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Abstract Over the past several decades, palliative care has seen tremendous development in Western countries, but there is still inadequate access to palliative care among non-dominant ethnocultural groups. The Chinese have been the largest immigrant group in New Zealand since the 19th century(1). They have unique beliefs and practices around illness, death, dying and filial piety(2). These differ greatly from those in Western cultures and have notable implications for hospice palliative care planning and provision. However, immigrant Chinese community remains a relatively marginalised and under-researched group in palliative care(3-5). This results in limited knowledge about its culture and people among health professionals, as well as the lack of experience in providing terminal care to Chinese immigrants. Through the introduction of New Zealand Palliative Care Strategy and the analysis of Chinese immigrants' difficulties and preferences for palliative care, this aims to increase understanding of how cultural values of Chinese affect their acceptance and decision-making with respect to palliative care so that for efficiently providing palliative care to this ethnic minority group in New Zealand.
Resumen En las últimas décadas, los cuidados paliativos han experimentado un enorme desarrollo en los países occidentales, pero el acceso a los mismos sigue siendo insuficiente entre los grupos etnoculturales no dominantes. Los chinos son el mayor grupo de inmigrantes en Nueva Zelanda desde el siglo XIX(1). Tienen creencias y prácticas únicas en torno a la enfermedad, la muerte, el morir y la piedad filial(2). Éstas difieren en gran medida de las de las culturas occidentales y tienen notables implicaciones para la planificación y prestación de cuidados paliativos en los hospicios. Sin embargo, la comunidad china inmigrante sigue siendo un grupo relativamente marginado y poco investigado en el ámbito de los cuidados paliativos(3-5). Esto se traduce en un conocimiento limitado sobre su cultura y su población entre los profesionales sanitarios, así como en la falta de experiencia en la prestación de cuidados terminales a los inmigrantes chinos. A través de la introducción de la Estrategia de Cuidados Paliativos de Nueva Zelanda y el análisis de las dificultades y preferencias de los inmigrantes chinos en materia de cuidados paliativos, este ensayo pretende aumentar la comprensión de cómo los valores culturales de los chinos afectan a su aceptación y la toma de decisiones con respecto a los cuidados paliativos para que para proporcionar de manera eficiente los cuidados paliativos a este grupo étnico minoritario en Nueva Zelanda.
Resumo Nas últimas décadas, os cuidados paliativos tem experimentado um enorme desenvolvimento nos países ocidentais mas ainda há acesso inadequado a cuidados paliativos entre grupos étnico-culturais não dominantes. Os chineses tem sido o maior grupo de imigrantes na Nova Zelândia desde o século XIX(1). Eles tem crenças e práticas singulares em torno de doença, morte, morrer e devoção filial(2). Isso difere grandemente das culturas ocidentais e tem implicações notáveis no planejamento e fornecimento de cuidados paliativos em lares de idosos. Entretanto, a comunidade de imigrantes chineses permanece sendo um grupo relativamente marginalizado e sub-investigado no que diz respeito a cuidados paliativos(3-5). Isso resulta em conhecimento limitado sobre sua cultura e povo entre profissionais da saúde, bem como na falta de experiência em fornecer cuidados terminais a imigrantes chineses. Através da introdução da Estratégia de Cuidados Paliativos da Nova Zelândia e a análise das dificuldades e preferências de imigrantes chineses para cuidados paliativos, esse estudo tente aumentar a compreensão de como valores culturais de chineses afetam sua aceitação e tomada de decisão a respeito de cuidados paliativos, de maneira a eficientemente fornecer cuidados paliativos a esse grupo étnico minoritário na Nova Zelândia.
Subject(s)
Humans , Palliative Care , Cultural Characteristics , Emigrants and Immigrants , Terminal Care , China , Health Strategies , Western World , New ZealandABSTRACT
A total of three early gastric cancers (EGC)patients with submucosal severe fibrosis were successfully treated by endoscopic precise muscular dissection (EPMD) from May 2018 to August 2020.All the three lesions were en bloc resection and specimens were not damaged. The maximum diameter of specimens and fibrosis areas were 2.0-5.7 cm and 0.5-0.8 cm, respectively. The operation time was from 30 to 70 mins. Intraoperative perforation occurred in one case, post-operation fever cccured in one case, and no delayed perforation or bleeding occured. Two cases were cured resection and one case was non-cured resection without additional treatment. No recurrence or metastasis was observed during follow-up period.According to primary results, EPMD can be used for EGC with submucosal severe fibrosis, but the safety and effectiveness need clinical validation with more samples.
