Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Nomogram for overall survival in ampullary adenocarcinoma using the surveillance,epidemiology,and end results database and external validation

BACKGROUND Ampullary adenocarcinoma is a rare malignant tumor of the gastrointestinal tract.Currently,only a few cases have been reported,resulting in limited information on survival.AIM To develop a dynamic nomogram using internal and external validation to predict survival in patients with ampullary adenocarcinoma.METHODS Data were sourced from the surveillance,epidemiology,and end results stat database.The patients in the database were randomized in a 7:3 ratio into training and validation groups.Using Cox regression univariate and multivariate analyses in the training group,we identified independent risk factors for overall survival and cancer-specific survival to develop the nomogram.The nomogram was validated with a cohort of patients from the First Affiliated Hospital of the Army Medical University.RESULTS For overall and cancer-specific survival,12(sex,age,race,lymph node ratio,tumor size,chemotherapy,surgical modality,T stage,tumor differentiation,brain metastasis,lung metastasis,and extension)and 6(age;surveillance,epidemiology,and end results stage;lymph node ratio;chemotherapy;surgical modality;and tumor differentiation)independent risk factors,respectively,were incorporated into the nomogram.The area under the curve values at 1,3,and 5 years,respectively,were 0.807,0.842,and 0.826 for overall survival and 0.816,0.835,and 0.841 for cancer-specific survival.The internal and external validation cohorts indicated good consistency of the nomogram.CONCLUSION The dynamic nomogram offers robust predictive efficacy for the overall and cancer-specific survival of ampullary adenocarcinoma.

Serological surveillance for SARS-CoV-2 antibodies among students,faculty and staff within a large university system during the pandemic

BACKGROUND At the end of December 2019,the world faced severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2),which led to the outbreak of coronavirus disease 2019(COVID-19),associated with respiratory issues.This virus has shown significant challenges,especially for senior citizens,patients with other underlying illnesses,or those with a sedentary lifestyle.Serological tests conducted early on have helped identify how the virus is transmitted and how to curb its spread.The study hypothesis was that the rapid serological test for SARS-CoV-2 antibodies could indicate the immunoreactive profile during the COVID-19 pandemic in a university population.AIM To conduct active surveillance for serological expression of anti-SARS-CoV-2 antibodies in individuals within a university setting during the COVID-19 pandemic.METHODS This sectional study by convenience sampling was conducted in a large university in Niteroi-RJ,Brazil,from March 2021 to July 2021.The study population consisted of students,faculty,and administrative staff employed by the university.A total of 3433 faculty members,60703 students,and 3812 administrative staff were invited to participate.Data were gathered through rapid serological tests to detect immunoglobulin(Ig)M and IgG against SARS-CoV-2.Theχ²or Fisher's exact test was used to conduct statistical analysis.A 0.20 significance level was adopted for variable selection in a multiple logistic regression model to evaluate associations.RESULTS A total of 1648 individuals were enrolled in the study.The proportion of COVID-19 positivity was 164/1648(9.8%).The adjusted logistic model indicate a positive association between the expression of IgM or IgG and age[odds ratio(OR)=1.16,95%CI:1.02-1.31](P<0.0024),individuals who had been in contact with a COVID-19-positive case(OR=3.49,95%CI:2.34-5.37)(P<0.001),those who had received the COVID-19 vaccine(OR=2.33,95%CI:1.61-3.35)(P<0.001)and social isolation(OR=0.59,95%CI:0.41-0.84)(P<0.004).The likelihood of showing a positive result increased by 16%with every ten-year increment.Conversely,adherence to social distancing measures decreased the likelihood by 41%.CONCLUSION These findings evidenced that the population became more exposed to the virus as individuals discontinued social distancing practices,thereby increasing the risk of infection for themselves.

Epidemiology of Mpox Outbreaks and Implications for Surveillance in Imo State, Nigeria

Mpox disease is caused by a double-stranded DNA virus, genus Orthopoxvirus of the family Poxviridae. The incubation period is usually 6 to 13 days but can range from 5 to 21 days while symptoms and signs may persist for 2 to 5 weeks. Although, the clinical features are usually less severe when compared to the deadly smallpox, the disease can be fatal with case fatality rate between 1% and 10%. In Imo State, Nigeria, there has been a changing epidemiology of the disease in the last 6 years and the frequency and geographic distribution of cases have progressively increased. This study aims to conduct a review of the disease epidemiology between 2017 and 2023 and implications for surveillance in Imo State. Surveillance data from the Surveillance Outbreak Response and Management System (SORMAS) was extracted between January 2017 and December 2023 across the 27 Local Government Areas (LGAs) of Imo State. A line list of 231 suspected cases was downloaded into an excel template and analyzed using SPSS® version 20 software. Analysis was done using descriptive statistics and associations were tested using Fischer’s exact at 0.05 level of significance. Of the 231 suspected cases, 57.1% (132) were males, 42.9% (99) were females and the modal age group was between the ages of 0 - 4 (32.5%). Eight (8) LGAs (districts) accounted for 71% (n = 164) of all the suspected cases. 21.2% (49) were confirmed positive, 27 males (55.1%) and 22 females (44.9%) (p > 0.05). Modal age group was 20 - 24 (22.4%, n = 11), 18% (9) were children under 14 years, p > 0.05. Case fatality rate was 8% (n = 4). There was no significant association between mortality and age group. Five (5) LGAs accounted for about 60% (29) of all confirmed cases. These LGAs contribute only 20% to the total population in the State. Only 5.6% and 4% of suspected and confirmed cases, respectively, had knowledge of contact with an infectious source. The study described the epidemiology of Mpox outbreaks between 2017 and 2023 and the findings have significant implications on detection and outbreak response activities.

Central environmental protection inspection and carbon emission reduction: A tripartite evolutionary game model from the perspective of carbon neutrality

Since the carbon neutrality target was proposed,many countries have been facing severe challenges to carbon emission reduction sustainably.This study is conducted using a tripartite evolutionary game model to explore the impact of the central environmental protection inspection(CEPI)on driving carbon emission reduction,and to study what factors influence the strategic choices of each party and how they interact with each other.The research results suggest that local governments and manufacturing enterprises would choose strategies that are beneficial to carbon reduction when CEPI increases.When the initial willingness of all parties increases 20%,50%—80%,the time spent for the whole system to achieve stability decreases from 100%,60%—30%.The evolutionary result of“thorough inspection,regulation implementation,low-carbon management”is the best strategy for the tripartite evolutionary game.Moreover,the smaller the cost and the larger the benefit,the greater the likelihood of the three-party game stability strategy appears.This study has important guiding significance for other developing countries to promote carbon emission reduction by environmental policy.

How to use the Surveillance,Epidemiology,and End Results(SEER)data:research design and methodology

In the United States(US),the Surveillance,Epidemiology,and End Results(SEER)program is the only comprehensive source of population-based information that includes stage of cancer at the time of diagnosis and patient survival data.This program aims to provide a database about cancer incidence and survival for studies of surveillance and the development of analytical and methodological tools in the cancer field.Currently,the SEER program covers approximately half of the total cancer patients in the US.A growing number of clinical studies have applied the SEER database in various aspects.However,the intrinsic features of the SEER database,such as the huge data volume and complexity of data types,have hindered its application.In this review,we provided a systematic overview of the commonly used methodologies and study designs for retrospective epidemiological research in order to illustrate the application of the SEER database.Therefore,the goal of this review is to assist researchers in the selection of appropriate methods and study designs for enhancing the robustness and reliability of clinical studies by mining the SEER database.

Calibration of CO and CO2 Monitors Used in Periodic Inspection of Vehicles at Fixed Stations for Environmental Control

Global efforts for environmental cleanliness through the control of gaseous emissions from vehicles are gaining momentum and attracting increasing attention. Calibration plays a crucial role in these efforts by ensuring the quantitative assessment of emissions for informed decisions on environmental treatments. This paper describes a method for the calibration of CO/CO2 monitors used for periodic inspections of vehicles in cites. The calibration was performed in the selected ranges: 900 - 12,000 µmol/mol for CO and 2000 - 20,000 µmol/mol for CO2. The traceability of the measurement results to the SI units was ensured by using certified reference materials from CO/N2 and CO2/N2 primary gas mixtures. The method performance was evaluated by assessing its linearity, accuracy, precision, bias, and uncertainty of the calibration results. The calibration data exhibited a strong linear trend with R² values close to 1, indicating an excellent fit between the measured values and the calibration lines. Precision, expressed as relative standard deviation (%RSD), ranged from 0.48 to 4.56% for CO and from 0.97 to 3.53% for CO2, staying well below the 5% threshold for reporting results at a 95% confidence level. Accuracy measured as percent recovery, was consistently high (≥ 99.1%) for CO and ranged from 84.90% to 101.54% across the calibration range for CO2. In addition, the method exhibited minimal bias for both CO and CO2 calibrations and thus provided a reliable and accurate approach for calibrating CO/CO2 monitors used in vehicle inspections. Thus, it ensures the effectiveness of exhaust emission control for better environment.

Automatic Road Tunnel Crack Inspection Based on Crack Area Sensing and Multiscale Semantic Segmentation

The detection of crack defects on the walls of road tunnels is a crucial step in the process of ensuring travel safetyand performing routine tunnel maintenance. The automatic and accurate detection of cracks on the surface of roadtunnels is the key to improving the maintenance efficiency of road tunnels. Machine vision technology combinedwith a deep neural network model is an effective means to realize the localization and identification of crackdefects on the surface of road tunnels.We propose a complete set of automatic inspection methods for identifyingcracks on the walls of road tunnels as a solution to the problem of difficulty in identifying cracks during manualmaintenance. First, a set of equipment applied to the real-time acquisition of high-definition images of walls inroad tunnels is designed. Images of walls in road tunnels are acquired based on the designed equipment, whereimages containing crack defects are manually identified and selected. Subsequently, the training and validationsets used to construct the crack inspection model are obtained based on the acquired images, whereas the regionscontaining cracks and the pixels of the cracks are finely labeled. After that, a crack area sensing module is designedbased on the proposed you only look once version 7 model combined with coordinate attention mechanism (CAYOLOV7) network to locate the crack regions in the road tunnel surface images. Only subimages containingcracks are acquired and sent to the multiscale semantic segmentation module for extraction of the pixels to whichthe cracks belong based on the DeepLab V3+ network. The precision and recall of the crack region localizationon the surface of a road tunnel based on our proposed method are 82.4% and 93.8%, respectively. Moreover, themean intersection over union (MIoU) and pixel accuracy (PA) values for achieving pixel-level detection accuracyare 76.84% and 78.29%, respectively. The experimental results on the dataset show that our proposed two-stagedetection method outperforms other state-of-the-art models in crack region localization and detection. Based onour proposedmethod, the images captured on the surface of a road tunnel can complete crack detection at a speed often frames/second, and the detection accuracy can reach 0.25 mm, which meets the requirements for maintenanceof an actual project. The designed CA-YOLO V7 network enables precise localization of the area to which a crackbelongs in images acquired under different environmental and lighting conditions in road tunnels. The improvedDeepLab V3+ network based on lightweighting is able to extract crack morphology in a given region more quicklywhile maintaining segmentation accuracy. The established model combines defect localization and segmentationmodels for the first time, realizing pixel-level defect localization and extraction on the surface of road tunnelsin complex environments, and is capable of determining the actual size of cracks based on the physical coordinatesystemafter camera calibration. The trainedmodelhas highaccuracy andcanbe extendedandapplied to embeddedcomputing devices for the assessment and repair of damaged areas in different types of road tunnels.

Unmanned Aerial Vehicle Inspection Routing and Scheduling for Engineering Management

Technological advancements in unmanned aerial vehicles(UAVs)have revolutionized various industries,enabling the widespread adoption of UAV-based solutions.In engineering management,UAV-based inspection has emerged as a highly efficient method for identifying hidden risks in high-risk construction environments,surpassing traditional inspection techniques.Building on this foundation,this paper delves into the optimization of UAV inspection routing and scheduling,addressing the complexity introduced by factors such as no-fly zones,monitoring-interval time windows,and multiple monitoring rounds.To tackle this challenging problem,we propose a mixed-integer linear programming(MILP)model that optimizes inspection task assignments,monitoring sequence schedules,and charging decisions.The comprehensive consideration of these factors differentiates our problem from conventional vehicle routing problem(VRP),leading to a mathematically intractable model for commercial solvers in the case of large-scale instances.To overcome this limitation,we design a tailored variable neighborhood search(VNS)metaheuristic,customizing the algorithm to efficiently solve our model.Extensive numerical experiments are conducted to validate the efficacy of our proposed algorithm,demonstrating its scalability for both large-scale and real-scale instances.Sensitivity experiments and a case study based on an actual engineering project are also conducted,providing valuable insights for engineering managers to enhance inspection work efficiency.

Lightweight and polarized self-attention mechanism for abnormal morphology classification algorithm during traditional Chinese medicine inspection

Objective To propose a Light-Atten-Pose-based algorithm for classifying abnormal morphol-ogy in traditional Chinese medicine(TCM)inspection to solve the problem of relying on manual labor or expensive equipment with personal subjectivity or high cost.Methods First,this paper establishes a dataset of abnormal morphology for Chinese medi-cine diagnosis,with images from public resources and labeled with category labels by several Chinese medicine experts,including three categories:normal,shoulder abnormality,and leg abnormality.Second,the key points of human body are extracted by Light-Atten-Pose algo-rithm.Light-Atten-Pose algorithm uses lightweight EfficientNet network and polarized self-attention(PSA)mechanism on the basis of AlphaPose,which reduces the computation amount by using EfficientNet network,and the data is finely processed by using PSA mecha-nism in spatial and channel dimensions.Finally,according to the theory of TCM inspection,the abnormal morphology standard based on the joint angle difference is defined,and the classification of abnormal morphology of Chinese medical diagnosis is realized by calculat-ing the angle between key points.Accuracy,frames per second(FPS),model size,parameter set(Params),and giga floating-point operations per second(GFLOPs)are chosen as the eval-uation indexes for lightweighting.Results Validation of the Light-Atten-Pose algorithm on the dataset showed a classification accuracy of 96.23%,which is close to the original AlphaPose model.However,the FPS of the improved model reaches 41.6 fps from 16.5 fps,the model size is reduced from 155.11 MB to 33.67 MB,the Params decreases from 40.5 M to 8.6 M,and the GFLOPs reduces from 11.93 to 2.10.Conclusion The Light-Atten-Pose algorithm achieves lightweight while maintaining high ro-bustness,resulting in lower complexity and resource consumption and higher classification accuracy,and the experiments prove that the Light-Atten-Pose algorithm has a better overall performance and has practical application in the pose estimation task.

Liver cell cancer surveillance practice in Nigeria:Pitfalls and future prospects

Hepatocellular carcinoma(HCC)is a disease of public health concern in Nigeria,with chronic hepatitis B and C infections contributing most to the disease burden.Despite the increasing incidence of HCC,surveillance practices for early diagnosis and possible cure are not deeply rooted in the country.This article aims to review the current status of HCC surveillance in Nigeria,stressing the encounters,breaches,and potential prospects.Several factors,such as limited tools for screening and diagnostics,insufficient infrastructure,and low cognizance among the doctors,and the general public affect the surveillance practices for HCC in Nigeria.Moreover,the lack of standardized guidelines and protocols for HCC surveillance further intensifies the suboptimal diagnosis and treatment.Nevertheless,there are opportunities for refining surveillance practices in the country.This would be achieved through boosted public health sensitization campaigns,integrating HCC screening into routine clinical services,and leveraging technological developments for early detection and monitoring.Furthermore,collaboration between government agencies,healthcare providers,and international organizations can facilitate the development of comprehensive HCC surveillance programs person-alized to the Nigerian setting.Thus,HCC surveillance practice faces substantial challenges.By addressing the drawbacks and leveraging prospects,Nigeria can improve HCC surveillance,with subsequent improved outcomes for individuals at risk of developing the disease.

Analysis of the Application of Bridge Rapid Inspection and Evaluation Technology

Rapid bridge inspection and evaluation mainly uses information technology to test the quality of bridge infrastructure and structures,integrates the test results with the existing management system,completes the bridge status assessment,establishes information management files to provide bridge disease problem inspection and analysis,and provides support for the application of disposal measures.This paper briefly discusses the necessity of applying rapid inspection and evaluation technology and analyzes the bridge’s rapid inspection and evaluation content,inspection system,and application process.We look forward to the future application prospects of this technology and supporting those in this field.

Health anxiety and work loss in patients diagnosed with serrated polyposis syndrome:A cross sectional study

BACKGROUND Serrated polyposis syndrome(SPS)is a polyposis condition with neoplastic potential,but its psychological impact is not well understood.AIM To assess health anxiety prevalence in a regional Australian cohort of SPS patients and explore factors influencing it,including workforce impacts of regular surveillance.METHODS This cross-sectional study screened patients aged 18-65 undergoing colonoscopy in a regional gastroenterology practice between January 2015 and June 2022.Eligible SPS patients were invited to participate.Data included the Short Health Anxiety Inventory,employment status,and previous demographic and medical findings.RESULTS Health anxiety was found in 21.57%of SPS patients,with anxious patients being significantly more concerned about surveillance(OR=7.70).Patients lost an average of 11.04 work hours per colonoscopy.CONCLUSION Health anxiety in SPS patients aligns with rates in other gastroenterology populations.Identifying it may improve management,though further research is needed to better understand prevalence and care improvements.

DEVELOPMENT AND ERROR ANALYSIS OF AN INSPECTING SYSTEM FOR MEASURING THE ROTATIONAL INERTIA OF BULLETS

介绍了一种用于测量弹丸转动惯量的高精度测量仪器，该仪器利用双悬丝扭摆机构、光电计时系统提取摆动周期信息，由MCS-51系列单片机组成的测量系统进行数据处理，并由LED显示器测量结果。文中阐述了仪器的工作原理， 推导了所需的计算公式，分析了产生测量误差的因素，进行了定量精度分析，给出了实验结果与测量精度。

DEVELOPMENT AND PRELIMINARY APPLICATION OF OBJECTIFYING SYSTEM FOR TCM COLOR INSPECTION

An objectifying system for color inspections of traditional Chinese medicine （CITCM） is developed. The entire system includes two parts ： The hardware and the software. The hardware is an image acquiring device under a standard lighting condition, and it mainly includes a xenon lamp with color temperature of 5 500 K as light source, an integrating sphere used for diffusing light and a high resolution CCD camera. The software is used for digital image processing, and the procedure is divided into three steps. Firstly the skin/non-skin classifi- cation is performed by utilizing the threshold in chrominance channels of the RGB color space. Secondly, the fa- cial features are localized by using the image segmentation and coordinates sorting. Finally, the facial special re- gion（SR） corresponding to five internal organs is achieved by utilizing masks designed to take advantage of mor- phology. Subsequently, the chromaticity is calculated. The system is tested by taking 83 samples of 30 young and 53 elderly people. The experiment shows that there is significant difference of all SRs between the young and the elderly, and the system has better performance for objectifying research of CITCM.

Surveillance of Hand,Foot,and Mouth Disease in China's Mainland (2008-2009)

Objective Since HFMD was designated as a class C communicable disease in May 2008,18 months surveillance data have been accumulated to December 2009.This article was to describe the distribution of HFMD for age,sex,area,and time between 2008 and 2009,to reveal the characteristics of the epidemic.Methods We analyzed weekly reported cases of HFMD from May 2008 to December 2009,and presented data on the distribution of age,sex,area and time.A discrete Poisson model was used to detect spatial-temporal clusters of HFMD.Results More than 1 065 000 cases of HFMD were reported in China's Mainland from May 2008 to December 2009 （total incidence：12.47 per 10 000）.Male incidence was higher than female for all ages and 91.9% of patients were 5 years old.The incidence was highest in Beijing,Shanghai,Zhejiang and Hainan.The highest peak of HFMD cases was in April and the number of cases remained high from April to August.The spatial-temporal distribution detected four clusters.Conclusion Children 5 years old were susceptible to HFMD and we should be aware of their vulnerability.The incidence was higher in urban than rural areas,and an annual pandemic usually starts in April.

Advances in Computer Vision-Based Civil Infrastructure Inspection and Monitoring

Computer vision techniques, in conjunction with acquisition through remote cameras and unmanned aerial vehicles (UAVs), offer promising non-contact solutions to civil infrastructure condition assessment. The ultimate goal of such a system is to automatically and robustly convert the image or video data into actionable information. This paper provides an overview of recent advances in computer vision techniques as they apply to the problem of civil infrastructure condition assessment. In particular, relevant research in the fields of computer vision, machine learning, and structural engineering is presented. The work reviewed is classified into two types: inspection applications and monitoring applications. The inspection applications reviewed include identifying context such as structural components, characterizing local and global visible damage, and detecting changes from a reference image. The monitoring applications discussed include static measurement of strain and displacement, as well as dynamic measurement of displacement for modal analysis. Subsequently, some of the key challenges that persist toward the goal of automated vision-based civil infrastructure and monitoring are presented. The paper concludes with ongoing work aimed at addressing some of these stated challenges.

Helicobacter pylori associated gastric intestinal metaplasia:Treatment and surveillance

Gastric cancer(GC) is one of the leading causes of cancer related death in the world, particularly in East Asia. According to the Correa's cancer cascade, noncardia GC is usually developed through a series of mucosal changes from non-atrophic gastritis to atrophic gastritis(AG), intestinal metaplasia(IM), dysplasia and adenocarcinoma. Atrophic gastritis and IM are therefore generally considered to be pre-neoplastic gastric lesions. Helicobacter pylori(H. pylori) infection is an important initiating and promoting step of this gastric carcinogenesis cascade. Emerging long-term data showed that eradication of H. pylori reduced the risk of subsequent cancer development. It however remains confusing whether eradication of the bacterium in individuals with pre-neoplastic gastric lesions could regress these changes as well as in preventing cancer. Whilst H. pylori eradication could likely regress AG, the presence of IM may be a point of no return in this cascade. Hence, surveillance by endoscopy may be indicated in those with extensive IM or those with incomplete IM, particularly in populations with high GC risk. The optimal interval and the best tool of surveillance endoscopy remains to be determined in future studies.

Surveillance for hepatocellular carcinoma in chronic liver disease:Evidence and controversies

Primary liver cancer is the sixth most common cancer in the world and the third cause of cancer-related death.Hepatocellular carcinoma(HCC)represents more than90%of primary liver cancers and generally occurs in patients with underlying chronic liver disease such as viral hepatitis,hemochromatosis,primary biliary cirrhosis and non-alcoholic steatohepatitis.Especially cirrhotic patients are at risk of HCC and regular surveillance could enable early detection and therapy,with potentially improved outcome.We here summarize existing evidence for surveillance including ultrasound,other radiological modalities and various serum biomarkers,and current international guideline recommendations for surveillance.Ultrasound andα-fetoprotein(alone or in combination)are most frequently used for surveillance,but their sensitivities and specificities are still far from perfect,and evidence for surveillance remains weak and controversial.Various other potential surveillance tools have been tested,including serum markers as des-carboxyprothrombin,lectin-boundα-fetoprotein,and(most recently)circulating TIE2-expressing monocytes,and radiological investigations such as computed tomographyscan or magnetic resonance imaging-scan.Although early results appear promising,these tools have generally been tested in diagnostic rather than surveillance setting,and in most cases,no detailed information is available on their cost-effectiveness.For the near future,it remains important to define those patients with highest risk of HCC and most benefit from surveillance,and to restrict surveillance to these categories.

Application of ultrasonic inspection in monitoring dynamic healing of mandibular fracture in rabbit model

Objective:To investigate the feasibility of ultrasonic diagnosis for monitoring fracture healing. Methods:Thirty rabbit models with fraction of mandible body were established by surgically removing partial lower jawbone.At the 1st,2nd,4th,6th,8th and 12th week after the operation, they were examined by X-ray and ultrasound,respectively.All detection results were scored according to a generally accepted standard.Spearman rank correlation analysis was conducted to explore the relationship between the results of the two inspection methods.Results:In each healing stage,the results of the ultrasonic inspection were basically consistent with those of the X-ray examination,as supported by a Spearman rank correlation coefficient of 0.892(P【0.001). Conclusions:Non-invasive ultrasonic inspection can be used instead of X-ray examination to monitor and diagnose fracture healing.