Relación densidad septo-ventrículo izquierdo como parámetro de detección de anemia en tomografía computarizada no contrastada de tórax en observadores con entrenamiento básico / Septum-Left Ventricular Density Ratio as a Parameter for Detecting Anemia in Non-Contrasted Chest Computed Tomography in Observers with Basic Training

Introducción: La anemia es frecuentemente subdiagnosticada dada su vaga sintomatología. Estudios con evaluación subjetiva-visual por expertos describen signos tomográficos sugerentes de anemia, tales como el septo denso. Proponemos que lectores con entrenamiento básico realicen mediciones objetivas de alto poder estadístico para la detección de anemia. Material y Métodos: Se cruzaron datos de tomografía computarizada (TC) de tórax no contrastada (2021) con medición de hemoglobina plasmática (Hb) realizada 24 horas antes o después del estudio tomográfico. Dos estudiantes de Medicina, previamente entrenados, realizaron mediciones de Unidades Hounsfield (UH) en el septo interventri-cular (SIV) y cavidades ventriculares derecho (VD) e izquierdo (VI). Las relaciones SIV/VI y SIV/VD se correlacionaron con los valores de Hb. Se analizó la variabilidad interob-servador y se determinó el punto de corte óptimo para detectar anemia. Resultados: En una muestra de 112 casos, hubo alta concordancia interobservador con r de 0,85 (VD), 0,67 (SIV) y 0,87 (VI). La relación SIV/VI obtuvo el mayor AUC con 0,86 (IC 95%: 0,72 a 0,91), con una sensibilidad de 80% y especificidad de 88% utilizando un punto de corte de 1,15. Conclusiones: La razón SIV/VI con punto de corte de 1,15 es un parámetro confiable para detectar anemia mediante TC de tórax no contrastada, en observadores con entrenamiento básico.

Introduction: Anemia is frequently underdiagnosed given its vague symptomatology. Studies with subjective-visual evaluation by experts describe tomographic signs suggestive of anemia, such as a dense septum. This study aims to evaluate if readers with basic training can perform high statistical value measurements for anemia detection. Material and Methods: Data of non-contrast thoracic computed tomography (CT) (2021) with a measurement of plasma hemoglobin (Hb) performed 24 hours before or after the CT were identified. Two previously trained medical students performed measurements of Hounsfield Units (HU) on the interventricular septum (IVS) and right (RV) and left (LV) ventricular cavities. The SIV/VI and SIV/VD ratios were correlated with Hb values. Interobserver variability was analyzed and the optimal cut-off point to detect anemia was determined. Results: In a sample of 112 cases, there was a high interobserver correlation with r of 0.85 (VD), 0.67 (SIV), and 0.87 (VI). SIV/VI ratio obtained the highest AUC with 0.86 (95% CI: 0.72 to 0.91), with a sensitivity of 80% and specificity of 88% using a cut-off point of 1.15. Conclusions: The SIV/VI ratio with a cut-off point of 1.15 is a reliable parameter to detect anemia using non-contrast chest CT in observers with basic training.

Sihler's Staining of the Thoracic Cutaneous Nerve and its Significance / Tinción de Sihler del Nervio Cutáneo Torácico y su Relevancia

SUMMARY: Our team has modified Sihler's intramuscular nerve staining method to allow for calculation of nerve density. Therefore, this study aimed to show the overall distribution pattern of the thoracic cutaneous nerves to provide a morphological basis for selecting and matching sensory reconstruction during skin flap transplantation. Twelve Chinese adult cadavers were dissected; the thoracic skin was removed, and the modified Sihler's staining method was performed. Centered around the nipple, the chest skin was divided into four regions: medial-superior, lateral-superior, lateral-inferior, and medial-inferior. The thoracic skin was not only innervated by the branches of the 1st to 7th intercostal and supraclavicular nerves, but also by a small number of nerves that directly reached the skin and passed through the pectoralis major muscle. There is a phenomenon of cross overlap between the branches of adjacent intercostal nerves. The branches of the 2nd to 7th intercostal nerves were distributed in the breast, and the branches of the lateral and anterior cutaneous branches were densely distributed around the nipple, forming a grid-like anastomosis. There was no cross-overlapping innervation between the anterior cutaneous branches on both sides. The density of nerve distribution in the four regions of the chest was in the order of the medial-superior, lateral-superior, lateral-inferior and medial-inferior region, respectively. These results may be used to map sensory regions when designing thoracic skin flaps for reconstruction surgery to obtain improved sensory recovery.