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Objective To investigate the bystander effect injury to lung-heart-liver-spleen caused by 12C6+ beam radiation,and explore the prevention and treatment effect of Guiqiyiyuan ointment on the injury and its mechanism.Methods Ninety healthy male Wistar rats were randomly divided into 3 groups:NC group (normal control,normal saline 2ml/kg,n=30),SR group (simple radiation,8Gy,2ml/kg,n=30),GO group (Guiqiyiyuan ointment 11.83g/kg,radiation,8Gy,n=30).All the rats received intragastric administration for 7 days.The right side of the lung was modeled by 12C6+ beam radiation.After modeling,the rats were killed at 48h.The heart,liver and spleen were taken.The malonaldehyde (MDA),glutathione (GSH),glutathione peroxidase (GSH-Px),superoxide dismutase (SOD) contents were measured by colorimetry,DNA methylation rate was assayed by ELISA,and the expressions of Dnmt1,Dnmt3a and Dnmt3b were detected by immunohistochemistry.Results Compared with NC group,the contents of SOD,GSH and GSH-Px decreased (P＜0.01),MDA increased (P＜0.01),the level of DNA methylation decreased (P＜0.01),and the expressions of Dnmt1,Dnmt3a and Dnmt3b increased in SR group (P＜0.01).Compared with SR group,the contents of SOD,GSH and GSH-Px increased (P＜0.01),MDA decreased (P＜0.01),the level of DNA methylation increased (P＜0.01),and the expressions of Dnmt1,Dnmt3a and Dnmt3b decreased in GO group (P＜0.01).Dnmtl,Dnmt3a and Dnmt3b proteins were expressed in the cytoplasm of myocardial cells,hepatocytes and peripheral B cells of the white pulp in spleen,in all the groups.The color of NC group was light brown-brown,showing a weak positive expression.The color of SR group was brown-brown,showing a strong positive expression.The color of GO group was light brown-tan,showing a moderate positive expression.Conclusion The Guiqiyiyuan ointment can reduce the bystander effect caused by the 12C6+ beam radiation,and its mechanism is related to improving the oxidative stress reaction and the level of DNA methylation.
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Objective To evaluate the role of oxidation reaction in the decrease in the activity of acetylcholinesterase (AChE) in the diaphragm of rats with sepsis.Methods Thirty pathogen-free healthy adult male Sprague-Dawley rats,weighing 220-260 g,were divided into 3 groups using a random number table:sham operation group (group S,n=8),sepsis group (group Sep,n =12) and antioxidant group (group Ant,n=10).Sepsis was induced by cecal ligation and puncture.Group S underwent simple laparotomy.N-acetylcystein 20 mg/kg was injected subcutaneously at 3,6,12 and 18 h after operation,and deferoxamine 20 mg/kg was injected subcutaneously at 3 h after operation in group Ant,while the equal volume of normal saline was given instead in S and Sep groups.At 24 h after operation,the surviving rats were sacrificed,and the diaphragm was removed for determination of the malondialdehyde (MDA) content and activities of AChE,myeloperoxidase (MPO),superoxide dismutase (SOD) and catalase (CAT).SOD/CAT ratio was calculated.Results Compared with group S,the AChE activity was significantly decreased,and MPO and SOD activities were increased in Sep and Ant groups,the MDA content and SOD/CAT ratio were significantly increased,and the CAT activity was decreased in group Sep,and the CAT activity was significantly increased in group Ant (P＜0.05).Compared with group Sep,the AChE and CAT activities were significantly increased,and the MDA content,MPO and SOD activities and SOD/CAT ratio were decreased in group Ant (P＜0.05).Conclusion Oxidation reaction is partially involved in the decrease in the activity of AChE in the diaphragm of rats with sepsis.
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<p><b>BACKGROUND</b>The antagonistic actions of anticholinesterase drugs on non-depolarizing muscle relaxants are theoretically related to the activity of acetylcholinesterase (AChE) in the neuromuscular junction (NMJ). However, till date the changes of AChE activity in the NMJ during sepsis have not been directly investigated. We aimed to investigate the effects of sepsis on the antagonistic actions of neostigmine on rocuronium (Roc) and the underlying changes of AChE activity in the NMJ in a rat model of cecal ligation and puncture (CLP).</p><p><b>METHODS</b>A total of 28 male adult Sprague-Dawley rats were randomized to undergo a sham surgery (the sham group, n = 12) or CLP (the septic group, n = 16). After 24 h, the time-response curves of the antagonistic actions of 0.1 or 0.5 μmol/L of neostigmine on Roc (10 μmol/L)-depressed diaphragm twitch tension were measured. Meanwhile, the activity of AChE in the NMJ was detected using a modified Karnovsky and Roots method. The mRNA levels of the primary transcript and the type T transcript of AChE (AChET) in the diaphragm were determined by real-time reverse transcription-polymerase chain reaction.</p><p><b>RESULTS</b>Four of 16 rats in the septic group died within 24 h. The time-response curves of both two concentrations of neostigmine in the septic group showed significant upward shifts from those in the sham group (P < 0.001 for 0.1 μmol/L; P = 0.009 for 0.5 μmol/L). Meanwhile, the average optical density of AChE in the NMJ in the septic group was significantly lower than that in the sham group (0.517 ± 0.045 vs. 1.047 ± 0.087, P < 0.001). The AChE and AChETmRNA expression levels in the septic group were significantly lower than those in the sham group (P = 0.002 for AChE; P = 0.001 for AChET).</p><p><b>CONCLUSIONS</b>Sepsis strengthened the antagonistic actions of neostigmine on Roc-depressed twitch tension of the diaphragm by inhibiting the activity of AChE in the NMJ. The reduced content of AChE might be one of the possible causes of the decreased AChE activity in the NMJ.</p>
Subject(s)
Animals , Male , Rats , Acetylcholinesterase , Metabolism , Androstanols , Pharmacology , Cecum , Wounds and Injuries , Cholinesterase Inhibitors , Pharmacology , Diaphragm , Metabolism , Disease Models, Animal , Ligation , Neostigmine , Pharmacology , Neuromuscular Junction , Neuromuscular Nondepolarizing Agents , Pharmacology , Punctures , Random Allocation , Rats, Sprague-Dawley , SepsisABSTRACT
<p><b>OBJECTIVE</b>To prepare a drug-loading film using chitosan and carboxymethyl chitosan as the carrier materials for delivering matrine to oral ulcers.</p><p><b>METHODS</b>Matrine-loading films using chitosan or carboxymethyl chitosan as the carrier materials were prepared by solution casting method and orthogonal experiment at room temperature. The mechanical properties, surface morphology and drug-loading capacity of the drug-loading film were characterized using tensile test, scanning electron microscopy (SEM), swelling test and in vitro drug release test.</p><p><b>RESULTS</b>When the molecular weight of chitosan was 650 000 and the mass ratio of chitosan/glycerol was 1:1.4, the prepared film had the maximum mechanical strength and tensile modulus reaching 0.7875 MPa. SEM observation showed that matrine aggregated at the bottom of the drug-loading film with an asymmetrical distribution. The in vitro drug release test showed that the film had a high drug-loading capacity and a sustained drug release property. The duration of drug release from the drug-loading film was prolonged as the molecular weight of chitosan increased, reaching 23 h when the molecular weight of chitosan was 650 000. The duration of drug release was further increased to 108 h when the bottom of the drug-loading film was coated with a layer of 1% carboxymethyl chitosan.</p><p><b>CONCLUSION</b>The matrix materials of the drug-loading film are natural, green, nontoxic and biodegradable, and the preparation of the film is simple without using large quantities of organic solvents. The novel drug-loading film can obviously prolong the duration of drugs release for better local drug delivery to oral ulcers in a sustained manner.</p>
