68Ga-DOTATATE-avid pulmonary sclerosing pneumocytoma in a man of North African descent: Case report, imaging findings and pathology.

Pulmonary sclerosing pneumocytoma (PSP) is a benign tumor originating from primitive respiratory epithelium which tends to present as an asymptomatic solitary lesion in the periphery of the lung. It primarily occurs in women, with a 5:1 ratio of female to male, and in East Asian populations. We describe a rare case of a gallium-68 (68Ga)-DOTATATE avid PSP in a middle-aged man of North African ancestry. Contrast-enhanced computed tomography (CT) revealed an enhancing ovoid 2-cm solid lesion within the periphery of the left upper lobe abutting the superior portion of the lateral left ventricular wall. A fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) demonstrated low-level FDG uptake, but a 68Ga-DOTATATE PET/CT showed avid tracer uptake, concerning for a carcinoid tumor. The lesion was surgically excised, and the histopathologic analysis revealed the typical morphologic and histochemical markers of a PSP. We conclude that, although rare, PSP can be a differential consideration when evaluating a 68Ga-DOTATATE-avid solitary lung nodule concerning for carcinoid tumor, in all genders and in ethnicities other than East Asian.

Machine learning combining CT findings and clinical parameters improves prediction of length of stay and ICU admission in torso trauma.

OBJECTIVE: To develop machine learning (ML) models capable of predicting ICU admission and extended length of stay (LOS) after torso (chest, abdomen, or pelvis) trauma, by using clinical and/or imaging data. MATERIALS AND METHODS: This was a retrospective study of 840 adult patients admitted to a level 1 trauma center after injury to the torso over the course of 1 year. Clinical parameters included age, sex, vital signs, clinical scores, and laboratory values. Imaging data consisted of any injury present on CT. The two outcomes of interest were ICU admission and extended LOS, defined as more than the median LOS in the dataset. We developed and tested artificial neural network (ANN) and support vector machine (SVM) models, and predictive performance was evaluated by area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: The AUCs of SVM and ANN models to predict ICU admission were up to 0.87 ± 0.03 and 0.78 ± 0.02, respectively. The AUCs of SVM and ANN models to predict extended LOS were up to 0.80 ± 0.04 and 0.81 ± 0.05, respectively. Predictions based on imaging alone or imaging with clinical parameters were consistently more accurate than those based solely on clinical parameters. CONCLUSIONS: The best performing models incorporated imaging findings and outperformed those with clinical findings alone. ML models have the potential to help predict outcomes in trauma by integrating clinical and imaging findings, although further research may be needed to optimize their performance. KEY POINTS: • Artificial neural network and support vector machine-based models were used to predict the intensive care unit admission and extended length of stay after trauma to the torso. • Our input data consisted of clinical parameters and CT imaging findings derived from radiology reports, and we found that combining the two significantly enhanced the prediction of both outcomes with either model. • The highest accuracy (83%) and highest area under the receiver operating characteristic curve (0.87) were obtained for artificial neural networks and support vector machines, respectively, by combining clinical and imaging features in the prediction of intensive care unit admission.

An Objective Structured Clinical Examination for Medical Student Radiology Clerkships: Reproducibility Study.

