X-ray Examination Research Articles

Efficacy of combination treatment in a patient with temporomandibular joint dysfunction

Background: Muscle and joint dysfunction is a common complication, particularly in females over 40 years. It is strongly associated with age-related hormonal changes in the bones, as well as concomitant dentoalveolar deformities and tooth loss. Case description: The efficacy of combination treatment of dentoalveolar abnormalities and deformities complicated by temporomandibular joint (TMJ) dysfunction was demonstrated. The efficacy of combination treatment in patients with missing teeth, as well as dentoalveolar abnormalities and deformities complicated by TMJ dysfunction, was confirmed. To ensure a representative before-and-after comparison, the restoration of masticatory efficiency following orthodontic and orthopedic rehabilitation was assessed. A physical examination in patient M. revealed hypertonia of masticatory muscles, restricted mouth opening, jaw shifting to the left, partially absent dentition in distal sections, and prosthetic restoration failure. On MRI, there were signs of deforming arthrosis of both TMJs. The following observation methods were used to assess the efficacy of rehabilitation: questioning to identify symptoms of TMJ pain; follow-up examination for joint clicking when opening the mouth; palpation of the external pterygoid muscle, masticatory muscle, and internal pterygoid muscle; X-ray examination (TMJ CT and MRI) following treatment; masticatory efficiency assessment using a masticatory performance test (according to Trezubov) before and after treatment. Diagnostic testing following combination orthodontic and orthopedic treatment revealed that the patient’s left TMJ no longer felt heavy, and she could open her mouth easily; moreover, jaw shifting resolved, and masticatory muscle rigidity decreased. Conclusion: This clinical case demonstrates why orthopedic surgeons and orthodontists must collaborate in the diagnosis and treatment of TMJ dysfunction. The authors present a well-established approach to the treatment of patients with TMJ dysfunction that has been used successfully in clinical practice for several years.

Retrospective analysis and clinical features of periapical tissue regeneration

Background: Chronic periodontitis is associated with changes in periapical tissues. Untimely diagnosis and lack of appropriate mechanical treatment increase the incidence of chronic periodontitis. Periodontitis that causes destructive changes due to long-term inflammation of periapical tissues is of particular concern. Thus, the treatment of destructive periodontal diseases is a pressing issue in modern dentistry. Aim: To assess periapical tissue regeneration following treatment in chronic periodontitis patients. Materials and Methods: A retrospective analysis of the destruction and regeneration of periapical tissues before and after treatment during 3–6 months was performed in 20 patients. Results: A retrospective analysis of X-ray findings in 20 patients revealed bone destruction of varying degrees. Low-quality root canal preparation was due to various factors, primarily the anatomy and topography of root canals. Of the 20 patients who required treatment for chronic periodontitis with varying degrees of destruction, 16 came back for follow-up appointments and received endodontic treatment. Following treatment, X-ray findings were used to identify taper root canal preparation and assess the quality of obturation up to the root apex. X-ray examination was performed after 3 months in patients with clinical signs of periodontitis and after 6 months in patients without clinical signs of periodontitis. After 3 months, X-ray findings showed a reduction in bone destruction in the causative tooth area, indicating an improvement. Conclusion: The study of periapical tissue regeneration following treatment in chronic periodontitis patients revealed that effective apical preparation, as well as appropriate irrigation and root canal filling, promote regeneration in periodontitis. Healing of periapical tissues is essential for effective root canal treatment.

