Instrumentation failure following pediatric spine deformity growth-sparing surgery using traditional growing rods or vertical expandable prosthetic titanium ribs.

BACKGROUND: Instrumentation failure (IF) is a major complication associated with growth-sparing surgery for pediatric spinal deformities; however, studies focusing on IF following each surgical procedure are lacking. We aimed to evaluate the incidence, timing, and rates of unplanned return to the operating room (UPROR) associated with IF following each surgical procedure in growth-sparing surgeries using traditional growing rods (TGRs) and vertical expandable prosthetic titanium ribs (VEPTRs). METHODS: We reviewed 1,139 surgical procedures documented in a Japanese multicenter database from 2015 to 2017. Of these, 544 TGR and 455 VEPTR procedures were included for evaluation on a per-surgery basis. IF was defined as the occurrence of an implant-related complication requiring revision surgery. RESULTS: The surgery-based incidences of IF requiring revision surgery in the TGR and VEPTR groups were 4.3% and 4.0%, respectively, with no significant intergroup difference. Remarkably, there was a negative correlation between IF incidence per surgical procedure and the number of lengthening surgeries in both groups. In addition, rod breakage in the TGR group and anchor-related complications in the VEPTR group tended to occur relatively early in the treatment course. The surgery-based rates of UPROR due to IF in the TGR and VEPTR groups were 2.0% and 1.5%, respectively, showing no statistically significant difference. CONCLUSIONS: We found that IF, such as anchor related-complications and rod breakage, occurs more frequently earlier in the course of lengthening surgeries. This finding may help in patient counseling and highlights the importance of close postoperative follow-up to detect IF and improve outcomes.

Comparison of Clinical Results of Crescent-Shaped Expanded Polytetrafluoroethylene (e-PTFE) and Granulated Rib Cartilage for Filling The Nasal Base to correct Midface Depressions.

Objective: The center of the face plays an important role in the fullness of our facial contours, however, sunken center of the face is more common in Asians than in Europeans and Americans. Expanded polytetrafluoroethylene (PTFE) and rib cartilage are commonly used to fill the nasal base to improve the hollowing of the center of the face. This study aimed to compare the efficacy and safety of crescent-shaped expanded polytetrafluoroethylene (e-PTFE) with granulated rib cartilage for nasal base filling to treat midface depressions. Methods: Fifty-one patients with mild to moderate midface depression and normal occlusion admitted to our department from June 2017 to August 2020 were selected. Comprehensive rhinoplasty was performed, which included nasal base filling using crescentic e-PTFE or granulated rib cartilage. They are all women, with an average age of 27.4 years. The e-PTFE group (group A) had 27 cases, while the granulated rib cartilage group (group B) had 24. Changes in two face parameters, the wing ear line and facial convexity, were measured and recorded based on preoperative and postoperative photographs of the patients and using 3D imaging technology. Postoperative complications and satisfaction were assessed by questionnaires to compare the two surgical approaches' differences, advantages, and disadvantages. Results: Postoperative midface depression improved significantly in 51 patients. Most of the patients who underwent both procedures showed significant improvement in the wing ear line and facial convexity. The 3D imaging has also helped us to more objectively assess the changes in midface concavity. Some patients experienced acute discomfort, such as foreign body sensation and stiffness in the surgical area, for the first three months after nasal base filler surgery. Still, these symptoms resolved on their own within six months. Most patients (92.6% in group A and 91.6% in group B) felt that they had natural facial expressions and were satisfied with the filler results. Conclusion: The use of crescentic e-PTFE and granular rib cartilage to fill the nasal base is easy to operate and has a quick postoperative recovery, allowing for good postoperative results. However, after some of the granular rib cartilage filling treatments, the height of the nasal base was lowered, which may be connected to its limited structural support, ease of displacement, and resorption. Crescentic e-PTFE is superior to granular rib cartilage in terms of both morphology and mechanical support. The crescentic e-PTFE filling method provides rapid postoperative recovery and good shape maintenance, but local stiffness is more pronounced than in the granular rib cartilage group. This may help the plastic surgeon's choice of surgical procedure.

Evaluation of a novel phytase derived from Citrobacter braakii and expressed in Aspergillis oryzae on growth performance and bone mineralization indicators in nursery pigs.

