Search Results (244)

Modern external beam radiotherapy (EBRT) on lung cancer improved dose distribution thanks to advanced dose calculation algorithms, but side effects and relapses can occur in any case onset. Differential diagnosis of relapses and side effects is difficult, and when computed tomography (CT) is uncertain 18-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) can support the diagnosis, even if it can also be difficult to construe. The aim of this retrospective analysis was to evaluate 18F-FDG PET/CT qualitative patterns and semiquantitative parameters, both automatic and preceded by physicians, in interpreting lung lesions in the radiotherapy (RT) lung irradiation field. In total, 94 patients (pts) submitted to EBRT (3 months before) for stage II lung cancer were included (74 men, 20 women, mean age of 68 years old, range of 49–84 years old). CT scans were performed on pts, which showed lung lesions in the RT field. 18F-FDG-PET/CT scans were analyzed qualitatively as negative or positive, and the presence of the lung area with a high 18F-FDG uptake pattern was distinguished as the following: focal/wide, deep/shade, or homogeneous/inhomogeneous. Furthermore, the following semiquantitative parameters were collected: gSUVmax (global standardized uptake value max), MTV (tumor metabolic volume), metabolic spatial distribution (MSD) = proximal SUVmax/distal SUVmax, and intratumoral difference in spatial distribution (IDSD%) = [distal SUVmax/proximal SUVmax] × 100. 18F-FDG PET/CT was related to the pts’ outcome (biopsy and/or clinical–instrumental follow-up): positive for lung relapse, negative if the lesions were phlogistic. The following diagnostic performance parameters of 18F-FDG PET/CT were calculated: sensitivity (Sens), specificity (Spec), diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV). Qualitative variables were compared by Chi-squared test, while for semiquantitative parameters Student’s t-test was applied; p < 0.05 was considered statistically significant. Statistics tests were performed with MedCalc V.22.018 ©2024. In 76/94 (80.8%) pts, 18F-FDG uptake was higher compared to the background; in 18/94 (19.2%) no high 18F-FDG uptake areas were detected. Outcome was positive for lung relapse in 49/94 pts, while negative in 45/94, with disease prevalence of 52.13% (95%CI = 41.57–62.54%). In the 18/94 pts without high 18F-FDG uptake, the outcome was negative for lung relapse. In 49/76 pts with higher 18F-FDG uptake, the outcome confirmed the presence of relapse, while in 27/76 the lesion was phlogistic. Results about the Sens, Spec, DA, PPV, and NPV (95%CI) were, respectively: 100% (92.75–100%), 40% (25.7–55.67%), 71.28% (61.02–80.14%), 64.47% (58.84–69.73%), and 100% (81.47–100%). Chi-square test showed significant statistical difference between the positive and negative outcome for patterns focal/wide (p = 0.02) and deep/shade (p < 0.00001). A total of 35/49 (71.4%) pts with lung relapse had a focal lesion and 15/27 (55.6%) with phlogosis had a wide pattern. A total of 34/49 (69.4%) pts with lung relapse had a deep pattern and 25/27 (92.6%) with lung phlogosis had the shade one. Significant difference was observed in evaluating the three patterns (p = 0.00007), with prevalence of “focal/deep/homogeneous” patterns in lung relapse and “wide/shade/inhomogeneous” in phlogosis. gSUVmax, MTV, MSD, and IDSD% were in the following order: in the 76 pts, 5.63 (1.4–24.7), 42.49 (4.94–193), 3.61 (1–5.54), and 70.7% (18–100%); in the 49/76 true positive pts, 6.93 (1.5–24.7), 35.28 (4.94–85.99), 3.30 (1.05–5.54), and (18–95%); in the 27/76 false positive pts, 3.27 (1.4–19.2), 38.37 (4.94–193), 1.57 (1–2.13), and 78.6% (4.7–100%). The difference was statistically significant only for MSD (t = 2.779; p = 0.0069) and IDSD% (t = 2.769; p = 0.0071). 18F-FDG-PET/CT confirms its high sensitivity and NPV in evaluating lung lesions after RT. To improve physician confidence in interpreting lung 18F-FDG uptake without further support, MSD and IDSD% could be considered. Heterogeneity of lung lesions, especially in radiotreated tissue, can be turned from a drawback to a resource and analyzed for differentiating relapses from EBRT side effects. Considering the calculation of semiquantitative parameters that require “human intelligence”, even if slightly more time-consuming, can improve the nuclear physician’s confidence in interpreting 18F-FDG PET/CT images. Full article

Tomicus pilifer is a major pest that threatens Pinus koraiensis forests in the northeast region of China. In this study, we employed scanning electron microscopy (SEM) to observe the sensilla on the antennae, mouthparts, and legs of both male and female T. pilifer adults, analyzing the differences in sensillum types, external morphology, and quantities between sexes. The results revealed six types of sensilla on the antennae of both males and females, including sensilla trichoidea, sensilla zigzag, sensilla coeloconica, sensilla chaetica, Böhm bristles, and sensilla basiconica. Among these, sensilla basiconica was the most abundant, with four subtypes identified, and sensilla basiconica III was observed only on the male antennae, indicating sexual dimorphism in sensillum types. The mouthparts exhibited the greatest diversity in sensilla, with seven types identified: sensilla basiconica, sensilla twig basiconica, sensilla coeloconica, sensilla trichoidea, sensilla chaetica, sensilla zigzag, and sensilla digitiformia. Of these, sensilla basiconica and sensilla twig basiconica, responsible for olfactory or gustatory functions, were concentrated at the distal ends of the maxillary palps and labial palps. On the legs, sensilla trichoidea, sensilla zigzag, and sensilla chaetica were distributed on all segments. The findings of this study provide a scientific basis for further research into the olfactory and feeding behaviors, as well as electrophysiological studies, of T. pilifer. Full article

Background/Aim: Third molar impaction with the consequent root resorption of second molars often creates complexities in treatment planning and execution. In the past, the root canal treatment (RCT) of second molars was required in these cases to avoid pulp necrosis and infection. The aim of this paper is to report a surgical/retrograde approach for the maintenance of pulp vitality, proposed as retrograde vital pulp treatment (rVPT), in cases of asymptomatic or reversibly affected teeth with root resorptions caused by impacted adjacent teeth. Methods: A case report on the rVPT of two upper second molars with root resorption due to third molar impaction is presented. The chief complaint of the patient was a slight pain during bite involving the upper second molars. Heat and cold sensitivity tests were performed, suggesting a healthy pulp status. A cone beam computed tomography (CBCT) scan was performed to aid the diagnosis and treatment planning, showing bilateral upper third molar impaction and both distal roots of the upper second molars affected by external root resorption (ERR). In both cases, the third molar was surgically extracted, the surface of the root with ERR was smoothened and rVPT was carried out by performing a 3 mm retrograde preparation of the root canal and its retrograde sealing using a hydraulic calcium silicate-based cement (hCSCs). Results: Heat and cold sensitivity tests were performed 1 month, 3 months, 6 months and 1 year after the treatment. The patient reported no pain, and the pulp sensitivity was maintained in all follow-up periods. A CBCT scan was performed 24 months after the treatment, reporting a complete perirradicular endogenous bone apposition. Conclusions: Based on the successful clinical and radiographic outcomes observed in the present case after two years of follow-up, rVPT is proposed for the maintenance of pulp vitality in cases of asymptomatic or reversibly affected teeth with ERR caused by impacted adjacent teeth. Full article

Background/Objectives: It is unclear whether enamel margins should be beveled in direct resin-based restorations. This study evaluated the influence of enamel beveling on the marginal quality of mesio-occluso-distal (mod) cavity boxes. Methods: Seventy-five caries-free human molars were divided into three groups. Mod-cavities with the entire margin in the enamel were prepared ± proximal bevel (n = 25). Twenty-five beveled mod-cavities served as control. Each group was restored with five material combinations: micro hybrid composite with etch-and-rinse (ER) or self-etch (SE) adhesive, compomer with ER or SE, and low-shrinkage composite with ER. A complex filling technique was used in the control. After artificial aging (1000 thermal cycles, 5/55 °C), the percentage of continuous margins (PCM) of the proximal boxes was analyzed by scanning electron microscopy using epoxy replicas (×300), and the marginal seal was assessed by light microscopy after dye penetration (×64). Statistical analysis was performed using Kruskal–Wallis and Mann–Whitney U tests (p < 0.05). Results: No significant differences in PCM were found between the restorative systems (p = 0.075). The composite with low shrinkage showed the highest mean PCM of all groups (78.1%). Significant differences in marginal seal were observed between the restoratives after bevel preparation (p < 0.05). Beveling significantly improved the PCM only for the hybrid composite (p < 0.05), whereby the effect on marginal seal was less pronounced. Conclusions: Clinicians should be aware that beveling mod-cavities does not necessarily improve the marginal quality of direct resin-based restorations bonded with well-established adhesives and may be more beneficial for traditional hybrid composites. Full article

Wings are a crucial evolutionary trait of insects and constitute an important part of their sensory system. Phloem-feeding aphids specialising in particular host plant species require an efficient sensory system and locomotive abilities to find an appropriate plant to complete the life cycle. Wings (in winged morphs) play a crucial role in this dispersal, but the sensory part of their structure is neglected. Here, we review campaniform sensilla, responsible for sensing the mechanical deformations of wings, in the aphid subfamily Eriosomatinae, where many species are host-alternating, which requires distant flights. Based on light and scanning electron microscopy, we illustrate sensilla and their arrangement on wings in 10 species. We also provide a broader sensory background by correlating their number with other important olfactory and campaniform sensilla of the antennae and legs. We find a strong relation of forewing sensilla with olfactory receptors on antennae, but their number is specific for particular morphs, depending on the required flight effort, led by the abundance of the host plant. Morphs migrating to less abundant host have 1.15 to 1.77 more campaniform sensilla per 1 mm of forewing length than morphs migrating to more abundant host. Aphids reveal a relatively high number of sensilla on the distal part of the forewings, showing their importance for effective sensing the deformation of wing. Full article

Background: The knee joint performs a vital function in human movement, supporting significant loads and ensuring stability during daily activities. Methods: The objective of this study was to develop and validate a subject-specific framework to model knee flexion–extension by integrating 3D gait data with individualized musculoskeletal (MS) and finite element (FE) models. In this proof of concept, gait data were collected from a 52-year-old woman using Xsens inertial sensors. The MS model was based on the same subject to define realistic loading, while the 3D knee FE model, built from another individual’s MRI, included all major anatomical structures, as subject-specific morphing was not possible due to unavailable scans. Results: The FE simulation showed principal stresses from –28.67 to +44.95 MPa, with compressive stresses between 2 and 8 MPa predominating in the tibial plateaus, consistent with normal gait. In the ACL, peak stress of 1.45 MPa occurred near the femoral insertion, decreasing non-uniformly with a compressive dip around –3.0 MPa. Displacement reached 0.99 mm in the distal tibia and decreased proximally. ACL displacement ranged from 0.45 to 0.80 mm, following a non-linear pattern likely due to ligament geometry and local constraints. Conclusions: These results support the model’s ability to replicate realistic, patient-specific joint mechanics. Full article

Whole-leg radiographs (WLRs) are widely used to assess coronal alignment before total knee arthroplasty (TKA), but may be inaccurate in patients with atypical morphotypes or malrotation. This study evaluated the discrepancy between WLR and 3D computed tomography (CT) scans across coronal plane alignment of the knee (CPAK) morphotypes and introduced a novel projection index—the femoral notch projection ratio (FNPR). In CPAK III knees, 19% of cases exceeded a clinically relevant threshold (>3° difference), prompting investigation of underlying projection factors. In 187 knees, coronal angles—including the medial distal femoral angle (MDFA°), medial proximal tibial angle (MPTA°), femoral mechanical angle (FMA°), and arithmetic hip–knee–ankle angle (aHKA°)—were measured using WLR and CT. Rotational positioning on WLR was assessed using FNPR and the patellar projection ratio (PPR). CPAK classification was applied. WLR systematically underestimated alignment, with the greatest bias in CPAK III (MDFA° + 1.5° ± 2.0°, p < 0.001). FNPR was significantly higher in CPAK III and VI (+1.9° vs. −0.3°, p < 0.001), indicating a tendency toward internally rotated limb positioning during imaging. The PPR–FNPR mismatch peaked in CPAK III (4.1°, p < 0.001), suggesting patellar-based centering may mask rotational malprojection. Projection artifacts from anterior osteophytes contributed to outlier measurements but were correctable. Valgus morphotypes with oblique joint lines (CPAK III) were especially prone to projection error. FNPR more accurately reflected rotational malposition than PPR in morphotypes prone to patellar subluxation. A 3D method (e.g., CT) or repeated imaging may be considered in CPAK III to improve surgical planning. Full article

The main objective of proton beam therapy is to precisely irradiate diseased tissue while minimizing damage to healthy cells. For effective treatment, the linear energy transfer (LET) is a key parameter in ensuring the destruction of diseased cells, and both the dose and LET are typically represented as functions of depth. The distribution of dose and LET in the target depends on the beam properties, including beam energy, energy spread, beam size, and beam emittance. The aim of this work is to present the method used to characterize the proton beam properties obtained from the machine employed in the simulation and to determine the dose and dose-averaged LET (LET_d) values, including their peak positions in depth. These results are used to predict the dose and LET_d at different depth positions under experimental conditions. We utilized GEANT4, a Monte Carlo (MC) simulation-based software, to examine the integral depth-dose position and the peak position of the LET_d. The proton source was obtained from a cyclotron accelerator, specifically the Varian ProBeam Compact spot scanning system at King Chulalongkorn Memorial Hospital in Bangkok, Thailand. The system provides proton energies ranging from 70 MeV to 220 MeV. In this study, four proton energies—70 MeV, 100 MeV, 150 MeV, and 220 MeV—were chosen to characterize the beam properties. The 80%–20% distal fall-off obtained from the simulation was used to determine the energy spread for each selected energy by matching the depth-dose peak with the measurement data. The optimal energy spreads were found to be 1.5%, 1.25%, 1%, and 0.5% for proton energies of 70 MeV, 100 MeV, 150 MeV, and 220 MeV, respectively. These energy spreads ensure that the difference in the depth-dose profile is below 1% when comparing the simulated and measured depth-dose profiles. Furthermore, the peak LET_d was found to be approximately 1 mm away from the R₈₀ position, a depth that corresponds to 80% of maximum dose, for each energy. This information can be used to guide the desired LET_d position by utilizing the R₈₀ depth position. Full article

Background: Arterial variations in the upper limb, although infrequent, carry critical clinical implications. The presence of superficial ulnar and radial arteries, especially when originating from high levels, increases the risk of iatrogenic injury, misdiagnosis, and surgical complications. To confirm and describe, through ultrasound and anatomical dissection, the presence of a high-origin superficial ulnar artery and a superficial radial artery in a cadaver, highlighting their anatomical trajectory and clinical relevance. Methods: A cross-sectional ultrasound and anatomical study was conducted on 150 upper limbs from fresh-frozen cadavers. High-frequency ultrasound was used to scan the vasculature from the axilla to the wrist. Subsequently, dissection was performed to confirm sonographic findings. Results: One case (0.66%) of concurrent superficial ulnar artery and superficial radial artery was identified in the left arm of a 79-year-old male cadaver. The superficial ulnar artery originated from the axillary artery and coursed superficially along the forearm, anterior to the flexor muscles. The superficial radial artery emerged from the brachial artery and ran subcutaneously in the distal forearm. These arteries remained in close relation to key neural and venous structures, increasing their vulnerability to clinical error. Conclusions: The identification of high-origin superficial arteries is essential for clinical practice. Ultrasound serves as a reliable, non-invasive method for detecting such variations preoperatively. Awareness of these anomalies can prevent inadvertent vascular injuries, improve diagnostic accuracy, and inform safer surgical and anesthetic approaches in upper limb interventions. Full article

Objective: This ex vivo study aimed to evaluate the influence of different acquisition protocols, combining voxel size and field of view (FOV), across four cone-beam computed tomography (CBCT) systems, on the accuracy of alveolar bone level measurements for periodontal assessment. Materials and Methods: A dry human mandible was used, with standardized radiopaque markers placed on the cementoenamel junction (CEJ) of the buccal–mesial and buccal–distal aspects of teeth 34 and 43. CBCT scans were performed using four systems—Veraview^® X800, OP300 Pro^®, I-CAT Next Generation^®, and Orthophos XG^®—applying various combinations of field of view (FOV) and voxel resolution available in each device. Reference measurements were obtained in situ using a digital caliper. CBCT images were exported in DICOM format and analyzed with OnDemand3D software (version 4.6) to obtain paracoronal sections. Linear measurements from the CEJ to the alveolar crest were recorded in triplicate and compared to the gold standard using ANOVA and the Dunnett test (α = 0.05). Results: Protocols with smaller voxel sizes and limited FOVs generally yielded measurements closer to the gold standard. However, some larger-FOV protocols with intermediate voxel sizes also achieved comparable accuracy. Among the systems, the I-CAT showed lower agreement within in situ measurements, while others demonstrated reliable performance depending on the acquisition parameters. Conclusions: The findings suggest that CBCT protocols with smaller voxel sizes and reduced FOVs can enhance measurement accuracy in periodontal bone assessments. Nevertheless, intermediate protocols may offer a balance between diagnostic quality and radiation exposure, aligning with the ALADA principle. This study reinforces the need for standardized acquisition parameters tailored to periodontal imaging. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Traditional diagnostics like EMG and NCSs are invasive and do not visualize nerve morphology. This study aims to evaluate the diagnostic and prognostic value of high-resolution ultrasonography in patients with CTS using a standardized scanning protocol and to evaluate the relationship between sonographic findings and traditional electrodiagnostic results. Methods: In this observational study with both prospective and retrospective components, 31 subjects were included. Between November 2023 and June 2024, 11 symptomatic CTS patients were scheduled for surgical decompression and 14 healthy controls were prospectively enrolled. Additionally, six post-surgical CTS patients who had undergone decompression between 2016 and 2021 were retrospectively included for comparative analysis. All underwent clinical and ultrasonographic assessments of the median nerve at predefined anatomical landmarks. EMG was performed in the CTS groups. Ultrasound was repeated at 1, 3, and 6 months postoperatively to monitor morphological changes. Results: CTS patients had significantly increased the median nerve CSA compared to controls. Postoperative ultrasound showed progressive CSA reduction correlating with clinical improvement and EMG recovery. The CSA correlated moderately to strongly with distal motor latency. Conclusions: High-resolution ultrasound is a reliable, non-invasive tool for diagnosing and monitoring CTS. Standardized protocols are needed to support broader clinical adoption and establish it as a standalone diagnostic method. Full article

Objectives: This study investigated the potential of Hounsfield unit (HU) values obtained from computed tomography (CT) scans as predictors of mechanical complications (MCs) in patients undergoing long-segment spinal fusion involving the pelvis. Additionally, it identified a threshold HU value associated with an increased risk of MCs. Methods: We conducted a retrospective, multicenter review of patients who underwent long-segment spinal fusion involving the pelvis, with a minimum follow-up period of two years. Patients were categorized based on the presence or absence of postoperative MCs. Both preoperative and postoperative radiographic parameters were analyzed, and HU values were quantified from CT images. Logistic regression modeling was used to identify independent risk factors for MCs. Results: Among 129 patients, 33 (25.6%) developed MCs, including proximal and distal junctional failures, rod fractures, and cases necessitating re-operation. The HU values were significantly lower in the MC group, whereas conventional bone mineral density (BMD) measurements showed no significant difference. Global alignment parameters, such as the sagittal vertical axis (SVA) and global tilt (GT), were consistently higher in patients with MCs. Receiver operating characteristic analysis identified 131 HU as the optimal cut-off, yielding a sensitivity of 56.4% and a specificity of 69.7%. Multivariate analysis confirmed that lower HU values were independently associated with the occurrence of MCs. Conclusions: Lower HU values and larger radiological global alignment parameters are significant predictors of MCs in patients undergoing surgery for adult spinal deformity. These findings underscore the importance of CT-based quantitative assessments in preoperative planning. Full article

In this article, we present a case of a 49-year-old woman presenting with a recurrent metastatic neuroendocrine tumor. Background: Insulinomas are neuroendocrine tumors derived from beta cells of the pancreas that secrete insulin. Usually, they are benign tumors; however, metastatic insulinomas are an extremely rare malignant form of these tumors, carrying a significantly worse prognosis. Case Presentation: A 49-year-old woman, a patient in the University Hospital in Wroclaw in the Department of Endocrinology, Diabetes and Isotope Therapy, first presented with abdominal pain in 2009, when ultrasound and further examination led to the diagnosis of a tumor in the pancreas (a solid pseudopapillary tumor of the pancreas—meta NET G2), and the patient underwent distal pancreatectomy with splenectomy. For ten years, she was under observation, and her symptoms, such as abdominal pain, nausea, weight loss, and general weakness, reappeared in 2019. Then, magnetic resonance imaging (MRI) showed a lesion in the liver, and further histopathology revealed neuroendocrine tumor (NET) metastasis to the liver. In 2022, the patient presented with loss of consciousness and convulsion, loss of weight, and hypoglycemia after meals. In April 2022, the daily glycemic profile was recorded and a 72 h fasting test was performed; however, their results excluded insulinoma. Positron emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (18F-FDG) and PET with gallium-68-DOTA-(Tyr3)-octreotate (68Ga-DOTA-TATE) showed a metastatic proliferative process in the liver. Persistent hypoglycemia led to another hospitalization in May 2022, and repeated tests allowed for the diagnosis of insulinoma. Treatment with somatostatin analogs and diazoxide was started. A CT scan in November 2022 and a PET scan in January 2023 showed new metastases to the liver, bones, and cervical lymph nodes, and it was decided to intensify the treatment. In May 2023, the patient was qualified for Lutathera treatment for insulinoma at the University Clinical Hospital in Poznań. In June 2023, another disturbing symptom was reported by the patient, a painful lump in the breast. During diagnostics, metastases with high proliferation markers were found in both breasts. Two months later, in August 2023, the patient received another dose of Lutathera. In October 2023, significant progression of liver lesions, metastases to bones of the spine, ribs, and pelvis, and periaortic and pelvic lymphadenopathy were found as well as elevated values of neuron-specific enolase and calcitonin. The patient was also referred to the Palliative Medicine Home Hospice. In consultation with the Lower Silesian Cancer Center, the decision was made to forgo further treatment with PRRT and initiate systemic chemotherapy. Despite the chosen treatment, the patient died on 27/DEC/2023. Conclusions: This case report can serve clinicians, as it presents a case of an extremely rare and insidious tumor, metastatic insulinoma. Full article

Ultrasound-guided botulinum toxin type A (BoNT-A) injections play a critical role in the management of upper limb spasticity. This is the second part of ‘The Elias University Hospital Approach: A Visual Guide to Ultrasound-Guided Botulinum Toxin Injection in Spasticity’ and it focuses on the proximal upper limb muscles, complementing the first part, which addressed the distal upper limb muscles. This guide provides a detailed analysis of ultrasound anatomy, clinical relevance, and injection strategies for the latissimus dorsi, teres major, subscapularis, pectoralis major, pectoralis minor, deltoid, triceps brachii, biceps brachii, brachialis, and brachioradialis. Using the Elias University Hospital (EUH) model, it presents a structured approach to BoNT-A administration, ensuring precision, safety, and optimal outcomes in spasticity management. To enhance clinical application, this guide incorporates a wide array of high-quality ultrasound images and dynamic videos, offering a comprehensive and practical understanding of scanning techniques, anatomical structures, and injection procedures. This second part of the series serves as an essential reference for clinicians, aligning with the first installment to provide a complete and systematic approach to ultrasound-guided BoNT-A therapy for upper limb spasticity. Full article

Two-photon endomicroscopy (2PEM), an endomicroscopic imaging technique based on the two-photon excitation effect, provides several technical benefits, including high spatiotemporal resolution, label-free structural and metabolic imaging, and optical sectioning. These characteristics make it extremely promising for biomedical imaging applications. This paper classifies distal-scanning 2PEMs based on their actuation mechanism (PZT or MEMS) and excitation–collection optical path configuration (common or separate path). Recent representative advancements are reviewed. Furthermore, we introduce its biomedical applications in tissue, organ, and brain imaging with free-behaving mice. Finally, future development directions for distal-scanning 2PEM are discussed. Full article