Nuestro equipo ha modificado el método de tinción nerviosa intramuscular de Sihler para permitir el cálculo de la densidad nerviosa. Por lo tanto, este estudio tuvo como objetivo mostrar el patrón de distribución general de los nervios cutáneos torácicos proporcionando una base morfológica para seleccionar y combinar la reconstrucción sensorial durante el trasplante de colgajo de piel. Se diseccionaron 12 cadáveres de individuos adultos chinos. Se eliminó la piel torácica y se realizó el método de tinción de Sihler modificado, centrada alrededor del pezón, la piel del pecho se dividió en cuatro regiones: medial- superior, lateral-superior, lateral-inferior y medial-inferior. La piel torácica no solo estaba inervada por los ramos de los nervios intercostal y supraclavicular 1º a 7º, sino también por un pequeño número de nervios que llegaban directamente a la piel y pasaban a través del músculo pectoral mayor. Existe un fenómeno de superposición cruzada entre los ramos de los nervios intercostales adyacentes. Los ramos de los nervios intercostales 2º a 7º se distribuyeron en la mama, y los ramos de los ramos cutáneos lateral y anterior se distribuyeron densamente alrededor del pezón, formando una anastomosis en forma de rejilla. No hubo inervación cruzada entre los ramos cutáneos anteriores en ambos lados. La densidad de la distribución nerviosa en las cuatro regiones del tórax estaba en el orden de región medial-superior, lateral-superior, lateral-inferior y medial-inferior, respectivamente. Estos resultados pueden ser útiles para mapear regiones sensoriales al diseñar colgajos de piel torácicos para utilizarlos en cirugía de reconstrucción y obtener así una mejor recuperación sensorial.

¿Será realmente una verdadera comunicación interventricular? / Could it really be a true ventricular septal defect?

Ventricular septal defect (VSD) is one of the most common congenital defects. It has a wide variety of clinical spectrum of presentation depending on the location and size of the defect. Generally, small restrictive VSDs present spontaneous closure during follow-up. A clinical case is presented with suspected persistent perimembranous VSD, with described intraoperative anatomical findings of aneurysmal cribriform membrane, ruling out VSD.

La comunicación interventricular (CIV) es uno de los defectos congénitos más comunes. Tiene una amplia variedad de espectro clínico de presentación dependiendo de la localización y tamaño del defecto. Por lo general, en los CIV restrictivos pequeños presentan un cierre espontáneo durante el seguimiento. Se presenta un caso clínico con sospecha de CIV perimembranosa persistente, con hallazgos anatómicos intraoperatorios descritos de membrana cribiforme aneurismática descartandose CIV.

Management of lung diseases under ultrasound monitoring: potential to make bronchopulmonary dysplasia in preterm infants as an avoidable disease / 中国当代儿科杂志

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Despite significant progress in the understanding of its etiology, mechanisms, prevention, and treatment, the prognosis remains poor. BPD not only has a high mortality rate but also causes persistent respiratory, neurological, and cardiovascular impairments in survivors. The author's team has successfully prevented the occurrence of BPD by managing neonatal lung diseases under lung ultrasound monitoring for nearly 7 years, opening up a new approach in BPD prevention. This article provides a brief overview of the approach, aiming to facilitate further research and provide more scientifically sound management strategies to prevent or minimize the occurrence of BPD.