RADIOLOGICAL ASSESSMENT OF SPONDYLOLISTHESIS OF LUMBOSACRAL SPINE

Introduction: One major injury or frequent minor injuries cause the vertebral body, pedicle and superior articular surfaces to slide forward. This disorder is known as spondylolisthesis and is usually accompanied by symptoms, often proportional to the degree of forward movement. Patients may complain of pain in the lower back that spreads to the thighs, and limited range of motion is possible Objectives: The aim of this study is to determine the frequency of spondylolisthesis by age and gender in the patients studied at SKB Mostar. Research methodology: The method of content analysis was used to retrospectively examine X-ray, CT and MRI examinations of patients with the clinical features of lumbar pain syndrome in the period from 1 January 2019 to 1 January 2020 in patients who underwent radiological examination of the LS spine at the Clinical Institute of Radiology of the University Clinical Hospital Mostar. Data were collected from IMPAX at the SKB Mostar Department of Radiology. The input parameters that were observed were: pain syndrome, diagnosis. The output parameters were the radiological findings from the X-ray, CT, and MRI scans. Results: During the study period, 297 spinal scans were performed, and spondylolisthesis was found in 32 patients, or 11%. The youngest respondent was 8 years old, and the oldest was 85 years old. The average age of the respondents was 64.37 years. The largest number of respondents was in the age group of over 75 years old. Of the tests performed, the most common were CT scans, followed by MRI, and the rarest were X-ray scans. The highest prevalence of spondylolisthesis was found in vertebrae L4-L5 and L5-S1 at 41%. Spondylolisthesis was found bilaterally in 9% of cases at the L3-L4 and L5 vertebrae. Conclusion: Most often, spondylolisthesis is found in L4-L5 and L5-S1 vertebrae. There was no difference according to gender, and most often subjects older than 75 years had spondylolisthesis.

Foreign bodies in the gastrointestinal tract in children: algorithm of management and choice of instruments for endoscopic removal

BACKGROUND: A foreign body (FB) in the gastrointestinal tract (GIT) may require either emergent removal or careful observation till its natural coming out. The effectiveness of endoscopic procedure (EP) in pediatrics depends on adequate medical knowledge and medical equipment. Not uncommon, endoscopists and surgeons from adult medical centers remove FB in children. Over the past decades, EP in the GIT has become the safest and most successful technique for FB diagnosis and removal. Up to now, there is no algorithm for managing and removing FB in children, or it does not always meet needs in clinical practice. To assess and choose the most optimal endoscopic equipment and instrumental accessories regarding child’s age, FB type and its harmful effects is still an important issue. AIM: To improve a management algorithm and selection of optimal equipment to ensure timely diagnostics and successful endoscopic removal of FBs from GIT in children. METHODS: A retrospective three-center analysis of children’s medical histories with suspected FBs in GIT from 2017 to 2020. The following parameters were analysed: clinical, X-ray and endoscopic diagnostic techniques depending on patient's age, FB location, its type and radiopacity, time before its removal, as well as type and effectiveness of endoscopic instrument, duration of endoscopic procedure, its effectiveness and complications, if any. RESULTS: 1173 children were taken in the study (boys n=676, girls n=497,) average age 3.5±3.3, (0–17 y.o.). FB diagnosis was confirmed in 1008 (100%) patients; endoscopy was performed in 756 (75%) cases; endoscopic removal — in 751 out of 756 cases. Surgeries were made to three children with giant trichobezoars and to two children with magnet objects which were complicated by perforation in one case and by intestinal obstruction in the other one. The performed retrospective analysis of children’s medical histories with suspected GIT FBs allowed to modify the algorithm of multidisciplinary approach to the management and endoscopic removal of swallowed objects. Examination by an ENT specialist and a pediatric surgeon was mandatory at the reception department. The pediatric surgeon formulated indications for X-ray examination in two projections. The confirmed fact of FB swallowing and X-ray findings could be indicators for CT scanning. After FB presence has been confirmed, the patient is jointly consulted by a pediatric surgeon, anesthesiologist and endoscopist so as to determine indications and time interval for removing a swallowed object endoscopically. Endoscopic instruments — net, rat tooth, forceps, loop and basket — turned out to be the most universal ones for removing four FB types, with the best average time of the procedure. There were no complications related to FB endoscopic removal. CONCLUSION: The proposed algorithm modification in child’s management and removal of GIT FB, the optimal choice of endoscopic equipment and manipulation accessories depending on patient’s age, FB location, type and its harm are key points to its successful and effective FB removal in children.

Three-dimensional printed apical barrier model technology for pre-clinical dental education.