A total of 297 pigs (DNA 241 × 600; initially 8.64 ±â€…0.181 kg) were used in a 21-d trial to determine the efficacy of a novel phytase derived from Citrobacter braakii and expressed in Aspergillis oryzae (HiPhorius; DSM Nutritional Products, Animal Nutrition & Health, Parsippany, NJ) on pig growth and bone mineralization indicators. Pens of pigs were assigned to 1 of 5 dietary treatments in a randomized complete block design with 5 pigs per pen and 12 pens per treatment. The trial was initiated 14-d after weaning. The first three treatments were formulated to contain 0.09% aP; without added phytase (control), or the control diet with 600 or 1,000 FYT/kg of added phytase (considering a release of 0.15% or 0.18% aP, respectively). The remaining two treatments were formulated to contain 0.27% aP, one without added phytase and the other with 1,000 FYT/kg. From days 0 to 21, pigs fed increasing phytase in diets containing 0.09% aP had increased (linear, P ≤ 0.002) ADG, ADFI, and G:F, but added phytase in the 0.27% aP diet did not impact growth performance. Increasing phytase in diets containing 0.09% aP increased percentage bone ash in metacarpals and 10th ribs (linear, P < 0.001; quadratic, P = 0.004, respectively), and increased grams of Ca and P in metacarpals, 10th ribs, and fibulas (linear, P ≤ 0.027). Adding 1,000 FYT/kg phytase in diets with 0.27% aP increased (P ≤ 0.05) percentage bone ash and grams of Ca and P in fibulas and 10th ribs compared with pigs fed 0.27% aP without added phytase. Increasing aP from 0.09% to 0.27% in diets without added phytase increased (P < 0.001) ADG, ADFI, and G:F. Increasing aP from 0.09% to 0.27% in diets without added phytase increased bone density (P ≤ 0.002) in fibulas and metacarpals, percentage bone ash in all bones (P ≤ 0.074), and increased (P < 0.05) grams of Ca and P in fibulas and 10th ribs. Pigs fed diets containing 0.09 or 0.27% aP, both with 1,000 FYT added phytase, had increased (P < 0.05) bone density in fibulas and metacarpals, percentage bone ash in all bones, and increased grams of Ca and P in fibulas and 10th ribs. For growth performance (average of ADG and G:F), aP release was calculated to be 0.170% for 600 FYT/kg and 0.206% for 1,000 FYT/kg. For the average of all bone measurements (average of 3 bones for both bone density and percentage bone ash), aP release was calculated to be 0.120% and 0.125% for 600 and 1,000 FYT/kg, respectively.

Approximately 60% to 80% of phosphorus (P) in feedstuffs of plant origin is stored in the form of phytic acid. Phytase is an enzyme used in swine diets to improve the digestibility of phytate-bound P. As phytase sources continue to advance, their efficacy must be evaluated. In this study, nursery pigs (9 kg) were used to determine the efficacy of a novel phytase derived from Citrobacter braakii and expressed in Aspergillis oryzae in releasing phytate-bound P. Increasing phytase added to diets deficient in aP improved growth performance and bone mineralization. Adding phytase to a diet already adequate in aP did not affect growth performance, but improved bone mineralization indicators. Available P release attributed to phytase was estimated using growth performance and found to be 0.170% for 600 FYT/kg and 0.206% for 1,000 FYT/kg. For the average of all bone measures, the estimated aP release was 0.120% for 600 FYT/kg and 0.125% for 1,000 FYT/kg. Results of this study indicate an increasing release of phytate-bound P with increasing additions of the novel phytase tested in nursery diets and confirm that additional P is needed for bone development compared to growth.

Effects of the Fourth Ventricle Compression Technique and Rib Raising Osteopathic Technique on Autonomic Nervous System Activity Measured by Heart Rate Variability in 35 Healthy Individuals.

