Background There is lack of guidance on specific CT protocols for imaging patients with coronavirus disease 2019 (COVID-19) pneumonia. Purpose To assess international variations in CT utilization, protocols, and radiation doses in patients with COVID-19 pneumonia. Materials and Methods In this retrospective data collection study, the International Atomic Energy Agency (IAEA) coordinated a survey between May and July 2020 regarding CT utilization, protocols, and radiation doses from 62 healthcare sites in 34 countries across five continents for CT exams performed in COVID-19 pneumonia. The questionnaire obtained information on local prevalence, method of diagnosis, most frequent imaging, indications for CT, and specific policies on use of CT in COVID-19 pneumonia. Collected data included general information (patient age, weight, clinical indication), CT equipment (CT make and model, year of installation, number of detector rows), scan protocols (body region, scan phases, tube current and potential), and radiation dose descriptors (CT dose index (CTDI vol ) and dose length product (DLP)). Descriptive statistics and generalized estimating equations were performed. Results Data from 782 patients (median age (interquartile range) of 59(15) years) from 54 healthcare sites in 28 countries were evaluated. Less than one-half of the healthcare sites used CT for initial diagnosis of COVID-19 pneumonia and three-fourth used CT for assessing disease severity. CTDI vol varied based on CT vendors (7-11mGy, p<0.001), number of detector-rows (8-9mGy, p<0.001), year of CT installation (7-10mGy, p=0.006), and reconstruction techniques (7-10mGy, p=0.03). Multiphase chest CT exams performed in 20% of sites (11 of 54) were associated with higher DLP compared with single-phase chest CT exams performed in 80% (43 of 54 sites) (p=0.008). Conclusion CT use, scan protocols, and radiation doses in patients with COVID-19 pneumonia showed wide variation across healthcare sites within the same and different countries. Many patients were scanned multiple times and/or with multiphase CT scan protocols. See also the editorial by Lee .

The reverse flow island sural flap is presented as an alternative to flaps currently used for reconstruction of small and medium substance losses in the distal third of the leg, ankle, and heel. This is a random type of flap, based on the reverse flow of the superficial sural artery, which mainly depends on the anatomy of the perforators of the peroneal artery system. The anatomic structures that constitute the pedicle are the superficial and deep fascias, the sural nerve, the short saphenous vein, and the superficial sural artery. The skin island and the subcutaneous cellular tissue complement the flap proper. This skin island was demarcated at any point of the median or distal thirds of the leg, having the short saphenous vein and the sural nerve on its central axis. The distal dissection limit of the pedicle is located 5 centimeters above the lateral malleolus. This limit is established so as to ensure the integrity of the perforators from the principal arteries of the leg, mainly the peroneal artery, responsible for the reverse flow nourishing the flap. These perforators will affect anastomoses with the superficial sural artery in charge of irrigating the structures compounding the flap.A total of 71 patients were operated on with this technique, some of them with basic pathologic abnormalities limiting the distal blood flow, such as diabetes mellitus, and some others having proven vascular insufficiency or displaying unstable areas attributable to problems such as pseudarthrosis and osteomyelitis, which needed to be covered. Fifteen flaps (21.1 percent) suffered partial necrosis, which did not compromise the final result, and another three (4.2 percent) showed total loss. The flap in question has great mobility and versatility, allowing the treatment of specific areas of the lower limb, without sacrificing important arteries or mobilizing structures that might bring about functional deficits.

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In spite of the recent advances in the experimental detection of x-ray spectra, theoretical or semi-empirical approaches for determining realistic x-ray spectra in the range of diagnostic energies are important tools for planning experiments, estimating radiation doses in patients, and formulating radiation shielding models. The TBC model is one of the most useful approaches since it allows for straightforward computer implementation, and it is able to accurately reproduce the spectra generated by tungsten target x-ray tubes. However, as originally presented, the TBC model fails in situations where the determination of x-ray spectra produced by an arbitrary waveform or the calculation of realistic values of air kerma for a specific x-ray system is desired. In the present work, the authors revisited the assumptions used in the original paper published by . They proposed a complementary formulation for taking into account the waveform and the representation of the calculated spectra in a dosimetric quantity. The performance of the proposed model was evaluated by comparing values of air kerma and first and second half value layers from calculated and measured spectra by using different voltages and filtrations. For the output, the difference between experimental and calculated data was better then 5.2%. First and second half value layers presented differences of 23.8% and 25.5% in the worst case. The performance of the model in accurately calculating these data was better for lower voltage values. Comparisons were also performed with spectral data measured using a CZT detector. Another test was performed by the evaluation of the model when considering a waveform distinct of a constant potential. In all cases the model results can be considered as a good representation of the measured data. The results from the modifications to the TBC model introduced in the present work reinforce the value of the TBC model for application of quantitative evaluations in radiation physics.

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Wave energy is a renewable and non-polluting source and its use is being studied in different countries. The paper presents an overview on the harnessing of energy from waves and the activities associated with setting up a plant for extracting energy from waves in Port of Pecem, on the coast of Ceara State, Brazil. The technology employed is based on storing water under pressure in a hyperbaric chamber, from which a controlled jet of water drives a standard turbine. The wave resource at the proposed location is presented in terms of statistics data obtained from previous monitoring. The device components are described and small scale model tested under regular waves representatives of the installation region. Based on the experimental results values of prescribed pressures are identified in order to optimize the power generation.

Purpose:To assess the viability of McFarlane skin flaps in rats with administration of sildenafil. Methods: Twenty Wistar rats were distributed into two groups: Control (dorsal skin flap, subdermal application of saline solution at 0.9%) and Study (dorsal skin flap, subdermal application of sildenafil). Seven days after the surgery, flaps were photographed and graphically rendered. Then, they were analyzed with AutoCAD software. Three biopsies (proximal, medial and distal) of each flap were collected for histological analysis. Results: Macroscopic analysis showed that animals of the study group had greater necrotic areas (p=0.003) in the dorsal skin flaps. Additionally, histological analysis of the distal third of these flaps showed a tendency to less granulated tissue formation in animals treated with sildenafil. Conclusion: Sildenafil subdermally was associated with lower viability of the random skin flap in rats. Key words: Wound Healing. Surgical Flaps. Cyclic GMP. Nitric Oxide. Rats. RESUMOObjetivo: Avaliar a viabilidade de retalhos cutâneos de ratos à McFarlane após a administração de sildenafil. Métodos: Vinte ratos Wistar foram distribuídos em dois grupos: Controle (confecção do retalho cutâneo dorsal, aplicação subdérmica de solução salina a 0,9%) e Estudo (confecção do retalho cutâneo dorsal, aplicação subdérmica de sildenafil). Sete dias após a operação, os retalhos foram fotografados e representados graficamente, para serem analisados com o programa AutoCad. Três biópsias (cranial, média e caudal) foram coletadas de cada retalho, para análise histológica. Resultados: A análise macroscópica evidenciou que os animais do grupo Estudo apresentaram maiores áreas de necrose (p=0,003) nos retalhos cutâneos dorsais. Além disso, a análise histológica dos terços distais dos retalhos mostrou uma tendência à formação de menos tecido de granulação nos animais que receberam o sildenafil. Conclusão: O sildenafil subdérmico esteve associado com uma pior viabilidade tecidual dos retalhos cutâneos dorsais de ratos. Descritores: Cicatrização de Feridas. Retalhos Cirúrgicos. GMP Cíclico. Óxido Nítrico. Ratos.