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RoFo : Fortschritte Auf Dem Gebiete Der... Feb 2021To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries,...
PURPOSE
To examine the relationship between superficial lesions (such as bruises, hematomas, deep abrasions, and soft tissue emphysema) and internal post-traumatic injuries, assessed using whole-body computed tomography (WBCT), and to determine if these are valid markers for internal injuries.
METHODS AND MATERIALS
250 patients who underwent WBCT emergency scans for suspected polytrauma were retrospectively analyzed after institutional review board approval of the study. The scans were carried out on patients who met the criteria for standard operating procedures for WBCT emergency scans. WBCT covering the entire head, neck, chest, and abdomen (including pelvis and proximal lower extremities) and at least one phase with intravenous contrast agent were included in the study. Initial analyses of immediate WBCT scans was carried out by a consultant radiologist and a radiological resident. The first reading focused on internal damage that needed immediate therapy. The second reading focused on a detailed analysis of the skin and subcutaneous tissue and their relation to internal injuries without the time pressure of an emergency setting, carried out by another experienced radiologist. All skin lesions and the degree of penetration and a comparison between the two readings were reported in tables.
RESULTS
Superficial lesion of the chest was detected in 19 patients, 17 of them had an internal injury of the thorax while only two patients, with hematoma of the chest wall, had no internal injuries. Skin and subcutaneous lesions of the chest had the strongest association with an internal injury. Skin lesions of the abdominal wall were observed in 30 patients. In only 11 cases, these lesions were correlated with internal injuries, such as fractures or active bleeding. 52 skin and subgaleal lesions of the scalp were observed. In 20 of these patients, an intracranial or internal injury was detected. In 3 patients, skin abrasions of the neck were present and in only one of them, this finding was associated with an internal injury.
CONCLUSION
Trauma patients whose history and clinical presentation meet the standard operating procedures for WBCT emergency scans and who present with a cutaneous lesion, especially at the neurocranium or chest wall, should be observed for internal injuries by WBCT.
KEY POINTS
· Presence or lack of a superficial injury of the abdominal wall is not a reliable predictive indication of any internal abdominal injury.. · Superficial lesions of the chest and the neurocranium require a CT scan.. · Superficial injuries of the chest wall had the strongest association with internal injuries..
CITATION FORMAT
· Klempka A, Fischer C, Kauczor H et al. Correlation Between Traumatic Skin and Subcutaneous Injuries and the Severity of Trauma. Fortschr Röntgenstr 2021; 193: 177 - 185.
Topics: Abdominal Injuries; Administration, Intravenous; Adult; Aged; Awareness; Contrast Media; Craniocerebral Trauma; Emergency Service, Hospital; Female; Humans; Injury Severity Score; Male; Middle Aged; Multiple Trauma; Radiologists; Retrospective Studies; Skin; Subcutaneous Tissue; Thoracic Injuries; Tomography, X-Ray Computed; Whole Body Imaging
PubMed: 33242897
DOI: 10.1055/a-1207-0797 -
International Wound Journal Oct 2020An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her... (Review)
Review
An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning-related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.
Topics: Female; Humans; Male; Operating Rooms; Pressure Ulcer; Risk Assessment; Risk Factors
PubMed: 32496025
DOI: 10.1111/iwj.13408 -
RNA Biology Nov 2021RNA-sequencing (RNA-seq) analysis of gene expression and alternative splicing should be routine and robust but is often a bottleneck for biologists because of different...
RNA-sequencing (RNA-seq) analysis of gene expression and alternative splicing should be routine and robust but is often a bottleneck for biologists because of different and complex analysis programs and reliance on specialized bioinformatics skills. We have developed the '3D RNA-seq' App, an R shiny App and web-based pipeline for the comprehensive analysis of RNA-seq data from any organism. It represents an easy-to-use, flexible and powerful tool for analysis of both gene and transcript-level gene expression to identify differential gene/transcript expression, differential alternative splicing and differential transcript usage (3D) as well as isoform switching from RNA-seq data. 3D RNA-seq integrates state-of-the-art differential expression analysis tools and adopts best practice for RNA-seq analysis. The program is designed to be run by biologists with minimal bioinformatics experience (or by bioinformaticians) allowing lab scientists to analyse their RNA-seq data. It achieves this by operating through a user-friendly graphical interface which automates the data flow through the programs in the pipeline. The comprehensive analysis performed by 3D RNA-seq is extremely rapid and accurate, can handle complex experimental designs, allows user setting of statistical parameters, visualizes the results through graphics and tables, and generates publication quality figures such as heat-maps, expression profiles and GO enrichment plots. The utility of 3D RNA-seq is illustrated by analysis of data from a time-series of cold-treated Arabidopsis plants and from dexamethasone-treated male and female mouse cortex and hypothalamus data identifying dexamethasone-induced sex- and brain region-specific differential gene expression and alternative splicing.
Topics: Alternative Splicing; Animals; Arabidopsis; Cerebellar Cortex; Cold Temperature; Computational Biology; Dexamethasone; Gene Expression Regulation; Glucocorticoids; Hypothalamus; Mice; RNA; RNA-Seq; Software
PubMed: 33345702
DOI: 10.1080/15476286.2020.1858253 -
Clinical Oral Investigations Sep 2022The aim of this study was to develop and validate a deep learning-based convolutional neural network (CNN) for the automated detection and categorization of teeth...
OBJECTIVE
The aim of this study was to develop and validate a deep learning-based convolutional neural network (CNN) for the automated detection and categorization of teeth affected by molar-incisor-hypomineralization (MIH) on intraoral photographs.
MATERIALS AND METHODS
The data set consisted of 3241 intraoral images (767 teeth with no MIH/no intervention, 76 with no MIH/atypical restoration, 742 with no MIH/sealant, 815 with demarcated opacity/no intervention, 158 with demarcated opacity/atypical restoration, 181 with demarcated opacity/sealant, 290 with enamel breakdown/no intervention, 169 with enamel breakdown/atypical restoration, and 43 with enamel breakdown/sealant). These images were divided into a training (N = 2596) and a test sample (N = 649). All images were evaluated by an expert group, and each diagnosis served as a reference standard for cyclic training and evaluation of the CNN (ResNeXt-101-32 × 8d). Statistical analysis included the calculation of contingency tables, areas under the receiver operating characteristic curve (AUCs) and saliency maps.
RESULTS
The developed CNN was able to categorize teeth with MIH correctly with an overall diagnostic accuracy of 95.2%. The overall SE and SP amounted to 78.6% and 97.3%, respectively, which indicate that the CNN performed better in healthy teeth compared to those with MIH. The AUC values ranging from 0.873 (enamel breakdown/sealant) to 0.994 (atypical restoration/no MIH).
CONCLUSION
It was possible to categorize the majority of clinical photographs automatically by using a trained deep learning-based CNN with an acceptably high diagnostic accuracy.
CLINICAL RELEVANCE
Artificial intelligence-based dental diagnostics may support dental diagnostics in the future regardless of the need to improve accuracy.
Topics: Artificial Intelligence; Dental Enamel Hypoplasia; Dental Materials; Humans; Incisor; Molar; Prevalence
PubMed: 35608684
DOI: 10.1007/s00784-022-04552-4 -
BioMed Research International 2021West Africa has witnessed the unprecedented outbreak of Ebola virus disease (EVD). The Ebola virus (EBOV) can cause Ebola hemorrhagic fever, which is documented as the... (Review)
Review
BACKGROUND
West Africa has witnessed the unprecedented outbreak of Ebola virus disease (EVD). The Ebola virus (EBOV) can cause Ebola hemorrhagic fever, which is documented as the most deadly viral hemorrhagic fever in the world. RT-PCR had been suggested to be employed in the detection of Ebola virus; however, this method has high requirements for laboratory equipment and takes a long time to determine Ebola infection. Although Xpert Ebola is a fast and simple instrument for the detection of Ebola virus, its effect is still unclear. This study is aimed at evaluating the accuracy of Xpert Ebola in diagnosing Ebola virus infection.
METHODS
Using the keywords "Xpert" and "Ebola virus", relevant studies were retrieved from the database of PubMed, Embase, Web of Science, and Cochrane. RT-PCR was employed as a reference standard to evaluate whether the study is eligible to be included in the meta-analysis. Data from these included studies were extracted by two independent assessors and were then analyzed by the Meta-DiSc 1.4 software to produce the heterogeneity of sensitivity (SEN), specificity (SP), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic advantage ratio (DOR) of the study. The results of pooled analysis were plotted, together with the summary receiver operating characteristic (SROC) curve plotted by calculating the area under the curve (AUC). Generated pooled summary estimates (95% CIs) were calculated for the evaluation of the overall accuracy of this study.
RESULTS
Five fourfold tables were made from the four studies that were included in the meta-analysis. The pooled sensitivity of Xpert Ebola was 0.98 (95% confidence interval (CI) (0.95, 0.99)), and the pooled specificity was 0.98 (95% CI (0.97, 0.99)). The pooled values of positive likelihood ratio was 53.91 (95% CI (12.82, 226.79)), with negative likelihood ratio being 0.04 (95% CI (0.02, 0.08)) and diagnostic odds ratio being 2649.45 (95% CI (629.61, 11149.02)). The AUC was 0.9961.
CONCLUSIONS
Compared with RT-PCR, Xpert Ebola has high sensitivity and specificity. Therefore, it is a valued alternative method for the clinical diagnosis of Ebola virus infection. However, the Xpert Ebola test is a qualitative test that does not provide quantitative testing of EBOV concentration. Whether it can completely replace other methods or not calls for further evidences.
Topics: Africa, Western; Animals; Area Under Curve; Databases, Factual; Ebolavirus; Hemorrhagic Fever, Ebola; Humans; Molecular Diagnostic Techniques; Odds Ratio; ROC Curve; Reference Standards; Sensitivity and Specificity
PubMed: 34055977
DOI: 10.1155/2021/5527505 -
Data in Brief Jun 2023This paper provides experimental data on the temperature rise during granular flows in a small-scale rotating drum due to heat generation. All heat is believed to be...
This paper provides experimental data on the temperature rise during granular flows in a small-scale rotating drum due to heat generation. All heat is believed to be generated by conversion of some mechanical energy, through mechanisms such as friction and collisions between particles and between particles and walls. Particles of different material types were used, while multiple rotation speeds were considered, and the drum was filled with different amounts of particles. The temperature of the granular materials inside the rotating drum was monitored using a thermal camera. The temperature increases at specific times of each experiment are presented in form of tables, along with the average and standard deviation of the repetitions of each setup configuration. The data can be used as a reference to set the operating conditions of rotating drums, in addition to calibrating numerical models and validating computer simulations.
PubMed: 37383737
DOI: 10.1016/j.dib.2023.109282 -
The British Journal of General Practice... Apr 2020Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Centor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis.
AIM
To compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis.
DESIGN AND SETTING
A meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds.
METHOD
MEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice.
RESULTS
Ten studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The -value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration.
CONCLUSION
Both Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection.
Topics: Humans; Pharyngitis; Primary Health Care; Sensitivity and Specificity; Streptococcal Infections; Streptococcus pyogenes; Symptom Assessment
PubMed: 32152041
DOI: 10.3399/bjgp20X708833 -
Ginekologia Polska 2020Ergonomics in laparoscopy has been gaining increasing attention. The research literature on ergonomics is growing worldwide; however, there are no studies or data from...
OBJECTIVES
Ergonomics in laparoscopy has been gaining increasing attention. The research literature on ergonomics is growing worldwide; however, there are no studies or data from Turkey. Our study provides information on the awareness and use of ergonomics in laparoscopic gynecology in Turkey.
MATERIAL AND METHODS
A questionnaire consisting of 25 questions was sent by email to 225 laparoscopists who are members of the Turkish Society of Gynecological Endoscopy.
RESULTS
In response, 45.7% of the questionnaires were returned. Six respondents (5.9%) had never experienced pain, and two respondents (1.9%) always experienced pain during or after laparoscopy. The shoulders, neck, and back were the most common sites where respondents experienced pain. Most of the respondents (64.1%) utilized one monitor during laparoscopic surgery, and only 2% of respondents utilized a monitor below eye level. Less than 50% of the respondents were aware of ergonomic guidelines.
CONCLUSIONS
Even though less than half of the Turkish gynecological laparoscopist respondents were aware of ergonomic guidelines, more than half used appropriate visual systems, operating tables, hand instruments, and had large enough operating rooms. Only the number and level of monitors used by respondents were not in accordance with ergonomic guidelines.
Topics: Ergonomics; Gynecology; Humans; Laparoscopy; Musculoskeletal Diseases; Occupational Diseases; Operating Rooms; Pain; Posture; Turkey
PubMed: 32236933
DOI: 10.5603/GP.a2020.0036 -
European Review For Medical and... Apr 2023There have been insufficient reports to date regarding the treatment of cervical spinal tuberculosis, and the optimal surgical approaches to treating this condition have... (Review)
Review
Application of combined anterior and posterior approaches for the treatment of cervical tuberculosis with anterior cervical abscess formation and kyphosis using a Jackson operating table: a case report and literature review.
BACKGROUND
There have been insufficient reports to date regarding the treatment of cervical spinal tuberculosis, and the optimal surgical approaches to treating this condition have yet to be established.
CASE REPORT
This report describes the treatment of a case of tuberculosis associated with a large abscess and pronounced kyphosis through the use of a combined anterior and posterior approach with the aid of the Jackson operating table. This patient did not exhibit any sensorimotor abnormalities of the upper extremities, lower extremities, or trunk, and presented with symmetrical bilateral hyperreflexia of the knee tendons, while being negative for Hoffmann's sign and Babinski's sign. Laboratory test results revealed an erythrocyte sedimentation rate (ESR) of 42.0 mm/h and a C-reactive protein (CRP) of 47.09 mg/L. Acid-fast staining was negative, and spine magnetic resonance imaging revealed the destruction of the C3-C4 vertebral body and a posterior convex deformity of the cervical spine. The patient reported a visual analog pain score (VAS) of 6, and exhibited an Oswestry disability index (ODI) score of 65. Jackson table-assisted anterior and posterior cervical resection decompression was performed to treat this patient, and at 3 months post-surgery the patient's VAS and ODI scores were respectively reduced to 2 and 17. Computed tomography analyses of the cervical spine at this follow-up time point revealed good structural fusion of the autologous iliac bone graft with internal fixation and improvement of the originally observed cervical kyphosis.
CONCLUSIONS
This case suggests that Jackson table-assisted anterior-posterior lesion removal and bone graft fusion can safely and effectively treat cervical tuberculosis with a large anterior cervical abscess combined with cervical kyphosis, providing a foundation for future efforts to treat spinal tuberculosis.
Topics: Humans; Tuberculosis, Spinal; Abscess; Operating Tables; Treatment Outcome; Spinal Fusion; Kyphosis; Cervical Vertebrae; Retrospective Studies; Thoracic Vertebrae; Debridement
PubMed: 37140294
DOI: 10.26355/eurrev_202304_32115 -
The Cochrane Database of Systematic... Dec 2022Echocardiogram is the reference standard for the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. A simple blood assay for... (Review)
Review
BACKGROUND
Echocardiogram is the reference standard for the diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. A simple blood assay for brain natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) may be useful in the diagnosis and management of hsPDA, but a summary of the diagnostic accuracy has not been reviewed recently.
OBJECTIVES
Primary objective: To determine the diagnostic accuracy of the cardiac biomarkers BNP and NT-proBNP for diagnosis of haemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates. Our secondary objectives were: to compare the accuracy of BNP and NT-proBNP; and to explore possible sources of heterogeneity among studies evaluating BNP and NT-proBNP, including type of commercial assay, chronological age of the infant at testing, gestational age at birth, whether used to initiate medical or surgical treatment, test threshold, and criteria of the reference standard (type of echocardiographic parameter used for diagnosis, clinical symptoms or physical signs if data were available).
SEARCH METHODS
We searched the following databases in September 2021: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. We also searched clinical trial registries and conference abstracts. We checked references of included studies and conducted cited reference searches of included studies. We did not apply any language or date restrictions to the electronic searches or use methodological filters, so as to maximise sensitivity.
SELECTION CRITERIA
We included prospective or retrospective, cohort or cross-sectional studies, which evaluated BNP or NT-proBNP (index tests) in preterm infants (participants) with suspected hsPDA (target condition) in comparison with echocardiogram (reference standard).
DATA COLLECTION AND ANALYSIS
Two authors independently screened title/abstracts and full-texts, resolving any inclusion disagreements through discussion or with a third reviewer. We extracted data from included studies to create 2 × 2 tables. Two independent assessors performed quality assessment using the Quality Assessment of Diagnostic-Accuracy Studies-2 (QUADAS 2) tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We used bivariate and hierarchical summary receiver operating characteristic (HSROC) random-effects models for meta-analysis and generated summary receiver operating characteristic space (ROC) curves. Since both BNP and NTproBNP are continuous variables, sensitivity and specificity were reported at multiple thresholds. We dealt with the threshold effect by reporting summary ROC curves without summary points.
MAIN RESULTS
We included 34 studies: 13 evaluated BNP and 21 evaluated NT-proBNP in the diagnosis of hsPDA. Studies varied by methodological quality, type of commercial assay, thresholds, age at testing, gestational age and whether the assay was used to initiate medical or surgical therapy. We noted some variability in the definition of hsPDA among the included studies. For BNP, the summary curve is reported in the ROC space (13 studies, 768 infants, low-certainty evidence). The estimated specificities from the ROC curve at fixed values of sensitivities at median (83%), lower and upper quartiles (79% and 92%) were 93.6% (95% confidence interval (CI) 77.8 to 98.4), 95.5% (95% CI 83.6 to 98.9) and 81.1% (95% CI 50.6 to 94.7), respectively. Subgroup comparisons revealed differences by type of assay and better diagnostic accuracy at lower threshold cut-offs (< 250 pg/ml compared to ≥ 250 pg/ml), testing at gestational age < 30 weeks and chronological age at testing at one to three days. Data were insufficient for subgroup analysis of whether the BNP testing was indicated for medical or surgical management of PDA. For NT-proBNP, the summary ROC curve is reported in the ROC space (21 studies, 1459 infants, low-certainty evidence). The estimated specificities from the ROC curve at fixed values of sensitivities at median (92%), lower and upper quartiles (85% and 94%) were 83.6% (95% CI 73.3 to 90.5), 90.6% (95% CI 83.8 to 94.7) and 79.4% (95% CI 67.5 to 87.8), respectively. Subgroup analyses by threshold (< 6000 pg/ml and ≥ 6000 pg/ml) did not reveal any differences. Subgroup analysis by mean gestational age (< 30 weeks vs 30 weeks and above) showed better accuracy with < 30 weeks, and chronological age at testing (days one to three vs over three) showed testing at days one to three had better diagnostic accuracy. Data were insufficient for subgroup analysis of whether the NTproBNP testing was indicated for medical or surgical management of PDA. We performed meta-regression for BNP and NT-proBNP using the covariates: assay type, threshold, mean gestational age and chronological age; none of the covariates significantly affected summary sensitivity and specificity.
AUTHORS' CONCLUSIONS
Low-certainty evidence suggests that BNP and NT-proBNP have moderate accuracy in diagnosing hsPDA and may work best as a triage test to select infants for echocardiography. The studies evaluating the diagnostic accuracy of BNP and NT-proBNP for hsPDA varied considerably by assay characteristics (assay kit and threshold) and infant characteristics (gestational and chronological age); hence, generalisability between centres is not possible. We recommend that BNP or NT-proBNP assays be locally validated for specific populations and outcomes, to initiate therapy or follow response to therapy.
Topics: Humans; Infant; Infant, Newborn; Cross-Sectional Studies; Infant, Premature; Natriuretic Peptide, Brain; Prospective Studies; Retrospective Studies
PubMed: 36478359
DOI: 10.1002/14651858.CD013129.pub2