Luz UVC como estratégia de desinfecção do ar e superfícies hospitalares / Luz UV-C como estrategia de desinfección del aire y superficies hospitalarias / UVC light as a strategy for disinfection of hospital air and surfaces

Resumo Objetivo Avaliar a eficácia antimicrobiana de um dispositivo fixo emissor de luz UV-C na desinfecção de diferentes superfícies do ambiente hospitalar e sua eficácia antifúngica na qualidade do ar. Métodos Estudo quase-experimental realizado em uma unidade de internação hospitalar, que utilizou o Bioamostrador de ar Andersen® de seis estágios para análise do ar; e na avaliação das superfícies, utilizaram-se três suspensões de microrganismos (Acinetobacter sp. MDR, Escherichia coli e Klebsiella pneumoniae produtora de KPC) para contaminar o ambiente. Para ambos foram feitas coletas pré (controle) e pós-acionamento da luz UV-C (teste). Resultados Na avaliação do ar houve uma redução importante da contagem de colônias após a luz UV-C e não foram encontrados fungos patogênicos ou toxigênicos em nenhum dos dois momentos. Em relação à desinfecção das superfícies, nenhum crescimento bacteriano foi observado após a intervenção da luz, demonstrando 100% de inativação bacteriana nas condições testadas. Conclusão A utilização da tecnologia com emissão de luz UV-C fixa foi eficaz e pode ser considerada uma intervenção promissora para protocolos de desinfecção de superfícies hospitalares.

Resumen Objetivo Evaluar la eficacia antimicrobiana de un dispositivo fijo emisor de luz UV-C para la desinfección de diferentes superficies del ambiente hospitalario y su eficacia antifúngica en la calidad del aire. Métodos Estudio cuasi experimental realizado en una unidad de internación hospitalaria, en que se utilizó el biomuestreador de aire Andersen® de seis etapas para el análisis del aire. En el análisis de las superficies, se utilizaron tres suspensiones de microorganismos (Acinetobacter sp. MDR, Escherichia coli y Klebsiella pneumoniae productora de KPC) para contaminar el ambiente. En ambos se tomó una muestra antes (control) y después de accionar la luz UV-C (prueba). Resultados En el análisis del aire hubo una reducción importante del recuento de colonias después de la luz UV-C y no se encontraron hongos patógenos ni toxigénicos en ninguno de los dos momentos. Con relación a la desinfección de las superficies, no se observó ningún crecimiento bacteriano después de la intervención de la luz, lo que demuestra un 100 % de inactivación bacteriana en las condiciones analizadas. Conclusión El uso de la tecnología con emisión de luz UV-C fija fue eficaz y puede ser considerada una intervención prometedora para protocolos de desinfección de superficies hospitalarias.

Abstract Objective To evaluate a fixed UV-C light emitting device for its antimicrobial effectiveness in the disinfection of distinct surfaces and its antifungal effectiveness on air quality in the hospital environment. Methods This quasi-experimental study was conducted in a hospital inpatient unit, in which a six-stage air Biosampler (Andersen®) was used for air analysis. In the evaluation of surfaces, three suspensions of microorganisms (Acinetobacter sp. multidrug-resistant, Escherichia coli, and KPC-producing Klebsiella pneumoniae) were used to contaminate the environment. In both evaluations, pre- (control) and post-activation of UV-C light (test) collections were made. Results In the air evaluation, an important reduction was observed in the colony count after irradiation with UV-C light, and pathogenic or toxigenic fungi were not found in either of the two moments. Regarding the disinfection of surfaces, no bacterial growth was observed after the application of UV-C light, showing 100% bacterial inactivation under the tested conditions. Conclusion The use of fixed UV-C light emission technology was effective and can be considered a promising intervention for hospital surface disinfection protocols.

Utility of Panoramic Radiographs in the Screening of Individuals with Edentulous Arches: A Need-Analysis Study

Abstract Objective: To evaluate the utility of panoramic radiographs in pre-prosthetic screening of edentulous arches. Material and Methods: Panoramic radiographs taken for three years were retrospectively analyzed. Observations from the radiographs shall be categorized and classified into either of the two categories, namely: 'findings with minimal impact on denture fabrication' and 'findings which affect denture fabrication and require further evaluation.' Anatomic variations, jaw pathologies, and residual ridge resorption patterns were assessed. Results: This study included the initial screening of 23,020 panoramic radiographs, out of which 505 (showing either one or both edentulous arches) were included for the study purpose. The age range of the subjects was from 21 to 94 years. 52.6% of the radiographs showed positive findings. More than half of the radiographs belonged to the males (52.5%). Hyperpneumatization of the maxillary sinus, crestal position of the mental foramen, and retained root fragments were the most common entities noted in the radiographs. Changes in the mental foramen were significantly higher in males than females (p=0.002). Conclusion: Observations from this study showed that panoramic radiographs have high utility for screening edentulous arches, and they should be used in routine clinical practice before denture fabrication.

