Anatomical Areas Research Articles

Diode laser light and sclerotherapy in the treatment of venous malformations in the maxillofacial region

Objective: to compare outcomes after treatment of venous malformations (VM) in the maxillofacial region using diode laser light and sclerotherapy with 3 % Aethoxysclerol foam.Materials and methods. 40 patients with venous malformations of the maxillofacial region were enrolled in the study. Patients were divided into two equal groups of 20 individuals each: in Group 1, patients were treated with diode laser light; in Group 2, patients had sclerotherapy with 3 % Aethoxysclerol foam. For laser therapy, Lachta-Milon diode laser (Russia) with an optical light guide having a flat end of 0.4–0.6 mm, wavelength 980 nm, pulse-periodic mode with interval 0.1–0.25 seconds at power 3.5–5.5 was used. In Group 2 VM sclerotherapy by L. Tessari’s technique (2000) in the maxillofacial region consisted of injection of microfoam made of 3 % Aethoxysclerol solution into the malformation lumen.Results. In all patients, management was successful without intraoperative or postoperative bleeding. The performed study revealed that sclerotherapy with Aethoxysclerol foam is most effective for treating large and medium-sized malformations resulting in significant reduction in formation size. To treat malformations located in difficult anatomical areas, such as peri-orbital or hard and soft palate, diode laser with wavelength 980 nm and power ranging from 3.5 to 5.5 W turned to be the most effective.Conclusion. Endovascular laser obliteration is an effective and safe technique for treating venous malformations in the maxillofacial region. It is also a method of choice for malformations located in the peri-orbital area.

Skin ultrasound for rheumatologists: Technical issues and challenges.

In several rheumatic diseases, the skin is involved and therefore it is an organ of interest which may be investigated by the rheumatologist. Ultrasound imaging has been proposed for assessing multiple skin conditions providing qualitative and quantitative information about different parameters in distinct skin layers. Our aim was to describe with a pictorial essay the main challenges that the ultrasound imaging may encounter when investigating the healthy skin in different body areas. Fourteen healthy subjects were submitted to skin ultrasound. The body areas that were investigated were decided following the 17 modified Rodnan skin score anatomical areas used in systemic sclerosis. Skin ultrasound was performed with a GE Logiq 10 with two probes (20 and 24 MHz). For an optimal quantification of the skin layers, the dermis interfaces either with the epidermis and hypodermis were investigated. The results of the ultrasound analysis are described and summarized in a pictorial essay which shows that some main factors may significantly influence the quality of the images of the skin layers. Specifically, age, scanning position, probe frequency, and the optimal positioning of some anatomical areas, in particular the hands and digits, emerged as factors that may have a relevance in influencing the quality of the imaging of the skin layers. Moreover, some technical suggestions are proposed to help optimizing and standardizing the performance of skin ultrasound assessment in healthy population. The pictorial essay we performed shows that the performance of skin ultrasound in healthy subjects still presents several issues that need to be addressed. The definition of the interface in different body areas is the first step which should be standardized before any measurement of the thickness of the skin layers is performed in rheumatic diseases.

The Application of Mohs Micrographic Surgery in the Treatment of Acral Basal Cell Carcinoma: A Report of Two Cases

Background/Objectives: Mohs micrographic surgery (MMS) is a precise skin surgery technique that is particularly useful in the treatment of high-risk skin cancers and tumors located in challenging anatomical areas. Methods: we report two cases of basal cell carcinoma located in the acral areas effectively treated using MMS. Results: the presented cases demonstrate that MMS is an excellent surgical modality providing outstanding medical, cosmetic, and functional outcomes. Moreover, this study provides another dermoscopic presentation of acral basal cell carcinoma in a patient without the diagnosis of hereditary genetic syndromes associated with an increased risk of skin cancer. Conclusions: basal cell carcinoma located on hands and feet, albeit rare, should be included in the differential diagnosis of amelanotic skin tumors in acral areas.

Effects of Neoadjuvant Radiation and Recipient Vessel Characteristics on Microvascular Complication Rates in Reconstruction of Lower Extremity Soft-Tissue Sarcoma Defects.

