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Abuelhassan UE, Alsalem AA, Alshafa FA, Alshahrani FS, AlShahrani MA, ALAmri AK, Alaqil MA, Al Asim AA, Alsultan EM, Al Mani SY, Badawi AG, Alshehri EF, Alshehri EA, ALAmri NK, Abdalla AM, Khalaf M, Ghalyoob TM, Elnamaky M, Mahmoud IM. Clinical Features and Predictors of Mortality in Patients With Acute Pulmonary Embolism: A Retrospective Study From Southern Saudi Arabia. Cureus 2024; 16:e55623. [PMID: 38586707 PMCID: PMC10995892 DOI: 10.7759/cureus.55623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND AND METHODOLOGY We aimed to investigate the clinical characteristics, outcomes, and mortality predictors in patients with acute pulmonary embolism (PE). Adult patients who were admitted to the Armed Forces Hospital Southern Region, Khamis Mushait, a large tertiary hospital in Southern Saudi Arabia, with the diagnosis of acute PE were retrospectively examined for the predictors of one-year mortality. RESULTS The overall in-hospital mortality was 15.6% among 212 patients. In univariate analysis, only age was significantly associated with increased early mortality, whereas age, obesity, presence of active malignancy, hypertension, use of thrombolytics, and Simplified Pulmonary Embolism Severity Index (sPESI) were significantly associated with increased late mortality. By use of binary logistic regression, the presence of obesity (HR 6.010, 95%CI 0.048-16.853, p=0.030), active malignancy (HR 3.040, 95%CI 1.147-8.059, p=0.025), and the use of thrombolytics (HR 8.074, 95%CI 2.719-23.977, p<0.001), were independently significant factors for late (overall) mortality, respectively. CONCLUSIONS Among Saudi Arabian patients in the Southern Region, our data show that age is an independent factor for increased early and late mortality. The presence of obesity, active malignancy, and the use of thrombolytics, were independently significant factors for increased late (one-year) mortality. These factors should be taken into account for risk stratification and decisions on tailored management of patients with PE. Further prospective multicenter studies are needed.
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Affiliation(s)
- Usama E Abuelhassan
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
- Department of Respiratory Medicine, Faculty of Medicine, Cairo University, Cairo, EGY
| | - Ali A Alsalem
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Fawwaz A Alshafa
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Fahad S Alshahrani
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Maram A AlShahrani
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Amal K ALAmri
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Meaad A Alaqil
- Department of Internal Medicine, King Khalid University Hospital, Abha, SAU
| | - Ahmad Ali Al Asim
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Eman M Alsultan
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Salihah Y Al Mani
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Azizah G Badawi
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Elham F Alshehri
- Department of Medicine, Ministry of Health, Aseer District, Abha, SAU
| | - Eissa A Alshehri
- Department of Radiology, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Nour K ALAmri
- Department of Internal Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | | | - Mervat Khalaf
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, EGY
| | - Tayseer M Ghalyoob
- Department of Radiology, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
| | - Medhat Elnamaky
- Department of Pulmonary Medicine, Al-Azhar University - Assiut Branch, Assiut, EGY
| | - Ibrahim M Mahmoud
- Department of Critical Care Medicine, Armed Forces Hospital Southern Region (AFHSR), Khamis Mushayt, SAU
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, EGY
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Xiong L, Zhuo L, Zhang J, Liang S, Wang Z. Pulmonary embolism and hemorrhage after displacement of angiographic catheter tip to pulmonary artery: A case report and literature review. Heliyon 2024; 10:e24542. [PMID: 38322923 PMCID: PMC10843997 DOI: 10.1016/j.heliyon.2024.e24542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
Pulmonary embolism and massive hemoptysis caused by intravascular foreign bodies have rarely been reported. We report a case of an end-stage renal disease patient in which the tip of the angiographic catheter fell off into the pulmonary artery during endovascular interventional opening when the patient underwent vascular access occlusion for dialysis. During the operation, the foreign body was displaced repeatedly and finally anchored to the posterior basal segment branch of the right lower pulmonary artery. A pulmonary embolism occurred during the operation, and massive hemoptysis and hemorrhagic shock occurred after anticoagulation and thrombolytic therapy. After receiving anti-shock and symptomatic treatment, the patient gradually recovered. After six months of follow-up, no pulmonary embolism or pulmonary infarction occurred. Our case report presents an alternative approach to extracting a foreign object from the pulmonary artery by locating the foreign object within the vascular terminations, without resorting to forceful removal. This method mitigates the potential risks of pulmonary embolism and bleeding associated with forceful extraction.
