Search

Background: The study aimed to evaluate the diagnostic efficacy of routine follow‐up in detecting recurrent disease in hypopharyngeal carcinoma. Methods: Data from 76 patients with a total of 620 follow‐up visits, 367 radiological studies, and 126 panendoscopies were retrospectively assessed regarding the diagnosis of recurrent disease based on the results of (I) radiological studies, (II) clinical examinations, and (III) clinical symptoms. Results: All locally relapsed patients became symptomatic, and new onset of dysphagia (p < 0.001) was the most frequent complaint. The sensitivity for detecting local recurrences was 100% for both patients' symptom assessments and clinical examinations. The highest overall accuracy was found for clinical examinations (93.4%), followed by symptom assessments (80.5%), and radiological studies (73.8%). The risk of false positive radiological reports and subsequent panendoscopies was 2.2 times higher after previous radiotherapy (32.0% vs. 14.6%; p < 0.001). Conclusion: Symptom assessments and clinical examinations are highly efficient for detection of local failures. [ABSTRACT FROM AUTHOR]

Aims: This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA). Methods: This study analyzed 506 cadaveric humeri of adult patients. All humeri were CT scanned using 0.625 × 0.625 × 0.625 mm cubic voxels. The images acquired were used to generate 3D surface models of the humerus. Next, 3D landmarks were automatically calculated on each 3D bone using custom-written C++ software. The anatomical landmarks analyzed were the transepicondylar axis, the humerus anatomical axis, and the peak of the perpendicular axis of the greater tuberosity. Lastly, the angle between the transepicondylar axis and the greater tuberosity axis was calculated and defined as the GTVA. Results: The value of GTVA was 20.9° (SD 4.7°) (95% CI 20.47° to 21.3°). Results of analysis of variance revealed that females had a statistically significant larger angle of 21.95° (SD 4.49°) compared to males, which were found to be 20.49° (SD 4.8°) (p = 0.001). Conclusion: This study identified a consistent relationship between palpable anatomical landmarks, enhancing IMN accuracy by utilizing 3D CT scans and replicating a 20.9° angle from the greater tuberosity to the transepicondylar axis. Using this angle as a secondary reference may help mitigate the complications associated with malrotation of the humerus following IMN. However, future trials are needed for clinical validation. Cite this article: Bone Jt Open 2024;5(10):929–936.

Chemotherapy-induced peripheral neuropathy (CIPN) is a side effect of cancer treatment, often linked with pain complaints. Patients report mechanical and thermal hypersensitivity that may emerge during chemotherapy treatment and may persist after cancer remission. Whereas the latter situation disturbs the quality of life, life itself may be endangered by the appearance of CIPN during cancer treatment. The causes of CIPN have almost entirely been ascribed to the neurotoxicity of chemotherapeutic drugs in the peripheral nervous system. However, the central consequences of peripheral neuropathy are starting to be unraveled, namely in the supraspinal pain modulatory system. Based on our interests and experience in the field, we undertook a review of the brain-centered alterations that may underpin pain in CIPN. The changes in the descending pain modulation in CIPN models along with the functional and connectivity abnormalities in the brain of CIPN patients are analyzed. A translational analysis of preclinical findings about descending pain regulation during CIPN is reviewed considering the main neurochemical systems (serotoninergic and noradrenergic) targeted in CIPN management in patients, namely by antidepressants. In conclusion, this review highlights the importance of studying supraspinal areas involved in descending pain modulation to understand the pathophysiology of CIPN, which will probably allow a more personalized and effective CIPN treatment in the future. [ABSTRACT FROM AUTHOR]

Introduction. Hepatic fibrosis (HF) is a complication of a congenital or acquired pathological process caused by an excess of non-functional liver tissue. The study aim was to assess the etiopathogenetic and diagnostic aspects of HF in children to evaluate surgical treatment. Materials and methods. The observational study was conducted within the CNSPCPP "Natalia Gheorghiu" of the MPHI Institute of Mother and Child, during 2018-2023, and reflects the results of the examination of 26 children aged 0-18 years diagnosed with HF caused by some congenital and acquired diseases. Paraclinical examinations included: liver ultrasound (USG) / liver elastography, MRI and CT imaging of the liver, molecular genetic testing (whole genome sequencing, next generation sequencing (NGS)), and liver biopsy. Statistical processing: through the Med Star (Medical Student Addiction Research) program. Results. In the 26 children diagnosed with HF, the following congenital pathologies were found Wilson's disease - 3 (11.53%) cases, biliary atresia - 6 (23.08%), autoimmune hepatitis - 2 (7.69%), sclerosing cholangitis - 2 (7.69%), glycogenosis - 2 (7.69%), congenital liver fibrosis - 2 (7.69%), hereditary hemochromatosis - 2 (7.69%) cases, as well as acquired pathologies such as: hepatitis B - 4 (15. 38%), hepatitis C - 3 (11.53%). In all children suspected of HF, changes in the biochemical examination of blood were detected, by increasing the values of liver enzymes, direct and indirect bilirubin, GGTP, alkaline phosphatase, LCTG, cholesterol, as well as increased levels of amylase, beta-lipoproteins, phospholipids, 5-nucleotidase, lipoprotein. There was a decrease in serum levels of total protein, albumin, and disorders of the coagulation system. USG/hepatic elastography revealed hepatosplenomegaly, increased echogenicity of liver tissue, decreased transhepatic perfusion with portal hypertension (HTP), and collaterals in the splanchnic bed. MRI of the liver was performed in 8 (30.78%) children in the cholangiographic regime and by CT with venous and arterial phase angiography - in 10 (38.46%) children. Characteristic changes for HF were assessed. The severity of HF was eloquent by the method of liver biopsy performed pre-and post-surgery. Histological changes of HF with varying degrees of impairment were found in all patients examined. Molecular genetic methods confirmed genetic diseases in 11 children with HF. Conclusions. HF occurs in many genetic and acquired pathologies and is associated with complex pathological mechanisms, with severe consequences and poor prognosis for the child's health. Early recognition of the symptoms of HF categorizes the investigations to identify the etiology of liver damage and suggests the type of treatment recommended individually. [ABSTRACT FROM AUTHOR]

