Computed Tomography Research Articles

Total Arthroscopic Resection of the Talocalcaneal Coalition in Adults: Key Points of Surgical Technique.

Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC. A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16-57 years). The mean follow-up period was 38.93 ± 15.69 months (range, 11-59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale scores were evaluated pre- and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases. The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini-incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle-hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study. Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini-incisions were necessitated in complex situations.

Correlation between CT-based phenotypes and serum biomarker in interstitial lung diseases

BackgroundThe quantitative analysis of computed tomography (CT) and Krebs von den Lungen-6 (KL-6) serum level has gained importance in the diagnosis, monitoring, and prognostication of interstitial lung disease (ILD). However, the associations between quantitative analysis of CT and serum KL-6 level remain poorly understood.MethodsIn this retrospective observational study conducted at tertiary hospital between June 2020 and March 2022, quantitative analysis of CT was performed using the deep learning-based method including reticulation, ground glass opacity (GGO), honeycombing, and consolidation. We investigated the associations between CT-based phenotypes and serum KL-6 measured within three months of the CT scan. Furthermore, we evaluated the performance of the combined CT-based phenotypes and KL-6 levels in predicting hospitalizations due to respiratory reasons of ILD patients.ResultsA total of 131 ILD patients (104 males) with a median age of 67 years were included in this study. Reticulation, GGO, honeycombing, and consolidation extents showed a positive correlation with KL-6 levels. [Reticulation, correlation coefficient (r) = 0.567, p < 0.001; GGO, r = 0.355, p < 0.001; honeycombing, r = 0.174, p = 0.046; and consolidation, r = 0.446, p < 0.001]. Additionally, the area under the ROC of the combined reticulation and KL-6 for hospitalizations due to respiratory reasons was 0.810 (p < 0.001).ConclusionsQuantitative analysis of CT features and serum KL-6 levels ascertained a positive correlation between the two. In addition, the combination of reticulation and KL-6 shows potential for predicting hospitalizations of ILD patients due to respiratory causes. The combination of reticulation, focusing on phenotypic change in lung parenchyma, and KL-6, as an indicator of lung injury extent, could be helpful for monitoring and predicting the prognosis of various types of ILD.

Presentation and management of patients with adrenal masses: a large tertiary centre experience.

Adrenal masses are found in up to 5-7% of adults. The 2016 European guidelines on the management of adrenal incidentalomas have standardised the workup of these patients, but evidence of their impact on clinical practice is lacking. Retrospective review of clinical presentation, radiological characteristics, and final diagnosis of a large cohort of patients with adrenal masses referred to a tertiary care centre 1998 to 2022. Sub-analysis compares outcomes before and after implementing the 2016 guidelines. 1397 patients (55.7% women; median age 60 years [interquartile range, IQR, 49-70]) were included. Incidental discovery was the most frequent mode of presentation (63.7%) and 30.6% of patients had masses ≥4 cm (median 2.9 cm [IQR, 1.9-4.7]). Unenhanced computed tomography (CT) Hounsfield Units (HU) were available for 763 patients; of these, 32.9% had heterogeneous masses or >20 HU. The most common diagnoses were adrenocortical adenoma (ACA, 56.0%), phaeochromocytoma (12.7%), adrenocortical carcinoma (10.6%), and metastases (5.7%). At multivariable analysis, significant predictors of malignancy included HU >20 or heterogeneous density (Odds Ratio, OR 28.40), androgen excess (OR 27.67), detection during cancer surveillance (OR 11.34), size ≥4 cm (OR 6.11) and male sex (OR 3.06). After implementing the 2016 guidelines, the number of adrenalectomies decreased (6.1% pre-2016 vs. 4.5% post-2016) and the number of patients discharged increased (4.4% pre-2016 vs. 25.3% post-2016) for benign non-functioning adrenal masses. Implementing the 2016 guidelines positively impacted clinical practice, reducing unnecessary surgeries and increasing the discharge rate for benign adrenal masses, thereby preserving healthcare resources and patient burden.

Radio-Biological Confrontation in the Diagnosis of Invasive Aspergillosis: About Two Cases and Review of Literature

Invasive pulmonary aspergillosis due to Aspergillus fumigatus is an often serious mycosis, usually occurring in severely immunocompromised patients. It is accompanied by a high mortality rate due to its often difficult and late diagnosis. Diagnosis is based on early chest computed tomography and mycological examination of respiratory samples. Both patients had presented with acute respiratory distress, developing in a context of fever and deterioration of the general condition despite the initiation of broad-spectrum empirical treatment. In each of them, a chest CT scan was performed, objectifying atypical cavitary images not suggesting pulmonary aspergillosis. Cytobacteriological examination of sputum and search for Mycobacterium tuberculosis were negative. Serology for aspergillus antigens and a sample of bronchoalveolar lavage fluid for a mycological study were requested. Direct examination of bronchoalveolar lavage fluid was negative, but culture allowed the identification of Aspergillus fumigatus. Galactomannan testing was positive. Given these results, treatment with injectable voriconazole was initiated in our two cases. The evolution was marked by a clinical improvement of one patient and the death of the other patient. Invasive pulmonary aspergillosis is a major concern due to the frequency of its complications. Its diagnosis must be early to ensure adequate management for a better prognosis.

Aortic root parameter analysis for transcatheter aortic valve implantation in the Pakistani population: a retrospective study

BackgroundTranscatheter aortic valve implantation (TAVI) is a growing treatment for aortic stenosis, but anatomical variations exist across populations. Asians tend to have smaller aortic annuli and higher bicuspid valve morphology compared to Westerners, potentially impacting TAVI valve selection and outcomes. This study analyzes aortic root parameters in Pakistani patients undergoing TAVI.ResultsWe conducted a retrospective analysis of 78 patients who underwent TAVI at the Peshawar Institute of Cardiology from January 2021 to March 2024. Pre-procedural CT scans were analyzed for aortic annulus diameters, area, and other relevant parameters. The mean age was 72.41 years (SD ± 11.99), and 61.5% were male. Aortic annulus diameters (minimum, mean, maximum) were 21.18 mm (SD ± 3.99), 24.21 mm (SD ± 3.93), and 27.49 mm (SD ± 4.43), respectively. Bicuspid aortic valves were present in 34.61% of patients.ConclusionsOur findings suggest that Pakistani patients undergoing TAVI may have aortic root dimensions comparable to Western populations, with a substantial prevalence of bicuspid valves. However, coronary heights were similar to those reported in Asian populations with smaller annuli. Further studies are needed to assess TAVI outcomes in Pakistani patients and determine if tailored valve sizing strategies are required.

Minimally invasive resection of a giant esophageal schwannoma

Benign tumors of the esophagus are uncommon, and primary esophageal schwannoma of the esophagus is even rarer, accounting for 2% of cases. Less than 30 cases have been reported in the literature. Here we report a case of a young man with a symptomatic giant esophageal schwannoma, which was completely removed by laparoscopic three-staged esophagectomy. This is the first case of such a large lesion being removed by a minimally invasive approach. Our patient was a 22-year-old male, presented with dysphagia and dyspnea for five years. An endoscopy and CT scan suggested a giant leiomyoma. Postoperative biopsy revealed a primary esophageal schwannoma. We present our case of benign esophageal tumor measuring about 10.5 cm in greatest dimension. This is the first schwannoma resection performed with the Mckeown technique among the limited case reports in the literature. Esophageal schwannoma must be kept as a possible diagnosis in patients presenting with benign esophageal tumors. Esophagectomy is the mainstay of treatment for giant esophageal schwannomas. Minimally invasive esophagectomy can be safely performed for giant benign esophageal tumors. doi: https://doi.org/10.12669/pjms.40.10.8824 How to cite this: Qureshi S, Khan S, Abbasi WA, Sohail M. Minimally invasive resection of a giant esophageal schwannoma. Pak J Med Sci. 2024;40(10):2447-2450. doi: https://doi.org/10.12669/pjms.40.10.8824 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Emergence of Incidentalomas Following Chest CT Screening for COVID-19 Infection: A Multicenter Cross-Sectional Study

Emergence of Incidentalomas Following Chest CT Screening for COVID-19 Infection: A Multicenter Cross-Sectional Study

The polar vessel sign: insights from CT imaging analysis in Asian Indian primary hyperparathyroidism.

Data on the polar vessel sign (enlarged feeding vessel terminating in parathyroid lesions) on four-dimensional computed tomography (4D-CT) is limited. We performed a retrospective analysis to determine the prevalence, predictors, and adjunctive utility of polar vessel sign in pre-operative 4D-CT of patients with primary hyperparathyroidism (PHPT). One radiologist blinded to the patients' details reported the 4D-CT of eighty-four operated patients with histopathology-proven single-gland PHPT. Two protocols were used to obtain arterial-phase images: timed via bolus tracking (n = 41) or fixed at 20 s after contrast injection (n = 43). Seventy-one patients were symptomatic for PHPT, with median serum calcium 12.1 mg/dL. On the arterial phase of 4D-CT, 88.1% of lesions had the polar vessel sign, including 7/9 asymptomatic patients, 6/6 parathyroid carcinomas, and 3/4 ectopic(1:mediastinum, 2:thyro-thymic ligament). Predictors of polar vessel sign were maximum lesion dimension (2.2 vs. 1.4 cm; P = 0.03), solid-cystic CT morphology (47.3% vs. none; P = 0.004), and bolus tracking-timed arterial phase (55.4% vs. none; P = 0.001). Of these, bolus tracking improved the polar vessel's visualization (100% vs. 76.7%; P = 0.001) independent of lesion dimension and solid-cystic morphology. The latter two predicted polar vessel sign in images obtained at a fixed interval (20 s). A significantly lower proportion of bolus tracking-timed scans had lesion percentage arterial enhancement (PAE) < 128.9% (2/41 vs. 9/43; P = 0.04). Even with suboptimal PAE, the polar vessel helped identify 9/11 lesions. The polar vessel sign demonstrated an additive role to PAE during CT reporting. Bolus tracking is valuable in optimizing vessel and tumor arterial enhancement and is easily incorporated into parathyroid 4D-CT protocol.

Racial referral bias in cardiac computed tomography: Differences, disparities or discrimination?

Disparities exist in medicine and can affect patient care. We sought to understand influences of racial biases in diagnostic testing within a Cardiac CT (CCT) population. Race of CCT patients, referring physicians and the population in the catchment area were captured between February 2006 and November 2021. The frequency of CCT referrals for each race was indexed to the catchment population. Of 21,241 CCT patients, 17,514 (82.5​%) patients were White. The Non-White population was comprised of 467(2.2​%) Indigenous, 656(3.1​%) Black, 932(4.4​%) Asian, 276(1.3​%) South Asian, 1100(5.2​%) Middle Eastern and 296(1.4​%) Latin American races. The catchment population was 907,675, with 619,514 individuals of whom 69.7​% identified as White. Compared to the catchment population, there was a disproportionately higher referral rate for Whites than Non-Whites. The referral index for Whites was higher than Non-Whites (1.2 versus 0.6, p​<​0.001)). This pattern was consistent across all racial minorities and age categories. A total of 356 physicians (236(66.3​%) White, 4(1.2​%) Black, 39(12.0​%) Asian, 30(9.2​%) South Asian, 43(13.2​%), Middle Eastern and 4 (1.2​%) Latin American) made referrals to CCT. The racial difference in referral patterns was independent of physician race and was independent of their years in practice. Racial differences exist in CCT referrals. These differences are independent of prevalence of disease, physician race or years in practice. This study supports the need to better understand reasons for disparity and strategies to mitigate potential bias.

Computed tomography for the detection of myocardial hypoperfusion in acute myocardial infarction and the associated CT-to-catheter time

Emergency computed tomography (CT) often does not allow for comprehensive coronary artery assessment. However, CT may reveal pathological myocardial hypoperfusion suggestive of acute myocardial infarction (AMI), especially in patients presenting with a different diagnostic hypothesis. CT hypoperfusion is known to be associated with myocardial infarction, however the diagnostic value of CT hypoperfusion for the detection of AMI is still not well evaluated. This was a single-centre retrospective study including patients who underwent invasive coronary angiography (ICA) due to suspected AMI based on incidental perfusion defects upon emergency CT imaging between 2018 and 2023. A total of 22 patients (mean age 66.3 ± 10.8 years, 11 female) were included in this analysis. The diagnosis of AMI was established in all cases leading to ICA. Culprit coronary artery lesions with an indication of percutaneous coronary intervention were detected in all patients who underwent ICA. Spearmann correlation for hypoperfused segments on CT imaging and the corresponding vascular territory upon ICA was significantly substantial (ρ = 0.73, p = < 0.001). The higher the number of affected myocardial segments, the faster ICA was initiated. Mean time between the suspicion of AMI on CT imaging and ICA was 196 (29–4044) minutes. Myocardial hypoperfusion on emergency CT imaging should be considered as AMI until proven otherwise, independent of the clinical scenario leading to performance of CT imaging and whether imaging was performed for the exclusion of non-cardiac pathologies. Early initiation of further diagnostic workup may potentially avoid delays to invasive treatment and reduce the CT-to-catheter-time. Our study explicitly underlines that myocardial hypoperfusion upon contrast enhanced CT imaging needs to be considered as sign of acute myocardial infarction and indicates targeted clinical workup to rule out this diagnosis and to shorten the timeframe from imaging diagnosis to interventional treatment.

Validation of abdominal ultrasound examination for assessment of abdominal wall thickness and size of left lobe of liver in morbidly obese patients in comparison with CT and operative findings

BackgroundIncreased abdominal wall thickness and size of left lobe of liver affect the ergonomics of bariatric surgery increasing its difficulty and leading to need of special preparations such as extra-long instruments. Computed tomography (CT) abdomen is the gold standard modality in assessment of abdominal wall thickness and size of left lobe of liver, but it has many drawbacks such as radiation and contrast. In this study, we validate ultrasound as an alternative to CT by comparing its results with CT abdomen and operative findings.ResultsAbdominal ultrasound examination gives accurate results in assessment of anterior abdominal wall thickness and size of left lobe of liver in morbidly obese patients compared to CT and intra-operative with slight difference between values which is clinically accepted. Accuracy of ultrasound examination was 78.6%, 74.1%, and 100% for midline measurements, midclavicular line measurements and size of lt lobe of liver measurements, respectively. Ultrasound examination has sensitivity of 75%, 66.7% and 63.2% for midline measurements, midclavicular line measurements and size of lt lobe of liver measurements, respectively. Ultrasound examination specificity was 50%, 77.1% and 75.3% for midline measurements, midclavicular line measurements and size of lt lobe of liver measurements, respectively.ConclusionAbdominal ultrasound examination is a valid method in preoperative assessment of anterior abdominal wall thickness and size of left lobe of liver in morbidly obese patients. It is reliable, easy, and cheap and avoids drawbacks of CT.

GPT-Driven Radiology Report Generation with Fine-Tuned Llama 3.

