Image Timing After COVID-19 Infection in Athletes.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has significantly impacted National Collegiate Athletic Association (NCAA) athletics, with specific concerns for cardiac involvement after infection. Pericardial abnormalities have been seen in up to 39.5% of athletes after COVID-19 infection, while myocardial involvement has been reported at a lower rate of 2.7%. To date, myocardial injury has been seen in 0.6% to 0.7% of athletes when using symptom screening and imaging as clinically indicated, which increases to 2.3% to 3.0% when all athletes with COVID-19 undergo cardiac magnetic resonance (CMR) imaging. PURPOSE: This study will examine whether there exists an ideal time from positive COVID-19 results to obtaining imaging to increase the likelihood of finding abnormalities. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: NCAA athletes at West Virginia University who were found to be COVID-19 positive on routine screening were required to undergo echocardiography (ECG) and CMR. These data were reviewed by cardiology and determined to be normal or abnormal. Statistical analysis with logistic regression and descriptive statistics was performed to evaluate whether a time existed where abnormalities on imaging were most likely to be found. RESULTS: A total of 41 athletes were included in this study. ECG was performed earlier on average than CMR imaging, at 18.2 days versus 27.5 days. No significant difference was found in timing from COVID-19 infection diagnosis and abnormalities seen on imaging for either ECG or CMR imaging. CONCLUSION: The risk of cardiac involvement in athletes in the setting of COVID-19 has already been documented. This study suggests that imaging timing is independent of cardiac involvement with no correlation to specific time periods where more abnormalities may be found. However, CMR imaging showing changes at day 54 after infection suggests cardiac findings can be seen months after imaging. CLINICAL RELEVANCE: Cardiac imaging for athletes after contracting COVID-19 does not show a significant relationship to time of imaging. However, given the cardiac involvement seen months after diagnosis, further examination of prolonged cardiac effects must be carried out.

Altered glutamate-glutamine and amide proton transfer-weighted values in the hippocampus of patients with amnestic mild cognitive impairment: A novel combined imaging diagnostic marker.

Background and purpose: Early diagnosis of amnestic mild cognitive impairment (aMCI) and timely management to delay the onset of Alzheimer's disease (AD) would benefit patients. Pathological metabolic changes of excitatory/inhibitory neurotransmitters and abnormal protein deposition in the hippocampus of aMCI may provide a new clue to imaging diagnosis. However, the diagnostic performance using these hippocampal metabolite measurements is still unclear. We aimed to quantify right hippocampal glutamate-glutamine (Glx) and gamma-aminobutyric acid (GABA) levels as well as protein-based amide proton transfer-weighted (APTw) signals of patients with aMCI and investigate the diagnostic performance of these metabolites. Methods: In this cross-sectional study, 20 patients with aMCI and 20 age- and gender-matched healthy controls (HCs) underwent MEGA Point Resolved Spectroscopy (MEGA-PRESS) and APTw MR imaging at 3 T. GABA+, Glx, and APTw signals were measured in the right hippocampus. The GABA+ levels, Glx levels, Glx/GABA+ ratios, and APTw values were compared between the HCs and aMCI groups using the Mann-Whitney U test. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were used to evaluate MEGA-PRESS and APTw parameters' diagnostic performance. Results: Compared with HCs, patients with aMCI had significantly lower Glx levels in the right hippocampus (7.02 ± 1.41 i.u. vs. 5.81 ± 1.33 i.u., P = 0.018). No significant changes in the GABA+ levels were observed in patients with aMCI (HCs vs. aMCI: 2.54 ± 0.28 i.u. vs. 2.47 ± 0.36 i.u., P = 0.620). In addition, Glx/GABA+ ratios between the two groups (HCs vs. aMCI: 2.79 ± 0.60 vs. 2.37 ± 0.55, P = 0.035) were significantly different. Compared with HCs, patients with aMCI showed higher APTw values in the right hippocampus (0.99 ± 0.26% vs. 1.26% ± 0.28, P = 0.006). The ROC curve analysis showed that Glx, GABA+, Glx/GABA+, and APTw values had an area under the curve (AUC) of 0.72, 0.55, 0.70, and 0.75, respectively, for diagnosing aMCI. In the ROC curve analysis, the AUC of the combination of the parameters increased to 0.88, which is much higher than that observed in the univariate analysis (P < 0.05). Conclusion: The combination of right hippocampal Glx levels and APTw values improved the diagnostic performance for aMCI, indicating it as a promising combined imaging diagnostic marker. Our study provided a potential imaging diagnostic strategy of aMCI, which may promote early detection of aMCI and facilitate timely intervention to delay the pathological progress toward AD.

