X-ray Manifestations Research Articles

Diagnosis and management of work related musculoskeletal disorders as occupational diseases in Germany

This article introduces the occupational disease diagnosis of work-related musculoskeletal disorders such as lumbar and spinal injuries in Germany, and focuses on the research and standard values of the maximum pressure tolerance of intervertebral discs. This article mainly introduces the dose model limits and their applications proposed by the Mainz Dortmund Dosis model (MDD), the judgment of the German Social Court (Bundessozialgericht, BSG), and the German Spinal Research Re evaluation (Deutsche Wirbels ulentudieⅡ, DWSⅡ) ; X-ray manifestations and measurements of intervertebral disc injury; Problems in actual cases and diagnosis. In order to provide reference and inspiration for the occupational diseases diagnosis of work related musculoskeletal disorders in China.

Clinical characteristics and outcomes of neonatal SARS-CoV-2 infection after the release of the epidemic situation of COVID-19

BackgroundWith the release of the coronavirus disease 2019 (COVID-19) pandemic in late 2022 in China, the number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) roared, including neonatal cases. However, there were few studies on neonatal COVID-19, especially multi-center case reports. This study aimed to explore clinical characteristics and short-term outcomes of neonatal COVID-19 in China.MethodsWe reviewed 187 cases of neonatal COVID-19 between December 11, 2022, and January 12, 2023. The diagnosis was assessed by symptoms, laboratory tests, X-ray manifestations, and diagnosis code. Clinical characteristics and outcomes were evaluated.ResultsIn 187 neonatal cases with COVID-19, 84 (44.9%) had severe SARS-CoV-2 infection. Most patients had confirmed exposure to SARS-CoV-2. Fever and respiratory symptoms were common (75.4% and 71.7%, respectively). Severe patients were more likely to have high alanine transaminase (ALT) (> 40U/L) (11.9% vs. 3.9%) and high N-terminal pro-brain natriuretic peptide (NT-proBNP) (> 2000pg/mL) (38.0% vs. 19.6%), compared with nonsevere ones (P < 0.05). None of the patients received COVID-19-specific medical interventions. A few severe patients received corticosteroids (1.1%), and immunoglobulin (0.5%), respectively. All patients were discharged home after the medical care with a median length of stay (LOS) of four days and none of them met the criteria of multisystem inflammatory syndrome in neonates (MIS-N).ConclusionsAfter the release of the epidemic situation of COVID-19 in late 2022 in China, more neonatal cases with severe COVID-19 had high ALT and NT-proBNP level. Few specific medical interventions were given, and the outcome was satisfying.

X-ray diagnostics diseases of the temporomandibular joints

TMJ diseases, the occurrence of which can be caused by numerous factors, are a common pathology among the population. The purpose of the study was to research the characteristics of x-ray manifestations and the informativeness of x-ray techniques in the x-ray diagnosis of TMJ diseases. 645 X-ray images of 344 patients aged 18 to 65 years were analyzed. It has been established that the X-ray picture of most TMJ diseases is characterized by the presence of functional changes or a combination of functional and organic manifestations. The most common pathology is dysfunctional disorders of the TMJ. It was concluded that the primary X-ray diagnosis of TMJ diseases is advisable to carry out using orthopantomographs, which allow examining the TMJ in the lateral projection according to a special program with the patient’s mouth open and closed. The use of computed tomography makes it possible to identify not only functional abnormalities, but also early manifestations of organic changes in the bone elements of the TMJ on a series of tomographic sections in different planes.

AI Models for Chest Radiograph Analysis: Internal Clinical Trial vs. Gold Standards

Our vision is to develop an AI-based software which is capable of analyzing frontal PA chest X-rays for disease diagnosis, detection, and prediction through the analysis of several different X-ray manifestations and findings which are inter-correlated to arrive to a final result. We utilize state of-the-art AI, thereby facilitating in empowering of the world through our med-tech ecosystem. It is being developed with the intention of enhanced cardiopulmonary care, bridging the gaps in healthcare, by giving conclusive and comprehensive diagnosis at lower costs and reducing the number of unnecessary diagnostic tests which, often, serve as the main cause of the delay between diagnosis and treatment. Why X-rays? X-rays have been chosen as the input because it is Non-invasive mode of diagnostic test, affordable, accessible and has much lesser radiation exposure compared to other imaging methods of CT, MRI, PET.

