bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Assessment of Tc-99m Methylene Diphosphonate (MDP) Radiopharmaceutical Prepared Using Different Cold Kit Fractionation Methods
Authors: Thokchom Arun Kumar , Kumar Rajesh , Bharati Sanjay , Vasumathi  
Published: August 2023

Purpose:
Tc-99m Methylene diphosphonate (MDP) is prepared in house by labeling MDP cold kit. Each kit is a single time use vial and contains large amounts of reagent sufficient for preparing multiple doses. Therefore, several centers are adopting the practice of fractionating the MDP kit so that it can be used multiple times. The aim of the study was to evaluate the effect of kit fractionation on radiopharmaceutical property.

Materials and Methods:
The MDP kit was fractionated using two different approaches, namely, vial and syringe method. The quality of Tc-99m MDP prepared using these approaches was assessed and compared with that prepared by the conventional method. The image quality was evaluated in a total of 100 patients.

Results:
The vial and syringe fractionated Tc-99m MDP showed >95% RCP till the 4th and 2nd days of fractionation, respectively. Percentage radiochemical purity deteriorated to 83.6% and 88% on the 8th day of fractionation in the vial and syringe method, respectively. No microbial growth was observed in any of these methods till the 8th day of fractionation. The reconstituted MDP solution during all preparations was clear and colorless in appearance with pH ranging from 6.5 to 7.5. The image contrast, contrast-to-noise, and signal-to-noise ratio were statistically similar in both methods compared to the conventional method until the 2nd day of fractionation. The image quality data showed no statistical difference among images of vial and syringe fractionated MDP as compared to the conventional unfractionated Tc-99m MDP.

Conclusions:
The observations revealed that if fractionated with utmost care, both methods yield almost similar results.
Angiogenesis versus Metabolic Imaging in Locally Advanced Breast Cancer Patients – A Comparative Study
Authors: Kumar Sunil , Vatsa Rakhee , Shukla Jaya , Singh Gurpreet , Bal Amanjit , Mittal Bhagwant Rai 
Published: August 2023

Purpose:
The comparison of angiogenesis imaging (Ga-68-DOTA-Arginine-Glycine-Aspartic Acid [RGD]) positron emission tomography/computed tomography [PET/CT]) with metabolic imaging (F-18 fluorodeoxyglucose [FDG] PET/CT) in primary staging and response assessment to neoadjuvant chemotherapy (NACT) in locally advanced breast cancer (LABC) patients.

Methods:
In this prospective study, 85 female patients with LABC were subjected to two PET/CT studies (Ga-68-DOTA-RGD2 and F-18 FDG) within 1 week of each other. Thirty patients had repeat studies 4 weeks after completing eight cycles of NACT. Response assessment was done by RECIST 1.1 criteria.

Results:
Ga-68-DOTA-RGD2 and F-18 FDG uptake in the primary tumor were seen in all patients. Ipsilateral axillary and internal mammary lymph nodes were detected in 77 (90.5%) versus 80 (94.1%) and 22 (25.8%) versus 27 (31.7%) patients on Ga-68-DOTA-RGD2 and F-18 FDG scans, respectively. Ipsilateral supra-clavicular lymph nodes and skeletal lesions were noted in 17 (20%) versus 21 (24.7%) patients and 23 (27.0%) versus 24 (28.2%) patients on Ga-68-DOTA-RGD2 versus F-18 FDG studies, respectively. However, the Ga-68-DOTA-RGD2 did not show uptake in F-18 FDG avid liver lesions (LLs) in 10 patients, adrenal lesion in one patient, mediastinal lymph nodes in 2 patients, lung nodules, and pleural soft-tissue deposits, each in one patient. In response assessment, 23 and 25 patients had concordance with RECIST1.1 criteria on F-18 FDG and Ga-68-DOTA-RGD2 scans, respectively. However, there were discordant results in four patients on Ga-68-DOTA-RGD2 scan and two patients on F-18 FDG scans.

Conclusion:
Metabolic imaging is better in primary staging and chemotherapy response assessment than angiogenesis imaging in LABC patients. The latter may miss the metastatic soft-tissue deposits, adrenal, and LLs.
Fully Automated Synthesis of Nitrogen-13-NH3 by SHIs HM-18 Cyclotron and Dedicated Module for Routine Clinical Studies
Authors: Akhilesh Singh K. , Shanker Nilesh , Subhash Kheruka C , Sanjay Gambhir , Dixit Manish 
Published: August 2023

Aims:
The production of nitrogen-13 (13N)-NH3 by ethanol method using automated synthesizer and accessing the production yield, quality control for clinical application.

