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Background: Prompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing. Methods: We obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve. Results: Based on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively. Conclusions: Our study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points. [ABSTRACT FROM AUTHOR]

Abstract Background Prompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing. Methods We obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve. Results Based on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively. Conclusions Our study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points.

Background/Objectives: Osteoporotic vertebral fractures (OVFs) significantly impair quality of life. This study evaluates the impact of STIR sequence MR imaging on clinical decision-making for treating OVFs, mainly focusing on how MRI findings influence treatment modifications compared to those based solely on CT scans. Methods: This retrospective analysis reviewed cases from the Manninger Jenő National Traumatology Institute over ten years, where patients with suspected OVFs underwent CT and STIR sequence MR imaging. The study examined changes in treatment plans initiated by MRI findings. The diagnostic effectiveness of MRI was compared against CT in terms of sensitivity, specificity, and the ability to influence clinical treatment paths. Results: MRI detected 1.65 times more fractures than CT scans. MRI influenced treatment adjustments in 67% of cases, leading to significant changes from conservative–conservative, conservative–surgery, and surgery–surgery based on fracture characterizations provided by MRI. Conclusions: This study demonstrates that integrating STIR sequence MR imaging into the diagnostic pathway for OVFs significantly enhances the accuracy of fracture detection and profoundly impacts treatment decisions. The ability of MRI to reveal specific fracture features that are not detectable by CT scans supports its importance in the clinical evaluation of OVFs, suggesting that MRI should be incorporated more into diagnostic protocols to improve patient management and outcomes. The findings advocate for further research to establish STIR MRI as a standard osteoporosis management tool and explore its long-term benefits in preventing secondary fractures. [ABSTRACT FROM AUTHOR]

Background: Fatigue remains one of the most common and disabling problems in Multiple Sclerosis (MS) and several factors could contribute to the development and/or exacerbation of this symptom. So, the aim of this study is to assess fatigue in MS patients and identify its correlations with other clinical, functional and radiological signs. Materials and methods: This is a prospective collection study that included adult patients with MS. In addition to clinical and radiological assessment, we used the Visual Analog Scale-fatigue (VAS-f) and Fatigue Severity Scale (FSS) self-questionnaire to assess fatigue and the Expanded Disability Status Scale (EDSS) for disability. Univariate and multivariate analysis was performed using Social Package for Social Sciences (SPSS) version 20 software. Results: The mean age of the 103 patients (71 women and 32 men) was 41.57 ± 11.22 years and the mean EDSS was 5.12 ± 1.97. Fatigue was found in 94 patients among whom 26% had severe fatigue (VAS-f ≥ 7). We found that 53.2% had moderate fatigue and 15.6% had severe fatigue according to the FSS. We did not find an association between fatigue severity and EDSS, age, sex and place of birth/residence; however, fatigue severity was correlated with the duration of disease progression, progressive form of the disease, depressed mood and presence of demyelinating plaques in the cerebellum. Conclusion: The appropriate management of fatigue in MS requires first a good evaluation and a good semiological analysis. [ABSTRACT FROM AUTHOR]

Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem–canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary. [ABSTRACT FROM AUTHOR]

Sarcopenia, an extremely common condition in cancer patients, is described as a progressive and generalized musculoskeletal disorder that is associated with an increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. By contrast, cachexia is defined as a syndrome characterized by weight loss with the concomitant loss of muscle and/or fat mass. Cancer cachexia leads to functional impairment, reduced physical performance, and decreased survival, and is often accompanied by cancer progression and reduced response to therapy. The literature states that cancer patients with cachexia or sarcopenia have many more complications than patients without these conditions. The interplay between physiologic sarcopenia and cancer cachexia is, in part, responsible for the complexity of studying wasting disorders in the cancer population, particularly in the geriatric population. For these reasons, a comprehensive assessment of the body composition and physical function of these patients is necessary. There are several modalities adapted to measure skeletal muscle mass, such as dual-energy X-ray absorptiometry (DEXA), bioelectrical impedance analysis (BIA), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). The gold standard for the measurement of quantitative and qualitative changes in body composition in patients with cancer is the analysis of tissue density using a CT scan. However, this technique remains poorly implemented in clinical practice because of the use of ionizing radiation. Similarly, DEXA, MRI, and US have been proposed, but their use is limited. In this review, we present and compare the imaging techniques that have been developed so far for the nutritional assessment of cancer patients. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between erectile dysfunction (ED) as well as epistaxis (ES) in relation to the extent of iliac atherosclerosis. Methods: In this retrospective cross-sectional study, all consecutive male patients treated at our institution from 01/2016 to 12/2020 undergoing abdominal CT scan were evaluated. Patients (n = 1272) were invited by mail to participate in the study in returning two questionnaires for the evaluation of ED (IIEF-5) and ES. Patients who returned filled-in questionnaires within a 3-month deadline were included in the study. The extent of atherosclerosis in the common iliac artery (CIA) and the internal iliac artery (IIA) was assessed by calcium scoring on unenhanced CT. Stratification of results was performed according to reported IIEF-5 scores and consequential ED groups. Results: In total, 437 patients (34.4% of contacted) met the inclusion criteria. Forty-two patients did not fulfill predefined age requirements (< 75 years) and 120 patients had to be excluded as calcium scoring on nonenhanced CT was not feasible. Finally, 275 patients were included in the analysis and stratified into groups of "no-mild" (n = 146) and "moderate-severe" (n = 129) ED. The calcium score (r=-0.28, p < 0.001) and the number of atherosclerotic lesions (r=-0.32, p < 0.001) in the CIA + IIA showed a significant negative correlation to the IIEF-5 score, respectively. Patients differed significantly in CIA + IIA calcium score (difference: 167.4, p < 0.001) and number of atherosclerotic lesions (difference: 5.00, p < 0.001) when belonging to the "no-mild" vs. "moderate-severe" ED group, respectively. A multivariable regression model, after adjusting for relevant baseline characteristics, showed that the number of atherosclerotic CIA + IIA lesions was an independent predictor of ED (OR = 1.05, p = 0.036), whereas CIA + IIA calcium score was not (OR = 1.00031, p = 0.20). No relevant correlation was found between ES episodes and IIEF-5 scores (r=-0.069, p = 0.25), CIA + IIA calcium score (r=-0.10, p = 0.87) or number of atherosclerotic CIA + IIA lesions (r=-0.032, p = 0.60), respectively. Conclusions: The number of atherosclerotic lesions in the iliac arteries on nonenhanced abdominal CT scans is associated with the severity of ED. This may be used to identify subclinical cardiovascular disease and to quantify the risk for cardiovascular hazards in the future. Trial registration: BASEC-Nr. 2020 − 01637. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most prevalent malignancy diagnosed in women globally (22%), and it ranks second to cervical cancer (18.5%) in India. Breast cancer is becoming more prevalent in both developed and developing countries; the peak occurrence of breast cancer in developed countries occurs after the age of 50, whereas it occurs after the age of 40 in India. Objectives: 1. To correlate clinical, radiological, and gold standard pathological parameters in assessing the tumor response to Neoadjuvant chemotherapy (NACT) in locally advance breast cancer (LABC). 2. To find out the rates of response after neoadjuvant chemotherapy in patients of locally advanced breast cancer under following categories a. Clinical, b. Pathological, c. Radiological 3. To study the various prognostic factors to determine the outcome of the disease related to mortality and morbidity. Material & Methods: Study Design: Prospective hospital based observational study. Study area: The study was carried out in the Department of General surgery, B.J Government Medical College and Sassoon general Hospital, Pune. Study Period: 1 year. Sample size: study consisted of 55 subjects. Sampling method: Simple random Sampling Technique. Study tools and Data collection procedure: The following protocol was followed • Clinically and radiologically (by Mammography) suspected cases of locally advanced Ca breast were enrolled for the study after informed written consent. • Histopathological diagnosis was made by FNAC. • In the cases where FNAC was not conclusive, tru-cut biopsy was done • Once histopathological diagnosis was confirmed estrogen and progesterone receptor status was found out by immunohistochemistry. • Clinical stage IIIa and IIIb i.e locally advanced breast cancer (LABC) patients were considered for the further study (total number of patients was 55). Results: A total of 18 (29%) patients had clinical complete response (CCR) of these 16 patients, only 10 patients (62.5%) had a correlating pathological complete response (pCR). In our study. 53 (90- 4%) patients had an infiltrating ductal carcinoma while 2 had infiltrating lobular carcinoma. Majority (94 29%) of the patients had an infiltrating ductal carcinoma. Conclusion: The current study reveals that clinical assessment of response to NACT has higher sensitivity than radiological assessment, but the overall poor sensitivity and specificity rates of clinical assessment need the search for a better way of evaluation. [ABSTRACT FROM AUTHOR]

