bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time of Observation in Xenobiotic Ingestions in Children
Authors: Capua Maya , Amlicke Maire , Esposito Emily , Belfer Joshua , Bellis Mitchell , Falkowitz Daria , Teng David 
Published: April 2022

Objectives
Children endure a prolonged observation after xenobiotic ingestions, despite low associated morbidity and mortality. The primary objective was to describe the management and outcomes of acute xenobiotic exposures in asymptomatic pediatric patients presenting to the emergency department (ED). A secondary objective was to explore the impact of vital signs on the patients' management and outcomes.

Methods
We conducted a retrospective review of asymptomatic children (younger than 18 years) presenting to a pediatric ED after a toxic ingestion from 2014 to 2018. Ingestions of hydrocarbons, acetaminophen, salicylates, sulfonylureas, caustic, and/or extended release agents were excluded. Demographic and clinical data were abstracted.

Results
Of 2817 charts, we identified 109 asymptomatic patients with a mean age of 4.7 years. The average observation from registration to disposition was 4.06 hours. Five patients were admitted and were subsequently discharged within 24 hours. Of the discharged patients, 2 returned within 72 hours and were subsequently discharged home. A total of 321 asymptomatic patients presented with ≥1 abnormal vital signs (mean age, 6.6 years) and were observed in the ED for an average of 4.54 hours. They had a higher percentage of ingestions related to suicide attempts (odds ratio, 6.8). Twenty-two were admitted. Of those discharged home, 11 returned to the ED within 72 hours; all were subsequently discharged home.

Conclusions
Prolonged observations may not be necessary after ingestions in asymptomatic children. Vital sign abnormalities at presentation did not impact disposition. Prospective studies are needed to determine the safety and efficacy of this shortened observation.
Changes in the Pattern of Superficial Lymphatic Drainage of the Abdomen after Abdominoplasty
Authors: Bassalobre Milena , Liebano Richard Eloin , da Silva Milla Pompilio , Castiglioni Mário Luiz Vieira , Sadala Adria Yared , Ferreira Lydia Masako , Nahas Fabio Xerfan 
Published: April 2022

Background:
The changes in the pattern of lymphatic drainage of the superficial abdominal wall after abdominoplasty are still unknown. These changes may increase the risk of numerous complications, including seroma formation. Depending on the alterations, the manual lymphatic drainage technique should be modified in postoperative patients. The aim of this study was to map the pattern of lymphatic drainage of the superficial infraumbilical abdominal wall after abdominoplasty.

Methods:
Twenty women with indications for abdominoplasty were selected in the Plastic Surgery Division of the Federal University of São Paulo. Intradermal lymphoscintigraphy with dextran 500–99m-technetium was performed in 20 female patients in the preoperative phase and 1 and 6 months after abdominoplasty to evaluate superficial lymphatic drainage of the abdominal wall.

Results:
Before surgery, all patients presented with abdominal lymphatic drainage toward the inguinal lymph nodes. One and 6 months after abdominoplasty, only 15 percent exhibited the same drainage pathway. Drainage toward the axillary lymph node chain occurred in 65 percent of the patients, 10 percent displayed a drainage pathway toward both the axillary and inguinal lymph nodes, and lymphatic drainage was indeterminate in 10 percent of the cases.

Conclusions:
A significant change in lymphatic drainage pathway occurred in the infraumbilical region after abdominoplasty. The axillary drainage path was predominant after the operation, in contrast to the inguinal path observed in the preoperative period. However, 35 percent of cases exhibited alternative drainage. No significant changes were documented between 1 and 6 months postoperatively.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Versatility of the Fixed-Mobile Septal Extension Graft for Nasal Tip Reshaping
Authors: Rohrich Rod J. , Chamata Edward S. , Alleyne Brendan , Bellamy Justin L. 
Published: April 2022