Computed tomography and anatomy of the abdominal structures in the giant anteater (Myrmecophaga tridactyla).

The giant anteater (Myrmecophaga tridactyla) is the largest of the Neotropical vermilinguans. This animal is the second mammal most frequently run over on the roads of Cerrado biome, Brazil. Therefore, it is pivotal to know the anatomy of this species to contribute to the clinical care of these animals. Thus, the aim of this study was to identify the anatomical structures in the abdominal region of the giant anteater using computed tomography (CT). For this, the tomographic analysis was performed in sequential order in the craniocaudal direction in five giant anteaters. Moreover, four giant anteater corpses were used for anatomical studies, where two corpses were sectioned in cross sections of approximately 3 cm each, and two animals were dissected to identify the abdominal organs. The association between CT and anatomical study allowed the visualization of anatomical structures found in the abdominal cavity, such as the topographic anatomy facilitates the identification of organs on CT images. The findings of this study demonstrated that CT is a good technique to provide detailed information about the anatomical structures in the abdominal cavity and that this study can be used as CT and anatomical reference for veterinarians who care for wild animals.

Diagnóstico Errôneo de Angiossarcoma Cardíaco na Era COVID-19 / Misdiagnosis of a Cardiac Angiosarcoma During the COVID-19 Pandemic

Resumo Os últimos meses de 2019 foram marcados pelo surgimento de uma nova pandemia, denominada "COVID-19". Desde então, essa infecção e suas complicações têm sido a prioridade de profissionais de saúde, com muitos sintomas atribuídos às suas apresentações precoces e tardias. Até o momento, outras doenças, mesmo em situações fatais, têm sido negligenciadas ou diagnosticadas incorretamente devido à atribuição dos sintomas do paciente à presença da infecção por COVID-19. Apresentamos aqui um caso de angiossarcoma cardíaco, em um menino que, cerca de 2 meses antes, havia sido infectado com COVID-19. Dado o histórico de infecção, a abordagem inicial foi o manejo da miopericardite pós-COVID-19. No entanto, o quadro do paciente piorou, exigindo reavaliação por multimodalidades com maior precisão. Por fim, o paciente foi diagnosticado com um tumor cardíaco. Este artigo procura enfatizar a importância da atenção a outras doenças e condições fatais na era COVID-19, com ênfase em evitar diagnósticos incorretos de outras doenças.

Abstract The final months of 2019 saw the emergence of a new pandemic termed "COVID-19". Since then, this infection and its complications have been the priority of healthcare providers, with many symptoms attributed to its early and late presentations. Thus far, other diseases, even fatal situations, have been overlooked or misdiagnosed due to the attribution of patient symptoms to the presence of COVID-19 infection. We herein present a case of cardiac angiosarcoma in a young boy who had previously become infected with COVID-19 about two months earlier. Given the history of infection, the initial approach was post-COVID-19 myopericarditis management. However, the patient's condition worsened, necessitating reevaluation via multimodalities with higher precision. Ultimately, the patient was diagnosed with a cardiac tumor. This article seeks to underscore the significance of taking heed of other diseases and fatal conditions during the COVID-19 pandemic with an emphasis on avoiding misdiagnosing other diseases.