The treatment approach for soft-tissue sarcomas (STS) of the lower extremity has shifted toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS). The resulting defects often require reconstruction with free tissue transfer for adequate outcomes. Data has demonstrated a potential increased risk of microvascular complications for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic areas of the lower extremity have a high proportion of unnamed perforators that are available as recipient vessels, increasing the technical difficulty. We aimed to determine if the characteristics of recipient vessels that were used for reconstruction of STS defects influenced rates of microvascular complications in our patients. A retrospective chart review of all patients who underwent reconstruction of lower extremity STS defects with free tissue transfer from 2009-2020 was conducted. Data regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications was compared across groups. A total of 204 free flaps were included. The overall microvascular complication rate was 13.7% (28 cases). Most microvascular complications were detected postoperatively (82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis (20 cases, 71.4%). While there was a trend toward increased microvascular complications with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach statistical significance (OR = 1.98, p = 0.52). The use of perforating branches as recipient vessels did not confer increased risk of microvascular complications (OR = 0.87, p = 0.75). Reconstruction of irradiated lower extremity STS defects represents a particularly challenging issue. This analysis demonstrates that free tissue transfer can be safely performed using irradiated vessels without significant increased risk of microvascular complications. Furthermore, unnamed perforating branches can also be successfully used for reconstruction in anatomically challenging areas of the lower extremity.

Unveiling the Burden: A Six-Year Retrospective Analysis of Pressure Ulcer Epidemiology in a ICU

Objective: This study describes the epidemiological changes in pressure ulcers (PUs) in a Portuguese intensive care unit (ICU) from January 2017 to June 2023, characterizes critically ill patients with PUs, identifies specific risk factors, and assesses the effectiveness of implemented preventive measures. Materials and Methods: A retrospective observational cohort study was conducted, analyzing records of ICU patients with PUs during the specified period. Data were extracted from the institution’s Global Risk Management application and the ICU’s electronic PU registry. The study included patients with ICU stays longer than 24 h and excluded those with ineligible clinical records or incomplete characterization data. Results: Among 3816 evaluated patients, 257 developed a total of 345 PUs, averaging 1.4 PUs per patient. The average PU prevalence rate was 6.81%, with the highest prevalence in 2020 (11.0%) and the lowest in 2022 (3.48%). The average incidence rate was 3.76%, peaking at 5.71% in 2020 and declining to 2.54% in 2023. The sacrum and heels were the most commonly affected areas, with Category 2 PUs being the most frequent. Key intrinsic risk factors included systemic diseases and sensory deficits, with pressure identified as a significant extrinsic factor. Preventive measures focused on risk assessment and pressure control. Conclusions: The study reveals a PU prevalence of 6.81% and an average incidence of 3.76%, underscoring the need for enhanced preventive strategies, especially in anatomical areas like the sacrum and heels. It emphasizes the importance of personalized assessments, continuous education for nursing staff, and a multidisciplinary approach to improve patient outcomes and care quality in the ICU.

Effects of Postural Conditions During Magnetic Resonance Imaging on Thigh Muscle Size.

Magnetic resonance imaging (MRI) is the gold standard for measuring muscle size. However, postural conditions for thigh musculature have not been standardized across studies, with some employing supine or prone positions and the thigh either placed on the examination table or suspended to avoid contact. In either case, the thigh is compressed or sagged by gravity, potentially affecting muscle size. This study aimed to examine the effects of postural conditions on thigh muscle size. Twenty Olympic-style weightlifters and 20 untrained controls (10 men and 10 women in each group) underwent 3-Tesla MRI in the supine and prone positions, with the thigh in compressed and suspended conditions to determine the maximal anatomical cross-sectional area (ACSAmax) and muscle volume of 15 thigh muscle groups/individual muscles. Postural conditions changed the ACSAmax of the quadriceps (range of postural-related changes: 1.0%-7.9%), hamstrings (0.8%-19.1%), and adductors (2.4%-19.2%). Regardless of measurement position, the total volume of thigh muscles decreased under compressed conditions (0.6%-3.8%). Quadriceps and adductors decreased in muscle volume under compressed conditions (0.9%-4.0% and 0.8%-6.6%), while hamstrings increased (1.4%-9.3%). Male weightlifters, who possessed the largest thigh muscle volume, showed greater postural-related changes in the muscle volume of quadriceps, hamstrings, and adductors than the other subgroups. Therefore, postural conditions during MRI substantially change thigh muscle size, and the magnitude of the change depends on muscle size. Our results provide invivo evidence of the compressive behavior of thigh muscles and a new technical perspective for assessing thigh muscle size.

Insights from the assessment of anatomic valve orifice area after transcatheter aortic valve implantation using transesophageal echocardiography

Abstract Background Although transthoracic echocardiography (TTE) is the gold standard for evaluating effective valve orifice area (EOA) after transcatheter aortic valve implantation (TAVI), the continuous formula is inherently different from anatomic valve orifice area because it implies a minimum jet width through the aortic valve. It has also been reported that the doppler method with TTE overestimates the mean gradient due to pressure recovery and is even less accurate after TAVI. On the other hand, recent technological developments have improved image resolution, making valve morphology possible using transesophageal echocardiography (TEE). Purpose The purpose of this study was to compare transcatheter aortic valve (TAV) area using TEE and TTE to evaluate whether there is a significant difference in each area and to explore factors that influence the difference in area. Methods Patients who underwent TEE-guided TAVI and SAPIEN3 implantation between February 2019 and March 2023 and had aortic valve evaluation with TTE before discharge were included. We retrospectively evaluated the TAV after TAVI using TTE and TEE. Aortic valve orifice area was calculated by two methods: EOA index (doppler-area: DA) calculated by the continuous doppler formula using TTE and t-AVA index (trace-area: TA) derived by the trace method using TEE. TAV tracing was performed in early systole on the short-axis image of the aortic valve. The TAV tracing was performed by physicians specializing in echocardiography, and multiple physicians were blinded to the same case to eliminate inter-rater error. The percentage change between the two groups was calculated from the difference in area by TTE and TEE, and the 75th percentile of the percentage change was defined as the cutoff value for the group with the large difference in TAV area. Results Patients whose TAV was difficult to observe by TEE were excluded, and 464 patients were finally analyzed. TA was significantly larger than DA (1.56±0.28 cm2/m2 vs 1.18±0.26 cm2, p<0.001) and similar for all TAV sizes. However, even though TA expanded as valve size increased, the largest area of DA was observed in the 26mm TAV, and the 29mm TAV was comparable to the 26mm TAV. Only a weak correlation was shown between DA and TA (correlation coefficient: 0.356). There were 43 cases of moderate prosthetic valve-patient mismatch (PPM: EOA-i<0.85cm) in DA, but only 1 case in TA. In multivariate logistic regression analysis, women (OR 2.25, 95% CI 1.17-4.34, p < 0.015) and LV mass index (OR 1.01, 95% CI 1.00-1.02, p < 0.041) were independent factors for the large difference in TAV area. Conclusion After TAVI, the TAV area with TEE was larger than the EOA-i with TTE, and PPM was rarely seen. Depending on valve size, patient background, and cardiac morphology, there are cases of overestimation of postoperative AS in TTE, which may need to be carefully evaluated in women and patients with larger LV mass index.

In-silico insights into personalised therapy selection of anti-arrhythmic drugs and ablation using patient-specific biatrial models for atrial fibrillation