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Affiliation(s)
- Liangwei Xiong
- Department of Nephrology, Anyue County People's Hospital, Ziyang City, Sichuan Province, 642350, PR China
| | - Li Zhuo
- Department of Nephrology, Anyue County People's Hospital, Ziyang City, Sichuan Province, 642350, PR China
| | - Jianhua Zhang
- Interventional Department, Fengjie County People's Hospital of Chongqing, 404600, PR China
| | - Shaoyong Liang
- Department of Hepatobiliary Surgery, Fengjie County People's Hospital of Chongqing, 404600, PR China
- Department of Hepatobiliary Surgery, Fengjie Hospital, The Second Affiliated Hospital of Chongqing Medical University, 404600, PR China
| | - Zongding Wang
- Department of Hepatobiliary Surgery, Fengjie County People's Hospital of Chongqing, 404600, PR China
- Department of Hepatobiliary Surgery, Fengjie Hospital, The Second Affiliated Hospital of Chongqing Medical University, 404600, PR China
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Peng YF, Ma LY, Luo M. Elevation of Serum Prostate-Specific Antigen Levels in Males With Pulmonary Embolism. Clin Appl Thromb Hemost 2024; 30:10760296241250002. [PMID: 38779806 PMCID: PMC11113070 DOI: 10.1177/10760296241250002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024] Open
Abstract
Hypoxemia is a clinical characteristic of pulmonary embolism (PE). Hypoxemia is associated with variations in serum prostate-specific antigen (PSA) levels. Thus, the present study aimed to determine serum PSA levels in patients with PE, which may be helpful in improving clinical evaluation in screening for prostate diseases in those with PE. Clinical data from 61 consecutive male patients with PE and 113 age-matched healthy male controls were retrospectively analyzed. The pulmonary artery obstruction index (PAOI) was used to evaluate the pulmonary embolic burden. Compared with healthy controls, serum total PSA (tPSA) levels were significantly increased (P = .003), and free PSA (fPSA)/tPSA ratio was significantly decreased in patients with PE (P < .001). There was no significantly difference in serum fPSA levels between patients with PE and healthy controls (P = .253). A significant positive association was observed between serum tPSA levels and PAOI in patients with PE (β = .270, P = .036). Multivariable linear regression analysis revealed that serum tPSA levels were independently associated with PAOI in patients with PE (β = .347, P = .003). Serum tPSA levels were higher in male patients with PE than those in healthy controls, but fPSA was not affected. These findings highlight that PE may elevate serum tPSA levels, and that measures of tPSA should be interpreted with caution in screening for prostate diseases in patients with PE.
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Affiliation(s)
- You-Fan Peng
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Li-Ya Ma
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Miao Luo
- Life Science and Clinical Research Center, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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Jianling Q, Lulu J, Liuyi Q, Lanfang F, Xu M, Wenchen L, Maofeng W. A nomogram for predicting the risk of pulmonary embolism in neurology department suspected PE patients: A 10-year retrospective analysis. Front Neurol 2023; 14:1139598. [PMID: 37090975 PMCID: PMC10113433 DOI: 10.3389/fneur.2023.1139598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectiveThe purpose of this retrospective study was to establish a numerical model for predicting the risk of pulmonary embolism (PE) in neurology department patients.MethodsA total of 1,578 subjects with suspected PE at the neurology department from January 2012 to December 2021 were considered for enrollment in our retrospective study. The patients were randomly divided into the training cohort and the validation cohort in the ratio of 7:3. The least absolute shrinkage and selection operator regression were used to select the optimal predictive features. Multivariate logistic regression was used to establish the numerical model, and this model was visualized by a nomogram. The model performance was assessed and validated by discrimination, calibration, and clinical utility.ResultsOur predictive model indicated that eight variables, namely, age, pulse, systolic pressure, hemoglobin, neutrophil count, low-density lipoprotein, D-dimer, and partial pressure of oxygen, were associated with PE. The area under the receiver operating characteristic curve of the model was 0.750 [95% confidence interval (CI): 0.721–0.783] in the training cohort and 0.742 (95% CI: 0.689–0.787) in the validation cohort, indicating that the model showed a good differential performance. A good consistency between the prediction and the real observation was presented in the training and validation cohorts. The decision curve analysis in the training and validation cohorts showed that the numerical model had a good net clinical benefit.ConclusionWe established a novel numerical model to predict the risk factors for PE in neurology department suspected PE patients. Our findings may help doctors to develop individualized treatment plans and PE prevention strategies.