Síndrome de leiomiomatose cutânea e uterina múltipla: relato de três casos clínicos / Multiple cutaneous and uterine leiomyomatosis syndrome: report of three clinical cases

A síndrome de Reed ocorre em mulheres com múltiplos leiomiomas cutâneos e leiomiomatose uterina. Relatam-se três casos de pacientes do sexo feminino, acompanhadas em hospital universitário, com pápulas e nódulos eritêmato-acas- tanhados dolorosos em membros superiores e tórax, agravados por frio, pressão e estresse, e associados a miomatose uterina. Foram realizados diversos tratamentos prévios, sem sucesso, tais como: aplicação de corticoterapia e toxina botulínica intralesional, bloqueadores de canais de cálcio, neuromoduladores e analgésicos orais. Foi, então, realizado tratamento cirúrgico, com melhora dos sintomas. O co- nhecimento e o esclarecimento dessa síndrome é fundamental para estabelecer a relação com miomatose uterina e câncer de células renais, para que, então, a partir da lesão de pele, se faça o rastreio das demais neoplasias, diagnóstico precoce e a educação em saúde.

Reed syndrome occurs in women with multiple cutaneous leiomyomas and uterine leiomyomatosis. We report the case of three female patients followed at a university hospital with painful erythematous-brown papules and nodules on the upper limbs and chest, aggravated by cold, pressure, stress, and associated with uterine myoma- tosis. Several previous unsuccessful treatments were performed, such as the applica- tion of corticotherapy and intralesional botulinum toxin, calcium channel blockers, neuromodulators, and analgesics. Surgical treatment was performed with the im- provement of symptoms. Knowledge and clarification of this syndrome are essential to establish a relationship between uterine myomatosis and renal cell neoplasm, so that, after the skin lesion, screening for other neoplasms, early diagnosis, and health education can be carried out.

Recomendações para o rastreamento do câncer de mama no Brasil do Colégio Brasileiro de Radiologia, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia / Recommendations for breast cancer screening in Brazil from the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations

Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline, EMBASE, Cochrane Library, EBSCO, CINAHL e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos, deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos ou, ainda, portadoras de mutação genética ou com forte história familiar, beneficiam-se do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível. (AU)

Objective: To present the update of the recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published in Medline, Embase, Cochrane Library, Ebsco, Cinahl and Lilacs between January 2012 and July 2022 was searched. Recommendations were based on this evidence, by consensus of the expert committee of the three entities. Recommendations: Annual mammographic screening is recommended for women aged between 40 and 74 years old. Above 75 years should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast câncer, chest irradiation before age 30, carriers of genetic mutation or with a strong family history, benefit from complementary screening, being considered individually. Tomosynthesis is an evolution of mammography and should be considered in screening, whenever accessible and available. (AU)

Un tipo de válvula aórtica bicúspide poco frecuente / A rare type of bicuspid aortic valve

The bicuspid aortic valve corresponds to the most common valve defect in the general population. This can present asymptomatically as an incidental finding or symptomatically due to valve disease (stenosis and regurgitation), aortopathy, and infective endocarditis. Imaging techniques such as transthoracic and transesophageal echocardiography are fundamental pillars in diagnosis and treatment, determining the need for surgical intervention and the type of surgery to be performed. The case of a young patient with a less frequent bicuspid aortic valve phenotype is presented.

Câncer de colo uterino na gestação / Cervical cancer in pregnancy

PONTOS-CHAVE • A incidência de câncer durante a gestação tem aumentado devido à tendência das mulheres em postergar a gravidez. O câncer de colo de útero é a terceira neoplasia mais comumente diagnosticada durante o período gestacional. • O rastreamento e o diagnóstico devem se dar como nas pacientes não gestantes; a citologia oncótica cervical é o exame obrigatório do pré-natal, e a colposcopia com biópsia pode ser realizada em qualquer período da gestação. • A gestação complicada pelo diagnóstico de um câncer deve sempre ser conduzida em centro de referência e por equipe multidisciplinar. • A interrupção da gestação em situações específicas, para tratamento-padrão, é respaldada por lei. • A quimioterapia neoadjuvante é uma alternativa segura de tratamento durante a gestação, para permitir alcançar a maturidade fetal. Apresenta altas taxas de resposta, sendo relatada progressão neoplásica durante a gestação em apenas 2,9% dos casos. O risco de malformações fetais decorrentes da quimioterapia é semelhante ao da população geral. Contudo, a quimioterapia está associada a restrição de crescimento intraútero, baixo peso ao nascer e mielotoxicidade neonatal. • Na ausência de progressão de doença, deve-se levar a gestação até o termo.