Pelvic fractures healing in osteosynthesis by external device

Aim: To analyze radiological data of pelvic fractures healing after osteosynthesis by external device, to determine the possibility of correction during the union and terms of fixation. Background. Visualization of fracture healing and knowledge of X-ray manifestations in dynamics makes it possible to control and manage the reparative process of bone tissue during union of the pelvic bones. Material and methods. The clinical and radiological picture of pelvic fractures healing and the results of treatment in 207 polytrauma patients were studied. All observations are divided by the type of fracture according to M.Tile classification. Results: The analysis of long-term treatment outcomes of pelvic trauma was carried out in 154(74,39%) patients, in the period from 1,5 to 16 years after surgery. All patients showed complete healing of the pelvic fractures and long bones injuries and their functional recovery. Conclusions: Correction of the pelvic ring injuries with an external fixation device is possible in almost all cases. X-ray dynamics provides control of the union process of the pelvic bones and allows to manage it.

Plasma anti-myosin autoantibodies in the diagnosis of necrotizing enterocolitis

We aimed to assess whether autoantibodies can be used as biomarkers for necrotizing enterocolitis (NEC) and applied for its early diagnosis. A prospective observational study was conducted in neonates with suspected NEC abdominal distension (the developmental study), which consisted of 50 neonates finally divided into NEC (n = 24) and non-NEC (n = 26) cohorts based on follow-up results. Serum samples were collected within 48 h of illness onset and used for screening NEC-associated plasma autoantibodies by autoantigen microarray. Additionally, we validated anti-myosin autoantibodies by enzyme-linked immunosorbent assay (ELISA) in an independent validation study, for which we selected plasma samples within 48 h of onset of NEC (n = 38) and samples of gestational age- and weight-matched controls (n = 13). Autoantigen microarray revealed that both IgG and IgM anti-myosin autoantibodies in plasma from neonates with NEC were significantly higher than those in neonates with other diagnoses. ELISA showed that plasma anti-myosin autoantibodies increased in the NEC cohort, with 1.5-fold higher levels than in the non-NEC cohort. Anti-myosin autoantibodies were able to distinguish NEC from non-NEC, achieving an area under the curve (AUC) of 0.8856 (95% confidence interval (CI): 0.7918–0.9795), with sensitivity of 81.58% and specificity of 76.93%. Plasma anti-myosin autoantibodies were significantly higher in all three subtypes of NEC (P < 0.0001 for NEC I; P = 0.0018 for NEC II; P = 0.0011 for NEC III), especially in NEC stage I than that in the non-NEC controls.Conclusion: Anti-myosin autoantibodies may be applied as a promising diagnostic marker for NEC, especially for NEC stage I.What is Known:• Intestinal damage and self-antigen exposure may lead to increased autoantibodies, and they are widely used as biomarkers for diagnosing inflammatory bowel disease.• Necrotizing enterocolitis (NEC) is a devastating disease with overwhelming inflammation and immune dysregulation.What is New:• Increased autoantibodies were present in patients with NEC, even before typical X-ray manifestations.• Anti-myosin autoantibodies may be applied as a promising diagnostic marker for NEC.

Multi-Level Training and Testing of CNN Models in Diagnosing Multi-Center COVID-19 and Pneumonia X-ray Images