Aims: Machine-learning (ML) prediction models in orthopaedic trauma hold great promise in assisting clinicians in various tasks, such as personalized risk stratification. However, an overview of current applications and critical appraisal to peer-reviewed guidelines is lacking. The objectives of this study are to 1) provide an overview of current ML prediction models in orthopaedic trauma; 2) evaluate the completeness of reporting following the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement; and 3) assess the risk of bias following the Prediction model Risk Of Bias Assessment Tool (PROBAST) tool. Methods: A systematic search screening 3,252 studies identified 45 ML-based prediction models in orthopaedic trauma up to January 2023. The TRIPOD statement assessed transparent reporting and the PROBAST tool the risk of bias. Results: A total of 40 studies reported on training and internal validation; four studies performed both development and external validation, and one study performed only external validation. The most commonly reported outcomes were mortality (33%, 15/45) and length of hospital stay (9%, 4/45), and the majority of prediction models were developed in the hip fracture population (60%, 27/45). The overall median completeness for the TRIPOD statement was 62% (interquartile range 30 to 81%). The overall risk of bias in the PROBAST tool was low in 24% (11/45), high in 69% (31/45), and unclear in 7% (3/45) of the studies. High risk of bias was mainly due to analysis domain concerns including small datasets with low number of outcomes, complete-case analysis in case of missing data, and no reporting of performance measures. Conclusion: The results of this study showed that despite a myriad of potential clinically useful applications, a substantial part of ML studies in orthopaedic trauma lack transparent reporting, and are at high risk of bias. These problems must be resolved by following established guidelines to instil confidence in ML models among patients and clinicians. Otherwise, there will remain a sizeable gap between the development of ML prediction models and their clinical application in our day-to-day orthopaedic trauma practice. Cite this article: Bone Jt Open 2024;5(1):9–19.

Background: Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potential mortality and present formidable challenges in surgical and antimicrobial treatment. Methods: In June 2022, we searched the literature using PubMed and EMBASE for published studies on the diagnosis of diabetic foot infection (DFI). On the basis of pre‐determined criteria, we reviewed prospective controlled, as well as non‐controlled, studies in English. We then developed evidence statements based on the included papers. Results: We selected a total of 64 papers that met our inclusion criteria. The certainty of the majority of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot/Infectious Diseases Society of America scheme correlates with the patient's likelihood of the need for hospitalisation, lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers such as erythrocyte sedimentation rate (ESR), C‐reactive protein and procalcitonin are supportive, but not diagnostic, of soft tissue infection. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Although non‐culture techniques, especially next‐generation sequencing, are likely to identify more bacteria from tissue samples including bone than standard cultures, no studies have established a significant impact on the management of patients with DFIs. In patients with suspected diabetic foot osteomyelitis, the combination of a positive probe‐to‐bone test and elevated ESR supports this diagnosis. Plain X‐ray remains the first‐line imaging examination when there is suspicion of diabetic foot osteomyelitis (DFO), but advanced imaging methods including magnetic resonance imaging (MRI) and nuclear imaging when MRI is not feasible help in cases when either the diagnosis or the localisation of infection is uncertain. Intra‐operative or non‐per‐wound percutaneous biopsy is the best method to accurately identify bone pathogens in case of a suspicion of a DFO. Bedside percutaneous biopsies are effective and safe and are an option to obtain bone culture data when conventional (i.e. surgical or radiological) procedures are not feasible. Conclusions: The results of this systematic review of the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is still a need for more prospective controlled studies of high quality. [ABSTRACT FROM AUTHOR]

Pheochromocytoma is a rare neuroendocrine neoplasm. It is characterized by overproduction of catecholamines, which causes clinical symptoms associated with elevated blood pressure values, and can even lead to life-threatening complications. The tumor can be associated with genetic syndromes such as multiple endocrine neoplasia type 2 (MEN-2) or von Hippel–Lindau syndrome (VHL), and currently available and constantly evolving genetic testing makes it possible to detect the inherited form and plan appropriate therapy. Management of pheochromocytoma is based on initial laboratory diagnosis, confirmation by imaging studies, determination of hormonal activity and resulting therapy. Surgical resection by laparoscopic approach is the most recommended. For unresectable tumors or advanced disease with distant metastases, systemic therapies under development currently allow the cure or inhibition of tumor progression. In this paper, we will review advances in management of pheochromocytoma over the past decade and potential directions for future research. [ABSTRACT FROM AUTHOR]