Subject(s)
Alkaloids , Chemistry , Chitosan , Chemistry , Delayed-Action Preparations , Drug Delivery Systems , Drug Liberation , Glycerol , Chemistry , Microscopy, Electron, Scanning , Quinolizines , ChemistryABSTRACT
<p><b>OBJECTIVE</b>To investigate the development of lactose intolerance in neonates with non-infectious diarrhea and its association with diarrhea, and to evaluate the diagnostic values of fecal pH value and urine galactose determination for neonatal lactase deficiency.</p><p><b>METHODS</b>Seventy hospitalized neonates who developed non-infectious diarrhea between October 2012 and June 2015 were enrolled as the diarrhea group, and 162 hospitalized neonates without non-infectious diarrhea were enrolled as the non-diarrhea group. Test paper was used to determine fecal pH value. The galactose oxidase method was used to detect urine galactose. The neonates with positive galactose oxidase were diagnosed with lactase deficiency, and those with lactase deficiency and diarrhea were diagnosed with lactose intolerance. According to the results of urine galactose detection, 69 neonates in the diarrhea group who underwent urine galactose detection were classified into lactose intolerance group (45 neonates) and lactose tolerance group (24 neonates), and their conditions after treatment were compared between the two groups. The follow-up visits were performed for neonates with diarrhea at 3 months after discharge.</p><p><b>RESULTS</b>Fecal pH value and positive rate of urine galactose (65% vs 54%) showed no significant differences between the diarrhea and non-diarrhea groups (P>0.05). Fecal pH value showed no significant difference between the lactose intolerance and lactose tolerance groups (P>0.05), while the neonates in the lactose intolerance group had a significantly longer time to recovery of defecation than those in the lactose tolerance group (P<0.05).</p><p><b>CONCLUSIONS</b>The incidence of lactase deficiency is high in neonates, and diarrhea due to lactose intolerance tends to occur. Determination of fecal pH value has no significance in the diagnosis of lactose intolerance in neonates with diarrhea.</p>
Subject(s)
Humans , Infant, Newborn , Diarrhea, Infantile , Galactose , Urine , Hydrogen-Ion Concentration , Lactase , Lactose IntoleranceABSTRACT
<p><b>BACKGROUND</b>Overexpression of G-protein coupled receptor 34 (GPR34) affects the progression and prognosis of human gastric adenocarcinoma, however, the role of GPR34 in gastric cancer development and progression has not been well-determined. The current study aimed to investigate the effect of GPR34 knockdown on the proliferation, migration, and apoptosis of HGC-27 gastric cancer cells and the underlying mechanisms.</p><p><b>METHODS</b>The expression of GPR34 in gastric cancer cell line HGC-27 was detected by quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. HGC-27 cells were employed to construct the stable GPR34 knockdown cell model in this study. Real-time RT-PCR and Western blotting were applied to validate the effect of short hairpin RNA (ShRNA) on the expression of GPR34 in HGC-27 gastric cells. The proliferation, migration of these cells were examined by Cell Counting Kit-8 and transwell. We also measured expression profile of PI3K/PDK1/AKT and ERK using Western blotting.</p><p><b>RESULTS</b>The ShRNA directed against GPR34 effectively inhibited both endogenous mRNA and protein expression levels of GPR34, and significantly down-regulated the expression of PIK3CB (P < 0.01), PIK3CD (P < 0.01), PDK1 (P < 0.01), phosphorylation of PDK1 (P < 0.01), Akt (P < 0.01), and ERK (P < 0.01). Furthermore, GPR34 knockdown resulted in an obvious reduction in HGC-27 cancer cell proliferation and migration activity (P < 0.01).</p><p><b>CONCLUSIONS</b>GPR34 knockdown impairs the proliferation and migration of HGC-27 gastric cancer cells in vitro and provides a potential implication for therapy of gastric cancer.</p>
Subject(s)