[Patent foramen ovale as the cause of recurrent embolic strokes. Case report].

А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.

Diagnostic Performance of Antigen Rapid Diagnostic Tests, Chest Computed Tomography, and Lung Point-of-Care-Ultrasonography for SARS-CoV-2 Compared with RT-PCR Testing: A Systematic Review and Network Meta-Analysis.

(1) Background: The comparative performance of various diagnostic methods for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remains unclear. This study aimed to investigate the comparison of the 3 index test performances of rapid antigen diagnostic tests (RDTs), chest computed tomography (CT), and lung point-of-care-ultrasonography (US) with reverse transcription-polymerase chain reaction (RT-PCR), the reference standard, to provide more evidence-based data on the appropriate use of these index tests. (2) Methods: We retrieved data from electronic literature searches of PubMed, Cochrane Library, and EMBASE from 1 January 2020, to 1 April 2021. Diagnostic performance was examined using bivariate random-effects diagnostic test accuracy (DTA) and Bayesian network meta-analysis (NMA) models. (3) Results: Of the 3992 studies identified in our search, 118 including 69,445 participants met our selection criteria. Among these, 69 RDT, 38 CT, and 15 US studies in the pairwise meta-analysis were included for DTA with NMA. CT and US had high sensitivity of 0.852 (95% credible interval (CrI), 0.791-0.914) and 0.879 (95% CrI, 0.784-0.973), respectively. RDT had high specificity, 0.978 (95% CrI, 0.960-0.996). In accuracy assessment, RDT and CT had a relatively higher than US. However, there was no significant difference in accuracy between the 3 index tests. (4) Conclusions: This meta-analysis suggests that, compared with the reference standard RT-PCR, the 3 index tests (RDTs, chest CT, and lung US) had similar and complementary performances for diagnosis of SARS-CoV-2 infection. To manage and control COVID-19 effectively, future large-scale prospective studies could be used to obtain an optimal timely diagnostic process that identifies the condition of the patient accurately.

Ionizing Radiation Exposure in Children with Vesicoureteral Reflux: Should We Be Alarmed? / Exposición a radiacion ionizante en niños con reflujo vesicoureteral: Debemos preocuparnos?

Objectives Ionizing radiation imaging is commonly used for diagnosis and follow up in children with vesicoureteral reflux (VUR). We aim to measure the effective dose (mSv) in patients with VUR. Methods We reviewed our electronic database of patients under 8-years-old with VUR. Primary endpoint was to calculate the effective radiation dose (ED). Absolute frequencies and percentages were reported for global qualitative variables. This study conducted a logistic regression model to calculate the odds ratio for radiation exposure. Analysis was performed using STATA version 14.0 (StataCorp LLC, College Station, TX, EEUU). Results A total of 140 patients were found, 97 were assessed for eligibility. We included 59 patients in the final analysis. Mean age was 20 ± 17.9 months, 66% were females. Most cases of VUR were bilateral (44%) and high grade (93.4%). The lowest number of studies per patient was two, with a minimum radiation of 5.7 mSv. The highest radiation was estimated at 20.7 mSv corresponding to a total of five studies. Logistic regression showed that highest grades of VUR and age of first UTI episode were associated with higher ED (OR, 1.7; 95% CI, 0.87-3.31), (OR 1.02; 95% CI 0.97-1.07) respectively. A mean ED for children with VUR was estimated of 5.5 ± 3 mSv/year. Conclusion In our study, the children with VUR were exposed to 5.5 mSv/year without counting the natural background radiation, which is alarming, and we believe should raise awareness worldwide in how we are unnecessarily diagnosing indolent VUR cases and following patients.