This study aimed to address three questions in AI-assisted COVID-19 diagnostic systems: (1) How does a CNN model trained on one dataset perform on test datasets from disparate medical centers? (2) What accuracy gains can be achieved by enriching the training dataset with new images? (3) How can learned features elucidate classification results, and how do they vary among different models? To achieve these aims, four CNN models—AlexNet, ResNet-50, MobileNet, and VGG-19—were trained in five rounds by incrementally adding new images to a baseline training set comprising 11,538 chest X-ray images. In each round, the models were tested on four datasets with decreasing levels of image similarity. Notably, all models showed performance drops when tested on datasets containing outlier images or sourced from other clinics. In Round 1, 95.2~99.2% accuracy was achieved for the Level 1 testing dataset (i.e., from the same clinic but set apart for testing only), and 94.7~98.3% for Level 2 (i.e., from an external clinic but similar). However, model performance drastically decreased for Level 3 (i.e., outlier images with rotation or deformation), with the mean sensitivity plummeting from 99% to 36%. For the Level 4 testing dataset (i.e., from another clinic), accuracy decreased from 97% to 86%, and sensitivity from 99% to 67%. In Rounds 2 and 3, adding 25% and 50% of the outlier images to the training dataset improved the average Level-3 accuracy by 15% and 23% (i.e., from 56% to 71% to 83%). In Rounds 4 and 5, adding 25% and 50% of the external images increased the average Level-4 accuracy from 81% to 92% and 95%, respectively. Among the models, ResNet-50 demonstrated the most robust performance across the five-round training/testing phases, while VGG-19 persistently underperformed. Heatmaps and intermediate activation features showed visual correlations to COVID-19 and pneumonia X-ray manifestations but were insufficient to explicitly explain the classification. However, heatmaps and activation features at different rounds shed light on the progression of the models’ learning behavior.

Aspects of X-ray diagnostics of inflammatory processes in the maxillary sinuses

Studying the characteristics X-ray pictures of the maxillary sinuses more than 350 patients with odontogenic diseases of the maxillary sinuses and no odontogenic of origin, as well as images of the maxillary sinuses in normal. We used data of orthopantomography, panoramic zonography middle and upper areas of the face, radiography of the paranasal sinuses, cone-beam and multislice computed tomography. Diseases of the maxillary sinuses characterized by a variety of origin and X-ray manifestations, which makes the complexity of the diagnosis. In this regard, the necessary knowledge of X-ray skialogicheskih features of pathological processes and the efficiency of X-ray techniques to objective detect not only the changes in the sinuses, but the factors causing the them. Multi -projection X-ray computed tomography examination of the maxillary sinus and alveolar process of the maxilla is a reliable method of assessing the state of the maxillary sinuses and the differentiation of the origin of maxillary sinusitis. Common dental X-ray techniques are limited diagnostic capabilities of assessing the state of the mucous membrane and the walls of the maxillary sinuses, which must be considered when interpreting the image.

ФАКТОРЫ РИСКА И КЛИНИЧЕСКИЕ ПРОЯВЛЕНИЯ МИКОБАКТЕРИОЗА ЛЁГКИХ. СИСТЕМАТИЧЕСКИЙ ОБЗОР

The present study is a systematic review with a meta-analysis of risk factors for lung mycobacteriosis (LM) and diseases that influence the incidence, clinical manifestations and etiology of the infection under investigation. The authors made a selection of papers. The search for papers was carried out in English and Russian in the PubMed, Web of Science, Сochrane Library, eLibrary electronic databases with the analysis of references from the articles found. Articles published from 2000 to 2020 were selected. The following results are obtained. Regarding smoking: with the two gradations of the factor (the patient smokes or not), the incidence of LM in smokers varied from 13.8±0.03% to 71.2±0.06%. Regarding tuberculosis: the incidence of LM and tuberculosis ranged from 6.7±0.01% to 17.6±0.02%. Regarding chronic obstructive pulmonary disease (COPD): the incidence of LM in patients with COPD was determined on average at 11.2±0.01%. Regarding bronchiectasis: the incidence of bronchiectasis in patients with LM is 30.1±0.02%. Regarding diabetes mellitus: the frequency of patients with LM and diabetes mellitus in one study group was 6.7±0.01%, and in the other – 17.6±0.02%. Regarding malignancies: the frequency of such patients was determined from 17.1±0.04% to 50.0±0.07% of cases. Regarding HIV infection and LM: the incidence of detected LM in patients with HIV was determined on average at the level of 8.9±0.01%. Regarding cough in LM: the frequency of patients with this symptom in the first group was 46.2±0.07%, in the second group – 88.9±0.02%. Regarding hemoptysis in LM: the frequency of patients with this symptom ranged from 3.8±0.03% to 30.1±0.02%. X-ray manifestations of lesions in LM occurred with a frequency of 42.3±0.04% to 100%. The most significant role in etiology belongs to non-tuberculous mycobacteria species, such as slow-growing M. avium complex, and fast-growing M. abscessus complex, M. chelonae, M. fortuitum. Keywords: Lung mycobacteriosis, nontuberculous mycobacteria, clinical manifestations, risk factors.