Relación entre dimensiones antropométricas de tronco y valores de espirometría / Association between anthropometric dimensions of trunk and spirometry indices

Los objetivos del presente estudio fueron primero evaluar la asociación de dimensiones antropométricas de tórax y tronco con índices espirométricos, segundo, ajustar una ecuación de predicción con dimensiones antropométricas de tronco y tercero, comparar nuestro modelo predictivo con dos ecuaciones diagnósticas. Se evaluaron 59 estudiantes universitarios entre 20 y 40 años, de ambos sexos, sin hábito tabáquico. Las variables consideradas fueron: edad, sexo, peso, estatura, diámetro transverso de tórax, diámetro anteroposterior de tórax, perímetro de tórax, altura de tórax, altura de tronco, flujo espiratorio máximo (FEM), volumen espiratorio forzado en el primer segundo (VEF1) y capacidad vital forzada (CVF). Se utilizó el análisis de regresión múltiple para estimar los valores espirométricos en función de las variables demográficas y antropométricas. La CVF y el VEF1 tienen asociación lineal directa con el diámetro transverso de tórax, altura de tórax, perímetro de tórax y altura de tronco. Se ajustó una ecuación de regresión lineal múltiple que indicó que es posible estimar la CVF y el VEF11 en función de la altura de tronco y el perímetro de tórax para ambos sexos. Estas variables son capaces de explicar el 74 % de los valores de CVF y el 68 % de los valores de VEF1. Al comparar los valores obtenidos por nuestras ecuaciones predictivas con las ecuaciones de referencia nacional observamos que nuestros resultados son más cercanos a los de Quanjer et al. (2012) que a los de Knudson et al. (1983). La altura de tronco y el perímetro de tórax tienen asociación directa con el VEF1 y CVF y son buenos predictores del VEF1 y CVF en estudiantes universitarios. Nuestros valores estimados son más cercanos a las ecuaciones de Quanjer et al. (2012) en comparación a las estimaciones de Knudson (1983).

SUMMARY: The purposes of the present study were first to evaluate the association between anthropometric dimensions of the thorax and trunk with spirometric indices, second, to fit a prediction equation with anthropometric dimensions of the trunk, and third, to compare our predictive model with two diagnostic equations. Fifty-nine university students between 20 and 40 years old, of both sexes and non-smokers were recruited. Variables considered were age, sex, weight, height, chest transverse diameter, chest anteroposterior diameter, chest perimeter, chest height, trunk height, maximum expiratory flow (PEF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Multiple regression analysis was used to estimate spirometric values based on demographic and anthropometric variables. FVC and FEV1 have a direct linear association with chest transverse diameter, chest height, chest circumference, and trunk height. A multiple linear regression equation was fitted, indicating that it is possible to estimate FVC and FEV1 as a function of trunk height and chest girth for both sexes. These variables can explain 74% of the FVC values and 68% of the FEV1 values. Comparing the values obtained by our predictive equations with the national reference equations, we observe that our results are closer to those of Quanjer et al. (2012) than to those of Knudson et al. (1983). Trunk height and chest circumference have a direct association with FEV1 and FVC and are good predictors of FEV1 and FVC in university students. Our estimated values are closer to Quanjer et al. (2012) than Knudson et al. (1983) prediction equations.

