Evaluation of the Nursing Management for Patients on Underwater Chest Drainage at Kenyatta National Hospital

Aim: To evaluate the nursing management for patients undergoing underwater chest drainage (UWCD) management at Kenyatta National hospital (KNH). Methods: A cross-sectional study conducted at the medical and surgical wards of KNH. Data were obtained from 101 consenting nurses selected through simple random sampling using a researcher administered questionnaire. Ten participant observations were made among nurses who were systematically sampled. Ten key informant interviews were conducted among nurse managers of these departments who were purposively sampled. Data were analysed using SPSS version 21. Findings: Most participants (46.5%) had average knowledge while 6.9% were poor. This means that 46.5% of the participants either had to refer to guidelines on UWCD management or assisted by a more competent nurse while 6.9% were unable to manage UWCD patients. Factors affecting the levels of knowledge and competence included level of nursing education (p = 0.043), length of working experience (p = 0.022) and the attitude of the participants towards UWCD nursing management (p = 0.022). There was low adherence to the Nursing Council of Kenya (NCK) guidelines (17%). Most nurses used “shortcuts” in provision of care. Majority (62.6%) faced challenges in provision of care. The challenges include inadequate knowledge (37.1%), heavy workload (27.4%) and lack of guidelines (16.9%). Conclusions: There is a knowledge and competence gap in the nursing management of UWCD patients at KNH. Majority used “shortcuts” in nursing care with low adherence to NCK guidelines. There is a need to improve the knowledge and competence in order to ensure patients safety and reduce complications.

Bradycardia Secondary to Negative Suction Pressure Applied to Chest Drain

Positive pressure generated in peritoneal cavity by gas insufflation during laparoscopic procedures can cause hemodynamic instability. There are a few case reports suggesting similar occurrences during thoracoscopic procedures as well. The mechanism behind the conditions above is explained to be due to stretch force applied to peritoneum and pleura which causes vagal stimulation. We wish to present a case where a high negative pressure applied to pleural cavity lead to treatment-resistant bradycardia. The possible mechanism behind this occurrence was traction pressure on pleura which triggered vagal activity. The bradycardia subsided on reducing or discontinuing negative suction pressure. To best of our knowledge this the first case report on bradycardia associated with high negative suction pressure applied to inter costal drain.

Chest Drain Insertion-Made Easy with Gum Bougie

Background: Surgical Chest drain insertion is a lifesaving procedure. It requires skills and experience towards its prompt insertion. Quite often there is delay or failure caused in its insertion due to excessive fat and loose skin in the axillary area while using the conventional methods. Numerous guidelines exist advising its safe placement, but mishaps still occur, as reported multiple times, while placing the chest drain. In addition to this, a delay or failure of its successful insertion can lead to disastrous consequences. Case: We would like to share, with fellow readers, a novel technique which we used in placing a surgical chest drain successfully. We used a gum bougie to guide the chest drain into the pleural cavity instead of using metal trocar, stellate or long forceps. Conclusion: By using this method, we experienced that not only it reduced the amount of time taken for the procedure, but it also had positive impact on the ease of insertion without fear of causing damage to internal organs, which ultimately boosted the operator’s confidence.

Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score,oxygenation index,and chest radiography grading

BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome(RDS),but current assessment methods for RDS pose a cumulative risk of harm to neonates.Thus,a less harmful method for assessing the health of neonates with RDS is needed.AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores,oxygenation index,and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity.METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022.The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest Xray grade of each newborn before and after treatment were collected.Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity.RESULTS The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment(P<0.05).Spearman correlation analysis showed that before and after treatment,the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score,oxygenation index,and chest X-ray grade(ρ=0.429–0.859,P<0.05).Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS(area under the curve=0.805–1.000,P<0.05).CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score,oxygenation index,and chest X-ray grade.The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.

Life Time Attributable Cancer Risk Estimated Using Scanner Reported Dose Length Product during Chest Computed Tomography Imaging in Young Children

This study aims to estimate the lifetime attributable cancer risk (LAR) for pediatric chest computed tomography (CT) examinations in five age groups using recently published age and region-specific conversion coefficients multiplying the widely available scanner registered dose length products (DLP) displayed on the CT console and hence calculating the Effective Dose (ED). The ED is then multiplied by the International Commission on Radiological Protection (ICRP) published risk factor for LAR. The obtained LAR values are compared with the international literature. Factors that may affect the LAR value are reported and discussed. The study included one hundred twenty five chest CT examinations for both males and females aged from less than one year to fifteen years. The patients reported data are from one single medical institution and using two CT scanners from June 2022 to December 2023. The results of this study may serve as benchmark for institutional radiation dose reference levels and risk estimation.

Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses:A case report and review of literature

BACKGROUND Hereditary multiple exostoses is a rare genetic disorder characterized by the growth of multiple osteochondromas affecting primarily long bones.Chest wall lesions may represent a challenge,particularly in pediatric patients.Pain is a common manifestation.However,life-threatening complications can result from direct involvement of adjacent structures.Surgical resection with appropriate reconstruction is often required.CASE SUMMARY A 5-year-old male who was diagnosed with hereditary multiple exostoses presented with significant pain from a large growing chest wall exostosis lesion.After appropriate preoperative investigations,he underwent surgical resection with reconstruction of his chest wall using a biologic bovine dermal matrix mesh.CONCLUSION Resection of chest wall lesions in children represents a challenge.Preoperative planning to determine the appropriate reconstruction strategy is essential.

Pulmonary Edema and Pleural Effusion Detection Using Efficient Net-V1-B4 Architecture and AdamW Optimizer from Chest X-Rays Images

This paper presents a novelmulticlass systemdesigned to detect pleural effusion and pulmonary edema on chest Xray images,addressing the critical need for early detection in healthcare.A new comprehensive dataset was formed by combining 28,309 samples from the ChestX-ray14,PadChest,and CheXpert databases,with 10,287,6022,and 12,000 samples representing Pleural Effusion,Pulmonary Edema,and Normal cases,respectively.Consequently,the preprocessing step involves applying the Contrast Limited Adaptive Histogram Equalization(CLAHE)method to boost the local contrast of the X-ray samples,then resizing the images to 380×380 dimensions,followed by using the data augmentation technique.The classification task employs a deep learning model based on the EfficientNet-V1-B4 architecture and is trained using the AdamW optimizer.The proposed multiclass system achieved an accuracy(ACC)of 98.3%,recall of 98.3%,precision of 98.7%,and F1-score of 98.7%.Moreover,the robustness of the model was revealed by the Receiver Operating Characteristic(ROC)analysis,which demonstrated an Area Under the Curve(AUC)of 1.00 for edema and normal cases and 0.99 for effusion.The experimental results demonstrate the superiority of the proposedmulti-class system,which has the potential to assist clinicians in timely and accurate diagnosis,leading to improved patient outcomes.Notably,ablation-CAM visualization at the last convolutional layer portrayed further enhanced diagnostic capabilities with heat maps on X-ray images,which will aid clinicians in interpreting and localizing abnormalities more effectively.

Cardiotoxicity induced by fluoropyrimidine drugs in the treatment of gastrointestinal tumors

In this editorial,we review the article published in World J Gastrointest Oncol 2019,11:1031-1042.We specifically focus on the occurrence,clinical characteristics,and risk factors of fluoropyrimidine drug-related cardiotoxicity in patients with gastrointestinal tumors.Despite significant advancements in diagnostic and therapeutic techniques that have reduced mortality rates associated with digestive system tumors,the incidence and mortality rates of treatment-related car-diotoxicity have been increasing,severely impacting the survival and prognosis of cancer patients.Fluoropyrimidine drugs are widely used as antimetabolites in the treatment of malignant tumors,including gastrointestinal tumors,and they represent the second largest class of drugs associated with cardiotoxicity.However,there is often a lack of awareness or understanding regarding their cardiotoxic effects and associated risks.

粉尘作业人员DR高千伏胸片表现和肺功能检查结果分析

目的:分析粉尘作业人员数字化X线摄影(DR)高千伏胸片表现和肺功能变化,探讨两者对粉尘作业人员的健康监护作用。方法:收集白银市某矿山2021年1—12月在白银市第一人民医院进行年度职业健康体检的400名员工为研究对象。按照是否从事接尘作业分为接尘组和对照组各200名。所有研究对象均行DR高千伏胸片和肺功能检查,对检查结果进行分析比较。结果:接尘组DR高千伏胸片异常率(66.0%)高于对照组(34.5%),差异有统计学意义(P<0.05);接尘组肺功能指标用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、肺活量25%时流速(FEF25)、肺活量50%时流速(FEF50)与肺活量75%时流速(FEF75)等指标均低于对照组,差异有统计学意义(P<0.05)。接尘组不同工龄组间DR高千伏胸片和肺功能差异显著,工龄>30年与工龄≤10年及工龄11~20年接尘人员DR高千伏胸片、肺功能比较,工龄21~30年与工龄≤10年人员DR高千伏胸片和肺功能比较,差异均有统计学意义(P<0.05)。粉尘作业人员随着年龄的增长和工龄的延长,DR高千伏胸片病变检出率呈上升趋势,肺功能指标FVC、FEV1、FEV1/FVC、FEF25、FEF50、FEF75呈下降趋势。结论:粉尘作业人员的DR高千伏胸片表现和肺功能变化相比未接触粉尘者,主要与工龄有关。DR高千伏胸片表现可以提供直接证据,而肺功能检查则能发现早期异常。两者联合检查有助于粉尘作业人员的健康监护和评估,从而更好地保障其职业健康权益。

Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

Chest Radiography: General Practitioners’ Compliance with Recommendations

Introduction: Chest radiography is the most frequently prescribed imaging test in general practice in France. We aimed to assess the extent to which general practitioners follow the recommendations of the French National Authority for Health in prescribing chest radiography. Methodology: We conducted a retrospective analysis study, in two radiology centers belonging to the same group in Saint-Omer and Aire-sur-la-Lys, of requests for chest radiography sent by general practitioners over the winter period between December 22, 2013, and March 21, 2014, for patients aged over 18 years. Results: One hundred and seventy-seven requests for chest X-rays were analyzed, 71.75% of which complied with recommendations. The most frequent reason was the search for bronchopulmonary infection, accounting for 70.08% of prescriptions, followed by 11.2% for requests to rule out pulmonary neoplasia, whereas the latter reason did not comply with recommendations. Chest X-rays contributed to a positive diagnosis in 28.81% of cases. The positive diagnosis was given by 36.22% of the recommended chest X-rays, versus 10% for those not recommended. Conclusion: In most cases, general practitioners follow HAS recommendations for prescribing chest X-rays. Non-recommended chest X-rays do not appear to make a major contribution to diagnosis or patient management, confirming the value of following the recommendations of the French National Authority for Health.

Rib Osteosynthesis for Sub-Acute Management of a Flail Chest in a Tertiary Centre in a Low-Middle Income Country of Sub-Saharan Africa: Case Report at Douala Laquintinie Hospital

Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management. Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest. Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient’s clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.

Application Value of NLR,PLR,LMR,HEART score,and POCT in Early Warning and Accurate Graded Diagnosis of High-Risk Chest Pain in Emergency Medicine

Objective: To evaluate the application value of neutrophils/lymphocytes (NLR), platelets/lymphocytes (PLR), lymphocytes/monocytes (LMR), HEART (history, electrocardiogram, age, risk factors, and troponin) score, and point-of- care testing (POCT) in the early warning and precise diagnosis of high-risk chest pain in emergency medicine. Methods: A total of 157 patients with acute chest pain who were admitted to the emergency department and chest pain treatment unit of our hospital between August 2022 and September 2023 were selected. Rapid testing of bedside myocardial markers (ultrasensitive troponin (hs-cTnI), myoglobin (MYO), creatine kinase isoenzyme (CK-MB), D-dimer (D-Dimer), and N-terminal B-type natriuretic peptide precursor (NT-proBNP)) was performed on the patients using a POCT device (ThermoKing BioMQ60proB). A HEART score was used to classify the patients into low (n = 53), intermediate (n = 59), and high-risk (n = 45) groups, and the NLR, PLR, and LMR were calculated. The NLR, PLR, and LMR values were compared among the three groups of patients, and the optimal cutoff values as well as sensitivity and specificity were determined based on receiver operating characteristic (ROC) analysis. Results: The HEART scores of patients in the low-risk, intermediate-risk, and high-risk groups were (2.72 ± 0.24), (4.75 ± 0.56), and (5.32 ± 0.73) respectively, and the differences were statistically significant (P < 0.05). Compared with the low-risk group, the intermediate-risk group and high-risk group had a significantly higher NLR and PLR, and a significantly lower LMR;the high-risk group had higher NLR and PLR and lower values of LMR as compared to the other two groups, and the difference was statistically significant (P < 0.05). The ROC curves suggested that the area under the curve, sensitivity, and specificity of the combined diagnosis of NLR, PLR, LMR, HEART score, and POCT were greater than those of LR, PLR, and LMR with HEART score and POCT alone. Conclusion: The combined application of NLR, PLR, LMR, HEART score, and POCT has significant application value in the early warning and precise diagnosis of emergency high-risk chest pain. It provides a more simple, easy-to-access, and efficient assessment index for the clinical prediction and treatment of emergency high- risk chest pain.

Impact of Optimizing Emergency Nursing Processes on Resuscitation Success in Patients with Acute Chest Pain

Objective:To analyze the effect of optimizing the emergency nursing process in the resuscitation of patients with acute chest pain and the impact on the resuscitation success rate.Methods:66 patients with acute chest pain received by the emergency department of our hospital from January 2022 to December 2023 were selected as the study subjects and divided into two groups according to the differences in the emergency nursing process,i.e.,33 patients receiving routine emergency care were included in the control group,and 33 patients receiving the optimization of emergency nursing process intervention were included in the observation group.Patients’resuscitation effect and satisfaction with nursing care in the two groups were compared.Results:The observation group’s consultation assessment time,reception time,admission to the start of resuscitation time,and resuscitation time were shorter than that of the control group,the resuscitation success rate was higher than that of the control group,and the incidence of adverse events was lower than that of the control group,with statistically significant differences(P<0.05);and the observation group’s satisfaction with nursing care was higher than that of the control group,with statistically significant differences(P<0.05).Conclusion:Optimization of emergency nursing process intervention in the resuscitation of acute chest pain patients can greatly shorten the rescue time and improve the success rate of resuscitation,with higher patient satisfaction.

数字化DR胸部正斜位摄片在急诊肋骨骨折患者中的诊断价值

目的:探讨与分析数字化DR胸部正斜位摄片在急诊肋骨骨折患者中的诊断价值.方法:选择2021年8月—2023年5月我院收治的192例急诊肋骨骨折患者为研究对象,所有患者都给予传统X线与数字化DR胸部正斜位摄片检查,同时所有患者都给予手术检查,判断诊断价值.结果:在192例患者中,数字化DR胸部正斜位摄片检查的图像优良率为97.40%,高于传统X线的84.90%,差异有统计学意义(P<0.05).手术确诊为肋骨骨折142例(骨折组),其中隐匿性骨折32例、多发性骨折68例、单发性骨折42例.传统X线判断为肋骨骨折126例,其中隐匿性骨折26例、多发性骨折64例、单发性骨折36例.数字化DR胸部正斜位摄片判断为肋骨骨折141例,其中隐匿性骨折31例、多发性骨折68例、单发性骨折42例.数字化DR胸部正斜位摄片对隐匿性骨折、多发性骨折、单发性骨折的检出率为96.88%、100.00%、100.00%,传统X线为81.25%、94.12%、85.71%,组间比较差异有统计学意义(P<0.05).传统X线与数字化DR胸部正斜位摄片诊断肋骨骨折的灵敏度为87.32%、99.30%,特异性为96.00%、100.00%,数字化DR胸部正斜位摄片诊断肋骨骨折的灵敏度高于传统X线,组间差异有统计学意义(P<0.05).结论:数字化DR胸部正斜位摄片在急诊肋骨骨折患者中的应用具有很高的图像优良率,对不同类型的骨折都有很高的检出率,还可提高诊断的总体灵敏度.

A modified HEART risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome

ObjectiveTo validate a modified HEART [History, Electrocardiograph （ECG）, Age, Risk factors and Troponin] risk score in chest pain patients with suspected non-ST-segment elevation acute coronary syndrome （NSTE-ACS） in the emergency department （ED）.Methods This retrospective cohort study used a prospectively acquired database and chest pain patients admitted to the emergency department with suspected NSTE-ACS were enrolled. Data recorded on arrival at the ED were used. The serum sample of high-sensitivity cardiac Troponin I other than conventional cardiac Troponin I used in the HEART risk score was tested. The modified HEART risk score was calculated. The end point was the occurrence of major adverse cardiac events （MACE） defined as a composite of acute myocardial infarction （AMI）, percu-taneous intervention （PCI）, coronary artery bypass graft （CABG）, or all-cause death, within three months after initial presentation.Results A total of 1,300 patients were enrolled. A total of 606 patients （46.6%） had a MACE within three months： 205 patients （15.8%） were diag-nosed with AMI, 465 patients （35.8%） underwent PCI, and 119 patients （9.2%） underwent CABG. There were 10 （0.8%） deaths. A progres-sive, significant pattern of increasing event rate was observed as the score increased （P ＆lt; 0.001 byχ2 for trend）. The area under the receiver operating characteristic curve was 0.84. All patients were classified into three groups： low risk （score 0-2）, intermediate risk （score 3-4）, and high risk （score 5-10）. Event rates were 1.1%, 18.5%, and 67.0%, respectively （P ＆lt; 0.001）.ConclusionsThe modified HEART risk score was validated in chest pain patients with suspected NSTE-ACS and may complement MACE risk assessment and patients triage in the ED. A prospective study of the score is warranted.

Diagnostic Value of the Thoracic Ultrasonography Compared to Conventional Chest X-Rays in Pneumonia for Children between 0 to 15 Years: Case Study in Two Hospitals in Yaoundé

Introduction: The diagnosis of pneumonia is usually made based on clinical manifestations and chest X-ray. The use of ultrasound in detecting pulmonary diseases in general, and especially consolidation syndrome has been demonstrated. The objective of this study was to determine the accuracy of thoracic ultrasound compared to chest X-ray in the diagnosis of infectious pneumonia in children. Methods: Children between 0 to 15 years were included in our study. The lung ultrasound results obtained were compared with those of the chest X-ray used as the reference. Our data were introduced into the EpiInfo 3.5.4 software and analyzed with the EpiInfo 3.5.4 and IBMSPSS Statistics version 20.0 softwares. Microsoft Office Excel 2016 was used to produce Charts. Continuous quantitative variables were presented. Cohen’s Kappa concordance test was applied with confidence interval of 95%. Results: 52 children were enrolled in the study. In imaging, the dominant sign was consolidation syndrome (75.0%) of cases by chest radiography, and in 78.8% of cases by lung ultrasound (p Conclusion: Our study demonstrated that lung echography is a non-ionizing and reliable tool in the diagnosis of childhood’s pneumonia.

Acute Chest Syndrome in Children with Sickle Cell Anaemia: An Audit in Port Harcourt, Nigeria

Acute chest syndrome (ACS) is a leading cause of death from sickle cell disease worldwide accounting for about 25% of all deaths. The aim of this study was to determine the prevalence, clinical features and outcome in Port Harcourt, Nigeria. Materials and Methods: A retrospective cohort study during a five year period. Records of all patients with sickle cell anaemia (SCA) admitted into the Wards were examined. Those enrolled for the study satisfied two criteria: 1) lower respiratory tract symptoms and 2) new pulmonary infiltrates on the chest radiograph. Sociodemographics, genotype, clinical and laboratory features, treatment given and outcome were obtained. Data were analysed by descriptive statistics. Variables were compared by students’ t-test. P value ≤ 0.05 was regarded as significant. Results: A total of 345 children with sickle cell anaemia were admitted during the 5 year period. Twelve of them had acute chest syndrome (3.5%). Majority 7 (58.3%) of them were under 5 years. There were more males 8 (66.7%) than female 4 (33.3%). The most common clinical features were fever 12 (100%), cough 10 (83.3%), chest pain 5 (41.7%), pulmonary consolidation 12 (100%), and respiratory distress 12 (100%). The admitting diagnosis were bronchopneumonia 6 (50%), severe malaria 3 (25%) and vaso-occlusive crises 3 (25%). There were very high levels of leukocyte. Received ceftriaxone or ampicillin + gentamicin ± oral erythromycin), paracetamol 12 (100%), ibuprofen 8 (66.7%), tramadol 3 (25.0%), pentazocine 8 (66.7%) and blood transfusion 9 (75%). The average length of stay was 7 days (range 4 - 14 days). One patient died (8.3%). Conclusion: ACS is not uncommon in children with SCA in Port Harcourt. Education of parents on the need to recognize early symptoms of the disease is essential. Clinicians must be trained to correctly diagnose and manage it promptly and efficiently to avoid its related disastrous consequences.

Primary Chondrosarcoma of the Chest Wall— A Case Report

A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass. Initial work up of the finding included a CT scan of the chest which revealed a non-calcified, solid right anterior chest wall mass with invasion of the anterior fifth rib and intercostal space. The patient was presented at multidisciplinary conference with the patient’s primary physician, a medical oncologist, radiologist, pathologist and oncologic surgeon in attendance. The decision was to perform surgical resection of the mass to treat this primary mesenchymal malignancy. The anterior aspect of the fifth rib and intercostal muscles were resected with negative margins. Pathology confirmed the mass to be a low-grade chondrosarcoma. Due to the low-grade nature, low metastatic potential and negative margins of the tumor, the decision was made not to pursue adjuvant chemotherapy or radiation therapy. The patient made full recovery.

Residual Feature Attentional Fusion Network for Lightweight Chest CT Image Super-Resolution

The diagnosis of COVID-19 requires chest computed tomography(CT).High-resolution CT images can provide more diagnostic information to help doctors better diagnose the disease,so it is of clinical importance to study super-resolution(SR)algorithms applied to CT images to improve the reso-lution of CT images.However,most of the existing SR algorithms are studied based on natural images,which are not suitable for medical images;and most of these algorithms improve the reconstruction quality by increasing the network depth,which is not suitable for machines with limited resources.To alleviate these issues,we propose a residual feature attentional fusion network for lightweight chest CT image super-resolution(RFAFN).Specifically,we design a contextual feature extraction block(CFEB)that can extract CT image features more efficiently and accurately than ordinary residual blocks.In addition,we propose a feature-weighted cascading strategy(FWCS)based on attentional feature fusion blocks(AFFB)to utilize the high-frequency detail information extracted by CFEB as much as possible via selectively fusing adjacent level feature information.Finally,we suggest a global hierarchical feature fusion strategy(GHFFS),which can utilize the hierarchical features more effectively than dense concatenation by progressively aggregating the feature information at various levels.Numerous experiments show that our method performs better than most of the state-of-the-art(SOTA)methods on the COVID-19 chest CT dataset.In detail,the peak signal-to-noise ratio(PSNR)is 0.11 dB and 0.47 dB higher on CTtest1 and CTtest2 at×3 SR compared to the suboptimal method,but the number of parameters and multi-adds are reduced by 22K and 0.43G,respectively.Our method can better recover chest CT image quality with fewer computational resources and effectively assist in COVID-19.