РЕНТГЕНОЛОГИЧЕСКИЕ ПРОЯВЛЕНИЯ ОСТЕОМИЕЛИТОВ ЧЕЛЮСТЕЙ

Among purulent-necrotic processes in the jaws, odontogenic osteomyelitis occurs in most cases in comparison with posttraumatic and hematogenic osteomyelitis. A separate group of jaw lesions consists of radiation, bisphosphonate and phosphoric necrosis, which at the stage of joining the inflammation have x-ray manifestations of the osteomyelitic process. X-ray semiotics of osteomyelitis of the jaws is diverse. X-ray features of osteomyelitis depend on the etiology, stage of course and form of the bone inflammatory process. X-ray diagnosis of osteomyelitis should be carried out taking into account the history of the disease and identifying factors that contribute to their development. Since orthopantomography does not provide comprehensive information about the state of the dental system, this technique can be considered as a method of primary detection of osteomyelitis of the jaws. At the next stage of diagnosis, it is advisable to use a CT scan, especially for lesions of the upper jaw with spread to other facial bones.

Mobile chest X-ray manifestations of 54 deceased patients with coronavirus disease 2019: Retrospective study.

To describe the mobile chest X-ray manifestations of deceased patients with coronavirus disease 2019 (COVID-19).In this retrospective study, we analyzed in patients with COVID-19 from Tongji Hospital (Wuhan, China), who had been died between February 18 and March 25, 2020. Two radiologists analyzed the radiologic characteristics of mobile chest X-ray, and analyzed the serial X-ray changes.Fifty-four deceased patients with COVID-19 were included in the study. We found that 50 (93%) patients with lesions occurred in the bilateral lung, 4 (7%) patients occurred in the right lung, 54 (100%) patients were multifocal involvement. The number of lung fields involved was 42 (78%) patients in 6 fields, 3 (6%) patients in 5 lung fields, 4 (7%) patients in 4 lung fields, and 5 (9%) patients in 3 lung fields. Fifty-three (98%) patients had patchy opacities, 3 (6%) patients had round or oval solid nodules, 9 (17%) patients had fibrous stripes, 13 (24%) patients had pleural effusion, 8 (15%) patients had pleural thickening, 6 (11%) patients had pneumothorax, 3 (6%) patients had subcutaneous emphysema. Among the 24 patients who had serial mobile chest X-rays, 16 (67%) patients had the progression of the lesions, 8 (33%) patients had no significant change of the lesions, and there was no case of reduction of the lesions.The mobile chest X-ray manifestations of deceased patients with COVID-19 were mostly bilateral lung, multifocal involvement, and extensive lung field, and pleural effusion, pleural thickening, and pneumothorax probably could be observed. The serial mobile chest X-ray showed that the chest lesions were progressive with a high probability.

The Potential of Glycyrrhizinate in the Management of COVID-19: A Systematic Review of the Efficacy and Safety of Glycyrrhizin Preparations in the Treatment of SARS and MERS.

The SARS-CoV-2 outbreak in 2019 highlighted the fact that no specific medications providing effective treatment have been identified and approved. We explored the possibilities for COVID-19 by systematically reviewing evidence on the efficacy and safety of glycyrrhizin preparations for SARS and MERS. Electronic databases were systematically searched from inception to February 2020 for eligible studies that evaluated the efficacy and safety of glycyrrhizin preparations for SARS and MERS. A quantitative analysis or descriptive analysis was applied. Five retrospective cohort studies were included, and NOS scores ranged from 5-7 points. The clinical symptoms of dry cough, chest distress and dyspnoea improved quickly, and elevated serum levels of aminotransferase decreased after compound glycyrrhizin treatment. The SARS-CoV antibody appeared earlier in the treated group than in the control group ([Formula: see text][Formula: see text]d). Compared to that with conventional medications, the average period from peak to 50% improvement of lesions, in terms of X-ray manifestations, was shorter with compound glycyrrhizin treatment ([Formula: see text]2.1[Formula: see text]d), and treatment reduced the dosage ([Formula: see text][Formula: see text]mg/d) and duration of the corticosteroids used, without other serious adverse reactions. Based on the available evidence regarding glycyrrhizin preparations for treating SARS and MERS, we infer that compound glycyrrhizin could be an optional therapeutic strategy for SARS-CoV-2 infections, especially those complicated with liver damage. Further research using well-designed randomized clinical trials (RCTs) is warranted to determine the dosage and duration of use of compound glycyrrhizin and to monitor its specific adverse effects.