Chemotherapy-induced peripheral neuropathy (CIPN) is a side effect of cancer treatment, often linked with pain complaints. Patients report mechanical and thermal hypersensitivity that may emerge during chemotherapy treatment and may persist after cancer remission. Whereas the latter situation disturbs the quality of life, life itself may be endangered by the appearance of CIPN during cancer treatment. The causes of CIPN have almost entirely been ascribed to the neurotoxicity of chemotherapeutic drugs in the peripheral nervous system. However, the central consequences of peripheral neuropathy are starting to be unraveled, namely in the supraspinal pain modulatory system. Based on our interests and experience in the field, we undertook a review of the brain-centered alterations that may underpin pain in CIPN. The changes in the descending pain modulation in CIPN models along with the functional and connectivity abnormalities in the brain of CIPN patients are analyzed. A translational analysis of preclinical findings about descending pain regulation during CIPN is reviewed considering the main neurochemical systems (serotoninergic and noradrenergic) targeted in CIPN management in patients, namely by antidepressants. In conclusion, this review highlights the importance of studying supraspinal areas involved in descending pain modulation to understand the pathophysiology of CIPN, which will probably allow a more personalized and effective CIPN treatment in the future.

Insurance prior authorization (PA) is a determination of need, required by a health insurer for an ordered test/procedure. If the test/procedure is denied, a peer-to-peer (P2P) discussion between ordering provider and payer is used to appeal the decision. The objective of this study was to measure the number and patterns of unnecessary PA denials. This was a retrospective review at a quaternary cancer center from October 2021 to March 2022. Included were all patients with outpatient imaging orders for surgical planning or surveillance of gastrointestinal, endocrine, or skin cancer. Primary outcome was unnecessary initial denial (UID) defined as an order that required preauthorization, was initially denied by the insurer, and subsequently overturned by P2P. Nine hundred fifty seven orders were placed and 419 required PA (44%). Of tests requiring authorization, 55/419 (13.1%) were denied. Variability in the likelihood of initial denial was seen across insurers, ranging from 0% to 57%. Following P2P, 32/55 were overturned (58.2% UID). The insurers most likely to have a UID were Aetna (100%), Anthem (77.8%), and Cigna (50.0%). UID was most common for gastrointestinal (58.9%) and endocrine (58.3%) cancers. Average P2P was 33.5 min (interquartile range 28-40). The majority of imaging studies initially denied were overturned after P2P. If all UIDs were eliminated, this would represent 108 less P2P discussions with an estimated time-savings of 60.3 h annually within a high-volume surgical oncology practice. Combined personnel costs to the health systems and stress on patients with cancer due to image-associated PAs and P2P appear hard to justify. [ABSTRACT FROM AUTHOR]

Nutcracker syndrome is a rare inborn vascular abnormality in which the left renal vein is trapped and compressed between the superior mesenteric artery and the aorta. Compression leads to congestion and dilation of the left renal vein, erythrocyturia with or without proteinuria, pelvic congestion and pelvic pain in women and varicocele and/or swelling of the left testicle in men. The affected individuals may report low abdominal pain and discomfort in the left flank. The diagnosis is based on imaging studies (abdominal ultrasound, computed tomography with contrast enhancement, angiography, magnetic resonance imaging). Nutcracker syndrome is part of the differential diagnosis of hematuria and pelvic pain. The treatment is interventional (percutaneous transluminal angioplasty of the left renal vein) or surgical. The authors present a 46-year-old female patient with nutcracker syndrome diagnosed using contrast-enhanced computed tomography for hematuria since childhood. [ABSTRACT FROM AUTHOR]

Objectives: The present study was carried out to evaluate diagnostic accuracy of ultrasound (US) in delineating various rotator cuff and associated non rotator cuff pathologies (RCPs) of shoulder joint compared to Magnetic Resonance Imaging (MRI). Methods: Fifty consecutive symptomatic subjects in age-group 18-75 years (mean ±SD: 56.0±13.6 years; 39-male, 11-female) were evaluated. US performer and MRI reporting radiologists were blinded to results of each-other. The sensitivity, specificity, and accuracy of US was measured for diagnosing various musculo-tendinous pathologies of shoulder against MRI gold standard. Results: MRI detected RCPs in all subjects while US was abnormal in 46(92%) cases. Supraspinatus was the most frequently affected tendon. Remarkably, 28% patient had polytendon abnormalities. US showed sensitivity of 84% and specificity of 87.5% for tendinosis; sensitivity of 78.1% and specificity of 94.4% for partial thickness tear (PTT) and 100% sensitivity and specificity for diagnosing full thickness tear. However, sensitivity of US for diagnosing PTT of infraspinatus tendon, subscapularis tendinosis and teres-minor atrophy was low. US had high specificity for diagnosing non-RCPs but sensitivity was low. Conclusions: A normal shoulder US may not rule out with certainty some rotator cuff and associated non-rotator cuff abnormalities. It is suggested to search for polytendon abnormalities which may be missed.