Context:

13N, together with 18F, 15O, and 11C, is one of the positron emitters that can be produced on the multi-gigabecquerel scale in biomedical cyclotrons. (13N)-ammonia is frequently used for cardiac PET studies. It is widely applied for the evaluation of myocardial perfusion in the clinical assessment of cardiac disorders. Simple, fast, and reliable preparation methods have contributed to the routine application of this tracer. Although only two methods are available, a challenge remains to adopt a more efficient and consistent approach to its production. For clinical application, routine production of this tracer is mandatory in compliance with regulatory guidelines. Being at hospital radiopharmacy it is our responsibility to support the clinical service with uninterrupted production and supply of (13N)-NH3.

Materials and Methods:
The chemicals were used commercially available from Sigma Aldrich, India, Ltd., and Fisher Scientific, India, Ltd. (Mumbai, India), Sep-Pak CM cartridges (Waters India, Pvt., Ltd.,). Radio-thin layer chromatography was carried out using aluminum sheets precoated with silica gel 60 F254 (E. Merck, India).

Results:
The protocol developed with MPS-100 synthesizer yield (13N)-NH395–97% (EOB) with a synthesis time of around 7 min.

Conclusions:
With the installation of HM-18 cyclotron at our hospital, center is capable to produce (13N)-NH3 of good yield and purity through the ethanol method, for mycocardial perfusion studies. Our protocol is simple, reproducible, and robust.
Utility of WhatsApp in emergency urological practice
Authors: Sharma Aditya Prakash , Singh Saket , Devana Sudheer Kumar , Chaudhary Kapil , Pareek Tarun , Singh Shrawan K. 
Published: August 2023

Introduction:
The messaging application ‘WhatsApp’ is used in clinical practice, often for communication between a medical trainee and a consultant. We designed this study to find the interrater reliability of the data transmitted through this application and validating its use in urological practice.

Materials and Methods:
Clinical details and computerized tomographic (CT) images of 30 patients visiting the urology emergency were posted in a closed WhatsApp group involving three consultants (SKD, APS, and KC). The CT images were posted in the WhatsApp group as Whole Image (WI) and Image of Interest (IOI) format and rated on a scale of 1–5. The consultants formulated a provisional diagnosis and initial management strategy. The interrater reliability of these responses was analyzed in the study.

Results:
Mean WI rating ranged from 3.03 ± 0.61 to 3.73 ± 0.64 (Cronbach alfa [α]-0.494, P = 0.006). Mean IOI rating ranged from 3.4 ± 0.56 to 4.13 ± 0.73 (α-0.824, P < 0.0001). For diagnosis, the proportion of observed agreement (P0) was 83.3% for SKD and APS, 76.6% for SKD and KC, and 73.3% for APS and KC. For management, P0 was 86.6% for APS and KC, 86.6% for SKD and APS, and 80% for SKD and KC.

Conclusions:
WhatsApp Messenger serves to transmit good quality pictures of CT scan images. A reasonable diagnosis and management strategy can be formulated using this app with fair inter-rater reliability.
Robot-assisted laparoscopic ureteral reimplant
Authors: Tyagi Vipin , Pahwa Mrinal , Lodha Praveen , Mistry Tejas , Chadha Sudhir 
Published: August 2023

Introduction:
Open ureteral reimplant has been the gold standard for management of lower ureteric strictures. With the widespread acceptance of robotic surgery, robotic-assisted laparoscopic ureteral reimplant (RALUR) is becoming the preferred choice for performing ureteral reimplant. We present our single-institution and single-surgeon experience of performing RALUR.

Materials and Methods:
We performed a retrospective analysis of 40 patients who underwent RALUR at our institute in the last 5 years. Demographic data were recorded along with presenting complaint and diagnosis. Intraoperative variables included operative and docking time, blood loss, intraoperative complications, technique, and procedure performed. Postoperative data that were analyzed included complications, hospital stay, and outcomes. Patient satisfaction score was calculated using a numerical scale of points 1–6.

Results:
The mean age of patients was 31.5 ± 9.8 years (r = 4–45). Male: female ratio was 3:5. The most common presenting symptom was flank pain, and the most common etiology was iatrogenic strictures in adults and congenital vesicoureteral reflux in children. The mean operative time and blood loss were 135.3 ± 45.1 min (r = 84–221) and 67.7 ± 31.4 ml (r = 32–118), respectively. There were no intraoperative complications and nil conversion to open surgery. The mean length of hospital stay was 4.5 ± 2.3 days (r = 3–9). Radiographic success was achieved in 41 out of 44 ureters. Eighty-five percent of the patients were completely satisfied with robotic approach and its outcomes.