Clinically, apical barrier procedure can be adopted to create an immediate artificial barrier for tooth with an open apex. Given that the quality of the barrier is crucial, the apical barrier procedure is known for its high technical sensitivity, posing significant learning challenges for dental students. Therefore, a new dental teaching model not only effectively enhances the future clinical skills of dental students but also benefits a wider range of patients. A new dental model for simulating apical barrier procedure in vitro, is helpful for dental students to practice apical barrier procedure. This study aims to design, assess, and evaluate the feasibility of a three-dimensional (3D) printed apical barrier model for pre-clinical dental education. A novel 3D-printed apical barrier model was developed, consisting of a tooth model and a matching blind box. Total 200 3D-printed apical barrier models were used to train dental students, and fifty fifth-year dental students participated in this voluntary hands-on course. Each student performed apical barrier procedures on four 3D-printed models. The outcome of the first model served as the representative result for the "direct barrier group", whereas the outcome of the fourth model represented the result of the "post-training barrier group". The quality of the apical barrier procedure was assessed through X-ray examination, and a questionnaire was used to evaluate the 3D-printed model's benefits, with scores ranging from 1 (strongly agree) to 5 (strongly disagree). The overall rating for the 3D-printed model was 2.0 ± 0.6. The model was noted for its high degree of realism, ease of use, and practical applicability. Post-training assessments showed significant improvements in the density of apical barrier fillings (P< 0.05), reduction in underfilling rates (P< 0.05), and decrease in overfilling distances (P< 0.05). Students overwhelmingly agreed that the model was beneficial for training in apical barrier procedures (1.06 ± 0.24), helped identify their shortcomings (1.62 ± 0.53), and improved their operational skills (1.90 ± 0.51). Both the questionnaire feedback and the quality of the fillings confirmed the feasibility and efficacy of the 3D-printed apical barrier model for dental education. The students had the possibility to learn the correct apical barrier procedure on printed dental models.

Intestinal malrotation in newborns and infants: comparative possibilities of ultrasound and radiologic methods of investigation

BACKGROUND: Intestinal malrotation is a congenital pathology that results from abnormal fixation and rotation of the midgut during fetal development. This pathological condition is most often diagnosed during the first month of life and is often manifested by the presence of regurgitation, restlessness, vomiting with an admixture of bile, low weight gain. The narrow root of the mesentery facilitates the formation of midgut ingestion, which can lead to ischemia and necrosis and requires urgent surgical intervention. Ultrasound and radiologic examination with contrast are currently used to diagnose malrotation. AIM: To improve the diagnosis of intestinal malrotation in newborns and infants by carrying out a comparative analysis of the capabilities of radiologic and ultrasound methods of investigation when they are used in combination. MATERIALS AND METHODS: Data from 112 patients aged from 1 day from birth to 3 months 26 days between 2016 and 2024 with ultrasound signs of malrotation detected by microconvex and linear transducers were analyzed. 50 children were further followed up with this provisional or final diagnosis. Contrast agent passages and irrigographs were performed on an AXIOM Luminos DRF (Siemens), with 1 to 15 radiographs and up to 8 X-ray examination series obtained. RESULTS: The most common ultrasound sign of malrotation was atypical location of mesenteric vessels, and the most common radiologic sign was left-sided location of the colon and high standing of the cecum. Assessment of the location of the duodenojejunal junction was complicated in most cases. Surgery was performed in 17 children, one of them for suspected intestinal obstruction, and a ring-shaped pancreas was found in 4 patients. The diagnosis of malrotation was made in 40 children out of 50, in 4 cases this was discordant with the radiologic findings. Concomitant abnormal location of internal organs was detected in 12 patients. CONCLUSION: Screening ultrasound examination of all newborns should be considered as the pathology may be asymptomatic. It is important to include suspicion of malrotation in the diagnosis because of the possible manifestation of the pathology at a later age. It is currently not possible to completely abandon radiologic examination with contrast in the diagnosis of malrotation.

EFFECTIVE DOSE ANALYSIS IN ABDOMEN AP EXAMINATION PATIENTS WITH CALDOSE_X VERSION 5.0

This study evaluates radiation dose exposure during diagnostic radiology procedures using X-rays and their potential risks, including cancer, to optimize radiation safety through the CALDose_X software that calculates the absorbed organ dose, effective dose, and cancer risk, according to the lowest possible achievable (ALARA) principle. This study used a quantitative experimental design to evaluate the impact of filter thickness variations on Entrance Surface Air Kerma (ESAK) and effective dose by analyzing data from 54 patients undergoing AP Abdominal X-ray examinations. The results showed that the effective dose to the abdominal organs varied with exposure factors and Focus to Detector Distance (FDD), where the colon wall had the highest sensitivity with doses ranging from 0.030 mSv to 0.126 mSv, followed by the stomach and pancreas. Increasing kV, mAs, and FDD increased the effective dose, emphasizing the importance of careful dose management. This study concluded that exposure factors and FDD affect the effective dose received by the abdominal organs, with recommendations to monitor patient doses, revise national diagnostic reference levels, and establish standard protocols with health authorities. Keywords: CALDose_X, X-ray Exposure Factor, patient dose, ESAK, Effective Dose, Abdomen AP.

Removal of soft tissue foreign bodies in the hand under microscopy: a retrospective observational study

Purpose: Numerous studies have focused on techniques for detecting foreign bodies in soft tissue in the hand, but removal remains a subject of interest. In this study, we describe the microscope-assisted removal of foreign bodies in the hand. Methods: We reviewed records of patients treated for foreign bodies in the hand at our department from July 2013 to May 2023. In 16 patients aged 23 to 55 years, the following variables were analyzed: the cause of trauma; the time interval from trauma to surgery; the location, type, size, and number of foreign bodies; patient complaints; imaging technique; and procedure type. Under local anesthesia, a slit incision was made at the suspected site. Foreign bodies were completely removed using micro-instruments under microscopic guidance. Results: Stab injuries were the most common (n=13), and there was one case each of abrasion, traffic accident, and bee sting. The middle finger (n=5) was the most affected, followed by the thumb (n=4), index (n=3), little finger (n=2), ring finger (n=1), and palm (n=1). Foreign bodies included glass (n=6), wood (n=4), seashell (n=2), fish bone, a pencil tip, a bee stinger, and metal. Their size ranged from 1 to 20 mm. Patient complaints included a foreign body sensation, localized pain, swelling, discoloration, and a skin lesion. X-ray examinations were performed in all cases, and ultrasonography was conducted in five cases. Conclusion: A microscopic approach allows precise, safe, and complete removal of foreign bodies without tissue damage, highlighting the efficacy of this technique in hand surgery.

048. Roux-En-Y Duodenojejunostomy as Surgical Treatment for Congenital Duodenal Obstruction: A Case Report

Background: Congenital duodenal obstruction is an anatomical abnormality in newborn. Various intrinsic and extrinsic etiologies can cause duodenal obstruction. The surgical treatment that commonly performed on duodenal obstruction in neonates is duodenoduodenostomy. However, several etiologies conditions such as preduodenal portal vein (PDPV) and pancreatic annulare cause duodenoduodenostomy is nearly impossible to be performed, so an alternative treatment is necessary. Case: This case describes female neonate with congenital duodenal obstruction which had been suspected since in pregnancy due to polyhydramnios, an OGT was installed with greenish yellow residue after the baby was born. Based on abdominal x-ray examination, a double bubble appearance was seen. The patient then underwent surgery when he was 5 days old. Intraoperatively, there was PDPV and pancreas annulare covering the 3rd-4th part of duodenum, so it was decided to perform Roux-en-y duodenojejunostomy. Conclusion: In patients with congenital duodenal obstruction with special etiology and anatomy such as PDPV and pancreatic annulare, it is possible to perform a roux-en-y duodenojejunostomy. Even though this operation is rarely performed on neonate and more common in adult patients, it can be an alternative in cases of congenital duodenal obstruction.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

ObjectiveTo analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. MethodsThis retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. ResultsThe mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. ConclusionsThe best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

Study on the Consistency of Point-of-Care Ultrasound and Chest X-ray in the Diagnosis of Postoperative Thoracic Abnormalities in Children with Congenital Heart Disease

Objective: This study aimed to explore the consistency of point-of-care ultrasound (POCUS) and chest X-ray in the diagnosis of postoperative thoracic abnormalities in children with congenital heart disease. Methods: The clinical data of 68 children with congenital cardiosurgery in our hospital from January 2021 to August 2024 were retrospective analyzed. Six children were excluded, and 62 cases were finally included. POCUS was performed 24 hours after surgery. After the examination of POCUS, chest X-ray examination was conducted. The results of POCUS and chest X-ray examinations in children, as well as the clinical incidence of postoperative thoracic abnormalities were recorded. The effect of POCUS and chest X-ray in the diagnosis of postoperative thoracic abnormalities was compared. Results: POCUS had slightly higher diagnostic sensitivity of pleural effusion and atelectasis than chest X-ray. The sensitivity of POCUS in diagnosing pulmonary edema was consistent with that of chest X-ray. However, POCUS had slightly lower sensitivity in diagnosing pneumothorax than chest X-ray. The specificity of POCUS in diagnosing pneumothorax and atelectasis was consistent with that of chest X-ray. However, POCUS had slightly higher specificity in the diagnosis of pleural effusion and pulmonary edema than chest X-ray. The kappa values of POCUS and chest X-ray in diagnosing pleural effusion, pneumothorax, atelectasis and pulmonary edema were 0.546, 0.565, 0.502 and 0.701, respectively. Conclusion: POCUS and chest X-ray examinations have good consistency in the diagnosis of postoperative thoracic abnormalities in children with congenital heart disease.

Preliminary Application of Bilateral Submandibular Horizontal Incision in the Treatment of Upper Cervical Tumors.

The upper cervical spine has a complex anatomical structure, making anterior surgical approaches challenging and prone to complications. This study aims to explore the use of bilateral submandibular incisions to provide safer and more convenient exposure of the upper cervical spine and to assess the feasibility of this approach for anterior surgical treatment of complex upper cervical diseases. From November 2019 to August 2021, three patients with malignant tumors of the upper cervical spine were subjected to an anterior-posterior combined approach for cervical tumor resection. The cohort consisted of one male and two females, aged between 41 and 51 years. The anterior approach began with a submandibular incision, followed by blunt dissection through the prevertebral muscles to expose the diseased vertebra. Subsequently, the diseased vertebra was excised, and either a titanium cage or a pre-customized 3D-printed artificial vertebral body was implanted anteriorly. Then, posterior fixation of the cervical spine was performed using pedicle screws to provide additional stability. Follow-up ranged from 8 to 34 months. All patients experienced varying degrees of pain relief within 24 hours post-operation. Frankel grading showed improvement by at least one grade in all three cases. Regular X-ray and magnetic resonance imaging examinations revealed no tumor recurrence or involvement of adjacent vertebrae in the surgical area. The anterior bilateral submandibular horizontal incision approach offers comprehensive exposure of the anatomical structures of the upper cervical spine. This approach introduces a new option for the anterior treatment of upper cervical spine diseases.

FUNCTIONAL POSSIBILITIES OF ESOPHAGEAL-GASTIC ANASTOMOSIS IN THE REMOTE POSTOPERATIVE PERIOD ACCORDING TO THE DATA OF THE MORPHO-FUNCTIONAL STUDY

Resume. Purpose: Morpho-functional assessment of the method of endoprosthesis of failure of the esophageal-gastric anastomosis sutures in the distant postoperative period. Introduction. Currently, views on treatment tactics in the case of the inability to suture esophageal anastomoses are contradictory and have diametrically opposite opinions — from extremely gentle to extremely aggressive. Optimism of supporters of palliative resections is due not only to the almost identical mortality with radical operations, which is 4.0-31.6%, but also to the possibility of ensuring 5-year survival of 8.5-15.7% of operated patients. Thus, a number of questions remain relevant, including the study of morpho-functional shifts in tissue cells of the esophageal-gastric anastomosis with the assessment of its functional capabilities in the distant postoperative period based on morphological research. Material and methods. The work was performed in the Department of Surgery of the Gastrointestinal Tract and Esophagus of the State University «IZNG named after V.T. Zaitsev National Academy of Medical Sciences of Ukraine» with the presentation of the results of a morpho-functional study and statistical analysis of the treatment of patients with the development of failure of esophageal-intestinal anastomoses in the postoperative period. All patients were fitted with self-expanding stents, stents from M.I.Tech Co., Ltd. (Korea), covered esophageal HANAROSTENT with an antireflux valve - 14 and Boston Scientific Corp. were used for endoprosthetics. (USA), covered with Ultraflex-2 esophagus. In the long-term period, all patients discharged from the hospital underwent a control X-ray and endoscopic examination every 1-2 months, during which a biopsy was performed and material was taken for the next morphological examination. For light microscopy, tissue fragments of the esophageal-gastric junction were fixed in a 10% solution of neutral formalin for 24 hours at a temperature of +20°C, after which they were dehydrated with ethyl alcohol and embedded in paraffin. Sections were prepared from paraffin blocks and stained with Ehrlich’s hematoxylin and eosin. Research results. The long-term results of endoprosthesis of failed esophageal-gastric anastomosis sutures in 43 stented patients were evaluated. Of great interest is the morpho-functional state of the esophageal-gastric anastomosis in the long term after surgery (3- 24 months), as these terms determine the functional capabilities of the anastomosis. Taking into account that during the research it is possible to detect initial morpho-functional shifts in the tissues of the examined organs, it should be assumed that in the future hypoxia of the stomach and esophagus increases and the degree of expressiveness of these disorders maintains the same sequence. Conclusions. The conducted studies expanded the understanding of the pathogenesis of morpho-functional disorders occurring in the distant postoperative period, confirmed the priority of metabolic disorders in tissue cells in diseases of the gastrointestinal tract, and also allowed to give a prognostic assessment of the functional possibilities of the further development of the gastric process. further tactics of managing patients at the next stage of treatment.

Effect of endodontically treated teeth on prosthetically guided orthodontics with clear aligners: a case series

BackgroundProsthetically guided orthodontics (PGO) can correct the malocclusion for better prosthetic rehabilitation in esthetic rehabilitation. Unlike conventional orthodontic treatment, only minor tooth movement is designed in PGO according to the requirement of subsequent restoration. For better appearance during the treatment, PGO is often performed with clear aligners, which have no metal brackets. It has been proven that the PGO with clear aligners can achieve generally satisfactory outcomes. However, its risk has not been fully known due to the paucity of relevant studies.Case presentationThree patients who needed esthetic rehabilitation with mild malocclusion were included in this study. After evaluation, a prosthetic solution alone was considered insufficient to provide optimal outcomes. Thus, they were treated using PGO with clear aligners (Invisalign Go, Align Technology, Santa Clara, California, USA) and accomplished prosthetic rehabilitation subsequently. Dental history and X-ray examination revealed that endodontically treated teeth (ETT) existed in all the cases. Intraoral photographs were collected to compare the pre-treatment and post-treatment dentition. After PGO, posterior ETT did not maintain their position as scheduled and lost occlusal contacts, while all the anterior teeth, including anterior ETT, were moved to the designed position. Corresponding prosthetic rehabilitation was used to solve it after consulting with the patients.ConclusionsOcclusal contact loss of posterior ETT is a potential risk in PGO with clear aligners, affecting the orthodontic result.

The spinal consequences of HT-2 toxin and selenium deficiency during bone maturation in mice.

In our investigation, we probed the ramifications of low selenium diets and HT-2 mycotoxin exposure on spinal development and structural fidelity in murine models. A cohort of 48 male mice was segregated into six groups: a control set, a singular low selenium diet group, two cohorts exposed to distinct concentrations of HT-2 toxin (1.6 and 3.2 mg/kg·bw·d), and two assemblies subjected to a confluence of low selenium intake and each designated HT-2 dosage. Across an 8-week investigative period, parameters such as body mass, markers of bone metabolism, and cellular vigor were assiduously monitored. Analytical techniques encompassed biomechanical assessments, X-ray scrutiny, and micro-computed tomography (micro-CT) evaluations. Our results unveiled a dose-dependent diminution in the body mass of mice exclusively exposed to HT-2 toxin, whereas concurrent exposure to both low selenium and HT-2 toxins elicited a synergistic effect. Pertinent shifts were observed in calcium, phosphorus, and vitamin D concentrations, as well as in the operational dynamics of osteoblasts and osteoclasts, aligning with toxin dosage and combined exposure. Variations in biomechanical attributes were also discerned, mirroring the levels of toxin exposure. Micro-CT and X-ray examinations further corroborated the extensive detrimental impact on the cortical and trabecular architecture of the mice's spinal columns. This inquiry elucidates the complex synergistic interactions between low selenium and HT-2 mycotoxin on murine spinal development and integrity under co-exposure conditions. These findings accentuate the exigency of comprehensively understanding the solitary and joint effects of these toxins on osseous health, providing pivotal insights for future toxicological research and public health strategies.

Primary ciliary dyskinesia in children: clinical, laboratory-instrumental and genetic characteristics

Background. Primary ciliary dyskinesia (PCD) is an orphan disease, and diagnosis is difficult because there is no gold standard for diagnosis. Aim. Clinical, laboratory-instrumental, genetic characteristics of PCD in children. Materials and methods. From 2009 to 2024, 31 patients with a genetically confirmed diagnosis of PCD were observed as part of a multicenter, open-ended, descriptive pilot longitudinal study. Examination methods: clinical and anamnestic method; X-ray examination and computed tomography of the chest organs and paranasal sinuses, tracheobronchoscopy; sputum/aspirate cultures of the tracheobroncheal tree with determination of sensitivity to antibiotics; transmission electron microscopy, high-speed video microscopy of the ciliated epithelium, cytological examination of bronchoalveolar lavage; monitoring computer pulse oximetry, echocardiography, audiometry, spirometry with bronchodilator test. Results. Respiratory symptoms in the neonatal period have 80% of children with PCD, lateralization defects – 35%, congenital heart defects – 13%, bronchiectasis – 68%, purulent endobronchitis – 62%, year-round rhinitis – 84%, hearing loss, otitis – 65%. The average age of onset of symptoms was 1 [1; 1] weeks, and the verification of diagnosis was 6 [2,5; 8] years. The main pathogens of chronic respiratory infection with PCD are Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus. The most common cause of PCD was biallelic variants of the DNAH5 gene. Conclusion. The diagnosis of PCD should be based on the application of the maximum number of diagnostic tests.

Limitations when using artificial intelligence services to analyze chest X-rays

Background: One of the first radiology areas in which artificial intelligence began to be used and is still actively used to this day is chest X-ray examination. However, when interpreting these studies using artificial intelligence, radiologists still face a number of limitations on a daily basis that must be taken into account when making a medical opinion and which developers need to pay attention to in order to further improve the algorithms to increase their efficiency. Aims: Identification of limitations in the use of currently available artificial intelligence services for chest X-ray examinations and identification of promising directions for their further development. Materials and methods: A retrospective analysis of 155 cases of disagreement between the results of conclusions of artificial intelligence services and medical opinions when analyzing chest X-ray examinations was carried out. All cases included in the study were obtained from the Unified Radiological Information Service of the Unified Medical Information and Analytical System of Moscow. Results: Among the 155 analyzed cases of disagreement, 48 (31.0%) were false positives and 78 (50.3%) were false negatives. The remaining 29 (18.7%) cases were excluded from further study because they turned out to be true positive (27) or true negative (2). Among the 48 false-positive cases, the majority (93.8%) was due to the fact that the artificial intelligence service mistook normal anatomical structures of the chest (97.8% of cases) or a catheter shadow (2.2% of cases) for pneumothorax. Among false-negative studies, the proportion of missed clinically significant pathologies was 22.0%. Almost half of these cases (44.4%) were associated with missed lung nodes. The most common clinically insignificant pathology was calcifications in the lungs (60.9%). Conclusions: On the part of AI services, there was a tendency towards overdiagnosis. All false-positive cases were associated with erroneous detection of clinically significant pathology: pneumothorax, lung nodules, and pulmonary consolidation. Among false-negative cases, the proportion of missing clinically significant pathology was small and amounted to less than one-fourth.

Accuracy and costs of bedside methods for confirming nasoenteral feeding tube position: a diagnostic accuracy study.

To analyze the accuracy and costs of bedside methods for confirming the position of a nasoenteral feeding tube newly inserted blindly by nurses. Diagnostic accuracy study of three clinical methods (ultrasound, epigastric auscultation, and pH measurement) compared to radiography. The direct costs of each method used to confirm the positioning of the nasoenteral tube were also measured. Seventy-six adult patients underwent a total of 87 nasoenteral tube insertion procedures in hospital units located within the Northeast region of the State of São Paulo, Brazil. The clinical methods were conducted on all study participants in the specified sequence: ultrasound (as index test), followed by epigastric auscultation and pH measurement (also index tests). The outcomes regarding the confirmation of the accurate positioning of the nasoenteral tube are as follows: ultrasonography demonstrated sensitivity and specific of 79.0% and 66.7%, respectively. Epigastric auscultation exhibited a sensitivity of 81.3% and specificity of 83.3%. The pH measurement method displayed sensitivity and specificity of 89.3% and 100% respectively. Additionally, in terms of estimated direct costs, the pH measurement method incurred a higher cost (USD $8.31) compared to the other methods, with a difference of USD $6.68. Based on these results, X-ray examination remains the primary method for confirming the placement of nasoenteral tubes recently inserted blindly at the bedside. However, when considering the costs of the evaluated methods, it is advisable to consider the variations in expenses between non-radiological methods and X-ray examinations.

Comparative analysis of operative time, blood loss, and X-ray parameters: Two-dimensional navigation guided percutaneous endoscopic transforaminal discectomy vs. conventional microscopic surgery for lumbar disc herniation

PurposeThis retrospective comparative study aims to evaluate the clinical efficacy of two-dimensional (2D) navigation-guided percutaneous endoscopic transforaminal discectomy in comparison to conventional microscopic surgery for the treatment of lumbar disc herniation (LDH), based on operative time, blood loss, and X-ray examination parameters. MethodsClinical data of patients who underwent either 2D navigation-assisted endoscopic (2D-NAE) discectomy or conventional microscopic surgery for LDH were retrospectively reviewed. Baseline characteristics, perioperative data, clinical outcomes (including visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and Modified MacNab criteria), and complications were compared between the two groups. ResultsA total of 95 patients were included, with 80 having complete follow-up data. The 2D navigation group comprised 47 patients, while the conventional microscopic surgery group had 33 patients. Both groups showed significant improvement in VAS and ODI scores at each follow-up time point (P < 0.05). The perioperative analysis favored the 2D navigation-assisted group, with a significantly shorter operative time (42.77 ± 7.56 vs. 59.33 ± 3.30 min; p < 0.01) and lower blood loss (10.34 ± 2.24 vs. 11.55 ± 2.20 ml; p = 0.02). The number of X-ray examinations required was similar between the two groups (2.34 ± 0.48 vs. 2.39 ± 0.56; p = 0.65), and post-operative hospitalization durations were comparable (p = 0.5). Clinical efficacy, as reflected by VAS scores for legs and ODI scores, showed no significant differences between the groups. Additionally, the Modified MacNab criteria indicated similar rates of excellent and good outcomes. ConclusionBoth 2D-NAE discectomy and conventional microscopic surgery demonstrated comparable therapeutic outcomes for LDH, with favorable clinical efficacy and safety profiles. However, 2D-NAE surgery may offer additional benefits, including shorter operative times, reduced blood loss, and fewer X-ray examinations.

Diagnostic reference levels for the city of Moscow during X-ray examinations

Diagnostic reference levels are one of the effective tools for optimizing patient radiation doses in diagnostic radiology. The staff of domestic radiology departments does not have an understanding of the development process and use of diagnostic reference levels during X-ray examinations, although this tool is a generally accepted in practice abroad. The article shows the experience of forming regional diagnostic reference levels based on measurements provided by the accredited testing laboratory of the Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department. The diagnostic reference levels for radiography in Moscow were developed for eight of the most common types of examinations based on the operation of 216 digital X-ray machines. The resulting levels, expressed in the dose-area product (cGy-cm2) and effective dose (mSv), were compared with the local diagnostic reference levels for the Ryazan region, Russia, and national diagnostic reference levels for other countries. The analysis showed continuity in the values. Some types of studies have been optimized. The developed diagnostic reference levels are the quality performance indicators foe diagnostic radiology departments and will be used to optimize a patient radiation dose during diagnostic studies in Moscow.