[Display omitted] • The study focuses on detecting diethyl chlorophosphate (DCP), a toxic simulant for nerve agents. • TPAHY and TPAPD were developed as ICT based sensors for DCP with detection limits of 23.31 nM and 28.42 nM. • TPAHY is utilised for on-the-spot DCP detection, showing yellow-to-orange colour shifts and orange fluorescence. • TPAHY is also explored in Hela cell imaging, expanding its applications beyond detection. Detecting diethyl chlorophosphate (DCP), a highly toxic chemical simulant for nerve agents like Sarin, Soman, and Tabun, is crucial due to its prevalence in warfare scenarios, as well as its presence in contaminated soil and air. Traditional detection methods often struggle with sensitivity and versatility, limiting their effectiveness in real-time, on-the-spot applications. Effective detection is vital for safety, environmental monitoring, and mitigating the risks associated with these hazardous substances. There is a pressing need for advanced sensors that can offer high sensitivity, specificity, and practicality in various environments. In our study, we developed and introduced two ICT-based fluorocolorimetric sensors, TPAHY and TPAPD, designed for the detection of DCP. These sensors exhibit remarkable sensitivity, with limits of detection (LOD) at 23.31 nM for TPAHY and 28.42 nM for TPAPD. TPAHY proves to be an efficient sensor for the on-spot DCP detection, showcasing practical applications such as fluorescent sprays, pens, and detection devices. Upon addition of DCP, TPAHY undergoes a distinct colorimetric shift from yellow to orange, coupled with an enhancement of orange fluorescence. Conversely, TPAPD demonstrates a colorimetric transition from colourless to yellow and experiences fluorescence quenching from blue emission. To understand the underlying mechanisms, we conducted studies using density functional theory (DFT) and lifetime measurements, providing deeper insights into the sensor behaviours. The development of TPAHY and TPAPD provides reliable, sensitive, and versatile solutions for monitoring DCP. TPAHY not only serves as a useful tool for detecting DCP in various field applications but also extends its utility to biological imaging, as demonstrated in HeLa cell studies. This dual functionality enhances its relevance for both environmental monitoring and broader scientific investigations. These sensors represent a significant advancement in the detection of toxic chemicals, offering improved safety and research capabilities. [ABSTRACT FROM AUTHOR]

Objectives: The present study was carried out to evaluate diagnostic accuracy of ultrasound (US) in delineating various rotator cuff and associated non rotator cuff pathologies (RCPs) of shoulder joint compared to Magnetic Resonance Imaging (MRI). Methods: Fifty consecutive symptomatic subjects in age-group 18-75 years (mean ±SD: 56.0±13.6 years; 39-male, 11-female) were evaluated. US performer and MRI reporting radiologists were blinded to results of each-other. The sensitivity, specificity, and accuracy of US was measured for diagnosing various musculo-tendinous pathologies of shoulder against MRI gold standard. Results: MRI detected RCPs in all subjects while US was abnormal in 46(92%) cases. Supraspinatus was the most frequently affected tendon. Remarkably, 28% patient had polytendon abnormalities. US showed sensitivity of 84% and specificity of 87.5% for tendinosis; sensitivity of 78.1% and specificity of 94.4% for partial thickness tear (PTT) and 100% sensitivity and specificity for diagnosing full thickness tear. However, sensitivity of US for diagnosing PTT of infraspinatus tendon, subscapularis tendinosis and teres-minor atrophy was low. US had high specificity for diagnosing non-RCPs but sensitivity was low. Conclusions: A normal shoulder US may not rule out with certainty some rotator cuff and associated non-rotator cuff abnormalities. It is suggested to search for polytendon abnormalities which may be missed. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study focused to evaluate and investigate optimized (using QbD) and novel ketoconazole (KTZ)-loaded solid lipid nanoparticles (KTZ-SLNs; 2% w/v KTZ) for enhanced permeation across skin. KTZ-SLNs were evaluated for size, distribution, zeta potential (ZP), percent entrapment efficiency (%EE), drug release, morphology (HRTEM and FESEM), thermal behaviour (DSC), spectroscopic (FTIR), and solid-state/diffraction characterization (X-ray diffraction, XRD). Moreover, ex vivo permeation and drug deposition into rat skin were conducted using Franz diffusion cell. The same was confirmed using human dermatome skin and fluorescence, confocal Raman, and vibrational ATR-FTIR microscopic methods. An in vivo dermatokinetics study was performed in rats to assess the extent of KTZ permeation into the skin. Stability including accelerated and photostability studies were conducted at different temperatures (2–8, 30, and 40 °C) for 12 months. The spherical, optimized KTZ-SLN formulation (KOF1) showed particle size of 293 nm and high EE of 88.5%. Results of FTIR, DSC, and XRD confirmed formation of KTZ-SLNs and their amorphous nature due to presence of KTZ in a dissolved state in the lipid matrix. In vitro release was slow and sustained whereas ex vivo permeation parameters were significantly high in KTZ-SLNs as compared to free drug suspension (KTZ-SUS) and marketed product (Nizral®; 2% KTZ w/v). Drug retention was 10- and five-fold higher than KTZ-SUS and marketed product, respectively. In vivo dermatokinetics parameters improved significantly with SLN formulation (410–900% enhanced). Confocal Raman spectroscopy experiment showed that KTZ-SLNs could penetrate beyond the human stratum corneum into viable epidermis. Fluorescent microscopy also indicated improved penetration of KTZ-SLNs. KTZ-SLNs were photostable and showed long-term stability over 12 months under set conditions. [ABSTRACT FROM AUTHOR]

Abstract Objective Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. Methods Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. Results Themean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when agewas compared between the groups, a statistically significant difference (p=0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p=0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p=0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 x 109/mcL and 232.00 ± 71.04 x 109/mcL respectively; p=0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p