Humans , Apoptosis , Genetics , Physiology , Blotting, Western , Cell Line, Tumor , Cell Proliferation , Genetics , Physiology , RNA, Small Interfering , Genetics , Real-Time Polymerase Chain Reaction , Receptors, Lysophospholipid , Genetics , Metabolism , Stomach Neoplasms , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain.</p><p><b>METHODS</b>From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups (sliver needle group and TCM fumigation group) according to propotion of 1:1. In sliver needle group, there were 17 males and 13 females aged from 28 to 55 years old with an average age of (45.70 +/- 4.15), treated with sliver needle; In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of (43.03 +/- 5.86), treated with TCM fumigation. Changes of force-displacement distance (FDD), specific absorption rate (S) of two groups were observed before treatment, 1 week and 3 months after treatment respectively, VAS scoring and Roland-Morris disability questionnaire (RMDQ) were used to access clinical effects.</p><p><b>RESULTS</b>(1) VAS score of silver needle group was 4.77 +/- 0.78, 1.99 +/- 1.08 and 2.55 +/- 0.94, respectively before treatment, at 1 week and 3 months after treatment,while VAS score in TCM fumigation group were 4.43 +/- 0.61, 2.48 +/- 0.71 and 3.05 +/- 0.86, respectively. VAS score of two groups after treatment were sigificant decrease than that of before treatment (P < 0.05). There was no sigificant differences between two groups before treatment, but sliver needle group performed well in analgesia than TCM fumigation group, and had obvious differences (P < 0.05). RMDQ score of silver needle group was 13.63 +/- 1.96, 5.87 +/- 2.33 and 6.53 +/- 2.89, respectively before treatment, at 1 week and 3 months after treatment, while RMDQ score in TCM fumigation group were 13.40 +/- 2.01, 6.90 +/- 2.31, 9.23 +/- 2.87, respectively. There was no significant differences between two groups before treatment and 1 week after treatment (P > 0.05), and had obvious differences between two groups at 3 months after treatment (P < 0.01). Both groups could obvious improve dysfunction caused by chronic low back pain, and curative effect of sliver needle groups was more endurable. (2) Following-up at 3 months after treatment, FDD of multifidus, erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased (P < 0.05); In TCM fumigation group, FDD of multifidus and erector spinae on both side were increased at 1 week after treatment (P < 0.05), but had no significant meaning at 3 months after treatment on health side (P>0.05). There was no significant meaning before treatment (P > 0.05), FDD of multifidus, erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment (P < 0.05); but no obvious meaning on health side. FDD of both side in sliver needle group were obvious increased at 3 months after treatment. (3) There was correlation among differences of FDD in multifidus and erector spinae, VAS score and differences of RMDQ, and Spearman correlation coefficient R was 0.517, 0.811, 0.746 and 0.625; There was correlation between items of soft tissue tension and sympotoms, function and life quality. Conclusion:Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back, and improve objectivity of therapeutic evaluation for chronic low back pain.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acupuncture Therapy , Drugs, Chinese Herbal , Chemistry , Low Back Pain , Drug Therapy , Therapeutics , Muscle Tonus , Needles , Paraspinal MusclesABSTRACT
ObjectiveTo investigate the mechanism and prevention of invisible injury of recurrent laryngeal nerve (RLN) system in thyroid surgery, with the application of intraoperative neuromonitoring ( IONM ) system. MethodsThe type of invisible RLN injury and its protection with the application of IONM system were analyzed. ResultsThe causes of invisible RLN injury mainly included stretching of Berry ligament or the tumor,contusion, thermal injury, cutting of silk and suction injury. RLN invisible injury was recoverable through neurotrophic and symptomatic treatment. No permanent vocal cord paralysis occurred. ConclusionsWith the application of IONM system, some invisible type of RLN injuries can be found. The risk of RLN injury can be reduced if the surgical techniques are improved with the development of study on mechanism of IONM system.
