bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Tool-in-lesion” Accuracy of Galaxy System—A Robotic Electromagnetic Navigation BroncHoscopy With Integrated Tool-in-lesion-Tomosynthesis Technology
Authors: Bhadra Krish , Rickman Otis B. , Mahajan Amit K. , Hogarth Douglas Kyle 
Published: April 2023

Background:
The Galaxy System (Noah Medical) is a novel robotic endoluminal platform using electromagnetic navigation combined with integrated tomosynthesis technology and augmented fluoroscopy. It provides intraprocedural imaging to correct computerized tomography (CT) to body divergence and novel confirmation of tool-in-lesion (TIL). The primary aim of this study was to assess the TIL accuracy of the robotic bronchoscope with integrated digital tomosynthesis and augmented fluoroscopy.

Methods:
Four operators conducted the experiment using 4 pigs. Each physician performed between 4 and 6 nodule biopsies for 20 simulated lung nodules with purple dye and a radio pacifier. Using Galaxy’s “Tool-in-Lesion Tomography (TOMO+)” with augmented fluoroscopy, the physician navigated to the lung nodules, and a tool (needle) was placed into the lesion. TIL was defined by the needle in the lesion determined by cone-beam CT.

Results:
The lung nodule’s average size was 16.3 ± 0.97 mm and was predominantly in the lower lobes (65%). All 4 operators successfully navigated to all (100%) of the lesions in an average of 3 minutes and 39 seconds. The median number of tomosynthesis sweeps was 3 and augmented fluoroscopy was utilized in most cases (17/20 or 85%). TIL after the final TOMO sweep was 95% (19/20) and tool-touch-lesion was 5% (1/20). Biopsy yielding purple pigmentation was also 100% (20/20).

Conclusion:
The Galaxy System demonstrated successful digital TOMO confirmed TIL success in 95% (19/20) of lesions and tool-touch-lesion in 5% (1/20) as confirmed by cone-beam CT. Successful diagnostic yield was achieved in 100% (20/20) of lesions as confirmed by intralesional pigment acquisition.
Differences in Hearing, Balance, and Quality-of-Life Outcomes in Petroclival Versus Nonpetroclival Posterior Fossa Meningiomas
Authors: Gillard Danielle M. , Jiam Nicole T. , Morshed Ramin A. , Bhutada Abhishek S. , Crawford Ethan D. , Braunstein Steve W. , Sabes Jennifer Henderson , Theodosopoulos Philip V. , Cheung Steven W. 
Published: April 2023

Objective
To compare hearing, tinnitus, balance, and quality-of-life treatment outcomes of petroclival meningioma and nonpetroclival cerebellopontine angle meningioma cohorts.

Study Design
A retrospective cohort study of 60 patients with posterior fossa meningiomas, 25 petroclival and 35 nonpetroclival, who were treated at a single tertiary care center between 2000 and 2020.

Intervention
A survey battery that included the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing, Tinnitus Functional Index, Dizziness Handicap Inventory (DHI), and Short Form Health Survey. Petroclival and nonpetroclival cohorts were matched for tumor size and demographic features.

Main Outcome Measures
Differences between groups in hearing, balance outcomes, and quality of life and patient factors that influence posttreatment quality of life.

Results
Petroclival meningioma patients reported poorer audiovestibular outcomes with a higher rate of deafness in the tumor ear (36.0% versus 8.6%, p = 0.032) and lower functional hearing by the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing (76.6 [6.1] versus 82.0 [4.4], p < 0.001). Current dizziness rate was higher (48.0% versus 23.5%, p = 0.05), with more severe dizziness by DHI (18.4 [4.8] versus 5.7 [2.2], p < 0.001). Both cohorts had similar high quality of life and low tinnitus severity indices. Quality-of-life Short Form Health Survey predictors were tumor size (p = 0.012) and DHI (p = 0.005) in multivariable analysis.