The Conversional Efficacy of Ex Vivo Lung Perfusion and Clinical Outcomes in Patients Undergoing Transplantation of Donor Lungs by Ex Vivo Lung Perfusion: A Meta-Analysis.

BackgroundEx vivo lung perfusion (EVLP) is a relatively new technique that can be used to assess and repair the donor lungs, increasing the utilization of high-risk lungs. However, its effect on outcomes of lung transplantation patients is uncertainty. This meta-analysis is conducted to assess the impact of EVLP on donor lungs and outcomes of recipients compared with the standard lung transplantation.Material/MethodsWe systematically searched for studies comparatively analyzing the efficacy of EVLP and standard cold storage in lung transplantation. The hazard ratio (HR), relative risk (RR), and weighted mean difference (WMD) were used as the effect size (ES) to evaluate the survival outcomes, categorical variables, and continuous variables respectively.ResultsA total of 20 published articles (including 2574 donors and 2567 recipients) were eligible. The chest x-ray manifestations and PaO2/FiO2 100% were more deficient in the EVLP group than the standard group. EVLP improved the function of high-risk donor lungs with the conversion rate ranging from 34% to 100%. The EVLP group had a lower incidence of primary graft dysfunction 3, but longer intensive care unit stay. Other clinical outcomes between the 2 groups were similar.ConclusionsThe pooled results indicated that EVLP could be used to assess and improve high-risk donor lungs and had non-inferior postoperative outcomes compared with the standard cold storage. EVLP not only increased the utilization of marginal donors, but also could extend preservation time and reduce the total ischemia time of donors.

Correlation research between imaging performance and pulmonary function of pneumoconiosis patients at stage three

Objective: To study the imaging performance and pulmonary function of pneumoconiosis patients at stage three. Methods: 89 cases of pneumoconiosis patients at stage three for high thousand volt back chest, chest CT, pulmonary function, analysis the relationship of high thousand volt back chest, chest CT manifestations and pulmonary function. Results: In patients with chest X-ray progressive massive fibrosis range of 2.31-102.95 cm(2), divide patients according to the X-ray performance into three groups, the difference of each group pulmonary function index FVC、FEV(1)、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV is statistically significant (P<0.01) , the difference of FEV(1)/FVC%、RV/TLC、DLCO is no statistical significance (P>0.05) . Checked by related, in pneumoconiosis patients at stage three, the X-ray manifestations and pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、DLCO showed a negative correlation (r=-0.326, -0.438, -0.251, -0.344, -0.317, -0.337, -0.425, -0.347, -0.230) . With the deterioration of the X-ray imaging findings, pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、DLCO is a trend of decrease (P<0.05) . The X-ray changes is not associated with RV/TLC. By linear regression analysis, FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、DLCO regression equation are meaningful. The RV/TLC regression equations is meaningless. The volume of the patients with chest CT progressive massive fibrosis range of 4.86~179.74 cm(3), divide patients according to the chest CT performance into three groups, the difference of each group pulmonary function index FVC、FEV(1)、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV、RV/TLC is statistically (P<0.05) , the difference of FEV(1)/FVC%、DLCO is no statistical significance (P>0.05) . Checked by related, in pneumoconiosis patients at stage three, chest CT manifestations and pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV showed a negative correlation (r=-0.360, -0.419, -0.256, -0.432, -0.366, -0.326, -0.254, -0.405, ) , It is not associated with the RV/TLC、DLCO. With the deterioration of the chest CT imaging findings, pulmonary function index FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV is a trend of decrease (P<0.05) . By linear regression analysis, FVC、FEV(1)、FEV(1)/FVC%、PEF、MEF(75%)、MEF(50%)、MEF(25%)、MVV regression equations are meaningful. The RV/TLC、DLCO regression equations are meaningless. Conclusion: It is correlated with chest X-ray, chest CT manifestations and pulmonary function in pneumoconiosis patients at stage three, that could help guide clinicians comprehensive evaluation in patients with pulmonary function status.