BACKGROUND: Objective structured clinical examinations (OSCEs) are a useful method to evaluate medical students' performance in the clerkship years. OSCEs are designed to assess skills and knowledge in a standardized clinical setting and through use of a preset standard grading sheet, so that clinical knowledge can be evaluated at a high level and in a reproducible way. OBJECTIVE: This study aimed to present our OSCE assessment tool designed specifically for radiology clerkship medical students, which we called the objective structured radiology examination (OSRE), with the intent to advance the assessment of clerkship medical students by providing an objective, structured, reproducible, and low-cost method to evaluate medical students' radiology knowledge and the reproducibility of this assessment tool. METHODS: We designed 9 different OSRE cases for radiology clerkship classes with participating third- and fourth-year medical students. Each examination comprises 1 to 3 images, a clinical scenario, and structured questions, along with a standardized scoring sheet that allows for an objective and low-cost assessment. Each medical student completed 3 of 9 random examination cases during their rotation. To evaluate for reproducibility of our scoring sheet assessment tool, we used 5 examiners to grade the same students. Reproducibility for each case and consistency for each grader were assessed with a two-way mixed effects intraclass correlation coefficient (ICC). An ICC below 0.4 was deemed poor to fair, an ICC of 0.41 to 0.60 was moderate, an ICC of 0.6 to 0.8 was substantial, and an ICC greater than 0.8 was almost perfect. We also assessed the correlation of scores and the students' clinical experience with a linear regression model and compared mean grades between third- and fourth-year students. RESULTS: A total of 181 students (156 third- and 25 fourth-year students) were included in the study for a full academic year. Moreover, 6 of 9 cases demonstrated average ICCs more than 0.6 (substantial correlation), and the average ICCs ranged from 0.36 to 0.80 (P<.001 for all the cases). The average ICC for each grader was more than 0.60 (substantial correlation). The average grade among the third-year students was 11.9 (SD 4.9), compared with 12.8 (SD 5) among the fourth-year students (P=.005). There was no correlation between clinical experience and OSRE grade (-0.02; P=.48), adjusting for the medical school year. CONCLUSIONS: Our OSRE is a reproducible assessment tool with most of our OSRE cases showing substantial correlation, except for 3 cases. No expertise in radiology is needed to grade these examinations using our scoring sheet. There was no correlation between scores and the clinical experience of the medical students tested.

Neuroprotective effect of omega-3 polyunsaturated fatty acids in the 6-OHDA model of Parkinson's disease is mediated by a reduction of inducible nitric oxide synthase.

OBJECTIVE: Parkinson's disease (PD) is characterized by deterioration of the nigrostriatal system and associated with chronic neuroinflammation. Glial activation has been associated with regulating the survival of dopaminergic neurons and is thought to contribute to PD through the release of proinflammatory and neurotoxic factors, such as reactive nitric oxide (NO) that triggers or exacerbates neurodegeneration in PD. Polyunsaturated fatty acids (PUFAs) exert protective effects, including antiinflammatory, antiapoptotic, and antioxidant activity, and may be promising for delaying or preventing PD by attenuating neuroinflammation and preserving dopaminergic neurons. The present study investigated the effects of fish oil supplementation that was rich in PUFAs on dopaminergic neuron loss, the density of inducible nitric oxide synthase (iNOS)-immunoreactive cells, and microglia and astrocyte reactivity in the substantia nigra pars compacta (SNpc) and striatal dopaminergic fibers. METHODS: The animals were supplemented with fish oil for 50 days and subjected to unilateral intrastriatal 6-hydroxydopamine (6-OHDA)-induced lesions as a model of PD. RESULTS: Fish oil mitigated the loss of SNpc neurons and nerve terminals in the striatum that was caused by 6-OHDA. This protective effect was associated with reductions of the density of iNOS-immunoreactive cells and microglia and astrocyte reactivity. DISCUSSION: These results suggest that the antioxidant and antiinflammatory properties of fish oil supplementation are closely related to a decrease in dopaminergic damage that is caused by the 6-OHDA model of PD.

Elimination of Transcoarctation Pressure Gradients Has No Impact on Left Ventricular Function or Aortic Shear Stress After Intervention in Patients With Mild Coarctation.

OBJECTIVES: This study sought to investigate the impact of transcatheter intervention on left ventricular function and aortic hemodynamics in patients with mild coarctation of the aorta (COA). BACKGROUND: The optimal method and timing of transcatheter intervention for COA remains unclear, especially when the severity of COA is mild (peak-to-peak transcoarctation pressure gradient <20 mm Hg). Debate rages regarding the risk/benefit ratio of intervention versus long-term effects of persistent minimal gradient in this heterogeneous population with differing blood pressures, ventricular function, and peripheral perfusion. METHODS: We developed a unique computational fluid dynamics and lumped parameter modeling framework based on patient-specific hemodynamic input parameters and validated it against patient-specific clinical outcomes (before and after intervention). We used clinically measured hemodynamic metrics and imaging of the aorta and the left ventricle in 34 patients with mild COA to make these correlations. RESULTS: Despite dramatic reduction in the transcoarctation pressure gradient (catheter and Doppler echocardiography pressure gradients reduced by 75% and 47.3%, respectively), there was only modest effect on aortic flow and no significant impact on aortic shear stress (the maximum time-averaged wall shear stress in descending aorta was reduced 5.1%). In no patient did transcatheter intervention improve left ventricular function (e.g., stroke work and normalized stroke work were reduced by only 4.48% and 3.9%, respectively). CONCLUSIONS: Transcatheter intervention that successfully relieves mild COA pressure gradients does not translate to decreased myocardial strain. The effects of the intervention were determined to the greatest degree by ventricular-vascular coupling hemodynamics and provide a novel valuable mechanism to evaluate patients with COA that may influence clinical practice.

Medical Registry Data Collection Efficiency: A Crossover Study Comparing Web-Based Electronic Data Capture and a Standard Spreadsheet.

BACKGROUND: Electronic medical records and electronic data capture (EDC) have changed data collection in clinical and translational research. However, spreadsheet programs, such as Microsoft Excel, are still used as data repository to record and organize patient data for research. OBJECTIVE: The objective of this study is to assess the efficiency of EDC as against a standard spreadsheet in regards to time to collect data and data accuracy, measured in number of errors after adjudication. METHODS: This was a crossover study comparing the time to collect data in minutes between EDC and a spreadsheet. The EDC tool used was Research Electronic Data Capture (REDCap), whereas the spreadsheet was Microsoft Excel. The data collected was part of a registry of patients who underwent coronary computed tomography angiography in the emergency setting. Two data collectors with the same experience went over the same patients and collected relevant data on a case report form identical to the one used in our Emergency Department (ED) registry. Data collection tool was switched after the patient that represented half the cohort. For this, the patient cohort was exactly 30 days of our ED coronary Computed Tomography Angiography registry and the point of crossover was determined beforehand to be 15 days. We measured the number of patients admitted, and time to collect data. Accuracy was defined as absence of blank fields and errors, and was assessed by comparing data between data collectors and counting every time the data differed. Statistical analysis was made using paired t -test. RESULTS: The study included 61 patients (122 observations) and 55 variables. The crossover occurred after the 30th patient. Mean time to collect data using EDC in minutes was 6.2±2.3, whereas using Excel was 8.0±2.0 (P <.001), a difference of 1.8 minutes between both means (22%). The cohort was evenly distributed with 3 admissions in the first half of the crossover and 4 in the second half. We saw 2 (<0.1%) continuous variable typos in the spreadsheet that a single data collector made. There were no blank fields. The data collection tools showed no differences in accuracy of data on comparison. CONCLUSIONS: Data collection for our registry with an EDC tool was faster than using a spreadsheet, which in turn allowed more efficient follow-up of cases.

Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase

BACKGROUND: Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome.METHODS: This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10-29%, basophils ≥ 20%, platelets > 1 × 106/µL or <1 × 105/µL and white blood cells > 1 × 105/µL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin < 10 g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity.RESULTS: Risk factors for poor survival in multivariate analysis were Grades 3-4 hematologic toxicity (p-value = 0.001), blasts 10-29% (p-value = 0.023), and hemoglobin < 10 g/dL (p-value = 0.04). Risk factors for not achieving major cytogenetic response were blasts 10-29% (p-value = 0.007), hemoglobin < 10 g/dL (p-value = 0.001), and previous use of interferon (p-value = 0.032). Risk factors for progression to the blast phase were hemoglobin < 10 g/dL (p-value = 0.005), basophils ≥ 20% (p-value = 0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment > 12 months (p-value = 0.030).CONCLUSION: These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.

Accelerated phase chronic myeloid leukemia: evaluation of clinical criteria as predictors of survival, major cytogenetic response and progression to blast phase.