Summary:
Key goals of nasal tip reshaping include precise control of tip shape and position, along with restoration of proper structural support. Unfortunately, traditional techniques attempting to address these goals have yielded unpredictable results. In this article, the authors detail their surgical technique and discuss the numerous aesthetic and functional benefits of this graft, along with its applicability to a wide variety of patient populations and nasal deformities. The authors’ technique utilizing the fixed-mobile septal extension graft has demonstrated reliability in establishing proper tip positioning through precise adjustments to tip rotation and projection, while simultaneously providing a stable structure for maintaining tip support. While fixed at the anterior septal angle, this graft also proves beneficial in maintaining natural tip mobility because of its anterior extension past the septum. The fixed-mobile septal extension graft is versatile and reliable when used for tip reshaping and support.
Occupational Prevention of COVID-19 Among Healthcare Workers in Primary Healthcare Settings: Compliance and Perceived Effectiveness of Personal Protective Equipment
Authors: Abed Alah Muna Talal Theyab , Abdeen Sami , Selim Nagah , Tayar Elias , Bougmiza Iheb 
Published: April 2022

Objectives
It is crucial for healthcare workers (HCWs) to comply with infection prevention and control precautions such as the appropriate use of personal protective equipment (PPE) for their safety and the safety of patients. In this study, we aimed to assess HCWs’ compliance with the appropriate use of PPE in primary healthcare settings in Qatar along with its associated factors and explore their perceived effectiveness of different PPE items in protecting against COVID-19 infection.

Methods
A Web-based survey was conducted between November 2020 and January 2021 targeting all clinical HCWs under the umbrella of Primary Health Care Corporation.

Results
A total of 757 HCWs completed the survey, and most were between 30 and 39 years of age (50.2%), females (62.7%), and nurses (35.3%). Eighty eight percent of participants believed that PPE could provide high or very high protection against COVID-19. About one-half (53%) were found to be fully compliant with PPE use during patient interactions with suspected or confirmed COVID-19 cases, whereas three-quarters (76.3%) were fully compliant while performing aerosol-generating procedures. Healthcare workers’ age, nationality, health center region, area of work, clinical experience, frequency of interaction with suspected or confirmed COVID-19 cases, and the perceived effectiveness of PPE were significant predictors of full compliance with PPE. Shortage of PPE was the commonest reported barrier to appropriate use.

Conclusions
Despite HCWs’ high perceived effectiveness for PPE in protecting against COVID-19 infection, their full compliance rate with using PPE was moderate and needs further improvement.
Comparing Hospital Length of Stay Risk-Adjustment Models in US Value-Based Physician Payments
Authors: Ghosh Arnab K. , Ibrahim Said , Lee Jennifer , Shapiro Martin F. , Ancker Jessica 
Published: April 2022

Backgroung and Objectives:
Under the Affordable Care Act, the US Centers for Medicare & Medicaid Services created Physician Value-Based Payment Modifier Program and its successor the Merit-Based Incentive Payment System to tie physician payments to quality and cost. The addition of hospital length of stay (LOS) to these value-based physician payment models reflects its increasing importance as a metric of health care cost and efficiency and its association with adverse health outcomes. This study compared the Centers for Medicare & Medicaid Services–endorsed LOS risk-adjustment methodology with a novel methodology that accounts for pre-hospitalization clinical, socioeconomic status (SES), and admission-related factors as influential factors of hospital LOS.

Methods:
Using the 2014 New York, Florida, and New Jersey State Inpatient Database, we compared the observed-to-expected LOS of 2373102 adult admissions for 742 medical and surgical diagnosis-related groups (DRGs) by 3 models: (a) current risk-adjustment model (CRM), which adjusted for age, sex, number of chronic conditions, Elixhauser comorbidity score, and DRG severity weight, (b) CRM but modeling LOS using a generalized linear model (C-GLM), and (c) novel risk-adjustment model (NRM), which added to the C-GLM covariates for race/ethnicity, SES, discharge destination, weekend admission, and individual intercepts for DRGs instead of severity weights.

Results:
The NRM disadvantaged physicians for fewer medical and surgical DRGs, compared with both the C-GLM and CRM models (medical DRGs: 0.49% vs 13.17% and 10.89%, respectively; surgical DRGs: 0.30% vs 13.17% and 10.98%, respectively). In subgroup analysis, the NRM reduced the proportion of physician-penalizing DRGs across all racial/ethnic and socioeconomic groups, with the highest reduction among Whites, followed by low SES patients, and the lowest reduction among Hispanic patients.

