG PET/CT, reducing their diagnostic value. Somatostatin-based PET/CT has been proposed to detect active CS. Contrarily to 18F-FDG uptake, which reflects nonspecific leukocyte infiltration, 68Ga-DOTATOC may identify active granulomatosis. Herein, we underline the specificity of 68Ga-DOTATOC PET in challeging clinical situations including refractory CS, and chronic CS in patients with cardiac device, or false-positive 18F-FDG PET/CT results.
A Case of Primary Sacral Lymphoma Evaluated by 18F-FDG PET/CT
Authors: Xu Tingting , Fu Wenhui , Zhang Xinyi , Chen Yue 
Published: September 2020

Abstract
Primary sacral lymphoma is an unusual bone malignant tumor that poses a diagnostic challenge. Herein, we report a rare case of primary sacral lymphoma, which was initially assessed as suspicious bone metastasis. The subsequent histology and immunohistochemistry of the sacral biopsy confirmed the diagnosis of diffuse large B-cell lymphoma.
Graft-Versus-Host Disease Presenting as a Myositis and Myonecrosis
Authors: Patel Dhruv M. , Newallo Domnique S. , Barron Bruce 
Published: September 2020

Abstract
Graft-versus-host disease (GVHD) is a major complication of bone marrow transplantation. Polymyositis with myonecrosis is a rare manifestation of GVHD. Here, we report the case of a 32-year-old man with acute myeloid leukemia who developed GVHD after transplant. He subsequently developed polymyositis, which was diagnosed on PET/CT and confirmed on pathology. Treatment with corticosteroids resulted in the resolution of the symptoms. Abnormal muscular FDG uptake resolved on the follow-up PET/CT.
Widespread Metastatic Gastric Signet-Ring Cell Carcinoma Shown by 68Ga-FAPI PET/CT
Authors: Fan Chunlei , Guo Wei , Su Guoqiang , Chen Bo , Chen Haojun 
Published: September 2020

Abstract
The present study compared 68Ga-FAPI and 18F-FDG PET/CT in a patient with GSRCC (gastric signet-ring cell carcinoma). In this case, 68Ga-FAPI PET/CT shows much higher tumor-to-background contrast of primary tumor and reveals more metastatic lesions than 18F-FDG PET/CT. This case demonstrates that 68Ga-FAPI PET/CT outperforms 18F-FDG in identifying both primary and metastatic lesions in GSRCC.
Pembrolizumab Exacerbates Thyroid Diseases Shown on FDG PET/CT
Authors: Wang Xuezhu , Wang Jingnan , Yang Xu , Zhao Haitao , Huo Li 
Published: September 2020

Abstract
A 51-year-old woman with a history of sarcomatoid hepatocellular carcinoma, status post resection, underwent FDG PET/CT. In addition to abnormal activity elsewhere, the images showed focal activity in the isthmus of the thyroid, suggestive of malignant involvement, and diffuse mild activity in the left lobe of the thyroid, suggestive of thyroiditis. After a 10-week anti–PD-1 pembrolizumab therapy, the follow-up FDG PET/CT scan demonstrated much more intense activity in both the isthmus and the left lobe of the thyroid. Pathological examination revealed papillary thyroid cancer in the isthmus and thyroiditis in the left lobe of the thyroid.
68Ga-FAPI Outperforms 18F-FDG PET/CT in Identifying Bone Metastasis and Peritoneal Carcinomatosis in a Patient With Metastatic Breast Cancer
Authors: Pang Yizhen , Zhao Liang , Chen Haojun 
Published: September 2020

Abstract
A 60-year-old woman, previously treated for breast cancer, was referred to gastroenterologists due to persistent abdominal distension. 18F-FDG PET/CT revealed multiple abnormal foci at the skeleton including the bilateral ilium, peritoneum, and omentum. 68Ga-FAPI PET/CT was performed for further detecting the primary lesion, which showed a greater number of bone metastases and higher uptake in peritoneal carcinomatoses than 18F-FDG. Biopsy at the left ilium and omentum indicated metastases from breast cancer. This case highlighted that 68Ga-FAPI may outperforms 18F-FDG PET/CT in identifying bone metastasis and peritoneal carcinomatosis.
Clinical and Striatal Dopamine Transporter Predictors of Mild Behavioral Impairment in Drug-Naive Parkinson Disease
Authors: Yoo Han Soo , Lee Sangwon , Chung Seok Jong , Ye Byoung Seok , Sohn Young H. , Yun Mijin , Lee Phil Hyu 
Published: September 2020

Purpose
Neuropsychiatric symptoms are important and frequent nonmotor features in Parkinson disease (PD). We explored mild behavioral impairment (MBI) in drug-naive patients with PD and its clinical and dopamine transporter (DAT) correlates.

