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)

Manejo no quirúrgico de la artrosis de rodilla: ¿Son efectivos los medicamentos orales complementarios? / Non-surgical management of knee osteoarthritis: are complementary oral medications effective?

La artrosis es una enfermedad progresiva de las articulaciones sinoviales que causa dolor, impotencia funcional, discapacidad, y degeneración progresiva de la articulación. En sus tratamientos, sobre todo en etapas tempranas, existen distintas intervenciones para evitar tanto su desarrollo y progresión como también para lograr un adecuado manejo de los síntomas, y hay tratamientos médicos orales no convencionales con evidencia controvertida. El objetivo de este trabajo es proporcionar una actualización, dirigida a especialistas en Ortopedia y Traumatología, respecto a la evidencia actual sobre las terapias complementarias orales en el tratamiento de la artrosis de rodilla. Se hace referencia a los métodos fármacológicos complementarios más usados y estudiados, mencionando el método de acción y las consecuencias estudiadas sobre la artrosis de rodilla. Se finaliza con una tabla de recomendaciones basada en evidencia actual.

Osteoarthritis (OA) is a progressive disease of the synovial joints that causes pain, functional impairment, disability, and progressive degeneration of the joint. Regarding its treatments, especially in early stages, there are different interventions to avoid its development and progression and also to achieve an adequate management of symptoms, and there are unconventional oral medical treatments with controversial evidence. The objective of the present paper is to provide an update, to specialists in Orthopedics and Traumatology, regarding the current evidence on complementary oral therapies in the treatment of knee osteoarthritis. References are made to the most widely used and studied complementary pharmacological methods, mentioning the method of action and the consequences studied on knee osteoarthritis. The article ends with a table of recommendations based on current evidence.

Trauma craneoencefálico penetrante por una herida de arpón. Presentación de un caso / Penetrating cranioencephalic trauma due to harpoon wound. Presentation of a case

RESUMEN Las heridas craneocerebrales penetrantes más frecuentes son las provocadas por armas de fuego; las restantes resultan de rara frecuencia. Se presentó un caso que recibió agresión craneoencefálica por arpón, de forma accidental, fuera del agua. Se describieron los detalles del suceso, los exámenes complementarios, la conducta adoptada, el manejo neuroquirúrgico, y la sorprendente evolución postoperatoria del paciente (AU).

ABSTRACT The most frequent penetrating craniocerebral wounds are those caused by firearms; the remaining ones are rare. We presented a case that received accidental cranioencephalic aggression by harpoon, an event that occurred out of the water. Details of the event, complementary examinations, adopted behavior and neurosurgical management that were decided, as well as the surprising post-operative evolution of the patient were described (AU).

Intraperitoneal Barium From Gastrointestinal Perforations: Reassessment of the Prognosis and Long-Term Effects.

OBJECTIVE. The purpose of this study was to reassess the outcome and potential consequences of intraperitoneal barium leakage during radiologic evaluation of the gastrointestinal tract. MATERIALS AND METHODS. This retrospective study included 18 patients who had significant intraperitoneal leakage of barium from gastrointestinal perforations that were not suspected or diagnosed before the radiologic procedures. This complication occurred during a barium enema examination in nine patients, an upper gastrointestinal study in seven, and a small bowel series in two patients. All patients underwent urgent laparotomy for repair of perforation, with vigorous peritoneal lavage and antibiotic therapy. RESULTS. All patients had an uneventful recovery and were followed for 4-17 years (mean, 8.5 years). Radiographs obtained during this interval showed that a significant amount of residual barium was retained in the abdominal cavity. Six patients had a total of 10 subsequent abdominal operations for unrelated conditions, and some had developed barium granulomas and peritoneal adhesions. However, none of the patients in this series experienced intestinal obstruction or any clinical symptoms related to barium deposits in the abdominal cavity. CONCLUSION. Intraperitoneal leakage of barium is a rare complication of radiologic gastrointestinal examinations, and this series of 18 cases reflects 3 decades of experience at two major medical centers. The presented data indicate that the commonly held and perpetuated concept about the high rate of morbidity and mortality of this complication would not be valid in the modern era of medical and surgical management.

Nasopharyngeal diffuse large B-cells lymphoma causing acute airway obstruction amid COVID-19 crisis: an anaesthetist's nightmare.

Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.

A predictive model with radiographic signs can be a useful supplementary diagnostic tool for complete discoid lateral meniscus in adults.

PURPOSE: To investigate the diagnostic accuracy of radiographic signs for complete discoid lateral meniscus and whether a predictive model combining the radiographic signs can improve its diagnostic accuracy in adults. METHODS: A total of adult 119 knees with complete discoid lateral meniscus confirmed by arthroscopy and 119 age- and sex-matched knees with normal meniscus were included. The radiographic signs of lateral joint space, fibular head height, lateral tibial spine height, lateral tibial plateau obliquity, lateral femoral condyle squaring, lateral tibial plateau cupping, lateral femoral condyle notching, and the condylar cut-off sign were evaluated. The receiver-operating characteristic (ROC) curves and area under the curve (AUC) were evaluated for best accuracy. A prediction model was developed by multivariable regression with generalized estimating models, and was validated using data from 111 knees of children with complete discoid lateral meniscus and 111 normal controls. RESULTS: The fibular head height, lateral joint space, lateral tibial plateau obliquity, and the condylar cut-off sign were significantly different between the complete discoid lateral meniscus and the normal groups (p < 0.05). Among the four radiographic signs, the fibular head height showed the highest accuracy with 78.9% sensitivity and 57.3% specificity. The prediction models developed by logistic regression showed significantly improved accuracy for complete discoid lateral meniscus compared to the fibular head height (sensitivity: 69.8%, specificity: 82.9%, p = 0.001). For validation, the AUC of children seemed to be larger than that of adults, which indicated that the prediction models could be applied for children to detect complete discoid lateral meniscus. CONCLUSION: Among several radiographic signs, the fibular head height can be used as a screening tool for complete discoid lateral meniscus. The prediction models combined with lateral joint space, fibular head height, lateral tibial plateau obliquity, and/or the condylar cut-off sign yielded a much higher diagnostic value than each radiographic sign. Therefore, fibular head height and prediction models combined with radiographic signs can provide improved diagnostic value for complete discoid lateral meniscus. LEVEL OF EVIDENCE: III.

Association Among Dyskinesia of the Lumbar Spine Segment, Inclination Angle of the Lumbosacral Spine, and Low Back Pain in Young Athletes: A Predictive Correlational Study.

OBJECTIVE: This predictive correlational study aimed to investigate the association among low back pain (LBP), dyskinesia of the lumbosacral spine segment (determined by inertial sensors), and inclination angles: the inclination angle of the lumbosacral spine (alpha), the inclination angle of the thoracolumbar spine (beta), and the inclination angle of the upper thoracic section (gamma). Our hypothesis was that young athletes with LBP had a particular dyskinesia: nonphysiological movements of the lumbosacral segment of the spine. METHODS: The study group consisted of 108 young athletes aged 10 to 16 years (male/female 44%/56%; 12.3 ± 1.8 years; 160.1 ± 12.0 cm; 51.1 ± 13.8 kg; 4.3 ± 2.4 training years; 3.7 ± 2.1 training h/wk). The alpha, beta, and gamma angles were measured with a digital inclinometer. The position of the lumbosacral segment at the maximum extension was determined with the inertial sensors, positioned at the 11th thoracic vertebra (T11), the third lumbar spine vertebra (L3), and the second sacral spine vertebra (S2). The data were analyzed using Student's t tests, tetrachoric correlation coefficients, and logistic regression. RESULTS: There was a significant statistical difference in alpha angles (t = 9.4, P < .001) and lumbar positions in extension (t = 6.4, P < .001) between groups with LBP and without LBP. The logistic regression indicated that LBP in young athletes was significantly associated with the increased alpha angle and nonphysiological lumbar position in extension measured by a sensor at the third lumbar spine vertebra. CONCLUSION: There was a strong association among LBP, increased inclination angle of the lumbosacral spine, and dyskinesia of the lumbar spine segment in young athletes.

An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture.

OBJECTIVE: To find a new reference for assessment of pediatric forearm radiographs besides the traditional RCL. METHODS: RCLs were drawn on the anteroposterior (AP) and lateral radiographs of 170 normal pediatric forearms. Three lines were drawn on each radiograph: the first was drawn along the longitudinal center of the radial neck (N-line); the second, along the radial shaft (S-line); and the third, through the midpoints of the proximal and distal radial physes (P-line). RESULTS: The P-line was least likely to miss the capitellum on both AP views and lateral views, and the P-line most frequently passed through the central third of the capitellum on both AP views and lateral views. CONCLUSIONS: Our proposed radiocapitellar P-line was found to be much more reliable in younger children than traditional RCLs.

Diagnostic accuracy of digital X-ray radiogrammetry on hand bone loss for patients with rheumatoid arthritis.

BACKGROUND: This study will aim to evaluate the diagnostic accuracy of digital X-ray radiogrammetry (DXR) on hand bone loss (HBL) for rheumatoid arthritis (RA). METHODS: In this study, we will search the literature from PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG from the inception to June 1, 2019 without language restrictions. All case-controlled studies on assessing diagnostic accuracy of DXR on HBL for diagnosis of RA will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be used for eligible studies. We will apply RevMan V.5.3 software and Stata V.12.0 software for statistical analysis. RESULTS: We will evaluate diagnostic accuracy of DXR on HBL in patients with RA by assessing the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION: This study will detect the diagnostic accuracy of DXR evaluation on HBL in patients with RA. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019139489.

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.

Quiste óseo solitario: presentación de un caso. Bayamo, 2017 / Solitary bone cyst. Presentation of a case. Bayamo, 2017

Las lesiones óseas elementales son el reflejo de procesos patológicos en los que hay una modificación de la estructura del hueso, de su contenido de sales de calcio o densidad y del periostio: osteoporosis, osteoesclerosis, osteolisis, osteonecrosis y periostitis. En el niño los tumores óseos se clasifican en benignos y malignos y el diagnóstico de éstos se realiza a través del método clínico basado en imágenes radiológicas; los más frecuentes son los benignos del tipo de quiste óseo solitario. Se interconsulta en el Hospital Pediátrico General Milanés de Bayamo a preescolar con esta enfermedad que acude a la consulta de urgencias con dolor intenso en el brazo derecho después de haber tirado una pelota. A través del método clínico quedó demostrada fractura ósea patológica que se comprueba a través de la radiografía de fémur derecho, observándose una imagen metafisaria ovalada, bien delimitada radiolúcida, sin reacción perióstica, localizada centralmente y adelgazando la cortical, con el diagnóstico definitivo de tumor óseo solitario(AU)

The elementary bone lesions are the reflection of pathological processes in which there is a modification of the bone structure, its content of calcium salts or density and the periosteum: osteoporosis, osteosclerosis, osteolysis, osteonecrosis and periostitis. In the child, bone tumors are classified as benign and malignant and the diagnosis of these is made through the clinical method based on radiological images; the most frequent are the benign of the type of solitary bone cyst. Interview in the General Milanés Pediatric Hospital of Bayamo to preschool with this disease that goes to the emergency room with severe pain in the right arm after throwing a ball. Through the clinical method, a pathological bone fracture was demonstrated, which can be seen through the X-ray of the right femur, showing an oval, well-delimited radiolucent metaphyseal image, without periosteal reaction, located centrally and thinning the cortex, with the definitive diagnosis of bone tumor lonely(EU)

An Emergency Department Presentation of Severe Colitis After a Home Hydrogen Peroxide Enema.

BACKGROUND: Health information found on open access Internet platforms is often unscrutinized, unreliable, and can lead to considerable morbidity for patients and their presentation to the emergency department. Currently, home treatments for constipation and other gastrointestinal ailments featuring the use of hydrogen peroxide (H2O2) enemas are readily available. CASE REPORT: We present a case of a 48-year-old female with a history of fibroids who presented to the emergency department with acute abdominal pain after self-administering a 3% H2O2 enema, which she learned about on the Internet as a treatment for constipation. She subsequently developed a severe colitis with evidence of pneumatosis and focal perforation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although toxicity from oral ingestions of H2O2 is well described in the literature, there are few reports of the sequelae related to rectal administration. Due to its significant morbidity and the public health concerns related to this mechanism of toxicity, emergency physicians are at the frontlines for diagnosing and properly managing these patients. This case report reviews the patient's presentation, findings, and management.

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.

Pharmacological treatment of inhalation injury after nuclear or radiological incidents: The Chinese and German approach.

Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.

Usefulness of synchrotron radiation for three-dimensional microstructure analysis of the mouse tibia.

This study was to construct a quantitative analysis for the diagnosis and evaluation of osteoporosis by using synchrotron radiation based X-ray, which can analyze the three-dimensional microstructure of white mouse tibia. The anatomical structure and microstructure of the white mouse tibia was obtained through synchrotron radiation, and to achieve this, three-dimensional structural analysis was performed. Then, we visualized the quantified analysis and microstructure information with high-resolution imagery through the image data obtained by synchrotron radiation. In addition, it was confirmed that synchrotron radiation can obtain more reliable results through accurate observation than analysis by the mechanical method. The present invention can provide the diagnosis and evaluation associated with osteoporosis. It is expected that this will provide a basis for the evaluation and prevention of evidence-based skeletal diseases.

Diaphragmatic dysfunction.

The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.

Contrast radiography before diverting stoma closure in rectal cancer is not necessary on a routine basis. / El estudio radiológico con contraste antes del cierre del estoma derivativo en el cáncer de recto no es necesario de forma rutinaria.

INTRODUCTION: Diverting stomata are recommended in patients with low anterior resection and risk factors in order to reduce the severity of anastomotic leaks. Usually, a radiology study is performed prior to the closure of the stoma to detect subclinical leaks. The aim of the present study is to assess the clinical utility of the radiology study. METHODS: A prospective cohort study of patients undergoing anterior rectal resection for rectal cancer and those who underwent stoma closure without contrast enema. This study was carried out after a retrospective review of radiology study results prior to the closure of the stoma in patients operated from 2007 to 2011. RESULTS: Eighty-six patients met the study criteria. Thirteen patients (15.1%) presented pelvic sepsis. Contrast enema before stoma closure was pathological in 8 patients (9.3%). Five out of the 13 patients with pelvic sepsis had a pathological radiological study, compared to only 3 out of the 73 patients without intra-abdominal complications after rectal resection (38.5% vs. 4.1%; P=.001). Based on these results, we conducted a prospective study omitting the contrast enema in patients with no postoperative complications. Thirty-eight patients had their stoma closed without a prior radiology study. None of the patients presented pelvic sepsis. CONCLUSIONS: Radiology studies of the colorectal anastomosis before reconstruction can safely be omitted in patients without pelvic sepsis after the previous rectal resection.

Photodynamic therapy at ultra-low NIR laser power and X-Ray imaging using Cu3BiS3 nanocrystals.

Materials with efficient potential in imaging as well as therapy are gaining particular attention in current medical research. Photodynamic therapy (PDT) has been recently recognized as a promising treatment option for solid tumors. Still, most of the nanomaterial-based PDT modules either employ an additional photosensitizer or require high power laser sources. Also, they suffer from a lack of responsiveness in the near-infrared (NIR) region. Nanomaterials that could realize PDT independently (without any photosensitizer), at safe laser dose and in the deep tissue penetrative NIR region would definitely be better solid tumor treatment options. Methods: Herein, Cu- and Bi-based bimetal chalcogenide (Cu3BiS3), with absorption in the NIR region was developed. High-performance PDT of cancer and high-contrast x-ray imaging of tumor were performed in vivo. Biocompatibility of the NCs was also assessed in vivo. Results: The highlight of the results was the realization of ultra-low dose NIR laser-mediated PDT, which has not been achieved before, leading to complete tumor regression. This could be a breakthrough in providing a pain- and scar-less treatment option, especially for solid tumors and malignant/benign subcutaneous masses. Though the NCs are active in the photo-thermal therapy (PTT) regime as well, focus is given to the exciting aspect of extremely low power-induced PDT observed here. Conclusion: Their extended in vivo biodistribution with commendable hemo- and histo-compatibilities, along with imaging and multi-therapeutic capabilities, project these Cu3BiS3 NCs as promising, prospective theranostic candidates.