A Photodynamic and Photochemotherapeutic Platinum-Iridium Charge-Transfer Conjugate for Anticancer Therapy.

The novel hetero-dinuclear complex trans,trans,trans-[PtIV(py)2(N3)2(OH)(µ-OOCCH2CH2CONHCH2-bpyMe)IrIII(ppy)2]Cl (Pt-Ir), exhibits charge transfer between the acceptor photochemotherapeutic Pt(IV) (Pt-OH) and donor photodynamic Ir(III) (Ir-NH2) fragments. It is stable in the dark, but undergoes photodecomposition more rapidly than the Pt(IV) parent complex (Pt-OH) to generate Pt(II) species, an azidyl radical and 1O2. The Ir(III)* excited state, formed after irradiation, can oxidise NADH to NAD⋅ radicals and NAD+. Pt-Ir is highly photocytotoxic towards cancer cells with a high photocytotoxicity index upon irradiation with blue light (465 nm, 4.8 mW/cm2), even with short light-exposure times (10-60 min). In contrast, the mononuclear Pt-OH and Ir-NH2 subunits and their simple mixture are much less potent. Cellular Pt accumulation was higher for Pt-Ir compared to Pt-OH. Irradiation of Pt-Ir in cancer cells damages nuclei and releases chromosomes. Synchrotron-XRF revealed ca. 4× higher levels of intracellular platinum compared to iridium in Pt-Ir treated cells under dark conditions. Luminescent Pt-Ir distributes over the whole cell and generates ROS and 1O2 within 1 h of irradiation. Iridium localises strongly in small compartments, suggestive of complex cleavage and excretion via recycling vesicles (e.g. lysosomes). The combination of PDT and PACT motifs in one molecule, provides Pt-Ir with a novel strategy for multimodal phototherapy.

An investigation into chiropractic intern adherence to radiographic guidelines in clinical decisions with a descriptive comparison to clinical practitioners.

OBJECTIVE: The purpose of this study was to assess chiropractic interns' knowledge and adherence to radiographic clinical practice guidelines (CPGs) and compare their clinical decisions to previous surveys of established practitioners in Canada and Australia. METHODS: A clinical decision-making survey was administered to 88 interns. The survey contained clinical scenarios and vignettes with inquiries regarding indications for radiographic referral, the likelihood of referral, and the application of CPGs. RESULTS: Forty-four percent (43.75%) of the interns were aware of CPGs, 38.75% were unsure, and 17.5% were not aware. When asked specific questions about the appropriateness of diagnostic imaging, the interns' responses were similar to those of practitioners in Canada and Australia. When interns evaluated a clinical vignette, there was lower compliance with CPGs. CONCLUSION: The interns' clinical decisions regarding the use of diagnostic radiography did not significantly differ from those of practitioners who were surveyed in other related studies. Interns were inconsistent in applying their decision making in clinical cases. Notwithstanding the similarities with practitioners, some deviation from the guidelines indicates the need for further intern education to improve the implementation of CPGs for optimal cost-effective and clinically appropriate care.

Analysis of misdiagnosed cases of neck, shoulder, waist and leg pain caused by bone metastases and early warning measures / 中国基层医药

Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.

Exploration of the X-ray Dark-Field Signal in Mineral Building Materials.

Mineral building materials suffer from weathering processes such as salt efflorescence, freeze-thaw cycling, and microbial colonization. All of these processes are linked to water (liquid and vapor) in the pore space. The degree of damage following these processes is heavily influenced by pore space properties such as porosity, pore size distribution, and pore connectivity. X-ray computed micro-tomography (µCT) has proven to be a valuable tool to non-destructively investigate the pore space of stone samples in 3D. However, a trade-off between the resolution and field-of-view often impedes reliable conclusions on the material's properties. X-ray dark-field imaging (DFI) is based on the scattering of X-rays by sub-voxel-sized features, and as such, provides information on the sample complementary to that obtained using conventional µCT. In this manuscript, we apply X-ray dark-field tomography for the first time on four mineral building materials (quartzite, fired clay brick, fired clay roof tile, and carbonated mineral building material), and investigate which information the dark-field signal entails on the sub-resolution space of the sample. Dark-field tomography at multiple length scale sensitivities was performed at the TOMCAT beamline of the Swiss Light Source (Villigen, Switzerland) using a Talbot grating interferometer. The complementary information of the dark-field modality is most clear in the fired clay brick and roof tile; quartz grains that are almost indistinguishable in the conventional µCT scan are clearly visible in the dark-field owing to their low dark-field signal (homogenous sub-voxel structure), whereas the microporous bulk mass has a high dark-field signal. Large (resolved) pores on the other hand, which are clearly visible in the absorption dataset, are almost invisible in the dark-field modality because they are overprinted with dark-field signal originating from the bulk mass. The experiments also showed how the dark-field signal from a feature depends on the length scale sensitivity, which is set by moving the sample with respect to the grating interferometer.

Monitoring of Ultra-High Dose Rate Pulsed X-ray Facilities with Radioluminescent Nitrogen-Doped Optical Fiber.

We exploited the potential of radiation-induced emissions (RIEs) in the visible domain of a nitrogen-doped, silica-based, multimode optical fiber to monitor the very high dose rates associated with experiments at different pulsed X-ray facilities. We also tested this sensor at lower dose rates associated with steady-state X-ray irradiation machines (up to 100 keV photon energy, mean energy of 40 keV). For transient exposures, dedicated experimental campaigns were performed at ELSA (Electron et Laser, Source X et Applications) and ASTERIX facilities from CEA (Commissariat à l'Energie Atomique-France) to characterize the RIE of this fiber when exposed to X-ray pulses with durations of a few µs or ns. These facilities provide very large dose rates: in the order of MGy(SiO2)/s for the ELSA facility (up to 19 MeV photon energy) and GGy(SiO2)/s for the ASTERIX facility (up to 1 MeV). In both cases, the RIE intensities, mostly explained by the fiber radioluminescence (RIL) around 550 nm, with a contribution from Cerenkov at higher fluxes, linearly depend on the dose rates normalized to the pulse duration delivered by the facilities. By comparing these high dose rate results and those acquired under low-dose rate steady-state X-rays (only RIL was present), we showed that the RIE of this multimode optical fiber linearly depends on the dose rate over an ultra-wide dose rate range from 10-2 Gy(SiO2)/s to a few 109 Gy(SiO2)/s and photons with energy in the range from 40 keV to 19 MeV. These results demonstrate the high potential of this class of radiation monitors for beam monitoring at very high dose rates in a very large variety of facilities as future FLASH therapy facilities.

Micro-CT visualization of the CNS: Performance of different contrast-enhancing techniques for documenting the spider brain.

Spider brain and central nervous system (CNS) have remained unexplored, due in part to the difficulty of observing these organs, usually only possible through histological preparations. Recently, internal anatomy studies have been supplemented by the inclusion of X- ray micro-CT. Unmineralized tissue such as the body of invertebrates requires a staining process to enhance tissue X-ray absorption and improve contrast during observation. Many current protocols are based on iodine staining requiring critical point drying (CPD) of the sample for optimal contrast. This process induces shrinking of the soft tissue generating artifacts in the morphology, volume, and even position of internal structures. Phosphotungstic acid (PTA) is an alternative staining agent recently used in marine invertebrate and plant studies. Here, we used several specimens of the common spider Araneus diadematus to visualize the spider brain and compare both contrast-enhancing ethanol-based solutions. We assessed a gradient of staining times, observed and tested the repercussions of CPD, and examined the use of vacuum to accelerate PTA diffusion. We show that PTA provides the best contrast on micro-CT scans in ethanol eliminating the need for CPD, and offering more realistic in situ visualizations of the internal organs. In combination with different scanning settings, PTA allowed observation of internal organs like the CNS, digestive system, muscles, and finer structures like the retina, visual nerves, and optic neuropiles. This fast and less invasive method could facilitate the proper documentation of the internal anatomy in the context of evolutionary, developmental and functional studies.

Neodymium (3+)-Coordinated Black Phosphorus Quantum Dots with Retrievable NIR/X-Ray Optoelectronic Switching Effect for Anti-Glioblastoma.

