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Objective: To retrospectively analyze and assess the long-term effectiveness of robotic navigation and traditional closed reduction internal fixation in the treatment of Delbet type II femoral neck fracture in children. Methods: A total of fifty-five patients diagnosed with pediatric Delbet type II femoral neck fracture, who were admitted to Foshan Hospital of Traditional Chinese Medicine between January 2018 and June 2022, were included in this study. Among them, 22 cases of nailing under robotic navigation were set as the observation group, and 33 cases of nailing under fluoroscopy of the C-arm machine were set as the control group. All patients had their femoral neck fractures closed and repositioned first. After confirming the satisfactory fracture repositioning under the fluoroscopic view of the C-arm machine, internal fixation was performed by inserting hollow compression screws in the corresponding surgical way.A comparative analysis was conducted between the two groups to assess the disparity in the amount of X-ray exposure during surgery, the number of guide pins inserted, and the duration of the surgical procedure. The quality of comparative fracture reduction was assessed according to the Haidukewych criteria on the first postoperative hip X-ray, and the parallelism and distribution of the comparative screws were measured. The incidence of hip function and postoperative complications according to the Ratliff criteria were evaluated between each of the subgroups at the final follow-up. Results: Comparison of general information, operation duration, and quality of fracture reduction between the two groups failed to reveal statistically significant results (P > 0.05). The observation group had a lower number of X-ray exposures and guide pin placements compared to the control group, and this difference was statistically significant (P < 0.05).At the last follow-up, the observation group exhibited superior screw parallelism and distribution, as well as hip joint function, compared to the control group, and this difference was statistically significant (P < 0.05). The incidence of complications in the observation group was lower than that in the control group; however, the difference was not statistically significant (P > 0.05). Conclusion: Closed reduction and internal fixation under orthopedic robot navigation can achieve better long-term efficacy in treating Delbet type II femoral neck fracture in children. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD. Methods: Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered. Results: The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05). Conclusion: BR-modified BD maintains BD's physical properties, with improved flow, making it a promising DPC agent that warrants further study. [ABSTRACT FROM AUTHOR]

Aims: Rotator cuff related shoulder pain (RCRSP) is a prevalent cause of musculoskeletal pain. Patients presenting with this condition often undergo diagnostic imaging. However, many patients appear to have difficulty recalling the nature of their diagnosis. This may impact their rehabilitation outcomes. The aim of this study was to explore peoples' recall of their structural features relating to RCRSP by comparing their recalled description of their condition with the contents of their imaging reports as reported in an online questionnaire. In doing so, we aim to explore the potential emphasis they place on structural features related to their condition. Methods: This study was a content analysis embedded within a larger survey study published previously. Data containing patients' recall of their diagnosis was used from the study, and analysed using content analysis to quantify content in terms of codes and categories. The aims of frequency, completeness and accuracy of recall were then explored. Results: The analysis identified eight categories of terminology either recalled by patients or reported in imaging reports. The most frequent categories in reports were tendinopathy (71%) and joint (67%), but only 17% and 36% of participant responses contained these codes, respectively. Participants' completeness of recall compared with their imaging report was 30% on average. In terms of accuracy, only 8 out of 95 participants recalled their diagnoses 100% correctly. Conclusion: This study indicates that patients have poor overall recall of their RCRSP‐related structural features. We contend that participants may have been able to recall what they viewed to be the most prominent structural feature in their imaging findings. It may be important for clinicians to consider the impact of diagnostic labelling, and whether a patient's ability to recall such labelling may have an influence on their outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Screening trials and meta-analyses emphasize the ratio of cancer death rates in screening and control arms. However, this measure is diluted by the inclusion of deaths from cancers that only became detectable after the end of active screening. Methods: We review traditional analysis of cancer screening trials and show that ratio estimates are inevitably biased to the null, because follow-up (FU) must continue beyond the end of the screening period and thus includes cases only becoming detectable after screening ends. But because such cases are expected to occur in equal numbers in the two arms, calculation of the difference between the number of cancer deaths in the screening and control arms avoids this dilutional bias. This difference can be set against the number of invitations to screening; we illustrate by reanalyzing data from all trials of tomography screening of lung cancer (LC) using this measure. Results: In nine trials of LC screening from 2000 to 2013, a total of 94,441 high-risk patients were invited to be in screening or control groups, with high participation rates (average 95%). In the older trials comparing computed tomography to chest X-ray, 88,285 invitations averted 83 deaths (1068 per death averted (DA)). In the six more recent trials with no screening in the control group, 69,976 invitations averted 121 deaths (577 invitations per DA). Discussion: Screens per DA is an undiluted measure of screening's effect and it is unperturbed by the arbitrary duration of FU. This estimate can be useful for program planning and informed consent. [ABSTRACT FROM AUTHOR]

Investigation of the fruits of Rhododendron molle G. Don led to the isolation of three new grayanane-type diterpenoids, rhodomolleins LIV-LVI (1-3). The structures and absolute configurations of new compounds were fully elucidated by spectroscopic analysis and single-crystal X-ray diffraction, including HRESIMS, 1 D and 2 D NMR data. Compounds 1-3 were evaluated for analgesic activities utilizing an acetic acid-induced writhing test in mice. Compound 1 showed a significant antinociceptive effect with writhe inhibition rates of 72.9% and 100% at doses of 6 mg/kg and 20 mg/kg in mice, respectively. The binding mode of 1 to N-ethylmaleimide-sensitive factor (NSF, PDB: 6IP2) was explored by molecular docking, indicating the presence of hydrogen bond interactions which account for its analgesic activity. [ABSTRACT FROM AUTHOR]

A significant proportion of revisions after reverse shoulder arthroplasty (RSA) is attributed to the humeral component. The purpose of this study is to evaluate the radiographic and clinical outcomes of the hybrid humerus technique for RSA using a Grammont-style humeral prosthesis in an onlay fashion with metaphyseal bone impaction grafting technique and undersized stem to avoid humeral stress shielding, notching, and loosening. This is a prospective case series of patients who underwent RSA using the hybrid humerus technique with a minimum 2-year follow-up. Key steps of this technique include the use of undersized Grammont-style stem, impaction bone grafting of the proximal 5 cm of the humerus, and adjusting the height and offset of the stem depending on the patient stature, desired lateralization and distalization, and joint and soft tissue tension. Radiographic assessments were performed immediately after surgery, and at 1 and 2 years after surgery. These included assessment of metaphyseal and diaphyseal filling ratio, cortical narrowing, radiolucent lines, cortical lucencies, spot welding, scapular notching, and stem alignment. Preoperative and 2-year postoperative clinical assessments included American Shoulder and Elbow Surgeons score, Constant-Murley Score, University of California Los Angeles score, visual analog scale for pain, and active range of motion. Correlation between the filling ratios and clinical outcomes were also evaluated. Sixty-one patients were included in the study. The average metaphyseal and diaphyseal filling ratio on the postoperative X-ray was 0.66 and 0.54, and 0.67 and 0.54 at 2 years, respectively. Stress shielding was graded as none in 24 (40.7%), mild in 33 (55.9%), and moderate in 2 (3.4%). No stem had a change in position of more than 5°. At 2 years of follow-up, no humeral implant loosening was noted, with only 2 (3.4%) of the stems at risk of loosening. Thirty-nine (66.1%) had no notching, 14 (23.7%) were graded as mild, and 6 (10.2%) had moderate signs of notching. All clinical assessments significantly improved at 2 years (P <.001), with a weak negative correlation between visual analog scale and metaphyseal filling ratio (r = −0.268, P =.036) but none between diaphyseal filling ratio and clinical outcomes. The hybrid humerus technique of metaphyseal bone grafting with a low filling ratio stem presents a promising solution for reducing humeral complications in RSA. This technique demonstrates a low incidence of stress shielding and loosening, with excellent clinical outcomes at 2 years. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the demographic-, radiographic-, and surgery-related factors influencing postoperative functional internal rotation (fIR) following reverse total shoulder arthroplasty (RTSA). Methods: In this retrospective cohort study, patients who underwent RTSA between June 2013 and April 2018 at a single institution were assigned to two groups ("IROgood" or "IRObad"). Patients were classified as having good fIR (≥8 points in the Constant–Murley score (CS) and fIR to the twelfth thoracic vertebra or higher) or poor fIR (≤2 points in the CS and fIR to the twelfth thoracic vertebra or lower) after RTSA with a single implant model. The minimum follow-up period was two years. Standardized shoulder-specific scores (Visual Analogue Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES), Constant–Murley score (CS)) were used to assess the pre- and postoperative functional status of patients. Postoperative radiographic evaluation included the distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), acromiohumeral distance (AHD), glenoid inclination (GI), medialization of the center of rotation (COR), lateralization of the humerus, and distalization of the greater tuberosity. Additionally, preoperative evaluation included rotator cuff arthropathy according to Hamada, glenoid version, anterior or posterior humeral head subluxation, and fatty infiltration of the rotator cuff according to Goutallier. Univariate analysis of demographic, surgical, radiographic, and implant-associated parameters was performed to identify factors associated with postoperative fIR. The Shapiro–Wilk test assessed the normal distribution of the data. Intergroup comparisons regarding demographic and surgery-related factors were conducted using the Mann–Whitney-U Test. Radiographic changes were compared using chi-square or Fisher's exact tests. The significance level was set at p < 0.05. Results: Of a total of 42 patients, 17 (age: 73.7 ± 5.0 years, follow-up (FU) 38 months [IQR 29.5–57.5]) were included in the "IRObad" group, and 25 (age: 72 ± 6.1 years, FU 47 months [IQR 30.5–65.5]) were included in the "IROgood" group. All patients were treated with the same type of implant (glenosphere size: 36 mm, 14.3%; 39 mm, 38.1%; 42 mm, 47.6%; neck-shaft angle: 135° in 68.0%; 155° in 32.0%) and had comparable indications. Univariate analysis did not reveal any of the investigated demographic, radiographic, or surgery-related parameters as risk factors for poor postoperative fIR (p > 0.05). Conclusion: None of the investigated factors, including implant-associated parameters, influenced postoperative fIR after RTSA in this cohort. [ABSTRACT FROM AUTHOR]

Background: Offspring consistently exhibit similar imaging features as their parents in cases of degenerative lumbar scoliosis (DLS). Nevertheless, the role of genetic factors in the pathogenesis of DLS remains uncertain. Methods: A prospective analysis was conducted on 35 patients with DLS and their 36 offspring. Genomic DNA was extracted from 71 blood samples for gene mutation analysis using whole exome sequencin. Various demographic and imaging parameters were compared. Results: In 11 pedigrees of the 35 family members with DLS, 13 suspected pathogenic genes were identified. Among the 35 DLS patients, 11/35(31.5%) exhibited susceptibility gene mutations (mutant group), while 24/35(68.5%) had no pathogenic gene mutations (non-mutant group). AVR was more severe in mutant group than that in no-mutant group (p < 0.05). Among the 36 offspring, 11/36(30.6%) cohorts presented susceptibility genes (mutant group), 25/36(69.4%) cohorts presented no pathogenic genes (no-mutant group). More cohorts in the mutant group presented vertebral rotation (72.8%) and scoliosis (45.5%) than those (24%), (12%) in the no-mutant group, respectively (p < 0.05). Among the 36 offspring, 8/36(22.2%) presented scoliosis (study group), they all presented the same scoliosis orientation and apex vertebrae/disc location to their parents, the other 28/36(77.8%) cohorts without scoliosis were enrolled as control group, the mutation rate (62.5%) was higher in study group than that (21.4%) in control group. Conclusions: Genetic influences are significant in the onset of DLS, with affected families showing similar scoliosis patterns and identical apex vertebrae. Moreover, individuals with genetic mutations tend to have more pronounced vertebral rotation and at a higher risk of developing scoliosis. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications. Background: Confirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X‐rays and missed enteral nutrition and/or medications. Design: Prospective observational study using STROBE checklist. Methods: Data collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X‐rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability. Results: Of 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X‐rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication. Conclusion: Ongoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one‐fifth of patients required X‐rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition. Relevance to Clinical Practice: Caution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing. [ABSTRACT FROM AUTHOR]

Simple Summary: This study investigated a new blood test (9G testTM Cancer/Lung) for early lung cancer detection. This test measures complexes of autoantibodies with specific lung cancer antigens for CYFRA 21-1 and p53. This study found that the diagnostic performances were significantly better than traditional methods at identifying LC, especially in early stages. The test showed good overall accuracy (AUC of 0.945) and detected early-stage lung cancer with high sensitivity (87.5%). This suggests it could be a valuable tool alongside existing scans like X-rays and LDCT for improving early LC detection. The early detection of lung cancer (LC) improves patient outcomes, but current methods have limitations. Autoantibodies against tumor-associated antigens have potential as early biomarkers. This study evaluated the 9G testTM Cancer/Lung, measuring circulating complexes of two antigen–autoantibody immune complexes (AIC) against their respective free antigens (CYFRA 21-1 and p53) for LC diagnosis. We analyzed 100 LC patients and 119 healthy controls using the 9G testTM Cancer/Lung, quantifying the levels of AICs (CYFRA 21-1-Anti-CYFRA 21-1 autoantibody immune complex (CIC) and p53-Anti-p53 autoantibody immune complex (PIC)), free antigens (CYFRA 21-1 and p53), and ratios of AICs/antigens (LC index). The levels of the CICs and PICs were significantly elevated in LC compared to the controls (p < 0.0062 and p < 0.0026), while free antigens showed no significant difference. The CIC/CYFRA 21-1 and PIC/p53 ratios were also significantly higher in LC (all, p < 0.0001). The LC index, when combining both ratios, exhibited the best diagnostic performance with an area under the curve (AUC) of 0.945, exceeding individual CICs, PICs, and free antigens (AUCs ≤ 0.887). At a cut-off of 3.60, the LC index achieved 81% sensitivity and 95% specificity for LC diagnosis. It detected early-stage (Stage I–II) LC with 87.5% sensitivity, exceeding its performance in advanced stages (72.7%). The LC index showed no significant differences based on age, gender, smoking status (former, current, or never smoker), or pack years smoked. The LC index demonstrates promising potential for early LC diagnosis, exceeding conventional free antigen markers. [ABSTRACT FROM AUTHOR]

[Purpose] The purpose of this study was to compare the effectiveness of the Structural Diagnosis and Management (SDM) approach with Myofascial Release (MFR) in improving plantar heel pain, ankle range of motion, and disability. [Subjects] Sixty-four subjects, aged 30–60 years, with a diagnosis of plantar heel pain, plantar fasciitis, or calcaneal spur by a physician according to ICD-10, were equally allocated to the MFR (n = 32) and SDM (n = 32) groups by hospital randomization and concealed allocation. [Methods] In this assessor-blinded randomized clinical trial, the control group performed MFR to the plantar surface of the foot, triceps surae, and deep posterior compartment calf muscles, while the experimental group performed a multimodal approach utilizing the SDM concept for 12 sessions over 4 weeks. Both groups also received strengthening exercises, ice compression, and ultrasound therapy. Pain, activity limitations and disability were assessed as primary outcomes using the Foot Function Index (FFI) and Range of motion (ROM) assessment of the ankle dorsiflexors and plantar flexors using a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and a 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. [Results] Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including pain, activity level, disability, range of motion, and function after the 12-week intervention period (p <.05). The SDM group showed more improvements than MFR for FFI pain (p <.01), FFI activity (p <.01), FFI (p <.01) and FADI (p = <.01). [Conclusion] Both MFR and SDM approaches are effective in reducing pain, improving function, ankle range of motion, and reducing disability in plantar heel pain, however, the SDM approach may be a preferred treatment option. [ABSTRACT FROM AUTHOR]

Dental caries occurs from the interaction between oral bacteria and sugars, generating acids that damage teeth over time. The importance of X-ray images for detecting oral problems is undeniable in dentistry. With technological advances, it is feasible to identify these lesions using techniques such as deep learning, machine learning, and image processing. Therefore, the survey and systematization of these methods are essential to determining the main computational approaches for identifying caries in X-ray images. In this systematic review, we investigated the primary computational methods used for classifying, detecting, and segmenting caries in X-ray images. Following the PRISMA methodology, we selected relevant studies and analyzed their methods, strengths, limitations, imaging modalities, evaluation metrics, datasets, and classification techniques. The review encompassed 42 studies retrieved from the Science Direct, IEEExplore, ACM Digital, and PubMed databases from the Computer Science and Health areas. The results indicate that 12% of the included articles utilized public datasets, with deep learning being the predominant approach, accounting for 69% of the studies. The majority of these studies (76%) focused on classifying dental caries, either in binary or multiclass classification. Panoramic imaging was the most commonly used radiographic modality, representing 29% of the cases studied. Overall, our systematic review provides a comprehensive overview of the computational methods employed in identifying caries in radiographic images and highlights trends, patterns, and challenges in this research field. [ABSTRACT FROM AUTHOR]

Complex medical terminology utilized in clinical documentation can present barriers to patients understanding their medical findings. We aimed to generate easy-to-understand summaries of clinical radiology reports using large language models (LLMs) and evaluate their safety and quality. Eight board-certified physician reviewers evaluated 1982 LLM-generated radiology report summaries (computed tomography, magnetic resonance imaging, ultrasound, and x-ray) for safety and quality, using predefined rating criteria and the corresponding original radiology reports for reference. Physician reviewers determined 99.2% (1967 out of 1982) of the LLM-generated summaries to be safe. The reviewers scored the quality of the LLM-generated summaries from "5—Very Good" to "1—Very Poor," respectively, as follows: 80.6%, 11.1%, 5.7%, 1.7%, and 0.9%. Safety varied significantly across imaging modality (P =.002). Large language models can be used to generate safe and high-quality summaries of clinical radiology reports. Further investigation is warranted to determine the impact of LLM-generated summaries on patient perception of understanding, knowledge of their medical conditions, and overall experience. [ABSTRACT FROM AUTHOR]

The incidence of paediatric fractures among winter sport athletes is not adequately studied. Our objective was to categorize fractures that occurred in paediatric skiers and snowboarders at a single ski resort. X-rays of 756 skiers/snowboarders aged 3–17 diagnosed with a fracture were categorized using the Salter-Harris (SH) classification. SH fractures were seen in 158 (21%) patients, with 123 (77%) being Type II. There were no significant differences between patients with a SH fracture and patients with a non-SH fracture for age, sex, snowboarding or skiing, mechanism of injury, terrain or the resort conditions on the day of injury. The most common mechanism of injury was falling onto snow while collisions resulted in more severe injuries. Compared to fractures without growth plate involvement, a higher proportion of SH fractures were seen in the humerus, radius, fibula and thumb; a lower proportion of SH fractures were observed at the tibia and clavicle. [ABSTRACT FROM AUTHOR]

Purpose: Operative fixation of femoral neck fractures (FNFs) remains challenging. Complications are not infrequent, especially in displaced patterns. Numerous fixation techniques have been previously described in the literature; however, there remains a paucity of data regarding outcomes of these injuries treated with the femoral neck system (FNS). Methods: Patients with a displaced FNF (OTA/AO 31B) treated with the FNS at a single level 1 academic trauma center between 1/1/2019 and 1/1/2023 were identified. Radiographs were reviewed to assess fracture displacement, location, and characteristics. Patient records were further reviewed to assess for complications, reoperations, and osseous union. Results: Forty-three patients (65% male) with 44 FNFs were identified with a mean age of 35.0 years (range, 13–61 years). Two patients developed a deep infection requiring surgical debridement, four patients underwent a total hip arthroplasty, and one patient underwent a valgus intertrochanteric osteotomy for nonunion. There were three cases of femoral head AVN. Mean follow-up was 482.5 days among all patients, and 36 fractures had at least 6 months of follow-up or reached bony union. Conclusions: Here, we present a series of patients treated with the FNS for internal fixation and report a 18% reoperation rate. This is lower than the average rate that has been previously reported in similar patient populations in the literature treated with alternative methods of internal fixation. Thus, the FNS appears to be a safe and effective option for treatment of these injuries. [ABSTRACT FROM AUTHOR]

Background: The incidence of hip fractures is increasing. Femoral intertrochanteric fractures make up 50% of hip fractures and are treated by intramedullary nails. Implant breakage is a recognized complication that can have rare and serious implications. This study aimed to investigate implant breakage rates after surgical treatment for femoral intertrochanteric fractures. Methods: This was a retrospective multicenter analysis. All 1854 patients who underwent surgical treatment for femoral intertrochanteric fractures were selected from 12 hospitals (TRON group) between 2016 and 2020. Exclusion criteria included implants other than those specified and follow-up periods less than three months. Demographic data, surgical details, and radiographic assessments were collected from medical records and X-ray evaluations. Results: Among the 983 study patients, consisting of 245 males (24.9%) and 738 females (75.1%), the implant breakage rate was 0.31%, with three confirmed cases. The average age was 83.9 years. The mean follow-up period was 640.9 days. Two cases were linked to ASULOCK implants, and one to an OLSII implant. Statistical analysis showed a significantly higher incidence of ASULOCK implant breakage (p < 0.001). In the two cases of ASULOCK implant breakage and one case of OLSII implant breakage, breakage in all three implants occurred at the anti-rotation screws. Conclusions: There were no implant breakages of the main body of the implants; all breakages occurred in the additional anti-rotation screw. The necessity of the anti-rotation screw will require further discussion. These results can potentially inform clinical decisions and guide further research in preventing implant breakage. [ABSTRACT FROM AUTHOR]

Background: Transabdominal ultrasound is used to detect fecal impaction, but the rectum is difficult to visualize without bladder urine or with gastrointestinal gas. Objective: We developed a transgluteal cleft approach that is unaffected by these factors and sought to determine if our ultrasound method could detect and classify fecal matter in the lower rectum using this approach. Methods: We classified ultrasound images from hospitalized patients into four groups: Group 1 (bowed and rock-like echogenic areas), Group 2 (irregular and cotton candy-like hyperechoic areas), Group 3 (flat and mousse-like hyperechoic areas), and Group 4 (linear echogenic areas in the lumen). Stool characteristics were classified as hard, normal, and muddy/watery. Sensitivity and specificity were determined based on fecal impaction and stool classification accuracy. Results: We obtained 129 ultrasound images of 23 patients. The sensitivity and specificity for fecal retention in the rectum were both 100.0%. The recall rates were 71.8% for Group 1, 93.1% for Group 2, 100.0% for Group 3, and 100.0% for Group 4. The precision rates were 96.6% for Group 1, 71.1% for Group 2, 88.9% for Group 3, and 100.0% for Group 4. Our method was 89.9% accurate overall. Conclusion: Transgluteal cleft approach ultrasound scanning can detect and classify fecal properties with high accuracy. [ABSTRACT FROM AUTHOR]

Background: Radiography is commonly used in the assessment of spinal disorders, despite a lack of high-quality evidence demonstrating improved clinical outcomes or additional benefit to the patient. There is disagreement amongst chiropractors regarding the appropriate use of radiography for clinical management. This study aims to qualitatively explore chiropractors' perceptions on the use of spinal radiographs in clinical practice with respect to how they determine when to order radiographs; and how they use radiographs to inform clinical management. Methods: Online qualitative semi-structured interviews were conducted with 17 Australian chiropractors who currently manage patients with spinal disorders. Convienence, snowball, and purposive sampling strategies were used to ensure an appropriate breadth and depth of participant characterisitcs and beliefs. Interview data were recorded, transcribed and analysed using framework analysis. Results: Three themes were developed to describe how chiropractors determined when to order radiographs. These themes included specific findings from the clinical encounter that may inform clinical management, their perceptions of radiation risk, and the influence of clinical experience/intuition. Three themes and four subthemes were developed for how chiropractors use radiographs to inform their management. These themes explored the use of radiography for the application of chiropractic technique, as well as the role of radiographs in predicting patient prognosis, and as an educational tool to provide reassurance. Conclusion: Australian chiropractors' decision-making around spinal radiography is diverse and can be influenced by a number of clinical and external factors. Previously unexplored uses of spinal radiography in clinical practice were highlighted. Some chiropractors reported potential benefits of radiography that are currently not supported by research evidence. Future research should address how radiographic findings are reported to patients with spinal disorders and how this could be optimised to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the impact of sarcopenia on clinical outcomes after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). Methods: We retrospectively analyzed the medical records of patients with single-segment OVCF who underwent percutaneous kyphoplasty (PKP) between September 2021 and August 2022. Patients were categorized into a sarcopenia group (43 patients) and a non-sarcopenia group (125 patients) based on their Advanced Skeletal Muscle Index (ASMI). Clinical and radiological data were collected and analyzed. Results: There were no significant differences between the sarcopenia and non-sarcopenia groups in age, sex, bone mineral density (BMD), body mass index (BMI), fractured segment, fracture type, surgical approach, bone cement volume, bone cement distribution, comorbidities, preoperative and immediate postoperative VAS and ODI scores (P >.05). However, the time to ambulation, hospital stays, VAS and ODI scores at follow-up, excellent/good rate, and the incidence of residual pain and re-fractures in the non-sarcopenia group were significantly better than those in the sarcopenia group (P <.05). Meanwhile, radiological outcomes, including regional kyphosis and vertebral height loss rate, were significantly better in the non-sarcopenia group than in the sarcopenia group at 6 and 12 month follow-ups (P <.05). Conclusion: Clinical outcomes after PKP in patients with OVCF could be negatively affected by sarcopenia. Therefore, prevention and treatment of sarcopenia should be actively considered in the management of patients with OVCF. [ABSTRACT FROM AUTHOR]

