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Introduction: Malignancy-associated ascites (MAA) is the second cause of new-onset ascites after cirrhosis with portal hypertension (PHT), and is usually related to peritoneal carcinomatosis. Ascitic fluid is an exudate, with low serum-ascites albumin gradient (SAAG), ≥500 lymphocytes/mm3 and positive cytology. However, MAA may show atypical patterns. Signet ring cell carcinoma (SRCC) is a poor prognosis adenocarcinoma subtype with special clinical and endoscopic presentation. Case summary: A 68-year-old female, without relevant medical history, with a ventriculoperitoneal shunt (VPS), presented a 1-week increase of abdominal perimeter, loose stools, hyporexia, and fever. In repeated paracentesis, ascites showed transudate properties, high SAAG, low cellularity, negative cultures, and cytologies. She didn’t have neurological impairments nor VPS dysfunctions. Significant PHT and other ascites etiologies were excluded. Ascites persisted despite evacuation paracentesis and diuretics. Further diagnostic workup finally revealed peritoneal carcinomatosis probably originated in a cecal SRCC. Conclusions: We report an atypical presentation of MAA (transudative ascites, SAAG suggesting PHT, low cellularity, and initially negative cytology) due to a rare adenocarcinoma subtype, representing a challenge regarding its unusual characteristics and difficulties to reach a final diagnosis. Resumen: Introducción: La ascitis asociada a malignidad (AAM) es la segunda causa de ascitis de debut después de la cirrosis con hipertensión portal (HP) y suele relacionarse a carcinomatosis peritoneal. El líquido ascítico es un exudado, con gradiente de albúmina suero-ascitis (GASA) bajo, ≥500 linfocitos/mm3 y citología positiva. Sin embargo, la AAM puede presentar patrones atípicos. El carcinoma de células en anillo de sello (CCAS) es un subtipo de adenocarcinoma de mal pronóstico con una presentación clínica y endoscópica características. Resumen del caso: Una mujer de 68 años, sin antecedentes de interés, portadora de una derivación ventrículo-peritoneal (DVP), consultó por aumento del perímetro abdominal, deposiciones diarreicas, hiporexia y fiebre de una semana de evolución. En paracentesis repetidas la ascitis presentaba características de trasudado, GASA alto, baja celularidad y resultado negativo para cultivos y citologías. Se excluyeron alteraciones neurológicas y malfuncionamiento de la DVP. La HP significativa y otras etiologías de ascitis fueron descartadas. La ascitis persistió pese a paracentesis evacuadoras y diuréticos. Tras realizar pruebas complementarias adicionales finalmente se objetivó la presencia de carcinomatosis peritoneal probablemente originada en un CCAS del ciego. Conclusiones: Describimos una presentación atípica de AAM (trasudado, GASA sugestivo de HP, baja celularidad y citología inicialmente negativa) debido a un subtipo raro de adenocarcinoma, lo que representa un reto clínico considerando sus características inhabituales y las dificultades para conseguir un diagnóstico definitivo.

Abstract Background The optimal total knee arthroplasty (TKA) rotational alignment and how best to obtain and measure it are debatable. The aim was to analyse the reliability of the Berger femoral, three different tibial and four different combined two-dimensional computer tomography (2D-CT) TKA component rotation measurements, and to ascertain which rotational values best predict a successful clinical outcome. Methods The 2D-CT scans were obtained post-operatively on 60 patients who had TKA. We determined one femoral [Berger’s femoral angle (BFA)], three tibial [Berger’s tibial angle (BTA), anatomical tibial angle (ATA) and bimalleolar posterior tibial component angle (BM_PTCA)] and four combined [transepicondylar posterior tibial component angle (TE_PTCA), bicondylar posterior tibial component angle (BC_PTCA, transepicondylar bimalleolar angle (TE_BM) and bicondylar bimalleolar angle (BC_BM)] TKA rotation angles. We made all measures in 23 patients twice by three observers and determined inter- and intra-observer agreement using the Bland–Altman plot method. We analysed measures of 55 patients using the area under the ROC curve (AUC) analysis to ascertain the discriminative capacity of BFA, ATA, TE_PTCA and BC_PTCA for predicting a successful clinical outcome according to the Knee Society Score (KSS) threshold. Results ATA showed the smaller inter- and intra-observer average of differences (−0.1° and 1.6°, respectively) of the studied methods followed by BFA (−0.9° and 1.4°), TE_PTCA (−2.1° and 2.7°) and BC_PTCA (−0.5° and 1.8°). BFA (−4° to 2.1° and −6.1° to 8.8°) and BC_PTCA (−4.4° to 3.4° and −7.9° to 4.4°) showed the narrower inter- and intra-observer limits of agreement. A TKA device rotation (BC_PTCA)