Abstract Introduction Current treatment approaches for Atrial Fibrillation (AF) often lack personalisation, adopting a one-size-fits-all paradigm that disregards inter-patient diversity and its unique interplay with therapeutic responses. In-silico drug trials have demonstrated some value in the personalisation of care; however, their integration with patient-specific anatomical data and the synergistic effects of combined therapies remain unknown. Purpose To evaluate the patient-specific response to anti-arrhythmic drugs (AADs) and their efficacy both individually and in combination with pulmonary vein isolation (PVI) using personalised biatrial models created from imaging data. Methods Patient-specific biatrial models (n=70) were constructed from late gadolinium-enhanced MRI images by manual segmentation from the Atrial Segmentation Challenge (2018) dataset (Fig.1A). Models were pre-processed with landmark selection, regional assignment, and fibre allocation before simulations (Fig.1B). PVI was modelled as electrically inert rings around the pulmonary veins (Fig.1C) and AADs were administered via ionic modulation within CARPentry software (Fig.1D). Four commonly used AADs were evaluated: vernakalant, acute and chronic amiodarone, flecainide, and digoxin. Finite element simulations were performed with the addition of AADs, both individually and in combination with PVI, to evaluate their efficacy in terminating AF (Fig.2A). These simulations were post-processed to produce phase singularity (PS) density maps to evaluate changes in wavefront patterns and locations of re-entry and wavefront break-up (Fig.2B). Results The combination of digoxin with PVI and digoxin alone demonstrated the highest effectiveness in terminating AF, both achieving success in 68.4% of cases (95% CI: 67.5% to 89.3%, p≤0.0001). This efficacy significantly exceeded that of other AADs used either alone or in combination with PVI (15.8%-57.9%), whereas PVI alone demonstrated 0% efficacy (p≤0.05). The combined therapy exhibited a multi-faceted localisation pattern (Fig.2A), with AADs initially redistributing PSs to the pulmonary veins and left atrial appendage. This redistribution resulted in synergistic effects in terminating AF episodes in 52.6% more cases when combined with PVI (Fig.2B). Comparative analyses showed an inverse correlation between baseline PS density count and anatomical surface area with AF termination across all treatments, with significant correlations observed with vernakalant alone (rho=-0.55, p≤0.05) and combined with PVI (rho=-0.77, p≤0.05). Conclusions This study demonstrates the significance of personalised treatment selection in optimising patient outcomes. Combined therapeutic interventions have shown synergistic benefits in AF termination, surpassing individual therapies in this patient-specific model cohort. This shows the translational potential of using patient-specific stratification to inform treatment selection.Biatrial model generationAF therapeutic simulation and processing

Tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiography

Abstract Background The assessment of tricuspid valve (TV) and functional tricuspid regurgitation (FTR) in left side valvular disease is crucial in assessing the need for surgical intervention. Despite the declining incidence of rheumatic disease, it remains a a common cause of valvulopathy. According to current guidelines, TV surgery is recommended in presence of severe TR or non-severe with annulus dilatation assessed by two-dimensional echo (2DE). Objectives To assess tricuspid annulus (TA) 3D dimensions in relation to the severity of tricuspid regurgitation (TR) and to identify new parameters associated with the presence of severe TR in this scenario. Methods Fifty patients (Age: 69±9, 82% women) with rheumatic heart disease without previous valve replacement and functional tricuspid regurgitation (FTR) were prospectively included. Two-dimensional echocardiography (2DE) and three-dimensional transthoracic full-volume datasets of the tricuspid valve (TV) were acquired. Two orthogonal planes corresponding to the anatomical antero-posterior (APD), septum-lateral (SLD), long intercommisural (LID), and area (A3D) of the TA were analyzed by 3D transesophageal echocardiography (3DTE) (Figure 1), in addition to 2D diameter. TR was graded into two groups: severe (n=14) or non-severe (n=26). The area under the curve (AUC), sensitivity (Se), and specificity (Sp) to identify the presence of severe FTR were calculated. Results All parameters differed significantly (p<0.05) between the two groups (2D: 18.6±1.9 vs. 23.3±2.0 mm/m2; APD 17.0±3.3 vs. 21.5±3.0 mm/m2; SLD: 18.9±2.0 vs. 22.5±2.0 mm/m2; LID: 20.9±2.6 vs. 26.1±3.5 mm/m2; A: 5.6±1.3 vs. 7.6±1.4 cm2/m2). 2D diameter (Cut-off point: 20.6 mm/m2, AUC: 0.850, Se: 86%, Sp: 72%), A3D (Cut-off point: 6.5 cm2/m2, AUC: 0.835, Se: 86%, Sp: 78%), and LID (Cut-off point: 23.3 mm/m2, AUC: 0.833, Se: 78.6%, Sp: 77.8%) were the parameters with the best performance for severe FTR detection. Conclusions New 3D-derived parameters provide relevant information in the assessment of TA and offer good diagnostic performance for identifying severe FTR in this subgroup of patients.2D/3D Echo TA measurements