This study aimed at examining the bond strength between zirconia and ceramic veneer, following the ISO 9693 guidelines. A total of fifty specimens of zirconia/ceramic‐veneer system were produced using two commercial zirconias (VITA YZ‐HTWhite and Zolid HT+ White, referred to as Group A and Group B, respectively) and a ceramic‐veneering material (Zirkonia 750). The microstructure (via x‐ray diffraction analysis, XRD and Secondary Electron mode, SEM) and the mechanical properties (via 3‐point bending tests) of the two groups were assessed. Then, experiments were conducted according to the ISO 9693 and conventional protocols applied for producing zirconia/ceramic‐veneer restorations. Bond strength values, measured by 3‐point bending tests, were 34.42 ± 7.60 MPa for Group A and 31.92 ± 6.95 MPa for Group B. SEM observations of the cohesively fractured surfaces (on the porcelain side) and the examination for normality using the Shapiro–Wilk test suggested the use of Weibull statistical analysis. Median strength (σ50%) for Group A and Group B was 34.76 and 32.22 MPa, while the characteristic strength (σ63.2%) was 35.78 and 33.14 MPa, respectively. The Weibull modulus disparity between groups (12.69 and 13.07) was not significant. Bond strength exceeded the ISO 9693 minimum of 20 MPa, suggesting satisfactory strength for clinical use. [ABSTRACT FROM AUTHOR]

Purpose: Olecranon fractures are classified using the commonly accepted Mayo classification. Its reliability has been analyzed by means of radiographs. A CT scan is often obtained due to joint involvement. Purpose of this study was to evaluate the intra- and interobserver reliability of the Mayo classification based on CT examination. Methods: Radiographic and CT images of 20 olecranon fractures were classified by four surgeons at two time points 30 days apart. Intra- and interobserver reliability were assessed using kappa coefficients. Results: Mean intraobserver reliability between X-rays was substantial and between CTs almost perfect (0.76 and 0.82, respectively). Mean interobserver reliability was fair for X-rays and moderate for CTs (0.32 and 0.44, respectively). Conclusion: Despite the more detailed imaging compared with radiography only moderate interobserver reliability was found for the classification of olecranon fractures based on CT imaging. This might lead to inconsistent fracture classification in both scientific and clinical setting. [ABSTRACT FROM AUTHOR]

Background: The formation of white spots, which represent early carious lesions, is a major issue with fixed orthodontics. The addition of remineralizing agents to orthodontic adhesives may prevent the formation of white spots. The aim of this study was to produce a composite orthodontic adhesive combined with nano-bioactive glass-silver (nBG@Ag) for bracket bonding to enamel and to investigate its cytotoxicity, antimicrobial activity, remineralization capability, and bond strength. Methods: nBG@Ag was synthesized using the sol-gel method, and characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy with an attenuated total reflectance attachment (ATR-FTIR). The cytotoxicity test (MTT) and antimicrobial activity of adhesives containing 1%, 3%, and 5% (wt/wt) nBG@Ag were evaluated, and the shear bond strength of the adhesives was measured using a universal testing machine. Remineralization was assessed through microhardness testing with a Vickers microhardness tester and scanning electron microscopy (SEM). Statistical analyses were conducted using the Shapiro-Wilk test, Levene test, one-way ANOVA, Robust-Welch test, Tukey HSD method, and two-way ANOVA. Results: The biocompatibility of the adhesives was found to be high, as confirmed by the lack of significant differences in the cytotoxicity between the sample and control groups. Discs made from composites containing nBG@Ag exhibited a significant reduction in the growth of Streptococcus mutans (p < 0.05), and the antibacterial activity increased with higher percentages of nBG@Ag. The shear bond strength of the adhesives decreased significantly (p < 0.001) after the addition of nanoparticles, but it remained above the recommended value. The addition of nBG@Ag showed improvement in the microhardness of the teeth, although the differences in microhardness between the study groups were not statistically significant. The formation of hydroxyapatite deposits on the tooth surface was confirmed through SEM and energy-dispersive X-ray spectroscopy (EDX). Conclusion: Adding nBG@Ag to orthodontic adhesives can be an effective approach to enhance antimicrobial activity and reduce enamel demineralization around the orthodontic brackets, without compromising biocompatibility and bond strength. [ABSTRACT FROM AUTHOR]

In implantology, among the key choices, to obtain predictable results, it is essential to establish, using cone beam computed tomography (CBCT), the bone site and where to insert the implants; during the surgical phase, these sites must be identified on the oral mucosa. Surgical templates are a valid aid, especially in complex cases which require the insertion of more than three or four implants. In cases of a single implant, on the other hand, surgical guides are rarely used, and the implant is often inserted freehand; therefore, the identification of the implant site on the oral mucosa (after choosing the location on the CBCT) is more difficult. For this reason, the clinician uses the teeth in the arch as a reference. This study evaluates the ability of the human eye to identify, on the oral mucosa, where the implant collars will be positioned, the position of which has previously been chosen on the CBCT, in cases where the hands-free surgical technique (without surgical guides) is used. The verification of this precision is carried out using particular thermo-printed templates which contain radiopaque metal spheres. The results show that, in the freehand technique, it is difficult to precisely identify the implant sites (chosen via X-ray) on the mucosa, especially when they are far from natural teeth adjacent to the edentulous area. In case of monoedentulism, the freehand implant technique seems to be applicable by expert implantologists with a reduced risk of error; in fact, clinical experience helps to find the correct correspondence between the implant site chosen on the CBCT and its identification on the mucosa. The level of experience is fundamental in the clinician's decision about whether or not to use surgical guides; in fact, doctors with little experience should use surgical guides even in the simplest cases to reduce the risk of error. [ABSTRACT FROM AUTHOR]

Background: Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. Methods: Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined—surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. Results: The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. Conclusion: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis. [ABSTRACT FROM AUTHOR]

To generate synthetic medical data incorporating image-tabular hybrid data by merging an image encoding/decoding model with a table-compatible generative model and assess their utility. We used 1342 cases from the Stony Brook University Covid-19-positive cases, comprising chest X-ray radiographs (CXRs) and tabular clinical data as a private dataset (pDS). We generated a synthetic dataset (sDS) through the following steps: (I) dimensionally reducing CXRs in the pDS using a pretrained encoder of the auto-encoding generative adversarial networks (αGAN) and integrating them with the correspondent tabular clinical data; (II) training the conditional tabular GAN (CTGAN) on this combined data to generate synthetic records, encompassing encoded image features and clinical data; and (III) reconstructing synthetic images from these encoded image features in the sDS using a pretrained decoder of the αGAN. The utility of sDS was assessed by the performance of the prediction models for patient outcomes (deceased or discharged). For the pDS test set, the area under the receiver operating characteristic (AUC) curve was calculated to compare the performance of prediction models trained separately with pDS, sDS, or a combination of both. We created an sDS comprising CXRs with a resolution of 256 × 256 pixels and tabular data containing 13 variables. The AUC for the outcome was 0.83 when the model was trained with the pDS, 0.74 with the sDS, and 0.87 when combining pDS and sDS for training. Our method is effective for generating synthetic records consisting of both images and tabular clinical data. [ABSTRACT FROM AUTHOR]

Introduction: Left bundle branch pacing (LBBP) is a physiological pacing modality. However, the long procedure and fluoroscopy time of LBBP is still a problem. This study aims to compare the clinical outcomes between transthoracic echocardiography (TTE)‐ and X‐ray‐guided LBBP. Methods: This is a single‐center, prospective, randomized controlled study. Consecutive patients who underwent LBBP in our team from June 2022 to November 2022 were enrolled. Procedure and fluoroscopy time, pacing parameters, electrophysiological and echocardiographic characteristics, as well as complications were recorded at implantation and during follow‐up. Results: In this study, 60 patients were enrolled and divided into two groups: 30 patients were allocated to the X‐ray group and the remaining 30 to the TTE group. There was no significant difference in the success rate between the two groups (86.7% vs. 76.7%, p = .317). The procedure time of TTE group was comparable to that of the X‐ray group (9.0 vs. 12.0 min, p = .063). However, the fluoroscopy time in the TTE group was significantly lower than that of the X‐ray group (2.5 vs. 5.0 min, p = .002). There were no statistically significant differences in pacing parameters, electrophysiological and echocardiographic characteristics, or complications between the two groups at implantation and during follow‐up. Conclusion: TTE‐guided LBBP is a feasible and safe method. Compared with X‐ray, TTE showed a comparable success rate and procedure time, but it could significantly reduce the fluoroscopy time of LBBP. [ABSTRACT FROM AUTHOR]