Assessment of treatment response in patients (pts) with leptomeningeal metastases (LM) represents a significant challenge and standardized criteria are needed. In 2017, the RANO LM Working Group proposed a standardized scorecard to evaluate MRI findings (further simplified in 2019). Here, we aim to validate the prognostic impact of response to treatment assessed using this tool in a multicentric cohort of breast cancer (BC) pts. Pts with BC‐related LM diagnosed at two institutions between 2005 and 2018 were identified. Baseline and follow‐up MRI scans were centrally reviewed and response assessment was evaluated using 2019 revised RANO LM criteria. A total of 142 pts with BC‐related LM and available baseline brain MRI imaging were identified; 60 of them had at least one follow‐up MRI. In this subgroup, median overall survival (OS) was 15.2 months (95%CI 9.5‐21.0). At first re‐evaluation, radiological response by RANO criteria was: complete response (CR) in 2 pts (3%), partial response (PR) in 12 (20%), stable disease (SD) in 33 (55%) and progression of disease (PD) in 13 (22%). Median OS was 31.1 months (HR 0.10, 95%CI 0.01‐0.78) in pts with CR, 16.1 months (HR 0.41, 95%CI 0.17‐0.97) in pts with PR, 17.9 months (HR 0.45, 95%CI 0.22‐0.91) in pts with SD and 9.5 months in pts with PD (P =.029). A second blinded evaluation showed a moderate interobserver agreement (K = 0.562). Radiological response according to 2019 RANO criteria is significantly associated with OS in pts with BC‐related LM, thus supporting the use of this evaluation tool both in trials and clinical practice. [ABSTRACT FROM AUTHOR]

Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem–canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients’ demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.

Introduction: Robotic systems have been introduced to improve the precision of total knee arthroplasty. However, different robotic systems are available, each with unique features used to plan and execute the surgery. As such, due to this diversity, the clinical evaluation of each robotic platform should be separated. Methods: An extensive literature search of PubMed, Medline, Embase and Web of Science was conducted with subsequent meta-analysis. Randomised controlled trials, comparative studies, and cohort studies were included regarding robot-assisted total knee arthroplasty. Evaluated outcomes included clinical results, surgical precision, ligament balance, surgical time, learning curve, complications and revision rates. These were split up based on the robot-specific brand: ROBODOC (T-SOLUTION ONE), OMNIBOT, MAKO, NAVIO (CORI) and ROSA. Results: With a follow-up of more than 10 years, no improved clinical outcomes have been noted with the ROBODOC system compared to the conventional technique. If available, other platforms only present short-term clinical outcomes. Radiological outcomes are published for most robotic setups, demonstrating improved surgical precision compared to the conventional technique. Gap balance assessment is performed differently between all systems, leading to heterogeneous outcomes regarding its relationship on clinical outcomes. There is a similar learning curve based on operative time for all robotic platforms. In most studies, robot assistance requires longer operative time compared to the conventional technique. Complications and revision rates are published for ROBODOC and MAKO, without clear differences to conventional total knee arthroplasty. Conclusion: The main finding of this systematic review is that the current evidence regarding each robotic system is diverse in quantity and quality. Each system has its own specificities and must be assessed for its own value. Regarding scientific literature, the generic term of robotic should be banned from the general conclusion. Level of evidence: Systematic review level IV. [ABSTRACT FROM AUTHOR]

Abstract Background Malalignments of the lower extremity are common reasons for orthopedic consultation because it may lead to osteoarthritis in adulthood. An accurate and reliable radiological assessment of lower limb alignment in children and adolescents is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention. Objective First, does the analysis of full-length standing anteroposterior radiographs show a good intra- and interobserver reliability? Second, which parameter is most susceptible to observer-dependent errors? Third, what is the Standard Error of Measurement (SEM95%) of the absolute femoral and tibial length? Methods Two observers evaluated digital radiographs of 144 legs from 36 children and adolescents with pathological valgus alignment before a temporary hemiepiphysiodesis and before implant removal. Parameters included Mechanical Femorotibial Angle (MFA), Mechanical Axis Deviation (MAD), mechanical Lateral Distal Femoral Angle (mLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), mechanical Lateral Proximal Femoral Angle (mLPFA), mechanical Lateral Distal Tibial Angle (mLDTA), Joint Line Convergence Angle (JLCA), femur length, tibial length. Intra- and interobserver reliability (ICC2,1), SEM95% and proportional errors were calculated. Results The intra- and interobserver reliability for almost all measurements was found to be good to excellent (Intra-ICC2,1: 0.849–0.999; Inter-ICC2,1: 0.864–0.996). The SEM95% of both observers was found to be ± 1.39° (MFA), ± 3.31 mm (MAD), ± 1.06° (mLDFA) and ± 1.29° (mMPTA). The proportional error of MAD and MFA is comparable (47.29% vs. 46.33%). The relevant knee joint surface angles show a lower proportional error for mLDFA (42.40%) than for mMPTA (51.60%). JLCA has a proportional error of 138%. Furthermore, the SEM95% for the absolute values of the femoral and tibial length was 4.53 mm for the femur and 3.12 mm for the tibia. Conclusions In conclusion, a precise malalignment measurement and the knowledge about SEM95% of the respective parameters are crucial for correct surgical or nonsurgical treatment. The susceptibility to error must be considered when interpreting malalignment analysis and must be considered when planning a surgical intervention. The results of the present study elucidate that MAD and MFA are equally susceptible to observer-dependent errors. This study shows good to excellent intra- and interobserver ICCs for all leg alignment parameters and joint surface angles, except for JLCA. Trial registration: This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Level of evidence I, Diagnostic Study.

PurposeProne cross-table lateral x-ray (CTLxR) and colostogram aid surgical planning for anorectal malformations (ARMs) without perineal fistulas. We suggest objective imaging tools to classify ARMs.MethodsThree observers prospectively evaluated CTLxR and colostograms of male ARM patients (2012–2022) without perineal fistulas. The level of the rectal pouch was estimated with pubococcygeal (PC) and ischiatic (I) lines. On CTLxR, we described the “pigeon sign”, defined as the rectal pouch ending with a beak-like image, suspicious for a rectourinary fistula. ARM was defined as rectobulbar when the rectal pouch was below the I line, rectoprostatic when between PC and I lines, and rectovesical when above the PC line. Concordance was assessed with Fleiss' kappa. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the “pigeon sign” were calculated.ResultsThirteen patients were included in this study. The interobserver agreement on CTLxR was 69.2% (k = 0.54) on pouch ending, 84.6% (k = 0.69) on the “pigeon sign”, and 76.9% (k = 0.69) on diagnosis; concordance between observers and intraoperative diagnosis was 66.6% (k = 0.56). The “pigeon sign” had 75% sensitivity, 100% specificity, 100% PPV, and 50% NPV. The interobserver agreement on colostograms was 84.6% (k = 0.77) on pouch ending and 89.7% (k = 0.86) on diagnosis; concordance between observers and intraoperative diagnosis was 92.3% (k = 0.90).ConclusionPC and I lines and the “pigeon sign” are useful tools in examining CTLxR and colostograms. Adequate CTLxR interpretation may modify surgical strategy.

This work is aiming at estimating the radiation doses to members of the public in case of an emergency exposure situation related to a hypothetical uranium mining tailings dam rupture at the UDC - Decommissioning Unit of Caldas, MG, Brazil. The calculations will help to managing the exposures of emergency workers and residents in the region downstream the dam. The computer code chosen to perform the simulations was FLO-2D@ software. Due to the uncertainties involved, mainly regarding the waste rheology and activity concentrations and in parameters values to be used in the dose assessment, considerations were made for the study to present results derived from conservative assumptions. Through the creation of flood maps, it was possible to estimate the extent of the areas affected by the released materials. The results showed that in a scenario of the tailings dam breach, deposition of mud shall extend over 20 km downstream affecting an area of nearly 3 km2. Total dose for a member of the public living in most affected areas would be around 43 mSv/y in the early phase after the accident. Although only shielding would be recommended under current radiation protection regulation, evacuation/relocation is suggested due to the presence of long-lived radionuclides. This protective measure would probably already be indicated by the accident itself, regardless of radiological reasons. More realistic assessment should be performed before returning people, considering long-term environmental transport and uses of the area. It must also be considered that long-term exposures have more restricted recommended acceptable levels than those for the emergency phase.

Background: Malalignments of the lower extremity are common reasons for orthopedic consultation because it may lead to osteoarthritis in adulthood. An accurate and reliable radiological assessment of lower limb alignment in children and adolescents is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention. Objective: First, does the analysis of full-length standing anteroposterior radiographs show a good intra- and interobserver reliability? Second, which parameter is most susceptible to observer-dependent errors? Third, what is the Standard Error of Measurement (SEM95%) of the absolute femoral and tibial length? Methods: Two observers evaluated digital radiographs of 144 legs from 36 children and adolescents with pathological valgus alignment before a temporary hemiepiphysiodesis and before implant removal. Parameters included Mechanical Femorotibial Angle (MFA), Mechanical Axis Deviation (MAD), mechanical Lateral Distal Femoral Angle (mLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), mechanical Lateral Proximal Femoral Angle (mLPFA), mechanical Lateral Distal Tibial Angle (mLDTA), Joint Line Convergence Angle (JLCA), femur length, tibial length. Intra- and interobserver reliability (ICC2,1), SEM95% and proportional errors were calculated. Results: The intra- and interobserver reliability for almost all measurements was found to be good to excellent (Intra-ICC2,1: 0.849–0.999; Inter-ICC2,1: 0.864–0.996). The SEM95% of both observers was found to be ± 1.39° (MFA), ± 3.31 mm (MAD), ± 1.06° (mLDFA) and ± 1.29° (mMPTA). The proportional error of MAD and MFA is comparable (47.29% vs. 46.33%). The relevant knee joint surface angles show a lower proportional error for mLDFA (42.40%) than for mMPTA (51.60%). JLCA has a proportional error of 138%. Furthermore, the SEM95% for the absolute values of the femoral and tibial length was 4.53 mm for the femur and 3.12 mm for the tibia. Conclusions: In conclusion, a precise malalignment measurement and the knowledge about SEM95% of the respective parameters are crucial for correct surgical or nonsurgical treatment. The susceptibility to error must be considered when interpreting malalignment analysis and must be considered when planning a surgical intervention. The results of the present study elucidate that MAD and MFA are equally susceptible to observer-dependent errors. This study shows good to excellent intra- and interobserver ICCs for all leg alignment parameters and joint surface angles, except for JLCA. Trial registration: This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Level of evidence: I, Diagnostic Study. [ABSTRACT FROM AUTHOR]

Abstract Background Hemiplegic shoulder pain (HSP) is one of the most common complications of stroke. This work aimed to evaluate and analyze the clinical and radiological features of painful shoulder in hemiplegic stroke patients with evaluating the diagnostic role of shoulder ultrasound and shoulder MR imaging in assessment of the causes of shoulder pain. Methods 210 stroke patients with shoulder affection within 3 years of stroke development were enrolled. Clinical assessment including Medical Research Council scoring, The Brunnström motor recovery and Ashworth Scale. Shoulder ultrasound and MR imaging were done for 74 patients with painful hemiplegic shoulder. Results The prevalence of HSP was 35.2% with statistically significantly higher proportion of shorter disease duration, lower muscle power, lower BMR stage with higher proportion of bicipital tendinitis and complex regional pain syndrome in major versus moderate dependence (P

Pneumopericardium (PPC) is a rare but life-threatening condition that mostly accompanies air leak syndromes in neonates receiving positive pressure ventilation. PPC results from the rupture of the alveoli and subsequent dissection of air through the tissue planes into the mediastinum, pleura, or pericardial sac. This report describes the case of a term low birth weight neonate born in a peripheral hospital who developed respiratory distress soon after birth. He was transported with manual bag and tube ventilation, and was found to have air leak syndrome in the form of isolated PPC. The neonate was managed conservatively with spontaneous resolution of the PPC.