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Affiliation(s)
- Qiang Jianling
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Jin Lulu
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Qiu Liuyi
- Department of Pathology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Feng Lanfang
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Ma Xu
- Department of Vascular Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Li Wenchen
- Department of Neurology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Wang Maofeng
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
- *Correspondence: Wang Maofeng
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Orun S, Celikkol A, Basol BI, Yeniay E. Diagnostic accuracy of adropin as a preliminary test to exclude acute pulmonary embolism: a prospective study. BMC Pulm Med 2022; 22:351. [PMID: 36115957 PMCID: PMC9482749 DOI: 10.1186/s12890-022-02156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to investigate the diagnostic accuracy of adropin as a biomarker to exclude the diagnosis of acute pulmonary embolism (PE).
Methods
Patients admitted to the emergency department of a tertiary health centre between August 2019 and August 2020 and diagnosed with PE were included in this prospective cohort study. The amount of serum adropin was determined in patients with (PE) and compared with that of healthy volunteers. Receiver operating characteristic analysis was performed with the obtained data, and the area under the curve (AUC) with a 95% confidence interval was determined. The parameters of diagnostic accuracy for PE were determined.
Results
A total of 57 participants were included in the study (28 controls and 29 PE patients). The mean adropin level in the PE group was 187.33 ± 62.40 pg/ml, which was significantly lower than that in the control group (524.06 ± 421.68 pg/ml) (p < 0.001). When the optimal adropin cut-off value was 213.78 pg/ml, the likelihood ratio of the adropin test was 3.4, and the sensitivity of the adropin test at this value was 82% with specificity of 75% (95% CI; AUC: 0.821).
Conclusion
Our results suggest that adropin may be considered for further study as a candidate marker for the exclusion of the diagnosis of PE. However, more research is required to verify and support the generalizability of our study results.
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Wang Y, Pawar S, Dutta O, Wang K, Rivera A, Xue C. Macrophage Mediated Immunomodulation During Cryptococcus Pulmonary Infection. Front Cell Infect Microbiol 2022; 12:859049. [PMID: 35402316 PMCID: PMC8987709 DOI: 10.3389/fcimb.2022.859049] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 12/21/2022] Open
Abstract
Macrophages are key cellular components of innate immunity, acting as the first line of defense against pathogens to modulate homeostatic and inflammatory responses. They help clear pathogens and shape the T-cell response through the production of cytokines and chemokines. The facultative intracellular fungal pathogen Cryptococcus neoformans has developed a unique ability to interact with and manipulate host macrophages. These interactions dictate how Cryptococcus infection can remain latent or how dissemination within the host is achieved. In addition, differences in the activities of macrophages have been correlated with differential susceptibilities of hosts to Cryptococcus infection, highlighting the importance of macrophages in determining disease outcomes. There is now abundant information on the interaction between Cryptococcus and macrophages. In this review we discuss recent advances regarding macrophage origin, polarization, activation, and effector functions during Cryptococcus infection. The importance of these strategies in pathogenesis and the potential of immunotherapy for cryptococcosis treatment is also discussed.
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Affiliation(s)
- Yan Wang
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, United States
- Department of Microbiology and Immunology , Guangdong Medical University, Dongguan, China
| | - Siddhi Pawar
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Orchi Dutta
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Keyi Wang
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Amariliz Rivera
- Center for Immunity and Inflammation, New Jersey Medical School, Rutgers University, Newark, NJ, United States
| | - Chaoyang Xue
- Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, United States
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Manes TJ, Mohiuddin Z, Bage M. Pulmonary Embolism in Transit Across a Patent Foramen Ovale. Cureus 2022; 14:e23026. [PMID: 35464577 PMCID: PMC9001867 DOI: 10.7759/cureus.23026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
A pulmonary embolism (PE) is an obstruction in a pulmonary artery, and a saddle PE occurs when the obstruction is lodged in the main pulmonary trunk and spans the left and right pulmonary arteries. The current case study describes complications of a thrombus in transit across a patent foramen ovale (PFO). A 35-year-old female presented to the emergency department after a nontraumatic syncopal fall. She had recently returned from a cross-country flight 10 days before and had noticed left calf tenderness when exiting the plane. Vitals were notable for sinus tachycardia at 120 bpm. An electrocardiogram indicated an S1Q3T3 pattern, and chest computed tomographic angiography was positive for a saddle PE. A 2D (two-dimensional) transthoracic echocardiogram showed right ventricular free wall hypokinesis and McConnell’s sign. Echocardiogram findings were concomitant with a thrombus in transit across the interatrial septum, indicating a possible PFO. An emergency pulmonary embolectomy with cardiopulmonary bypass and closure of her PFO was performed the following morning and complicated by cardiogenic shock and subsequent cardiac arrest. The patient was resuscitated in the operating room but failed to be removed from cardiopulmonary bypass, requiring low-dose inotropic support and venoarterial extracorporeal membrane oxygenation flow at 4 L/min. After a repeat right pulmonary artery thrombectomy and two subsequent transesophageal echocardiograms indicated stable right ventricular systolic function, decannulation was performed. The patient was discharged on day 17 with long-term anticoagulation and home healthcare. In the current case report, the patient’s unstable and deteriorating condition was complicated by unusual findings of a thrombus in transit across a PFO. These additional echocardiogram findings represented an unusual case that warranted surgical treatment instead of systemic thrombolysis therapy because of the increased risk of systemic clot embolization.