Heteroatom interaction of atomically thin nanomaterials enables the improvement of electronic transfer, band structure, and optical properties. Black phosphorus quantum dots (BP QDs) are considered to be candidate diagnostic and/or therapeutic agents due to their innate biocompatibility and exceptional photochemical effects. However, BP QDs are not competitive regarding second near-infrared (NIR-II) window medical diagnosis and X-ray induced phototherapy. Here, an Nd3+ ion coordinated BP QD (BPNd) is synthesized with the aim to sufficiently improve its performances in NIR-II fluorescence imaging and X-ray induced photodynamic therapy, benefitting from the retrievable NIR/X-ray optoelectronic switching effects between BP QD and Nd3+ ion. Given its ultrasmall size and efficient cargo loading capacity, BPNd can easily cross the blood-brain barrier to precisely monitor the growth of glioblastoma through intracranial NIR-II fluorescence imaging and impede its progression by specific X-ray induced, synergistic photodynamic chemotherapy.

Case report: Morphological changes evident after manual therapy in two cases of late-diagnosed developmental dysplasia of the hip.

Background: Late diagnosed Developmental Dysplasia of the Hip (DDH) is the detection of DDH after 3 months of age and is associated with significantly poorer outcomes than when diagnosed and managed early. Late diagnosed DDH has lower rates of success with bracing, higher rates of surgery and higher rates of complications, including avascular necrosis of the femoral head and early osteoarthritis of the hip. We describe two cases of late-diagnosed DDH which demonstrated changes in femoroacetabular joint morphology on radiographic interpretation after a 6-month trial period of manual therapy. Case Presentation: Two cases (13 and 30 months of age) with late-diagnosed DDH presented to a private chiropractic clinic for conservative, non-bracing management. One case had unilateral DDH and the other bilateral DDH. A trial of manual therapy was utilized over a 6-month period. Both cases demonstrated changes to femoroacetabular morphology as well as improvements in gross motor activity and lower extremity muscle tone. Conclusion: Manual therapy, as an adjunct or alternative to static bracing, may be of benefit in individuals with late-diagnosed DDH not responding to bracing, and prior to more invasive interventions. Additional cases of manual therapy-based management of this condition are required to inform the design of future trials to investigate this hypothesis.

Clasificación de Imágenes de Neumonía a causa de Covid-19 utilizando Transfer-Learning basado en Redes Convolucionales / Classification of Images of Pneumonia Due to Covid-19 Using TransferLearning, Based on Convolutional Networks

La Inteligencia Artificial ha ayudado a lidiar diferentes problemas relacionados con los datos masivos y a su vez con su tratamiento, diagnóstico y detección de enfermedades como la que actualmente nos preocupa, la Covid-19. El objetivo de esta investigación ha sido analizar y desarrollar la clasificación de imágenes de neumonía a causa de covid-19 para un diagnostico efectivo y óptimo. Se ha usado Transfer-Learning aplicando ResNet, DenseNet, Poling y Dense layer para la elaboración de los modelos de red propios Covid-UPeU y Covid-UPeU-TL, utilizando las plataformas Kaggle y Google colab, donde se realizaron 4 experimentos. El resultado con una mejor clasificación de imágenes se obtuvo en el experimento 4 prueba N°2 con el modelo Covid-UPeU-TL donde Acc.Train: 0.9664 y Acc.Test: 0.9851. Los modelos implementados han sido desarrollados con el propósito de tener una visión holística de los factores para la optimización en la clasificación de imágenes de neumonía a causa de COVID-19(AU)

Artificial Intelligence has helped to deal with different problems related to massive data in turn to the treatment, diagnosis and detection of diseases such as the one that currently has us in concern, Covid-19. The objective of this research has been to analyze and develop the classification of images of pneumonia due to covid-19 for an effective and optimal diagnosis. Transfer-Learning has been used applying ResNet, DenseNet, Poling and Dense layer for the elaboration of the own network models Covid-Upeu and Covid-UpeU-TL, using Kaggle and Google colab platforms, where 4 experiments have been carried out. The result with a better classification of images was obtained in experiment 4 test N ° 2 with the Covid-UPeU-TL model where Acc.Train: 0.9664 and Acc.Test: 0.9851. The implemented models have been developed with the purpose of having a holistic view of the factors for optimization in the classification of COVID-19 images(AU)

Design and modeling of a Laue lens for radiation therapy with hard x-ray photons.

We have designed and modeled a novel optical system composed of a Laue lens coupled to an x-ray tube that produces a focused beam in an energy range near 100 keV (λ= 12.4 picometer). One application of this system is radiation therapy where it could enable treatment units that are considerably simpler and lower in cost than present technologies relying on linear accelerators. The Laue lens is made of Silicon Laue components which exploit the silicon pore optics technology. The lens concentrates photons to a small region thus allowing high dose rates at the focal area with very much lower dose rates at the skin and superficial regions. Monte Carlo simulations with Geant4 indicate a dose deposition rate of 0.2 Gy min-1in a cylindrical volume of 0.7 mm diameter and 10 mm length, and a dose ratio of 72 at the surface (skin) compared to the focus placed 10 cm within a water phantom. Work is ongoing to newer generation crystal technologies to increase dose rate.

Radiography and Clinical Decision-Making in Chiropractic.

The concern over x-ray exposure risks can overshadow the potential benefit of radiography, especially in cases where manual therapy is employed. Spinal malalignment cannot be accurately visualized without imaging. Manual therapy and the load tolerances of injured spinal tissues raise different criteria for the use of x-rays for spinal disorders than in medical practice. Current regulatory bodies rely on radiography risk assessments based on Linear-No-Threshold (LNT) risk models. There is a need to consider radiography guidelines for chiropractic which are different from those for medical practice. Radiography practice guidelines are summaries dominated by frequentist interpretations in the analysis of data from studies. In contrast, clinicians often employ a pseudo-Bayesian form of reasoning during the clinical decision-making process. The overrepresentation of frequentist perspectives in evidence-based practice guidelines alter decision-making away from practical assessment of a patient's needs, toward an overly cautious standard applied to patients without regard to their risk/benefit likelihoods relating to radiography. Guidelines for radiography in chiropractic to fully assess the condition of the spine and spinal alignment prior to manual therapy, especially with high velocity, low amplitude spinal manipulation (HVLA-SM), should necessarily differ from those used in medical practice.

Survey of X-ray induced Cherenkov excited fluorophores with potential for human use.

X-ray induced molecular luminescence (XML) is a phenomenon that can be utilized for clinical, deep-tissue functional imaging of tailored molecular probes. In this study, a survey of common or clinically approved fluorophores was carried out for their megavoltage X-ray induced excitation and emission characteristics. We find that direct scintillation effects and Cherenkov generation are two possible ways to cause these molecules' excitation. To distinguish the contributions of each excitation mechanism, we exploited the dependency of Cherenkov radiation yield on X-ray energy. The probes were irradiated by constant dose of 6 MV and 18 MV X-ray radiation, and their relative emission intensities and spectra were quantified for each X-ray energy pair. From the ratios of XML, yield for 6 MV and 18 MV irradiation we found that the Cherenkov radiation dominated as an excitation mechanism, except for aluminum phthalocyanine, which exhibited substantial scintillation. The highest emission yields were detected from fluorescein, proflavin and aluminum phthalocyanine, in that order. XML yield was found to be affected by the emission quantum yield, overlap of the fluorescence excitation and Cherenkov emission spectra, scintillation yield. Considering all these factors and XML emission spectrum respective to tissue optical window, aluminum phthalocyanine offers the best XML yield for deep tissue use, while fluorescein and proflavine are most useful for subcutaneous or superficial use.

Use of Radiography for New Patients Presenting to a Chiropractic Teaching Clinic: A Cross-sectional Analysis.

OBJECTIVE: The aim of this study was to identify the number and type of indications for radiographs ordered in a chiropractic teaching clinic in Malaysia. METHODS: A cross-sectional retrospective analysis was conducted using the medical health records of new patients who presented to the International Medical University Bukit Jalil teaching clinic for chiropractic care between August 2018 and July 2019. Data about sociodemographic characteristics, region of presenting complaint, radiography ordering rates, and referral indications were collected. We compared indications reported in the patient records with those listed in the International Medical University Chiropractic Clinical Manual. We conducted χ2 and logistic regression analysis to identify the association between radiography indications and the number of radiographs ordered. RESULTS: Data were collected for 1451 patients (741 [51.1%] women and 700 [48.9%] men). The most common body region for the presenting complaint was the lumbar/pelvic region (39.0%), and the overall radiograph use rate was 2.7%, with the highest number of radiographs for the lumbar spine. CONCLUSION: For the patient files sampled in this study, the overall radiograph order rate in the International Medical University Bukit Jalil Chiropractic teaching clinic was 2.7%.

Protecting HaCaT cells from ionizing radiation using persimmon tannin-Aloe gel composite.