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<p><b>OBJECTIVE</b>To evaluate the effectiveness and toxicity of sorafenib for advanced hepatocellular carcinoma.</p><p><b>METHODS</b>According to the Cochrane handbook for systematic review, two reviewers independently completed the whole process of literature search, study selection, data collection, and quality assessment. Seven electric databases(PubMed, Cochrane Library, Embase, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Chinese Scientific and Technical Journal Database, Chinese Medical Association Digital Periodicals Database) were searched and randomized controlled trials (RCT) of sorafenib in the treatment of advanced hepatocellular carcinoma were collected and analyzed.</p><p><b>RESULTS</b>Two RCT involving 828 patients were finally included. Compared with placebo, sorafenib significantly extended the overall survival and time to radiologic progression and improved the disease control rate. The main adverse effects were systemic, gastrointestinal, and dermatologic symptoms (grade 1 or 2 in severity), although the incidences were significantly higher in sorafenib groups than in control groups.</p><p><b>CONCLUSION</b>Sorafenib is effective and safe for the treatment of advanced hepatocellular carcinoma.</p>
Subject(s)
Humans , Antineoplastic Agents , Therapeutic Uses , Benzenesulfonates , Therapeutic Uses , Carcinoma, Hepatocellular , Drug Therapy , Liver Neoplasms , Drug Therapy , Niacinamide , Phenylurea Compounds , Pyridines , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To investigate the survival, growth and distribution of human amniotic epithelial cells (hAEC) after injected into injured rabbit vocal folds, in addition, to assess the ability of hAEC to affect the components of lamina propria extracellular matrix (ECM) and prevent vocal fold scarring.</p><p><b>METHODS</b>hAEC were isolated from human amnion and marked by Lenti-EGFP. Fifteen New Zealand rabbits were used for this experiment. EGFP-hAEC was injected into the left injured vocal folds in thirteen rabbits, and the contralateral thirteen vocal folds experienced an injured procedure only ("injured untreated control"), and four vocal folds were left as untreated controls. The survival, distribution, differentiation potential and secretion function of hAEC were examined by immunofluorescence method. HE staining and immunohistochemical staining were performed for the evaluation of collagen and fibronectin respectively.</p><p><b>RESULTS</b>hAEC showed a cobblestone-like growth. After implanted into the injured vocal folds, hAEC could survive in vocal fold lamina propria for 2 months. The immunofluorescence analysis showed the evidence of hAEC differentiation into muscle cells as well as secretion the ECM protein. Three months postoperatively, the density of collagen was higher in the injured untreated control folds than that in the injured vocal folds injected with hAEC and the untreated controls. Besides, the content of fibronectin in the injured untreated control group was significantly increased.</p><p><b>CONCLUSIONS</b>hAEC survived in the vocal folds lamina propria, and had the potentiality to differentiate into vocal folds tissue and secret some ECM components. The histological improvement caused by the injected cells demonstrate that hAEC had the ability to promote the repairment and regeneration of injured vocal folds.</p>
Subject(s)
Animals , Humans , Rabbits , Amnion , Cell Biology , Epithelial Cells , Transplantation , Regeneration , Transplantation, Heterologous , Vocal Cords , Pathology , General SurgeryABSTRACT
Objective To investigate the expression of heat shock protein-70(HSP70)in acute lung injury induced by paraquat poisoning.Methods A total of 72 Wistar rats were randomly divided into 3 groups(n=24 each group)and intraperitoneally injected with normal saline in group A,20 mg/kg paraquat in group B,and 40 mg/kg paraquat in group C.The lungs of rats were excised 1,3,6,12,and 24 hours after the injection,respectively.The expression of HSP70 in the lung tissue was detected by immunohistochemistry and Western blot.Results Paraquat induced acute lung injury in groups B and C.In group B,the expression of HSP70 increased at 2 hours,reached the peak at 6 hours,decreased at 12 hours,and returned to the baseline level at 24 hours.In group C,the expression of HSP70 increased at 1 hour,reached the peak at 3 hours,and returned to the baseline level at 24 hours.Conclusion Paraquat-induced acute lung injury may contribute to the enhanced expression of HSP70 in the bronchus,bronchiole,and alveolar epithelial cells,which indicates that HSP70 has a protective effect on lung injury.
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OBJECTIVE@#To assess the clinical application of spiral CT 3D reconstruction in forensic diagnosis of rib fracture.@*METHODS@#Thirty-five cases of rib fractures were collectively studied by X-ray, regular CT scan, and adoptive 3D reconstruction with spiral CT.@*RESULTS@#Clear and stereoscopic images of rib fractures without interference of the surrounding soft tissue were obtained in all of 35 cases examined.@*CONCLUSION@#Spiral CT 3D reconstruction could be a valuable means in forensic diagnosis of rib fracture.