Vielfalt als zentrale Schlüsselnorm der Medienregulierung prägt die Debatte um den Funktionsauftrag von öffentlich-rechtlichen Medien (ÖRM). Denn mediale Vielfalt gilt als normative Voraussetzung für freie Meinungsbildung und betont damit die demokratiestützende Aufgabe von ÖRM. Mit Blick auf verschiedene Demokratiemodelle und strukturelle Rahmenbedingungen wird Vielfalt als Qualitätsdimension allerdings bislang empirisch – gerade in vergleichender Perspektive – nur vereinzelt analysiert. Dieser Beitrag überprüft mit einer manuellen quantitativen Inhaltsanalyse von fast 6.000 Beiträgen der Politikberichterstattung mit nationalem Bezug, wie vielfältig die Hauptnachrichtensendungen der ÖRM auf ihren traditionellen und Online-Kanälen in Deutschland, Österreich und der deutschsprachigen Schweiz und im Vergleich zu anderen Nachrichtenangeboten sind. Die Resultate zeigen geringe Unterschiede zwischen Offline- und Online-Kanälen und zwischen den Medientypen. Themen- und Akteursvielfalt sind relativ hoch, mit Einschränkungen durch den Fokus auf Akteure der Exekutive. Gleichzeitig reflektiert die Berichterstattung politische Systeme und Demokratiemodelle; entsprechend fällt der Fokus auf die Exekutive im liberal-repräsentativen Modell in Deutschland am stärksten aus, während die stärkere Präsenz von Parlament und organisierter Zivilgesellschaft in der Schweiz eher dem deliberativen Modell entspricht.

Badan Riset dan Inovasi Nasional memiliki fasilitas riset yang digunakan untuk penelitian terhadap bahan nuklir yang memiliki potensi bahaya radiasi yang dapat membahayakan pekerja. Untuk mengurangi potensi bahaya radiasi, dilakukan pemantauan radiasi secara rutin oleh pekerja. Untuk mengoptimalkan pemantauan radiasi tersebut, dilakukan pengembangan 3 (tiga) buah monitor radiasi dengan menggunakan 1 (satu) detektor radiasi Sintilasi (S) dan 2 (dua) buah detektor GM (GM dan GMT) yang nantinya dapat terpasang dan memantau radiasi secara real-time. Pengujian terhadap 3 (tiga) monitor radiasi yang dikembangkan dilakukan dalam penelitian ini untuk mengetahui keakuratan pengukuran masing-masing monitor radiasi. Pengujian yang dilakukan adalah pengujian regresi linear untuk mendapatkan model konversi dari satuan cacah per detik ke satuan mikrosievert per jam. Selain itu, dilakukan pengujian ANOVA untuk melihat apakah ada perbedaan signifikan antara pengukuran laju dosis dari ketiga monitor radiasi dibandingkan dengan surveymeter yang telah terkalibrasi. Pengujian Tukey HSD dilakukan untuk menguji masing-masing monitor radiasi hasil pengembangan dan dibandingkan dengan surveymeter yang terkalibrasi. Hasil pengujian regresi linear antara surveymeter (GS) dengan ketiga monitor radiasi didapatkan koefisien determinasi diatas 0,95. Pengujian ANOVA yang dilakukan didapatkan bahwa terdapat perbedaan rata-rata hasil pengukuran laju dosis radiasi yang signifikan dari masing masing monitor radiasi. Hasil pengujian Tukey HSD menunjukkan bahwa hanya salah satu monitor radiasi yang memiliki rata-rata nilai pengukuran laju dosis radiasi yang tidak berbeda secara signifikan dengan rata-rata nilai pengukuran laju dosis radiasi dari surveymeter terkalibrasi. Oleh karena itu monitor radiasi GMT yang telah dikembangkan merupakan monitor radiasi yang telah layak untuk digunakan dalam pemantauan radiasi pada fasilitas riset bahan nuklir. Kata kunci: Detektor radiasi, regresi linear, ANOVA

Key points Certain radiological findings of acute muscle injury on MRI performed shortly prior to return to play may be considered risk factors of reinjury. There is a high risk of reinjury when two of these five radiological findings are present (connective tissue gap, loss of tendon tension, intermuscular oedema, callus gap and interstitial feather oedema). Despite appropriate progression during rehabilitation, MRI studies appear necessary in the decision to return to competition.