BACKGROUND Fourth ventricle compression (CV4) is a cranial osteopathic manipulation technique for brain and cranial nerve function. Rib raising is an osteopathic technique that reduces rib restriction and conditions associated with sympathetic hypertonia. This study aimed to evaluate the effects of the CV4 and rib raising osteopathic techniques on autonomic nervous system activity, measured by heart rate variability, in 35 healthy individuals. MATERIAL AND METHODS The study involved 35 healthy participants, randomly divided into 2 groups. The experimental group received osteopathic therapy in the form CV4 and rib raising techniques for 30 min. The placebo group had a sham procedure performed using an ultrasound transducer for 20 min. The test of heart rate variability was conducted for 6 min, with participants in a seated position. RESULTS A significant decrease in heart rate values was observed in the experimental group (P=0.012), and an increase in the standard deviation of all the rib raising intervals parameter and a decrease in the high frequency% parameter was observed in the placebo group (P=0.035, P=0.048; respectively). There were no differences in other parameters between the groups. CONCLUSIONS The use of the CV4 technique and rib raising technique leads to a significant decrease in heart rate, which can be interpreted as increased parasympathetic activity; however, the use of these techniques did not affect the other parameters.

Characterization and application of Croton blanchetianus Baill extract for lamb ribs preservation.

This research evaluated the antioxidant, antimicrobial and toxicity potential of the leaf extract of Croton blanchetianus Baill (ExCb) and its effect on the conservation of lamb ribs. The ExCb (control treatment) revealed higher concentration of 2,5-dihydroxybenzoic acid (190.10 mg/g), catechin (84.10 mg/g), rosmarinic acid (56.01 mg/g), 4-hydroxybenzoic acid (52.05 mg/g) and myricetin (40.00 mg/g). And it showed high phenolic content (204.05 mg GAE/g), antioxidant potential (11.78 µg/mL by DPPH and 140.40 mmol Sulf Fer/g by FRAP) and antimicrobial activity with inhibition for Staphylococcus aureus, Listeria innocua, Salmonella enterica, Escherichia coli and Aspergillus flavus. However, it showed toxicity against brine shrimp (Artemia Salina) (LD50 of 66.26 µg/mL). The 2,5-dihydroxybenzoic acid was indicated as the main compound responsible for the toxicity of ExCb. After treatment in an oven at 110 °C for 15 min, the toxicity of ExCb was reduced by over 7 times, the compound 2,5-dihydroxybenzoic acid was not identified, and still maintained the phenolic compounds content of 94.35% and antioxidant activity compared to the control (without thermal treatment). The application of absorbent containing 50 mg/mL of ExCb added to the packaging maintained the quality and prevented the lipid oxidation of lamb ribs during 10 days of refrigerated storage.

Delayed Union of Stress Fracture of the First Rib in a Yoga Instructor: A Case Report.

CASE: We describe the case of a 38-year-old woman, a yoga instructor, who had pain in the right shoulder and scapular region of 4 months' duration while performing yoga. Radiography and computed tomography diagnosed delayed union of a first rib stress fracture. The delayed union of stress fracture of the first rib was successfully treated with the limiting of yoga activity and low-intensity pulsed ultrasound (LIPUS). CONCLUSIONS: Physicians should be aware that even yoga posing can cause stress fractures of the first rib. LIPUS therapy may be effective for delayed union in addition to rest.

Accuracy of rib palpation for dry needling of deep periscapular musculature, measured with ultrasound.

INTRODUCTION: Dry needling of the periscapular musculature is a procedure commonly performed by physical therapists. Needling of the deep musculature may be challenging, and use of a thoracic rib as a "backstop" is often applied to prevent inadvertent puncture of the pleura. The aim of this study was to: 1) To examine the accuracy rate of experienced physical therapists in identifying a mid-scapular thoracic rib using palpation, 2) to understand patient characteristics that affect the accuracy rate, and 3) to examine if therapist confidence levels were associated with palpatory accuracy. METHODS: Two experienced physical therapists attempted to palpate a thoracic rib in the mid-scapular region of healthy participants (n = 101 subjects, 202 ribs), and self-reported their level of confidence in an accurate palpation. Their accuracy was verified with ultrasonography. RESULTS: The two physical therapists were accurate on 73.3% of palpations and did not differ in accuracy (72.0% vs. 75.0%, p = 0.747). The only ultrasonographic or subject characteristic measurement that correlated with improved accuracy was a reduced muscle thickness (p = 0.032). Therapists' self-reported confidence levels did not correlate to actual accuracy (p = 0.153). DISCUSSION: Physical therapists should be aware that palpation of a thoracic rib may not be as accurate as it may seem. The greater thickness of muscle in the area reduces the accuracy of accurate palpation. CONCLUSION: Dry needling of the periscapular muscles should be done with caution if using a rib as a "blocking" technique.