Objetivos La imagenología por radiación ionizante es una herramienta usada frecuentemente para el diagnóstico y seguimiento de pacientes con reflujo vesicoureteral (RVU). El objetivo del presente trabajo es calcular la dosis estimada en milisieverts (mSv) de pacientes con RVU. Métodos Se realizó una revisión retrospectiva de todos los pacientes menores de 8 años con RVU. El objetivo principal fue calcular la dosis de radiación efectiva recibida por los pacientes con base en los estudios imagenológicos realizados hasta el momento de la revisión de la base de datos. Las frecuencias y porcentajes fueron reportados para las variables cualitativas. Se realizó una regresión logística para calcular la asociación de factores de riesgo con la exposición a radiación. El análisis estadístico fue realizado con el programa STATA versión 14.0 (StataCorp LLC, College Station, TX, EEUU). Resultados Se identificaron 140 patientes, de los cuales 97 fueron evaluados para coprobar su elegibilidad. En total, 59 pacientes fueron incluidos para el análisis final. La edad promedio de los pacientes fue de 20 ± 1,.9 meses, y 66% eran mujeres. La mayoría de casos fueron bilaterales (44%) y de alto grado (93,4%). El menor número de estudios realizados por paciente fue 2, con una dosis mínima de radiación acumulada de 5,7 mSv. La máxima radiación acumulada fue de 20,7 mSv, correspondiente a un total de 5 estudios. La regresión logística demostró que altos grados de reflujo y la edad a la cual tuvieron la primera infección se asociaban con mayores dosis de radiación efectiva (razón de probabilidades [RP]: 1.7; intervalo de confianza del 95% [IC95%]: 0,87­3,31), (RP: 1,02; IC95%: 0,97­1,07), respectivamente. Estimamos una dosis efectiva de radiación de 5,5 ± 3 mSv/año en nuestra población. Conclusión Nuestro estudio demuestra que pacientes con reflujo son expuestos a un promedio de 5,5 mSv/año sin contar la radiación de base a la que se exponen todos los humanos anualmente, lo cual resulta alarmante. Esto debe generar introspección al momento de evaluar pacientes con reflujo y evitar efectos a largo y mediano plazos.

Omental lipoma in pediatric age group: clinical presentation, image findings and management

ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.

The European Society of Head and Neck Radiology Mentoring Programme: development and feedback during the first phase of the initiative.

There is increasing awareness of the benefits of formal mentorship programmes in radiology. In the context of the COVID 19 pandemic which impacted on education, professional engagement and networking within the wider radiological community, the European Society of Head and Neck Radiology (ESHNR) decided to develop a formal mentoring programme. The ESHNR mentoring initiative is novel in its scope, whereby European and international members of a subspecialty radiology society are matched into mentor-mentee pairings to disseminate good practice, knowledge and ideas. The purpose of this report is to describe the motivations, planning, challenges and early experience of the ESHNR mentoring programme together with initial feedback from the scheme.The development of the programme and iterative modifications during the first phase of the scheme are described. The programme has enrolled 33 mentors and 27 mentees with international representation and 24 mentor-mentee pairs have participated in 2.6 (mean) meetings. The experience and benefits reported by the participating ESHNR members (mentees and mentors) were evaluated by a questionnaire at six months following the start of the programme. There were 80% of mentors and 88% of mentees who strongly agreed that the mentoring programme was rewarding rather than an obligation, and all participants reported that they would recommend the scheme to colleagues.A formal mentoring programme has been established for an international subspecialty radiology society. The early experience is encouraging and suggests that it is both useful and sustainable. Our experiences may be of benefit to other subspecialty societies considering a mentoring programme.

Role of Peptides in Diagnostics.