• Polymicrobial and monomicrobial bloodstream infections were compared. • Polymicrobial infections were correlated with increased mortality. • Imaging studies led to surgical drainage in 20-27 % of patients in both groups. • Performance of imaging studies was correlated with better outcomes. : Appropriate antimicrobial therapy and surgical drainage, improve survival in patients with Gram negative bloodstream infections (BSI). Data about the yield of imaging studies in polymicrobial BSI is sparse. The aim of the study was to assess the need for imaging studies and surgical drainage among patients with polymicrobial compared to monomicrobial BSI. : In a retrospective cohort study of adult patients with Gram negative BSI, 135 patients with monomicrobial BSI were compared to 82 with polymicrobial BSI. Imaging studies were performed in 56.3 % of patients with monomicrobial BSI and in 50 % of polymicrobial BSI (p=0.4), surgical drainage was performed in 20.1 % of patients with monomicrobial BSI and 27.2 % of polymicrobial BSI (p=0.25). Surgical drainage was performed in 26.2 % of patients who survived vs. 11.8 % of patients who died (p=0.035). : There is no difference in the diagnostic approach to monomicrobial and polymicrobial Gram-negative BSI. Surgical drainage is associated with decreased mortality. [ABSTRACT FROM AUTHOR]

There are growing concerns that some COVID-19 survivors may acquire fibrosis and other irreversible lung abnormalities. The purpose of this prospective study was to assess the rate and predictors of complete resolution of COVID-19 pneumonia by pursuing a hypothetical relation between time and imaging pattern evolution using HRCT findings. A monocentric prospective cohort study with a consecutive-case enrolment design was implemented during a five-month period, having a total of 683 post-COVID patients eligible for inclusion and 635 evaluations with complete follow-up for chest HRCT. The target for post-COVID evaluations consisted of performing HRCT 90 days after a confirmed SARS-CoV-2 infection. The studied patients had an average age of 54 years, ranging between 18 and 85 years old, and an average duration from the first symptoms until HRCT was performed of 74 days. At the post-COVID follow-up, 25.8% had a complete imagistic remission. The most common appearance with HRCT was "ground glass" in 86.6% in patients with persistent COVID-19, followed by reticulations, present in 78.8%, and respectively pleural thickening in 41.2% of cases. The mean total HRCT scores were statistically significantly higher in patients older than 65 years (10.6 ± 6.0) compared to the 40–65 group (6.1 ± 6.1) and the 18–40 age group (2.7 ± 4.8) (p < 0.001). Chest HRCT is a "time window" in documenting temporal persistent radiologic features of lung injury 90 days after SARS-CoV-2 infection, determining the pathologic basis of so-called "long COVID". The complete remission was associated with a significantly higher average follow-up period and a significantly lower average patient age. Persistent HRCT features of ground glass, reticulation, and pleural thickening are associated with a higher total CT score and older age. [ABSTRACT FROM AUTHOR]

Coronary computed tomographic angiography (CTA) is a non-invasive procedure that makes it very convenient to imagine the anatomical ability to remove coronary artery disease in patients with chest pain in a population at low to moderate risk. For plaque identification and physiological assessment, coronary CTA may be used, facilitating thorough diagnostic and prognostic assessment of primary prevention in patients. Overall plaque load is assessed by the coronary CTA, plaque subtypes are distinguished and high-risk plaque is identified. The purpose of this article is to review existing applications and practices related to the use of automatic techniques in coronary CTA analysis and interpretation.

Abstract Fever and deranged transaminases with liver mass(es) on imaging mandates further evaluation of the mass(es) and should be followed radiologically and clinically. In the absence of a definitive diagnosis, repeat biopsy should be done.

Abstract Background Multiple polypoid colonic metastases are very rare which mainly originated from gastric carcinoma or melanoma. For rectal cancers, liver, lung and peritoneum are the most common metastatic sites. Here we present an unusual case with rectal adenocarcinoma and metachronous multiple colonic polypoid metastases. Case presentation A 53-year-old man who underwent radical resection for rectal cancer 2 years ago was admitted to our department for an elevation of CEA level of 18.4 ng/ml. Colonoscopy revealed ten ivory rubbery colonic polypoid lesions (about 5 mm in diameters) in the large bowel which were confirmed as signet ring cell carcinomas (SRCC) by biopsy, but full-body contrast enhanced CT and PET-CT showed no other suspicious lesion. Seven weeks later, a laparoscopic total colectomy was performed and more than 50 polypoid lesions were observed throughout the mucosal surface of the large intestine which were confirmed as metastatic SRCC by postoperative pathological examination. All the 34 paracolic lymph nodes retrieved were involved. After 4 months, diffuse abdominopelvic and multiple bone metastases were identified by CT and the patient died of the disease 1 month later. Conclusion Here we present an unusual case of multiple colonic polypoid metastases of rectal adenocarcinoma. For SRCC that is prone to have disseminated micrometastases, colonic ‘polyps’ may be the early noticeable sign of undetectable and extensive tumor spread. Instead of surgical resection of ‘the confined disease in colon’, systemic treatment maybe a more appropriate choice.