A Clinical Review of Slipping Rib Syndrome.

ABSTRACT: Slipping rib syndrome is pain created at the lower, anterior border of the rib cage when performing upper-extremity activities, coughing, laughing, or leaning over. Defects in the costal cartilage of ribs 8 to 10 result in increased movement of the ribs, impinging soft tissue and intercostal nerves. Advancements have been made in the diagnosis of slipping rib syndrome by dynamic ultrasound. Ultrasound can identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling. Although the mainstays of treatment continue to be reassurance, nonsteroidal anti-inflammatory drugs, physical therapy, intercostal nerve injections, osteopathic manipulative treatment, surgery for refractory pain, and botulinum toxin injections have been attempted, and there may be a role for prolotherapy in treatment. Surgical techniques are being examined secondary to recurrence of pain following resection. The hooking maneuver and surgery remain important for identification and treatment, respectively.

The use of 3D printing for osteopathic medical education of rib disorders.

Context: With the advent of increasingly accessible three-dimensional (3D) printing, the possibility to efficiently design and generate prototype innovations is also increasing. This type of manufacturing can potentially enhance medical education by allowing design of models specific to osteopathic manipulative medicine (OMM). Objectives: To determine the viability of a 3D-printed mechanically moveable rib cage in enhancing the teaching of rib osteopathic principles. Methods: A single-blind, qualitative study was conducted to evaluate the use of educating students with this novel 3D-printed, movable rib model vs. a traditional static rib model. A total of 237 first-year medical students participated in the study and received the same standardized lecture on the rib dysfunction. Students were also assigned at random to either a comparison group, which would utilize the 3D printed rib model, or the control group, which would utilize the traditional static model. Students would also complete an entrance and exit surveys assessing subjective scores of overall student satisfaction and objective scores for knowledge of OMM rib dysfunction and treatment. An independent samples t-test was applied to assess potential differences between select student evaluation scores (those with continuous variables) of the rib model in the comparison and experiment groups. Chi-square goodness of fit test was conducted to determine if there were any significant differences in entry and exit survey responses between the two groups. Descriptive statistics of the mean and standard deviation were also reported. Results: For both comparison and control groups, the mean score on an 11-point scale for the evaluation question, "Please rank on a scale of 0-10 how helpful you thought the rib models were to your education," was 9.08 (SD, 1.397). Independent t-test results showed that the comparison group had higher scores than the control group when queried about whether they felt the model accurately depicted the material presented (comparison group mean, 9.55 [SD, 978] vs. control group mean, 9.06 [SD, 1.33; t(235) = 3.253; p=0.01). Chi-square test of goodness-of-fit showed that the differences between the number of correct answers chosen by participants for Item 3 (a case-based question asking students which rib they would treat for a patient presenting to an OMT clinic) was statistically significantly higher for the comparison group (51.9% correct in comparison group vs. 48.1% in control group), even though both groups scored similarly on this item during the entry survey. Conclusions: The results of this study suggest that utilizing 3D printing to demonstrate somatic dysfunctions of the rib cage may improve understanding and student satisfaction for diagnosis and treatment.

Large-Volume Hyperthermia for Safe and Cost-Effective Targeted Drug Delivery Using a Clinical Ultrasound-Guided Focused Ultrasound Device.

Lyso-thermosensitive liposomes (LTSLs) are specifically designed to release chemotherapy agents under conditions of mild hyperthermia. Preclinical studies have indicated that magnetic resonance (MR)-guided focused ultrasound (FUS) systems can generate well-controlled volumetric hyperthermia using real-time thermometry. However, high-throughput clinical translation of these approaches for drug delivery is challenging, not least because of the significant cost overhead of MR guidance and the much larger volumes that need to be heated clinically. Using an ultrasound-guided extracorporeal clinical FUS device (Chongqing HAIFU, JC200) with thermistors in a non-perfused ex vivo bovine liver tissue model with ribs, we present an optimised strategy for rapidly inducing (5-15 min) and sustaining (>30 min) mild hyperthermia (ΔT <+4°C) in large tissue volumes (≤92 cm3). We describe successful clinical translation in a first-in-human clinical trial of targeted drug delivery of LTSLs (TARDOX: a phase I study to investigate drug release from thermosensitive liposomes in liver tumours), in which targeted tumour hyperthermia resulted in localised chemo-ablation. The heating strategy is potentially applicable to other indications and ultrasound-guided FUS devices.