The integration of deep learning into radiology has the potential to enhance diagnostic processes, yet its acceptance in clinical practice remains limited due to various challenges. This study aimed to develop and evaluate a fine-tuned large language model (LLM), based on Llama 3-8B, to automate the generation of accurate and concise conclusions in magnetic resonance imaging (MRI) and computed tomography (CT) radiology reports, thereby assisting radiologists and improving reporting efficiency. A dataset comprising 15,000 radiology reports was collected from the University of Medicine and Pharmacy of Craiova's Imaging Center, covering a diverse range of MRI and CT examinations made by four experienced radiologists. The Llama 3-8B model was fine-tuned using transfer-learning techniques, incorporating parameter quantization to 4-bit precision and low-rank adaptation (LoRA) with a rank of 16 to optimize computational efficiency on consumer-grade GPUs. The model was trained over five epochs using an NVIDIA RTX 3090 GPU, with intermediary checkpoints saved for monitoring. Performance was evaluated quantitatively using Bidirectional Encoder Representations from Transformers Score (BERTScore), Recall-Oriented Understudy for Gisting Evaluation (ROUGE), Bilingual Evaluation Understudy (BLEU), and Metric for Evaluation of Translation with Explicit Ordering (METEOR) metrics on a held-out test set. Additionally, a qualitative assessment was conducted, involving 13 independent radiologists who participated in a Turing-like test and provided ratings for the AI-generated conclusions. The fine-tuned model demonstrated strong quantitative performance, achieving a BERTScore F1 of 0.8054, a ROUGE-1 F1 of 0.4998, a ROUGE-L F1 of 0.4628, and a METEOR score of 0.4282. In the human evaluation, the artificial intelligence (AI)-generated conclusions were preferred over human-written ones in approximately 21.8% of cases, indicating that the model's outputs were competitive with those of experienced radiologists. The average rating of the AI-generated conclusions was 3.65 out of 5, reflecting a generally favorable assessment. Notably, the model maintained its consistency across various types of reports and demonstrated the ability to generalize to unseen data. The fine-tuned Llama 3-8B model effectively generates accurate and coherent conclusions for MRI and CT radiology reports. By automating the conclusion-writing process, this approach can assist radiologists in reducing their workload and enhancing report consistency, potentially addressing some barriers to the adoption of deep learning in clinical practice. The positive evaluations from independent radiologists underscore the model's potential utility. While the model demonstrated strong performance, limitations such as dataset bias, limited sample diversity, a lack of clinical judgment, and the need for large computational resources require further refinement and real-world validation. Future work should explore the integration of such models into clinical workflows, address ethical and legal considerations, and extend this approach to generate complete radiology reports.

Exploring the Diagnostic Challenges of Pseudotumoral Peritoneal Tuberculosis That Mimics Advanced Ovarian Cancer in Women: The Role of Laparoscopy in a Case Study

This case involves a 63-year-old multiparous woman with no significant medical history and no known exposure to tuberculosis. She presented with chronic abdominal pain and weight loss, anorexia, and subjective fevers. During the clinical examination, the patient was found to have ascites, bilateral pleural effusion, fever, and a general deterioration in her condition. Blood tests revealed normochromic normocytic anemia. The C-reactive protein was elevated, and the erythrocyte sedimentation rate was accelerated. Ferritin levels were raised. Her blood sugar, hepatic and renal functions were normals. The electrolyte panel showed no abnormalities. Serologies for hepatitis B, C, and HIV were negative, and the immunological profile was normal. The ascitic tap yielded a citrine-yellow fluid, and the cytochemical analysis indicated that the ascites were exudative. Analysis of the ascitic fluid revealed that the DNA test for Mycobacterium tuberculosis was negative, but the adenosine deaminase (ADA) level was elevated. Additionally, the CA125 level was significantly elevated, exceeding 600 UI/ml. A pelvic ultrasound identified a cystic pelvic mass with thick septations but without any solid tissue component, measuring 92x69 mm. The complementary CT (Computed Tomography) scan revealed enlarged ovaries, heterogeneous on the left, associated with a moderately abundant peritoneal effusion. The laparoscopic exploration revealed inflammatory peritoneal nodules, parietal adhesions, and serous ascites. Anatomopathology confirmed peritoneal tuberculosis. The peritoneal form, particularly in its pseudotumoral manifestation, can mimic ovarian cancer. Definitive diagnosis often requires invasive procedures.

Computed Tomography Anatomy of the Juvenile Cory's Shearwater (Calonectris borealis) Normal Nasal Cavity.

We conducted a detailed examination of the anterior cranial region of Cory's Shearwater (Calonectris borealis), employing cutting-edge imaging techniques and computed tomography (CT). The fusion of CT images with anatomical cross-sectional data played a pivotal role in providing a thorough depiction of the components constituting the anterior cranial region of this species. The explication of these structures holds significant potential as an essential procedure for the prognosis and management of diverse pathologies impacting the nasal cavity of Cory's Shearwater.

Pre-trained quantum convolutional neural network for COVID-19 disease classification using computed tomography images

Background The COVID-19 pandemic has had a significant influence on economies and healthcare systems around the globe. One of the most important strategies that has proven to be effective in limiting the disease and reducing its rapid spread is early detection and quick isolation of infections. Several diagnostic tools are currently being used for COVID-19 detection using computed tomography (CT) scan and chest X-ray (CXR) images. Methods In this study, a novel deep learning-based model is proposed for rapid detection of COVID-19 using CT-scan images. The model, called pre-trained quantum convolutional neural network (QCNN), seamlessly combines the strength of quantum computing with the feature extraction capabilities of a pre-trained convolutional neural network (CNN), particularly VGG16. By combining the robust feature learning of classical models with the complex data handling of quantum computing, the combination of QCNN and the pre-trained VGG16 model improves the accuracy of feature extraction and classification, which is the significance of the proposed model compared to classical and quantum-based models in previous works. Results The QCNN model was tested on a SARS-CoV-2 CT dataset, initially without any pre-trained models and then with a variety of pre-trained models, such as ResNet50, ResNet18, VGG16, VGG19, and EfficientNetV2L. The results showed the VGG16 model performs the best. The proposed model achieved 96.78% accuracy, 0.9837 precision, 0.9528 recall, 0.9835 specificity, 0.9678 F1-Score and 0.1373 loss. Conclusion Our study presents pre-trained QCNN models as a viable technique for COVID-19 disease detection, showcasing their effectiveness in reaching higher accuracy and specificity. The current paper adds to the continuous efforts to utilize artificial intelligence to aid healthcare professionals in the diagnosis of COVID-19 patients.

Three-dimensional finite element analysis of stress distribution on different complex macro designs in commercially available implants: An in-vitro study

ObjectiveThis study aimed to investigate the effects of different commercially available complex implant macro designs on stress distributions using Finite element analysis. The experiment is done under varying simulated bone conditions to provide reference for clinical application. Materials and methodsThe study employed the Finite Element Analysis (FEA) method to compare four commercially available complex implant macro designs on a Computer-Aided Design (CAD) model of a maxillary bone segment. The three-dimensional geometrical model of the implants was reconstructed from computed tomography (CT)-slices in Digital Imaging and Communications in Medicine (DICOM) format and contact condition between the implant and the bone was considered as ‘Bonded’, implying perfect osseointegration. All materials used in the models were assumed to be isotropic, homogeneous, and linearly elastic. The Finite element simulations employed load of 400 N under both axial and non-axial conditions Stresses were analysed under different bone conditions. ResultsAverage values of von Mises stresses were used for comparing stress levels between implant designs. There was a definite increase in the equivalent stress values from higher density(D1)to lower density (D4) bone conditions for all implants. The percentage of increase ranged from 23.63 to 49.39 on axial loading and 20.39 to 57.19 when subjected to non-axial loading. The equivalent stress values resulted from non-axial loading were 1.78–2.94 times higher than that of axial loading for all implants under all bone densities. Among the complex designs Equinox Myriad Plus implant exhibited the least stress under axial loading (12.749–19.046 MPa) and (37.462–49.217 MPa) for non-axial loading. The stress on the crestal module was higher (1.49–2.99 times) than the overall stress on the implant regardless of the loading direction or bone conditions. ConclusionsData from the present study shows Equinox Myriad Plus implant generating the least equivalent stress and this can be taken as indicator in the biomechanical performance of the design.

Blood Eosinophils Matter in Post-COVID-19 Pneumonia.

Even after the development of vaccines, SARS-CoV-2 continues to cause severe pneumonia all over the world. Consequently, in order to improve the management of patients and optimize the use of resources, predictors of disease severity and lung complications after COVID-19 pneumonia are urgently needed. Blood cell count is an easily available and reproducible biomarker. With this study, we aimed to explore the role of eosinophils in predicting disease behavior and pulmonary sequelae at first follow-up with computed tomography (CT). we evaluated blood cell count and other inflammatory markers, both at baseline and during hospitalization, in a large population of hospitalized COVID-19 patients. 327 patients were finally enrolled, 214 were classified as low-intensity medical care (LIMC) and 113 as high-intensity medical care. Eosinophils were higher at discharge in the HIMC group [0.1 (0-0.72) vs. 0.05 (0-0.34) × 109/L; p < 0.0001]. Moreover, in the multivariable analysis, age ≥ 62 years (OR 1.76 (1.05-2.8) p = 0.03) and Δ eosinophils ≥ 0.05 (OR 1.75 (1.05-2.9) p = 0.03) were two independent predictors of residual lung abnormalities in the whole patient population at first follow-up. an eosinophil increase during hospitalization could be a potential predictor of pulmonary sequelae in surviving patients after COVID-19 pneumonia.

Thermal hysteresis enhancement and dispersion thermal stability in paraffin actuators: Comparison of pan-nanofibers vs metal oxide nanoparticles use

In this research, the possibility of thermal property enhancement of paraffin actuators with nanofiber and metal oxide nanoparticle addition was experimentally evaluated. Besides pure paraffin compound, paraffin mixed with the CuO, Fe3O4, ZnO, Al2O3, and electrospun polyacrylonitrile (PAN) nanofiber nanoparticles were used, and a significant hysteresis improvement at first-level measurement was observed as 24.6, 26.2, 20.0, 29.2, and 30.8 % sequentially for the samples respectively compared with pure paraffin. Thermal dispersion stability of the nanocomposites was comprehended via computer tomographic (CT) investigation. The excessive precipitation of CuO, Fe3O4, and ZnO particles in the paraffin nanocomposite was observed. Precipitation of PAN Nanofiber- and Al2O3-Paraffin nanocomposite was not visually detectable via CT throughputs. The effect of thermal dispersion stability on the hysteresis performance of the nanocomposites was also investigated to ensure long-term consistent hysteresis performance advantages in paraffin actuators. Thermal dispersion stability effect on hysteresis performance of paraffin actuators with CuO, Fe3O4, ZnO, Al2O3, and PAN nanofiber nanocomposite paraffin compounds showed losses as 14.3, 14.6, 5.8, 4.3 and 2.2 % sequentially for the samples respectively.

Patellofemoral Instability in the Pediatric and Adolescent Population: From Causes to Treatments.

Patella instability is one of the most common knee injuries in the adolescent patient. There are several pathoanatomic risk factors which should be assessed via several modalities, including X-rays, magnetic resonance imaging (MRI), or even CT scan. We intend to review these risk factors along with the nonsurgical and surgical techniques used to prevent recurrent dislocations. We completed an extensive review of the recent literature concerning pediatric and adolescent patellar dislocation and subsequent treatment modalities. We review in detail the risk factors such as patella alta, trochlear dysplasia, lateralization of the tibial tubercle or medialization of the trochlear groove (increased tibial tubercle to trochlear groove (TT-TG) distance), lower limb malalignment, excessive femoral anteversion and/or tibial torsion, and hyperlaxity. There are classification systems for dislocators, and a natural progression of instability that patients often proceed through. Only after a patient has continued to dislocate after bracing and physical therapy is surgical treatment considered. Surgical techniques vary, with the workhorse being the medial patellofemoral ligament (MPFL) reconstruction. However, there are a variety of other techniques which add onto this procedure to address other anatomic risk factors. These include the tibial tubercle osteotomy to address a large TT-TG distance or trochleoplasty to address the lack of a trochlear groove. Nonsurgical and surgical treatments for patella dislocators are tailored to the pathoanatomic risk factors in each patient.

Cisto dentígero pós-traumático: relato de caso

The dentigerous cyst is an odontogenic cyst associated with the crown of unerupted teeth, inflammation or after trauma. It is asymptomatic, unilocular, predominantly in the mandible and male. The objective of this case was to report the diagnosis and treatment of the dentigerous cyst. The anamnesis, clinical examination and complementary tests were carried out in order to obtain a thorough diagnosis and the best possible treatment. The diagnosis through radiographic examinations and CT scans was extremely important, allowing the visualization of anatomical conditions and structures, dental fracture, presence of fixed plates and appearance of the lesion. Surgical treatment by means of enucleation was the most indicated technique according to the conditions presented, considering the circumstances of the patient and the size of the lesion. Complete removal of the lesion, extraction of element 45 and partial removal of the miniplate were performed. Therefore, the biopsy is essential to corroborate a differential diagnosis, the excisional type is recommended for small and benign lesions.