Non-rigid registration for medical images based on deformable convolution and multi-scale feature focusing modules / 生物医学工程学杂志

Non-rigid registration plays an important role in medical image analysis. U-Net has been proven to be a hot research topic in medical image analysis and is widely used in medical image registration. However, existing registration models based on U-Net and its variants lack sufficient learning ability when dealing with complex deformations, and do not fully utilize multi-scale contextual information, resulting insufficient registration accuracy. To address this issue, a non-rigid registration algorithm for X-ray images based on deformable convolution and multi-scale feature focusing module was proposed. First, it used residual deformable convolution to replace the standard convolution of the original U-Net to enhance the expression ability of registration network for image geometric deformations. Then, stride convolution was used to replace the pooling operation of the downsampling operation to alleviate feature loss caused by continuous pooling. In addition, a multi-scale feature focusing module was introduced to the bridging layer in the encoding and decoding structure to improve the network model's ability of integrating global contextual information. Theoretical analysis and experimental results both showed that the proposed registration algorithm could focus on multi-scale contextual information, handle medical images with complex deformations, and improve the registration accuracy. It is suitable for non-rigid registration of chest X-ray images.

Efficacy and safety of endoscopic diaphragm incision in children with congenital duodenal diaphragm / 中华儿科杂志

Objective: To explore the efficacy and safety of endoscopic diaphragm incision in pediatric congenital duodenal diaphragm. Methods: Eight children with duodenal diaphragm treated by endoscopic diaphragm incision in the Department of Gastroenterology of Guangzhou Women and Children's Medical Center from October 2019 to May 2022 were enrolled in this study. Their clinical data including general conditions, clinical manifestations, laboratory and imaging examinations, endoscopic procedures and outcomes were retrospectively analyzed. Results: Among the 8 children, 4 were males and 4 females. The diagnosis was confirmed at the age of 6-20 months; the age of onset was 0-12 months and the course of disease was 6-18 months. The main clinical manifestations were recurrent non-biliary vomiting, abdominal distension and malnutrition. One case complicated with refractory hyponatremia was first diagnosed with atypical congenital adrenal hyperplasia in the endocrinology department. After treatment with hydrocortisone, the blood sodium returned to normal, but vomiting was recurrent. One patient underwent laparoscopic rhomboid duodenal anastomosis in another hospital but had recurred vomiting after the operation, who was diagnosed with double duodenal diaphragm under endoscope. No other malformations were found in all the 8 cases. The duodenal diaphragm was located in the descending part of the duodenum, and the duodenal papilla was located below the diaphragm in all the 8 cases. Three cases had the diaphragm dilated by balloon to explore the diaphragm opening range before diaphragm incision; the other 5 had diaphragm incision performed after probing the diaphragm opening with guide wire. All the 8 cases were successfully treated by endoscopic incision of duodenal diaphragm, with the operation time of 12-30 minutes. There were no complications such as intestinal perforation, active bleeding or duodenal papilla injury. At one month of follow-up, their weight increased by 0.4-1.5 kg, with an increase of 5%-20%. Within the postoperative follow-up period of 2-20 months, all the 8 children had duodenal obstruction relieved, without vomiting or abdominal distension, and all resumed normal feeding. Gastroscopy reviewed at 2-3 months after the operation in 3 cases found no deformation of the duodenal bulbar cavity, and the mucosa of the incision was smooth, with a duodenal diameter of 6-7 mm. Conclusion: Endoscopic diaphragm incision is safe, effective and less invasive in pediatric congenital duodenal diaphragm, with favorable clinical applicability.

Updated Interpretation of the NCCN Clinical Practice Guidelines (Version 3. 2023) for Non-small Cell Lung Cancer / 中国肺癌杂志

Lung cancer is the malignant tumor with the highest morbidity and mortality in China. Non-small cell lung cancer (NSCLC) is the main pathological subtype of lung cancer. On April 13, 2023, the National Comprehensive Cancer Network (NCCN) released the third edition of the 2023 NCCN Oncology Clinical Practice Guidelines: Non-small Cell Lung Cancer, which reflects the latest advances in international lung cancer research. This article will interpret the main updated contents of the new edition of the guidelines, and compare it with the third edition of the NCCN guidelines in 2022, so as to provide references about the diagnosis and treatment of NSCLC for clinical medical personnel in China.
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Non-local attention and multi-task learning based lung segmentation in chest X-ray / 生物医学工程学杂志

Precise segmentation of lung field is a crucial step in chest radiographic computer-aided diagnosis system. With the development of deep learning, fully convolutional network based models for lung field segmentation have achieved great effect but are poor at accurate identification of the boundary and preserving lung field consistency. To solve this problem, this paper proposed a lung segmentation algorithm based on non-local attention and multi-task learning. Firstly, an encoder-decoder convolutional network based on residual connection was used to extract multi-scale context and predict the boundary of lung. Secondly, a non-local attention mechanism to capture the long-range dependencies between pixels in the boundary regions and global context was proposed to enrich feature of inconsistent region. Thirdly, a multi-task learning to predict lung field based on the enriched feature was conducted. Finally, experiments to evaluate this algorithm were performed on JSRT and Montgomery dataset. The maximum improvement of Dice coefficient and accuracy were 1.99% and 2.27%, respectively, comparing with other representative algorithms. Results show that by enhancing the attention of boundary, this algorithm can improve the accuracy and reduce false segmentation.

A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations / 中国修复重建外科杂志

OBJECTIVE@#To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.@*METHODS@#Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index.@*RESULTS@#Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R 2=0.084.@*CONCLUSION@#Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.

Thoracic trauma in national hospital Abuja, Nigeria: The epidemiology, injury severity and initial management options

Background: Trauma is the leading cause of death in individuals between the ages of 1 and 44 years and it is the third commonest cause of death regardless of age. Thoracic trauma is a relatively common cause of preventable death among trauma patients. The spectrum of injuries after blunt chest trauma presents a challenging problem to the emergency physician. This study is intended to discuss the epidemiology, severity and initial management strategies in chest trauma patients, in a low income country. Methods: A cross sectional retrospective study among chest trauma patients seen in the emergency room of National Hospital Trauma Centre, Abuja, Nigeria, from January 2015 to December 2017. Relevant patients' information was retrieved from the trauma registry kept in the trauma centre. Data processing and analysis was done using statistical package for social sciences (SPSS) version 24. Test of significance was done where applicable using chi square and student t test, using p value less than 0.05 as significant. Results are presented in tables and figures. Results: A total of 637 patients, male to female ratio of 3.6 and mean age of 34.18 ± 11.34 were enrolled into the study. The most common mechanisms of injury were MVC (54.6%) and assault (23.5%). Blunt injuries were 3.5 times more frequent than the penetrating injuries. The RTS of 12 (76.3%) and the ISS of 1-15 category (52.3%) were the most common scores. Up to 98% of patients were managed non-operatively. Recovery rate was high (89%) with relatively low mortality rate of 4.2%. Conclusion: Majority of thoracic trauma can be managed effectively by employing simple, non-operative procedures such as needle decompression and chest tube insertion. Efforts should be made to include these procedures in the skill set of every medical officer working in the emergency room, particularly in low and middle income countries where there is paucity of emergency physicians.

Bula gigante secundaria a neumonía adquirida en la comunidad en niños / Giant Bulla Secondary to Community-Acquired Pneumonia in Children

Introducción: Los neumatoceles y las bulas pulmonares son lesiones que se observan en los niños casi siempre asociadas a neumonías infecciosas, aunque sus causas pueden ser diversas. La importancia clínica de estos procesos radica en el peligro de crecimiento progresivo, que puede comprometer las funciones respiratoria y cardiovascular. Objetivo: Describir las experiencias derivadas del proceso de diagnóstico por imágenes y del tratamiento invasivo de casos atendidos. Presentación de los casos: Desde finales de 2021 y durante un período de un año, se atendieron, en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Universitario de Cienfuegos, cinco niños con neumonías extensas, que desarrollaron bulas de gran tamaño varios días después del tratamiento antimicrobiano adecuado. Estas necesitaron drenaje y aspiración percutáneos debido a su magnitud y a la presencia de síntomas cardiovasculares. Conclusiones: Las bulas que aparecieron como complicación de la neumonía en el niño pueden presentarse con una frecuencia no despreciable, y hay que mantenerse atentos a su evolución, porque, a diferencia de los neumatoceles, pueden crecer progresivamente y comprometer las funciones respiratoria y cardiovascular. El drenaje percutáneo y aspiración continua por cinco días resultó un método seguro y eficaz para tratar estos procesos(AU)

Introduction: Pneumoatoceles and pulmonary bullae are lesions that are observed in children almost always associated with infectious pneumonia, although their causes may be diverse. The clinical importance of these processes lies in the danger of progressive growth, which can compromise respiratory and cardiovascular functions. Objective: To describe the experiences derived from the imaging process and the invasive treatment of treated cases. Presentation of the cases: Since the end of 2021 and for a period of one year, five children with extensive pneumonia were treated in the pediatric intensive care unit of the University Pediatric Hospital of Cienfuegos, who developed large bullae several days after appropriate antimicrobial treatment. The bullae required percutaneous drainage and aspiration due to their magnitude and the presence of cardiovascular symptoms. Conclusions: The bulla that appeared as a complication of pneumonia in the child can occur with a not negligible frequency, and it is necessary to be attentive to their evolution, because, unlike pneumoatoceles, can grow progressively and compromise respiratory and cardiovascular functions. Percutaneous drainage and continuous aspiration for five days was a safe and effective method to treat these processes(AU)

Principios básicos de ecografía pulmonar en neonatología / Basic notions of lung ultrasound in neonatology

La ecografía pulmonar (EP) ha ganado terreno en el diagnóstico de la mayoría de las patologías respiratorias presentes desde el nacimiento. Es altamente sensible a las variaciones del contenidode aire y fluidos pulmonares, y constituye un verdadero densitómetro del parénquimapulmonar con una sensibilidad superior a la de los estudios radiológicos. Es no invasiva, rápida, fácil de realizar junto a la cama del paciente y, a diferencia de la radiología convencional, no presenta riesgos de radiación. Además, nosproporciona información dinámica en tiempo real en una variedad de entornos neonatales y, al igual que las evaluaciones del corazón y el cerebro, puede ser realizada por el neonatólogo. El objetivo de esta publicación es mostrarlos principales artefactos e imágenes que sepueden encontrar en la EP neonatal, así como los diferentes patrones de aireación, y destacar su utilidad en el estudio de los trastornosrespiratorios más frecuentes del neonato.

Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates.

Síndrome de Boerhaave: manejo diagnóstico y terapéutico en el Hospital Regional de Talca / Boerhaave Syndrome: diagnostic and therapeutic management at the Hospital Regional de Talca

Introduction: Boerhaave syndrome is a spontaneous rupture of the esophageal wall caused by a sudden increase in intraesophageal pressure. It represents an incidence of approximately 15% of all esophageal perforations, which do not exceed 3.1 per 1 million inhabitants per year. Objectives: To communicate the clinical presentation and management of patients with this syndrome, as well as to reveal the different options available in our service for its treatment. Methods: Search in the statistical data of the regional Hospital of Talca for patients with a diagnosis of Boerhaave syndrome. Five patients were found. Information was obtained from their clinical records and is presented as a clinical case report with a descriptive analysis of their management. Results: Of the 5 clinical cases presented, a classic clinical presentation can be observed, most of the patients presented with vomiting that later evolved with thoracic and/or epigastric pain, associated with imaging studies suggesting esophageal perforation. Management was surgical in 100% of the cases, applying different techniques described in the literature. Discussion and Conclusion: Boerhaave syndrome is a medical-surgical emergency that requires timely management. In spite of the variety of management and the consequences of each one of them, all the patients had an evolution that allowed them to preserve their lives until nowadays. Keeping a high index of suspicion and choosing the best management will have an impact on morbidity and mortality.