Development and validation of equation for predicting body composition in elderly women / Desarrollo y validación de ecuaciones para la predicción de la composición corporal en ancianas / Desenvolvimento e validação de equações para predição da composição corporal em idosas

ABSTRACT Introduction: Body composition assessment (BCA) using anthropometric measurements (AM) is used to monitor the nutritional and health status of the elderly. As predictor variables, MAs must be valid, practical, and quick, as they favor adherence and avoid possible resistance and embarrassment on the part of those being assessed and being minimally invasive. Objective: To develop and validate equations using accessible and minimally invasive anthropometric measurements for BCA in elderly women. Methods: 100 women (68.1±6.15 years) were randomly assigned to two groups: validation (n=40; 68.1±6.15 years); and estimation (n=60; 68.4±6.70 years). DXA was selected as the criterion measure, and MAs (body mass, height, skinfolds, circumferences) were selected as predictor variables. Means were compared using the paired Student's t-test; correlations were verified using Pearson's r-test; equations using Multiple Linear Regression. The level of agreement between the groups' results was checked using the Bland-Altman technique. Results: Two equations developed and tested (E3 and E4) met the validation criteria as they showed adequate correlation coefficients (E3: r=0.73; E4: r=0.70), low constant errors (E3: EC= −0.56; E4: EC=-0.90), total error (E3: ET=3.22; E4: ET=3.06) lower than the Standard Error of Estimate (E3: EPE=3.24; E4: EPE=3.21), indicating no statistically significant difference between the two BCA techniques observed (p>0.05). The Bland-Altman technique showed good agreement between the results of the two techniques. Conclusion: Two were validated: E3 (%Gdxa= −41.556 + 4.041(BMI) + 0.165(DcCox) − 0.440(CircCox) + 0.269(CircQuad) − 0.053(BMI)²); and E4 (%GdxaE4= 15.329 + 1.044(BMI) −1.055(CircAbra) + 0.282(CircQuad) + 0.164(DcCox) − 0.262(CircCox)). Notably, the small number of measurements were located in areas of the body that are easily accessible and have little body exposure, which minimizes possible embarrassment and favors adherence by the elderly. Level of Evidence IV; Correlational study to build a predictive equation.

RESUMEN Introducción: La evaluación de la composición corporal (ECC) mediante medidas antropométricas (MA) se utiliza para monitorizar el estado nutricional y de salud de las personas mayores. Las MA, como variables predictoras, deben ser válidas, prácticas y rápidas, ya que favorecen la adherencia y evitan posibles resistencias y vergüenzas por parte de los evaluados, además de ser mínimamente invasivas. Objetivo: Desarrollar y validar ecuaciones utilizando medidas antropométricas de fácil acceso y mínimamente invasivas para la ECC en mujeres de edad avanzada. Métodos: 100 mujeres (68,1±6,15 años) asignadas aleatoriamente a dos grupos: validación (n=40; 68,1±6,15 años); estimación (n=60; 68,4±6,70 años). Se seleccionó la DXA como medida criterio, y las MA (masa corporal, estatura, pliegues cutáneos, circunferencias) como variables predictoras. Las medias se compararon mediante la prueba t de Student emparejada; las correlaciones se comprobaron mediante la prueba r de Pearson; las ecuaciones mediante Regresión Lineal Múltiple. El nivel de concordancia entre los resultados de los grupos se comprobó mediante la técnica de Bland-Altman. Resultados: Dos ecuaciones desarrolladas y probadas (E3 y E4) cumplieron los criterios de validación, ya que mostraron coeficientes de correlación adecuados (E3: r=0,73; E4: r=0,70), errores constantes bajos (E3: EC= −0,56; E4: EC=-0,90), error total (E3: ET=3,22; E4: ET=3,06) inferior al error estándar de estimación (E3: EPE=3,24; E4: EPE=3,21), lo que indica que no se observaron diferencias estadísticamente significativas entre las dos técnicas de ECC (p>0,05). La técnica de Bland-Altman mostró una buena concordancia entre los resultados de las dos técnicas. Conclusión: Se validaron dos: E3 (%Gdxa= −41,556 + 4,041(IMC) + 0,165(DcCox) − 0,440(CircCox) + 0,269(CircQuad) − 0,053(IMC)²); y E4 (%GdxaE4= 15,329 + 1,044(IMC) −1,055(CircAbra) + 0,282(CircQuad) + 0,164(DcCox) − 0,262(CircCox)). Es de destacar que el reducido número de mediciones se localizaron en zonas del cuerpo de fácil acceso y con poca exposición corporal, lo que minimiza posibles situaciones embarazosas y favorece la adherencia por parte de los ancianos. Nivel de Evidencia IV; Estudio correlacional para construir una ecuación predictiva.