Conclusions:
After accounting for pre-hospitalization socioeconomic and clinical factors, the adjusted LOS using the NRM was lower than estimates from the current Centers for Medicare & Medicaid Services–endorsed model. The current model may disadvantage physicians serving communities with higher socioeconomic risks.
Automated Detection, Segmentation, and Classification of Pleural Effusion From Computed Tomography Scans Using Machine Learning
Authors: Sexauer Raphael , Yang Shan , Weikert Thomas , Poletti Julien , Bremerich Jens , Roth Jan Adam , Sauter Alexander Walter , Anastasopoulos Constantin 
Published: April 2022

Objective
This study trained and evaluated algorithms to detect, segment, and classify simple and complex pleural effusions on computed tomography (CT) scans.

Materials and Methods
For detection and segmentation, we randomly selected 160 chest CT scans out of all consecutive patients (January 2016–January 2021, n = 2659) with reported pleural effusion. Effusions were manually segmented and a negative cohort of chest CTs from 160 patients without effusions was added. A deep convolutional neural network (nnU-Net) was trained and cross-validated (n = 224; 70%) for segmentation and tested on a separate subset (n = 96; 30%) with the same distribution of reported pleural complexity features as in the training cohort (eg, hyperdense fluid, gas, pleural thickening and loculation). On a separate consecutive cohort with a high prevalence of pleural complexity features (n = 335), a random forest model was implemented for classification of segmented effusions with Hounsfield unit thresholds, density distribution, and radiomics-based features as input. As performance measures, sensitivity, specificity, and area under the curves (AUCs) for detection/classifier evaluation (per-case level) and Dice coefficient and volume analysis for the segmentation task were used.

Results
Sensitivity and specificity for detection of effusion were excellent at 0.99 and 0.98, respectively (n = 96; AUC, 0.996, test data). Segmentation was robust (median Dice, 0.89; median absolute volume difference, 13 mL), irrespective of size, complexity, or contrast phase. The sensitivity, specificity, and AUC for classification in simple versus complex effusions were 0.67, 0.75, and 0.77, respectively.

Conclusion
Using a dataset with different degrees of complexity, a robust model was developed for the detection, segmentation, and classification of effusion subtypes. The algorithms are openly available at https://github.com/usb-radiology/pleuraleffusion.git.
Hepatic Angiosarcoma With Diffuse Increased 18F-FDG Uptake on PET/CT
Authors: Zhou Ziang , Lu Xia , Wang Wei , Yang Jigang 
Published: April 2022

Abstract
A 51-year-old woman was diagnosed with fulminant hepatic failure based on laboratory indexes. Contrast-enhanced CT demonstrated numerous, widespread lesions in all segments of the liver. 18F-FDG PET/CT showed the abundant foci of increased 18F-FDG uptake in the enlarged liver. The liver transplantation was performed due to fulminant hepatic failure. Postoperative pathology demonstrated diffused hepatic angiosarcoma, which should be included in the differential diagnosis of diffuse 18F-FDG uptake hepatic lesions on PET/CT.
Incremental Value of 18F-PSMA-1007 PET/CT in Detection of Metastatic Renal Cell Carcinoma to the Brain
Authors: Sadeq Alyaa , Usmani Sharjeel , Esmail Abdulredha A. , Fathallah Wael , Alfeeli Mahmoud A. , Marafi Fahad 
Published: April 2022

Abstract

18F-PSMA PET/CT is an emerging standard of care in staging prostate cancer, evaluating biochemical recurrence and response to therapy. Despite the nomenclature, PSMA expression is also documented at the tumor-associated neovasculature of other malignant solid tumors including renal cell carcinoma. We report a case of 44-year-old man known to have renal cell carcinoma who underwent 18F-PSMA and 18F-FDG PET/CT for restaging after radical nephrectomy. A well-defined solitary cerebellar lesion with marked PSMA expression and equivocal FDG uptake was noted. MRI brain confirmed a matching cerebellar metastatic lesion. 18F-PSMA expression in the metastatic RCC raises a prospective guide to futuristic theragnostic uses.
First-in-Human Experience With 177Lu-DOTAGA.(SA.FAPi)2 Therapy in an Uncommon Case of Aggressive Medullary Thyroid Carcinoma Clinically Mimicking as Anaplastic Thyroid Cancer
Authors: Ballal Sanjana , Yadav Madhav Prasad , Moon Euy Sung , Rösch Frank , ArunRaj Sreedharan Thankarajan , Agarwal Shipra , Tripathi Madhavi , Sahoo Ranjit Kumar , Bal Chandrasekhar 
Published: April 2022