Context: Persimmon tannin (extract of Diospyros kaki L.f [Ebenaceae]) and Aloe gel (extract of Aloe vera (L.) Burm.f. [Asphodelaceae]) are known as anti-radiation agents. However, radiation resistance of the persimmon tannin-Aloe gel composite remains inconclusive.Objective: To investigate the capacity of the persimmon tannin-Aloe gel composite to protect against ionising radiation at the cellular level.Materials and methods: HaCaT (human epidermal keratinocytes) cells were pre-treated with PT-A-1 (the mass ratio of persimmon tannin and Aloe gel was 2:1) or the single component (persimmon tannin or Aloe gel) at various concentrations (0, 50, 100, 200, 400, 800 µg/mL. Control group: medium with no HaCaT cells), and then radiated with X-rays (radiation dose: 4, 8, 12, 16, and 20 Gy). Cell viability, cell apoptosis, and radiation-induced intracellular reactive oxygen species (ROS) generation were analysed by CCK-8, Hoechst 33258 staining/flow cytometry, and 2',7'-dichlorfluorescein diacetate (DCFH-DA) assay, respectively, for 12 or 24 h incubation after radiation.Results: The optimal radiation dose and post-radiation incubation period were determined to be 8 Gy and 12 h. CCK-8 activity detection showed that the cell activity was 77.85% (p < 0.05, IC50 = 55.67 µg/mL). The apoptotic rate was the lowest (4.32%) at 200 µg/mL of PT-A-1 towards HaCaT cells. ROS production was the most effectively suppressed by 200 µg/mL PT-A-1 towards HaCaT cells.Discussion and conclusions: The persimmon tannin-Aloe gel composite has good radioprotective effect, and which will facilitate its clinic application as a potential natural anti-radiation agent in future.

Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association's Adoption of "Choosing Wisely".

Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting "Choosing Wisely," we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.

Consortia of bioactives in supercritical carbon dioxide extracts of mustard and small cardamom seeds lower serum cholesterol levels in rats: new leads for hypocholesterolaemic supplements from spices.

Melatonin-rich and 1,8-cineole-rich extracts have been successfully obtained from yellow mustard (YM) and small cardamom (SC) seeds, respectively, employing green technology of supercritical CO2 (SC-CO2) extraction. Chemical profiling confirmed the presence of melatonin and 1,8-cineole and co-extractants in the respective extracts. Electron paramagnetic resonance spectroscopy attested strong antioxidant activities of the extracts foregoing pan-assay interference compounds involved in spectroscopic analysis. These extracts also exhibited synergistic efficacies greater than unity confirming antioxidant synergy among the co-extracted bioactives therein. To ascertain hypocholesterolaemic efficacies, these extracts were co-administered orally with Triton X (at the pre-optimised dose of 175 mg/kg body weight (BW)) to Wistar albino rats at doses of 550, 175 and 55 mg/kg BW. Serum total cholesterol levels in the rats were monitored on days 3, 7, 15 and 21. On day 21, total cholesterol level reduced appreciably by 49·44 % in rats treated with YM seed extract and by 48·95 % in rats treated with SC seed extract, comparable with atorvastatin-administered rats (51·09 %). Either extract demonstrated inhibitory effects on hepatic 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase activity. A molecular docking exercise identified specific compounds in the extracts which possessed binding affinities comparable with therapeutically used HMG-CoA reductase inhibitors. In silico and in vivo studies concertedly concluded that the consortium of bioactive components in the extracts cannot be considered as invalid metabolic panaceas and therefore these 'green' extracts could be safely subjected to clinical studies as preventive biotherapeutics for hypercholesterolaemia. These extracts could be consumed per se as hypocholesterolaemic supplements or could be ingredients of new spice-based therapeutic foods.