Lead-related tricuspid regurgitation: an important phenotype seen through the lens of computed tomography

Abstract Background The imaging diagnostic approach of patients with cardiac implantable electronic devices (CIED)-related tricuspid regurgitation (TR) is undefined. Functional cardiac computed tomography angiography (4D-CTA) provides a complementary role to echocardiography in the evaluation of tricuspid valve (TV) apparatus and right ventricle (RV) remodeling, but the capability to assess lead-leaflet interaction is unknown. Purpose To evaluate the role of 4D-CTA anatomical and morphological diagnostic assessment in a cohort of patients with severe TR and CIED vs those without. Methods Clinical, echocardiographic and CTA data were collected from two quaternary centers for patients with severe TR and a CIED evaluated between January 2017 to October 2023. Functional and morphological CTA information assessed lead-leaflet relationship to divide patients in those with lead-related TR, those with no lead-TR causal relationship, and those with severe isolated TR but without CIED. Primary end-point was the occurrence of all-cause death. Results A total of 143 patients were identified, roughly dividng the cohort into thirds. Baseline characteristics and imaging characteristics of these 3 groups revealed important differences suggesting a more advanced patophysiology phenotype for those with lead-related TR, particularly presenting both the largest 4D-CTA-derived TV maximum coaptation gap and anatomical regurgitant orifice area (see Figure 1). At regression analysis, time from CIED implantation (OR 1.01, CI 1.00-1.09, p=0.031) and >3 leaflets valve morphology (OR 2.90, CI 1.01-8.32, p=0.040) were independently associated with lead-related TR. After a median follow-up of 18 months, the primary end-point occurred in 36 patients (25%) and was more common among patients with lead-related TR (p-value overall= 0.007, see Figure 2). While no differences in the rate of TV intervention were found, excessive mortality persisted for lead-related TR group even after adjustement for age and gender (HR 6.49, CI 1.72-14.47, p=0.006). Conclusion Systematic 4D-CTA in patients with severe TR and presence of a CIED, identified a large number of patients with lead-related TR with important functional and anatomical implications including greater TR severity and > 3 leaflets. These findings appear to have prognostic relevance that might have decision-making implications for patient management.Figure 1Figure 2

Traffic injury as a medical and sanitary consequence of an emergency of man-made nature in Ukraine. Report four: analysis and characterization of the array of victims depending on the volume of damage

Background. Road traffic injuries always remain a significant medical and social problem for all mankind, and in Ukraine even during the full-scale invasion of the Russian Federation. The purpose of the study: to determine the clinical and nosological characteristics of victims of road traffic accidents according to the extent of damage in road users. Materials and methods. This article is a continuation of the cycle of publications that were previously published in the journal “Emergency Medicine”, that is, it is a component of a comprehensive study. The actual material of the study were 1,696 cases of road traffic injuries formed by the method of irreversible randomization. The resulting array was formed from victims who were injured in the conditions of a metropolis, a regional city, and a rural area. Results. The conducted analysis found that in the total body of the study, 78.25 % of victims of traffic accidents had damage of up to three anatomical and functional areas (AFAs). Greater damage (4–6 AFAs) occurs in 21.75 % of patients. In the array of those who survived, 79.71 % had damage to 4–6 AFAs, in the array of the dead — 34.68 %. The highest mortality rate is 27.78 % when six AFAs are damaged, and the lowest — with one injured AFA (2.37 %). It was also found that among the “drivers” traffic participants, victims with damage to two (31.56 %) and three AFAs (25.58 %) have the highest specific weight. Among the “passengers” traffic participants, victims with damage to two (33.73 %) and one AFA (26.56 %) have the highest specific weight. Among the “pedestrians” traffic participants, victims with damage to two (29.74 %) and three AFAs (25.15 %) have the highest percentage. Conclusions. 1. It was found that a large amount of damage in general causes a greater threat to the life of a victim of traffic accidents, but the trend is non-linear, that is, the survival is affected by other risk-creating factors. 2. All traffic participants in general have a relatively smaller injury (damage to 1–3 anatomical and functional areas). At the same time, the highest specific weight of such trauma is observed among drivers, and the lowest one among pedestrians. 3. There was a significant influence of the sign of participation in traffic and the extent of damage on the outcome of traumatic process in victims of traffic accidents.