Conclusion:
RALUR is a minimally invasive, safe, feasible, less morbid technique with good outcome.
Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia
Authors: Sivaraman Ananthakrishnan , Ramasamy Vasantharaja , Aarthy P. , Sankar Vinoth , Sivaraman P. B. 
Published: August 2023

Introduction:
With the emergence of multidrug-resistant organisms causing urosepsis after transrectal biopsy of prostate, the need for an alternative approach has increased. We assessed the safety and feasibility of transrectal ultrasound (TRUS) guided free-hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer.

Materials and Methods:
This prospective study was conducted from July 2019 to December 2020 in which patients with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination underwent magnetic resonance imaging-TRUS cognitive fusion transperineal prostate biopsy (target and systematic) using coaxial needle. Demographic, perioperative, and outcome data of 50 consecutive patients were analyzed.

Results:
The mean age of the patients was 69.6 ± 7.61 years, median PSA 13.55 ng/mL (4.17–672) and prostate size 45cc (16–520). Prostate Imaging–Reporting and Data System (PIRADS) 2, 3, 4, and 5 lesions were found in 2, 12, 12, and 24 patients, respectively. Average procedure duration was 20 min (15-40 min) and number of cores ranged from 12 to 38 (median 20). Forty out of fifty (40/50) patients experienced only mild pain with visual analog scale ≤2. Histopathological examination showed adenocarcinoma, benign prostatic hyperplasia, and chronic prostatitis in 41, 5, and 4 patients respectively with 82% cancer detection rate (CDR). Over 95% of cases showed clinically significant cancer (International Society of Urological Pathology class ≥ 2) and 91.7% of patients with PIRADS score 4/5 and 66.7% with PIRADS score 3 had malignancy. Three patients developed complications (two hematuria, one urinary retention), both were managed conservatively and none had urosepsis.

Conclusions:
Free-hand transperineal prostate biopsy by coaxial needle technique under LA is safe and feasible with good tolerability, high CDR, and minimal complications particularly reduced urosepsis.
Comparison of whole-body bone scintigraphy with axial skeleton magnetic resonance imaging in the skeletal evaluation of carcinoma prostate
Authors: Venkatachalapathy Vigneswara Srinivasan Sockkalingam , Rajeshkannan Ramiah , Sarma Manjit , Pooleri Ginil Kumar 
Published: August 2023

Introduction:
Whole-body bone scintigraphy (WBBS) is considered to be the standard of care in the initial skeletal evaluation of patients with carcinoma prostate. Magnetic resonance imaging (MRI) is a potential alternative technique for detecting bone metastasis. The objective of this study was to compare the diagnostic performance of WBBS with a single-photon emission computed tomography–computed tomography (SPECT-CT) correlation of the suspicious WBBS lesions to the axial skeleton (AS)-MRI in diagnosing bone metastasis in patients with carcinoma prostate.

Methods:
WBBS and AS-MRI were both performed during the initial skeletal evaluation in 35 patients of carcinoma prostate with the prostate-specific antigen (PSA) in the range of 10–50 ng/ml. Suspicious lesions on the WBBS were correlated on SPECT CT. The presence or absence of metastasis was determined by best valuable comparator. The validity parameters of WBBS and AS-MRI were computed and compared.

Results:
The sensitivity, specificity, positive predictive value, and negative predictive value of WBBS and AS-MRI for detecting patients with bone metastasis were 55.6%, 88.5%, 62.5%, 85.2% and 100.0%, 96.2%, 90.0%, 100%, respectively. The kappa value and the accuracy of WBBS were 0.457 and 80.0%, respectively. The kappa value and accuracy of AS-MRI were 0.928 and 97.1%, respectively.

Conclusions:
The diagnostic performance of AS-MRI in detecting patients with bone metastasis due to carcinoma prostate is superior to that of WBBS with SPECT-CT correlation of the suspicious lesions in the PSA range of 10–50 ng/ml.
Diagnostic accuracy of urinary aquaporin-1 as a biomarker for renal cell carcinoma
Authors: Cheriyan Abhilash , Nellickal Arun Jose , John Nirmal Thampi , Jeyaseelan Lakshmanan , Kumar Santosh , Devasia Antony , Kekre Nitin 
Published: August 2023

Introduction:
Optimal patient selection plays a vital role in management of renal tumors with the introduction of nephron-sparing approaches and active surveillance. A reliable and accurate diagnostic biomarker will be a useful adjunct to decision-making. We studied the diagnostic accuracy of urinary aquaporin-1 (uAQP-1), an upcoming urinary biomarker, for renal cell carcinoma.