Importância da experiência clínica para a mensuração da curva escoliótica de crianças pela técnica de Cobb / La importancia de la experiencia clínica en la medición de la curva escoliótica de niños mediante la técnica de Cobb / The importance of clinical experience for the measurement of scoliosis curve in children by Cobb technique

RESUMO A escoliose é definida como uma deformidade com desvio lateral da coluna no plano coronal, torsão da coluna e do tronco e distúrbio no perfil sagital. Essa alteração postural é avaliada por meio de radiografia de incidência anteroposterior, utilizando-se o método de Cobb. O objetivo do estudo é verificar a influência da experiência do avaliador sobre a confiabilidade intraexaminador e interexaminador do ângulo Cobb em curvaturas escolióticas de crianças. Foram incluídas na pesquisa 39 crianças portadoras de escoliose idiopática, com idade entre 7 e 18 anos. Os exames foram avaliados por dois fisioterapeutas, um quiropraxista e um estudante de fisioterapia - cada um avaliando duas vezes cada exame. A segunda avaliação ocorreu após sete dias, para confiabilidade intraexaminador. Ademais, as primeiras avaliações forneceram dados para confiabilidade interexaminador. A análise estatística foi realizada com coeficiente de correlação intraclasse (CCI), análise de Bland e Altman e análise descritiva do desvio absoluto médio, erro-padrão de medição e mínima mudança detectável. Observou-se boa confiabilidade (CCI>0,5) para as análises intraexaminadores entre os profissionais, e confiabilidade fraca (CCI=0,4) para o avaliador inexperiente. A confiabilidade interexaminador dos profissionais foi boa (CCI=0,6), e com a presença do avaliador inexperiente foi fraca (CCI=0,3). As avaliações entre os profissionais apresentaram menor variabilidade das medidas e valores de desvio-padrão quando comparadas com as do avaliador inexperiente. A mensuração dos ângulos da escoliose por meio do método de Cobb realizada por profissionais experientes apresentou melhores índices de concordância e de confiabilidade intra e interexaminadores e menor desvio-padrão e variabilidade entre as medidas.

RESUMEN La escoliosis se define como una alteración con curvatura lateral de la columna vertebral en el plano coronal, torsión de la columna vertebral y del tronco y trastorno en el perfil sagital. Esta alteración postural se evalúa mediante radiografía anteroposterior, utilizando el método de Cobb. El presente estudio tiene como objetivo verificar la influencia de la experiencia del evaluador para la fiabilidad intraexaminador e interexaminador del ángulo de Cobb en las curvaturas escolióticas de los niños. El estudio incluyó a 39 niños con escoliosis idiopática entre 7 y 18 años de edad. Los exámenes fueron evaluados por dos fisioterapeutas, un quiropráctico y un estudiante de fisioterapia, siendo que cada uno evaluó cada examen dos veces. Tras siete días, ocurrió una segunda evaluación para la fiabilidad intraexaminador. Además, las primeras evaluaciones proporcionaron datos para la fiabilidad interexaminador. El análisis estadístico se realizó con el coeficiente de correlación intraclase (ICC), con el análisis de Bland y Altman y con el análisis descriptivo de la desviación media absoluta, del error estándar de medición y del cambio mínimo detectable. Se observó una alta fiabilidad (ICC>0,5) en los análisis intraexaminadores entre los profesionales, y una baja fiabilidad (ICC=0,4) en los de evaluadores inexpertos. La fiabilidad interexaminador de los profesionales fue buena (ICC=0,6), y la presencia del evaluador inexperto fue baja (ICC=0,3). Las evaluaciones entre los profesionales mostraron una menor variabilidad de las medidas y valores de desviación estándar en comparación con los del evaluador inexperto. La medición de los ángulos de escoliosis utilizando el método de Cobb que había sido realizada por profesionales con experiencia mostró mejores índices de concordancia y fiabilidad intra e interexaminadores y una menor desviación estándar y variabilidad entre las mediciones.

ABSTRACT Scoliosis is defined as a deformity with lateral deviation of the spine in the coronal plane, torsion of the spine and trunk, and disturbances in the sagittal profile. This postural alteration is evaluated by anteroposterior incidence radiography using the Cobb method. The objective of this study was to verify the influence of evaluator experience on inter- and intra-rater reliability of the Cobb angle of scoliosis curvatures in children. In total, 39 patients aged 7 to 18 years with idiopathic scoliosis were included in this study. The exams were evaluated by two physical therapists, a chiropractor and a physical therapy student. Each evaluator rated each exam twice and the second evaluation occurred after seven days, characterizing the intra-rater reliability. Furthermore, the first evaluations provided the inter-rater reliability. Statistical analysis was performed with intraclass correlation coefficient (ICC), Bland-Altman analysis, descriptive analysis of mean absolute deviation, standard error of measurement, and minimum detectable chance. Correlations ranged from good (ICC>0.5) for intra-rater reliability among professionals to weak (ICC=0.4) for the inexperienced evaluator. The inter-rater reliability of the professional's evaluations was good (ICC=0.6) and the same analysis with the presence of an inexperienced evaluator was weak (ICC=0.3). Evaluations among professionals showed less variability of measurements and standard deviation values compared to the inexperienced evaluator. The measurement of the angles of the scoliosis through the Cobb method carried out by experienced professionals showed better agreement as well as intra- and inter-rater reliability, lower standard deviation, and variability among the measurements.