(1) Background: Endoscopy and morphological imaging are the mainstay of the diagnostic work up of laryngeal squamous cell carcinomas (LSCCs), which can be integrated in a multidisciplinary discussion to obtain a shared pretreatment staging. (2) Methods: A retrospective evaluation of patients, managed at a tertiary university hospital in Italy and submitted to major laryngeal surgery, has been performed. Four different stagings have been defined and compared: epTN (based on endoscopy and physical ENT examination); radTN (based on CT scan); cTN (based on multidisciplinary integration of the two above); pTN based on pathology on surgical samples. Oncological outcomes have been assessed. (3) Results: Three-year relapse free and disease specific survival were 88% and 92.5%, respectively, without significant differences between partial surgeries (n = 13) and total laryngectomies (n = 32). As for the pretreatment staging, and in particular the T classification, the cTN has been revealed as more reliable than epTN and radTN alone in predicting the final pT (Cohen kappa coefficient: 0.7 for cT, 0.44 for radT, 0.32 for epT). In the partial surgery group, we did not record any positive margin nor local recurrence, with a 100% overall and disease-specific survival. (4) Conclusions: The multidisciplinary approach is fundamental in the definition of the primary lesion in LSCC, in particular in order to safely perform surgical preservation of laryngeal function, which is associated with a higher laryngectomy-free survival than irradiation but to a lower salvageability in case of recurrence. [ABSTRACT FROM AUTHOR]

Background: There is currently no established gold standard for the treatment of calcaneal fractures., Objectives: To conduct a clinical and radiological evaluation of patients following intra-articular calcaneal fractures treated with the Polish modification of the Ilizarov method., Material and Methods: This was a 2-center retrospective study. We evaluated 27 patients (2 women and 25 men) aged 28-73 years (mean age 50.5 years) after treatment of intra-articular calcaneal fractures with the Polish modification of the Ilizarov method. We assessed pain using a visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scores, patient satisfaction with treatment, use of analgesics, duration of Ilizarov treatment, length of hospital stay, duration of surgery, patient's declared willingness to choose the same treatment again, complications, degenerative changes, Böhler angle, inflection angle, and Gissane angle., Results: The mean follow-up period was 3 years and 2 months. Following treatment, the mean VAS pain score was 2.3. Prior to surgery, all patients were taking analgesics in comparison with only 2 patients (7.4%) at long-term follow-up. The treatment was rated as satisfactory by 11 patients, with 16 patients rating it as highly satisfactory. The mean post-treatment AOFAS score was 76.6 points. The Ilizarov fixator was removed after a mean period of 88 days. The mean duration of hospital stay was 7.4 days. The mean duration of the procedure was 44 min. All patients would choose the same treatment again. Complications were observed in 5 patients. The long-term follow-up visit revealed degenerative changes in the talocalcaneal joint in 8 patients. The median Böhler angle was 5.5° preoperatively and 28.5° postoperatively, p < 0.001. The median preoperative inflection angle of 160° decreased to 145°, p < 0.001. The median preoperative Gissane's angle of 119° increased significantly to a median postoperative value of 143°, p < 0.001., Conclusions: The patients achieved good clinical and radiological outcomes.

The Stepnogorsk area Northern Kazakhstan has a long historymining activities. Mining activities have lots of environmental and health impacts. The aims of this study were to characterizing the general radiological situation of the area and evaluate radiation exposure by scenarios in settlements. In this study radiological assessment was performed for critical group living in the territory contaminated with radionuclides; working and studying at school located on territoryformer mining site. The annual dose burden is 2.5 mSv y .1 in Zavodskoy, 1.9 mSv y .1 in Kvartsitka and 3.6 mSv y .1 in Aqsu; and exposure from radon is around 11 mSv y .1 at the ground floor, and for teachers -up to 12 mSv y.1 . At settlements, however, under the hypothesis that all food contaminated with radionuclides and vegetables is cultivated locally in the territories with high background level, exposure from ingestion is 9.1 mSvy .1 in Zavodskoy, 8.3 mSv y .1 in Kvartsitka and 11.5 mSv y .1 in Aqsu. The combined effects of environmental problems have culminated into health problems. There are such possibility of the higher prevalence of cardiovascular, digestive and respiratory systems so it is necessary to evaluate or protect people living in Stepnogorsk area.

The human population is continuously exposed to natural radionuclides in environmental elements. The concentration of these nuclides is usually low, but different technological processes and activities can concentrate them in products, by-products, or wastes. These activities are, for example, coal mining, fertilizer production, ore mining, metal production, etc. These materials are labelled as NORM (Naturally Occurring Radioactive Material). The most common method of disposal for NORMs is deposition in different types of depositories. The long-term effects of these depositories on the environment and on human health are hard to estimate. The aim of the study is to assess radiation risk from the five selected NORM depositories (Ajka coal ash, Ajka red mud, Almásfüzitő red mud, Zalatárnok drilling mud, and Úrkút manganese residue) for members of the public and biota. The radionuclide concentrations were determined by HPGe gamma-spectrometry. The measured concentration was between 31 Bq/kg and 1997 Bq/kg for Ra-226, between 33 Bq/kg and 283 Bq/kg for Th-232, and between 48 Bq/kg and 607 Bq/kg for K-40. The dose estimation was investigated using RESRAD-ONSITE and RESRAD BIOTA, which are computer codes developed by the Argonne National Laboratory (USA). RESRAD-ONSITE can estimate the radiation risk from the radionuclides in the contaminated sites. The highest dose was observed in the case of the Ajka coal ash depository–without cover (12.38 mSv/y), and the lowest was in the case of Zalatárnok (0.53 mSv/y). The most significant contributors to the population dose are the uptakes through plants and external pathways, which account for more than 80% of the total dose on average. RESRAD-BIOTA code was used to estimate the radiation exposure of terrestrial organisms (plants and animals). During this work, the values of sum ratio factor (SRF), biota concentration guide (BCG), external dose, internal dose, and total dose were determined. [ABSTRACT FROM AUTHOR]