RESUMO Introdução: A avaliação da composição corporal (ACC) com auxílio das medidas antropométricas (MA) é utilizado no acompanhamento do estado nutricional e de saúde das populações idosas. As MAs como variáveis preditoras, devem ser válidas, práticas e rápidas, pois favorecem a adesão e evitam possíveis resistências e constrangimento das avaliadas, além de minimamente invasivas. Objetivo: Desenvolver e validar equações utilizando medidas antropométricas de fácil acesso e minimamente invasivas, para ACC de idosas. Métodos: 100 mulheres (68,1±6,15 anos) distribuídas aleatoriamente por dois grupos: validação (n=40; 68,1±6,15 anos); estimativa (n=60; 68,4±6,70 anos). Como medida critério selecionou-se a DXA, como variáveis preditoras as MAs (massa corporal, estatura, dobras cutâneas, circunferências). As médias foram comparadas com o teste t de Student pareado; as correlações verificadas com o teste r Pearson; as equações com a Regressão Linear Múltipla. O nível de concordância entre os resultados dos grupos foi verificado com a técnica Bland-Altman. Resultados: Duas equações desenvolvidas e testadas (E3 e E4) atenderam aos critérios de validação, pois, apresentaram coeficientes de correlação adequados (E3: r=0,73; E4: r=0,70), erros constantes baixos (E3: EC= −0,56; E4: EC=-0,90), erro total (E3: ET=3,22; E4: ET=3,06) menores que o Erro Padrão de Estimativa (E3: EPE=3,24; E4: EPE=3,21), indicando não existir diferença estatisticamente significativa entre as duas técnicas de ACC observadas (p>0,05). A técnica Bland-Altman demonstrou boa concordância entre os resultados das duas técnicas. Conclusão: Duas equações foram validadas: E3 (%Gdxa= −41,556 + 4,041(IMC) + 0,165(DcCox) - 0,440(CircCox) + 0,269(CircQuad) - 0,053(IMC)²); e E4 (%GdxaE4= 15,329 + 1,044(IMC) −1,055(CircAbra) + 0,282(CircQuad) + 0,164(DcCox) - 0,262(CircCox)). Destaca-se o fato do reduzido número de medidas situarem-se em áreas corporais de fácil acesso e de pouca exposição corporal, que minimizam possíveis constrangimentos e favorecem a adesão das idosas. Nível de Evidência IV; Estudo correlacional para construção de equação preditiva.

Uso de los rayos X en la guerra hispano-cubano-norteamericana

En Cuba, el primer departamento de rayos X se inauguró en el año 1907 por Francisco Domínguez Roldán. Poco se divulga un contacto previo durante el siglo XIX, en la guerra hispano-norteamericana. Este artículo describe el uso de los rayos X en la guerra hispano-cubano-norteamericana y su importancia en la historia de la Radiología. Para esta contienda, la parte norteamericana preparó sus barcos hospitales. El ejército habilitó el Relief y el Missouri, mientras que la marina lo hizo con Solace. También se convirtieron en buques hospitales el Olivette y el Bay State. Todos contaban con equipos de rayos X. El capitán Borden publicó un libro en 1900 "El uso de los rayos Roentgen por el departamento médico de la armada estadounidense en la guerra con España (1898)" que marcó un antes y un después en el uso de los rayos X. Este fue un hecho trascendental para la historia de la Radiología y favoreció un avance considerable en la sanidad militar y civil.

In Cuba, the first X-ray department was set up in 1907 by Francisco Domínguez Roldán. Little is reported about a previous contact during the 19th century in the Spanish-Cuban-American war. This article describes the use of X-rays in the Spanish-Cuban-American war and its importance in the history of Radiology. For this war the American side prepared its hospital ships. The Army fitted out the Relief and the Missouri, while the Navy did it with the Solace. The Olivette and the Bay State also became hospital ships. All were equipped with X-ray equipment. Captain Borden published a book in 1900 "The Use of Roentgen Rays by the Medical Department of the U.S. Navy in the War with Spain (1898)" which marked a before and after in the use of X-rays. This was a transcendental fact for the history of Radiology and favored a considerable advance in military and civilian health.

Could the radiographic image quality be affected by the excessive use of the photostimulable phosphor plate?

Abstract The study aimed to assess the influence of excessive use of a photostimulable phosphor plate (PSP) on the density, image noise, and contrast of radiographs. For that, radiographs of an acrylic block were acquired with a PSP of the Express intraoral system to assess the density and image noise. Initially, five images were obtained and exported (first group). After 400 exposures to X-rays and scannings of PSP, other five images were obtained and exported (second group). The same procedure was done after 800 (third group), 1200 (fourth group), 1600 (fifth group), and 2000 acquisitions (sixth group), resulting in 30 images to be evaluated. The mean and standard deviation of the gray values were calculated for the images using the ImageJ software. For contrast analysis, radiographs of an aluminum step-wedge were acquired with a new PSP following the same acquisition intervals. The percentage of contrast variation was calculated. Another two unused PSP receptors were employed to evaluate the method's reproducibility. The comparison of the results among the acquisition groups was performed with one-way Analysis of Variance (α=0.05). Intraclass Correlation Coefficient (ICC) assessed the reproducibility of the receptors. Image noise did not differ among the groups (p>0.05). There was a slight increase in density after 400 acquisitions and a slight difference in contrast for all acquisition groups without a pattern of increase or decrease (p<0.05). ICC showed excellent reliability for the methods. Therefore, excessive PSP use slightly affected the radiograph's density and contrast.

Resumo Objetivou-se avaliar a influência do uso excessivo de uma placa de fósforo fotoestimulável (PSP) na densidade, ruído e contraste das radiografias. Foram adquiridas radiografias de um bloco de acrílico com uma PSP do sistema intraoral Express para avaliar a densidade e o ruído da imagem. Inicialmente, cinco imagens foram obtidas e exportadas (primeiro grupo). Após 400 exposições aos raios X e escaneamentos, outras cinco imagens foram obtidas e exportadas (segundo grupo). O mesmo procedimento foi feito após 800 (terceiro grupo), 1200 (quarto grupo), 1600 (quinto grupo) e 2000 aquisições (sexto grupo), resultando em 30 imagens a serem avaliadas. A média e o desvio padrão dos valores de cinza foram calculados para as imagens usando o software ImageJ. Para análise de contraste, foram adquiridas radiografias de uma escala de alumínio com uma nova PSP seguindo os mesmos intervalos de aquisição. A porcentagem de variação do contraste foi calculada. Outras duas PSP sem uso prévio foram utilizadas para avaliar a reprodutibilidade dos métodos. A comparação dos resultados entre os grupos de aquisição foi realizada pela Análise de Variância one-way (α=0,05). O Coeficiente de Correlação Intraclasse (ICC) avaliou a reprodutibilidade dos receptores. O ruído da imagem não diferiu entre os grupos (p>0,05). Houve um leve aumento na densidade após 400 aquisições e uma pequena diferença no contraste para todos os grupos de aquisição sem padrão de aumento ou diminuição (p<0,05). O ICC mostrou excelente confiabilidade para os métodos. Portanto, o uso excessivo da PSP afetou levemente a densidade e o contraste radiográfico.

Survey on the awareness and application of radiation shielding specifications for γ-ray radiotherapy room / 中国职业医学

Objective: To investigate the implementation of GBZ/T 201.3-2014 Radiation Shielding Specification for Radiotherapy Room--Part 3: Radiotherapy Room of γ-ray Sources (hereinafter referred to GBZ/T 201.3-2014). Methods: A total of 129 personnels, who were involved in the approval and supervision of radiation diagnosis and treatment construction projects in 19 provincial administrative agencies, engaged in radiation protection testing and evaluation of γ-ray radiotherapy rooms in radiation health technology service institutions, and used GBZ/T 201.3-2014 in other institutions (environmental impact assessment, education and scientific research), were selected as the participants using a stratified random sampling method. A questionnaire survey was conducted to assess their awareness and application of the standard. Results: The participants' awareness of GBZ/T 201.3-2014 was ≥63.6%, but the training rate was only 9.1% to 50.0%. The familiarity with the various chapters of the standard was over 86.4%. And 42.6% of the participants reported using the standard at least once a year. Regarding the applicability of the standard, all of the participants believed that the standard meets the needs of approval, supervision, testing, or evaluation, and adapts to the updated development of radiotherapy equipment and technology. And 94.6% of the participants believed that the use of the standard could improve the level of protection design and management, and 92.2% believed that the standard was widely applied. Regarding the adequacy of the standard, 97.7% of the participants believed that the standard's reference for ambient dose equivalent rate was reasonable, while 34.1% believed that the standard needs revision. Conclusion: The participants are satisfied with the standard and believe its applicability. They have a good level of awareness of the standard, but there is a room for improvement in their familiarity with the shielding calculation related content of the standard. The promotion, training, and practicality of the standard need to be strengthened.

Multivariate correlation analysis of T1S and C7S / 中国骨伤

OBJECTIVE@#To determine whether C7 angles (C7 slope, C7S) could replace T1 angles (T1 slope, T1S) by correlation analysis of T1S and C7S.@*METHODS@#A total of 442 patients from July 2015 to July 2020 in outpatient and inpatient department were enrolled retrospectively, and 259 patients who could identify the upper endplate of T1 were screened out . Of them, there were 145 males and 114 females, aged from 20 to 83 years old with an average of (58.6±11.2) years, including 163 patients with cervical spine surgery and 96 non-surgical patients. Patients were stratified by sex, age, cervical kyphosis, cervical alignment imbalance, and cervical spine surgery. These 259 patients included 145 cases in the male group, 114 cases in the female group;76 cases in the youth group (<40 years old), 109 cases in the middle-aged group (40 to 60 years old), and 74 cases in the elderly group(>60 years old); 92 cases in the cervical kyphosis group, 167 cases in the non-kyphosis group;51 cases in the cervical sequence imbalance group, 208 cases in the non-imbalance group;163 cases in the cervical surgery group, 96 cases in the non-operation group. The correlations of C7S and T1S in various modalities groups were analyzed.@*RESULTS@#Of 442 patients, the recognition rate of upper endplate of T1 was 58.6%(259/442), and that of C7 was 90.7%. The mean T1S and C7S of the 259 patients were (24.5±8.0)° [(25.9±7.7)° in the male group and (23.7±6.9)° in the female group] and (20.8±7.3)° [(22.5±7.5)° in the male group and(19.7±5.8)° in the female group], respectively. The total correlation coefficient between C7S and T1S was r=0.89, R2=0.79, and the linear regression equation was T1S=0.91×C7S+4.35. In the above general information and the grouping of deformity factors, T1S was highly correlated with C7S(r value 0.85 to 0.92, P<0.05).@*CONCLUSION@#There is a high correlation between T1S and C7S in different factor groups. For cases where T1S cannot be measured, C7S can be used to provide guidance and reference for evaluating the sagittal balance of the spine, analyzing the condition, and formulating surgical plans.

Ultraviolet radiation and the human eye / Radiações ultravioletas e o olho humano

ABSTRACT This work is a critical review of the current understanding of the effect of ultraviolet radiation on the eye. It deals with the classification of this radiation, environmental level, and the factors that determine it, along with penetration into the human eye, toxicity to ocular structures, associated morbidities, events that may increase the vulnerability of the eye, and artificial eye filters.

RESUMO Esta é uma revisão crítica do efeito da radiação ul travioleta no olho. Trata da classificação dessa radiação, nível no meio ambiente e os fatores que o determinam, penetração no olho humano, toxicidade às estruturas dos oculares, morbidades associadas, eventos passíveis de aumentar a vulnerabilidade do olho e filtros oculares artificiais. Discute, ainda, o risco real dessas radiações ao olho humano à luz do conhecimento atual.

The probable radioprotective role of Acacia nilotica L. against biochemical and cytogenetic disorders induced in gamma irradiated male rats

Gum Arabic (Acacia nilotica L.) is a respected plant that has many nutrients and curative practices. It hinders, improves, or manages many disorders. The radio-protective activity of Acacia nilotica was investigated against γ-rays-induced testicle damage in rats. Twenty-four rats were correspondingly distributed into 4 groups; control, Acacia nilotica (15mg/kg, daily for 30 days), γ-irradiated (5Gy γ-rays, single dose) and Acacia nilotica plus γ-rays treated groups. The plasma testosterone and total antioxidant status (TAS) were estimated. Lipid peroxidation; malondialdehyde (MDA), reduced glutathione (GSH), malondialdehyde (MDA), superoxide dismutase (SOD), also glutathione peroxidase (GPx), catalase (CAT), tumor necrosis factor-α (TNF-α) with interleukin-1ß (IL-1ß), were determined in the testicle tissues. A testis weight, sperm count and motility, peripheral-blood and bone-marrow micronuclei (PMN and BMN), and frequency of chromosomal aberrations (CAs) were scored. A significant decline in the levels of plasma testosterone with TAS observed in the γ-irradiated rats. The results also showed significantly increased levels of testicle MDA, inflammatory markers, PMN, BMN and CAs frequencies and decrease in testes weight, sperm count and motility and levels of testicle antioxidants markers in gamma irradiated group. All these biochemical and fertility indices results were significantly enhanced in the Acacia nilotica plus γ-rays treated groups. However, the possible alleviate activity of Acacia nilotica on γ-rays-induced testicle injury in rats has not previously conversed, and this is the topic of this study.

Xeroderma pigmentosum: case report / Xeroderma pigmentoso: relato de caso

Abstract Objective: The aim of this study was to describe the disease and treatment and to alert health professionals for the identification of signs and symptoms and the need for an early diagnosis in patients with xeroderma pigmentosum (XP). Case description: An 8-year-old male patient was referred to the Joana de Gusmão Hospital (HIJG) in 2021 for evaluation and specialized care. Previously, the child was followed in his place of origin by oncologic and palliative care, where he was submitted to surgeries and chemotherapy. He was admitted to the HIJG using vismodegib, acitrein, tramadol, and solar protective measures. On physical examination, there were tumors and disseminated macular verrucous and ulcerated lesions. The imaging examination showed solid and expansive lesions on the face, and atelectasis and fibroscarring changes in the lung. The histopathological report proved the existence of melanocanthoma, carcinoma, and pyogenic granuloma. After the evaluation of the case, no surgery, chemotherapy, or radiotherapy was performed. It was decided to maintain the palliative treatment and to continue the use of tramadol for pain, and vismodegib and acitretin were used to control carcinomas and prophylactic measures. Comments: The XP is a rare disease of autosomal recessive inheritance whose mechanism comes from failure in the DNA repair by exposure to ultraviolet rays, resulting in lesions on the skin and mucous membranes. They start as sunburns and can progress to melanosis, areas with altered pigmentation, premature aging, poikiloderma, and areas of high risk for neoplasms.

RESUMO Objetivo: Descrever a patologia e o tratamento realizado e alertar profissionais de saúde sobre os sinais e sintomas e sobre a necessidade de diagnóstico precoce em pacientes com xeroderma pigmentoso (XP). Descrição do caso: Paciente do sexo masculino, oito anos, foi encaminhado ao Hospital Joana de Gusmão (HIJG) em 2021, com dianóstico de XP, para avaliação e atendimento especializado. Anteriomente, encontrava-se em serviço de oncologia e de cuidados paliativos em sua cidade de origem, mas já realizara cirurgias e quimioterapias previamente. Foi internado no HIJG em uso de vismodegibe, acitretina, tramadol e medidas de proteção solar. Ao exame físico, apresentou lesões maculares, verrucosas, ulceradas e tumores pelo corpo. Os exames de imagem revelaram lesões sólidas e expansivas na face e atelectasias e alterações fibrocicroscópicas no pulmão. O laudo histopatológico comprovou a existência de melanocantoma, carcinoma e granuloma piogênico. Após a avaliação do caso, optou-se por não realizar cirurgias, quimioterapia nem radioterapia. Decidiu-se manter o tratamento paliativo, continuando o uso de tramadol para dor, vismodegibe e acitretina para o controle de carcinomas e profilaxia à exposição ao sol. Comentários: O XP é uma doença rara de herança autossômica recessiva, cujo mecanismo provém de falha no reparo do DNA pela exposição à luz ultravioleta, resultando em lesões de pele e mucosas. Inicia-se como queimaduras solares e pode avançar para melanoses, áreas com pigmentação alterada, envelhecimento precoce, poiquilodermia e áreas de alto risco neoplásico.

Clinical study of radiation exposure from atrial fibrillation catheter ablation guided by magnetic navigation system and cryoballoon / 中华放射医学与防护杂志

Objective:To identify the method to reduce X-ray exposure during ablation of atrial fibrillation (AF) by comparing the cryoballoon (CRYO) ablation and remote magnetic navigation (RMN) ablation.Methods:A retrospective analysis was conducted on 144 patients undergoing CRYO ablation (CRYO group) and 121 patients undergoing RMN ablation (RMN group) in our hospital. Entrance surface doses at reference points online, exposure time during procedure and outcomes were analyzed for different types of patients.Results:Compared with the RMN group, the procedure time for the CRYO group significantly decreased [(165.0±23.6), (97.8±18.4) min, t=26.05, P<0.001]. However, the entrance surface dose value [(232.3±130.7), (669.0±387.5) mGy, Z=-12.29, P<0.001] and X-ray exposure time [(8.1±3.1), (23.4±6.2) min, t=-24.57, P<0.001] increased significantly for the CRYO group. No significant difference was found between the two groups in the proportion of maintaining sinus rhythm during follow-up of patients (71.9%, 75.7%, P=0.618). Multiple regression analysis showed that obese patients, patients with non-paroxysmal AF and patients with variant pulmonary veins were associated with an increase in entrance surface dose values in the CRYO group ( t=5.47, 2.23, 3.39, P<0.05). The X-ray exposure time for the three types patients above in the CRYO group also increased ( t=2.87, 3.86, 3.25, P<0.05) in the CRYO group. However, only obese patients in the RMN group had an increase in entrance surface dose value ( Z=-4.15, P<0.001) and no increase in exposure time. For the three types of patients above, there was no significant difference in proportion of maintaining sinus rhythm between the CRYO group and the RMN group during follow-up ( P>0.05). Conclusions:Compared with RMN ablation, the radiation exposure of CRYO AF ablation significantly increased, especially in obese patients, patients with non-paroxysmal AF and patients with pulmonary veins variation. The use of RMN for these types of patients may reduce the radiation exposure without affecting the procedure outcomes.

Analysis of misdiagnosed cases of neck, shoulder, waist and leg pain caused by bone metastases and early warning measures / 中国基层医药

Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.

Malformaciones arteriovenosas pulmonares: presentación de un caso clínico pediátrico y revisión de la literatura / Pulmonary arteriovenous malformations: presentation of a pediatric case and review of the literature

Las malformaciones arteriovenosas pulmonares (MAVP) consisten en comunicaciones directas entre el sistema arterial y el sistema venoso pulmonar, sin paso de la sangre por el lecho capilar, produciéndose un cortocircuito de derecha a izquierda extracardíaco, pueden ser congénitas o adquiridas. Algunos casos pueden ser asintomáticos, en cambio en otros pueden ocasionar diversas manifestaciones clínicas y se pueden asociar a complicaciones severas. En niños se observa una baja incidencia y son más frecuentes las formas congénitas. La MAVP se debe sospechar por las manifestaciones clínicas y las imágenes de la radiografía de tórax (RxTx) y su confirmación se realiza mediante una AngioTomografía Computada (TC) de tórax. La embolización endovascular es actualmente el tratamiento de elección, con excelentes resultados, aunque requiere de un seguimiento posterior y de un operador experimentado. Reportamos el caso de una niña que ingresó con clínica muy sugerente, incluyendo: disnea, acropaquia, cianosis periférica, e hipoxemia refractaria. Sin embargo, inicialmente el cuadro clínico fue confundido con una crisis asmática. La Angio-TC de tórax confirmó el diagnóstico y el tratamiento mediante embolización endovascular resultó exitoso.

Pulmonary arteriovenous malformations (PAVM) are communications between the arterial and the pulmonary venous system, without passage of blood through the capillary bed, causing a left to right extracardiac shunt. Some cases may be asymptomatic, while others may cause various clinical manifestations and may be associated with severe complications. In children a low incidence is observed, and congenital forms are more frequent. PAVM should be suspected by clinical manifestations and chest x-ray imaging and confirmed by chest Computed Tomography Angiography (CTA). Endovascular embolization is currently the treatment of choice, with excellent results, although it requires subsequent follow-up. We report a patient who was admitted with a very suggestive clinical history, including: dyspnea, clubbing, peripheral cyanosis, and severe hypoxemia, refractory to oxygen therapy. However, initially the clinical picture was confounded with an asthmatic crisis. CTA confirmed the diagnosis and treatment by endovascular embolization was successful.

Sunlight Exposure vs Oral Vitamin D Supplementation for Prevention of Vitamin D Deficiency in Infancy: ARandomized Controlled Trial

Objective: To compare the efficacy of sunlight exposure and oral vitamin D3 supplementation to achieve vitamin D sufficiency in infants at 6 months of age. Design: Open-label randomized controlled trial. Setting: Public hospital in Northern India (28.7°N). Participant: Breastfed infants at 6-8 weeks of age. Intervention: Randomized to receive sunlight exposure (40% body surface area for a minimum of 30 minutes/week) or oral vitamin D3 supplementation (400 IU/day) till 6 months of age. Outcome: Primary - proportion of infants having vitamin D sufficiency (>20 ng/mL). Secondary - proportion of infants developing vitamin D deficiency (<12ng/mL) and rickets in both the groups at 6 months of age. Results: Eighty (40 in each group) infants with mean (SD) age 47.8 (4.5) days were enrolled. The proportion of infants with vitamin D sufficiency increased after intervention in the vitamin D group from 10.8% to 35.1% (P=0.01) but remained the same in sunlight group (13.9%) and was significant on comparison between both groups (P=0.037). The mean (SD) compliance rate was 72.9 (3.4)% and 59.7 (23.6)% in the vitamin D and sunlight group, respectively (P=0.01). The geometric mean (95% CI) serum 25(OH) D levels in the vitamin D and sunlight group were 16.23 (13.58-19.40) and 11.89 (9.93-14.23) ng/mL, respectively; (P=0.02), after adjusting baseline serum 25(OH)D with a geometric mean ratio of 1.36 (1.06-1.76). Two infants in sunlight group developed rickets. Conclusion: Oral vitamin D3 supplementation is more efficacious than sunlight in achieving vitamin D sufficiency in breastfed infants during the first 6 months of life due to better compliance.

Fibroblast morphology, growth rate and gene expression in facial melasma

Abstract Background: In addition to melanocytic hyperfunction, changes are observed in the upper dermis of melasma, and fibroblasts play a central role in collagen synthesis and pigmentation induction. Objective: To explore the morphology, growth rate, and gene expression profile of fibroblasts from the skin with melasma in comparison to fibroblasts from the adjacent healthy skin. Methods: Ten women with facial melasma were biopsied (lesion and adjacent healthy skin), and the fragments were processed for fibroblast culture. Samples from five participants were seeded to evaluate growth (days 2, 5 and 8) and senescence (SA-β-gal) curves. The samples from the other participants were submitted to real-time PCR to comparatively evaluation of the expression of 39 genes. Results: Cultured fibroblasts from melasma skin were morphologically less fusiform in appearance and on average a 34% (95% CI 4%-63%) greater proportion of cells labeled with SA-β-gal than the fibroblasts from the adjacent skin. The cell growth rate was lower for the melasma samples after eight days (p < 0.01). The WNT3A, EDN3, ESR2, PTG2, MMP1, and SOD2 genes were up-regulated, whereas the COL4A1, CSF2, DKK3, COL7A1, TIMP4, CCL2, and CDH11 genes were down-regulated in melasma skin fibroblasts when compared to the ones from adjacent healthy skin. Study limitations: Small sample size; absence of functional tests. Conclusions: Fibroblasts from the skin with melasma showed a lower growth rate, less fusiform morphology and greater accumulation of SA-β-gal than those from adjacent photo exposed skin. Moreover, their gene expression profile comprised factors that may contribute to upper dermis damage and sustained melanogenesis.

Are inflammatory parameters an independent predictor of hip osteoarthritis severity? A prospective cross-sectional study

SUMMARY OBJECTIVE: This study aimed to investigate the relationship between the presence of hip osteoarthritis and the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and neutrophil-monocyte ratio. METHODS: Participants with hip osteoarthritis and healthy controls aged 45-75 years were recruited in the study. The participants with hip osteoarthritis were divided into two groups: mild/moderate hip osteoarthritis and severe hip osteoarthritis. Complete blood parameters of the participants were recorded, and neutrophil-lymphocyte ratio, neutrophil-monocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio were calculated. Pain severity was evaluated using a visual analog scale. RESULTS: A total of 76 participants with hip osteoarthritis and 59 healthy controls were included in the study. The mean age of the participants was 57.6±6.11 years. Mean neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were statistically significantly different between the hip osteoarthritis group and healthy control group (p<0.05). Platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values were not significantly different between the groups. Also, there was no difference between all inflammatory parameters and hip osteoarthritis severity (p>0.05). CONCLUSIONS: Neutrophil-lymphocyte ratio and neutrophil-monocyte ratio values were higher in patients with hip osteoarthritis than in healthy controls. Mean platelet-lymphocyte ratio, monocyte-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein values did not change according to the presence of hip osteoarthritis. Not all hematological indices give valuable information regarding the severity of hip osteoarthritis.

Principles Of Ultrasound Technology In Medical Imaging Of Non Ionization Images

The X-ray tube is one of the most important components in any X-ray system. In the beginning, physicists and physicians used gas ion tubes. The so-called Coolidge tube applied a high vacuum and is still used today. Medical examinations have required continuously improved designs of X-ray tubes (smaller focal spots at a higher output). The principle of the Goetze line focus is still applied in any diagnostic X-ray tube. Different anode materials and the rotating anode contributed to an increased output and reduced exposure time. Bearings needed special attention. Spiral groove bearings are the most advanced design today. The heat storage capacity of the anode and the tube housing assembly influences examination time and patient throughput. Cardiac imaging required less motion blurring in cine film images and increasing radiation exposure in interventional procedures called for measures to reduce dose. Protection against radiation and electric shock has always been a concern of design engineers. Focal spot sizes dedicated to specific applications and heat management within the total tube housing assembly will be future issues. Even with the event of ultrasound and MR technology, X-ray procedures will still be applied for diagnostic and interventional purposes.

Actualización en equipos de Rayos X portátiles en odontología: revisión de literatura / Update on Hand-Held X-Ray Devices in Dentistry: a Literature Review

Resumen En las últimas dos décadas ha aumentado el uso de equipos portátiles de rayos X intraorales, los cuales son estabilizados por el operador. Si bien todos los equipos radiográficos presentan un riesgo inherente por el uso de radiación ionizante, el uso indebido de los equipos portátiles puede aumentar la exposición del operador. Se recomienda el uso de los equipos portátiles en un trípode o activados desde un área protegida. Sin embargo, en casos altamente justificados para su uso sin estos aditamentos, se debe seguir recomendaciones para disminuir la exposición del operador. Debido a que la radioprotección es fundamental al trabajar con rayos X, se debe favorecer el uso de equipos radiográficos dentales fijos sobre los equipos portátiles, ya que estos proporcionan una menor dosis de radiación al operador.

Abstract In the last two decades, the use of portable intraoral X-ray devices, stabilized by the operator, has increased. While all radiographic devices present an inherent risk from ionizing radiation, improper use of portable devices can increase operator exposure. Use of portable devices on a tripod or powered from a protected area is recommended. However, in highly justified cases, for using without these accessories, recommendations should be followed to reduce operator exposure. Because radioprotection is essential when using X-rays, fixed dental radiographic devices should be favored over portable equipment since the first provides a lower radiation dose to the operator.

Perception of Orthopedics Surgeons about the Risks of Radiation Exposure in Fluoroscopy / Percepção de cirurgiões ortopédicos sobre os riscos da exposição à radiação na fluoroscopia

Abstract Objective The present study aims to understand the perceptions of orthopedists and traumatologists regarding the risk of exposure to ionizing radiation in fluoroscopy procedures. Methods An objective, structured, self-administered questionnaire with sociodemographic, professional, and occupational variables was developed, available through an invitation sent to orthopedist physicians whose contacts were made publicly available. Results A total of 141 questionnaires were answered and analyzed. Most respondents (99%) use fluoroscopy in their surgeries, and only 34.8% of the participants feel safe with the use of the equipment. It was observed that the knowledge about ionizing radiation is inadequate, because 22.6% of the participants are unaware of the type of radiation emitted in fluoroscopy and its biological effects. In addition, 52% of the participants did not know or do not understand the principles of radiological protection and their relationship with surgical practices. Conclusion We concluded that the radiological protection of most orthopedists in surgical procedures is inadequate, and initial and continued training programs of professionals are necessary, bringing health benefits to orthopedists and their patients.

Resumo Objetivo Este estudo visa compreender as percepções dos médicos ortopedistas e traumatologistas em relação ao risco da exposição à radiação ionizante nos procedimentos de fluoroscopia. Métodos Desenvolveu-se um questionário objetivo, estruturado, autoaplicável e com variáveis sociodemográficas, profissionais e ocupacionais, disponibilizado através de convite enviado a médicos ortopedistas cujos contatos estavam disponibilizados publicamente. Resultados Foram respondidos e analisados 141 questionários. A maioria dos respondentes (99%) utilizam a fluoroscopia em suas cirurgias, e apenas 34,8% dos participantes se sentem seguros com o uso do equipamento. Observou-se que o conhecimento sobre radiação ionizante é inadequado, pois 22,6% dos respondentes desconhecem o tipo de radiação emitida na fluoroscopia e seus efeitos biológicos. Além disso, 52% dos respondentes não conhecem ou não compreendem os princípios de proteção radiológica e suas relações com as práticas cirúrgicas. Conclusão Conclui-se que a proteção radiológica da maioria dos ortopedistas nos procedimentos cirúrgicos é inadequada e são necessários programas de formação inicial e continuada dos profissionais, trazendo benefícios para a saúde dos ortopedistas e de seus pacientes.

UVB irradiation differential regulate miRNAs expression in skin photoaging

Abstract Background: UVB irradiation can cause acute damage such as sunburn, or photoaging and melanoma, all of which are major health threats. Objective: This study was designed to investigate the mechanism of skin photoaging induced by UVB radiation in mice through the analysis of the differential expression of miRNAs. Methods: A UVB irradiation photoaging model was constructed. HE and Masson special stains were used to examine the modifications in the epidermis and dermis of mice. The miRNA expression profiles of the mouse skin model exposed to UVB radiation and the normal skin of mice were analyzed using miRNA-sequence analysis. GO and Pathway analysis were employed for the prediction of miRNA targets. Results: A total of 23 miRNAs were evaluated for significantly different expressions in comparison to normal skin. Among them, 7 miRNAs were up-regulated and 16 were down-regulated in the skin with photoaging of mice exposed to UVB irradiation. The differential expression of miRNA is related to a variety of signal transduction pathways, among which mmu-miR-195a-5p and mitogen-activated protein kinase (MAPK) signal pathways are crucial. There was a significant differential expression of miRNA in the skin of normal mice in comparison with the skin with photoaging induced by UVB irradiation. Study limitations: Due to time and energy constraints, the specific protein level verification, MAPK pathway exploration, and miR-195a-5p downstream molecular mechanism need to be further studied in the future. Conclusions: UVB-induced skin photoaging can be diagnosed and treated using miRNA.