European guidelines on quality criteria for diagnostic radiographic images of the lumbar spine - an intra- and inter-observer reproducibility study.

Background: The Commission of the European Communities has published guidelines to be used as a gold standard for quality assessment of diagnostic radiographic images. Image quality and radiation dose must be monitored and optimally balanced for diagnostic purposes on patients. The objective of the current study was to assess intra- and inter-observer reproducibility in less experienced observers using the proposed European Guidelines on Quality Criteria for Diagnostic Radiographic Images in a quality assessment of lumbar spine radiographs in primary chiropractic practice in Denmark. Methods: Two observers initially evaluated lumbar spine radiographs randomly selected from fifty chiropractic clinics, all connected to the national PACS server (KirPACS) in Denmark. All evaluations were performed twice by both observers using a four-week interval and for compliance with the European Quality Criteria for Diagnostic Radiographic Images. Inter- and intra-observer reproducibility was calculated using kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed. Results: The strength of the inter-observer agreement of general image quality at baseline ranged from moderate agreement (k = 0.47) to substantial agreement (k = 0.68). After four weeks, the inter-observer agreement still ranged from moderate agreement (k = 0.59) to substantial agreement (k = 0.71), but with increased agreement for both kappa coefficients. In relation to intra-observer agreement of general image quality, the strength for observer A ranged from moderate (k = 0.58) to substantial (k = 0.72) and the strength for observer B overall was substantial (k = 0.63-0.75). Conclusion: The European Guidelines on Quality Criteria for Diagnostic Radiographic Images are considered a gold-standard and used in a method for quality assurance within the Danish chiropractic profession. The inter-rater and intra-rater agreements in this study, using the CEC-criteria, were found mostly acceptable. With appropriate attention to clear understanding of the individual criteria and sufficient training, this method is found to be reliable, even using less experienced observers, to carry out Diagnostic Radiographic Image Quality-assurance in primary care settings.

Biosynthesis of selenium nanoparticles, characterization and X-ray induced radiotherapy for the treatment of lung cancer with interstitial lung disease.

Selinium nanoparticles (SeNPs) with minimal toxicity and efficient antioxidant properties were reported earlier for their anti-carcinogenic influence against various types of cancers, thus elevating its potential. In the present study, the anti-carcinogenic effect of selenium nanoparticles against lung cancer was studied. Selenium nanoparticles were biosynthesized and were characterized using UV- Vis absorption spectroscopy. A decrease in the absorption intensity was recorded with the increase in time, which represented the protein consumption during the reduction of SeO32- to Se0. The calculated average crystalline size from XRD studies of the synthesized selenium nanoparticles was found to be 88.89 nm which was in accordance with the TEM analysis while the SAED pattern has disclosed hexagonal ring structure with diffraction ring pattern.MTT assay was performed to evaluate the radio-sensitizing effect of selenium nanoparticles under the X-ray influence against cancer as well as healthy cell lines. SeNPs showed potent cytotoxicity effect in cancer cells whereas it showed relatively less toxic effect in normal healthy cells. However, caspase-3 activity was even more elevated when subjected to X-ray exposure than in the absence. These findings apparently revealed the cytotoxic potential of SeNPs + X-ray combination in the lung cancer cell lines.

Treatment of fecal impaction in children using combined polyethylene glycol and sodium picosulphate.

BACKGROUND AND AIM: Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction. METHODS: Children with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X-ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X-rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2-8 sachets (14.7 g/sachet) on days 1-2, reducing to 2-6 sachets on day 3. The SPS dose was 15-20 drops on days 2-3. RESULTS: Eighty-nine children (4-18 years) produced a large volume of soft stool (median/inter-quartile-range: 2.2/1.6-3.1 L) over 7 days. Stool volume on X-rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change. CONCLUSIONS: A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying.