Use of Thread-hanging Microwave Antenna to Assist in Precise Puncture of Lung Nodule and Influencing Factors / 肿瘤防治研究

Objective To explore a precise method with a microwave antenna for puncture of pulmonary nodules and analyze phenomena that affect the puncture results. Methods Clinical data of 107 cases with solitary malignant pulmonary nodules were collected, and the mean length of pulmonary nodules was 13.6±0.6 mm in CT axial position. A thread-hanging method was used to assist the puncture of pulmonary nodules. The procedure was successful when the needle was not withdrawn and inserted into the central region of the nodule. The success rate and complications of the pulmonary procedure were recorded. The incidence of the following phenomena were also documented: needle coercing, needle slipping, needle tip pushing, pulmonary nodule prolapsing, radial nodule deformation, nodular masking, and radial movement distance of needle tip. Results In all of 107 cases evaluated, the antenna puncture was successful in 101 cases (94.4%) but failed in 6 cases (5.6%). Pneumothorax and pulmonary hemorrhage occurred in 23 (21.5%) and 19 cases (17.8%), respectively. The following phenomena occurred: needle coercing in 9 cases (8.4%), needle slipping in 6 cases (5.6%), needle tip pushing in 19 cases (17.8%), pulmonary nodule prolapsing in 15 cases (14%), radial nodule deformation in 14 cases (13.1%), and nodular masking in 5 cases (4.7%). The mean radial adjusting distance of needle tip was 0.7±0.4 cm. Conclusion The thread-hanging method can assist in the accurate puncture of microwave antenna for pulmonary nodules. We should focus and deal with phenomena that may occur and affect the result of puncture.

High risk factors in images for infiltrating lung adenocarcinoma manifesting as peripheral ground-glass nodules / 中国胸心血管外科临床杂志

@#Objective     To explore the correlation between the imaging features of peripheral ground-glass pulmonary nodules and the invasion degree of lung adenocarcinoma, and the high risk factors for infiltrating lung adenocarcinoma under thin-slice CT, which provides some reference for clinicians to plan the surgical methods of pulmonary nodules before operation and to better communicate with patients, and assists in building a clinical predictive model for invasive adenocarcinoma. Methods    Clinical data of the patients with peripheral ground-glass pulmonary nodules (diameter≤3 cm) in thin-slice chest CT in the First Affiliated Hospital of Soochow University from January 2019 to January 2020 were continuously collected. All patients underwent thin-slice CT scan and thoracoscopic surgery in our center. According to the pathological examination results, they were divided into two groups: an adenocarcinoma lesions before infiltration group, and an invasive lung adenocarcinoma group. The thin-slice CT imaging parameters of pulmonary nodules were collected. The nodular diameter, mean CT value, consolidation tumor ratio (CTR), nodular shape, vacuolar sign, bronchial air sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign and other clinical data were collected. Univariate and multivariate analyses were conducted to analyze the independent risk factors for the infiltrating lung adenocarcinoma, and to analyze the threshold value and efficacy of each factor for the identification of infiltrating lung adenocarcinoma. Results     Finally 190 patients were enrolled. There were 110 patients in the adenocarcinoma lesions before infiltration group, including 21 males and 89 females with a mean age of 53.57±10.90 years, and 80 patients in the invasive lung adenocarcinoma group, including 31 males and 49 females with a mean age of 56.45±11.30 years. There was a statistical difference in the mean CT value, nodular diameter, CTR, gender, smoking, nodular type, nodular shape, vacuolar sign, lobulation sign, burr sign, lesion boundary, pleural depression sign, vascular cluster sign between the two groups (P<0.05). However, there was no statistical difference between the two groups in age (P=0.081), lesion site (P=0.675), and bronchial air sign (P=0.051). Multiple logistic regression analysis showed that nodular diameter, mean CT value, CTR and lobulation sign were independent risk factors for differentiating preinvasive adenocarcinoma from invasive adenocarcinoma. At the same time, the threshold value was calculated by Youden index, indicating that the CTR was 0.45, the nodal diameter was 10.5 mm and the mean CT value was –452 Hu. Conclusion     In the peripheral ground-glass pulmonary nodules, according to the patient's CT imaging features, such as mixed ground-glass nodules, irregular shapes, vacuoles, short burrs, clear boundaries, pleural indentations, and vascular clusters, have a certain reference value in the discrimination of the invasion degree of ground-glass pulmonary nodules. At the same time, it is found in this research that peripheral ground-glass pulmonary nodules with diameter greater than 10.5 mm, CT value greater than –452 Hu, CTR greater than 0.45 and lobulation sign are more likely to be infiltrating lung adenocarcinoma.

Research progress on invasive cervical resorption / 口腔疾病防治

@#Tooth absorption can be divided into physiological absorption and pathological absorption. Root absorption of mature deciduous teeth is physiological absorption. Pathological absorption includes internal absorption and external absorption. Internal absorption, also known as intramedullary absorption, includes inflammatory absorption and alternative absorption. External tooth absorption originates from the outer surface of the root or the neck of the tooth and can be divided into inflammatory absorption, alternative absorption, pressure resorption and invasive cervical resorption. Invasive cervical resorption (ICR) is pathological damage caused by many factors, which usually begins in the cemento-enamel junction and extends peripherally or horizontally in the dentin. It hardly invades the pulp. Orthodontic devices, trauma, bleaching, systemic diseases, and the use of certain medications can all lead to invasive cervical resorption. The clinical manifestations of ICR are usually asymptomatic or not obvious, and most of which are found in imaging examinations. Because caries and internal absorption are often misdiagnosed through plain apical radiography, cone beam computed tomography (CBCT) can help to better understand the situation of invasive cervical resorption. Because the pathogenesis and etiology of invasive cervical resorption are not fully understood, clinical negligence and inadequate treatment of invasive cervical resorption can even cause unnecessary tooth loss. This article reviews the latest research progress on the histopathologic features, pathogenic mechanism, susceptibility factors, diagnosis and treatment of ICR, with special emphasis on susceptibility factors and their mechanisms.

Epidermoid cyst in the right mandible: a case report and literature review / 口腔疾病防治

Objective@#To discuss the possible etiology, pathogenesis, clinical features, diagnosis and treatment of epidermoid cysts of the jaw and to provide a reference for clinical diagnosis and treatment.@*Methods@#A case of an epidermoid cyst in the right mandible with retained deciduous teeth and succedaneous impacted teeth was reviewed and analyzed in combination with the relevant literature.@*Results@#A patient presented with a mass in the right mandible that had persisted for 1 month after being found at imaging examination. Tooth 83 was retained, and tooth 43 was unerupted. Swelling was characterized by no obvious tenderness, fluctuation, or table tennis sensation and was observed in the lingual alveoli of teeth 83, 44, and 45. Imaging revealed a low-density shadow in the apex of teeth 83, 44, 45, and 46, approximately 1.9 cm × 2.6 cm × 1.6 cm in size, which wrapped around the dental crown of tooth 43. Preliminary diagnoses were as follows: right mandibular mass thought to be a dentigerous cyst; impacted tooth 43; and retained primary tooth 83. The mass in the right mandible was removed, and teeth 43 and 83 were extracted under intravenous and inhalation anesthesia. During the operation, the mass was observed to have a thin cyst wall and contained bean-like residue. Histopathological examination indicated an epidermoid cyst in the right mandible. At the 1-week follow-up examination, the patient reported no discomfort, and the surgical area showed good recovery. According to the literature, epidermoid cysts are benign cysts originating from ectopic ectodermal tissue that can occur throughout the body but rarely in the oral cavity and are even extremely rarer in the jaw. Epidermoid cysts of the jaw, which have no specific clinical manifestations, can be confused with odontogenic cysts such as dentigerous cysts and odontogenic tumors. Dental pulp tests and other techniques can serve as a reference for clinicians. The diagnosis is confirmed via histopathology. Surgical removal is a common treatment, with a good prognosis and a low recurrence rate.@*Conclusion@#The principle of treatment for an epidermoid cyst of the jaw is similar to that for a jaw cyst. The prognosis is good when the cyst is removed completely.

Clinical analysis of orthodontic traction of impacted upper incisors / 口腔疾病防治

Objective@#To study the effect of orthodontic traction on the roots and periodontal soft and hard tissues of buried obstructed upper incisors.@*Methods@#This study was reviewed and approved by the ethics committee, and informed consent was obtained from the patients. From January 2018 to December 2022, 40 patients who underwent orthodontic traction on impacted upper incisors were selected; those whose contralateral homonymous apical foramen was not developed were placed in group A (23 cases), and those whose contralateral homonymous apical foramen was developed were placed in group B (17 cases). Software was used to measure the root length of the impacted upper incisors in groups A and B on cone beam CT (CBCT) images before and after traction and compare the changes in alveolar bone (alveolar bone width, labral bone plate thickness, and horizontal height of alveolar bone) and keratinized gingival width between each impacted upper incisor and the corresponding contralateral tooth immediately and one year after traction@*Results@#The root length of the impacted upper incisors increased after traction compared to before traction (P<0.05). The width of the alveolar bone at the completion of traction in group A was similar to that of the contralateral homonymous tooth (P>0.05), whereas the width of the alveolar bone at the completion of traction in group B did not reach that of the contralateral homonymous tooth, with a significant difference in width (P<0.05). Neither the labial bone plate height or width in group A or B reached that of the contralateral homonymous tooth after traction (P<0.05). The keratinized gingival width on the affected side was also significantly smaller than that on the contralateral side (P<0.05), but it was increased significantly in group A at the one-year follow-up visit (P<0.05).@*Conclusion@#Tooth traction is conducive to impacted upper incisor root growth, alveolar bone reconstruction and keratinized gingival growth but cannot produce complete symmetry with respect to the contralateral side.

An analysis of results of 392 times of CT quality control and room radiological protection testing in Guangdong Province, China / 中国辐射卫生

Objective To provide a theoretical basis for radiation health supervision through an analysis of the situation of computed tomography (CT) equipment quality control and CT room radiological protection in Guangdong Province, China in recent years. Methods We collected the data of 392 times of CT quality control and radiological protection testing by a third-party radiological health technical service institution in Guangdong Province from 2019 to 2021. We analyzed the levels of CT-owning hospitals, CT manufacturers, CT quality control test results, and the pass rate of radiation protection tests. Results The examined CT scanners were from different levels of hospitals in Guangdong Province, and were manufactured by nine major CT equipment manufacturers at home and abroad. The pass rate of CT room radiological protection was 99.88%, and the ambient dose equivalent rates of five monitoring points exceeded the limit, with four at the control room door and one at the shield wall of the room. The overall pass rate of CT equipment quality control was 99.49%, and the non-conforming parameters were the accuracy of positioning light and the deviation of reconstructed slice thickness. Conclusion In recent years, CT equipment quality control and room radiation protection in Guangdong Province have been at a high level.

Progress in diagnosis and treatment of hepatic alveolar echinococcosis / 器官移植

Hepatic echinococcosis is a chronic parasitic disease, which is caused by the larvae of Echinococcus multilocularis. It has a high risk of disability and mortality, which is also known as "parasite cancer". In clinical practice, hepatic echinococcosis can be divided into hepatic alveolar echinococcosis and hepatic cystic echinococcosis. Hepatic echinococcosis is widely prevalent worldwide. It mainly occurs in the populations residing agricultural and pastoral areas in western China, posing significant threats to the quality of life of local residents. At present, surgery is the main treatment for hepatic echinococcosis in clinical settings. With rapid development of surgical diagnosis and treatment technology and deepening understanding of hepatic echinococcosis, diagnosis and treatment regimens have also been constantly improved. In this article, research progresses on the diagnosis and treatment of hepatic alveolar echinococcosis were reviewed, aiming to provide reference for clinicians, deliver early diagnosis and treatment, mitigate adverse effects of this disease upon patients and improve clinical prognosis.

Correlation of 18F-sodium fluoride uptake and radiodensity in extraosseous metastases of medullary thyroid carcinoma

ABSTRACT Objective: Although 18F-sodium fluoride (18F-NaF) uptake is frequently observed in extraosseous metastases of medullary thyroid carcinoma (MTC) with calcification, it can also occur in metastatic sites without visible calcium deposition, leading to the hypothesis that visually undetectable calcium accumulation may be responsible for this uptake. The aim of this study was to indirectly support this hypothesis by analyzing the correlation between the degree of 18F-NaF uptake and radiodensity in extraosseous MTC metastases, since calcium deposition can increase attenuation even when not visually detectable. Subjects and methods: Extraosseous metastatic lesions of 15 patients with MTC were evaluated using 18F-NaF positron-emission tomography (PET)/computed tomography (CT) and segmented by levels of standardized uptake value (SUV). The correlation between mean SUV and mean Hounsfield unit (HU) values was assessed for the entire group of segments and for two subgroups with different mean HU values. Results: Very high correlations were observed between mean SUV and mean HU values for both the entire group of segments and the subgroup with a mean HU value greater than 130 (p = 0.92 and p = 0.95, respectively; p < 0.01). High correlation (p = 0.71) was also observed in the subgroup with mean HU values ranging from 20 to 130 (p < 0.01). Conclusion: The findings of the present study suggest that there is an association between 18F-NaF uptake and calcium deposition in extraosseous metastases of MTC, supporting the hypothesis that visually undetectable calcium accumulation may be responsible for 18F-NaF uptake in regions without visible calcium deposition.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system

Abstract This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

A descaracterização da política de financiamento da CT&I: uma análise do FNDCT / La descaracterización de la política de financiación de CT&I: un análisis del FNDCT / The mischaracterization of the ST&I funding policy: an analysis of the Brazilian Fund for the Development of Science and Technology

Resumo Este estudo tem como objetivo analisar criticamente os mecanismos que desidratam o Fundo Nacional de Desenvolvimento Científico e Tecnológico (FNDCT), debilitando-o na sua função de promover o desenvolvimento econômico e social. Os dados foram extraídos das bases do sistema integrado de orçamento e planejamento (SIOP) e do relatório de execução orçamentária, entre 2012 e 2021, disponibilizados pela financiadora de estudos e projetos (FINEP). Os resultados da investigação apontam que, do ponto de vista quantitativo, há um processo de desidratação, por mecanismos como a desvinculação de receitas da união (DRU), a formulação do projeto de lei orçamentária anual (PLOA) e as reservas de contingência. Do lado qualitativo, há descompasso entre a promessa de uma política arrojada e inovadora e uma estrutura de governança centralizada e burocrática. Os fundos setoriais não enfrentam problemas de arrecadação, mas a gestão centralizada e subserviente a políticas fiscais de austeridade leva a uma execução orçamentária quantitativamente insuficiente e qualitativamente pobre em diversificação, quadro que descaracteriza a política de financiamento de ciência, tecnologia e inovação (CT&I), deixando de cumprir a promessa de desenvolvimento via inovação.

Resumen Este estudio tiene como objetivo analizar críticamente los mecanismos que deshidratan el fondo nacional de desarrollo científico y tecnológico (FNDCT), debilitándolo en su función de promover el desarrollo económico y social. Los datos fueron extraídos de las bases del sistema integrado de planificación y presupuesto y del informe de ejecución presupuestaria entre 2012 y 2021, puestos a disposición por la financiadora de estudios y proyectos. Los resultados de la investigación indican que, desde el punto de vista cuantitativo, existe un proceso de deshidratación, a través de mecanismos como la Desvinculación de Ingresos de la Unión Federal, la formulación del proyecto de ley presupuestaria anual y las reservas de contingencia. En el aspecto cualitativo, existe un desajuste entre la promesa de una política audaz e innovadora y una estructura de gobierno centralizada y burocrática. Los fondos sectoriales no enfrentan, en promedio, problemas de recaudación, pero la gestión centralizada supeditada a políticas fiscales de austeridad conduce a una ejecución presupuestaria cuantitativamente insuficiente y cualitativamente pobre en términos de diversificación, situación que descaracteriza la política de financiamiento para la ciencia, tecnología e innovación (CT&I), incumpliendo con la promesa de desarrollo a través de la innovación.

Abstract This study aims to critically analyze the mechanisms that depletethe Brazilian fund for the development of science and technology (FNDCT), jeopardizing its ability to promote economic and social development. Data were extracted from the integrated budget and planning system (SIOP) bases and the budget execution report between 2012 and 2021, made available by the Brazilian funding agency FINEP. The quantitative results indicate a process of "dehydration" due to changes such as the regulation that allows the executive to redirect resources previously earmarked for the fund (called DRU), the formulation of the legislation on the annual budget (PLOA) and the contingency reserves. The qualitative analysis shows a mismatch between the promise of a bold and innovative science and technology policy and a centralized and bureaucratic governance structure. Sectoral funds do not face, on average, problems in raising resources. However, the centralized management subservient to fiscal austerity policies leads to quantitative insufficient budget execution and qualitatively poor diversification. As outcomes, this situation mischaracterizes the ST&I funding policy, failing to comply with the promise of development through innovation.

Apport du scanner thoracique dans le dépistage des cas suspects de COVID-19 au Service d'imagerie médicale du Centre Hospitalier et Universitaire (CHU) de Libreville - Gabon / Contribution of chest ct-scan in the screening of suspected cases of COVID-19 at the Medical Imaging Department

Objectifs.Evaluer l'apport de la TDM thoracique dans le diagnostic de la COVID-19 chez les patients suspects en prenant comme référence le Test RT ­PCR et secondairement déterminer les anomalies scanographiques caractéristiques associés au Test RT ­PCR.Matériels etméthodes.Il s'est agi d'une étude rétrospective, descriptive à visée analytique, menée au service d'imagerie du CHU de Libreville. Aux vues de la disponibilité des dossiers nous avons exploité ceux de la période d'activité de mars à juin 2020, soit une période quatre mois. Cette étude a inclus tous les patients ayant une infection à COVID-19 confirmée par la réaction de polymérase en chaine en temps réel (RT ­PCR), après écouvillonnages nasal et/ou pharyngé et / ou les signes typiques de la pneumonie à COVID-19. Pour déterminer les anomalies scanographiques caractéristiques de la COVID-19 associées au test RT ­PCR nous avons comparé 25 patients avec un test RT ­PCR négatifs et 119 patients avec un test RT ­PCR positifs. Une valeur de p < 0,05 était considérée comme significative. La sensibilité de la TDM thoracique a été calculée à l'aide de la relation, Sensibilité=VP/ (VP+FN), (VP : vrai positif de la TDM : TDM positive et test RT PCR positif ; et le FN : Faux négatif de la TDM : TDM négative et test RT PCR positif). L'analyse statistique a été rendu possible grâce au logiciel SPSS 25. Résultats. En régression logistique multivariée, les anomalies scanographiques caractéristiques de la COVID-19 positivement associés à un test RT ­PCR positif étaient :verre dépoliOR = 33,236, IC95% [6,939 ­59,192], p=0,0001), la condensation alvéolaire (OR = 8,093 [1,488 ­44,013]; p=0,016). La sensibilité du scanner thoracique pour le diagnostic de la COVID-19, chez les patients suspects était de 93,2%, la spécificité de 64,2% avec une valeur prédictive positive de 90,2% et une valeur prédictive négative de 73,0%.Conclusion.Le diagnostic scanographique de la COVID-19 chez les patients suspects est aisé avec une bonne sensibilité et spécificité. La présence des anomalies scanographiques caractéristiques à type de verre dépoli et de condensation alvéolaire est associéeà un test RT ­PCR positif

Objective. Evaluate the contribution of Thoracic CT in the diagnosis of COVID-19 in suspected patients by taking the RT ­PCR Test as a reference and secondarily determine the impact of the RT ­PCR Test on characteristic scan abnormalities, in the service of thoracic imaging at Libreville University Hospital.Materials and methods. This was a retrospective, descriptive study with an analytical aim. In view of the availability of files, we used those from the period of activity from March to June 2020, i.e. a four-month period. To determine the impact of the RT ­PCR test on characteristic scan abnormalities, we compared 25 patients with negative RT ­PCR and 119 patients with negative RT ­PCR. A value of p < 0.05 was considered significant. The sensitivity of chestCT was calculated using the relationship, Sensitivity=VP/(VP+FN), (VP: true positive of CT: positive CT and positive RT PCR test; and FN: False negative CT: negative CT and positive RT PCR test). Statistical analysis was made possible using SPSS 25 software.Results. In multivariate logistic regression, CT abnormalities characteristic of COVID-19 were positively associated with a positive RT ­PCR: ground glass, (OR = 33.236, 95% CI [6.939 ­59.192], p = 0.0001), condensation alveolar (OR = 8.093 [1.488 ­44.013]; p = 0.016). The sensitivity of chest CT for the diagnosis of COVID-19 in suspected patients was 93.2%, the specificity of 64.2% with a positive predictive value of 90.2% and a negative predictive value of 73. 0%.Conclusion. CT diagnosis of COVID-19 in suspected patients is easy with good sensitivity and specificity. The presence of characteristic scan abnormalities such as ground glass and alveolar condensation is associated with a positive RT ­PCR tes

Impacto del PET/CT en el diagnóstico de insulinoma / Impact of PET/CT in the Diagnosis of Insulinoma

Introducción: La tomografía de emisión de positrones es una técnica diagnóstica no invasiva que permite tomar imágenes del organismo que muestra el metabolismo de los órganos del cuerpo. Objetivo: Destacar el valor de la PET/CT en el diagnóstico imagenológico prequirúrgico del enfermo. Presentación de caso: Se presentó un paciente masculino de 39 años sin antecedentes de importancia, con un cuadro de hipoglucemias severas de 5 años de evolución, a pesar de los múltiples estudios imagenológicos se incluyó la ecoendoscopía digestiva, lo que no fue posible evidenciar la lesión tumoral. Se le realiza PET/CT cuyo resultado fue crucial para localizar el tumor, se le dio al paciente la oportunidad de un tratamiento quirúrgico y la demostración anatomopatológica de insulinoma. Conclusiones: Los insulinomas son tumores pancreáticos poco frecuentes que provocan hiperinsulinismo endógeno y son difíciles de visualizar debido a su tamaño por las técnicas de imágenes convencionales, por lo que el PET/CT es un estudio bastante efectivo para localizar la lesión tumoral, y así realizar un procedimiento quirúrgico(AU)

Introduction: Positron emission tomography is a non-invasive diagnostic technique, allowing images of the body to be taken that show the metabolism of the body's organs. Objective: To highlight the value of PET/CT in the pre-surgical imaging diagnosis of the patient. Case presentation: We report the case of a 39-year-old male patient with no significant medical history, but a 5-year history of severe hypoglycemia. Despite multiple imaging studies, digestive ultrasound endoscopy was included, which was not possible to demonstrate the tumor lesion. PET/CT was performed, the result of which was crucial in locating the tumor. The patient was given the opportunity for surgical treatment and the pathological demonstration of insulinoma. Conclusions: Insulinomas are rare pancreatic tumors that cause endogenous hyperinsulinism and are difficult to visualize due to their size using conventional imaging techniques, therefore PET/CT is a fairly effective study to locate the tumor lesion, and thus perform a surgical procedure(AU)

Primera colocación del dispositivo AMPLATZER™, Amulet™ para cierre de orejuela en Costa Rica utilizando Heart Navigator / First placement of the AMPLATZER™ Amulet™ device for appendage closure in Costa Rica using Heart Navigator

RESUMEN El cierre de la orejuela izquierda mediante un dispositivo facilita la prevención de un accidente cerebrovascular en pacientes con antecedente de fibrilación auricular no valvular y contraindicación para el uso de medicamentos anticoagulantes. Este artículo presenta dos casos de pacientes con historia de fibrilación auricular en el Hospital Calderón Guardia, ambos con el antecedente de sangrado digestivo y contraindicación para la anticoagulación, en los que se logró el cierre de la orejuela izquierda mediante la colocación exitosa del dispositivo AmuletTM, utilizando TAC y Heart Navigator, técnicas de imagen que se están convirtiendo en el estándar de oro de muchos centros internacionales de referencia en cardiología intervencionista.

ABSTRACT Closure of the left atrial appendage with a device facilitates the prevention of stroke in patients with a history of nonvalvular atrial fibrillation and a contraindication to the use of anticoagulant medications. This article presents two cases of patients with a history of atrial fibrillation at the Calderón Guardia Hospital, both with a history of digestive bleeding and contraindication to anticoagulation, in whom closure of the left atrial appendage was achieved through successful placement of the AmuletTM device, using CT and Heart Navigator, imaging techniques that are becoming the gold standard in many international reference centers in interventional cardiology.

Comparación de sistemas de evaluación diagnóstica de la severidad de la osteoartrosis en imágenes de TAC de las ATM

Objetivo: Comparar y validar sistemas diagnósticos de severidad de Osteoartrosis (OA) de las articulaciones temporomandibulares (ATM) en imágenes de tomografía computada (TAC). Método: Se efectuó un estudio observacional, retrospectivo, analítico y ciego. Se evaluaron 99 pacientes (198TAC-ATM), aplicando los criterios de siete diferentes sistemas diagnósticos. Un clínico calibrado (K=0,7) efectuó las evaluaciones. La validez de contenido se efectuó bajo los criterios Ahmad. La consistencia interna se determinó con Alpha de Cronbach. Se correlacionaron los datos con Rho de Spearman. Resultados: La severidad de la erosión condilar presenta alta correlación positiva entre las clasificaciones Alexiou/Arayasantiparb (rho=0,986) y baja entre Cömert/Alexiou (rho=0,421) y Cömert/Arayasantiparb (rho=0,422). La esclerosis condilar presentó fuerte correlación entre las clasificaciones de Cömert/Alexiou, Masilla/Alexiou y Cömert/Masilla (rho=857;rho=0,853;rho=0,998). Los datos presentaron alta consistencia interna (Alfa Cronbach=0,897) y baja validación de contenido (36,2%). Conclusiones: Las mediciones de los 7 sistemas presentan alta fiabilidad. La erosión ósea, esclerosis y osteofitos son medidos en cuatro niveles de severidad y con similar escala en tres sistemas de diagnóstico (Alexiou, Arayasantiparb y Cömert), sugiriendose complementar con determinación del espacio articular y movilidad condilar, como propone RDC/TMD para TTM. La validación de contenido fue baja, solo los sistemas diagnósticos de Cömert y Alexiou superaron el 50%.

Objective: To compare and validate diagnostic systems for the severity of Osteoarthrosis (OA) of the temporomandibular joints (TMJ) in computed tomography (CT) images. Method: An observational, retrospective, analytical, blinded, retrospective study was performed. Ninety-nine patients (198MSCT-ATM) were evaluated, applying the criteria of seven different diagnostic systems. A calibrated clinician (K=0.7) performed the evaluations. Content validity was performed under the Ahmad criteria. Internal consistency was determined with Cronbach's Alpha. Data were correlated with Spearman's Rho. Results: For condylar erosion severity, there was a high positive correlation between Alexiou/Arayasantiparb (rho=0.986) and a low one between Cömert/Alexiou (rho=0.421) and Cömert/Arayasantiparb (rho=0.422) classifications. For condylar sclerosis, we found a strong correlation between Cömert/Alexiou, Masilla/Alexiou and Cömert/Masilla classifications (rho=857; rho=0.853; rho=0.998). The data presented high internal consistency (Cronbach's alpha=0.897) and low content validation (36.2%). Conclusions: The measurements of the 7 systems have a high reliability. Bone erosion, sclerosis and osteophytes are measured at four levels of severity and with a similar scale in three diagnostic systems (Alexiou, Arayasantiparb and Cömert). We suggest to complement it with the determination of joint space and condylar mobility, as proposed by RDC/TMD. Content validity was low, only the Cömert and Alexiou diagnostic systems were higher than 50%.

Insertion methods and gap/void formation in atraumatic restorative technique: A micro-CT analysis

Abstract Wetting the dentin is critical to atraumatic restorative treatment. The conventional insertion can be challenging when using high-viscosity glass-ionomer cement. This study evaluated the formation of gaps and voids after three insertion methods using micro-CT. Teeth underwent removal of occlusal and proximal caries through the atraumatic restorative treatment technique. Then, they were fixed in an artificial dental arch to simulate the clinical condition and were restored using three insertion methods: conventional, Centrix injection, and double-filling. Previous dentin conditioning procedures, steel matrix and wooden wedge application, and post-insertion procedures (digital compression and surface protection) were the same. The material was inserted using a manual instrument in the conventional technique and was inserted with a syringe in the Centrix injection group. In the double-filling technique, the tooth received a first layer of a flowable ionomer (through modifying the powder/liquid ratio), and a second layer (with standard ratio) was applied before the final set of the first one. A micro-CT unit scanned each tooth before and after restoration. Each cavity was defined as the volume of interest, and the volumes of gaps and voids were calculated. Data were analyzed using one-way ANOVA and Tukey posthoc test (p < .05). Double-filling had improved filling volume with lower values for gap volume, followed by Centrix injection. The conventional technique had the highest gap volume. No statistically significant difference was observed for void volume. Double-filling demonstrated fewer gaps, followed by Centrix injection, which is critical to obtain better adhesive, remineralizing, and antibacterial activities.

Resumo O molhamento da dentina parcialmente desmineralizada no fundo da cavidade dentária é fundamental para o sucesso do tratamento restaurador atraumático. No entanto, o método de inserção convencional pode ser desafiador ao usar cimento de ionômero de vidro de alta viscosidade. Este estudo avaliou a formação de gaps e vazios internos após três métodos de inserção de cimento de ionômero de vidro de alta viscosidade usando micro-CT. Dez terceiros molares foram submetidos à remoção de cárie oclusal através da técnica de tratamento restaurador atraumático e complementação proximal (com ou sem lesão pré-existente). Em seguida, foram fixados em uma arcada dentária artificial para simular a condição clínica. Os dentes foram restaurados usando a técnica de tratamento restaurador atraumático com três métodos de inserção: convencional, injeção Centrix e dupla inserção. Os procedimentos anteriores de condicionamento dentinário, inserção de matriz de aço, aplicação de cunha de madeira e procedimentos pós-inserção do material (como compressão digital e proteção de superfície) foram os mesmos para os três grupos testados. O material foi inserido com instrumento manual na técnica convencional, seguindo a metodologia clássica do tratamento restaurador atraumático. O material foi inserido com um dispositivo desenvolvido especificamente para esse fim na técnica de inserção com seringa tipo Centrix. Na técnica de dupla obturação, o dente recebeu uma primeira camada do cimento de ionômero de vidro mais fluido (obtido através da modificação da relação pó/líquido), e uma segunda camada (com relação pó/líquido padrão) foi aplicada antes da presa final da primeira. Um micro-CT escaneou cada dente antes e depois da restauração. Cada cavidade foi definida como o volume de interesse, e os volumes de gaps e vazios foram calculados. Os dados foram analisados por ANOVA one-way e teste post-hoc de Tukey com nível de significância de 5%. A dupla inserção melhorou significativamente o volume de preenchimento com valores percentuais mais baixos para o volume do gap, seguido pela injeção com seringa tipo Centrix. A técnica convencional apresentou o maior percentual de volume de gap. Nenhuma diferença estatisticamente significativa foi observada para o volume de vazios internos. O grupo de dupla inserção demonstrou menor formação de gaps, seguido pelo grupo de injeção com seringa tipo Centrix, que é fundamental para obter melhores atividades adesivas, remineralizantes e antibacterianas.

Prognostic role of metabolic 18F?FDG PET/CT parameters and hematological prognostic indicators in patients with colorectal cancer

Background: The aim of this study is to evaluate the role of preoperative 18F?fluorodeoxyglucose (FDG) positron emission tomography朿omputed tomography (PET/CT) parameters, including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), hematologic prognostic indicators in patients with colorectal cancer (CRC) in terms of predicting prognosis. Methods: One hundred and one patients who had undergone 18F?FDG PET/CT for initial staging were evaluated retrospectively. Patient data including pathologic stage at presentation, histology, tumor location, and overall survival (OS) were analyzed. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), serum carcinoembryonic antigen (CEA) (ng/mL), CA?125 (cancer antigen 125) (U/mL), and CA19?9 (U/mL) levels, which were obtained within 2 weeks of the PET/CT examination, were used for hematological data. Results: The TNM Classification of Malignant Tumors stage and PET/CT parameters, including SUVmax, MTV, and TLG, were found to be correlated with survival rate in univariate analysis (P < 0.05). All hematological markers excluding PLR were also significantly associated with survival time. Receiver operating characteristics (ROC) analysis revealed that the optimal SUVmax cutoff value for predicting survival time in patients with CRC was >17.9 (Area under curve (AUC) = 0.625; P < 0.05). The calculated sensitivity and specificity values for this cutoff were 60% and 65.7%, respectively. To predict the survival time in these patients, the optimal MTV cutoff value was >34.29 (AUC = 0.775; P < 0.001; sensitivity = 85%; specificity = 62.3%). The optimal TLG cutoff value for predicting survival time was >270.4 (AUC = 0.790; P < 0.001; sensitivity = 77.5%; specificity = 68.9%). Conclusions: FDG PET/CT metabolical parameters are useful for predicting the prognosis in patients with CRC. High preoperative NLR and high tumor markers were also shown to be negative independent prognostic factors in these patients

An Incidental Finding Of Button Battery In The Nose Without Any Complication- A Case Report Of A Rare Presentation

Aim And Background-A foreign body in nose presents with unilateral purulent nasal discharge, nasal obstruction and nasal bleed.We present a case in which a button battery remained uncomplicated in the nasal cavity for a year. However, if it is found, it should be removed as early as possible. A 6-year-old female child presented with aCase Description – one-year history of foul-smelling, left-sided nasal discharge. During anterior rhinoscopy, a black, rigid mass was observed. A circular foreign object was found in the floor of the left nasal cavity during a CT (computed tomography) scan of the Nose and PNS (paranasal sinuses). General anesthesia was used during the diagnostic nasal endoscopy on the child. A foreign body was visualized and removed using a curved curette. The nasal mucosa was normal on follow-up, and there was no septal perforation. A detailed history, assessment and radiological examination plays aConclusion- key role in management of foreign bodies.We report that a button battery was left in the nose for a long time without causing any problems. There were no complications from an unnoticed button battery in theClinical Significance: nose for a year. However, if it is found, it should be removed.

Prevalencia del segundo conducto en dientes anteroinferiores usando Tomografía Computadorizada Cone Beam / Second root canal prevalence in lower anterior teeth using Cone Beam Computed Tomography

Introducción: Es un error común pensar que los dientes anteroinferiores, por lo general, tienen un solo conducto radicular con una sola raíz. Sin embargo, un estudio realizado por Vertucci et. al., (1974), mostraron una alta prevalencia (13%) de dos conductos radiculares en los dientes anteroinferiores, lo que estimuló más investigaciones. Objetivo: El propósito de este estudio fue determinar la prevalencia del segundo conducto radicular en los dientes anteroinferiores en una población nicaragüense, estos fueron detectados por medio de tomografía computadorizada (Cone Beam). Materiales y Métodos: En el estudio se analizaron 293 piezas dentales, de canino a canino de la arcada inferior. Para realizar el análisis se utilizó el software libre Radiant DICOM Viewer 2021.2.2, se realizaron cortes sagitales, axiales y coronales para ver la prevalencia del segundo conducto radicular. Resultados: De las 293 piezas dentarias analizadas se encontró que 259 presentaban un solo conducto que correspondía al 88.4% y 34 dientes presentaban dos conductos que correspondían al 11.6%. De acuerdo con el análisis tomográfico, se encontró que en los cortes axiales y sagitales fue donde se observó la presencia del segundo conducto. Con respecto a la presencia del segundo conducto de acuerdo al tercio del canal radicular se identificó que la mayoría se presentó en el tercio medio (52.94%), seguido por coronal (29.41%) y por último el tercio apical (17.65%). De acuerdo con la clasificación de Vertucci se encontró que se presenta un mayor porcentaje del tipo I con 88.40%, seguido por el tipo III con 4.44%, después el tipo V con 3.41%, y el tipo II con 2.39%. El de menor porcentaje fue el tipo VI con 1.37%, mientras que, en las piezas analizadas, no se encontraron los tipos IV, VII y VIII. Conclusión: Basados en los resultados obtenidos en este estudio, la prevalencia de un segundo conducto en dientes anteroinferiores fue de 11.6%.

Title The prevalence of a second root canal in mandibular anterior teeth using Cone Beam Computed Tomography. Abstract Introduction: It is a common misconception that the mandibular anterior teeth usually have a single root canal with a single root. However, a study by Vertucci et. al., (1974), showed a high prevalence (13%) of two root canals in the lower anterior teeth, which stimulated further investigations. Objective: The purpose of this study was to determine the prevalence of the second root canal in the mandibular anterior teeth in a Nicaraguan population, these were detected by means of computed tomography (Cone Beam). Materials and methods: In the study, 293 teeth were analyzed, from canine to canine of the mandibular teeth. To perform the analysis, the free software Radiant DICOM Viewer 2021.2.2 was used, sagittal, axial and coronal views were made to see the prevalence of the second root canal. Results: Of the 293 teeth analyzed, it was found that 259 had a single root canal corresponding to 88.4%, and 34 teeth had two root canals corresponding to 11.6%. According to the tomographic analysis, it was found that the presence of the second root canal was observed only in the axial and sagittal views. Regarding the presence of the second canal according to the third of the root canal, it was identified that the majority presented in the middle third (52.94%), followed by coronal (29.41%) and finally the apical third (17.65%). According to the Vertucci classification, it was found that there is a higher percentage of type I with 88.40%, followed by type III with 4.44%, then type V with 3.41%, and type II with 2.39%. The one with the lowest percentage was type VI with 1.37%, while in the pieces analyzed, types IV, VII and VIII were not found. Conclusion: Based on the results obtained in this study, the prevalence of a second root canal in lower anterior teeth was 11.6%.

A RETROSPECTIVE STUDY BETWEEN CLINICAL EXAMINATION, FOCUSSED ABDOMINAL SONOGRAM IN TRAUMA AND CT SCAN IN BLUNT INJURY ABDOMEN IN A TERTIARY CARE CENTRE

Aims and Objectives: Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department and is responsible for substantial morbidity and mortality in developing countries. It requires high degree of suspicion, investigation and management. The most commonly injured abdominal organs are liver and spleen. The aim of this study was to find etiology, early diagnosis and management of patients with blunt abdominal trauma based on clinical examination, FAST and CT scan. A retrospective study of 60 cases of blunt Abdominal trauma patients Methods: presenting to emergency and outpatient department of Surgery of Silchar Medical College and Hospital from September 2020 to September 2021 was done. Amongst the studied cases most Results: common age group involved was (21–30) years (28 cases). Liver was found to be the most common injured organ (22 cases) followed by bowel and spleen. FAST was the most commonly used investigation after blunt abdominal trauma. CT was used only in hemodynamically stable patients (19 cases). The most common intra-operative finding was Intestinal perforation and the most common surgery performed was the repair or resection and anastomosis of intestinal perforation. Most common mode of injury wa Conclusions: s road traffic accidents and predominantly, men were affected. Clinical examination alone is inadequate because patients may have altered mental status. Initial resuscitation followed by physical examination and monitoring of clinical parameters and FAST and computed tomography (CT) abdomen are very important to detect patients with minimal and clinically untraceable sign of abdominal injury. Rapid diagnosis, early timed referral, adequate and trained staff, careful monitoring, early decision to go for operative or nonoperative management can help save many lives.

CLINICAL AND THERAPEUTIC ASPECTS OF DIVERTICULITIS: A NARRATIVE REVIEW

Diverticulitis is a gastrointestinal condition in which diverticula (small sacs or pouches) in the colon become inamed or infected. This article is a review of the current understanding of diverticulitis and covers its causes, symptoms, diagnosis, and treatment. Epidemiological studies have shown that diverticulitis mainly affects older adults and the incidence increases with age. The Western diet, which is high in fat and low in ber, has been implicated in the development of diverticulitis. The most common presenting symptom is abdominal pain, often localized to the left lower quadrant, and other symptoms include fever, nausea, vomiting, and changes in bowel habits. The diagnosis of diverticulitis is based on a combination of clinical, radiologic, and laboratory ndings. The preferred imaging modality is computed tomography (CT) with intravenous contrast. Mild cases can often be managed with conservative measures, such as bowel rest, antibiotics, and pain management. More severe cases may require hospitalization, intravenous antibiotics, and, in some cases, surgical intervention. Surgery may be required in cases of complicated diverticulitis, such as perforation, abscess formation, or stula formation, and in patients with recurrent diverticulitis. In conclusion, further research is needed to better understand the epidemiology of diverticulitis and its risk factors, especially in developing countries where the incidence of diverticulitis is believed to be lower.