Computer-Aided Diagnosis System for Bone Fracture Detection and Classification: A Review on Deep Learning Techniques

Bone fracture detection and classification was a large discussed topic over the last few years and many researchers proposed different technological solutions to tackle this task. Despite this, a universal approach able to support the classification of fractures in the human body still does not exist today. We aim to provide a first discussion concerning a selection of research works done in the technological domain, with a specific focus on Deep Learning. The objective was to underline a picture on the most promising studies for stimulating a knowledge improvement in the specific focus of bone fracture classification, necessary to start the development of an optimal shared framework. The evaluation has been made involving a first qualitative assessment based on strengths and weaknesses, providing a usage scenario evaluation. This could support the development of a helpful Computer Aided Diagnosis (CAD) system able to drive doctors in diagnosis tasks reducing diagnosis time, especially in the most complex tasks, and supporting the reduction of wrong diagnosis issues, especially during stressful working conditions, as what frequently happens in many emergency departments

Inmunolocalización temporal y espacial de osteopontina en la reparación de defectos óseos ortopédicos tratados con matriz ósea desmineralizada

Osteopontin (OPN) is the most abundant non-collagen protein in the bone matrix, where it fulfils the function of cellular adhesion and biomineralization. In the present work, the authors report the temporal and spatial localization of OPN during the repair of experimental orthopaedic bone defects treated with demineralized bone matrix (DBM) processed by the authors. 30 rabbits were used, which were given an orthopaedic bone defect of critical size in one of the radiuses, which was filled with DBM. The rabbits were euthanized in groups of 5 individuals at days 7, 15, 21, 30, 60 and 150. Histological cuts were immunomarked to establish the spatial and temporal immunomarcation of OPN. The histological cuts were observed with an optic microscope with which histological images were captured and analysed with the ImageJ software. The image analysis allowed the authors to establish the optic density (OD) and the integrated optic density (IOD). The data was analysed with the ANOVA and Fischer LSD tests. At day 7, the presence of OPN was observed only in the DBM particles, where the OD was 0.08 and the IOD was 1.64; at day 15, OPN marked different sites of collagen condensations and cells contained in the interior of the matrix. In this period the OD was 0.096 and the IOD, 9.26. At days 21 and 30, the OPN immunosignalled osteocytes, osteoblasts, osteoclasts and hypertrophic chondrocytes in the bone trabeculae adjacent   to the ossification zones. At day 21 the OD was 0.17 and IOD 6.22. At day 30, the OD was 0.14 and the IOD 2.52. At days 60 and 150, OPN was evenly distributed in the new bone matrix with an OD: 0.10 and IOD: 0.48, and OD: 0.35 and IOD: 3.80, respectively. The OD and IOD showed significant differences (p<=0.05) between days 7, 15, 21 and 30; and there was no difference at days 60 and 150 (p=0.05). OPN was found in the DBM particles: it increased the optic densities at day 15 and it diminished at day 60, after which it increased the OD and IOD again until day 150. It was established that the OPN immunoexpressed during the repair process in indifferentiated cells, osteoprogenitor chondrocytes and osteoblasts. The variation of OD and IOD allowed the authors to establish that the greatest degree of immunoexpression of OPN was at day 15 after repair initiated. On the other hand, the increase registered between days 60 and 150 post treatment was due to the biomineralization of the bone matrix.La osteopontina (OPN) es la proteína no colágena que más abunda en la matriz ósea, donde cumple funciones de adhesión celular y biomineralización. En el presente trabajo se informa la localización temporal y espacial de la OPN durante la reparación de defectos óseosortopédicos tratados con matriz ósea desmineralizada (MOD). Se emplearon 30 conejos a los que se les practicó un defecto óseo ortopédico de tamaño crítico en uno de sus radios. Los defectos se rellenaron con MOD obtenida según protocolo previamente informado. Los conejosfueron sacrificados en grupos de 5 a los 7, 15, 21, 30, 120 y 150 días de los cuales se recuperaron los defectos para identificar las estructuras histológicas y establecer la inmunomarcación espacial y temporal de OPN. Se realizaron cortes histológicos de los defectos que se tiñeron con hematoxilina y eosina (HE) e inmunomarcaron según técnicainmunohistológica. Los cortes inmunomarcados se observaron en un microscopio óptico de donde se capturaron imágenes histológicas a  20X para analizarlas con el software ImageJ y establecer la densidad óptica (DO) y densidad óptica integrada (DOI). Los datos se analizaron con un test ANOVOA y LSD Fisher. A los 7 días se observó la presencia de OPN solo en las partículas de MOD donde la DO: 0,109 y DOI: 3587,043; a los 15 días OPN marcaba distintos sitios de condensaciones colágenas y células en su interior, en este período DO fue 0,096 y la DOI: 10593,08. A los 21 y 30 días OPN señalaba trabéculas óseas, osteocitos, osteoblastos, osteoclastos y condrocitos hipertróficos inmediatos a las zonas de osificación, la DO fue 0,134 y DOI 14.639,7. A los 120 y 156 días OPN se encontraba uniformemente distribuida por la matriz del hueso nuevo con una DO: 0,0104; DOI: 4160,96 y DO: 0,081 y DOI 8878,9 respectivamente. Las DO y DOI mostraron diferencias significativas (p<=0,05) entre los 7, 15, 21 y 30 días y no existió diferencia a los días 120 y 150 días (p=0,05). OPN se halló presente en las partículas de MOD e incrementó las densidades ópticas a los 15, 21 y 30 días como producto del metabolismo celular posibilitando la adhesión celular y luego interviniendo en la biomineralización

A pectin-honey hydrogel prevents postoperative intraperitoneal adhesions in a rat model.

BACKGROUND: Adhesions are a common postoperative surgical complication. Liquid honey has been used intraperitoneally to reduce the incidence of these adhesions. However, solid barriers are considered more effective than liquids in decreasing postoperative intra-abdominal adhesion formation; therefore, a new pectin-honey hydrogel (PHH) was produced and its effectiveness was evaluated in a rat cecal abrasion model. Standardized cecal/peritoneal abrasion was performed through laparotomy in 48 adult Sprague-Dawley rats to induce peritoneal adhesion formation. Rats were randomly assigned to a control (C) and treatment (T) group. In group T, PHHs were placed between the injured peritoneum and cecum. Animals were euthanized on day 15 after surgery. Adhesions were evaluated macroscopically and adhesion scores were recorded and compared between the two groups. Inflammation, fibrosis, and neovascularization were histologically graded and compared between the groups. RESULTS: In group C, 17 of 24 (70.8%) animals developed adhesions between the cecum and peritoneum, while in group T only 5 of 24 (20.8%) did (p = 0.0012). In group C, one rat had an adhesion score of 3, sixteen had scores of 2, and seven rats had scores of 0. In group T, four rats had adhesion scores of 2, one rat had an adhesion score of 1 and nineteen have score 0 (p = 0.0003). Significantly lower grades of inflammation, fibrosis, and neovascularization were seen in group T (p = 0.006, p = 0.001, p = 0.002, respectively). CONCLUSION: PHH is a novel absorbable barrier that is effective in preventing intra-abdominal adhesions in a cecal abrasion model in rats. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12917-017-0965-z) contains supplementary material, which is available to authorized users

Morphological Study of the Alimentary Canal and Malpighian Tubules in the Adult of the Pollen Beetle Meligethes (Odonthogethes) chinensis (Coleoptera: Nitidulidae: Meligethinae)

Meligethinae has entirely become strictly anthophagous, also being called "pollen beetles", with all members (similar to 700 species) of this subfamily using pollen and other floral parts as food resources for their larvae and adults. In this study, we used light, fluorescence, and scanning electron microscopy (LM, FM, and SEM) to explore the fine morphological structure of the alimentary canal and Malpighian tubules of Meligethes (Odonthogethes) chinensis, a common Chinese pollen beetle associated with flowers of Rosaceae. The results show that the alimentary canal of M. (O.) chinensis is divided into three parts of foregut, midgut, and hindgut. The foregut is the shortest part and has no crop; the midgut is the widest part with numerous blunt-fingered gastric ceca; the front of the hindgut folds in a circle and then extends back to the anus. Six Malpighian tubules are attached to the colon to form a cryptonephridial system. We also provide a schematic color picture of the alimentary canal and Malpighian tubules in the hemocoelic cavity of the dissected M. (O.) chinensis. This study is the first to systematically study the general morphology of the alimentary canal and Malpighian tubules of Meligethinae, which can provide important support for subsequent anatomical and physiological studies of anthophagous beetles.Meligethes (Odonthogethes) chinensis is a highly specialized species of Nitidulidae in China that takes pollen as its main food source, and its main host plant is Rubus idaeus L. (Rosaceae). In this study, the structural morphology of the alimentary canal and Malpighian tubules of adult M. (O.) chinensis was observed under light, fluorescence, and scanning electron microscopy. The alimentary canal of adult M. (O.) chinensis is divided into foregut, midgut, and hindgut. The foregut is the shortest and consists of the pharynx, esophagus, proventriculus, and cardiac valve. The midgut is a straight, distended, cylindrical, thin-walled tube. Numerous blunt-fingered gastric ceca are distributed irregularly throughout the midgut. The hindgut is subdivided into the ileum, colon, and rectum. The ileum is coiled. The colon gradually enlarges posteriorly. The rectum is thickly muscled and followed by a membranous structure. The openings of proximal Malpighian tubules are evenly inserted into the junction of the midgut and hindgut, and distal Malpighian tubules are evenly attached to the colon to form a cryptonephridial system. In this study, we also compare the structure and infer the function of the alimentary canal and Malpighian tubules among beetles, as well as discuss the evolutionary and taxonomical implications