Sheep production systems are diverse in Europe, and welfare assessment should consider this diversity, including differences in breed type, climatic conditions, and time of the year. The aim of this study was to evaluate welfare in 100 commercial sheep farms in Spain, and therefore in Mediterranean conditions, using a list of 24 indicators, comprising three for good feeding, five for housing, 11 for health, and five for appropriate behavior. The list includes indicators from the AWIN protocol and other suggested indicators. Level of intensification was the main parameter that affected the welfare outcomes of feeding and health, but seasonality and flock size also affected some of the outcomes. Novel indicators included in the list (sternum evaluation, crowding behavior, subcutaneous abscesses, external parasitism, aggressive behaviors, wool pulling, ear posture, and reaction during restraint) were useful to evaluate welfare in Spanish farming conditions, but further studies should be performed to validate these indicators.

Objective: To present unprecedented radiological parameters that characterize the angle between the direct and indirect tendons of the proximal rectus femoris (RF) and its inclinations and to evaluate the population variability according to demographic variables.Materials and methods: From September 2019 to July 2021, using MRI multiplanar reconstructions of the proximal thigh/hip, two blinded radiologists measured the direct and indirect tendon angle and the inclination of each tendon in different planes. The intra- and inter-observer agreements were assessed with Bland–Altman analysis and intraclass correlation coefficient (ICC). The correlations between radiological parameters and demographic variables were evaluated using linear regression, Student’s t-test, and analysis of variance.Results: We performed 112 thigh/hip MRI scans on 91 football players of different age, gender, and disciplines (football and futsal). For observer 1 (the reference), the mean direct and indirect tendon angle was 56.74° ± 9.37, the mean indirect tendon slope was −7.90° ± 7.49, and the mean direct tendon slope was 22.16° ± 5.88. The three measurements showed inter- and intra-observer agreement (mean differences ∼0). No correlation was observed between age and the parameters. Likewise, no statistically significant differences were found for gender, dominant limb, examined limb, and sport.Conclusion: There is an inter- and intra-observer agreement in the measurements of the direct and indirect tendon angle and the inclination of each tendon. There is population variability in the proximal tendinous complex unrelated to demographic factors. These results allow further detection of morphological patterns that represent a risk factor for lesions in the RF in professional football and futsal players and other sports.

BackgroundDisseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis.ObjectivesTo describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period.MethodologyWe consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings.ResultsWe included all 30 patients reported during the study period—5, 9, and 16 in 2019, 2020, and 2021 respectively—20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8–30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p

Many Western countries have seen a pluralization and polarization of the political landscape in recent years. The resulting increase in diversity of political positions poses challenges to media that aim at providing citizens with orientation. Using Germany, Austria, and Switzerland as examples, the article analyzes how parties present themselves in the respective national parliament and how domestic media relay these utterances. The parties’ positions are examined via value frames that reflect three central cleavages of Western societies. The results show that parties express different combinations of posi-tions on these cleavages. Especially the cleavage related to globali-zation is clearly polarized, with right-wing populist parties at one end, conservative parties in a moderate place, and left-liberal parties at the other pole of the cleavage. Media reflect the parties’ positions mostly similarly to their own utterances in parliament. However, the right-wing populist parties are depicted in an even more polarized way compared to how they position themselves. The media thus fulfill their orientation function to different degrees across the party spectrum.

Abstract Most of the anterior thigh injuries are contusions or strains, however, some of these injuries can be career ending. Early diagnosis and correct treatment are key to successful outcome. Analyzing injury mechanism and adding both clinical and imaging findings, clinicians can make the right treatment decisions already often in the acute phase of the injury. Low grade contusions and muscle strains are treated well with planned rehabilitation, but complete tendon injuries or avulsions can require operative treatment. Also, neglected minor injuries could lead to chronic disabilities and time lost from play. Typical clinical presentation of anterior thigh injury is swelling and pain during hip flexion or knee extension. In more severe cases a clear gap can be palpated. Imaging methods used are ultrasound and magnetic resonance imaging (MRI) which are helpful for clinicians to determine more exact the extent of injury. MRI can identify possible tendon retractions which may need surgery. Clinicians should also be aware of other traumatic lesions affecting anterior thigh area such as myositis ossificans formation. Optimal treatment should be coordinated including acute phase treatment with rest, ice, and compression together with designed return-to-play protocol. The anatomical structure involved lines the treatment pathway. This narrative review describes these more common reasons for outpatient clinical visits for anterior thigh pain and injuries among soccer players.

