Revisiting racial disparities in ED CT utilization during the Affordable Care Act era: 2009–2018 data from the NHAMCS

Emergency Radiology - To examine the trends in CT utilization in the emergency department (ED) for different racial and ethnic groups, factors that may affect utilization, and the effects of...     

Corpus luteum with ovarian stromal edema is associated with pelvic pain and confusion for ovarian torsion

Abdominal Radiology - To distinguish the corpus luteum with adjacent ovarian stromal edema as an entity associated with pelvic pain, with confounding ultrasound features that may lead to...     

Evaluation of Cutting-Tool Coating on the Surface Roughness and Hole Dimensional Tolerances during Drilling of Al6061-T651 Alloy

Aluminum alloys are soft and have low melting temperatures; therefore, machining them often results in cut material fusing to the cutting tool due to heat and friction, and thus lowering the hole quality. A good practice is to use coated cutting tools to overcome such issues and maintain good hole quality. Therefore, the current study investigates the effect of cutting parameters (spindle speed and feed rate) and three types of cutting-tool coating (TiN/TiAlN, TiAlN, and TiN) on the surface finish, form, and dimensional tolerances of holes drilled in Al6061-T651 alloy. The study employed statistical design of experiments and ANOVA (analysis of variance) to evaluate the contribution of each of the input parameters on the measured hole-quality outputs (surface-roughness metrics R_a and R_z, hole size, circularity, perpendicularity, and cylindricity). The highest surface roughness occurred when using TiN-coated tools. All holes in this study were oversized regardless of the tool coating or cutting parameters used. TiN tools, which have a lower coating hardness, gave lower hole circularity at the entry and higher cylindricity, while TiN/TiAlN and TiAlN seemed to be more effective in reducing hole particularity when drilling at higher spindle speeds. Finally, optical microscopes revealed that a built-up edge and adhesions were most likely to form on TiN-coated tools due to TiN’s chemical affinity and low oxidation temperature compared to the TiN/TiAlN and TiAlN coatings.     

An unusual presentation of a common disease

We present a case of perforating granuloma annulare (PGA), in which we show the natural history of lesions and outline the different clinical types. Our patient responded well to intralesional triamcinolone acetonide 10mg/ml injections. Although she was otherwise well, PGA can be associated with diabetes mellitus in up to 17 percent of cases. Differential clinico-histopathological diagnosis, specifically in relation to necrobiosis lipoidica diabeticorum is being discussed. Treatment for PGA is difficult; apart from topical and/or intralesional steroids (clearance up to 54% in one case series), other options include Psoralen plus UVA (PUVA), systemic isotretinoin, chloroquine or hydroxylchloroquine, sulphapyridine, dapsone, topical application of imidazole creams, and liquid nitrogen. Spontaneous remission has also been reported in up to 77 percent in one case series.     

Predicting ICU readmission among surgical ICU patients: Development and validation of a clinical nomogram

Background

Unplanned intensive care unit readmission within 72 hours is an established metric of hospital care quality. However, it is unclear what factors commonly increase the risk of intensive care unit readmission in surgical patients. The objective of this study was to evaluate predictors of readmission among a diverse sample of surgical patients and develop an accurate and clinically applicable nomogram for prospective risk prediction.