Variations of HRV and skin conductance reveal the influence of CV4 and Rib Raising techniques on autonomic balance: A randomized controlled clinical trial.

INTRODUCTION: The aim of the present study was to evaluate whether Fourth Ventricle Compression Technique (CV4) and Rib Raising (RR) osteopathic techniques influence Autonomic Nervous System (ANS) activity, as measured by Heart Rate Variability (HRV) and Skin Conductance (SC). METHOD: A randomized-controlled clinical trial has been performed from June 2010 to January 2011. 32 healthy adults (33.9 ± 14 years, and 72% female) were selected. Subjects were randomized in three groups: CV4 group, RR group and Placebo group. Each subject of each group underwent respective technique only once. HRV and SC were continuously recorded during the session. All data analysis was performed using SPSS statistical software (version 21.0) and the significance level was considered at p ≤ 0.05. RESULTS: RR technique intra-group subject analysis showed a significant decrease in LF/HF ratio (F = 25.18; p < 0.001), a statistically significant decrease of LF (F = 27.09; p < 0.001), and increase of HF, both at the end of treatment (F = 27.09; p < 0.001). CV4 technique intra-group subject analysis showed a significant reduction of the LF/HF ratio (F = 81.15; p < 0.001), a significant decrease in LF (F = 38.29; p < 0.001) and a significant increase of HF, at the end of treatment (F = 38.28; p < 0.001). Between-group analysis showed only a significant difference in LF/HF ratio between CV4 and PL groups (F = 3.44; p = 0.042). DISCUSSION: Our results suggest that the application of CV4 and RR techniques favors a shift in the autonomic balance towards a parasympathetic predominant state. Thus, their use within OMT protocol, as holistic approach, might improve the outcome of the treatment of clinical neuro-vegetative conditions.

Unexpected radioactive iodine accumulation on whole-body scan after I-131 ablation therapy for differentiated thyroid cancer.

We retrospectively evaluated the frequency of unexpected accumulation of radioactive iodine on the post-therapy whole-body scan (Rx-WBS) after radioactive iodine (RAI) ablation therapy in patients with differentiated thyroid cancer (DTC). We searched our institutional database for Rx-WBSs of DTC patients who underwent RAI ablation or adjuvant therapy between 2012 and 2019. Patients with distant metastasis diagnosed by CT or PET/CT before therapy, and those had previously received RAI therapy were excluded. In total, 293 patients (201 female and 92 male, median age 54 years) were selected. Two nuclear medicine physicians interpreted the Rx-WBS images by determining the visual intensity of radioiodine uptake by the thyroid bed, cervical and mediastinal lymph nodes, lungs, and bone. Clinical features of the patients with and without the metastatic accumulation were compared by chi-square test and median test. Logistic regression analyses were performed to compare the association between the presence of metastatic accumulation and these clinical factors. Eighty-four of 293 patients (28.7%) showed metastatic accumulation. Patients with metastatic RAI accumulation showed a significantly higher frequency of pathological N1 (pN1) and serum thyroglobulin (Tg) > 1.5 ng/ml under TSH stimulation (p = 0.035 and p = 0.031, respectively). Logistic regression analysis indicated that a serum Tg > 1.5 ng/ml was significantly correlated with the presence of metastatic accumulation (odds ratio = 1.985; p = 0.033). In conclusion, Patients with Tg > 1.5 ng/ml were more likely to show metastatic accumulation. In addition, the presence of lymph node metastasis at the initial thyroid surgery was also associated with this unexpected metastatic accumulation.

Solitary rib lesions showing prostate-specific membrane antigen (PSMA) uptake in pre-treatment staging 68 Ga-PSMA-11 positron emission tomography scans for men with prostate cancer: benign or malignant?

OBJECTIVES: To determine the proportion of solitary rib lesions on pre-treatment 68 Gallium-labelled prostate-specific membrane antigen (PSMA)/computed tomography (CT) scans in men with prostate cancer that are malignant and examine any predictive factors. PATIENTS AND METHODS: This retrospective single tertiary referral institution cohort study of men reviewed the results of 68 Ga-PSMA-11 positron emission tomography (PET)/CT scans performed for primary staging prior to treatment of prostate cancer from July 2014 to September 2019. Men with PSMA uptake outside the prostate in only the rib lesion were included. A solitary rib lesion was considered to be malignant if it increased in size on follow-up imaging. A lesion was considered benign if the prostate-specific antigen (PSA) level remained <0.1 µg/L following a radical prostatectomy (RP), <2 µg/L above nadir following radiotherapy (RT) as per the Phoenix criteria, histology was benign on rib biopsy, or follow-up imaging showed no growth of the rib lesion. If a lesion did not meet these criteria it was considered indeterminate. RESULTS: A total of 62 men had PSMA uptake in a solitary rib lesion; 54 went on to have RPs and eight underwent RT. In all, 61 of the men (98.4%) met the criteria for a benign rib lesion. Only one man had a false-negative malignant lesion. This man had a rib lesion with a low maximum standardised uptake value (SUVmax ) of 2.21 reported as benign, but the postoperative PSA level was 0.67 µg/L and the rib lesion progressed on follow-up imaging, with development of widespread metastases. Of the benign rib lesions, there were four false positives reported as possible metastases. Three had percutaneous rib biopsies, two of which came back with benign histology and one was indeterminate. The indeterminate biopsy patient had a RP and his postoperative PSA level was <0.1 µg/L. A total of 43 (69.4%) men with benign rib lesions had a SUVmax greater than the SUVmax of the malignant lesion. CONCLUSION: To our knowledge, this is the first cohort study of men with PSMA-avid solitary rib lesions on pre-treatment 68 Ga-PSMA PET/CT staging scans for prostate cancer. Our results indicate that the vast majority of these lesions have low-intensity uptake and are benign. Intervention to confirm this is not usually required.

Ontogenetic changes to bone microstructure in an archaeologically derived sample of human ribs.

There is considerable variation in the gross morphology and tissue properties among the bones of human infants, children, adolescents, and adults. Using 18 known-age individuals (nfemale  = 8, nmale  = 9, nunknown  = 1; birth to 21 years old), from a well-documented cemetery collection, Spitalfields Christ Church, London, UK, this study explores growth-related changes in cortical and trabecular bone microstructure. Micro-CT scans of mid-shaft middle thoracic ribs are used for quantitative analysis. Results are then compared to previously quantified conventional histomorphometry of the same sample. Total area (Tt.Ar), cortical area (Ct.Ar), cortical thickness (Ct.Th), and the major (Maj.Dm) and minor (Min.Dm) diameters of the rib demonstrate positive correlations with age. Pore density (Po.Dn) increases, but age-related changes to cortical porosity (Ct.Po) appear to be non-linear. Trabecular thickness (Tb.th) and trabecular separation (Tb.Sp) increase with age, whereas trabecular bone pattern factor (Tb.Pf), structural model index (SMI), and connectivity density (Conn.D) decrease with age. Sex-based differences were not identified for any of the variables included in this study. Some samples display clear evidence of diagenetic alteration without corresponding changes in radiopacity, which compromises the reliability of bone mineral density (BMD) data in the study of past populations. Cortical porosity data are not correlated with two-dimensional measures of osteon population density (OPD). This suggests that unfilled resorption spaces contribute more significantly to cortical porosity than do the Haversian canals of secondary osteons. Continued research using complementary imaging techniques and a wide array of histological variables will increase our understanding of age- and sex-specific ontogenetic patterns within and among human populations.

The paleoradiology importance in the study of relics: the unique densitometric analysis of a bone relic of Saint Nicholas.

INTRODUCTION: DXA have greatly contributed to the development of paleoradiology, a branch of diagnostic imaging that allows to obtain information about human remains in contexts of archaeological and/or forensic interest. In this manuscript we report the unique experience of DXA performed on the relic of a Saint; in particular we analyzed a skeletal fragment of St. Nicholas, kept in the Basilica of Bari (Italy) since 1087. MATERIALS AND METHODS: The bone to be examined consisted of the posterior arch of the ninth left rib that was 12cm long, 1.2cm maximum width and 1.7cm thick at the body. The data acquired from the densitometric study were performed using the anthropometric measures reported in historical records of St. Nicholas' life: sex (male), age (75 years), weight (70kg), height (167cm), and ethnicity (Caucasian). In addition to the examination of the relic, a comparison assessment was made with the rib of a healthy 60 years old man (height of 170cm, without known skeletal pathologies). This sample had a length of 19cm, maximum width at the head 1cm, and 0.7cm thick at the body. The analysis of bone fragments is different from the analysis of bones in the context of the human body (where soft tissues are placed around the skeleton); for this reason, one of the most critical issues was to create a support that would allow the analysis of bone fragments. We simulated conditions similar to those occurring in patients: a density scale was established, using a specific plexiglass phantom on which the bone fragments to be examined were placed. From the analysis it was calculated the parameter bone mineral density (BMD), express in g/cm2, that indicates the relation between mass of bone mineral content and area of examined bone segment. BMD data was compared to a range normalized by age, sex and ethnicity (BMD-N). RESULTS: The results of the scannnig of St. Nicholas' rib showed a BMD of 0.97g/cm2 with a BMD-N between 0.77 and 1.08g/cm2. Simultaneous measurements of the relic compared with a reference rib showed highlighted BMD of 0.84g/cm2 for the relic and 0.50g/cm2 for the reference rib. The St. Nicholas data are 168% higher than reference bone. All our measurements of the relic indicated a high bone mineral density, most likely due to the presence of a high concentration of calcium salts. A relatively higher mineral density of the relic was seen compared to the healthy subject's rib. From the history of St Nicholas' life, we know of the long imprisonment at the age of 51 in damp and unhealthy environment. The results of this study suggest that a good bone mineral density was maintained by the Saint even in old age. An additional element that can influence bone mineral density is diet, certainly different during the time of St. Nicholas. The good bone densitometry indicates that the Saint maintained a proper diet, with a generally fair state of health. CONCLUSION: For this first DXA analysis of the rib relic of Saint Nicholas was necessary a long and complex experimental work to modify standard technique procedure to particular and unusual sample and Create specific supports and complementary instruments. Perform DXA analysis on relics permit to obtain additional information to living conditions, economical situation, behaviours, diet, diseaes, conservations conditions of remains, change of life style in different age. Our experimental work, the first of its kind, creates the way to analyze precious relics that often include only few bone fragments and data obtained by our work can be useful for a better management and movement of fragile relics. We ourselves are working on a new challenge for the analysis of bone finds from shipwrecks found at the bottom of the sea.

Fluorescence spectroscopy of Candida albicans biofilms in bone cavities treated with photodynamic therapy using blue LED (450 nm) and curcumin.

Fluorescence spectroscopy may assisst in the diagnosis and control of infectious processes associated with bone lesions of the oral cavity. The aim of this study was to analyze, through fluorescence spectroscopy, Candida albicans biofilms formed in artificial bone cavities treated with photodynamic therapy (PDT) mediated with 450-nm blue light-emitting diode (LED) and curcumin. Another aim of this study was to analyze the existence of a correlation between the effectiveness of the photodynamic treatments and the fluorescence spectroscopy images. Artificial bone lesions (n = 40) were made in bovine bones and inoculated with standard suspensions of Candida albicans (ATCC 18804) for biofilm formation (14 days / 36 °C ± 1 °C). The 40 specimens were distributed among four experimental groups (n = 10): L-C- (control), L + C- (LED for 5 min), L-C+ (curcumin for 5 min), and L + C+ (PDT). Aliquots of 100 µL were collected from the bone cavities after treatments and were seeded in duplicate on Sabouraud dextrose agar for 24 h at 36 °C ± 1 °C and the colony-forming units (CFU/ mL) were counted. Before and after each treatment, the specimens were subjected to spectral fluorescence and the images were compared using the Image J program. The log10 CFU/mL were compared with Kruskal-Wallis and Dunn's Multiple Comparison post-test (significance level at 0.05). The fluorescence histogram values before and after treatment were compared using Wilcoxon test (95%).The correlation between Candida albicans log10 CFU/mL and the number of the fluorescence red pixels spectroscopy was verified using Spearman correlation test. The reduction of Candida albicans log10 CFU/mL in the L + C+ (PDT) group was the most relevant and the fluorescence spectroscopy was correlated to the microbiological result. It was concluded that there was a consistency between the number of Candida albicans log10 CFU/mL and the red pixel data of the fluorescence images, demonstrating that the fluorescence diagnostic device reflects the true microbiological condition of Candida albicans biofilms in the bone cavities during the pre-treatment and post-treatment, thus providing the clinician the ability to dynamically, simply, and instantaneously verify the performance of the treatment used.