Abstract
A 56-year-old man was diagnosed with calcitonin negative, plasma chromogranin A–positive, immunohistochemistry-negative, high-grade MTC (medullary thyroid cancer) behaving clinically like anaplastic thyroid cancer and presented with progressive disease after conventional therapies. A theranostic approach of 68Ga-DOTA.SA.FAPi–guided 177Lu-DOTAGA.(SA.FAPi)2 radionuclide therapy was administered on compassionate grounds as per the Declaration of Helsinki because known standard lines of treatment were ineffective. Treatment with a single cycle of 1.65 GBq 177Lu-DOTAGA.(SA.FAPi)2 demonstrated a sustainable reduction in the neck mass with significant improvement in the quality of life of the patient. 177Lu-DOTAGA.(SA.FAPi)2 is a potential theranostic option for high-grade MTC refractory to standard therapeutic options.
FDG PET/CT in a Patient With Syphilis Suspected of Having Penile Cancer
Authors: Jakobsen Jakob Kristian , Szumniak Joanna , Stilling Christina , Fledelius Joan , Bouchelouche Kirsten 
Published: April 2022

Abstract
A 58-year-old man with large penile wound and enlarged regional lymph node was suspected of having disseminated penile cancer. FDG PET/CT for primary staging showed high FDG uptake on penis and in several enlarged lymph nodes. However, biopsies revealed no signs of malignancy, but ulceration, inflammation, fibrosis, and spirochetes. Furthermore, Wassermann test was positive. The patient was then treated for syphilis. To our knowledge, this is the first report on FDG PET/CT in a patient suspected of having penile cancer that turned out to be syphilis. Thus, syphilis can be added to the list of benign pitfalls in FDG PET/CT.
Comparison of 18F-FDG and 68Ga-FAPI PET/CT in Gastric Kaposi Sarcoma
Authors: Tatar Gamze , Beyhan Ediz , Erol Fenercioğlu Özge , Arslan Esra , Çermik Tevfik Fikret 
Published: April 2022

Abstract
Herein, we present the results of 18F-FDG PET/CT and 68Ga-FAPI-4 PET/CT of a patient with metastatic Kaposi sarcoma. A 47-year-old man with suspected gastric cancer was referred to 18F-FDG PET/CT for diagnosis and staging. PET/CT detected increased 18F-FDG uptake in metastatic lymphadenopathies and liver lesions. 68Ga-FAPI-4 PET/CT was performed for ongoing clinical trial. Although 68Ga-FAPI-4 PET/CT may be a better alternative than 18F-FDG for the imaging of primary tumoral infiltrations in the stomach, 18F-FDG seems to be a more useful agent for the Kaposi sarcoma in determining the extent of the disease and the localization of metastatic lesions.
FDG PET/CT in Metastatic Spindle Cell Sarcoma of Penile Origin
Authors: Kale Shubham Anil , Agrawal Archi , Menon Santosh , Joshi Amit , Murthy Vedang , Bakshi Ganesh , Prakash Gagan , Purandare Nilendu , Shah Sneha , Puranik Ameya , Rangarajan Venkatesh 
Published: April 2022

Abstract
Spindle cell sarcoma is a connective tissue tumor usually involving bone or muscle. Penis is an unusual and very rare site for the primary involvement of the tumor, especially mesenchymal tumor. We here present a case of a 27-year-old man diagnosed with spindle cell sarcoma of penile origin in which FDG PET/CT was done as part of workup.
Vaccine-Related Lymph Nodes
Authors: Ah-Thiane Loic , Ferrer Ludovic , Maucherat Bruno , Fleury Vincent , Le Thiec Maelle , Rusu Daniela , Rousseau Caroline 
Published: April 2022

Purpose
Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18F-FDG PET/CT.
We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18F-FDG.

Patients and Methods
Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs.

Results
Of the 226 patients in our cohort study, 120 patients underwent an 18F-fluorocholine PET/CT, 79 a 68Ga-PSMA-11 PET/CT, 6 an 18F-FDOPA PET/CT, and 21 a 68Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18F-fluorocholine and 12.7% (10/79 patients) with 68Ga-PSMA-11. None of our patients undergoing 18F-FDOPA or 68Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical (P < 10−4), with the number of vaccine doses received (P = 0.041), with a short delay between vaccination and PET/CT realization (P < 10−5), and with a higher prostate-specific antigen level for patients with PCa (P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area.