Background:. Abdominoplasty, one of the most commonly performed aesthetic procedures, aims at correcting excess abdominal skin and fat, but generates a long abdominal scar. The efficacy of an automated portative 1210-nm laser in improving the appearance of surgical scars has been previously demonstrated in a double-blind randomized controlled trial. The purpose of this work was to document the use of this laser in real-life practice. Methods:. Eighteen patients undergoing abdominoplasty and treated with the evaluated laser (UrgoTouch, Laboratoires Urgo; one single session immediately after the surgery) were included in this prospective, mono-center, observational study. Change in scar characteristics was assessed using the validated Observer Scar Assessment Scale, and the patients’ and surgeon’s satisfaction was rated using a four-point scale. Results:. The aesthetic outcome of the scars was very positive with a mean Observer Scar Assessment Scale score of 17.0 (SD 4.6) and 14.4 (SD 3.8) on the 6–60 point scale (60: the worst possible outcome) at 6 and 12 months, respectively. A high degree of satisfaction was also expressed by both surgeon and patients at 6 weeks, 6 months, and 12 months. No laser-related incident was reported during the study, including in patients with darker phototypes. Conclusions:. These findings seem to be consistent with previous clinical evidence on the use of this laser on fresh incisions. The high degree of satisfaction reported by both surgeon and patients seems to comfort the benefits of this procedure at short- and long-term and support the use of this laser in daily practice of plastic surgery.

Objectives: To investigate hip pain, hip range of motion and the presence and size of cam morphology among young soccer players and skiers. Design: Cross-sectional study. Methods: The hip joints of young male soccer players and male and female skiers were examined clinically for hip range of motion (ROM) and with MRI (the presence of cam morphology). All participants answered questions about hip pain, debut age for training/competing and training frequency. Results: Clinical examinations were performed on 135 athletes (60 male soccer players, 40 male skiers and 35 female skiers), of which 93 athletes had additional MRIs. Mean age was 17.7 (SD 1.2) years. Cam morphology (α-angle ≥60°) was significantly less present in female skiers (3%) compared with male skiers (38%, p ​

Abstract Muscle injuries of the lower limbs are currently the most common sport-related injuries, the impact of which is particularly significant in elite athletes. MRI is the imaging modality of choice in assessing acute muscle injuries and radiologists play a key role in the current scenario of multidisciplinary health care teams involved in the care of elite athletes with muscle injuries. Despite the frequency and clinical relevance of muscle injuries, there is still a lack of uniformity in the description, diagnosis, and classification of lesions. The characteristics of the connective tissues (distribution and thickness) differ among muscles, being of high variability in the lower limb. This variability is of great clinical importance in determining the prognosis of muscle injuries. Recently, three classification systems, the Munich consensus statement, the British Athletics Muscle Injury classification, and the FC Barcelona-Aspetar-Duke classification, have been proposed to assess the severity of muscle injuries. A protocolized approach to the evaluation of MRI findings is essential to accurately assess the severity of acute lesions and to evaluate the progression of reparative changes. Certain MRI findings which are seen during recovery may suggest muscle overload or adaptative changes and appear to be clinically useful for sport physicians and physiotherapists.

La lesión genera costos físicos, emocionales y económicos, por lo que se han buscado estrategias para acortar al máximo el período de recuperación. Una herramienta infrautilizada es la nutricional. Se presenta una revisión de la literatura científica mediante una búsqueda en 4 bases de datos (Pubmed/MEDLINE, Epistemonikos, Embase y Sportdiscus) sobre la fisiopatología de la lesión muscular y su modulación nutricional. Se describen cambios locales mediados por células y mediadores inflamatorios, y cambios secundarios en la composición corporal. Las intervenciones nutricionales publicadas comprenden el aumento de las proteínas de la dieta y ajuste de carbohidratos acorde a su menor gasto energético. No existen estudios que hayan evaluado directamente el uso de suplementos durante la lesión, pero sí evidencia indirecta, la mayoría favorable, en sarcopenia y recuperación muscular. La intervención nutricional durante la lesión es fundamental para disminuir las consecuencias negativas de la inactividad, la cual debe ser indicada de manera individualizada.