Diagnosis and Treatment of Slipping Rib Syndrome.

OBJECTIVE: (1) To investigate the clinical presentation, diagnosis, and treatment of slipping rib syndrome in athletes; (2) to investigate the hooking maneuver for diagnosis of slipping rib syndrome. DESIGN: Retrospective chart review of 362 athletes with rib pain. SETTING: Pediatric-based sports medicine clinic between January 1, 1999, and March 1, 2014. PATIENTS: Costochondritis, Tietze, fractures, rib tip syndrome, and unclear diagnoses were excluded. Athletes were included who had a palpable rib subluxation, mechanical rib symptom, positive hooking maneuver, or resolution of pain after the resection of a slipping rib segment. MAIN OUTCOME MEASURES: Slipping rib syndrome is associated with athletic performance. RESULTS: Fifty-four athletes were diagnosed with slipping rib syndrome, of which 38 (70%) were females. Mean age at presentation was 19.1 years (range 4-40 years). Mean number of previous specialist consultations per athlete was 2.3 and mean time from symptom onset to diagnosis was 15.4 months. The hooking maneuver was attempted 21 times (38.9%). Unilateral symptoms presented in 49 athletes (90.7%). The most symptomatic rib was the 10th, affecting 24 athletes (44.4%), eighth and ninth were affected in 17 athletes (31.5%) each. Most, 39 (72.2%), reported insidious onset of symptoms. Running, rowing, lacrosse, and field hockey were frequently associated activities. Twelve athletes had psychiatric diagnoses (22.2%), 10 (19.2%) were hypermobile. Sixty-six total imaging studies were performed. The most successful treatment options included: osteopathic manipulative treatment (71.4%), surgical resection (70%), and diclofenac gel (60%). CONCLUSIONS: Most athletes with slipping rib syndrome were active females with insidious onset of unilateral pain, a high prevalence of hypermobility and prolonged pain. The hooking maneuver was underused.

Anatomy of the Ribs and Management of their Fractures as Viewed by Avicenna (980-1037 Ad)

INTRODUCTION: Avicenna statedinteresting points on the symptoms of rib bone fractures, their physical examination, and also treatment and management of the complications in his master piece Canon in Tibb. METHOD: We reviewed Avicenna's Canon and his viewpoints on the anatomy of the rib bones and their fractures and compared it with conventional medicine. RESULT: He described the ana omy of the ribs; he explained the effectiveness of their structure in the prote tion of vital organs. He also suggested some methods for the management of rib fractures, such as using vacuum at the fracture site or open surgery in case of complications. CONCLUSION: Avicenna's point of view on the approach toward rib fractures had some similarities and differences with conventional practice. Some of his suggestions could be taken into account.

Tolerance of Rib Raising Among Hospitalized Patients: A Pilot Study.

CONTEXT: Rib raising is an osteopathic manipulative treatment modality that can help patients with various respiratory conditions to improve their work of breathing. However, the tolerance of this technique in hospitalized patients has not been assessed in a systematic manner. We hypothesized that rib raising would be a well-tolerated treatment modality for hospitalized patients admitted for asthma, pneumonia, chronic obstructive pulmonary disease, and/or congestive heart failure. OBJECTIVE: To determine hospitalized patients' tolerance of rib raising through a prospective pilot study. METHODS: The study included patients at University Hospitals-Richmond Medical Center and University Hospitals-Bedford Medical Center who were admitted for asthma, pneumonia, chronic obstructive pulmonary disease, and/or congestive heart failure between November 1, 2016, and October 31, 2017. Each patient was treated with rib raising, which was performed in a standardized fashion. Immediately after treatment, patients were asked to rate their tolerance of the procedure on a scale of 0 to 10, where 0 represented no discomfort and 10 represented maximum discomfort. RESULTS: The study population consisted of 87 hospitalized, non-intensive care unit patients. The mean tolerance score for rib raising was 1.18, and the median score was 0. The score was between 0 and 3 in 80 patients (92.0%), between 4 and 6 in 6 patients (6.9%), and between 7 and 10 in 1 patient (1.1%). CONCLUSION: Rib raising was shown to be well tolerated by the majority of the patients in the study population.