Differing X-ray patterns in seronegative and seropositive rheumatoid arthritis.

Anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) status are important predictors for rheumatoid arthritis (RA) erosivity. Qualitative differences on hand/feet radiographs have been described, indicating more carpal fusion in seronegative RA. This study explores these differences further using the total Sharp/van der Heijde score (TSS), digital X-ray radiogrammetry (DXR), and qualitative description. Matched seronegative (ACPA negative, RF negative, snRA) and seropositive (ACPA, RF > 3xULN, spRA) were examined. TSS scores both for erosions and joint space narrowing (JSN) were registered separately and compared for both groups. Joint compartments and single joints were compared, using a heat map. The degree of carpal fusion was quantified 0-5. DXR measurements (bone mineral density, cortical thickness, bone width, metacarpal index) were determined for each hand separately. Finally, selected radiographs were examined unblinded to search for non-quantifiable differences. A total of 56 snRA and 57 spRA patients were examined. spRA patients had more erosions and joint space narrowing. Erosion load differed significantly between spRA and snRA in the foot and metacarpophalangeal joint, but not in the wrist or proximal interphalangeal joint compartments. Intracompartmental differences were greater in spRA. JSN scores were greater in spRA, in all compartments except wrist. Carpal fusion and DXR scores did not differ between the groups. The qualitative comparison showed that snRA patients displayed periarticular ossifications, carpal shortening, and sparing of the CMC joints, whereas spRA patients had more CMC damage and less shortening. X-ray manifestations in snRA and spRA are qualitatively and quantitatively different. This suggests pathophysiological differences between the two forms. Key Points • Seronegative and seropositive RA display qualitatively and quantitatively different X-ray patterns, suggesting differences in the underlying pathophysiological process. This is the first time that this has been shown in a systematic, quantitative fashion.

Revealing a Highly Dynamic Cluster Core in Abell 1664 with Chandra

Abstract We present new, deep (245 ks) Chandra observations of the galaxy cluster Abell 1664 (z = 0.1283). These images reveal rich structure, including elongation and accompanying compressions of the X-ray isophotes in the NE–SW direction, suggesting that the hot gas is sloshing in the gravitational potential. This sloshing has resulted in cold fronts, at distances of 50, 110, and 325 kpc from the cluster center. Our results indicate that the core of A1664 is highly disturbed, as the global metallicity and cooling time flatten at small radii, implying mixing on a range of scales. The central active galactic nucleus (AGN) appears to have recently undergone a mechanical outburst, as evidenced by our detection of cavities. These cavities are the X-ray manifestations of radio bubbles inflated by the AGN and may explain the motion of cold molecular CO clouds previously observed with the Atacama Large Millimeter Array (ALMA). The estimated mechanical power of the AGN, using the minimum energy required to inflate the cavities as a proxy, is erg s−1, which may be enough to drive the molecular gas flows, and offset the cooling luminosity of the intracluster medium, at erg s−1. This mechanical power is orders of magnitude higher than the measured upper limit on the X-ray luminosity of the central AGN, suggesting that its black hole may be extremely massive and/or radiatively inefficient. We map temperature variations on the same spatial scale as the molecular gas and find that the most rapidly cooling gas is mostly coincident with the molecular gas reservoir centered on the brightest cluster galaxy’s systemic velocity observed with ALMA and may be fueling cold accretion onto the central black hole.

Viral and bacterial co-infection in hospitalised children with refractory Mycoplasma pneumoniae pneumonia.