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Evlakhov VI, Poiasov IZ. [Spontaneous fibrinolysis and possibilities of its acceleration in pulmonary embolism]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:25-31. [PMID: 34166341 DOI: 10.33529/angio2021207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This review contains the data concerning the mechanisms of spontaneous fibrinolysis in pulmonary vessels and possibilities of its acceleration in pulmonary embolism. The spontaneous fibrinolysis system is known to be sequential and multifactorial, with the interaction of accelerators (t-PA and u-PA) and inhibitors (alpha-2-antiplasmin, PAI-1, TAFI). The fibrinolytic processes take place in case of prevailing reactions of accelerating factors over inhibiting ones. The endothelium of pulmonary vessels possesses pronounced antithrombogenic and profibrinolytic properties, therefore, the processes of fibrinolysis in the pulmonary vascular bed normally occur more intensively than in the vessels of the systemic circulation. The membrane proteins of the endothelium annexins A2 activate plasminogen, whereas thrombomodulin inhibits the activity of PAI-1. The main approaches to increase the fibrinolysis intensity in conditions of pulmonary embolism may be aimed at elevating the activity of fibrinolytic enzymes (enhancing the synthesis of annexins A2, the use of NMDA-receptor antagonists) and suppressing its inhibitors (the use of monoclonal antibodies to alpha-2-antiplasmin, as well as plasminogen activator inhibitor-1 (PAI-1) and thrombin-activatable fibrinolysis inhibitor (TAFI). Promising directions for future research can be the synthesis of a new generation of tissue-type plasminogen activators, and investigations of the possibility of clinical application of antithrombin and thrombomodulin, angiotensin converting enzyme inhibitors and cortisol antagonists. To meet these challenges, it is necessary to develop new models of venous thrombosis and acute pulmonary embolism in different animal species, with the assessment of the changes in the venous haemodynamics and pulmonary microcirculation on the background of administration of a new class of fibrinolytic agents.
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Affiliation(s)
- V I Evlakhov
- Laboratory of Physiology of Visceral Systems named after Academician K.M. Bykov, Institute of Experimental Medicine, Saint Petersburg, Russia
| | - I Z Poiasov
- Laboratory of Physiology of Visceral Systems named after Academician K.M. Bykov, Institute of Experimental Medicine, Saint Petersburg, Russia
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Potigailo V, Kohli A, Pakpoor J, Cain DW, Passi N, Mohsen N. Recent Advances in Computed Tomography and MR Imaging. PET Clin 2020; 15:381-402. [PMID: 32888544 DOI: 10.1016/j.cpet.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Numerous advanced MR imaging and computed tomographic techniques have been developed and implemented in clinical practice over the past several years resulting in increased diagnostic accuracy and improved patient care. In this article, the authors highlight recent and emerging imaging techniques in functional and structural MR imaging, perfusion and vascular imaging, standardization of imaging practices, and selected applications of artificial intelligence in clinical practice.
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Affiliation(s)
- Valeria Potigailo
- Department of Radiology, University of Colorado Anschutz Medical Center, 12401 East 17th Avenue, Leprino, Mail Stop L954, Aurora, CO 80045, USA
| | - Ajay Kohli
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jina Pakpoor
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Donald Wesley Cain
- Department of Radiology, University of Colorado Anschutz Medical Center, 12401 East 17th Avenue, Leprino, Mail Stop L954, Aurora, CO 80045, USA
| | - Neena Passi
- University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Nancy Mohsen
- Department of Radiology, University of Pennsylvania, Hospital of the University of Pennsylvania, 1 Silverstein Suite 130, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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