Background: Intraoperative cholangiography (IOC) is a contrast-enhanced X-ray acquired during laparoscopic cholecystectomy. IOC images the biliary tree whereby filling defects, anatomical anomalies and duct injuries can be identified. In Australia, IOC are performed in over 81% of cholecystectomies compared with 20 to 30% internationally (Welfare AIoHa in Australian Atlas of Healthcare Variation, 2017). In this study, we aim to train artificial intelligence (AI) algorithms to interpret anatomy and recognise abnormalities in IOC images. This has potential utility in (a) intraoperative safety mechanisms to limit the risk of missed ductal injury or stone, (b) surgical training and coaching, and (c) auditing of cholangiogram quality. Methodology: Semantic segmentation masks were applied to a dataset of 1000 cholangiograms with 10 classes. Classes corresponded to anatomy, filling defects and the cholangiogram catheter instrument. Segmentation masks were applied by a surgical trainee and reviewed by a radiologist. Two convolutional neural networks (CNNs), DeeplabV3+ and U-Net, were trained and validated using 900 (90%) labelled frames. Testing was conducted on 100 (10%) hold-out frames. CNN generated segmentation class masks were compared with ground truth segmentation masks to evaluate performance according to a pixel-wise comparison. Results: The trained CNNs recognised all classes.. U-Net and DeeplabV3+ achieved a mean F1 of 0.64 and 0.70 respectively in class segmentation, excluding the background class. The presence of individual classes was correctly recognised in over 80% of cases. Given the limited local dataset, these results provide proof of concept in the development of an accurate and clinically useful tool to aid in the interpretation and quality control of intraoperative cholangiograms. Conclusion: Our results demonstrate that a CNN can be trained to identify anatomical structures in IOC images. Future performance can be improved with the use of larger, more diverse training datasets. Implementation of this technology may provide cholangiogram quality control and improve intraoperative detection of ductal injuries or ductal injuries. [ABSTRACT FROM AUTHOR]

Background: Considering the extensive use of bleaching agents and the occurrence of side effects such as enamel demineralization, this study aimed to assess the enamel changes of bleached teeth following the experimental application of chitosan-bioactive glass (CH-BG). Methods: In this in vitro study, CH-BG (containing 66% BG) was synthesized and characterized by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). Thirty sound human premolars were bleached with 40% hydrogen peroxide, and the weight% of calcium and phosphorus elements of the buccal enamel surface was quantified before and after bleaching by scanning electron microscopy/ energy-dispersive X-ray spectroscopy (SEM, EDX). Depending on the surface treatment of the enamel surface, the specimens were divided into three groups (n = 10): control (no treatment), MI Paste (MI), and CH-BG. Then the specimens were stored in artificial saliva for 14 days. The SEM/EDX analyses were performed again on the enamel surface. Data were analyzed by one-way ANOVA and Tukey's test and a p-value of < 0.05 was considered statistically significant. Results: In all groups, the weight% of calcium and phosphorus elements of enamel decreased after bleaching; this reduction was significant for phosphorus (p < 0.05) and insignificant for calcium (p > 0.05). After 14 days of remineralization, the weight% of both calcium and phosphorus elements was significantly higher compared to their bleached counterparts in both MI and CH-BG groups (p < 0.05). Following the remineralization process, the difference between MI and CH-BG groups was not significant (p > 0.05) but both had a significant difference with the control group in this regard (p < 0.05). Conclusions: The synthesized CH-BG compound showed an efficacy comparable to that of MI Paste for enamel remineralization of bleached teeth. [ABSTRACT FROM AUTHOR]

Introduction: Minimally invasive lumbar decompression (mild®) is becoming a popular procedure for treating lumbar spinal stenosis (LSS) secondary to hypertrophic ligamentum flavum (LF). The mild® procedure is commonly performed under live fluoroscopic guidance and carries a risk of radiation exposure to the patient and healthcare. Methods: One physician performed mild® on 41 patients at the Cleveland Clinic Department of Pain Management from October 2019 to December 2021, while wearing a radiation exposure monitor (Mirion Technologies). Mean fluoroscopy time, mean exposure per case, and mean exposure per unilateral level decompressed were the primary outcomes measured. The secondary outcome was to provide a comparison of radiation exposure during similar fluoroscopically guided procedures. Results: Mean patient fluoroscopy exposure time was 2.1 min ±0.9 (range: 1.1–5.6) fluoroscopy time per unilateral level decompressed. The mean patient radiation skin exposure from mild® was 1.1 ± 0.9 mGym2, and the mean total dose was 142.3 ± 108.6 mGy per procedure. On average, the physician was exposed to an average deep tissue exposure of 4.1 ± 3.2 mRem, 2.9 ± 2.2 mRem estimated eye exposure, and 14.7 ± 11.0 mRem shallow tissue exposure per unilateral level decompressed. An individual physician would exceed the annual exposure limit of 5 Rem after approximately 610 mild® procedures per year. Conclusions: This study is an attempt to quantify the radiation exposure to the physician and patient during the mild® procedure. Compared with other fluoroscopically guided pain management procedures, patient and physician radiation exposure during mild® was low. [ABSTRACT FROM AUTHOR]

Background and Aim: With increasing concerns over the stochastic effects of x-ray radiation in dental radiography, effective education of dental students in this field is important. According to studies, educational softwares enhance learning, therefore the aim of this study was to develop an educational software for dental radiation protection and to compare its effectiveness against classic lectures in Islamic Azad University, Tehran Dental branch. Material and Methods: The study was exploratory in the first stage and a clinical trial in the second. Software was developed based on ADA guideline, using ScreenRecorder and MultimediaBuilder. 46 dental students who have never received any education on dental radiation protection were divided into control (N=22) and test (N=24) groups which have been matched based on the GPA and VARK test results. The test group used the software, while the control group attended a lecture. Students’ learning rates were evaluated by using 2 identical 10-question multichoice tests taken immediately and after two weeks. The results were analyzed in SPSS25 using the Mann-U-Whitney test, independent samples t-test, and Pearson's chi-squared test. Results: Educational software was developed successfully. In both exams, the mean score in the test group was higher than that in the control group by a statistically significant difference (p<0.001). The mean scores of test group and control group were 8.91±1.31 and 6.13±1.67 in the first exam and 6.79±1.69 and 4.90±2.09 in the second one respectively. Conclusion: Multimedia educational software can improve learning of principles and methods of dental radiation protection in dental students. [ABSTRACT FROM AUTHOR]

Purpose: Compare two simple ways for treating boxer's fractures in active adults; conservative management by ulnar gutter slab and transverse pinning in fixation of fifth metacarpal's neck fracture regarding union, functional outcomes, and complications. Patients and methods: Ninety patients with fifth metacarpals' neck fractures with palmar angulation (30–70°) were managed either conservatively by an ulnar gutter slab or surgically by transverse pinning technique from January 2020 to December 2021. Only 84 patients completed a 1-year follow-up. Patients with old, open, or mal-rotated fractures were excluded. The block-randomization method was used to create equal groups. Patients were evaluated clinically and radiologically every 2–3 weeks until union, then at 6 and 12 months. Functional assessment at the final visit was done using the quick DASH score, total active motion (TAM), and total Active Flexion (TAF). Results: The mean radiological union time for the conservative group in this study was 7.76 weeks, while for the transverse pinning group, it was 7.38 weeks. There was no statistically significant difference between the two techniques regarding union rates and functional outcomes. All patients returned to their pre-injury jobs and level of activity. Conclusion: Both conservative management in ulnar gutter slab and percutaneous transverse pinning are considered effective methods in the treatment of simple extra-articular fifth metacarpal neck fractures with angulation between 30 and 70 degrees (AO: 77 A3.1). The functional and radiological results using both methods were satisfactory and statistically comparable. [ABSTRACT FROM AUTHOR]

Purpose: Interventions performed within the first hour after trauma increase survival rates. Literature showed that measuring times can optimize the trauma resuscitation process as time awareness potentially reduces acute care time. This study examined the effect of a digital clock placement on trauma resuscitation times in an academic level-1 trauma center. Methods: A prospective observational pre–post cohort analysis was conducted for six months before and after implementing a visible clock in the trauma resuscitation room, indicating the time passed since starting the in-hospital resuscitation process. Trauma patients (age ≥ 16) presented during weekdays between 9.00 AM and 9.00 PM were included. Time until diagnostics (X-Ray, FAST, or CT scan), time until therapeutic intervention, and total resuscitation time were measured manually with a stopwatch by a researcher in the trauma resuscitation room. Patient characteristics and information regarding trauma- and injury type were collected. Times before and after clock implementation were compared. Results: In total, 100 patients were included, 50 patients in each cohort. The median total resuscitation time (including CT scan) was 40.3 min (IQR 23.3) in the cohort without a clock compared to 44.3 (IQR 26.1) minutes in the cohort with a clock. The mean time until the first diagnostic and until the CT scan was 8.3 min (SD 3.1) and 25.5 min (SD 7.1) without a clock compared to 8.6 min (SD 6.5) and 26.6 min (SD 11.5) with a clock. Severely injured patients (Injury Severity Score (ISS) ≥ 16) showed a median resuscitation time in the cohort without a clock (n = 9) of 54.6 min (IQR 50.5) compared to 46.0 min (IQR 21.6) in the cohort with a clock (n = 8). Conclusion: This study found no significant reduction in trauma resuscitation time after clock placement. Nonetheless, the data represent a heterogeneous population, not excluding specific patient categories for whom literature has shown that a short time is essential, such as severely injured patients, might benefit from the presence of a trauma clock. Future research is recommended into resuscitation times of specific patient categories and practices to investigate time awareness. [ABSTRACT FROM AUTHOR]

Purpose: Breastfeeding provides optimal growth and development for infants. Lactating mothers may have challenges maintaining breastfeeding, and one of those challenges is being falsely advised to interrupt breastfeeding following radiologic studies. The aim of this study was to evaluate the knowledge, attitudes and experiences of healthcare professionals regarding breastfeeding after radiological imaging studies on lactating mothers. Method: In this cross-sectional study, an online survey consisting of 29 semi-structured questions was delivered to radiology technicians and physicians in radiology and pediatrics via social media. Mixed methods were used to analyze responses descriptively. Results: Of the 404 participants, 39% (n = 158) were radiology technicians, 31% (n = 125) were pediatricians, 11% (n = 46) were radiologists, 10% (n = 41) were pediatric residents and 8% (n = 34) were radiology residents. Of all healthcare professionals, 91% reported that breastfeeding does not need to be interrupted after ultrasound, 75% X-ray, 56% mammography, 62% non-contrast CT, 18% contrast-enhanced CT, 93% non-contrast MRI and 23% contrast-enhanced MRI. Interruption of breastfeeding was recommended more frequently after contrast-enhanced imaging studies (p < 0.01). After contrast-enhanced CT, 54% of participants recommended pumping and dumping for <24 h and 25% for 24–48 h; after contrast-enhanced MRI, these rates were found to be 57% and 20%, respectively. Of the healthcare professionals, 63% reported that their knowledge about management of breastfeeding after radiological studies was not sufficient. Conclusions: Situations requiring the interruption of breastfeeding after radiological studies are rare. However, recommendations in clinical practice vary in our country. Increasing the awareness and knowledge of healthcare professionals will prevent breastfeeding from being negatively affected. [ABSTRACT FROM AUTHOR]

The objective of this research was to analyze and elucidate the sagittal spinal posture status in older elementary school children, considering their gender and grade differences. The study involved 484 school children (252 males and 232 females) from grades V to VIII, assessed for sagittal spinal posture using the Formetric 4D System. The analysis, employing the Chi-squared test of independence along with the Z-test, did not reveal significant grade-related differences (p < 0.52) in the incidence of normal sagittal alignment or diagnosed outliers. However, within grade levels, no significant difference was observed for male participants (p < 0.80), while a significant difference was identified for females (p < 0.01). Examining gender differences across grades, a disparity was noted only among seventh graders concerning normal spine alignment and outlier existence (p < 0.01), favoring male participants. Regardless of the grade, a significant gender difference emerged in the location of diagnosed outliers: kyphosis (M = 108 vs. F = 72), lordosis (M = 5 vs. F = 14), kypholordosis (M = 18 vs. F = 66), and flatback outlier of the lumbar spine (M = 27 vs. F = 11). These findings suggest potential adjustments to the curriculum and highlight the need to tailor physical education instruction based on this study's outcomes. Consequently, these results imply the importance of a differentiated approach in preventing sagittal plane outliers of the spine in adolescent children. [ABSTRACT FROM AUTHOR]

Purpose: An efficient physics-informed deep learning approach for extracting spinopelvic measures from X-ray images is introduced and its performance is evaluated against manual annotations. Methods: Two datasets, comprising a total of 1470 images, were collected to evaluate the model's performance. We propose a novel method of detecting landmarks as objects, incorporating their relationships as constraints (LanDet). Using this approach, we trained our deep learning model to extract five spine and pelvis measures: Sacrum Slope (SS), Pelvic Tilt (PT), Pelvic Incidence (PI), Lumbar Lordosis (LL), and Sagittal Vertical Axis (SVA). The results were compared to manually labelled test dataset (GT) as well as measures annotated separately by three surgeons. Results: The LanDet model was evaluated on the two datasets separately and on an extended dataset combining both. The final accuracy for each measure is reported in terms of Mean Absolute Error (MAE), Standard Deviation (SD), and R Pearson correlation coefficient as follows: [ S S ∘ : 3.7 (2.7) , R = 0.89 ] , [ P T ∘ : 1.3 (1.1) , R = 0.98 ] , [ P I ∘ : 4.2 (3.1) , R = 0.93 ] , [ L L ∘ : 5.1 (6.4) , R = 0.83 ] , [ S V A (m m) : 2.1 (1.9) , R = 0.96 ] . To assess model reliability and compare it against surgeons, the intraclass correlation coefficient (ICC) metric is used. The model demonstrated better consistency with surgeons with all values over 0.88 compared to what was previously reported in the literature. Conclusion: The LanDet model exhibits competitive performance compared to existing literature. The effectiveness of the physics-informed constraint method, utilized in our landmark detection as object algorithm, is highlighted. Furthermore, we addressed the limitations of heatmap-based methods for anatomical landmark detection and tackled issues related to mis-identifying of similar or adjacent landmarks instead of intended landmark using this novel approach. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the combined effect of X‐ray radiation (IR) and hyperbaric oxygen (HBO) on oral squamous cell carcinoma (OSCC) cells and to explore the possible molecular mechanism. Methods: The OSCC cells were treated with or without IR, together with or without HBO co‐exposure. Cells were transfected with specific plasmids using Lipofectamine 2000. The cell varieties, apoptosis markers, and ferroptosis markers were determined by using appropriate method. OSCC xenograft mice model was categorized into several subgroups according to the specific treatement. GPX4 expressions were determined by immunohistochemistry (IHC) in OSCC tissues and were tested by ELISA in serums from OSCC patients. Results: The co‐exposure of IR and HBO significantly strengthened the cytotoxicity of IR on SCC15‐S cells in ferroptosis‐dependent manner. The regulated GPX4/ferroptosis mediated the HBO function on re‐sensitizing the radio‐resistant OSCC cells to IR. In xenograft mice, co‐exposure of IR and HBO can significantly reduce the tumor under IR activation compared with IR alone. Clinical data indicated that high GPX4 levels were associated with poor chemo‐radiotherapy outcome. Conclusions: HBO could re‐sensitize radio‐resistant OSCC cells through GPX4/ferroptosis regulation. These results provide a potential therapeutic strategy for clinical radio‐resistance. [ABSTRACT FROM AUTHOR]

The EOS™2D/3D system is a low-dose, 3D imaging system that utilizes two perpendicular X-ray beams to create simultaneous frontal and lateral images of the body. This is a useful modality to assess spinal pathologies. However, due to the slow imaging acquisition time up to 25 s, motion artifacts (MA) frequently occur. These artifacts may not be distinguishable from pathological findings, such as scoliosis, and may impair the diagnostic process. The aim of this study was to design a method to detect MA in EOS X-ray. We retrospectively analyzed EOS imaging from 40 patients wearing a radiopaque reference device during imaging. We drew a straight vertical line along the reference device. We measured deviations from it to quantify MA, presenting these findings through descriptive statistics. For a subset of patients with high MA, acquisitions were repeated after giving specific instructions to stand still. For these patients, we compared MA between the two acquisitions. In our study, a substantial proportion of patients exhibited MA ≥ 1 mm, with 80% in frontal projections and 87.9% in lateral projections. In the subjects who received a second acquisition, MA was significantly lower in the second images. Our method allows for a precise detection of MA on EOS images through a simple, yet reliable solution. Our method may improve the reliability of spine measurements, and reduce the risk of wrong diagnosis due to low imaging quality. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We examined the association between electronic health information sharing and repeat imaging in readmissions among older adults with and without Alzheimer disease (AD). STUDY DESIGN: Cohort study using national Medicare data. METHODS: Among Medicare beneficiaries with 30-day readmissions in 2018, we examined repeat imaging on the same body system during the readmission. This was evaluated between fragmented and nonfragmented (same-hospital) readmissions and across categories of electronic information sharing via health information exchanges (HIEs) in fragmented readmissions: admission and readmission hospitals share the same HIE, admission and readmission hospitals participate in different HIEs, one or both do not participate in HIE, or HIE data missing. This relationship was evaluated using unadjusted and adjusted logistic regression. RESULTS: Overall, 14.3% of beneficiaries experienced repeat imaging during their readmission. Compared with nonfragmented readmissions, fragmented readmissions were associated with 5% higher odds of repeat imaging on the same body system in older adults without AD. This was not mitigated by the presence of electronic information sharing: Fragmented readmissions to hospitals that shared an HIE had 6% higher odds of repeat imaging (adjusted OR, 1.06; 95% CI, 1.00-1.13). There was no difference seen in the odds of repeat imaging for older adults with AD. CONCLUSIONS: Despite substantial investment, HIEs as currently deployed and used are not associated with decreased odds of repeat imaging in readmissions. [ABSTRACT FROM AUTHOR]

Introduction: Orthopaedic surgeons are among the most frequent users of radiation and are often exposed to X-Ray radiation regularly. There is an overall unsatisfactory level of knowledge, attitude, and practices regarding the same among surgeons. This study aimed to assess the practices among orthopaedic surgeons regarding radiation and its hazards in India. Methodology: This questionnaire-based survey was conducted between March and September 2022. The questionnaire broadly assessed the knowledge, awareness, and practices among orthopaedic surgeons regularly exposed to X-ray radiation. The questionnaire consisted of objective and Likert scale questions which were distributed to the respondents electronically using publicly available contact information. A qualitative review of interpretations obtained from the responses and available evidence in the literature was then performed. Results: The response rate for the survey was 36.4%. 65.9% reported using trunk protection all the time during procedures. 57.1% of respondents reported not using thyroid protection during procedures. 92.3% reported not using protective goggles and 100% did not use appropriate gloves. 76.9% were not issued dosimeters, and only 5.5% of those who had been issued one wore it during radiation procedures. 58.2% reported having a dedicated employee to operate the machine. 86.8% of respondents did not have formal training and 81.3% were not aware of institutes offering formal training. Conclusion: There is very high compliance with the use of protection aprons among the respondents however, the use of other apparel like thyroid shields, protection goggles and gloves was poor. The awareness regarding radiation exposure was also poor as most respondents were not issued dosimeters, however, those issued with one were well aware of their exposure. It is imperative to prioritize both surgeons' and patients' safety where radiation exposure is concerned. [ABSTRACT FROM AUTHOR]

Summary: Lumbar fractures and/or multiple fractures at the lumbar or thoracolumbar regions are risk factors for sagittal malalignment in patients older than 70 years old. Although patients with OVF show a huge capacity to compensate after the fractures, lumbar and TL lumbar fractures require closer monitoring. Purpose: To assess the impact of osteoporotic vertebral fractures on the sagittal alignment of the elderly and identify risk factors for sagittal malalignment. Methods: We performed a retrospective study on a cohort of 249 patients older than 70 years old and diagnosed with osteoporosis who suffered chronic vertebral fractures. Demographic and radiological data were collected. Full-spine lateral X-rays were obtained to analyze the sagittal plane. Patients were classified according to the number and location of the fractures. Pearson's correlation coefficient was used to assess the relationships between the type of fractures and sagittal alignment. Results: A total of 673 chronic fractures were detected in 249 patients with a mean number of vertebral fractures per patient of 2.7 ± 1.9. Patients were divided into 9 subgroups according to the location and the number of fractures. Surprisingly, any of the aggregated parameters used to assess sagittal alignment exceeded the threshold defined for malalignment. In the second part of the analysis, 41 patients with sagittal malalignment were identified. In this subpopulation, an overrepresentation of patients with lumbar fractures (34% vs. 11%) and an under-representation of thoracic fractures (9% vs. 34%) were reported. We also observed that patients with 3 or more lumbar or thoracolumbar fractures had an increased risk of sagittal malalignment. Conclusions: Lumbar fractures and/or multiple fractures at the lumbar or thoracolumbar regions are risk factors for sagittal malalignment in patients older than 70 years old. Although patients show a remarkable capacity to compensate, fractures at the lumbar and thoracolumbar regions need closer monitoring. [ABSTRACT FROM AUTHOR]

Aim: To explore the nature and extent of peer‐reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research. Background: Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years. Design: A scoping review based on the steps suggested by the Joanna Briggs Institute. Methods: A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms 'nurse practitioner', 'medical imaging', 'diagnostic imaging', 'scan' and 'radiography'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021. Results: Eight themes were identified—country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image‐guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging. Conclusion: There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this. Relevance to Clinical Practice: Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x‐rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Studying near-miss errors is essential to preventing errors from reaching patients. When an error is committed, it may be intercepted (near-miss) or it will reach the patient; estimates of the proportion that reach the patient vary widely. To better understand this relationship, we conducted a retrospective cohort study using two objective measures to identify wrong-patient imaging order errors involving radiation, estimating the proportion of errors that are intercepted and those that reach the patient. This study was conducted at a large integrated healthcare system using data from 1 January to 31 December 2019. The study used two outcome measures of wrong-patient orders: (1) wrong-patient orders that led to misadministration of radiation reported to the New York Patient Occurrence Reporting and Tracking System (NYPORTS) (misadministration events); and (2) wrong-patient orders identified by the Wrong-Patient Retract-and-Reorder (RAR) measure, a measure identifying orders placed for a patient, retracted and rapidly reordered by the same clinician on a different patient (near-miss events). All imaging orders that involved radiation were extracted retrospectively from the healthcare system data warehouse. Among 293 039 total eligible orders, 151 were wrong-patient orders (3 misadministration events, 148 near-miss events), for an overall rate of 51.5 per 100 000 imaging orders involving radiation placed on the wrong patient. Of all wrong-patient imaging order errors, 2% reached the patient, translating to 50 near-miss events for every 1 error that reached the patient. This proportion provides a more accurate and reliable estimate and reinforces the utility of systematic measure of near-miss errors as an outcome for preventative interventions. [ABSTRACT FROM AUTHOR]

To assess the effect of digital enhancement on the image quality of radiographs obtained with photostimulable phosphor (PSP) plates partially damaged by ambient light. Radiographs of an aluminum step wedge were obtained using the VistaScan and Express systems. Half of the PSP plates was exposed to ambient light for 0, 10, 30, 60, or 90 s before being scanned. The resulting radiographs were exported with and without digital enhancement. Metrics for brightness, contrast, and contrast-to-noise ratio (CNR) were derived, and the ratio of each metric between the exposed-to-light and non-exposed-to-light halves of the radiographs was calculated. The resulting ratios of the radiographs with digital enhancement were subtracted from those without digital enhancement and compared among each other. For the VistaScan system, digital enhancement partially restored brightness, contrast, and CNR. For the Express system, digital enhancement only restored CNR and not the impact of ambient light on brightness and contrast. Specifically, digital enhancement restored 23.48% of brightness for the VistaScan, while percentages below 1% were observed for the Express. Digital enhancement restored 53.25% of image contrast for the VistaScan and 5.79% for the Express; 40.71% of CNR was restored for the VistaScan, and 35% for the Express. Digital enhancement can partially restore the damage caused by ambient light on the brightness and contrast of PSP-based radiographs obtained with the VistaScan, as well as on CNR for the VistaScan and Express systems. The exposure of PSP plates to light can lead to unnecessary retakes and increased patient exposure to X-rays. [ABSTRACT FROM AUTHOR]

Purpose: Fracture blisters, a common soft-tissue complication of pilon fractures, are associated with post-operative wound infections, delays in definitive fixation, and alterations in surgical plan. The purpose of this study was to (1) identify the delay in surgery attributable to the presence fracture blisters and (2) investigate the relationship of fracture blisters to comorbidities and fracture severity. Methods: Patients with pilon fractures at an urban level 1 Trauma center from 2010 to 2021 were identified. The presence or absence of fracture blisters was noted, along with location. Demographic information, time from injury to external fixator placement, and time to definitive open reduction internal fixation (ORIF) were collected. Pilon fractures were classified according to AO/OTA guidelines using CT imaging and plain radiographs. Results: 314 patients with pilon fractures were available for analysis, eighty (25%) of whom were found to have fracture blisters. Patients with fracture blisters had longer time to surgery compared to those without fracture blisters (14.2 days vs 7.9 days, p < 0.001). A greater proportion of patients with fracture blisters had AO/OTA 43C fracture patterns, compared with those without fracture blisters (71.3% vs 53.8%, p = 0.03). Fractures blisters were less likely to be localized over the posterior ankle (12%, p = 0.007). Conclusion: The presence of fracture blisters in pilon fractures are associated with significant delays in time to definitive fixation and higher energy fracture patterns. Fracture blisters are less commonly located over the posterior ankle which may support the implementation of a staged posterolateral approach when managing these injures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Normal alignment of the foot is important because the feet support the body's weight. The intrinsic muscles of the foot mainly maintain the alignment and movement of the foot, whereas the abductor hallucis (AbdH) aligns the first metatarsophalangeal joint and maintains the medial longitudinal arch. OBJECTIVE: This study was conducted to investigate the muscle activity of the AbdH and hallux valgus (HV) angle during three different foot exercises. METHODS: Participants included 15 subjects aged 20–24 years with mild HV. All subjects performed three different foot exercises in random order: short foot exercise (SF), toe spread out exercise (TSO), and TSO with a pressure bio-feedback unit (TSOP). The muscle activity of the AbdH and the HV angle were measured during each foot exercise using surface electromyography and X-ray and then compared using one-way repeated-measures analysis of variance, followed by Bonferroni adjustment. RESULTS: AbdH muscle activity differed significantly among SF, TSO, and TSOP. AbdH muscle activity was greater in TSOP (89.60%) than in SF (19.99%) and TSO (60.96%) (p = 0.006). The HV angle was significantly smaller in TSOP (15.72 ∘) than in SF (18.85 ∘) and TSO (16.81 ∘) (p = 0.001). CONCLUSIONS: TSOP can be recommended as an effective AbdH strengthening exercise in subjects with mild HV. [ABSTRACT FROM AUTHOR]

Stent under-expansion is a predictor of restenosis and stent thrombosis. It remains uncertain whether enhanced stent imaging (ESI) (CLEARstent) guidance can improve stent under-expansion. Our aim was to assess the effect of using ESI on stent under-expansion, after percutaneous coronary intervention (PCI) in a single center, cross-sectional observational study. Participants attending our cardiology clinic with stable angina or acute coronary syndrome, from March to September 2020 were recruited. A total of 164 patients who underwent post-PCI ESI (CLEARstent) were compared with 77 age- and sex-matched control patients. Post-procedural minimal lumen diameter (MLD) was calculated. The patients in the ESI-guided PCI group, had a median age of 61 (54–69 IQR 25-75) years and 76.8% (n = 126) were males. The patients in ESI-guided PCI group had a greater minimal lumen diameter compared with the X-ray guided PCI group (βeta coefficient:2.88 (95% CI:2.58–2.99) vs βeta coefficient 2.55 (95% CI 2.34–2.63), P <.001). Our finding supports the use of the ESI system to optimize stent placement as expressed by the MLD. [ABSTRACT FROM AUTHOR]

Background: Proximal tibia fractures are often accompanied by extensive soft tissue injuries, which lead to frequent post-operative complications like wound dehiscence, infection, and non-union. In such injuries, there is a need for anatomical reduction and stable fixation for a good surgical outcome. The surgical procedures involving internal fixation have increased the complication rate of such fractures. Ilizarov ring fixation can provide stable fixation, does not need extensive soft tissue dissection, and encourages early mobilization. Objectives: This study aimed to assess the functional and radiological outcome of proximal tibia fractures managed with Ilizarov technique with or without minimal internal fixation. Methods: 35 patients with either intra-articular as well as extra-articular proximal tibia fractures between January 2018 and May 2022 were included in this study. All the included patients were operated on using Ilizarov technique. The functional outcome was assessed using the Modified Rasmussen Criteria for clinical assessment, and the radiological outcome by Modified Rasmussen Criteria for radiological assessment. Results: All patients achieved radiological union at a mean duration of 16 weeks. Full weight-bearing was also allowed at a mean of 12 weeks. Functional results were excellent in 22 cases, good in 12 cases and poor in one. Most patients achieved functional range of motion at the knee joint (average flexion 128o ) except one, who had a flexion of less than 110o . Axial malalignment of less than 10o was seen in 4 cases, and articular step of less than 5 mm was seen in 2 cases. Conclusion: Ilizarov ring fixation is an excellent method of fixation in proximal tibia fractures, both extra-articular and intra-articular. It gives stable fixation, encourages early mobilization, has a higher union rate, and prevents damage to the soft tissue envelope, which is often compromised in such fractures. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the effect of muscle energy technique (MET) on pelvic alignment, leg length, pain, and fatigue in chronic low back pain (CLBP) patients with leg length discrepancy (LLD). Forty-two CLBP patients with LLD volunteered to participate and were randomly assigned to the MET group (n = 21) and placebo group (n = 21). The intervention group performed three METs with 5 s of isometric contraction and 30 s of rest once, and the placebo group performed three times the placebo-MET, maintaining the same posture as the MET group without muscle isometric contraction. X-ray equipment, tape measure, and visual analog scale were used to evaluate pelvic alignment, leg length, pain, and fatigue before and after each intervention. In comparison pre- and postintervention, only the MET group showed significant changes in pelvic alignment, leg length, pain, and fatigue (p < 0.05). In comparison between groups, there were significant differences in all variables (pelvic alignment, leg length, pain, fatigue) (p < 0.05). The results of this study confirmed the therapeutic effect of MET for improving pelvic alignment, functional LLD, pain, and fatigue in CLBP patients with functional LLD. Future research is needed to evaluate the long-term effect on more chronic low back pain patients. [ABSTRACT FROM AUTHOR]

Six undescribed bicyclic sesquiterpene coumarins, kuhistanin A, ferukrin isovalerate, 9' β ,12' α - ferukrin isovalerate, (17′ E)- 9' α , 12' β - isomarcandin, (17′ Z)- 9' α , 12' β - isomarcandin and (17′ E) - isomarcandin, together with nine known ones were isolated from the roots of Ferula kuhistanica Korovin. The structures of them were elucidated using NMR and HRESIMS data analysis. The relative configurations of the isolates were confirmed by NOE correlations and NMR calculation. The absolute configurations of them were confirmed by X-ray diffraction analysis and ECD calculation. Anti-vitiligo, anti-inflammatory and cytotoxicity of the isolates were tested. Acetyl feselol, feselol, ferusingensine I and farnesiferol A significantly increased the melanin content at the concentration of 10 μM. (17′ E) - 9' α , 12' β - isomarcandin exhibited strong cytotoxicity against HT-29 cell line with IC 50 values of 8.94 ± 0.47 μM, and (17′ E) - isomarcandin demonstrated strong cytotoxicity against Hela, A549 and HT-29 cell lines with IC 50 values of 5.29 ± 0.25, 4.01 ± 0.20, and 4.16 ± 0.21 μM, respectively. This study concluded that, isolated compounds from F. kuhistanica demonstrated strong bioactivity towards anti-vitiligo and cytotoxicity and active compounds are suggested as anti-vitiligo and cytotoxicity agent for future drug development. Six undescribed sesquiterpene coumarins kuhistanin A, ferukrin isovalerate, 9' β ,12' α - ferukrin isovalerate, (17′ E)- 9' α , 12' β - isomarcandin, (17' Z)- 9' α , 12' β - isomarcandin and (17′ E) - isomarcandin, together with nine known ones were isolated from the roots of F. kuhistanica. The isolates were tested their anti-vitiligo, anti-inflammatory and cytotoxic activities. [Display omitted] • Six undescribed sesquiterpene coumarins were isolated from F. kuhistanica roots • The structural elucidation of these compounds was described. • Anti-vitiligo and cytotoxic activities of the isolates were tested. [ABSTRACT FROM AUTHOR]

Four undescribed amide alkaloids hongkongensines A-C and 1-(1-oxo-6-hydroxy-2 E ,4 E -dodecadienyl)-piperidine, five known amide alkaloids, and three known neolignans were isolated from the aerial part of Piper hongkongense. The planar structures of these compounds were determined by detailed analyses of HR-ESI-MS and NMR data. The absolute configurations of hongkongensines A-C were elucidated by single-crystal X-ray diffraction analysis and ECD calculations. Moreover, the inhibitory activities of PCSK9 expression in vitro for all compounds were assessed by PCSK9 AlphaLISA screening. Kadsurenone (10) displayed a significant inhibitory activity at 5 μM with an inhibition rate of 51.98%, compared with 55.55% of berberine (BBR 5 μM). [Display omitted] • Four undescribed amide alkaloids were isolated from Piper hongkongense. • Their absolute configurations were elucidated by single-crystal X-ray diffraction and ECD calculations. • Hongkongensine C (3) is a chlorine-containing natural product. • Kadsurenone (10) displayed a significant inhibitory activity of PCSK9 expression. [ABSTRACT FROM AUTHOR]