To investigate the impact of viral and bacterial co-infection in hospitalised children with Mycoplasma pneumoniae pneumonia (RMPP). Retrospective analysis of 396 children with RMPP in our hospital admitted between 1 January 2011 and 31 December 2016 was performed. Nasal aspirate samples were collected for pathogen detection and clinical data were collected. We analysed clinical characteristics, lung imaging characteristics and pathogenic species among these children. Of the 396 RMPP cases, 107 (27.02%) had co-infection with other pathogen, with Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus being the most common bacteria of infection and human bocavirus (HBoV), human rhinovirus, respiratory syncytial virus being the most common viruses of infection. Children with co-infection were younger than that with single infection (P = 0.010). Children with both virus and bacteria co-infection had been the youngest (P = 0.040). Children with co-infection had a longer fever process, higher leukocyte count, higher C-reactive protein compared with single infection (P < 0.05). Children with co-infection had a higher percentage of pnemothorax and diffuse large area of inflammation in chest X-ray manifestation compared with children with single infection (P < 0.05). S. pneumonia and HBoV was the leading cause of co-infection in RMPP. Co-infections led to more disease severity in children with RMPP compared with single infections.

Percutaneous Kirschner wire fixation combined with mini external fixation for treatment of the fifth metacarpal base fractures

Objective To evaluate the clinical outcomes of the minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation in the treatment of the fifth metacarpal base fractures. Methods Eleven patients underwent this minimally invasive technique were enrolled and followed up. All of the patients were diagnosed as the fifth metacarpal base fractures according to the typical X-ray manifestation. In this modified procedure, the fracture was reduced by mini external fixation traction and manual manipulation, and the fifth metacarpal was then fixed to the fourth and third metacarpal by 2 percutaneous Kirschner wires. All the fixation devices were removed 6 weeks postoperatively. The mean follow-up period was 15.7 weeks. X-ray, VAS score, range of motion (ROM) as well as the grip strength of the affected hand were checked for all the patients and the TAM scoring system was used for the function evaluation. Results All the 11 patients achieved satisfied union for the fifth metacarpal base fractures without wire tract infection or screw rod loosening and break. The average postoperative VAS score was 1.13. The patients achieved an averaged 89.3% grip strength compared to the healthy side. According to the TAM scoring system, the results were excellent in 6 cases, good in 4 cases and fair in 1 case. Conclusion The minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation appears to be an effective and safe procedure for treatment of the fifth metacarpal base fractures. Key words: Fractures,bone; External fixators; Fifth metacarpal base; Minimally invasive technique

The influence of metabolic disorders on X-ray changes in patients with osteoarthritis and the method for their prediction