Methods
We recruited 275 drug-naive patients with PD who had undergone Unified Parkinson’s Disease Rating Scale, a neuropsychological battery, Neuropsychiatric Inventory, and N-(3-[18F]fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) PET within 6 months. Patients with PD were divided into groups without MBI (PD-MBI−, n = 186) and with MBI (PD-MBI+, n = 89) according to the Neuropsychiatric Inventory. We performed comparative analysis of DAT availability, cognitive function, and motor deficits between the groups.

Results
Mild behavioral impairment was found in 32.4% of PD patients at the time of diagnosis, and affective dysregulation and decreased motivation were the 2 most common neuropsychiatric domains. Dopamine transporter availability in the anterior caudate (odds ratio, 0.60; P = 0.016) and anterior putamen (odds ratio, 0.58; P = 0.008) was associated with the development of MBI in PD. PD-MBI+ group had a lower z-score in memory-related tests and Stroop color reading test than PD-MBI− group. PD-MBI+ group had a higher Unified Parkinson’s Disease Rating Scale motor score after controlling for DAT availability in the posterior putamen than PD-MBI− group (P = 0.007).

Conclusions
This study suggests that early behavioral impairment is associated with more pathological involvement in the anterior striatum, memory and frontal dysfunction, and motor deficits, which could be regarded as a different phenotype in PD.
Left Ventricular Infected Thrombus Detected by 18F-FDG PET/CT and MRI in Disseminated Staphylococcus Infection
Authors: García Vicente Ana María , Villar García Miguel , Blanch Sancho José Javier , Soriano Castrejón Ángel 
Published: September 2020

Abstract
We present the case of a 61-year-old woman with fever and acute meningitis. Clinical evaluation revealed maculopapular rash, right gluteus cellulitis, and centered retinal hemorrhages. In the intensive care unit, persistent Staphylococcus bacteremia was detected. However, transesophageal echocardiography did not reveal pathologic features. 18F-FDG PET/CT and cardiac MRI diagnosed a left ventricular infected thrombus, an extremely rare condition especially in patients without structural cardiopathy.
Primary Inferior Vena Cava Leiomyosarcoma With Hepatic Metastases on FDG PET/CT
Authors: Zou Sijuan , Zhou Jianyuan , Tang Ming , Wang Ziqing , Zhu Xiaohua 
Published: September 2020

Abstract
Leiomyosarcomas originating from the inferior vena cava are very rare malignant tumors with an extremely poor prognosis. We report FDG PET/CT findings of pathology-proven hepatic metastases from leiomyosarcoma originating from the inferior vena cava in a young woman whose initial presentation was worsening abdominal and chest pain.
Bilateral Epiphora as Only Presenting Sign of Total Paranasal Sinus Aplasia
Authors: Yagci Buket , Mangan Mehmet Serhat , Toslak Iclal Erdem , Balik Ayse Ozlem , Ozogul Murat 
Published: September 2020

Abstract
A 20-year-old female patient was presented with a bilateral epiphora. She had no history of infection or trauma related to the sinus areas. On examination, her facial appearance was abnormal and fullness on the face was observed. The fluorescein dye disappearance test was positive in both eyes. The lacrimal system irrigation was patent nasolacrimal duct. However, the dacryoscintigraphy imaging scan demonstrated bilateral obstruction at the nasolacrimal duct-inferior meatus junction. Nasal endoscopy did not reveal any pathologic findings, and lateral nasal wall, septum, and nasal cavities were normal. The patient was referred to the radiology department for a computed tomography of the paranasal sinus as a preoperative diagnostic imaging for lacrimal intervention. Computed tomography revealed the absence of all paranasal sinuses on both sides as well as absence of the ostiomeatal complex and ethmoidal air cells. Both bony lacrimal canal was narrow. Epiphora may be initial sign of total paranasal sinus aplasia.
Cardiovascular disease and severe hypoxemia associated with higher rates of non-invasive respiratory support failure in COVID-19
Authors: Wang Jing Gennie , Liu Bian , Percha Bethany , Pan Stephanie , Goel Neha , Mathews Kusum S. , Gao Cynthia , Tandon Pranai , Tomlinson Max , Yoo Edwin , Howell Daniel , Eisenberg Elliot , Naymagon Leonard , Tremblay Douglas , Chokshi Krishna , Dua Sakshi , Dunn Andrew , Powell Charles , Bose Sonali 
Published: September 2020