Langerhans cell histiocytosis (LCH) is a myeloid neoplasm characterized by clonal neoplastic proliferation of Langerhans-type dendritic cells associated with an inflammatory infiltrate predominantly composed of lymphocytes and eosinophils. In this article, we present an unusual case of LCH with significant swelling in the left lacrimal sac region in a 3-year-old child, clinically mimicking acute dacryocystitis. Microscopically, it showed intense inflammatory infiltrate and histiocytes with irregular nuclei. The tumor cells were positive for S-100 protein, CD1a, and CD207 (langerin). Molecular study was positive for the V600E/E2/D mutation (EXON 15). This case emphasizes the importance of careful clinical, radiographic, and microscopic evaluation, as some neoplasms may mimic common benign lesions., (Copyright © 2024 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.)

In many imaging studies, each case is reviewed by human readers and characterized according to one or more features. Often, the inter-reader agreement of the feature indications is of interest in addition to their diagnostic accuracy or association with clinical outcomes. Complete designs in which all participating readers review all cases maximize efficiency and guarantee estimability of agreement metrics for all pairs of readers but often involve a heavy reading burden. Assigning readers to cases using balanced incomplete block designs substantially reduces reading burden by having each reader review only a subset of cases, while still maintaining estimability of inter-reader agreement for all pairs of readers. Methodology for data analysis and power and sample size calculations under balanced incomplete block designs is presented and applied to simulation studies and an actual example. Simulation studies results suggest that such designs may reduce reading burdens by >40% while in most scenarios incurring a <20% increase in the standard errors and a <8% and <20% reduction in power to detect between-modality differences in diagnostic accuracy and κ statistics, respectively. [ABSTRACT FROM AUTHOR]

Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory presentation, etiology and risk factors, and optimal imaging studies. [West J Emerg Med. 2014;15(7):–0.]

Abstract Sinusoidal obstruction syndrome (SOS) is a rare liver disorder due to hepatic vascular injury. Its rapid and accurate diagnosis is crucial for patient survival. SOS is often established clinically, based on Baltimore, modified Seattle, or European Society for Blood and Marrow Transplantation (EBMT) criteria. Unfortunately, such criteria are not highly specificity and fail to provide a timely, reliable differential diagnosis. The use of noninvasive imaging techniques, such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), has recently grown in this setting, some key imaging features offering diagnostic improvement. This review provides a synopsis of current noninvasive imaging techniques used for this purpose, summarizing accurate and reliable diagnostic features of SOS.

Abstract The novel ratiometric fluorescent probe HPQRB with an ESIPT effect based on Michael addition for highly sensitive and fast detection of sulfite in living HepG2 cells is reported. HPQRB can be easily synthesized by a two‐step condensation reaction. HPQRB has a large emission shift (Δλ=116 nm), which is beneficial for fluorescence imaging research, and its sulfite‐responsive site is based on a rhodamine‐like structure with the emission peak at 566 nm, which decreases with increasing sulfite concentration. and its HPQ structure always has an ESIPT effect throughout the reaction process, keeping the emission peak at 450 nm as a self‐reference. In particular, HPQRB has high selectivity for sulfite and responds quickly (within 30 s) with a low detection limit (44 nM). Furthermore, HPQRB has been successfully used for fluorescence imaging of sulfite in HepG2 cells, demonstrating the superior ability to detect sulfite under physiological conditions.

Cystic lymphangiomas (CLs) are benign congenital lymphatic malformations that are thought to represent developmental abnormalities rather than true neoplasms. The head and neck region is the most common site of occurrence, although CLs can be present elsewhere in the body including the axilla, mediastinum, groin, and retroperitoneum. More than 80% of CLs present before the age of two. Occurrence in adults is rare with only a few cases reported in the literature. We describe five cases of cervical CLs in adults and discuss imaging modalities used for diagnostics, clinicopathologic features, and therapeutic options. [ABSTRACT FROM AUTHOR]

Venous thromboembolism is a significant clinical entity that includes two associated medical disorders: deep vein thrombosis and pulmonary embolism. The goal of this article is to describe the optimal approach to evaluating venous thromboembolism including pretest probability clinical decision rules and appropriate testing to ensure an accurate diagnosis. [ABSTRACT FROM AUTHOR]

There are growing concerns that some COVID-19 survivors may acquire fibrosis and other irreversible lung abnormalities. The purpose of this prospective study was to assess the rate and predictors of complete resolution of COVID-19 pneumonia by pursuing a hypothetical relation between time and imaging pattern evolution using HRCT findings. A monocentric prospective cohort study with a consecutive-case enrolment design was implemented during a five-month period, having a total of 683 post-COVID patients eligible for inclusion and 635 evaluations with complete follow-up for chest HRCT. The target for post-COVID evaluations consisted of performing HRCT 90 days after a confirmed SARS-CoV-2 infection. The studied patients had an average age of 54 years, ranging between 18 and 85 years old, and an average duration from the first symptoms until HRCT was performed of 74 days. At the post-COVID follow-up, 25.8% had a complete imagistic remission. The most common appearance with HRCT was “ground glass” in 86.6% in patients with persistent COVID-19, followed by reticulations, present in 78.8%, and respectively pleural thickening in 41.2% of cases. The mean total HRCT scores were statistically significantly higher in patients older than 65 years (10.6 ± 6.0) compared to the 40–65 group (6.1 ± 6.1) and the 18–40 age group (2.7 ± 4.8) (p < 0.001). Chest HRCT is a “time window” in documenting temporal persistent radiologic features of lung injury 90 days after SARS-CoV-2 infection, determining the pathologic basis of so-called “long COVID”. The complete remission was associated with a significantly higher average follow-up period and a significantly lower average patient age. Persistent HRCT features of ground glass, reticulation, and pleural thickening are associated with a higher total CT score and older age.