Materials and Methods:
In this prospective biomarker study, urine samples were obtained preoperatively from 36 patients with an imaged renal mass suggestive of RCC and 24 healthy age-matched controls, chosen from among voluntary kidney donors. uAQP-1 concentrations were estimated with a sensitive and specific enzyme-linked immunosorbent assay (ELISA) and normalized by estimation of urinary creatinine. The Mann–Whitney U-test was used to compare differences between any two groups. A receiver operator characteristic (ROC) curve was plotted to analyze the diagnostic accuracy of uAQP-1 for RCC.

Results:
The median uAQP-1 concentration among the cases and controls was 8.78 ng/mg creatinine (interquartile range [IQR]: 5.56–12.67) and 9.52 ng/mg creatinine (IQR: 5.55–12.45), respectively. There was no significant difference in uAQP-1 concentrations between the two groups. ROC analysis showed that, for a cutoff value of 8 ng/mg creatinine, the sensitivity and specificity of uAQP-1 as a diagnostic test were 47.2% and 66.7%, respectively, and area under the curve was 0.52 (95% confidence interval: 0.42–0.62).

Conclusions:
uAQP-1 concentrations did not discriminate between healthy individuals and patients with RCC. The results of this study suggest that uAQP-1 may not be a suitable diagnostic biomarker for RCC in the study population.
Retrograde intrarenal surgery for renal stones in children <5 years of age
Authors: Chandramohan Vaddi , Siddalingaswamy P. M. , Ramakrishna Paidakula , Soundarya Ganesan , Manas Babu , Hemnath Anandan 
Published: August 2023

Introduction:
There are very few studies in the literature describing retrograde intrarenal surgery (RIRS) in preschool children. We have evaluated the feasibility, stone-free rate, and complications of RIRS in children <5 years of age.

Methods:
All children <5 years of age and stone size <2 cm (renal/proximal ureteric), who underwent RIRS at our hospital from February 2010 to May 2020 were included in this retrospective study. All children were prestented for the passive dilatation of ureter. A 7.5 Fr flexible ureterorenoscope was introduced over the ureteral access sheath (UAS) or over a guidewire. At 2 weeks, the stent was removed and at 2 months the child was evaluated for residual stones.

Results:
A total of 62 children with 67 renal units met the inclusion criteria. The mean age was 42.11 months (4–60 months). Mean weight was 13.31 kg (6–16.3 kg). Mean stone size was 11.9 mm (7.3–18.2 mm). Majority of the stones were in pelvis (37.8%). UAS 9.5/11.5 Fr was placed in 40 (63.5%) children. Mean operative time was 55.2 min; mean hospitalization was 61 h. Four out of the 67 renal units (5.9%) required conversion to minipercutaneous nephrolithotomy in the same sitting, due to access failure. Two cases who developed post-operative fever required a change of antibiotics. Two cases required ureteroscopy for steinstrasse postoperatively. Stone-free rate at 2 months for stones size ≤2 mm was 76.3%.

Conclusion:
Pediatric RIRS is a promising option in young children as it offers acceptable stone-free rates and a low incidence of high-grade complications. However, it requires expertise and should be offered in tertiary care centres.
Right Ventricle Response to Major Lung Resection (the RIVER Study)
Authors: Giustiniano Enrico , Nisi Fulvio , Piccioni Federico , Gambino Francesco , Aceto Romina , Lungu Ramona , Carrara Alfonso , Neganov Maxim , Cecconi Maurizio 
Published: August 2023

Backgrounds:
Major lung resection is associated with high postoperative morbidity and mortality, especially due to cardiorespiratory complications. Right ventricle (RV) ejection, pulmonary artery (PA) pressure, and tone are tightly coupled. Since the RV is exquisitely sensitive to changes in afterload, an acute increase in RV outflow resistance (i.e., acute pulmonary embolism [PE]) will cause acute RV dilatation and, a reduction of left ventricle compliance too, rapidly spiraling to acute cardiogenic shock and death. We investigated the changing in RV performance after major lung resection.

Materials and Methods:
We carried out transthoracic echocardiography (TTE) aiming at searching for the incidence of early RV systolic dysfunction (defined as tricuspid annulus plane systolic excursion [TAPSE] <17 cm, S’-tissue Doppler imaging <10 cm/s) and estimate the RV-PA coupling by the TAPSE/pulmonary artery pressures (PAPs) ratio after major lung resection. The TTE has been performed before and immediately after surgery.