Retrospective study on the incidence of cats and dogs' spinal injuries by computed tomographic scan. Part I: Cervical and Cervicothoracic / Estudo retrospectivo sobre incidência de injúrias em coluna vertebral de cães e gatos por meio de exame tomográfico. Parte I: Cervical e Cervicotorácica

Injuries involving the spine are frequent in dogs and knowledge of them is important to define the patient's treatment and prognosis. The objective of this retrospective study was to describe the epidemiological profile of animals and lesions in the cervical (C1-5) and cervicothoracic (C6-T2) spine diagnosed through tomographic examination. Compilation of computed tomography (CT) reports for the referred regions was carried out in a diagnostic center between 01/04/2017 and 30/04/2020, with or without contrast, from the clinical routine, in order to relate the most common lesions and their locations, as well as the species, breeds and ages most affected. A total of 1164 CT scans were performed in the period, 57.56% (n=670/1164) for the spine, with 89.7% (n=601/670) reports accessed, where both regions referred to here totaled 26.95% of the studies (n=162/601). Male mixed-breed dogs (MBD) showed the most lesions. For the cervical spine, the most identified lesion was disk extrusion and the site was C3-C4, while the mean age for lesions was 8.09±3.55 years. As for cervicothoracic, disk mineralization was more frequent and the mean age for lesions was 6.96±2.93 years. It was concluded that the spine is the main target of CT scans, that lesions related to the intervertebral disk were the main ones identified, and older MBD animals are the main ones affected.

As lesões envolvendo coluna vertebral são frequentes em animais de companhia, podendo ocorrer à nível vertebral, medula espinal, disco intervertebral, meninges ou raízes nervosas, e o conhecimento das mesmas é importante para definir o tratamento e prognóstico do animal. O objetivo desse estudo retrospectivo foi descrever o perfil epidemiológico dos animais e das lesões em coluna vertebral cervical (C1-5) e cervicotorácica (C6-T2) diagnosticadas por meio de exame tomográfico. Realizou-se a compilação de laudos de tomografias computadorizadas para as referidas regiões realizadas em centro diagnóstico comercial, entre 01/04/2017 a 30/04/2020, contrastadas e não-contrastadas, provenientes da rotina clínica, a fim de relacionar as lesões, raças e locais mais comuns. Foram realizados 1164 exames tomográficos no período avaliado, sendo 57,56% (n=670/1164) para a coluna, com 89,7% dos laudos acessados (n=601/670), sendo que as regiões cervical e cervicotorácica somaram 26,95% dos estudos (n=162/601). Em ambas regiões, os cães sem raça definida (SRD) machos foram os que mais demonstraram lesões. Para a coluna cervical, a lesão mais identificada foi extrusão de disco e o local mais afetado foi C3-C4, enquanto a média de idade para lesões foi 8,09±3,55 anos. Já para cervicotorácica, a mineralização de disco foi mais frequente e média de idade para ocorrência de lesões foi de 6,96±2,93 anos. Concluiu-se que a coluna vertebral foi o principal alvo de tomografias, as lesões relacionadas ao disco intervertebral foram as mais identificadas, sendo animais SRD com idade avançada os mais acometidos.

A method of lung puncture path planning based on multi-level constraint / 生物医学工程学杂志

Percutaneous pulmonary puncture guided by computed tomography (CT) is one of the most effective tools for obtaining lung tissue and diagnosing lung cancer. Path planning is an important procedure to avoid puncture complications and reduce patient pain and puncture mortality. In this work, a path planning method for lung puncture is proposed based on multi-level constraints. A digital model of the chest is firstly established using patient's CT image. A Fibonacci lattice sampling is secondly conducted on an ideal sphere centered on the tumor lesion in order to obtain a set of candidate paths. Finally, by considering clinical puncture guidelines, an optimal path can be obtained by a proposed multi-level constraint strategy, which is combined with oriented bounding box tree (OBBTree) algorithm and Pareto optimization algorithm. Results of simulation experiments demonstrated the effectiveness of the proposed method, which has good performance for avoiding physical and physiological barriers. Hence, the method could be used as an aid for physicians to select the puncture path.