Introduction: Breast implants follow-up with any type of examination is often neglected; this may cause an error or delay in the diagnosis of complications prosthesis-related such as BIA-ALCL. This study aims to better understand adequate follow-up criteria. Method: All female patients undergoing aesthetic breast augmentation and breast MRI in its follow-up conducted from April 2006 to December 2019 were included in this study. The variables analyzed were age, breast implant surgery date, time with the implant, reason for the examination, and the final examination report. A logistic regression analysis was conducted to search for the predictors of positive findings in MRI. A Cox Regression analysis and cumulative risk curves, controlled by age, was performed to investigate the relationship between time with implants and the risk of positive findings in MRI. Results: The patients submitted to MRI had complaints in 29.6% of cases, with pain being the most common, 13.9% of cases. In logistic regression analysis, time with the implant was associated with a higher risk of positive findings in univariate analysis (OR = 1.07, p = 0.036), but not in multivariate analysis. Both pain and breast form changes were independent predictors for positive findings in MRI, OR = 2.79, p = 0.04, and OR = 16.98, p < 0.001, respectively. The cumulative risk of positive findings in MRI increased considerably only after 10 years of implantation. Conclusions: Time with breast implants may be associated with a higher risk of changes in breast MRI examinations, although this relationship was not significant in multivariate logistic regression analysis. The cumulative risk for positive findings seems to increase considerably only after 10 years of implantation. This study draws attention to the paramount importance of follow-up with a clinical breast examination. Despite time with implants or patients' age, both pain and breast form changes were the most important predictors for MRI alterations. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative imaging, besides audiological evaluation, plays a major role in evaluation of candidacy for auditory implants, and in particular cochlear implants. It is essential to assess whether the basic criteria necessary for implantation are met. Diagnostic imaging is crucial not only in determining candidacy, but also determining the feasibility of cochlear implantation as it allow to anticipate surgical difficulties which could preclude or complicate the implantation of the device. The aim of the study is to present the protocol for the evaluation of preoperative imaging studies with particular focus on the factors potentially affecting clinical decisions in children qualified for cochlear implantation. Material and method: Preoperative imaging studies of 111 children performed prior to cochlear implantation were analyzed: high-resolution computed tomography (HRCT) of temporal bones and MRI. The assessment was made according to the presented protocol. Results: Pathologies and anomalies identified during the assessment of preoperative imaging studies significantly altered clinical decisions in 30% of patients. In the study group, in 17% of patients inner ear malformations were identified. 2.7% of children were disqualified from a cochlear implantation due to severe congenital inner ear malformations. 9% of the patients have had bacterial meningitis. In 50% of them difficulties related to complete or progressive cochlear ossification occurred. In 4.5% of patients less common surgical approaches other than mastoidectomy with a posterior tympanotomy were applied. Discussion: Preoperative imaging allow for the identification of significant pathologies and anomalies affecting qualification decisions and further treatment. HRCT and MRI are complementary to each other for preoperative imaging. The two modalities in combination allow accurate and optimal evaluation of the anatomical structures prior to implantation. Inner ear malformations and cochlear ossification following meningitis are relatively frequently encountered in children qualified for a cochlear implant. [ABSTRACT FROM AUTHOR]

Penile fracture is defined as a traumatic rupture of either corpus cavernosum or the tunica albuginea; sometimes it can be both. It may be caused by exotic masturbation acts, sexual intercourse, or other trauma to this area. This can be accompanied by injury to the urethra, which is the cause of hematuria as a symptom for some patients. Typically, diagnosis of penile rupture or fracture depends on clinical examination and history told by the patients. We are stating the importance of medical imaging in the diagnosis of patients with penile fracture by presenting a case of patient suffered from penile fracture after a fall on his penis where it affected the erection of two-third of his penis. In which, the proper diagnosis by imaging studies and taking actions accordingly can save the patients from unnecessary surgeries that indeed increase the bill of the medical care directly and indirectly. Therefore, most patients can be diagnosed cost-effectively and treated surgically without a need to delay surgery, which is often the case if one was to resort to other investigations. Investigations such as retrograde urethrography for suspected urethral injury should only be used when the diagnosis of penile fracture is in doubt.

Fever and deranged transaminases with liver mass(es) on imaging mandates further evaluation of the mass(es) and should be followed radiologically and clinically. In the absence of a definitive diagnosis, repeat biopsy should be done. [ABSTRACT FROM AUTHOR]

Large vessel involvement in giant cell arteritis has long been described, although its right frequency and potential prognostic value have only been highlighted for two decades. Large vessel involvement not only is associated with a high incidence of late aortic aneurysms, but also might cause greater resistance to glucocorticoids and longer treatment duration, as well as worse late cardiovascular outcomes. These data were brought to our attention, thanks to substantial progress recently made in large vessel imaging. This relies on four single, often complementary, approaches of varying availability: colour Doppler ultrasound, contrast-enhanced computed tomography with angiography and, magnetic resonance imaging, which all demonstrate homogeneous circumferential wall thickening and describe structural changes; 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT), which depicts wall inflammation and assesses many vascular territories in the same examination. In addition, integrated head-and-neck PET/CT can accurately and reliably diagnose cranial arteritis. All four procedures exhibit high diagnostic performance for a large vessel arteritis diagnosis so that the choice is left to the physician, depending on local practices and accessibility; the most important is to carry out the chosen modality without delay to avoid false or equivocal results, due to early vascular oedema changes as a result of high dose glucocorticoid treatment. Yet, ultrasound study of the superficial cranial and subclavian/axillary arteries remains a first line assessment aimed at strengthening and expediting the clinical diagnosis as well as raising suspicion of large-vessel involvement. In treated patients, vascular imaging results are poorly correlated with clinical-biological controlled disease so that it is strongly recommended not to renew imaging studies unless a large vessel relapse or complication is suspected. On the other hand, a structural monitoring of aorta following giant cell arteritis is mandatory, but uncertainties remain regarding the best procedural approach, timing of first control and spacing between controls. Individuals at greater risk of developing aortic complication, e.g. those with classic risk factors for aneurysm and/or visualised aortitis, should be monitored more closely. [ABSTRACT FROM AUTHOR]

Background: Multiple polypoid colonic metastases are very rare which mainly originated from gastric carcinoma or melanoma. For rectal cancers, liver, lung and peritoneum are the most common metastatic sites. Here we present an unusual case with rectal adenocarcinoma and metachronous multiple colonic polypoid metastases.Case Presentation: A 53-year-old man who underwent radical resection for rectal cancer 2 years ago was admitted to our department for an elevation of CEA level of 18.4 ng/ml. Colonoscopy revealed ten ivory rubbery colonic polypoid lesions (about 5 mm in diameters) in the large bowel which were confirmed as signet ring cell carcinomas (SRCC) by biopsy, but full-body contrast enhanced CT and PET-CT showed no other suspicious lesion. Seven weeks later, a laparoscopic total colectomy was performed and more than 50 polypoid lesions were observed throughout the mucosal surface of the large intestine which were confirmed as metastatic SRCC by postoperative pathological examination. All the 34 paracolic lymph nodes retrieved were involved. After 4 months, diffuse abdominopelvic and multiple bone metastases were identified by CT and the patient died of the disease 1 month later.Conclusion: Here we present an unusual case of multiple colonic polypoid metastases of rectal adenocarcinoma. For SRCC that is prone to have disseminated micrometastases, colonic 'polyps' may be the early noticeable sign of undetectable and extensive tumor spread. Instead of surgical resection of 'the confined disease in colon', systemic treatment maybe a more appropriate choice. [ABSTRACT FROM AUTHOR]

This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants' lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants' narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts on self and others. The paper shows: (1) that the impact of incidental findings may be greater than participants at first let on; (2) incidental findings can have significant effects on participants' social environment; and (3) participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants' experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. [ABSTRACT FROM AUTHOR]

Objective: It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury.Methods: We conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs).Results: We analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3).Conclusions: We identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately. [ABSTRACT FROM AUTHOR]

Pulmonary nodules risk classification in adenocarcinoma is essential for early detection of lung cancer and clinical treatment decision. Improving the level of early diagnosis and the identification of small lung adenocarcinoma has been always an important topic for imaging studies. In this study, the authors propose a deep convolutional neural network (CNN) with scale‐transfer module (STM) and incorporate multi‐feature fusion operation, named STM‐Net. This network can amplify small targets and adapt to different resolution images. The evaluation data were obtained from the computed tomography (CT) database provided by Zhongshan Hospital Fudan University (ZSDB). All data have a pathological label and their lung adenocarcinomas risk are classified into four categories: atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive adenocarcinoma. The authors' deep learning network STM‐Net was trained and tested for the risk stage prediction. The accuracy and the average area under the receiver operating characteristic curve achieved by their method are 95.455% and 0.987 for the ZSDB dataset. The experimental results show that STM‐Net largely boosts classification accuracy on the pulmonary nodules classification compared with state‐of‐the‐art approaches. The proposed method will be an effective auxiliary to help physicians diagnosis pulmonary nodules risk classification in adenocarcinoma in early‐stage. [ABSTRACT FROM AUTHOR]

Copyright of Dilemas Contemporáneos: Educación, Política y Valores is the property of Dilemas Contemporaneos: Educacion, Politica y Valores and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potentially mortality and present formidable challenges in surgical and antimicrobial treatment.Methods: In June 2018, we searched the literature using PuEbMed and EMBASE for published studies on the diagnosis of diabetic foot infection. On the basis of predetermined criteria, we reviewed prospective controlled, as well as noncontrolled, studies in any language, seeking translations for those not in English. We then developed evidence statements on the basis of the included papers.Results: From the 4242 records screened, we selected 35 papers that met our inclusion criteria. The quality of all but one of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot scheme correlates with the patient's likelihood of ulcer healing, of lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers are supportive, but not diagnostic, of soft tissue or bone infection. In patients with suspected diabetic foot osteomyelitis, both a positive probe-to-bone test and an elevated erythrocyte sedimentation rate are strongly associated with its presence. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Plain X-ray remains the first-line imaging examination when there is suspicion of diabetic foot osteomyelitis, but advanced imaging methods help in cases when either the diagnosis or the localization of infection is uncertain.Conclusion: The results of this first reported systematic review on the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is a need for more prospective controlled studies of high quality. [ABSTRACT FROM AUTHOR]