BACKGROUND: Published criteria defining the accelerated phase in chronic myeloid leukemia are heterogeneous and little is known about predictors of poor outcome. METHODS: This is a retrospective study of 139 subjects in the accelerated phase of chronic myeloid leukemia treated with imatinib at a single center in Brazil. The objective was to identify risk factors for survival, major cytogenetic response and progression to blast phase in this population. The factors analyzed were: blasts 10-29%, basophils≥20%, platelets>1×10(6)/µL or <1×10(5)/µL and white blood cells>1×10(5)/µL in the peripheral blood, as well as clonal evolution, splenomegaly, hemoglobin<10g/dL, time between diagnosis of chronic myeloid leukemia and imatinib treatment, and hematologic toxicity. RESULTS: Risk factors for poor survival in multivariate analysis were Grades 3-4 hematologic toxicity (p-value=0.001), blasts 10-29% (p-value=0.023), and hemoglobin<10g/dL (p-value=0.04). Risk factors for not achieving major cytogenetic response were blasts 10-29% (p-value=0.007), hemoglobin<10g/dL (p-value=0.001), and previous use of interferon (p-value=0.032). Risk factors for progression to the blast phase were hemoglobin<10g/dL (p-value=0.005), basophils≥20% (p-value=0.023), and time from diagnosis of chronic myeloid leukemia to imatinib treatment>12 months (p-value=0.030). CONCLUSION: These data indicate that patients with the above risk factors have a worse prognosis. This information can guide the therapy to be used.

Multiple intranigral unilateral LPS infusion protocol generates a persistent cognitive impairment without cumulative dopaminergic impairment.

Inflammation in Parkinson's disease (PD) is a continuous process and might be implicated in the progression of neuronal degeneration. Taking this into account, we proposed a new protocol with multiple and consecutive intranigral lipopolysaccharide (LPS) administration in order to analyze its effects on cognitive behavior. Additionally, striatal concentrations of the neurotransmitters dopamine (DA) and serotonin and their respective metabolites were assessed in three different time-points with the purpose of identifying the consecutive and cumulative effects of LPS infusions. We demonstrated that with a minimum administered dose there was stabilization of neuronal damage as revealed by absence of synergic effect on DA concentration. Although the DA decrease (-43%) generates an animal model of early phase of PD, without apparent motor impairment, the LPS group exhibited deficit in episodic-like memory behavior from the first time-point until the last one, indicating persisted disturbances in memory-recognition responses. These findings provide evidence that multiple intranigral LPS infusions are not sufficient to cause cumulative and progressive damage to dopaminergic neurons, but confirm that the LPS model can be adopted as a useful tool providing insight about the cognitive impairment observed in pre-motor phase of PD.

Is San Francisco's "The Shaking Man" an urban depiction of parkinsonism?

Art and Medicine often mingle in the most unexpected ways. One can often find in pictorial art the representation of many medical conditions. The same can happen with sculptures; however, the finding of an urban sculpture in a public space with features of parkinsonism is unique. We reported how "The Shaking Man", an urban sculpture located in the Yerba Buena Gardens in San Francisco, USA, is a contemporary representation of parkinsonism and compared it with other art works in different media that also present such thing to laymen.

Is San Francisco's “The Shaking Man” an urban depiction of parkinsonism? / Seria o “Shaking Man” de São Francisco, Califórnia, uma representação urbana de parkinsonismo?

Art and Medicine often mingle in the most unexpected ways. One can often find in pictorial art the representation of many medical conditions. The same can happen with sculptures; however, the finding of an urban sculpture in a public space with features of parkinsonism is unique. We reported how “The Shaking Man”, an urban sculpture located in the Yerba Buena Gardens in San Francisco, USA, is a contemporary representation of parkinsonism and compared it with other art works in different media that also present such thing to laymen.

Arte e Medicina frequentemente interagem das mais inusitadas maneiras. Muitas condições médicas podem ser encontradas em pinturas acadêmicas. O mesmo pode ocorrer com esculturas; no entanto, encontrar uma escultura em um espaço público exibindo sinais clínicos de parkinsonismo é um achado único. Relatou-se como “The Shaking Man”, que é uma estátua urbana localizada no Yerba Buena Gardens em São Francisco, EUA, pode ser uma representação contemporânea de parkinsonismo e foram realizadas comparações com outras obras de arte em diferentes mídias, as quais também demonstram parkinsonismo para o público leigo.