Background: Standard combination ipilimumab/nivolumab (I/N) is given as 4 induction doses for advanced stage melanoma followed by nivolumab single-agent maintenance therapy. While many patients receive less than 4 doses due to immune-related toxicities, it is unclear if fewer doses of I/N may still provide long term clinical benefit. Our aim is to determine if response assessment after 1 or 2 doses of I/N can predict long-term survival and assess if fewer doses of I/N can lead to similar survival outcomes. Methods: We performed a retrospective analysis on a cohort of patients with advanced melanoma who w0ere treated with standard I/N. Cox regression of progression-free survival (PFS) and overall survival (OS) models were performed to assess the relationship between response after 1 or 2 doses of I/N and risk of progression and/or death. Clinical benefit response (CBR) was assessed, defined as SD (stable disease) + PR (partial response) + CR (complete response) by imaging. Among patients who achieved a CBR after 1 or 2 doses of I/N, a multivariable Cox regression of survival was used to compare 1 or 2 vs 3 or 4 doses of I/N adjusted by known prognostic variables in advanced melanoma. Results: 199 patients were evaluated. Patients with CBR after 1 dose of I/N had improved PFS (HR: 0.16, 95% CI 0.08-0.33; p<0.001) and OS (HR: 0.12, 0.05-0.32; p<0.001) compared to progressive disease (PD). Patients with CBR (vs PD) after 2 doses of I/N also had improved PFS (HR: 0.09, 0.05-0.16; p<0.001) and OS (HR: 0.07, 0.03-0.14; p<0.001). There was no survival risk difference comparing 1 or 2 vs 3 or 4 doses of I/N for PFS (HR: 0.95, 0.37-2.48; p=0.921) and OS (HR: 1.04, 0.22-4.78; p=0.965). Conclusions: Early interval imaging with response during induction with I/N may be predictive of long-term survival in advanced stage melanoma. CBR after 1 or 2 doses of I/N is associated with favorable survival outcomes, even in the setting of fewer I/N doses received. Further studies are warranted to evaluate if electively administering fewer combination I/N doses despite tolerance in select patients may balance the benefits of therapy while decreasing toxicities. [ABSTRACT FROM AUTHOR]

Objectives: The present study aims to investigate the role of the first magnetic resonances (MRI) following radio-chemotherapy (RT-CT) in patients diagnosed with high-grade glioma. Methods: We retrospectively recorded radiological evaluations following RT-CT, symptoms related to disease progression (avoiding any sign due to radiotherapy or chemotherapy) and the change of therapeutic strategy. Results: In March 2021, at data analysis, the data of 149 patients diagnosed with high-grade glioma and treated between May 2013 and July 2020 were retrieved for the present analysis. Two out of 122 (1.6%), 5 out of 106 (4.7%) and 8 out of 92 (8.6%) asymptomatic patients received the diagnosis of disease recurrence at the time of the first, second and third MRI, respectively. Otherwise, 16 out of 27 (59.2%), 16 out of 24 (66.6%) and 13 out of 16 (82.2%) symptomatic patients changed their therapy after the first, second and third MRI, respectively. Among patients that experienced radiological signs of distant progression, 10 out of 14 were symptomatic and changed their therapy. Conclusions: MRIs performed by 6 months after the end of RT-CT lead to change treatment strategy mostly in symptomatic patients. [ABSTRACT FROM AUTHOR]

Introduction: Radiological assessment of the inflammatory diseases of the middle ear and inner ear is challenging and involves deep understanding of anatomy. Methodology: Total 100 eligible study participants were enrolled in the study. All patients (including paediatric age group) of both sexes referred from ENT department to Radiology department in Government Medical College and Hospital, Aurangabad. Total 100 eligible patients who were ready to participate and had given such written informed consent were included in the study. Results : HRCT was done in all the 100 study patients. Findings of the congenital anomalies on HRCT and during surgery was 100% same. There was aagreement of HRCT findings with Intra-operative findings in 75% of AOM/safe CSOM patients and 82.35% of unsafe CSOM patients. Overall accuracy was 87.88% in all the pathologies who were subjected to surgical exploration Conclusion: HRCT was found to be useful in the evaluation of pathologies of temporal bone including infective, congenital and trauma. In our study more than half of the study patients. HRCT is highly efficient in assessing the extent of the fracture line in temporal bone trauma and involvement of other structures. [ABSTRACT FROM AUTHOR]

BackgroundStandard combination ipilimumab/nivolumab (I/N) is given as 4 induction doses for advanced stage melanoma followed by nivolumab single-agent maintenance therapy. While many patients receive less than 4 doses due to immune-related toxicities, it is unclear if fewer doses of I/N may still provide long term clinical benefit. Our aim is to determine if response assessment after 1 or 2 doses of I/N can predict long-term survival and assess if fewer doses of I/N can lead to similar survival outcomes.MethodsWe performed a retrospective analysis on a cohort of patients with advanced melanoma who w0ere treated with standard I/N. Cox regression of progression-free survival (PFS) and overall survival (OS) models were performed to assess the relationship between response after 1 or 2 doses of I/N and risk of progression and/or death. Clinical benefit response (CBR) was assessed, defined as SD (stable disease) + PR (partial response) + CR (complete response) by imaging. Among patients who achieved a CBR after 1 or 2 doses of I/N, a multivariable Cox regression of survival was used to compare 1 or 2 vs 3 or 4 doses of I/N adjusted by known prognostic variables in advanced melanoma.Results199 patients were evaluated. Patients with CBR after 1 dose of I/N had improved PFS (HR: 0.16, 95% CI 0.08-0.33; p

Functional outcome following ankle fracture fixation is linked to the restoration of joint congruity, anatomic alignment and stability. If surgical fixation fails to achieve these goals, revision surgery may be indicated. This retrospective study aims to report a consecutive series of fourteen patients with a minimum of one year follow up after revision ankle fixation and describe CT scan based modified Pettrone score used to assess quality of primary fixation. Between April 2019 and August 2021, fourteen patients underwent revision ankle fracture fixation. Patients were identified by the multidisciplinary team through a review of intra-operative radiographs. Subsequently, a CT scan-based criteria which is modification of original Pettrone criteria based on plain radiographs was applied to further assess sub-optimal fixation. Demographic, clinical, radiological and patient-reported outcome measures data were collected and examined. Twelve patients exhibited protonation type injuries according to the Lauge-Hansen classification system. Syndesmotic joint was readdressed in eleven patients. The mean duration between the index surgery and the subsequent revision surgery was 46 days (inter-quartile range – 42 days). The mean Olerud-Molander Ankle Score was calculated as 58, with an IQR of 45. Similarly, the mean EQ-5D-3L VAS score was determined to be 69, with an IQR of 35. In our series, 60 % patients reported good to excellent results using OMAS. The quality-of-life scores of in these patients were also satisfactory. We recommend early revision fixation should be considered when primary fixation is considered inadequate in early post-operative period. The modified Pettrone criterion can be used to assess sub-optimal fixation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The development of abnormal foot will bring adverse effects on the growth and life of children. The early diagnosis of abnormal foot in children is conducive to the timely correction of children’s foot. Here, we review the classification methods of children’s foot types in order to provide valuable references for clinicians in the study of prevention and correction strategies of children’s abnormal foot types. METHODS: WanFang, VIP, CNKI, the Web of Science, and PubMed were searched for related literatures on the classification of children’s foot, and the methods for the classification of children’s foot types were summarized and systematically reviewed. RESULTS: (1)A total of 12 articles were finally included. The classification of children’s foot types can be divided into four methods: footprint index, radiological assessment, clinical examination, and anthropometric examination. (2)Each classification method has its own advantages and disadvantages. The footprint method is simple and quick, but the measurement results are one-sided. Radiological assessment method has potential radiation risk, high cost and complicated process. Although clinical examination method is quick and has low cost, it has strong subjectivity. Anthropometric tests are more accurate, but very time-consuming. (3)In the previous studies, the economical and fast foot printing method was selected as the classification method of children’s foot type, and a combination of multiple indicators was also used in some studies to improve the accuracy of children’s foot type classification. (4)The combination of multiple indicators is currently considered to be a accurate classification method. CONCLUSION: Most of foot type classification methods, which only display the structural characteristics of children’s feet in static state, lack gold standards. Future research needs to establish the relationship between static foot structure and dynamic foot function in order to achieve more accurate and scientific results in the classification of children’ foot types, thereby offering a good strategy for the healthy growth and development of children’s foot until the age of epiphyseal closure. [ABSTRACT FROM AUTHOR]

Background: Hemiplegic shoulder pain (HSP) is one of the most common complications of stroke. This work aimed to evaluate and analyze the clinical and radiological features of painful shoulder in hemiplegic stroke patients with evaluating the diagnostic role of shoulder ultrasound and shoulder MR imaging in assessment of the causes of shoulder pain. Methods: 210 stroke patients with shoulder affection within 3 years of stroke development were enrolled. Clinical assessment including Medical Research Council scoring, The Brunnström motor recovery and Ashworth Scale. Shoulder ultrasound and MR imaging were done for 74 patients with painful hemiplegic shoulder. Results: The prevalence of HSP was 35.2% with statistically significantly higher proportion of shorter disease duration, lower muscle power, lower BMR stage with higher proportion of bicipital tendinitis and complex regional pain syndrome in major versus moderate dependence (P < 0.001, P < 0.001, P < 0.001, P = 0.011 and P = 0.001 respectively). On multivariate analysis only short disease duration was statistically significant independent predictor. Participants with disease duration ≤2 months have 21.9 times higher odds to exhibit major rather than moderate dependence. By imaging there was high prevalence of joint effusion (47.3%), bicipital tendinitis (44.6%), bursitis (31%) and adhesive capsulitis (29.7%) in painful hemiplegic shoulder with a very good agreement between MRI and US in diagnosis. Conclusion: HSP has a high prevalence in stroke patient with increased morbidity due to various factors and US can be used as an alternative or a complementary to MRI for diagnosis of hemiplegic shoulder pain. [ABSTRACT FROM AUTHOR]

Background: Borderline Resectable Pancreatic Cancer (BRPC) remains a unique entity that is difficult to categorize due to variance in definitions and the small number of patients. The ultimate goal is to achieve a free resection (R0) after a favorable response to neoadjuvant therapy that is somewhat difficult to assess by current radiological parameters. Aim: To evaluate the role of Magnetic Resonance Imaging (MRI) pancreatic protocol, including Diffusion-Weighted Imaging (DWI), in patients with BRPC receiving neoadjuvant therapy, and further compare it to RECIST criteria and outcome. Methods: Histologically confirmed BRPC patients were prospectively included. DWI-MRI was performed pre- and post-therapy. Clinical characteristics with ensuing operability were recorded and correlated to radiological RECIST/apparent diffusion coefficient (ADC) change, preoperative therapy administrated, surgical resection status, and survival. Results: Out of 30 BRPC cases, only 11 (36.7%) ultimately underwent pancreaticoduodenectomy. Attaining a stationary or stable disease via ADC/RECIST was achieved in the majority of cases (60%/53.3% respectively). Of the 12 patients (40%) who achieved a regression by ADC, 11 underwent surgery with an R0 status. These surgical cases showed variable RECIST responses (PR=5, SD=4, PD=3). Responders by ADC to neoadjuvant therapy were significantly associated to presenting with abdominal pain (p =0.07), a decline in post-therapy CA19-9 (p<0.001), going through surgery (p<0.001), and even achieving better survival (p<0.001 vs. 0.66). Conclusion: DWI-MRI ADC picked up patients most likely to undergo a successful operative procedure better than traditional RECIST criteria. An algorithm incorporating novel radiological advances with CA19-9 deserves further assessment in future studies. [ABSTRACT FROM AUTHOR]

Objective: To assess Olfactory fossa depth based on Keros classification in different age groups of both genders using computerized tomography (CT). Material and Methods: This was a cross-sectional study done at Ziauddin University, Clifton, Karachi. The sample size was 270 adults including 160 males & 110 females. The assessment of the depth of the Olfactory fossa was carried out by measuring the height of lateral lamella of a cribriform plate on CT images. Results: Olfactory fossa from both sides of 270 patients were classified according to Keros classification. We found Type II to be the most frequent on both sides of the olfactory fossa in both genders. No significant difference in depth of olfactory fossa was found when compared in different age groups. Conclusion: The present study shows that the vast majority of the population comes under type II & type III Keros classification, thus emphasizing the need for pre-operative radiological assessment. The Association of right & left olfactory fossa depth in different age groups was found to be insignificant. [ABSTRACT FROM AUTHOR]

Abstract Background The Microplasty (MP) instrumentation designed for the Phase III Oxford mobile-bearing unicompartmental knee arthroplasty (UKA) system is considered a better option to achieve more accurate component positioning and alignment. In the present study, we focused on short-term clinical and radiological outcomes to determine whether the MP instrumentation can reduce the short-term revision rate and occurrence of outliers of metallic components. Methods The literature in PubMed, Embase, the Cochrane Library, and Web of Science was searched up to May 2020. Studies were scrutinized by two independent authors, and the revision rate, complication spectrum, and radiological assessment with outlier rates were specifically analyzed. RevMan 5.3 was used for the statistical analysis. Results Seven studies were included in the meta-analysis. Four studies reported both clinical and radiological outcomes, two reported only radiological outcomes, and one reported only clinical outcomes. The pooled analysis showed that the revision rate in the MP instrumentation group was 0.866 per 100 component years, while that in the control group was 1.124 (odds ratio, 0.77; p < 0.05). The subgroup analysis of the bearing dislocation rate showed a significantly greater reduction in the Korean population than in the populations of other countries (p < 0.05). The radiological assessment showed that the alignment of the femoral component was significantly improved (p < 0.05), while that of the tibial component was not (p > 0.05). Conclusion The newly developed MP instrumentation for Oxford UKA significantly reduced the revision rate of this treatment. The positioning of the femoral component was also proven to be better by radiological assessments.

Background: Surgery in pancreatic cancer remains the curative option, consequently drawing attention to the importance of an indeterminate group of patients potentially curable by undergoing this procedure, Borderline Resectable Pancreatic Cancer (BRPC). Despite this seemingly positive outlook the outcome of these patients remains undefined. Aim: To assess the response of BRPC patients to neoadjuvant treatment and the accuracy of radiological constraints in their selection. Methods: Data extraction from a university hospital filing system from September 2015 to September 2018 was performed to select patients with BRPC. The National Comprehensive Cancer Network (NCCN) criteria to define BRPC were used. Clinical, surgical and radiological parameters were collected pre/ post-operative for all cases and correlated to outcome. Results: Sixty patients with BRPC were identified. The outcome of neoadjuvant treatment was partial response in 6 (10%) patients, stable disease in 49 (81.7%) and progressive disease in 5 (8.3%). The majority (78.3%) of patients underwent pancreatectomy. In patients who underwent resection a median overall survival of 31 months (95% CI: 29.180 - 32.820) was achieved vs. 17 months (95% CI: 15.625 - 18.375) in non-resected cases (p < 0.001). Response to neoadjuvant therapy was found to be favorable for overall survival (p = 0.014) and progression-free survival (p = 0.006). Response Evaluation Criteria in Solid Tumors (RECIST) criteria did not predict operative potential. Conclusion: RECIST criteria lacked predictive potentiality for surgical intervention after neoadjuvant chemotherapy in a cohort of BRPC patients. The significant positive outcome observed in BRPC patients who underwent surgery emphasizes that the decision for this procedure should not depend on the response to neoadjuvant treatment per se.

Background: Autism spectrum disorder (ASD) is a group of neurodevelopmental conditions associated with quantitative differences in cortical and subcortical brain morphometry. Qualitative assessment of brain morphology provides complementary information on the possible underlying neurobiology. Studies of neuroradiological findings in ASD have rendered mixed results, and await robust replication in a sizable and independent sample. Methods: We systematically and comprehensively assessed neuroradiological findings in a large cohort of participants with ASD and age-matched controls (total N = 620, 348 ASD and 272 controls), including 70 participants with intellectual disability (47 ASD, 23 controls). We developed a comprehensive scoring system, augmented by standardized biometric measures. Results: There was a higher incidence of neuroradiological findings in individuals with ASD (89.4 %) compared to controls (83.8 %, p = .042). Certain findings were also more common in ASD, in particular opercular abnormalities (OR 1.9, 95 % CI 1.3–3.6) and mega cisterna magna (OR 2.4, 95 % CI 1.4–4.0) reached significance when using FDR, whereas increases in macrocephaly (OR 2.0, 95 % CI 1.2–3.2), cranial deformities (OR 2.4, 95 % CI: 1.0–5.8), calvarian / dural thickening (OR 1.5, 95 % CI 1.0–2.3), ventriculomegaly (OR 3.4, 95 % CI 1.3–9.2), and hypoplasia of the corpus callosum (OR 2.7, 95 % CI 1.1–6.3) did not survive this correction. Furthermore, neuroradiological findings were more likely to occur in isolation in controls, whereas they clustered more frequently in ASD. The incidence of neuroradiological findings was higher in individuals with mild intellectual disability (95.7 %), irrespective of ASD diagnosis. Conclusion: There was a subtly higher prevalence of neuroradiological findings in ASD, which did not appear to be specific to the condition. Individual findings or clusters of findings may point towards the neurodevelopmental mechanisms involved in individual cases. As such, clinical MRI assessments may be useful to guide further etiopathological (genetic) investigations, and are potentially valuable to fundamental ASD research.

BackgroundBorderline Resectable Pancreatic Cancer (BRPC) remains a unique entity that is difficult to categorize due to variance in definitions and the small number of patients. The ultimate goal is to achieve a free resection (R0) after a favorable response to neoadjuvant therapy that is somewhat difficult to assess by current radiological parameters.AimTo evaluate the role of Magnetic Resonance Imaging (MRI) pancreatic protocol, including Diffusion-Weighted Imaging (DWI), in patients with BRPC receiving neoadjuvant therapy, and further compare it to RECIST criteria and outcome.MethodsHistologically confirmed BRPC patients were prospectively included. DWI-MRI was performed pre- and post-therapy. Clinical characteristics with ensuing operability were recorded and correlated to radiological RECIST/apparent diffusion coefficient (ADC) change, preoperative therapy administrated, surgical resection status, and survival.ResultsOut of 30 BRPC cases, only 11 (36.7%) ultimately underwent pancreaticoduodenectomy. Attaining a stationary or stable disease via ADC/RECIST was achieved in the majority of cases (60%/53.3% respectively). Of the 12 patients (40%) who achieved a regression by ADC, 11 underwent surgery with an R0 status. These surgical cases showed variable RECIST responses (PR=5, SD=4, PD=3). Responders by ADC to neoadjuvant therapy were significantly associated to presenting with abdominal pain (p =0.07), a decline in post-therapy CA19-9 (p

Purpose: The aim of this study was to investigate the clinical and radiological results of the MAKO CT-based robotic-assisted system for total knee arthroplasty (TKA). Methods: A PRISMA systematic review was conducted using four databases (MEDLINE, EMBASE, Pubmed, GOOGLE SCHOLAR) to identify all clinical and radiological studies reporting information regarding the use and results of the CT-based robotic-assisted system to perform TKA between 2016 and 2020. The main investigated outcome criteria were postoperative pain, analgesia requirements, clinical scores, knee range of motion, implant positioning and the revision rate. The ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions) was used to evaluate the quality of included studies and the risk of bias. Results: A total of 36 studies were identified, of which 26 met inclusion criteria. Of these 26 studies, 14 were comparative. The follow-up varied from 30 days to 17 months. This CT-based, saw cutting Robotic TKA is associated with a significantly lower postoperative pain score (2.6 versus 4.5) and with significantly reduced time to hospital discharge (77 h versus 105), compared with conventional TKA. The two comparative studies assessing functional outcomes at 1 year reported significantly better functional scores with CT-based robotic TKA compared with conventional TKA (WOMAC score: 6 ± 6 versus 9 ± 8 (p < 0.05); KSS function score: 80 versus 73 (p = 0.005)). Only three comparative studies assessed implant positioning, and these reported better implant positioning with CT-based robotic-assisted TKA. Conclusion: The CT-based robotic-assisted system for TKA reduced postoperative pain and improved implant positioning with equal or slightly superior improvement of the functional outcomes at one year, compared to conventional TKA. Level of evidence: Systematic review level IV. [ABSTRACT FROM AUTHOR]

Summary: Objective: The purpose was to introduce the Vienna morphological Achilles tendon score (VIMATS), to evaluate its reproducibility and to assess its clinical application. Methods: In 38 patients a total number of 40 painful ATs and 20 volunteers were examined on a 3T magnetic resonance imaging (MRI) scanner using a standard MRI protocol. In 20 patients clinical scoring according to the Achilles tendon rupture score was available. Two observers independently assessed the thickness, continuity, signal intensity, and associated pathologies of the Achilles tendon (AT) according to the newly created VIMATS. Intraobserver and interobserver agreements were calculated and the clinical application of the VIMATS regarding its potential to differentiate between patients and volunteers was tested. Results: An analysis of the Intraclass correlation coefficient (ICC) yielded an excellent intraobserver (ICC 0.925) and interobserver agreement (ICC 0.946) for the total VIMAT score. A significant difference in total VIMATS was found between patients (47.6 ± StD 21.1 points) and volunteers (91.5 ± SD 10.9 points; p < 0.01) as well as a moderate correlation between morphological and clinical scoring (Pearson correlation 0.644). Conclusion: The VIMAT score is the first MRI score for the semiquantitative morphological evaluation of AT injuries and was shown to be an easy, fast and reproducible tool for assessing injuries of the AT. [ABSTRACT FROM AUTHOR]

The human population is continuously exposed to natural radionuclides in environmental elements. The concentration of these nuclides is usually low, but different technological processes and activities can concentrate them in products, by-products, or wastes. These activities are, for example, coal mining, fertilizer production, ore mining, metal production, etc. These materials are labelled as NORM (Naturally Occurring Radioactive Material). The most common method of disposal for NORMs is deposition in different types of depositories. The long-term effects of these depositories on the environment and on human health are hard to estimate. The aim of the study is to assess radiation risk from the five selected NORM depositories (Ajka coal ash, Ajka red mud, Almásfüzitő red mud, Zalatárnok drilling mud, and Úrkút manganese residue) for members of the public and biota. The radionuclide concentrations were determined by HPGe gamma-spectrometry. The measured concentration was between 31 Bq/kg and 1997 Bq/kg for Ra-226, between 33 Bq/kg and 283 Bq/kg for Th-232, and between 48 Bq/kg and 607 Bq/kg for K-40. The dose estimation was investigated using RESRAD-ONSITE and RESRAD BIOTA, which are computer codes developed by the Argonne National Laboratory (USA). RESRAD-ONSITE can estimate the radiation risk from the radionuclides in the contaminated sites. The highest dose was observed in the case of the Ajka coal ash depository–without cover (12.38 mSv/y), and the lowest was in the case of Zalatárnok (0.53 mSv/y). The most significant contributors to the population dose are the uptakes through plants and external pathways, which account for more than 80% of the total dose on average. RESRAD-BIOTA code was used to estimate the radiation exposure of terrestrial organisms (plants and animals). During this work, the values of sum ratio factor (SRF), biota concentration guide (BCG), external dose, internal dose, and total dose were determined.

In this study, the natural radioactivity in pit-water and paddy soil around a decommissioned uranium mine in eastern China was investigated. The gamma radiation absorbed dose rate, annual effective dose equivalent, radium equivalent activity, and radiation hazard index were calculated, and their spatial distribution was presented. The profile distribution of the activity concentrations of radionuclides was also investigated for the possible deposition effect. The radioactivity accumulation in the paddy-soil due to the irrigation was further discussed. It was shown that the accumulation of radioactivity in the paddy soil was limited from the irrigation. [ABSTRACT FROM AUTHOR]

Caustic esophageal stricture length assessment is essential for planning endoscopic management and predicting its prognosis. We aimed to assess the accuracy of contrast swallow study (CSS) in measuring stricture length in comparison to endoscopy (definitive investigation for actual length measurement). Medical records of caustic esophageal strictures between 2010 and 2020 were retrospectively reviewed. Reliability study was done to compare between radiological and endoscopic measurement of stricture length. 124 CSSs for 91 patients were analyzed. Six studies showed no stricture, single stricture was reported in 101 studies, double strictures were reported in 16 studies, triple strictures were reported in one study (136 radiological stricture). Endoscopy revealed 133 true strictures. Number of the strictures was consistent between CSS and endoscopy in 112 studies (90.3%) and different in 12 studies (9.7%). Eight endoscopies revealed strictures not reported in CSS (5.5% false negative strictures), while 10 CSSs reported 11 strictures that were not detected during the endoscopy (7.6% false positive strictures). Reliability analysis revealed interclass correlation coefficient = 0.6 (95% CI 0.5 to 0.7) indicating moderate reliability. CSS is not accurate in assessing caustic esophageal stricture length. Combination of CSS and endoscopic investigation is better for proper evaluation of these patients. Level III of evidence [ABSTRACT FROM AUTHOR]

Background The SARS-CoV-2 pandemic has underscored the multifaceted impact of the virus on human health, extending beyond the respiratory system to involve other organ systems, including the endocrine system. Emerging evidence suggests a notable interaction between COVID-19 and thyroid function, characterized by alterations in thyroid hormone levels and structural changes within the gland. This study aims to explore the association between thyroid density on CT imaging and lung involvement in patients with COVID-19, potentially offering new insights into the systemic effects of the virus. Methodology A retrospective cross-sectional analysis was conducted on 1,066 patients with COVID-19 who underwent chest CT scans without contrast at Government Medical College, Omandurar Government Estate, Chennai, which was designated as the COVID-19 care center from April to June 2021. Thyroid density and lung involvement were quantitatively assessed, and their correlation was analyzed using descriptive and inferential statistics, including the Kruskal-Wallis H test and Shapiro-Wilk test for normality. Results The study population predominantly exhibited normal thyroid density (749, 70.3%), followed by altered (212, 19.9%), nodular (104, 9.8%), and a single instance (0.1%) of absent thyroid density. Despite variability in lung involvement across different thyroid density categories, statistical analysis revealed no significant association between thyroid density and the extent of lung involvement in patients with COVID-19. Conclusions This study found no significant correlation between thyroid density and lung involvement in patients with COVID-19, suggesting that thyroid density on CT imaging may not serve as a reliable marker for lung involvement in this population. Further research is warranted to explore the complex interactions between COVID-19 and thyroid function, as well as the potential implications for patient management and prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Balasubramaniam et al.)

To evaluate the clinical diagnostic efficacy of accelerated 3D magnetic resonance (MR) neuroimaging by radiological assessment for image quality and artefacts. Prospective healthy volunteer study. Eight healthy subjects. Inversion Recovery (IR) prepared 3D Gradient Echo (GRE) sequence on a 1.5 T GE Signa HDx scanner. Independent radiological diagnostic quality assessments of accelerated 3D MR brain datasets were carried out by four experienced neuro-radiologists who were blinded to the acceleration factor and to the subject. The radiological grading was based on a previously reported radiological scoring key that was used for image quality assessment of human brains. Bland-Altman analysis. Optimization of the k-space sampling order was important for preserving contrast in accelerated scans. Despite having lower scores than fully sampled datasets, the majority of the compressed sensing (CS) accelerated brain datasets with k-space sampling order optimization (19/24 datasets by Radiologist 1, 24/24 datasets by Radiologist 2 and 16/24 datasets by Radiologist 3) were graded to be fully diagnostic indicating that there was adequate confidence for performing gross structural assessment of the brain. Optimization of k-space acquisition order improves the clinical utility of CS accelerated 3D neuroimaging. This method may be appropriate for routine radiological assessment of the brain. [ABSTRACT FROM AUTHOR]