Results:
After the end of the operation the echocardiographic parameters of the RV function worsened. TAPSE decreased from 24 (21 ÷ 28) to 18 (16 ÷ 22) mm (P = 0.015) and PAPs increased from 26 (25 ÷ 30) to 30 (25 ÷ 39) mmHg (P = 0.013). TAPSE/PAPs ratio decreased from 0.85 (0.80 ÷ 0.90) to 0.64 (0.54 ÷ 0.79) mm/mmHg (P = 0.002).

Conclusions:
In line with previous reports, after major lung resection the increase in afterload reduces the RV function, but the impairment remains clinically not relevant. The different clinical picture of an acute cor pulmonale due to PE implies that the pathogenesis of cardiac failure involves more pathways than the mere mechanic occlusion of the blood flow.
Frequency and Clinical Significance of Atrial Cavities in situ Thrombosis: A Large-Scale Study and Literature Review
Authors: Cresti Alberto , Baratta Pasquale , Aloia Elio , Sensi Francesco De , Solari Marco , Limbruno Ugo 
Published: August 2023

Background:
Atrial tachyarrhythmias are the main cause of atrial thrombosis, and are usually in the left appendage. The prevalence and causes of endocavitarian thrombosis have not been investigated in recent large-scale studies. Aim of our work was to describe the epidemiology, the clinical characteristics and predisposing factors of “extra-appendicular” atrial thrombosis and to report a systematic review of recent literature.

Methods and Results:
5,862 consecutive adult patients referred to a transesophageal echocardiographic exam, were enrolled. A total of 175 subjects with Atrial Thrombosis were found with a prevalence of 2.98%; among those 22 was found in left (0.38%) and 2 in the right (0.03%) atrium. Among the 22 patients with left atrial thrombosis, 8 were associated with prosthetic valves, 4 with mitral stenosis and the remaining with hypercoagulative conditions (cancer, septic shock, eosinophilic pneumonia, cardiogenic shock and warfarin under-dosage in permanent atrial fibrillation and decompensated heart failure). Cancer was associated in one of the two patients with a right atrial clot. The review of the literature from 2000 to December 2019 revealed conflicting results of 48 case reports of atrial cavity thrombosis; pooling this data proved the rarity of extra-appendage thrombosis and confirmed its association with a valvular heart disease or a systemic hypercoagulable state.

Conclusions:
Atrial “extra-appendage” thrombosis is a rare condition usually associated to “valvular” atrial fibrillation (such as prosthetic valves and mitral stenosis). A minority, but significant, cases are secondary to a thrombophilic conditions. In absence of valvular heart disease an underlying condition should be sought.
The Influence of Special Military Training on Left Ventricular Adaptation to Exercise in Elite Air Force Soldiers
Authors: Junianto Iwan , Soesanto Amiliana Mardiani , Radi Basuni , Yonas Emir , Kuncoro Ario Soeryo , Atmadikoesoemah Celly Anantaria , Sakti Damba Dwisepto Aulia 
Published: August 2023

Purpose:
The purpose of this study was to observe the influence of level physical training intensity on left ventricular (LV) adaptation in elite air force soldiers compared to regular basic military training.

Methods:
The LV adaptation of special military physical training for elite air force soldiers was compared with basic military training for regular troops. A group of the nonmilitary subject was also evaluated as a control group. The presence of LV adaptation was evaluated using some echocardiography parameters, including LV mass index (LVMI), LV ejection fraction (LVEF), global longitudinal strain (GLS), and myocardial work index. The parameters of the myocardial work index include global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE).

Results:
Forty-three elite air force soldiers underwent special military training, 43 regular troops underwent basic military training, and 23 nonmilitary subjects as a control group. Age, heart rate, blood pressure, and Cooper test results significantly differed among the three groups. Multivariate analysis among all groups showed that the level of physical training was associated with the LVMI (coefficient β = 6.061; 95% confidence interval [CI] = 1.91–10.22; P = 0.005), LVEF (coefficient β = −1.409; 95% CI = −2.41–[−0.41]; P = 0.006), LVGLS (coefficient β = 1.726; 95% CI = 1.20–2.25; P < 0.001), GWW (coefficient β = −13.875; 95% CI = −20.88–[−6.87]; P < 0.001), GWE (coefficient β = 0.954; 95% CI = 0.62–1.26; P < 0.001), GCW (coefficient β = 176.128; 95% CI = 121.16–231.10; P < 0.001), and GWI (coefficient β = 196.494; 95% CI = 144.61–248.38; P < 0.001).

Conclusions:
Higher intensity of physical training observed in a special military training is associated with higher LV GLS, GWE, GCW, GWI, and lower GWW value suggesting greater physiological adaptation than the lower intensity training.