The specificity of a diagnostic assay depends upon the purity of the biomolecules used as a probe. To get specific and accurate information of a disease, the use of synthetic peptides in diagnostics have increased in the last few decades, because of their high purity profile and ability to get modified chemically. The discovered peptide probes are used either in imaging diagnostics or in non-imaging diagnostics. In non-imaging diagnostics, techniques such as Enzyme-Linked Immunosorbent Assay (ELISA), lateral flow devices (i.e., point-of-care testing), or microarray or LC-MS/MS are used for direct analysis of biofluids. Among all, peptide-based ELISA is considered to be the most preferred technology platform. Similarly, peptides can also be used as probes for imaging techniques, such as single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The role of radiolabeled peptides, such as somatostatin receptors, interleukin 2 receptor, prostate specific membrane antigen, αß3 integrin receptor, gastrin-releasing peptide, chemokine receptor 4, and urokinase-type plasminogen receptor, are well established tools for targeted molecular imaging ortumor receptor imaging. Low molecular weight peptides allow a rapid clearance from the blood and result in favorable target-to-non-target ratios. It also displays a good tissue penetration and non-immunogenicity. The only drawback of using peptides is their potential low metabolic stability. In this review article, we have discussed and evaluated the role of peptides in imaging and non-imaging diagnostics. The most popular non-imaging and imaging diagnostic platforms are discussed, categorized, and ranked, as per their scientific contribution on PUBMED. Moreover, the applicability of peptide-based diagnostics in deadly diseases, mainly COVID-19 and cancer, is also discussed in detail.

Computed tomography and cross-sectional anatomy of the head in the giant anteater (Myrmecophaga tridactyla).

The aim of this study was to identify the anatomical structures in the head region of the giant anteater (Myrmecophaga tridactyla) using computed tomography. For this, three giant anteater corpses, adult and female, were used. The tomographic analysis was performed in sequential order in rostrocaudal direction. Subsequently, the heads of these animals were sectioned in cross sections of approximately 1.5 cm each. Tomographic images were compared with anatomical sections. The association between computed tomography and anatomical sections allowed the visualization of anatomical structures found in the nasal, oral, cranial, pharyngeal and ear cavities. An elongated oral cavity delimited by the elongated mandible was observed. The oral cavity was mainly occupied by a thin and elongated tongue formed mainly by the union of the sternoglossal muscles. The nasopharynx and oropharynx extended up to the neck at the level of the fifth cervical vertebra. The findings of this study suggest that the giant anteater has a head with structures morphologically adapted to its feeding habits, such as an elongated skull, tongue, styloid bones and mandible. In addition, based on the results of this study, it is possible to suggest that computed tomography is a pivotal tool for the veterinary routine of wild animals, since it allowed the identification of anatomical structures found in the head of the giant anteater.

Calcificación de los Procesos Estiloides: Sus Implicancias en Odontología. Presentación de un Caso

RESUMEN: El proceso estiloides es una delgada prominencia ósea cónica localizada en la superficie inferior del hueso temporal. Su longitud normal es de 20 a 25 mm, siendo mayor en los hombres. En ocasiones se produce su elongación o deformación con calcificación del ligamento estilohioideo, acompañado de diversos signos y síntomas lo que da origen al llamado síndrome de Eagle. La presencia de dolor inespecífico oro-cérvico-facial y la palpación de los procesos estiloides en la fosa tonsilar proporcionan un diagnóstico presuntivo que deberá ser confirmado con estudios por imágenes como la telerradiografía lateral de cráneo y la ortopantomografía. Se presenta un caso de síndrome de Eagle en un paciente de sexo masculino referido al Servicio de Diagnóstico por Imágenes de la Facultad de Odontología de la Universidad Nacional de Córdoba. La tomografía computada constituye el estudio por imágenes de excelencia ante la presunción de este síndrome ya que los diferentes cortes tomográficos y la reconstrucción 3D nos permiten observar los procesos estiloides elongados de manera precisa e inequívoca. Este diagnóstico es de gran relevancia ya que dependiendo de la severidad de la sintomatología el tratamiento puede ser quirúrgico para evitar las graves y s everas complicaciones que a veces suele ocasionar.