ABSTRACTRationaleAcute hypoxemic respiratory failure (AHRF) is the major complication of coronavirus disease 2019 (COVID-19), yet optimal respiratory support strategies are uncertain.ObjectivesTo describe outcomes with high-flow oxygen delivered through nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) in COVID-19 AHRF and identify individual factors associated with failure.MethodsWe performed a retrospective cohort study of hospitalized adults with COVID-19 treated with HFNC and/or NIPPV to describe rates of success (live discharge without endotracheal intubation (ETI)), and identify characteristics associated with failure (ETI and/or in-hospital mortality) using Fine-Gray sub-distribution hazard models.ResultsA total of 331 and 747 patients received HFNC and NIPPV as the highest level of non-invasive respiratory support, respectively; 154 (46.5%) in the HFNC cohort and 167 (22.4%) in the NIPPV cohort were successfully discharged without requiring ETI. In adjusted models, significantly increased risk of HFNC and NIPPV failure was seen among patients with cardiovascular disease (subdistribution hazard ratio (sHR) 1.82; 95% confidence interval (CI), 1.17-2.83 and sHR 1.40; 95% CI 1.06-1.84), respectively, and among those with lower oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) ratio at HFNC and NIPPV initiation (sHR, 0.32; 95% CI 0.19-0.54, and sHR 0.34; 95% CI 0.21-0.55, respectively).ConclusionsA significant proportion of patients receiving non-invasive respiratory modalities for COVID-19 AHRF achieved successful discharge without requiring ETI, with lower success rates among those with cardiovascular disease or more severe hypoxemia. The role of non-invasive respiratory modalities in COVID-19 related AHRF requires further consideration.
Functional immunoparalysis characterized by elevated Interleukin-10 and Interleukin-10- to-Lymphocyte Count Ratio is associated with severe disease and poor outcomes in coronavirus disease 2019 (COVID-19)
Authors: Henry Brandon Michael , Benoit Stefanie W. , Vikse Jens , Berger Brandon A. , Pulvino Christina , Hoehn Jonathan , Rose James , de Oliveira Maria Helena Santos , Lippi Giuseppe , Benoit Justin L. 
Published: September 2020

ABSTRACTObjectivesSevere coronavirus disease 2019 (COVID-19) is associated with a dysregulated immune state, called cytokine storm. While research has focused on the hyperinflammation, little research has been performed on the compensatory anti-inflammatory response which if severe may lead to a state of functional immunoparalysis. The aim of this study was to evaluate the anti-inflammatory response to COVID-19, by assessing interleukin-10 (IL-10) and IL-10/lymphocyte count ratio and their association with patient outcomes.MethodsAdult patients presenting to the emergency department (ED) with laboratory-confirmed COVID-19 were recruited. The primary endpoint was peak COVID-19 severity within 30 days of index ED visit. Additional endpoints included COVID-19 severity at ED disposition, development of severe acute kidney injury (AKI) or secondary bacterial infections.ResultsA total of 52 COVID-19 patients were enrolled. IL-10 and IL-10/lymphocyte count were significantly higher in patients with severe disease at both time points (all p<0.05), as well as in those who developed severe AKI and secondary bacterial infection (all p≤0.01). In multivariable analysis, a one-unit increase in IL-10 was associated with 42% increased odds of severe COVID-19 (p=0.031), whilst a one-unit increase IL-10/lymphocyte ratio was also associated with 32% increase in odds of severe COVID-19 (p=0.013).ConclusionsThe hyperinflammatory response to COVID-19 is accompanied by a simultaneous anti-inflammatory response, which is associated with poor outcomes and may increase the risk of secondary bacterial infections. IL-10 and IL-10/lymphocyte ratio at ED presentation were independent predictors of COVID-19 severity. Functional immunoparalysis in COVID-19 requires further investigation to enable more precise immunomodulatory therapy against SARS-CoV-2.