Tooth accidental displacement in extraction manoeuvres: a series of two cases

Tooth displacement in bordering anatomical areas is a rare and challenging complication that might occur in the attempt at tooth extraction. Displacement may be attributed to multiple factors, including inadequate clinical evaluation before surgery, an inappropriate extraction plan, the application of excessive force, the use of an incorrect surgical technique, or a lack of experience on the part of the operator. Additionally, anatomical characteristics of the patient must be considered. In this report, we present two examples of tooth displacement and describe the surgical approach adopted to achieve tooth removal.

Resolving the Controversy Surrounding the Function of the Corrugator Supercilii Muscle.

The corrugator supercilii muscle (CSM) has traditionally been recognized as a primary depressor of the eyebrows, playing a key role in expressing negative emotions and contributing to the formation of glabellar lines. However, recent studies indicate that the CSM may exhibit movements contrary to those previously documented, suggesting a more complex functional role. This research re-evaluates the anatomical and functional roles of the CSM and discusses their implications for botulinum toxin treatments. A prospective, intrapersonal comparative, and split-face study was conducted over a five-year period, from January 6, 2019, to January 6, 2024, involving 298 patients who underwent botulinum toxin injections. The study divided participants into seven groups, each targeting specific anatomical areas of the CSM and associated muscles. Injection techniques were varied to assess their impact on brow dynamics, with outcomes measured by changes in eyebrow position and expression lines. The study demonstrated that targeting specific portions of the CSM and depressor supercilii muscle (DSM) leads to distinct outcomes in brow elevation and the reduction of expression lines. However, this approach was also frequently associated with the development of omega-shaped wrinkles. Split-face evaluations further validated that the modified injection techniques achieved superior eyebrow elevation compared to traditional methods. This study challenges the traditional view of the CSM as primarily a brow depressor, highlighting its role in medial brow elevation. These findings underscore the need for a nuanced approach in esthetic medicine, particularly in botulinum toxin injections, to achieve balanced and natural facial expressions. Understanding the full range of CSM functions is crucial for optimizing esthetic outcomes and enhancing patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Temporary osteosynthesis of the tibial bones in repair of multiple and combined injuries

Background The incidence of injury worldwide remains high, with a global estimate of 6763 cases per 00,000 population (95 % confidence interval 6412–7147). Trauma to the limbs is a common injury to an individual anatomical area during multiple or combined trauma that accounts for 40 % to 85.2 % of cases. Assessment of the effectiveness of different fixation options and development of treatment algorithms are essential for patients with tibial fractures and multiple (combined) injuries.The objective was to determine how often temporary tibia fixation is applied for patients with multiple and combined injuries.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), CyberLeninka between 2008 and 2023 using search words and phrases: tibial injuries, osteosynthesis of lower limbs, multiple injuries, combined injuries, temporary osteosynthesis of the tibial bones.Results and discussion A differentiated approach to the repair of bone fractures resulting from multiple and combined injuries is mostly common with the choice of fixation technique depending on the severity of injury and the severity of the patient’s condition. The definitive internal bone fixation is normally used for stable patients, “damage control” strategy is secured for borderline and severe cases using primary temporary external fixation followed by staged surgical intervention. There is no generally accepted strategy for the use of early mobilization of long bone fractures as a component of anti-shock measures in a polytrauma patient.Conclusion Certain issues remain unresolved, including the use of osteosynthesis for tibial fractures in some cohorts of patients, the optimal time of transition to definitive internal fixation, the possibility of using extrafocal osteosynthesis as a definitive treatment, the optimal configuration and assemblies to be employed. The lack of high-quality randomized controlled trials in this field is an important limitation.

Early experience with an artificial intelligence-based module for brain metastasis detection and segmentation.

- Accurate detection, segmentation, and volumetric analysis of brain lesions are essential in neuro-oncology. Artificial intelligence (AI)-based models have improved the efficiency of these processes. This study evaluated an AI-based module for detecting and segmenting brain metastases, comparing it with manual detection and segmentation. - MRIs from 51 patients treated with Gamma Knife radiosurgery for brain metastases were analyzed. Manual lesion identification and contouring on Leksell Gamma Plan at the time of treatment served as the gold standard. The same MRIs were processed through an AI-based module (Brainlab Smart Brush), and lesion detection and volumes were compared. Discrepancies were analyzed to identify possible sources of error. - Among 51 patients, 359 brain metastases were identified. The AI module achieved a sensitivity of 79.2% and a positive predictive value of 95.6%, compared to a 93.3% sensitivity for manual detection. However, for lesions > 0.1cc, the AI's sensitivity rose to 97.5%, surpassing manual detection at 93%. Volumetric agreement between AI and manual segmentations was high (Spearman's ρ = 0.997, p < 0.001). Most lesions missed by the AI (53.8%) were near anatomical structures that complicated detection. - The AI module demonstrated higher sensitivity than manual detection for metastases larger than 0.1cc, with robust volumetric accuracy. However, human expertise remains critical for detecting smaller lesions, especially near complex anatomical areas. AI offers significant potential to enhance neuro-oncology practice by improving the efficiency and accuracy of lesion management.

Dirt Score in Large White Yorkshire Piglets during Preweaning Period Reared on Cement Concrete Floor

An experiment was carried out on 24 Large White Yorkshire piglets of either sex at the pig unit of LFC of C.V.Sc., Rajendranagar, Hyderabad from birth to weaning. All experimental piglets were reared on normal conventional concrete flooring along with their mother till weaning (56 days). An evaluation of cleanliness (dirt scoring) was performed fortnightly during the experimental period. Pig cleanliness was assessed using a fivepoint scale on 4 anatomical areas: rear, back, and both flanks, and each area was given a score from 0 to 4. The observed fortnightly dirt score was 0.56 ± 0.03, 0.60 ± 0.02, 0.70 ± 0.02, and 0.97 ± 0.11 at first, second, third, and fourth fortnight respectively. There was a continuous increase in dirt score as the age advances. Statistical analysis revealed the mean dirt score at the fourth fortnight was significantly (P&lt;0.01) different from the first, second, third, and overall mean dirt score.

Destabilization of Pedicle Screws and Migration of Connecting Rod into the Posterior Cranial Fossa in a Patient After Posterior Spondylosynthesis with a Screw System

When performing osteosynthesis for spinal instability after traumatic injury, diagnostic difficulties arise due to the migration of metal structure components to distant “atypical” anatomical areas, which is associated with the risk of neurological deficit and life-threatening conditions. This article presents a casuistic case of migration of a metal structure component through an iatrogenic opening in the occipital bone into the posterior cranial fossa in a patient who had previously undergone instrumental correction for comminuted fractures of the cervical vertebrae. It should be noted that there are no data on “spontaneous” perforation of the occipital bone by metal osteosynthesis elements in the domestic literature.

Microsurgical Reconstruction with and without Microvascular Anastomosis of Oncological Defects of the Upper Limb.

The choice of the most adequate surgical technique for upper limb defects remains challenging. The aim of this article is to discuss the main microsurgical (pedicled or free) reconstructive options for the post-oncological reconstruction of different anatomical areas of the upper extremity. We reviewed different reconstructive methods reported in the literature needing microsurgical expertise and compared them to our clinical experience, in order to provide further guidance in the choice of different flaps for upper limb soft tissue reconstruction. Six clinical cases, one for each anatomical district, are presented as examples of possible solutions. We report the options available in the literature for post-oncologic upper limb reconstruction, dividing them by anatomical area and type of flap: local flaps, regional flaps, free flaps, and distant pedicled flaps. Our examples of the reconstruction of each anatomical area of the upper limb include one reverse ulnar pedicled perforator flap, one free Antero-Lateral Thigh (ALT) flow-through flap, one perforator-based lateral arm flap, two myocutaneous latissimus dorsi pedicled flaps, and one parascapular perforator-plus flap. In oncological cases, it is important to consider reconstructive options that provide stable tissue and allow for the early healing of the donor and recipient site if the patient needs to undergo adjuvant radiotherapy or chemotherapy. A wider range of flap options is essential when choosing the proper technique according to the patient's needs, surgeon's preference, and logistical possibilities. Perforator flaps combine the advantages of other flaps, but they require microsurgical expertise. Free flap reconstruction remains the gold standard to obtain a better overall and cosmetic outcome in complex and wide defects, where no suitable local pedicled flap option exists. The pedicled latissimus dorsi flap should still be included among the reconstructive options for its strong vascularization, size, and arc of transposition.