Conclusions
Hearing and dizziness treatment outcomes of petroclival meningioma are poorer relative to other posterior fossa meningiomas. Despite audiovestibular outcome distinctions, the overall posttreatment quality of life was high for both petroclival and nonpetroclival meningioma.
The Role of Telemedicine for Evaluation and Management of Dizzy Patients: A Systematic Review
Authors: Meinhardt Gerek , Perez Nicole , Sharrer Christine , Ratmeyer Paul , Van Maele Nicholas , Robinson Lauren , Adkins David , Schuh Marissa , Bush Matthew L. 
Published: April 2023

Objectives
To conduct a scoping systematic review of the literature on the use of telemedicine to evaluate, diagnose, and manage patients with dizziness.

Data Sources
Web of Science, SCOPUS, and MEDLINE PubMed databases.

Study Selection
The inclusion criteria included the following: pertaining to telemedicine and the evaluation, diagnosis, treatment, or management of dizziness. Exclusion criteria included the following: single-case studies, meta-analyses, and literature and systematic reviews.

Data Extraction
Outcomes recorded for each article included the following: study type, patient population, telemedicine format, dizziness characteristics, level of evidence, and quality assessment.

Data Synthesis
The search returned 15,408 articles, and a team of four screened the articles for inclusion criteria status. A total of 9 articles met the inclusion criteria and were included for review. Of the nine articles, four were randomized clinical trials, three were prospective cohort studies, and two were qualitative studies. The telemedicine format was synchronous in three studies and asynchronous in six studies. Two of the studies involved acute dizziness only, four involved chronic dizziness only, one involved both acute and chronic dizziness, and two did not specify dizziness type. Six of the studies included the diagnosis of dizziness, two involved the evaluation of dizziness, and three involved treatment/management. Some of the reported benefits of telemedicine for dizziness patients included cost savings, convenience, high patient satisfaction, and improvement in dizziness symptoms. Limitations included access to telemedicine technology, Internet connectivity, and dizziness symptoms interfering with the telemedicine application.

Conclusions
Few studies investigate the evaluation, diagnosis, or management of dizziness using telemedicine. The lack of protocols and standards of care for telemedicine evaluation of dizzy patients creates some challenges in care delivery; however, these reviewed studies provide examples of the breadth of care that has been provided remotely.
The ongoing impact of COVID-19 on testing for and diagnoses of HIV and bacterial sexually transmitted infections in Oregon
Authors: Menza Timothy W. , Zlot Amy , Gonzalez-Pena Yuritzy , Capizzi Jeff , Bush Lea , Humphrey Sarah , Kapoor Hema , Moore Rebecca , Garai Jillian 
Published: April 2023

Abstract

Background
The COVID-19 pandemic has disrupted HIV and sexually transmitted infection (STI) testing accessibility. We sought to assess the longer-term impacts of COVID-19 on HIV and STI testing and diagnosis in Oregon.

Methods
First, we examined HIV, Neisseria gonorrhoeae (NG)/Chlamydia trachomatis (CT), and syphilis tests conducted at the Oregon State Public Health Laboratory (public sector) and a large commercial laboratory (private sector) and HIV, NG, CT, and primary and secondary (P&S) syphilis diagnoses in Oregon from 1/1/2019-12/31/2021. We compared monthly testing and diagnosis rates in five pre-specified time periods: pre-COVID-19 (1/2019-2/2020), stay-at-home order (3/2020-5/2020), reopening (6/2020-12/2020), vaccine availability (1/2021-6/2021), and Delta/early Omicron spread (7/2021-12/2021). Second, we calculated the number of HIV and STI diagnoses per test in the public and private sectors. Finally, we used seasonal autoregressive integrated moving average (SARIMA) models to predict expected HIV and STI diagnoses for comparison to those observed.

Results
Both public and private sector HIV and bacterial STI testing fell to nadirs in April 2020 with incomplete recovery to 2019 levels by the close of 2021. Compared to pre-COVID-19, public sector and private sector testing was significantly lower in all subsequent time periods. Compared to pre-COVID-19, P&S syphilis cases were 52%, 75%, and 124% greater in the reopening, vaccine availability, and Delta/early Omicron periods, respectively. From 3/2020-12/2021, we observed an excess of P&S syphilis cases (+37.1%; 95%CI: 22.2%, 52.1%) and a deficit in CT cases (-10.7%; 95%CI: -15.4%, -6.0%).

