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BACKGROUND: Studies have demonstrated that upper extremity musculoskeletal disorders (UEMSDs) are highly prevalent among weavers. In Iran, little information is available regarding the prevalence of MSDs and their causal risk factors among hand-woven shoe workers. This cross-sectional study aimed to determine the prevalence of UEMSDs and to identify risk factors associated with UEMSDs symptoms among 586 Iranian hand-woven shoe workers. METHODS: The data were collected using the Nordic Musculoskeletal Questionnaire and by direct observation of working postures via the Rapid Upper Limb Assessment (RULA) technique to determine ergonomic risks. RESULTS: The prevalence of MSDs symptoms was high among the hand-woven shoe workers. The mean RULA grand score of 6.3 indicated that in most cases the workers’ postures at their workstations needs to be investigated and changed immediately to prevent musculoskeletal injuries. The highest prevalence rates of MSDs were observed in the shoulders, wrists and arms. The result of multiple logistic regression modeling showed that risk factors associated with UEMSD symptoms were job experience, daily working hours, job satisfaction, working posture, work pressure, and discomfort at workstation, as well as individual factors, such as age, gender, BMI, material status, working conditions, education level, and lack of regular sport/physical activities. CONCLUSIONS: The findings of the present study emphasize that any interventional program in this industry has to focus on improving working conditions particularly by designing ergonomics-oriented workstations and hand tools.

Lupus is a common autoimmune disorder with the potential to affect all organ systems. Lupus enteritis is a rare complication that is seen in a subset of patients that present with gastrointestinal symptoms. Its diagnosis commonly involves imaging, showing bowel wall edema as the target sign and vascular engorgement of bowel vessels as the comb sign on CT scans. These findings can help guide the diagnosis, but they are nonspecific and are also found in other conditions that cause bowel wall ischemia. These symptoms are reversible if treated with immunosuppressants. Unfortunately, recurrence is common in lupus enteritis and perforation needs to be ruled out on presentation. In this report, we present the case of a patient with known lupus who was diagnosed with lupus enteritis on imaging and was treated with immunosuppressants. The patient's symptoms resolved subsequently. Our case highlights the fact that the appropriate diagnosis and management of this condition require physical exams, labs, and imaging.

Cerebral palsy (CP) is a neuro-developmental disorder. Spastic CP is the most common type of CP and is characterized by contractures of the extremities. Selective Percutaneous Myofascial Lengthening (SPML) is a minimally invasive procedure practiced by a handful of physicians in the US, and it decreases contractures and increases the range of motion in individuals with spastic CP. This study wanted to examine if there was an association between CP severity, socioeconomic status, and reoperation rates. This study used electronic medical records (EMR) to include 626 patients with spastic CP who had surgeries between January 2006 and December 2012. The zip codes from the EMR were used to determine the inflation-adjusted mean income and educational qualification (a high school education or higher) of the community via the US Census Bureau. Disease severity before the initial surgery was determined by using the functional mobility scale in the EMR to compute the Gross Motor Function Classification System (GMFCS) level. Then the data was graphed and averages were taken for the reoperation versus the no-reoperation populations, and Student's t-tests were run to determine statistical significance. The data showed that communities with higher education and income tended to reoperate more often. The higher number of reoperations in affluent communities could mean that either more affluent communities are better educated and know the benefits of bringing their children back for reoperation or that they require further education about physical therapy after the initial surgery to decrease the incidence of reoperation. This retrospective study is a level 2 study looking at the socioeconomic and educational backgrounds and disease severity and their association with reoperation rates.

It has been estimated that there are greater than 100,000 individuals in the US with sickle cell disease. Hepatic sequestration is a known sequelae of sickle cell disease that rarely leads to extreme hyperbilirubinemia (total serum bilirubin greater than 20 mg/dl). Our 26-year-old male patient, though compliant with regular transfusion exchanges, presented with hepatic sequestration, with minimal symptoms and hyperbilirubinemia up to approximately 40 mg/dl. The severity of asymptomatic hepatic sequestration seen in our patient has never been reported in the literature. This mandates a low threshold to screen for sickle cell complications and promptly treating these patients admitted to the hospital with exchange transfusions.

Achalasia is an uncommon disease that occurs due to inability of lower esophageal sphincter from relaxing, leading to dysphagia to liquids and solids. Clues to this diagnosis include: failed treatment with proton pump inhibitors, and changes on imaging studies including chest X-ray and barium esophagogram. Ultimately it is a diagnosis made on esophageal manometry. Swallow-induced syncope has been known in patients with achalasia for almost three centuries. Here we present the case of a patient with achalasia and a non-swallowing syncopal episode. To our knowledge and extensive search, there has been no report of a similar case.

HMG-CoA reductase inhibitors (statins) are one of the most widely used medications in the primary care setting, and like any medications they have many side effects. The common ones include myalgias and rare ones include dermatomyositis. Here we present the case of atorvastatin-induced dermatomyositis with an unfortunate progression. This mandates a low threshold for first contact doctors to screen their patients for new-onset muscle weakness and rash after starting a statin recently, like our patient who had started atorvastatin several months before. This case adds to the previously reported cases and provides further evidence for statins being triggers of immune-mediated disease. The appropriate management of this condition requires a collaborative effort involving clinical judgment, laboratory testing, and imaging.

Intravascular Ultrasound (IVUS) is an intra-operative imaging modality that facilitates observing and appraising the vessel wall structure of the human coronary arteries. Segmentation of arterial wall boundaries from the IVUS images is not only crucial for quantitative analysis of the vessel walls and plaque characteristics, but is also necessary for generating 3D reconstructed models of the artery. The aim of this study is twofold. Firstly, we investigate the feasibility of using a recently proposed region detector, namely Extremal Region of Extremum Level (EREL) to delineate the luminal and media-adventitia borders in IVUS frames acquired by 20 MHz probes. Secondly, we propose a region selection strategy to label two ERELs as lumen and media based on the stability of their textural information. We extensively evaluated our selection strategy on the test set of a standard publicly available dataset containing 326 IVUS B-mode images. We showed that in the best case, the average Hausdorff Distances (HD) between the extracted ERELs and the actual lumen and media were $0.22$ mm and $0.45$ mm, respectively. The results of our experiments revealed that our selection strategy was able to segment the lumen with $\le 0.3$ mm HD to the gold standard even though the images contained major artifacts such as bifurcations, shadows, and side branches. Moreover, when there was no artifact, our proposed method was able to delineate media-adventitia boundaries with $0.31$ mm HD to the gold standard. Furthermore, our proposed segmentation method runs in time that is linear in the number of pixels in each frame. Based on the results of this work, by using a 20 MHz IVUS probe with controlled pullback, not only can we now analyze the internal structure of human arteries more accurately, but also segment each frame during the pullback procedure because of the low run time of our proposed segmentation method., Comment: 15 pages, 5 figures, published in Elsevier Ultrasonics

Due to lower clinical significance, the management of Dieulafoy and Dieulafoy-like lesions is less commonly reported than the management of their impending venous equivalent, variceal bleeding. Though Dieulafoy and Dieulafoy-like lesions are often benign, they can become life-threatening in certain clinical scenarios, especially with substantial changes in hemodynamic blood flow, which results in hemorrhage. Post-procedural hemodynamic blood flow should be carefully monitored in patients who receive procedures that drastically alter hemodynamic flow pressures. Factoring in the presence of Dieulafoy and Dieulafoy-like lesions might deepen the complexity of an intuitive surgical or interventional procedure for an experienced operator, and should, therefore, involve the cooperative effort between surgical, interventional, and diagnostic services to appropriately manage the patients. The case we present demonstrates the dire consequences of a routine splenectomy when a considerable change in hemodynamic pressure across benign Dieulafoy-like lesions occurs in a patient with both splenic artery and venous thrombosis.

This work concentrates on Extremal Regions of Extremum Level (EREL) selection. EREL is a recently proposed feature detector aiming at detecting regions from a set of extremal regions. This is a branching problem derived from segmentation of arterial wall boundaries from Intravascular Ultrasound (IVUS) images. For each IVUS frame, a set of EREL regions is generated to describe the luminal area of human coronary. Each EREL is then fitted by an ellipse to represent the luminal border. The goal is to assign the most appropriate EREL as the lumen. In this work, EREL selection carries out in two rounds. In the first round, the pattern in a set of EREL regions is analyzed and used to generate an approximate luminal region. Then, the two-dimensional (2D) correlation coefficients are computed between this approximate region and each EREL to keep the ones with tightest relevance. In the second round, a compactness measure is calculated for each EREL and its fitted ellipse to guarantee that the resulting EREL has not affected by the common artifacts such as bifurcations, shadows, and side branches. We evaluated the selected ERELs in terms of Hausdorff Distance (HD) and Jaccard Measure (JM) on the train and test set of a publicly available dataset. The results show that our selection strategy outperforms the current state-of-the-art.