Conclusions
Detecting positive LNs after COVID-19 vaccination is not an exclusive 18F-FDG PET/CT pattern but is common on 18F-fluorocholine and possible on 68Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18F-FDOPA or 68Ga-DOTATOC PET/CT, this seems to have a lesser impact.
Double Trap Escape
Authors: Wang Sisi , Huang Qifeng , Dong Ke , Qin Chunxia , Wen Guanghua 
Published: April 2022

Abstract
A 55-year-old man was diagnosed with gastric adenocarcinoma. 18F-FDG PET/CT was performed, which detected an enlarged nodule with increased uptake located in the omentum between the transverse colon and liver, thus lymph node metastasis was under suspicion. The patient subsequently underwent 68Ga-FAPI PET/MRI clinical trial after signing the informed consent, which also revealed the abnormal focus with intense uptake. However, the histopathology of the nodule was unexpectedly diagnosed as fibrous hyperplasia after lymphadenectomy.
68Ga-PSMA Uptake in Brain Metastasis of Gastric Carcinoma
Authors: Kesim Selin , Oksuzoglu Kevser 
Published: April 2022

Abstract
A 69-year-old man with a known history of gastric and prostate adenocarcinoma was referred to 68Ga–prostate-specific membrane antigen (PSMA) PET/CT for restaging due to biochemical recurrence of prostate cancer. 68Ga-PSMA PET/CT revealed tracer accumulation in the primary prostatic lesion, lymph node, bone metastases, and brain lesion, which was later confirmed on biopsy to be metastasis of gastric carcinoma. This case reminds us of the variable spectrum of 68Ga-PSMA uptake in prostatic and nonprostatic metastatic lesions, the potential pitfalls on PET/CT images in the workup of patients with concomitant malignancies.
A Challenge for Emphysema Quantification Using a Deep Learning Algorithm With Low-dose Chest Computed Tomography
Authors: Choi Hyewon , Kim Hyungjin , Jin Kwang Nam , Jeong Yeon Joo , Chae Kum Ju , Lee Kyung Hee , Yong Hwan Seok , Gil Bomi , Lee Hye-Jeong , Lee Ki Yeol , Jeon Kyung Nyeo , Yi Jaeyoun , Seo Sola , Ahn Chulkyun , Lee Joonhyung , Oh Kyuhyup , Goo Jin Mo 
Published: April 2022

Purpose:
We aimed to identify clinically relevant deep learning algorithms for emphysema quantification using low-dose chest computed tomography (LDCT) through an invitation-based competition.

Materials and Methods:
The Korean Society of Imaging Informatics in Medicine (KSIIM) organized a challenge for emphysema quantification between November 24, 2020 and January 26, 2021. Seven invited research teams participated in this challenge. In total, 558 pairs of computed tomography (CT) scans (468 pairs for the training set, and 90 pairs for the test set) from 9 hospitals were collected retrospectively or prospectively. CT acquisition followed the hospitals’ protocols to reflect the real-world clinical setting. Using the training set, each team developed an algorithm that generated converted LDCT by changing the pixel values of LDCT to simulate those of standard-dose CT (SDCT). The agreement between SDCT and LDCT was evaluated using the intraclass correlation coefficient (ICC; 2-way random effects, absolute agreement, and single rater) for the percentage of low-attenuated area below −950 HU (LAA−950 HU), κ value for emphysema categorization (LAA−950 HU, <5%, 5% to 10%, and ≥10%) and cosine similarity of LAA−950 HU.

Results:
The mean LAA−950 HU of the test set was 14.2%±10.5% for SDCT, 25.4%±10.2% for unconverted LDCT, and 12.9%±10.4%, 11.7%±10.8%, and 12.4%±10.5% for converted LDCT (top 3 teams). The agreement between the SDCT and converted LDCT of the first-place team was 0.94 (95% confidence interval: 0.90, 0.97) for ICC, 0.71 (95% confidence interval: 0.58, 0.84) for categorical agreement, and 0.97 (interquartile range: 0.94 to 0.99) for cosine similarity.

Conclusions:
Emphysema quantification with LDCT was feasible through deep learning-based CT conversion strategies.