Conclusions
By 12/2021, HIV/STI testing had not recovered to pre-COVID-19 levels and HIV/STI continue to be underdiagnosed. Despite decreased testing, P&S syphilis cases have increased substantially.
Geosexual Archetype, Preventive Behaviors, and Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men
Authors: Dharma Christoffer , Guimond Tim , Salway Travis , Lachowsky Nathan J. , Card Kiffer G. , Gesink Dionne 
Published: April 2023

Background
Social geography plays an important role in transmission of sexually transmitted infections (STIs) among men who have sex with men. Previous qualitative work had identified 7 “geosexual archetypes,” each with distinct travel patterns for sex and potentially important differences in STI rates. The objective of this article was to explore what could be learned about STI transmission by looking at STI prevention strategies (condom use and preexposure prophylaxis use) and prevalence of STIs among these geosexual archetypes.

Methods
We analyzed data from the Sex Now 2019 online survey in Canada. Men who have sex with men who reported 3 or more partners in the past 6 months were included in the analysis (n = 3649).

Results
The most common archetype was “geoflexible” (sex at home, partner's home, and other places; 35.6%), followed by “privates” (sex only at own/partner's home; 23.0%); the least common archetypes was “rover” (sex not at home or partner's place; 4.0%). There were significant variations in both STI prevention strategies and prevalence of bacterial STIs in the past year by geosexual archetype. In particular, among those who were HIV negative, those who reported a geoflexible archetype and used preexposure prophylaxis but did not use condoms consistently had a 52.6% prevalence of bacterial STIs, which was much higher compared with all other groups. Within other archetypes, those living with HIV had the highest prevalence of bacterial STIs.

Conclusions
Geosexual archetype together with participant's STI prevention strategies was a strong predictor of bacterial STI risk. Understanding how place is connected to bacterial STIs is key in prevention as individuals do not live in isolation.
Differential screening for non-viral sexually transmitted infections by type of vaginitis testing
Authors: Pinto Casey N. , Jung Molly , Wimmer Megan , Goldblatt Claudia , Sweeney Nicole , Broache Molly , Van Der Pol Barbara 
Published: April 2023

ABSTRACT

Background
Data are lacking on adherence to Centers for Disease Control and Prevention testing guidelines among insured US women presenting with vaginal health complaints; thus, we quantified vaginitis testing frequency and assessed the co-testing rate for causes of vaginitis and Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).

Methods
This was a retrospective analysis of de-identified data from a medical database. Information from women, ages 18-50 years, was obtained from the Truven MarketScan Commercial Database (2012-2017) using Current Procedural Technology codes; chi-square testing was applied to determine co-testing differences for CT/NG based on vaginitis test type. Odds ratios were calculated to determine the association with CT/NG screening across vaginitis testing categories.

Results
Approximately 48% of 1,359,289 women received a vaginitis diagnosis that involved a laboratory-based test. Of these women only 34% were co-tested for CT/NG. CT/NG co-testing was highest for those with nucleic acid amplification testing for vaginitis and lowest for those with no vaginitis testing Current Procedural Technology code (respectively, 71% vs 23%, P < 0.0001).

Conclusions
The vaginitis nucleic acid amplification test, indicated by CPT code, was associated with statistically significant, higher CT/NG testing rates. Molecular diagnostics may support vaginitis testing in settings that have limited opportunities for microscopy and clinical exams and offer greater opportunity to offer comprehensive women’s healthcare that includes testing for chlamydia and/or gonorrhea infections.
Characterization of Vaginal Microbial Community Dynamics in the Pathogenesis of Incident Bacterial Vaginosis, a Pilot Study
Authors: Elnaggar Jacob H. , Lammons John W. , Taylor Christopher M. , Toh Evelyn , Ardizzone Caleb M. , Dong Amy , Aaron Kristal J. , Luo Meng , Tamhane Ashutosh , Lefkowitz Elliot J. , Quayle Alison J. , Nelson David E. , Muzny Christina A. 
Published: April 2023

Abstract

Background
Despite over 60 years of research, the etiology of bacterial vaginosis (BV) remains controversial. In this pilot study, we utilized shotgun metagenomic sequencing to characterize vaginal microbial community changes prior to the development of incident BV (iBV).