Rosaceae, Brassicaceae and pollen beetles: exploring relationships and evolution in an anthophilous beetle lineage (Nitidulidae, Meligethes-complex of genera) using an integrative approach

Background: Meligethes are pollen-beetles associated with flowers of Rosaceae as larvae. This genus currently consists of 63 known species in two subgenera, Meligethes and Odonthogethes, predominantly occurring in the eastern Palaearctic. We analyzed 74 morphological and ecological characters (169 states) of all species, as well as of 11 outgroup species from 7 Meligethinae genera (including Brassicogethes), to investigate their phylogeny. We also conducted a parallel molecular analysis on 9 Meligethes, 9 Odonthogethes, 3 Brassicogethes and 2 Meligethinus species based on DNA sequence data from mitochondrial (COI, 16S) and nuclear (CAD) genes. Results: Morphological phylogenetic reconstructions supported the monophyly of the whole genus and clades corresponding to purported subgenera Meligethes s.str. and Odonthogethes. Main species-groups were mostly confirmed, however some unresolved polytomies remained. Molecular data placed members of Brassicogethes (including 42 mostly W Palearctic species associated with Brassicaceae) as sister to Odonthogethes, with this clade being sister to Meligethes s.str. This phylogenetic scenario suggests that monophyletic Meligethes s.str., Odonthogethes and Brassicogethes should be regarded alternatively as three subgenera of a monophyletic Meligethes, or three genera in a monophyletic genus-complex, with mutually monophyletic Brassicogethes and Odonthogethes. Molecular analyses estimated the origin of this lineage at ca. 14–15 Mya from a common stem including Meligethinus. Conclusions: We hypothesize that the ancestor of Meligethes specialized on Rosaceae in the Middle Miocene (likely in Langhian Age) and subsequently radiated during Late Miocene and Plio-Pleistocene maintaining a trophic niche on this plant family. This radiation was primarily due to geographic isolation in E Asiatic mountain systems. Combined evidence from morphology, ancestral state parsimony reconstruction of host-plant associations and molecular evidence suggested that Rosoideae (Rosa spp.) represented the ancestral hosts of Meligethes s.str., followed by an independent shift of ancestral Odonthogethes (ca. 9–15 Mya) on Rubus (Rosoideae) and members of Rosaceae Spiraeoideae. Other ancestral Odonthogethes probably shifted again on the unrelated plant family Brassicaceae (maybe 8–14 Mya in S China), allowing a rapid westward radiation of the Brassicogethes clade

Inmunolocalizacion temporal y espacial de osteopontina en la reparación de defectos óseos ortopédicos tratados con matriz ósea desmineralizada

La osteopontina (OPN) es la proteína no colágena que más abunda en la matriz ósea. Cumple funciones de adhesión celular y biomineralización de la matriz extracelular. En el presente trabajo se informa la localización temporal y espacial de la OPN durante la reparación de defectos óseos ortopédicos tratados con matriz ósea desmineralizada (MOD). Se emplearon 30 conejos a los que se les practicó un defecto óseo ortopédico de tamaño crítico en uno de sus radios. Los defectos se rellenaron con MOD obtenida según protocolo previamente informado. Los conejos fueron sacrificados en grupos de 5 a los 7, 15, 21, 30, 120 y 150 días de los cuales se recuperaron los defectos para identificar las estructuras histológicas y establecer la inmunomarcación espacial y temporal de OPN. Se realizaron cortes histológicos de los defectos que se tiñieron con hematoxilina y eosina (HE) e inmunomarcaron según técnica inmunohistológica. Los cortes inmunomarcados se observaron en un microscopio óptico de donde se capturaron imágenes histológicas a 20X para analizarlas con el software ImageJ y establecer la densidad óptica (DO) y densidad óptica integrada (DOI). Los datos se analizaron con un test ANOVOA y LSD Fisher. A los 7 días se observó la presencia de OPN solo en las partículas de MOD donde la DO: 0,109 y DOI: 3587,043; a los 15 días OPN marcaba distintos sitios de condensaciones colágenas y células en su interior. En este período DO fue 0,096 y la DOI: 10593,08. A los 21 y 30 días OPN señalaba trabéculas óseas, osteocitos, osteoblastos, osteoclastos y condrocitos hipertróficos inmediatos a las zonas de osificación, la DO fue 0,134 y DOI 14.639,7. A los 120 y 150 días OPN se encontraba uniformemente distribuida por la matriz del hueso nuevo con una DO: 0,0104; DOI: 4160,96 y DO: 0,081 y DOI 8878,9 respectivamente. Las DO y DOI mostraron diferencias significativas (p<=0,05) entre los 7, 15, 21 y 30 días y no existió diferencia a los días 120 y 150 días (p=0,05). OPN se halló presente en las partí- culas de MOD e incrementó las densidades ópticas a los 15, 21 y 30 días como producto del metabolismo celular posibilitando la adhesión celular y luego interviniendo en la biomineralización

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients