bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational radiation exposure in doctors: an analysis of exposure rates over 25 years
Authors: Sharkey Amy R , Gambhir Parthivi , Saraskani Sepas , Walker Ross , Hajilou Ashcaan , Bassett Paul , Sandhu Navneet , Croasdale Peter , Honey Ian , Diamantopoulos Athanasios , Goh Vicky
Published: September 2021

Objectives:

Healthcare professionals’ occupational exposure to ionising radiation may be increasing due to increasing use of imaging and image-guided intervention. This study aims to assess the occupational exposure of doctors over a 25-year period at an NHS teaching hospital.

Methods:

Dosemeter measurements were collected prospectively from 1995 to 2019. Two retrospective analyses were performed over time (first including all measurements, second excluding “zero-dose” measurements), and by speciality. Group comparisons were undertaken using multilevel linear regression; a p-value <0.05 was deemed significant.

Results:

8,892 measurements (3,983 body, 1,514 collar, 649 eye, 2,846 hand), of which 3,350 were non-zero measurements (1,541 body, 883 collar, 155 eye, 771 hand), were included. Whole dataset analysis found a significant decrease in exposure for radiologists and cardiologists, as measured by body, hand and collar dosemeters over the last 25 years (p < 0.01 for all). The non-zero readings reflect the whole cohort analysis except in the case of eye dosemeters, which showed a significant decrease in exposure for cardiologists (p < 0.01), but a significant increase for radiologists and surgeons/anaesthetists (p < 0.01 for both).

Conclusions:

Whilst ionising radiation remains an occupational risk for doctors, the overall decreasing trend in occupational exposure is reassuring. However, a significant rise in eye dose for radiologists, surgeons and anaesthetists is concerning, and close monitoring is required to prevent future issues.

Advances in knowledge:

This paper is one of few evaluating the occupational radiation exposure to doctors over a 25-year period, showing that although most dosemeter measurements reflect decreasing exposure, the increase in eye exposure warrants caution.
A case-control study of airborne dissemination of bacteria during CT colonography
Authors: Taylor Alasdair , Williams Craig , Brown Amy
Published: September 2021

Objectives:

The COVID-19 pandemic has highlighted the importance of aerosol spread of infection. We have conducted a study to detect bacterial contamination of room surfaces and room air during CT colonography and confirm the efficacy of room disinfection procedures carried out between examinations.

Methods:

Systematic sampling of the CT examination couch and horizontal surfaces 1 m and 3 m from the couch was performed before and after patient examinations. A 1 m3 sample of room air was obtained during patient examinations. Samples were processed using routine laboratory methods. A case–control study design was used (30 CT colonography and 30 routine body CT scans).

Results:

Evidence of airborne dissemination of bacteria was detected in >30% of CT colonography examinations and <10% of control examinations (p = 0.01). No pathogenic bacteria were detected in surface samples taken before patient examinations.

Conclusion:

The room disinfection policy in use in our CT department is effective in eliminating pathogenic bacteria from surfaces in the patient environment. CT colonography causes contamination of room air with enteric bacteria in a significant proportion of cases.

Advances in knowledge:

CT colonography may possibly be an aerosol-generating procedure. Larger-scale investigation is needed to fully evaluate this potential infection risk.
COVID-19: Impact on radiology departments and implications for future service design, service delivery, and radiology education
Authors: Taylor Alasdair , Williams Craig
Published: September 2021

The pandemic caused by SARS-CoV-2 (severe adult respiratory distress syndrome Coronavirus-2) and its most severe clinical syndrome, COVID-19, has dramatically impacted service delivery in many radiology departments. Radiology (primarily chest radiography and CT) has played a pivotal role in managing the pandemic in countries with well-developed healthcare systems, enabling early diagnosis, triage of patients likely to require intensive care and detection of arterial and venous thrombosis complicating the disease. We review the lessons learned during the early response to the pandemic, placing these in the wider context of the responsibility radiology departments have to mitigate the impact of hospital-acquired infection on clinical care and staff wellbeing. The potential long-term implications for design and delivery of radiology services are considered. The need to achieve effective social distancing and ensure continuity of service during the pandemic has brought about a step change in the implementation of virtual clinical team working, off-site radiology reporting and postgraduate education in radiology. The potential consequences of these developments for the nature of radiological practice and the education of current and future radiologists are discussed.
Diffusion and quantification of diffusion of prostate cancer
Authors: Ueno Yoshiko , Tamada Tsutomu , Sofue Keitaro , Murakami Takamichi
Published: September 2021

For assessing a cancer treatment, and for detecting and characterizing cancer, Diffusion-weighted imaging (DWI) is commonly used. The key in DWI’s use extracranially has been due to the emergence of of high-gradient amplitude and multichannel coils, parallelimaging, and echo-planar imaging. The benefit has been fewer motion artefacts and high-quality prostate images.Recently, new techniques have been developed to improve the signal-to-noise ratio of DWI with fewer artefacts, allowing an increase in spatial resolution. For apparent diffusion coefficient quantification, non-Gaussian diffusion models have been proposed as additional tools for prostate cancer detection and evaluation of its aggressiveness. More recently, radiomics and machine learning for prostate magnetic resonance imaging have emerged as novel techniques for the non-invasive characterisation of prostate cancer. This review presents recent developments in prostate DWI and discusses its potential use in clinical practice.
MRI-guided focal boost to dominant intraprostatic lesion using volumetric modulated arc therapy in prostate cancer. Results of a phase II trial
Authors: Zapatero Almudena , Roch Maria , Castro Tejero Pablo , Büchser David , Martin de Vidales Carmen , González Saturnino , Rodríguez Pablo , San Jose Luis Alberto , Celada Guillermo , Murillo Maria Teresa
Published: September 2021

Objective:

To determine morphological and biological control as well as toxicity and quality of life (QoL) of men with localized prostate cancer (PCa) treated with MRI-guided focal boost radiotherapy.

Material and Methods:

30 patients with PCa and a visible dominant intraprostatic lesion (DIL) identified on mpMRI were included in a prospective Phase II trial. Matching point registration of planning CT and T2W, diffusion-weighted and a gradient-recalled echo (GRE) MRI images made in treatment position was used for prostate and tumour delineation. Treatment consisted on 35 daily fractions of 2.17 Gy with a concomitant focal boost to the DIL of 2.43 Gy using volumetric modulated arc therapy (VMAT) and image-guided radiation therapy (IGRT) with intraprostatic fiducial markers. Biochemical failure was analysed using PSA nadir +2 ng/mL criteria and local control using mpMRI evaluation at 6–9 months following RT. Acute and late toxicity were defined according to CTCAE v.4.0 and RTOG/EORTC scales and QoL was assessed using IPSS, EPIC short-form and UCLA-PCI questionnaires.

Results:

The median radiation dose to the prostate was 77.6 Gy (IQR 77.3–78.1), and to the DIL was 85.5 Gy (IQR 85.0–86.0). With a median follow up of 30.0 months (IQR 25.5–40.27), all patients remain free of biochemical relapse. An mpMRI complete response was observed in 25 patients during the first post-treatment evaluation at 6 months. The remaining five patients achieved a complete disappearance of the DIL both on T2 and DWI on the second mpMRI performed at 9 months following treatment. Six out of 30 (20%) patients presented acute Grade 2 urinary toxicity with no Grade 3 acute complications. Acute rectal toxicity was only found in 2 (6.6%) patients (both Grade 1). Only late Grade 1 urinary and rectal complications were observed in 3/30 patients, respectively, with no Grade 2 or more late toxicity. The urinary, bowel and sexual bother EPIC scores were slightly and insignificantly increased in the first 3 months post-treatment, returning to normal afterwards.

Conclusions:

mpMRI-guided focal boost using VMAT hypofractionated technique is associated with an excellent morphological and functional response control and a safe toxicity profile.

Advances in knowledge:

In the present trial, we examined the potential role of mpMRI for radiological assessment (functional and morphological) of treatment response in high-risk prostate cancer patients treated with MRI-guided focal radiotherapy dose intensification to dominant Intraprostatic lesion.
Dual-energy CT in pulmonary vascular disease
Authors: Vlahos Ioannis , Jacobsen Megan C , Godoy Myrna C , Stefanidis Konstantinos , Layman Rick R
Published: September 2021

Dual-energy CT (DECT) imaging is a technique that extends the capabilities of CT beyond that of established densitometric evaluations. CT pulmonary angiography (CTPA) performed with dual-energy technique benefits from both the availability of low kVp CT data and also the concurrent ability to quantify iodine enhancement in the lung parenchyma. Parenchymal enhancement, presented as pulmonary perfused blood volume maps, may be considered as a surrogate of pulmonary perfusion. These distinct capabilities have led to new opportunities in the evaluation of pulmonary vascular diseases. Dual-energy CTPA offers the potential for improvements in pulmonary emboli detection, diagnostic confidence, and most notably severity stratification. Furthermore, the appreciated insights of pulmonary vascular physiology conferred by DECT have resulted in increased use for the assessment of pulmonary hypertension, with particular utility in the subset of patients with chronic thromboembolic pulmonary hypertension. With the increasing availability of dual energy-capable CT systems, dual energy CTPA is becoming a standard-of-care protocol for CTPA acquisition in acute PE. Furthermore, qualitative and quantitative pulmonary vascular DECT data heralds promise for the technique as a “one-stop shop” for diagnosis and surveillance assessment in patients with pulmonary hypertension. This review explores the current application, clinical value, and limitations of DECT imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi-energy CT imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained.
Duration of acute esophageal toxicity in concomitant radio-chemotherapy for non-small cell lung cancer with different fractionation schedules
Authors: Socha Joanna , Wasilewska-Teśluk Ewa , Stando Rafal , Kuncman Lukasz , Kepka Lucyna
Published: September 2021

Objectives:

In our previous prospective trial on accelerated hypofractionated concomitant radiochemotherapy (AHRT-CHT) for non-small-cell lung cancer (NSCLC), the incidence of grade ≥3 acute esophageal toxicity (AET) was similar to that reported for conventionally fractionated concomitant radiochemotherapy (CFRT-CHT), but its duration was prolonged. Thus, we aimed to compare the duration of grade ≥3 AET between AHRT-CHT and CFRT-CHT.

Methods:

Clinical data of 76 NSCLC patients treated with CFRT-CHT (60–66 Gy/2 Gy) during 2015–2020 were retrospectively compared with the data of 92 patients treated with AHRT-CHT (58.8 Gy/2.8 Gy) in the prospective trial. The maximum grade of AET, incidence, and duration of grade ≥3 AET were the end points. Univariate and multivariate analyses were applied to correlate clinical and treatment variables with these end points.

Results:

Neither the maximum grade of AET (p = 0.71), nor the incidence of grade ≥3 AET (p = 0.87) differed between the two groups. The number of CHT cycles delivered (2 vs 1, p = 0.005) and higher esophagus mean BED (p = 0.009) were significant predictors for a higher maximum grade of AET; older age was a significant predictor for higher incidence of grade ≥3 AET (p = 0.03). The median duration of grade ≥3 AET in AHRT-CHT and CFRT-CHT group was 30 days (range 5-150) vs 7 days (range 3–20), respectively, p = 0.0005. In multivariate analysis, only the AHRT-CHT schedule (p=0.003) was a significant predictor for a longer duration of grade ≥3 AET.

Conclusion

Despite similar incidence of grade ≥3 AET, its duration is significantly prolonged in NSCLC patients treated with AHRT-CHT compared to CFRT-CHT.

Advances in knowledge

Reporting only the rate of grade ≥3 AET in clinical trials may underestimate the real extent of the esophageal toxicity; its duration should also be routinely reported.
Diagnostic performance of radiologists with different levels of experience in the interpretation of MRI of the placenta accreta spectrum disorder
Authors: Ghezzi Caroline Lorenzoni Almeida , Silva Cristiano Kohler , Casagrande Aline Spader , Westphalen Stephanie Sander , Salazar Cristiano Caetano , Vettorazzi Janete
Published: September 2021

Objectives:

There have been no investigations on the association between previous abdominopelvic MRI experience without placental MRI experience and diagnostic accuracy of placenta accreta spectrum (PAS). To evaluate the diagnostic performance of radiologists with different experience levels in interpreting PAS-related MRI findings.

Methods:

This retrospective study included 60 women who underwent MRI for placental assessment between 2016 and 2020. MR images were reviewed by four radiologists who were blinded to the clinical outcomes and had different experience levels in interpreting PAS-related MRI findings. The radiologists’ diagnostic performance was evaluated according to the pathologic and surgical outcomes. Simple κ statistics were calculated to determine agreement among the radiologists.

Results:

Of 60 women, 46 were diagnosed with PAS. The maternal age mean ± SD was 33.0 years ± 5.0 for the PAS absent group and 36.0 ± 4.3 for the PAS present group (p = 0.013). Overall, the most experienced radiologist had the highest sensitivity (100%, 95% confidence interval (CI): 92.3–100%) and NPV (100%, 95% CI: 63.1–100%) in PAS diagnoses. However, the PPV and specificity were independent of experience. The most experienced radiologist had the highest diagnostic accuracy in PAS (90%, 95% CI: 79.5–96.2%) and placenta percreta (95%, 95% CI: 86.1–99.0%). There was a strong association between definitive PAS diagnoses and the highest experience level. The κ values for the interobserver agreement regarding PAS diagnoses were 0.67 for the most experienced radiologist (p < 0.001) and 0.38, 0.40, and 0.43 for the other radiologists (p = 0.001) and regarding placenta percreta diagnoses were 0.87 for the senior radiologist (p < 0.001) and 0.63, 0.57, and 0.62 for the other radiologists (p < 0.001).

Conclusion:

Previous experience in interpreting PAS-related MRI findings plays a significant role in accurately interpreting such imaging findings. Previous abdominopelvic MRI experience without specific placental MRI experience did not improve diagnostic performance.

Advances in knowledge:

We believe that our study makes a significant contribution to the literature and that this paper will be of interest to the readership of your journal because to the best of our knowledge, this study is the first in which the correlation between previous experience in abdominopelvic MRI with no specific experience in PAS-related MRI and diagnostic accuracy of radiologists has been explored. Our results could aid in setting up specialized multidisciplinary teams to assist women with PAS disorders.
Serial changes in tumour measurements and apparent diffusion coefficients in prostate cancer patients on active surveillance with and without histopathological progression
Authors: Sushentsev Nikita , Caglic Iztok , Rundo Leonardo , Kozlov Vasily , Sala Evis , Gnanapragasam Vincent J , Barrett Tristan
Published: September 2021

Objective:

To analyse serial changes in MRI-derived tumour measurements and apparent diffusion coefficient (ADC) values in prostate cancer (PCa) patients on active surveillance (AS) with and without histopathological disease progression.

Methods:

This study included AS patients with biopsy-proven PCa with a minimum of two consecutive MR examinations and at least one repeat targeted biopsy. Tumour volumes, largest axial two-dimensional (2D) surface areas, and maximum diameters were measured on T  2 weighted images (T  2WI). ADC values were derived from the whole lesions, 2D areas, and small-volume regions of interest (ROIs) where tumours were most conspicuous. Areas under the ROC curve (AUCs) were calculated for combinations of T  2WI and ADC parameters with optimal specificity and sensitivity.

Results:

60 patients (30 progressors and 30 non-progressors) were included. In progressors, T  2WI-derived tumour volume, 2D surface area, and maximum tumour diameter had a median increase of +99.5%,+55.3%, and +21.7% compared to +29.2%,+8.1%, and +6.9% in non-progressors (p < 0.005 for all). Follow-up whole-volume and small-volume ROIs ADC values were significantly reduced in progressors (−11.7% and −9.5%) compared to non-progressors (−6.1% and −1.6%) (p < 0.05 for both). The combined AUC of a relative increase in maximum tumour diameter by 20% and reduction in small-volume ADC by 10% was 0.67.

Conclusion:

AS patients show significant differences in tumour measurements and ADC values between those with and without histopathological disease progression.

Advances in knowledge:

This paper proposes specific clinical cut-offs for T  2WI-derived maximum tumour diameter (+20%) and small-volume ADC (−10%) to predict histopathological PCa progression on AS and supplement subjective serial MRI assessment.
CT Hounsfield unit and histogram analysis for differentiation of recent versus remote vertebral compression fractures
Authors: Ryoo Chang Hyun , Chai Jee Won , Hong Sung Hwan , Choi Ja-Young , Yoo Hye Jin , Chae Hee Dong
Published: September 2021

Objectives:

The purpose of this study was to analyze the intraosseous tissue changes in recent vertebral compression fractures (VCFs) and to differentiate recent from remote VCFs using CT Hounsfield unit histogram analysis (HUHA).

Methods:

65 patients with T11 to L3 VCFs were included. HUHA of 2 vertebral bodies (VBs)— a fractured VB and the closest lower-level unaffected VB—was done. The mean Hounsfield unit (HU) value and HU proportions of 5 ranges (HU ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150) were obtained. Then, ΔHU value and ΔHU proportion were calculated by subtracting the values from the two vertebrae. Finally, the obtained values were compared between the recent and remote VCF groups and subjected to ROC curve analysis.

Results:

In recent VCF group, the ΔHU proportion (HU ≤ 0) corresponding to normal fatty marrow was lower (-0.17 vs 0.01) and the ΔHU proportion (HU > 150) representing trabecular bone was higher (0.23 vs 0.04) than in remote VCF group (p < 0.001). In the differentiation of recent from remote VCF, the ΔHU value and ΔHU proportion (HU > 150) showed high area under the curve (AUC, 0.939 and 0.912, respectively).

Conclusion:

CT HUHA demonstrated both trabecular bone and bone marrow changes in recent VCFs, and showed high diagnostic performance in differentiating between recent and remote VCFs.

Advances in knowledge:

With its vendor neutral applicability, CT HUHA can be used for the differentiation of recent and remote VCFs.
Axillary lymphadenopathy in a high-risk breast screening patient following the COVID-19 vaccine: a diagnostic conundrum
Authors: Musaddaq Besma , Brown Adam , Dluzewski Sam , Marafioti Teresa , Malhotra Anmol
Published: September 2021

A number of COVID-19 vaccines have been approved worldwide to help tackle the pandemic. As with many vaccines, this causes a reactive axillary lymphadenopathy which can mimic potentially metastatic disease in a breast screening patient. It is therefore important to be aware of this side-effect of the vaccination when evaluating the axilla in a breast screening patient. We present a case of biopsy-proven unilateral reactive axillary lymphadenopathy in a high risk BRCA carrier following administration of the Astra Zeneca vaccine.
Imaging features of adenosquamous carcinoma of the breast – A rare variant of metaplastic breast carcinoma
Authors: Sae-Kho Tiffany Marian , Bhatt Asha , Solanki Malvika H. , Jeans Elizabeth B. , Corbin Kimberly S. , Fazzio Robert T. , Glazebrook Katrina N.
Published: September 2021

Adenosquamous carcinoma of the breast is a rare subtype of metaplastic carcinoma, which accounts for <1% of invasive breast malignancy. Metaplastic carcinoma is usually high grade and aggressive with typically reported benign imaging features when compared to invasive ductal carcinoma. However, the adenosquamous variant is a subtype with a more favorable prognosis. Within the literature, there is limited imaging description with case studies focusing on metaplastic carcinoma. Herein, we report seven cases of the adenosquamous subtype describing the imaging findings with correlation to clinical history and pathology. The majority of patients (n = 6) presented with palpable breast masses. One patient was identified through screening mammography. Mammographically (n = 6), tumors appeared as irregular masses. Sonographically (n = 7), tumors appeared as irregular masses ranging from solid to mixed solid/cystic masses. On MRI (n = 1), one tumor appeared as an irregular rim enhancing mass. FDG PET/CT (n = 2) and whole-body bone scan (n = 1) were also available for review. The majority of tumors were low-grade (n = 6) with only one high-grade tumor. This case series of seven patients demonstrated predominantly suspicious imaging features despite the majority being low-grade tumors.
National Diagnostic Reference Level (DRL) for nuclear medicine computed tomography–positron emission tomography hybrid imaging studies for kuwait population: second phase dose audit-2019
Authors: Masoomi Michael , Al-Shammeri Iman , Al-Kandari Latifah , Elrahman Hany , Al-Shammeri Jehan
Published: September 2021

Objective:

Diagnostic reference levels (DRLs) for CT part of positron emission tomography-CT (PET-CT) examinations are limited. The study was aiming to execute the second phase of the national DRL in support of optimisation and dose reduction in State of KW.

Methods:

In this multicentre collaborative PET-CT study, oncology patient data were exclusively collected due to the National MOH Ethical Committee recommendation and limitation of the other studies. Median, Mean, SD, 75th, 25th percentiles as well as whole body (WB) effective dose (ED) were calculated. The study was UK-IPEM-based methodology and it was the second phase of the study in Kuwait.

Results:

Half body (HB) and WB scans were 65 and 35% of the total enterers (309). The third quartile dose–length product (DLP) (mGy x cm) and volumetric CT dose index (mGy) values for the HB (537, 5) were higher than the UK NDRL (400, 4.3) but were lower than the Swiss NDRL (620, 6) and the France NDRL (762, 7.7). Comparatively, the proposed NDRLs for the WB (684, 4.1) were lower than Swiss National Data (720, 5.0) though, the Swiss had about 5000 (HB) & 706 (WB), the UK had 370 (HB) and France had 1000 (HB) entries. Calculated ED varied from 4.1 to 10.2 mSv, (mean values = 6.9 mSv) for HB and from 2.6 to 7 mSv (mean value = 4.6 mSv).

Conclusions:

There was 9.1% improvement in NDRL for 2019, compared to 2018, but there is a continuous need for improving NDRL.

Advances in knowledge:

Data provided a trend of NDRL that is served as a national data bank for continuous optimisation.
Predicting factors for primary cervical cancer recurrence after definitive radiation therapy
Authors: Okubo Mitsuru , Itonaga Tomohiro , Saito Tatsuhiko , Shiraishi Sachika , Yunaiyama Daisuke , Mikami Ryuji , Sakurada Akira , Sugahara Shinji , Tokuuye Koichi , Saito Kazuhiro
Published: September 2021

Objectives:

The study aimed to retrospectively investigate the apparent diffusion coefficient (ADC) of primary cervical cancer to examine the recurrence correlations in patients treated with radiotherapy (RT).

Methods:

The ADC of 31 patients with cervical cancer treated with RT were analyzed as possible risk factors for recurrence. A receiver operating characteristic (ROC) curve of the mean ADC (ADCmean) for the recurrence was generated to determine the cut-off value that yielded optimal sensitivity and specificity. The patient population was subdivided according to the risk factors for recurrence, and the disease-free survival (DFS) was analyzed. The following were investigated to explore the risk factors for recurrence: age, performance status, stage, pelvic lymph node metastasis, histologic tumor grade, maximal diameter of the primary tumor, chemotherapy, and ADCmean.

Results:

The median follow-up duration of the patients was 25 months. The recurrence was recognized in 9 (29%) of the 31 cases. The ROC analysis of recurrence showed that the area under the ADCmean curve was 0.889 (95% CI, 0.771–1.000; p = 0.001). The cut-off value of ADC mean was 0.900 × 10− 3 mm2/s, with a sensitivity of 86.4% and a specificity of 88.9%. By univariate analysis, the ADCmean was the only factor significantly associated with recurrence.

Conclusion:

The ADCmean of the primary tumor is a potential predictive factor for the recurrence in of cervical cancer.

Advances in knowledge:

The ADCmean of the primary tumor is a predictor of recurrence in patients with pre-treatment cervical cancer evaluation.
Hydrogen sulfide (H2S) - therapeutic relevance in rehabilitation and balneotherapy Systematic literature review and meta-analysis based on the PRISMA paradig
Authors: MUNTEANU Constantin , MUNTEANU Diana , ONOSE Gelu
Published: September 2021

Background. An active molecule in sulfurous mineral - therapeutic waters and also in sapropelic mud is H2S, a hormetic gaseous molecule that can actively penetrate the skin. While high levels of H2S are extremely toxic, low levels are tolerated and have potential cytoprotective effects, with anti-inflammatory and antioxidant applications.
Objective. This systematic review aims to rigorously select related articles and identify within their content the main possible uses of hydrogen sulfide from balneary sources and to explain its physiological mechanisms and therapeutic properties.
Methods. To elaborate our systematic review, we have searched for relevant open access articles in 6 international databases: Cochrane , Elsevier , NCBI/PubMed , NCBI/PMC , PEDro , and ISI Web of Knowledge/Science , published from January 2016 until July 2021. The contextually quested keywords combinations/ syntaxes used are specified on this page. The eligible articles were analyzed in detail regarding pathologies addressed by hydrogen sulfide. All articles with any design (reviews, randomized controlled trials, non-randomized controlled trials, case-control studies, cross-sectional studies), if eligible according to the above-mentioned selection methodology, containing in the title the selected combinations, were included in the analysis. Articles were excluded in the second phase if they did not reach the relevance criterion.
Results. Our search identified, first, 291 articles. After eliminating the duplicates and non-ISI articles, remained 121 papers. In the second phase, we applied a PEDro selection filter, resulting in 108 articles that passed the relevance criterion and were included in this systematic review.
Conclusions. H2S biology and medical relevance are not fully understood and used adequately for sanogenic or medical purposes. More research is needed to fully understand the mechanisms and importance of this therapeutic gase. The link between balneotherapy and medical rehabilitation regarding the usage of hydrogen sulfide emphasises the unity for this medical speciality.
Water intake meets the Water from inside the human body – physiological, cultural, and health perspectives - Synthetic and Systematic literature review
Authors: MUNTEANU Constantin , TEOIBAS-SERBAN Droteea , IORDACHE Liviu , BALAUREA Mariana , BLENDEA Corneliu-Dan
Published: September 2021

Background. The average adult human body of 70 kilograms consists in about 67.85% water distributed evenly to an average of 70 % in all major organs of the body: skin, muscles, brain, spinal cord, liver, heart, lungs, spleen, kidneys, pancreas and gastro-intestinal tract. A smaller percentage is found in the bones (30%), teeth (5%) and fat tissue (50%).
Objective. This review article attempts to present different perspectives on the physiological properties of water in the human body. We describe from the ancient Chinese medicine theory about water being one of the 5 elements of nature and its harmonious interrelation with the other elements in order to balance the human body, to the successful experiments of researchers which demonstrated waters’ capability to change its molecular structure based on feelings, intentions and energy it was exposed to. We briefly describe the role of water for the human body and what effects can the lack of it have, especially dehydration with all the phases of severity. Also, we present the health benefits of drinking water and which type of water is best to consume. We shorty review the different types of natural mineral waters in Romania and the importance of the Romanian researches for balneology and how the waters cand be administrated in crenotherapy for different types of pathologies.
Methods. To elaborate our systematic review, we have searched for relevant open access articles and review articles in ISI Web of Science, published from January 2017 until August 2021. The terms used were water AND health in the title. Articles were excluded in the second phase if they did not reach the relevance citation criterion. The eligible articles were analyzed in detail regarding water importance for human health.
Results. Our search identified, first, 548 articles. After applying a PEDro like selection filter and, we selected 93 articles with a minimum of 8 points on our PEDro like filtering scale (good, very good, and excellent articles with a minimum of 5 citations per year). Detailed analysis of the 93 selected articles has conducted us to the elimination of 33 of them as being on a different subject than that of our article. To the 60 full articles retained for this systematic and synthetic article, we have added 10 articles found through a separate Google search, as being considered of high relevance for our subject and necessary to be included.
Conclusions. Water is essential for the entire planet and also indispensable for the survival of the human body.

Keywords: water intake, water balance, body water, water molecular structure, dehydration, crenotherapy
The outcomes of ultrasonic and laser therapy in case of temporomandibular disorders – an evidence based update
Authors: NEGUCIOIU Marius , KUI Andreea , MITARIU Mihai , MANZIUC Manuela , CONDOR Daniela , MITARIU Loredana , BUDURU Smaranda
Published: September 2021

Introduction. Temporomandibular disorders (TMDs) are considered multifactorial conditions, thereby with different therapy options, from occlusal equilibration, splint therapy, pharmacotherapy or physical therapy. Among the physical therapies, over the last years, laser therapy and ultrasound therapy have gained attention, as different experimental or clinical studies suggest their efficacy in case of TMDs. The aim of our literature review is to evaluate the available evidence on the effectiveness of laser and ultrasound therapy in the treatment of temporomandibular disorders. Material and method. A research of literature has been performed - articles published over the last 5 years (January 2016 until June 2021) were searched by introducing a combination of different terms, using the Pubmed, Scopus and Google Scholar databases. Results and discussions. A total number of 332 articles was found. For multiple publications regarding the same group of patients, the most recent studies were included. Initial analysis of titles and abstracts eliminated 232 articles, leaving 35 articles whose full text was examined. 20 articles met the inclusion criteria Conclusions. According to the findings of this literature update we can conclude that low level laser therapy, ultrasound therapy, and photobiomodulation may effectively reduce pain for patients suffering of muscular and joint TMDs. However, their effects appear to be only shortly maintained, and only for less complex cases. In addition, it was difficult to compare the studies included, as they do not offer an optimal usage (program, duration of sessions, or number of sessions) of each technique. In this context, we consider that further randomized clinical studies are necessarily to compare each physical technique as well as their synergic effect on the symptoms in case of temporomandibular disorders. Keywords: temporomandibular disorders, low level laser therapy, ultrasound therapy, photobiomodulation, TMD, LLLT
Osteoarthritis is not a disease, but rather an accumulation of predisposing factors. A systematic review
Authors: Gherghel Robert , Iordan Daniel-Andrei , Mocanu Mircea-Dan , Onu Ana , Onu Ilie
Published: September 2021

Introduction: Although they do not endanger the life of the individual, the major symptoms of osteoarthritis (OA), such as pain, inflammation and dysfunction, it will slowly decrease quality of life and performance, leading finally to disabilities. Due to the fact that this disease has no cure, strategies are still being sought to slow its evolution. The lack of understanding of the predisposing and triggering factors of OA, has led to different approaches to this pathology so discussed, but with modest results. This systematic review aims to debate the main phenomena underlying joint destruction in OA, and etiopathogenic theories.
Materials and Methods: In this study were included 58 bibliographic sources, of which title 39 refers to OA, 6 with inflammation, 28 with cartilage, 3 with chondrocytes, and 5 with synovitis. In this study were discussed the etiopathogenic theories of OA which include: age, alteration of the cartilaginous matrix, alteration of chondrocyte metabolism, microtrauma and major trauma, inflammation of the joints - synovitis and obesity.
Results: Increasing the level of understanding of predisposing factors, the occurrence of acute inflammatory phenomenon and the perpetuation of mechanisms that latently maintain chronic inflammation that over time develops a destructive effect on articular cartilage, would limit the negative effects of OA, delay the evolution and optimally combat that maintain the vicious circle: inflammation → production of enzymes → chondrolysis → inflammation.
Conclusions: These studies contribute significantly to the understanding of destructive phenomena in OA. More studies are needed on the risk factors of OA and its production mechanisms, to find increasingly effective therapies that limiting its progression.
Keywords: Osteoarthritis, etiopathogenic theories, chronic inflammation, age, obesity, cartilaginous matrixm, chondrocyte metabolism
A multidisciplinary approach for the physic-chemical characterization of peloids to new perspectives in the development for “hydrothermal Developing Countries” using partecipatory methodology
Authors: ROSSI Davide , URUCI Renata
Published: September 2021

The Osservatorio Termale Permanente (OTP) operated from 1996 to 2014 in the Italian and international therapeutic thermalism field. The main aim of OTP was the development of a multidisciplinary approach for the characterization of the quality of peloids for cutaneous application and their maturation process using different qualitative and quantitative analytic techniques opening at the Integrated Analytical Approach in the field of therapeutic thermalism. The main innovation introduced by OTP were rheology and surface tensiometry applications on peloids. The introduction of surface tensiometry included the skin as a fundamental element for the development of mud therapy protocols based on the bioadhesive properties of peloids. The interfacial investigations between peloids and skin led to the characterization of the exchange activity occurring during pelotherapy on the cutaneous surface in a non-invasive and fast way. On these bases, our work linked each other the multidisciplinarity approach to the study of hydrothermal resources performed by OTP with the concept of the participative methodology commonly applied to the development of projects in the field of development cooperation. This combined approach led us to develop a scientific proposal for the development of therapeutic thermalism in countries not yet improved in this field and characterized by the presence of hydrothermal resources.

Keywords: peloid, surface tensiometry, Rossi factor, rheology, Rheological Termal Mud, skin, integrated analytical approach, participative methodology, therapeutical thermal proposal, hydrothermal development countries
THE INFLUENCE OF BODY INDEX MASS ON THE LEISURE TYPES FOR THE STUDENTS OF THE FACULTY OF PHYSICAL EDUCATION AND SPORTS
Authors: Mocanu George-Dănuț , Iordan Daniel-Andrei
Published: September 2021

The study aims to investigate the ways of spending free time for a group of 180 students of the Faculty of Physical Education and Sports in Galati (years 1, 2 and 3 of cycle 1 / bachelor’s degree studies, with an average age of 22.34 ± 5.79 years.), by using a questionnaire-based survey, structured on 4 distinct factors: leisure time budget, causes limiting leisure time, favorite leisure activities and leisure sports activities. The purpose of the research is to determine the perception of students of the Faculty of Physical Education and Sports on how to spend free time and determine differences of opinion, depending on BMI / body mass index, by dividing them into 3 groups (underweight, normal weight or overweight). Results: The analysis of variance (ANOVA) indicates significant influences of the independent variable on the response values for the following items (F <.05): inaccessibility of going out with friends, stress generated by shopping, limiting free time to help others, spending free time with entourage and life partner, spending holidays in the country, etc. Socializing on the internet, physical sports activities, TV, internet and computer games, going out with friends are the preferred options for students, and reading gets low scores. The differences between groups (in most cases insignificant) however, signal that normal weight students watch TV and the Internet the least, but waste more time with commuting and household activities and have high scores when involved in most sports. Overweight people have low scores for time spent on favorite activities, are most dissatisfied with time management, work more overtime, spend less time with those around them, but prefer to spend time with their life partner or alone, have slightly better scores for reading and music auditions, get the lowest scores for involvement in most sports activities, but have high satisfaction generated by physical effort. Underweight students perceive the inaccessibility of going out with friends more strongly, are more affected by difficult homework, have a higher level of stress for reading, but perceive most other activities as less stressful, socialize more on the internet, prefer jogging and cycling / rollerblading as sports activities. Swimming is selected by all groups as indicated for optimizing health and ensuring body harmony, even if its practice is deficient, and contact / combat sports are indicated as the most risky for physical integrity.
Keywords: active and passive leisure, lifestyle, physical and mental health, opinions, accessibility
The importance of stratifying ischemic risk by using the Duke score in women with ischemic heart disease and hypothyroidism before inclusion in cardiovascular rehabilitation programs
Authors: GURZĂU Diana Andrada , CALOIAN Bogdan , COMŞA Horaţiu , SITAR-TĂUT Adela , ZDRENGHEA Dumitru , POP Dana
Published: September 2021

Introduction: The relationship between abnormal thyroid function and coronary heart disease has been known for a long time, and particularly, hypothyroidism is associated with an increased risk of cardiovascular disease. The aim of this study was to evaluate the ischemic risk by using the Duke score in women with ischemic heart disease and associated hypothyroidism before inclusion in cardiovascular rehabilitation program.
Materials and methods: We included in the study 150 female patients admitted to the Cardiology Department of the Clinical Rehabilitation Hospital Cluj-Napoca. All the patients included had ischemic heart disease and performed an exercise stress testing to evaluate the effort capacity and also to stratify the ischemic risk by calculating the Duke Score. After dosing the thyroid stimulating hormone (TSH) we divided the patients in two groups: with hypothyroidism and a control group.
Results: Patients with hypothyroidism were more frequently hypertensive, (98% vs 87%, p-0.035), and they had diabetes mellitus in a higher proportion (51% vs 22%, p-0.005). HDL cholesterol was significantly decreased in the group of patients with hypothyroidism: 40.36±10.39mg/dl vs 44.85±10.29mg/dl (p-0.01). Regarding the ischemic risk assessed by the Duke score, the statistically significant differences between the two groups were registered only for the category of high-risk patients, 5.55% vs 18% (p-0.048). Also, the TSH value was higher in the group with high-risk Duke score, 4.21±3.73µIU/ml, compared to the moderate-risk score group, 1.95±1.12µIU/ml(p-0.05).
Conclusion: In women with ischemic heart disease, assessing thyroid function can be useful to identify patients at high risk of ischemia. Patients with hypothyroidism tend to have a higher prevalence of cardiovascular risk factors, a higher ischemic risk objectified by the Duke score and more commonly multivascular coronary lesions. For these patients, the inclusion in cardiovascular rehabilitation programs is essential, but it is very important that the programs to be customized for each patient.

Keywords: coronary heart disease in women, exercise ECG, Duke score, ischemic risk, hypothyroidism, cardiovascular rehabilitation programs
Can inflammatory biomarkers play a role in the inclusion of patients with acute myocardial infarction in cardiac rehabilitation programs?
Authors: DĂDÂRLAT-POP Alexandra , ROȘIANU Horea , POPTILE Renaldo , TOMOAIA Raluca , BEYER Ruxandra , ȘERBAN Adela
Published: September 2021

Introduction: In spite of the enormous progress made over the last decades, acute coronary syndromes remain the leading cause of death globally. Inflammation plays an important role in coronary artery disease development. Although the role of inflammatory biomarkers in acute obstructive myocardial infarction is well established, there is no data regarding the potential differences between acute myocardial infarction (AMI) with ST segment elevation, AMI without ST segment elevation (NON-STEMI) and non-obstructive acute myocardial infarction (MINOCA), respectively. Also, it is well known that cardiac rehabilitation of acute myocardial infarction survivors significantly improves their long-term prognosis.
Aim of the study: To asses the possible existing differences between patients with STEMI, NON-STEMI and MINOCA in terms of clinical and paraclinical parameters, especially inflammatory biomarkers. A second objective of our study was to describe the relationship between inflammatory, cardiac necrosis enzymes and left ventricle systolic function.
Material and methods: The study included 35 adult patients admitted in the Cardiology service of the Niculae Stăncioiu Heart Institute, Cluj-Napoca with acute myocardial infarction. Demographic, clinical, echocardiographic and laboratory data were analyzed. Patients were divided into 3 groups, 19 patients (54.2%) were diagnosed with STEMI- group 1, 9 patients (25.7%) with NON-STEMI- group 2 and 7 patients (20%) with MINOCA- group 3, respectively. Dosage of serum inflammatory markers was performed on the day of admission.
Results and conclusion: The most common associated cardiovascular risk factor was arterial hypertension (65.7% of patients). Markers of myocardial necrosis (CK, CK-MB, hs Troponin) were significantly higher in patients with STEMI (p <0.05) in comparison with NON-STEMI and MINOCA patients. Congestive heart failure was most frequently encountered in STEMI patients. hsCRP value was higher among patients with STEMI. The value of ESR was significantly higher among patients with NON-STEMI. Serial dosage of inflammation biomarkers in patients with recent acute myocardial infarction may serve as valuable risk stratification instruments and also for functional capacity and recovery status assessment in patients included in cardiac rehabilitation programs.

Keywords: acute coronary syndrome; inflammatory biomarkers; non-obstructive acute myocardial infarction,
EFFECTIVENESS OF CERVICAL MANUAL MOBILIZATION TECHNIQUES VERSUS STRETCHING EXERCISES FOR PAIN RELIEF IN THE MANAGEMENT OF NECK PAIN
Authors: Waheed Nida , Amir Muhammad , Noureen Rabia , Nawaz Sumaira , Zaidi Syeda Wajeeha Raza
Published: September 2021

Introduction. A huge literature is available regarding the efficacy of various physiotherapy techniques for neck pain (NP), however, comparative study is still in scarcity. Therefore, this study aimed to compare effectiveness of stretching exercises versus manual mobilization techniques in the management of NP.
Material and method. A randomized controlled trial parallel-group design study was conducted on the patients suffering from NP. Participants with the history of NP, aged between 19 to 60 years, NP without radiculopathy, and no history of trauma were included in the study. Two outcome measures were used i.e., Numeric pain rating scale (NPRS) and neck pain disability index (NDI) questionnaire. Two groups were equally divided had twenty-five patients each. Group A received cervical stretching with strengthening exercises as home-treatment program and group B received manual mobilization with strengthening exercises as home-treatment program. Six sessions were given on alternate basis and assessed pre- and post-treatment information of all patients.
Results and discussions. Independent sample t-test was run to compare the post difference between stretching exercises and manual mobilization at 95% confidence interval (p<0.05). The Post NPRS difference between the groups shows no significant improvement (p=0.32). Similarly no significant difference was found in post NDI Disability (p=0.57). Therefore, both the treatment strategies are equally effective in improving NP and disability.
Conclusions. This clinical trial concluded that stretching or manual mobilization is equally effective to reduce pain and disability. Hence, improve the quality of life in neck pain survivors.
Keywords: Manual Mobilization Technique, Neck Pain, , Neck Pain Disability Index Questionnaire, Numeric Pain Rating Scale, Range of Motion, Stretching Exercises,