EVALUATING THE RELATIONSHIP BETWEEN RADIOTHERAPY CLINICAL TARGET VOLUME AND GAIT ACTIVITY IN HIGH GRADE GLIOMA

Abstract AIMS Walking speed or peak cadence serves as a potential indicator of overall health, particularly in older individuals, with documented predictive value for various health-related outcomes. The emergence of wearable technology for gait analysis has facilitated early disease detection and monitoring in conditions like Parkinson’s disease. This study aimed to explore the association between gait metrics and radiotherapy Clinical Target Volume (CTV) in participants with High-Grade Glioma (HGG) enrolled in the BrainWear study, which captures longitudinal physical activity data through wearable devices. METHOD 21 HGG participants provided accelerometer data before and after a course of radiotherapy. Using Spearman rank correlation analysis, we examined the relationship between CTV and gait features while considering the total radiotherapy dose and tumour location. Participant data was cut at the same time point of 14-days either side of the start or end of radiotherapy to ensure the data was aligned. RESULTS The analysis revealed a moderately negative correlation between CTV and peak cadence at the onset of radiotherapy. At the end of radiotherapy and in the two weeks following completion, both peak cadence in 1 minute and 30 minutes showed a stronger inverse correlation with CTV (Spearman’s ρ = -0.52 and ρ = -0.44 respectively, p-value &amp;lt;0.05). This suggests that higher CTV may be associated with decreased peak cadence, particularly at the time of expected radiotherapy toxicity. Subgroup analysis focusing on patients with CTV covering the motor cortex further illustrated a more significant inverse correlation between CTV size and peak cadence (Spearman’s ρ = -0.77, p-value &amp;lt;0.05). CONCLUSION This study highlights the importance of understanding the interplay between tumour treatment volume, location and physical function. Further exploration of CTV volume in relation to anatomical areas such as the motor cortex could provide deeper insights into this relationship and provide opportunities for personalised monitoring in HGG.

Dirt Score in Large White Yorkshire Piglets during the Postweaning Period Reared on Different Floor Types

An experiment was carried out on 24 Large White Yorkshire piglets of either sex at the pig unit of LFC of C.V.Sc., Rajendranagar, Hyderabad from weaning (56days) to 126 days. Piglets were reared on four types of flooring systems i.e., T1 (control group) reared on the concrete floor, T2 rubber mat, T3 elevated slatted floor, and T4 reared on soil floor. The floor space provided was 1.5 m2 per piglet during the post-weaning period. Pig cleanliness was assessed using a five-point scale on 4 anatomical areas: rear, back, and both flanks, and each area was given a score from 0 to 4. The cleanliness score was increased as the age advanced from first to ninth fortnight in all floor types. The overall mean cleanliness scores of LWY piglets maintained on four different floors was 2.21 ± 0.06, 2.57 ± 0.04, 0.63 ± 0.02, and 2.44 ± 0.03 in concrete, rubber mat, elevated slatted, and soil floor respectively. The overall mean dirt score of piglets reared on rubber mat floor was significantly (P&lt;.0.01) higher than the piglets on the elevated slatted floor, but it was comparable with concrete and soil floor. The higher cleanliness score of the piglets reared on rubber mat floor were dirtier than piglets on concrete and soil floor whereas, the piglets reared on elevated slatted (low score) were cleaner than rubber mat, soil, and concrete floors.