Methods
A cohort of African American women with a baseline healthy vaginal microbiome (no Amsel Criteria, Nugent Score 0-3 with no Gardnerella vaginalis morphotypes) were followed for 90 days with daily self-collected vaginal specimens for iBV (≥2 consecutive days of a Nugent score of 7-10). Shotgun metagenomic sequencing was performed on select vaginal specimens from 4 women, every other day for 12 days prior to iBV diagnosis. Sequencing data were analyzed through Kraken2 and bioBakery 3 workflows, and specimens were classified into community state types (CSTs). Quantitative PCR (qPCR) was performed to compare the correlation of read counts to bacterial abundance.

Results
Common BV-associated bacteria such as G. vaginalis, Prevotella bivia, and Fannyhessea vaginae were increasingly identified in the participants prior to iBV. Linear modeling indicated significant increases in G. vaginalis and F. vaginae relative abundance prior to iBV, while the relative abundance of Lactobacillus spp. declined over time. The Lactobacillus spp. decline correlated with the presence of Lactobacillus phages. We observed enrichment in bacterial adhesion factor genes on days prior to iBV. There were also significant correlations between bacterial read counts and abundances measured by qPCR.

Conclusions
This pilot study characterizes vaginal community dynamics prior to iBV and identifies key bacterial taxa and mechanisms potentially involved in the pathogenesis of iBV.
Artificial Intelligence: Singularity Approaches
Authors: TerKonda Sarvam P. , TerKonda Anurag A. , Sacks Justin M. , Kinney Brian M. , Gurtner Geoff C. , Nachbar James M. , Reddy Sashank K. , Jeffers Lynn L. 
Published: April 2023

Summary:
Artificial intelligence (AI) has been a disruptive technology within health care, from the development of simple care algorithms to complex deep-learning models. AI has the potential to reduce the burden of administrative tasks, advance clinical decision-making, and improve patient outcomes. Unlocking the full potential of AI requires the analysis of vast quantities of clinical information. Although AI holds tremendous promise, widespread adoption within plastic surgery remains limited. Understanding the basics is essential for plastic surgeons to evaluate the potential uses of AI. This review provides an introduction of AI, including the history of AI, key concepts, applications of AI in plastic surgery, and future implications.
Evaluation of Safety, Biodistribution, and Dosimetry of a Long-Acting Radiolabeled Somatostatin Analog 177Lu-DOTA-EB-TATE With and Without Amino Acid Infusion
Authors: Jiang Yuanyuan , Liu Qingxing , Wang Guochang , Zhang Jingjing , Zhu Zhaohui , Chen Xiaoyuan 
Published: April 2023

Purpose
Kidney is considered to be one of the dose-limiting organs in peptide receptor radionuclide therapy (PRRT). Amino acid cocktail infusion has been applied to reduce renal absorbed dose by inhibiting the proximal tubular reabsorption of the radiopeptide. An Evans blue-modified 177Lu-labeled octreotate (177Lu-DOTA-EB-TATE) has an extended circulation in the blood, which may make the amino acid infusion unnecessary. The aim of this study was to evaluate the safety, biodistribution, and dosimetry of 177Lu-DOTA-EB-TATE with and without amino acid infusion.

Patients and Methods
Ten patients with metastatic neuroendocrine tumors were randomly divided into 2 groups. The effect of amino acid infusion on renal uptake was assessed in a crossover randomized setting. Group A received 177Lu-DOTA-EB-TATE at a dose of 3.7 GBq without amino acid infusion for the first cycle and with amino acid infusion for the second cycle; group B received 177Lu-DOTA-EB-TATE at a dose of 3.7 GBq with amino acid infusion for the first cycle and without amino acid infusion for the second cycle. All patients underwent serial whole-body planar imaging at 1, 24, 96, and 168 hours and SPECT scan at 24 hours after radioligand administration. Abdominal CT was performed 2 days before PRRT for SPECT/CT fusion. The dosimetry was calculated using the HERMES software. Dosimetry evaluation was compared on a between-group and intrapatient basis.

Results
Administrations of 177Lu-DOTA-EB-TATE with or without amino acids were well tolerated. No grade 4 hematotoxicity was observed in any of the patients. Grade 3 thrombocytopenia was reported in 1 patient. No nephrotoxicity of any grade was recorded. No significant difference was observed in creatinine (75.1 ± 21.7 vs 67.5 ± 18.1 μmol/L, P = 0.128), blood urea nitrogen (4.5 ± 0.8 vs 5.1 ± 1.4 mmol/L, P = 0.612), or GFR (109.3 ± 25.2 vs 100.9 ± 24.9 mL/min, P = 0.398) before and after PRRT. For each cycle, there was no significant difference in whole-body effective dose, kidney effective dose, as well as residence time of the kidneys between group A and B (P > 0.05). By intrapatient comparison, without and with amino acid infusion also did not show significant difference in whole-body effective dose (0.14 ± 0.05 vs 0.12 ± 0.04 mSv/MBq, P = 0.612), kidney effective dose (1.09 ± 0.42 vs 0.73 ± 0.31 mSv/MBq, P = 0.093), and residence time of the kidneys (2.95 ± 1.58 vs 3.13 ± 1.11 hours, P = 0.674).

Conclusions

177Lu-DOTA-EB-TATE PRRT with and without amino acid infusion demonstrated a favorable safety profile in neuroendocrine tumor patients. Administration of 177Lu-DOTA-EB-TATE without amino acid infusion has acceptable slightly increased kidney absorbed dose and residence time of the kidneys, and does not affect kidney function. Further investigation in a larger cohort and long-term follow-up are warranted.
68Ga-PSMA PET/CT Detecting Metastatic Lesion of RCC
Authors: Jha Saurav , Hemrom Angel , Shamim Shamim Ahmed , Barwad Adarsh , Batra Atul 
Published: April 2023

Abstract
Renal cell carcinoma (RCC) accounts for ~2% of global cancers and deaths. Survival depends on initial staging and shows poor survival rate in metastatic disease. CT and MRI are used for evaluating RCC, and PET/CT is used for metastatic disease assessment. We report a case of RCC, where both 18F-FDG and 68Ga-PSMA PET/CT showed increased uptake in liver metastatic lesions; however, a subhepatic peritoneal deposit showed uptake only in PSMA. Also, liver lesions were seen better in PSMA owing to lesser background uptake, suggesting a possibility of 68Ga-PSMA being a potential tracer for RCC evaluation.
Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric trauma center
Authors: Russell Katie W. , Iantorno Stephanie E. , Iyer Rajiv R. , Brockmeyer Douglas L. , Smith Karch M. , Polukoff Natalya E. , Larsen Kezlen E. , Barnes Kacey L. , Bell Teresa M. , Fenton Stephen J. , Inaba Kenji , Swendiman Robert A. 
Published: April 2023

INTRODUCTION
Efficient and accurate evaluation of the pediatric cervical spine (c-spine) for both injury identification and posttraumatic clearance remains a challenge. We aimed to determine the sensitivity of multidetector computed tomography (MDCT) for identification of cervical spine injuries (CSIs) in pediatric blunt trauma patients.

METHODS
A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. All pediatric trauma patients age younger than 18 years who underwent c-spine imaging (plain radiograph, MDCT, and/or magnetic resonance imaging [MRI]) were included. All patients with abnormal MRIs but normal MDCTs were reviewed by a pediatric spine surgeon to assess specific injury characteristics.

RESULTS
A total of 4,477 patients underwent c-spine imaging, and 60 (1.3%) were diagnosed with a clinically significant CSI that required surgery or a halo. These patients were older, more likely to be intubated, have a Glasgow Coma Scale score of <14, and more likely to be transferred in from a referring hospital. One patient with a fracture on radiography and neurologic symptoms got an MRI and no MDCT before operative repair. All other patients who underwent surgery including halo placement for a clinically significant CSI had their injury diagnosed by MDCT, representing a sensitivity of 100%. There were 17 patients with abnormal MRIs and normal MDCTs; none underwent surgery or halo placement. Imaging from these patients was reviewed by a pediatric spine surgeon, and no unstable injuries were identified.

CONCLUSION
Multidetector computed tomography appears to have 100% sensitivity for detecting clinically significant CSIs in pediatric trauma patients, regardless of age or mental status. Forthcoming prospective data will be useful to confirm these results and inform recommendations for whether pediatric c-spine clearance can be safely performed based on the results of a normal MDCT alone.

LEVEL OF EVIDENCE
Diagnostic Tests or Criteria; Level IV.