ABSTRACT: Styloid process is defined as a thin conical bony prominence located on the undersurface of the temporal bone. Its normal length is 20 to 25 mm. Sometimes styloid process is elongated with ossification of stylohyoid ligament and when it is accompanied by a set of signs and symptoms it gives rise to the so called Eagle´s syndrome. Nonspecific pain in the oral cervicofacial area and styloid process palpation in the tonsillar fossa provide a presumptive diagnosis that should be confirmed by imaging studies such as lateral skull teleradiography and orthopantomography that confirm the elongation of styloid processes. An Eagle syndrome case of a male patient referred to the Department of Radiology at the National University of Córdoba School of Dentistry is reported. The computed tomography is the most accurate imaging modality for Eagle´s syndrome identification because through multiplanar reformatted images and three dimensional images allows to observe the elongated styloid processes in a precise and unequivocal way. This diagnosis is relevant since depending on the severity of the symptoms, surgical treatment may avoid serious and severe complications.

Clinical Y-view versus 3-dimensional assessments of intramuscular fat in patients with full-thickness rotator cuff tears.

RATIONALE AND OBJECTIVES: Recent evidence suggests an inhomogeneous distribution of intramuscular rotator cuff fat infiltration (FI) in a small sample of individuals with rotator cuff tears, yet clinically just a few slices at the scapular Y-view are used to evaluate FI in patients with rotator cuff tears. The purpose of this study was to determine if assessment of FI using the scapular Y-view is representative of the entire muscle in patients with full-thickness rotator cuff tears, and whether this varies by tear size. MATERIALS AND METHODS: Patients (N = 25) diagnosed with full-thickness rotator cuff tear and confirmed with magnetic resonance imaging (MRI) were included. Fat-water sequences were used to objectively quantify mean FI (%) in the entire 3D muscle and the mean from 3 slices at the Y-view. Mixed-model 2 × 2 ANOVAs were used to assess for differences between methods, and if results vary by tear-size. RESULTS: There were no statistically significant differences between mean amount of FI of the entire 3D muscle and mean Y-view in the supraspinatus or infraspinatus muscles (p > 0.05). Additionally, this did not differ across tear size groups (p > 0.05). CONCLUSION: Results of this study suggest FI assessed in the Y-view is not different (mean difference < 1.0%) from FI of the entire 3D muscle in patients with full-thickness rotator cuff tears. Therefore, the clinical utility of evaluating rotator cuff intramuscular fat infiltration with the Y-view is further supported in patients with full-thickness rotator cuff tears across tear sizes.

Intraductal Papillary Mucinous Neoplasm of the Pancreas: Need for a Tailored Approach to a Rare Entity.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features - presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It is rare with an incidence of 4 to 5 cases per 100 000. The relative lack of experience significantly hampers decision making for surgery (pancreatic head resection, distal pancreatectomy or enucleation) or follow-up.Herein we present two cases managed by diametrically different tactic according to the risk stratification - distal pancreatectomy with splenectomy and observation, respectively. An up-to-date literature review on the key points in diagnostics, indications for surgery, the extent of surgery, follow-up, and prognosis is provided.The tailored approach based on risk stratification is the cornerstone of management. Absolute indications for surgery are the lesions with high-risk stigmata, whereas the worrisome features should be evaluated by endoscopic ultrasound and fine-needle aspiration. Main duct and mixed type are usually referred to surgery, whereas the management of a branch type is more conservative due to the lower rate of invasive cancer. Strict postoperative follow-up is mandatory even in negative resection margins due to a high risk for recurrences and metachronous lesions.Despite the guidelines, the intraductal papillary mucinous neoplasm remains a major challenge for clinicians and surgeons in the balance the risk/benefit of observation versus resection. Risk stratification plays a key role in decision-making. Future trials need to determine the optimal period of surveillance and the most reliable predictive factors for concomitant pancreatic duct cancer.

Intraoperatives Tip-Foldover-Screening mittels Spread of Excitation Messungen.

BACKGROUND: In rare cases, a cochlear implantation can lead to a so-called tip fold-over during insertion of the electrode array. In order to detect or exclude such a misalignment a radiological check of the cochlear implant (CI) electrode array is carried out intra- or often post-operatively (gold standard), thereby exposing the patient to additional radiation. Alternatively, successful electrode insertion can be verified by measuring the spread of excitation (SOE). However, interpretation of the test results requires considerable expertise, and standardized measurement protocols and reference values are also essential. Therefore, the aim of the study is to evaluate an automated screening procedure in order to obtain a reliable statement about the normal tonotopic position of the implanted CI electrode array intraoperatively and with as little effort as possible. METHODS: For CI surgery with Cochlear™ Nucleus® implants, an intraoperative tip-fold-over (TFO) screening was performed in a bi-centric study in over 100 adult patients: Firstly, threshold measurements for electrically evoked compound action potential (ECAP) using AutoNRT™ were recorded. Subsequently, SOE measurements were carried out on electrodes 13 and 22. The automated evaluation of the SOE data sets then made it possible to make a dichotomous decision about a normal or abnormal test result. The position of the electrode array was checked intra- or post-operatively using conventional transorbital X-ray (reference method). RESULTS: The intraoperative TFO screening procedure is applicable in around 80% of cases. The accuracy of the screening for measurements via the active stimulation electrodes 13 / 22 is 63.9% / 95.4%. The classification error is 36.1% / 4.6% and the phi coefficient is 0.27 / 0.69. All radiologically proven tip-fold-overs were reliably identified with the intraoperative screening (sensitivity = 100%). A higher specificity (>95%) can be achieved only with measurements via electrode 22. CONCLUSIONS: The TFO Screening via measurement at electrode 22 can successfully distinguish between a correct and incorrect position of the electrode array due to a tip-fold-over, and the remaining cases would require further imaging.

Imaging Diagnostics and Pathology in SARS-CoV-2-Related Diseases.

In December 2019, physicians reported numerous patients showing pneumonia of unknown origin in the Chinese region of Wuhan. Following the spreading of the infection over the world, The World Health Organization (WHO) on 11 March 2020 declared the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak a global pandemic. The scientific community is exerting an extraordinary effort to elucidate all aspects related to SARS-CoV-2, such as the structure, ultrastructure, invasion mechanisms, replication mechanisms, or drugs for treatment, mainly through in vitro studies. Thus, the clinical in vivo data can provide a test bench for new discoveries in the field of SARS-CoV-2, finding new solutions to fight the current pandemic. During this dramatic situation, the normal scientific protocols for the development of new diagnostic procedures or drugs are frequently not completely applied in order to speed up these processes. In this context, interdisciplinarity is fundamental. Specifically, a great contribution can be provided by the association and interpretation of data derived from medical disciplines based on the study of images, such as radiology, nuclear medicine, and pathology. Therefore, here, we highlighted the most recent histopathological and imaging data concerning the SARS-CoV-2 infection in lung and other human organs such as the kidney, heart, and vascular system. In addition, we evaluated the possible matches among data of radiology, nuclear medicine, and pathology departments in order to support the intense scientific work to address the SARS-CoV-2 pandemic. In this regard, the development of artificial intelligence algorithms that are capable of correlating these clinical data with the new scientific discoveries concerning SARS-CoV-2 might be the keystone to get out of the pandemic.

Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model.

BACKGROUND: There is consensus that most complete ulnar collateral ligament (UCL) injuries in throwers would benefit from surgical intervention. Optimal treatment for partial UCL tears remains controversial. Stress ultrasonography has become a well-accepted diagnostic modality for assessing UCL injury. HYPOTHESIS: Partial UCL tears will result in an intermediate increase in ulnohumeral joint space gapping as compared with that of an intact UCL and a complete UCL tear, but the degree of joint space gapping will vary by anatomic location of the partial tear. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-one cadaveric elbows were divided into 7 groups representing different anatomic locations of UCL partial tears. Partial tears were simulated by cutting 50% of the measured width of the UCL at 6 locations: distal anterior/posterior, midsubstance anterior/posterior, and proximal anterior/posterior. A seventh partial tear was created by partially elevating the undersurface of the distal UCL to simulate the radiographic "T-sign." Valgus stress (15 daN) was applied to each cadaveric elbow at 30° of flexion using a standardized device. Each specimen was tested intact, partially torn, and completely torn. At each state, joint space was measured using stress ultrasonography, and the difference in joint space from unstressed to stressed (delta) was recorded. RESULTS: There were 10 right and 11 left upper extremity specimens. The mean delta was 0.58 mm for the intact state and <0.75 mm in all groups. Both distal partial tear groups had mean deltas <0.75 mm, similar to intact elbows. Proximal tears and the T-sign demonstrated intermediate deltas (0.99-1.23 mm). Midsubstance partial tears demonstrated the largest deltas (1.57-2.03 mm), similar to those of the complete tears. All complete tear groups had a mean delta >1.5 mm (1.54-3.03 mm). CONCLUSION: These findings suggest that partial tears introduce a spectrum of instability from functionally intact to completely torn. As a result, some may be biomechanically amenable to nonoperative treatment, while others would be indicated for early reconstruction. Further research into the biological and biomechanical determinants of nonoperative treatment failure will assist with more precise treatment recommendations. CLINICAL RELEVANCE: Describing the biomechanical consequences of different, clinically significant partial UCL tears potentially allows more precise recommendations for operative and nonoperative treatment.

Interpretación de patrones radiológicos sugerentes de COVID-19 en pediatría / Interpretation of radiological patterns suggesting COVID-19 in pediatrics

The CoVID-19 pandemic has impacted in a lesser extent and intensity to patients younger than 15 years. The role of different imaging studies of lung involvement has been extensively addressed, from the first cases of severe pneumonia and respiratory distress syndrome in adults. There are fewer reports of the comparative usefulness of conventional radiology, ultrasound, and computed axial tomography in children. Of those, ground glass opacities, crazy paving pattern and surrounding halo consolidation are the most characteristic. Even though none of them allows diagnostic confirmation, their correct interpretation helps in decision flows. Computed axial tomography is more accurate for defining the type and extent of lung parenchymal involvement. The role of the ultrasound in early stages in the emergency department is clearer in adults than in children, in whom there is a good correlation with chest tomography. This article addresses the different radiological patterns, their pathophysiological representation and differential diagnoses, in order to alert pediatricians of their interpretation, as well as the potential role of imaging diagnoses most frequently used in children with low acute respiratory infection.

La pandemia CoVID-19 ha impactado en una proporción e intensidad menor a los pacientes menores de 15 años. El rol de los diferentes estudios por imágenes del compromiso pulmonar ha sido extensamente abordado, desde los primeros casos de neumonías graves y síndrome de distrés respiratorio en adultos. En niños existen menos reportes de la utilidad de la radiología convencional, ecografía y tomografía axial computarizada. Sin embargo, los patrones más característicos observados en adultos se repiten en los niños. De ellos, el vidrio esmerilado, el patrón en empedrado y la consolidación con halo circundante son los más característicos. Aun cuando ninguno de ellos permite confirmación diagnóstica, su correcta interpretación ayuda en los flujos de decisiones. La tomografía axial computarizada es más certera para la definición de tipo y extensión del compromiso parenquimatoso pulmonar. El rol en los estadios tempranos en el servicio de urgencia de la ecografía es más claro en adultos que en niños, donde existe buena correlación con la tomografía de tórax. Este artículo aborda los diferentes patrones radiológicos, su representación fisiopatológica y diagnósticos diferenciales, con el objeto de apoyar a los pediatras en su interpretación, como también reconocer el rol de las técnicas de imágenes diagnósticas más frecuentemente utilizadas en niños con infección respiratoria aguda baja.