Purpose: To investigate the influence of metabolic syndrome indicators on X-ray manifestations of OA and to develop a mathematical model for determining the severity of X-ray changes, depending on metabolic manifestations. Methods: 63 patients with OA (14 males, mean age 58.0±0.82) with different phenotypes were examined in the Kharkiv Regional Hospital. The plan of examination included the following data: history of the disease, waist circumference (WC), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), immunoreactive insulin (IRI), HOMA-IR, total cholesterol (TC), low-density lipoprotein cholesterol (LDL). The knee X-ray was performed for all patients. The first stage of X-ray changes was determined in 8% of the patients, the second stage – in 58.7% and the third stage – in 33.3% of the patients respectively. Patients were divided into 2 groups: 1st – patients with stages I and II by Kellgren and 2nd – patients with stage III by Kellgren. The following indicators were selected as the most statistically significant: the level of FPG (mmol/l), HbA1C (%), LDL (mmol/l), WC (cm) and duration of type 2 diabetes mellitus (T2DM). The calculation of the criteria was carried out at 95% of confidence probability. To find the importance of each of the describing elementary rules in determining the various degrees of severity of X-ray changes, a metric approach to the map of interconnections between them was applied. The map was obtained by the method of multiple correspondent analysis. The classifier model was formed as a weighted sum of binary characteristic functions describing elementary rules. Results:The values of the selected indicators of metabolic syndrome in two groups of patients with radiological changes of different severity were the following: FPG 1st group – 8.85 [7.8, 9.6], 2nd group – 10.7 [11.4, 10.1]; HbA1C: 1st group – 8.75 [7.7, 9.7], 2nd group – 10.2 [9.3, 11.4]; LDL: 1st group – 4.04 [3.26; 4.66], 2nd group – 5.24 [4.59; 5.77]; WC: 1stgroup – 94.5 [88.0; 99.0], 2nd group – 110.0 [96.0; 119.0]; duration of T2DM: 1st group – 8.0 [4.0; 10.0], 2nd group – 11.0 [8.0, 13.0]. The ranges of values that were characteristic of X-ray changes of varying severity were estimated for each of the selected indicators. Thus, each group of patients received its description in the form of elementary rules, representing a comparison of individual indicators to some threshold values. The next step of model construction was to determine the importance of each of the selected elementary rules in determining one or another degree of X-ray changes. For this purpose, the spatial representation of the interrelationships between the stages of the X-ray changes with the elementary rules that describe them was obtained by the method of multiple correspondent analysis. Significance coefficients were calculated for clarifying the effect of metabolic indicators on the severity of X-ray changes and its quantitative characteristics. The values of the coefficients allow us to rank the indicators by their validity to determine one or another degree of X-ray changes (Table1) Significance coefficients are used in the mathematical model for determining the degree of X-ray changes based on the values of the five metabolic syndrome indicators. The model proposes to calculate the so-called index of X-ray changes expressiveness Iexpres by the formula (Fig. 1): the coefficients αi, j are given in the last columns of the table, i = 1, ... 5 – the number of the indicator, j = 1,2,3 – the number of the range of its values. According to the constructed model, if Iexpres> 0 – the level of X-ray changes is defined as expressed (stage 3), if Iexpres<0 – as less expressed (stage 1 and 2). With the proposed mathematical model, the degree of X-ray changes by Kellgren was correctly determined in 55 patients out of 63, that is, the overall accuracy of the model was 87.30%. X-ray changes of the third stage were diagnosed correctly in 18 patients out of 21, that is, the sensitivity of the model was 85.71%. Less distinct X-ray changes (stage 1 and 2) were correctly diagnosed in 37 patients out of 42, i.e the specificity of the model was 88.10%. Conclusions: An in-depth analysis of the relationships between metabolic parameters and X-ray changes of joints allowed to develop the mathematical model for determining the severity of X-ray changes with the use of certain metabolism indicators. The obtained model demonstrates high accuracy, specificity and sensitivity.Table 1The values of the coefficients of of metabolic indicators№ (i)IndicatorValue range№ (j)1st group2nd groupThe coefficient in the model (ai,j)1Duration of T2DM (years)<817,476,22-12,538–1026,136,988,49>1035,629,5639,432WC (cm)<100116,677,36−93,07≥10025,6213,4177,893FPG (mmol/l)<10117,877,29−105,81≥1025,3313,9786,364HbA1C (%)<9,7111,028,14−28,75≥9,726,359,1828,295LDL (mmol/l)≤4,6111,767,65−41,11>4,626,1510,2340,80 Open table in a new tab

Recurrent wheezing in neonatal pneumonia is associated with combined infection with Respiratory Syncytial Virus and Staphylococcus aureus or Klebsiella pneumoniae

Both viral and bacterial infections can be associated with wheezing episodes in children; however, information regarding combined infections with both viral and bacterial pathogens in full term neonates is limited. We sought to investigate the effects of viral–bacterial codetection on pneumonia severity and recurrent wheezing. A retrospective cohort study was conducted on neonates admitted to our hospital with pneumonia from 2009 to 2015. Of 606 total cases, 341 were diagnosed with RSV only, and 265 were diagnosed with both RSV and a potential bacterial pathogen. The leading four species of bacteria codetected with RSV were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Enterobacter cloacae. Neonates with RSV and a potential bacterial pathogen were significantly more likely to have worse symptoms, higher C-reactive protein values and more abnormal chest x-ray manifestations with Bonferroni correction for multiple comparisons (P < 0.01). On Cox regression analysis, an increased risk of recurrent wheezing was found for neonates positive for RSV–Staphylococcus aureus and RSV–Klebsiella pneumoniae. Our findings indicate that the combination of bacteria and RSV in the neonatal airway is associated with more serious clinical characteristics. The presence of RSV and Staphylococcus aureus or Klebsiella pneumoniae may provide predictive markers for wheeze.