Anatomical Location Research Articles

A Survey Study of the 3D Facial Landmark Detection Techniques Used as a Screening Tool for Diagnosis of the Obstructive Sleep Apnea Syndrome.

Obstructive Sleep Apnea (OSA) is a common disorder affecting both adults and children. It is characterized by repeated episodes of apnea (stopped breathing) and hypopnea (reduced breathing), which result in intermittent hypoxia. We recognize pediatric and adult OSA, and this paper focuses on pediatric OSA. While adults often suffer from daytime sleepiness, children are more likely to develop behavioral abnormalities. Early diagnosis and treatment are important to prevent negative effects on children's development. Without the treatment, children may be at increased risk of developing high blood pressure or other heart problems. The gold standard for OSA diagnosis is the polysomnography (sleep study) PSG performed at a sleep center. Not only is it an expensive procedure, but it can also be very stressful, especially for children. Patients have to stay at the sleep center during the night. Therefore, screening tools are very important. Multiple studies have shown that OSA screening tools can be based on facial anatomical landmarks. Anatomical landmarks are landmarks located at specific anatomical locations. For the purpose of the screening tool, a specific list of anatomical locations needs to be identified. We are presenting a survey study of the automatic identification of these landmarks on 3D scans of the patient's head. We are considering and comparing both knowledge-based and AI-based identification techniques, with a focus on the development of the automatic OSA screening tool.

Anatomic locations of ureterovascular fistulae: a review of 532 patients in the literature and a new series of 8 patients

IntroductionUreterovascular fistula (UVF) is a rare but potentially life-threatening condition. Since its primary description by Moschkowitz in 1908, many case reports, studies and reviews have been written about this condition with the suggestive symptoms and risk factors repeatedly discussed. This study will be focusing on the different locations of 532 out of 605 fistulae published from 1908 up to 2022 besides eight new patients of our own.Material and methodsA systematic review of the literature started using PubMed database searching for “ureteroarterial fistula”, “arteriovascular fistula” and “uretero vascular fistula” was performed yielding 122, 62 and 188 results respectively. Those studies and the cited literature in each study were examined to include studies, which did not appear in the primary search. A total of 605 patients in 315 publications were gathered. Only studies mentioning new patients, a clear indication of the location of the UVF, the presence/absence of urinary diversion (UD) as well as the type of UD if present were included. Ten duplicates as well as studies lacking information regarding the UVF and/or the UD (seven publications with 63 patients) were excluded, with 298 publications including 532 external patients remaining. Eight internal cases were included with a total of 540 cases.ResultsFrom the 540 included cases, 384 patients (71.1%) had no UD compared to 156 patients (28.9%) with UD. Due to the anatomical ureteral course, the common iliac artery (CIA) was the most common vascular component of UVF, irrespective of the presence or absence of UD. Any dispute to whether the crossing point is the common or the external iliac artery (EIA) was settled for the CIA. Further common vascular components besides CIA include the aorta, EIA, internal iliac artery (IIA) including its branches and vascular bypasses including the anastomosis sites. Other unusual arterial localizations were stated under the “others” category.ConclusionIdentifying the location of the bleeding artery in UVF is critical and represents the most important step for successful management. We present the largest summary of described locations up to date including our own.Graphical

Recordings of Superior Laryngeal Nerve Sensory Nerve Action Potentials in a Rat Model.

Superior laryngeal nerve (SLN) function is critical to laryngeal sensation. Sensory dysfunction in the larynx, mediated through the internal branch of the superior laryngeal nerve (iSLN), is thought to occur with aging and neurodegenerative disease. However, objective analysis of iSLN neurophysiology is difficult due to its anatomic location and small diameter. This study measures sensory nerve action potentials (SNAP) from the iSLN in a rat model. SNAP data were obtained from two adult rat strains (Sprague-Dawley, SD and Fischer 344 × Brown Norway F1 Hybrid rats, FBN). Evoked responses were obtained by stimulating the main trunk of the SLN and recording the response using a 160-μm cuff electrode placed around the iSLN. SNAP were averaged from 10 stimulations. Laryngeal adductor reflex (LAR) threshold measurements were obtained with stimulation of the iSLN and direct laryngoscopy. The sections of the iSLN were obtained for histologic analysis. SLN-evoked responses were successfully obtained in 18 hemi-laryngeal preparations (SD n = 13 and FBN n = 5) with corresponding LAR threshold measurements. Mean(±SD) SNAP latency, total duration, amplitude, negative durations, and intensity were 2.28 ms (±0.56), 2.13 ms (±0.70), 879 μV (±535), and 0.69 mA (±0.25), respectively. SLN stimulation threshold to elicit an LAR was of 0.84 mA (±0.31). It is feasible to record evoked SLN responses in two adult rat strains. This work may lead to a tractable animal model for objective measurements of SLN neurophysiology with various disease states. N/A Laryngoscope, 2024.

Transoral robotic parapharyngeal space dissection.

Transoral robotic surgery (TORS) provides a minimally invasive approach to address tumors in selected and challenging anatomical locations. Among the critical areas where TORS demonstrates its prowess is the oropharynx. Oropharyngeal tumors can invade parapharyngeal space (PPS) which contains vital structures such as the carotid artery, internal jugular vein, and cranial nerves IX-XII. A deeper understanding of the endoscopic anatomy of the parapharyngeal space could reduce the morbidity associated with tumor resection in this dense neurovascular area. This video-article provides a step-by-step cadaveric dissection of the lower PPS though a transoral robotic approach.

Comparison between the diagnostic utility of three-dimensional fluid attenuated inversion recovery (3D FLAIR) and three dimensional double inversion recovery (3D DIR) magnetic resonance sequences in the assessment of overall load of multiple sclerosis lesions in the brain

BackgroundMultiple sclerosis (MS) is a complex CNS demyelinating disease. Assessment of MS plaques in specific anatomic locations in the brain was challenging to detect by conventional MRI sequences. So, this study aimed to compare the diagnostic accuracy of 3D FLAIR (Fluid attenuation inversion recovery), or 3D DIR (Double inversion recovery) sequences to conventional 2D FLAIR and T2 sequences in detecting MS plaques in different anatomic sites, as well as counting the total lesion burden.MethodsA comparative cross-sectional study enrolled 30 MS patients on the basis of McDonald’s criteria 2017. All participants underwent a brain MRI study including 3D FLAIR or 3D DIR sequences, conventional 2D FLAIR, and T2 sequences.ResultsNo statistically significant difference between the 3D DIR and 3D FLAIR in total lesion (plaque) burden results; however, when each is compared to the conventional ones, both are superior. 3D FLAIR detected the most significant number of plaques in the periventricular region, followed by 2D FLAIR and T2W sequences, with 3D DIR being the least accurate in this region. Meanwhile, 3D DIR was the most precise and can detect a statistically significant number of cortical plaques compared to the 3D FLAIR and the conventional sequences. No statistically significant results on which sequence is best in regard to infratentorial plaque detection.Conclusion3D FLAIR and 3D DIR were superior to 2D FLAIR and T2 sequences in detecting overall lesion burden in MS. Moreover, the 3D DIR sequence was the most precise in the detection of the cortical plaques.

Trans-axillary sonography in the ABER (ABduction and External Rotation) position: a window to the subscapularis, teres major and latissimus dorsi.

Shoulder ultrasound is a key tool used by musculoskeletal practitioners to diagnose and treat a variety of upper girdle diseases. While magnetic resonance imaging is the cornerstone of shoulder imaging, sonography is readily available, practical and superior in its ability for dynamic assessment of musculoskeletal pathologies. The subscapularis, teres major and latissimus dorsi muscles are commonly involved in a myriad of pathology including myofascial pain and spasticity. There is scarce literature on the assessment of these muscles for diagnostic and therapeutic purposes. Conventional approaches to shoulder ultrasound have not included a dedicated assessment of the subscapularis muscle due to its inherent anatomical location deep to the scapular blade which blocks sound wave penetration. We describe an approach to visualizing the subscapularis muscle as a short addition to the established shoulder sonography format, which also permits assessment of both the latissimus dorsi and teres major muscles, which are important muscles for shoulder spasticity. The patient is imaged in a semi-recumbent position with the arms elevated above and behind the head in the ABduction and External Rotation (ABER) position. The relative ease of positioning and sonographic access to the musculature coupled with the potential for assessment and intervention makes this approach extremely desirable to the musculoskeletal practitioner looking to diagnose or treat muscle belly pathologies of the subscapularis, teres major or latissimus dorsi.

Lingual nerve revisited-A comprehensive review Part II: Surgery and radiology.

The lingual nerve (LN) is a branch of the mandibular division of the fifth cranial nerve, the trigeminal nerve, arising in the infratemporal fossa. It provides sensory fibers to the mucous membranes of the floor of the mouth, the lingual gingiva, and the anterior two-thirds of the tongue. Although the LN should rarely be encountered during routine and basic oral surgical procedures in daily dental practice, its anatomical location occasionally poses the risk of iatrogenic injury. The purpose of this section is to consider this potential LN injury risk and to educate readers about the anatomy of this nerve and how to treat it.

Epigenetic heterogeneity shapes the transcriptional landscape of regional microglia.

Microglia, the innate immune cells in the central nervous system, exhibit distinct transcriptional profiles across brain regions that are important for facilitating their specialized function. There has been recent interest in identifying the epigenetic modifications associated with these distinct transcriptional profiles, as these may improve our understanding of the underlying mechanisms governing the functional specialization of microglia. One obstacle to achieving this goal is the large number of microglia required to obtain a genome-wide profile for a single histone modification. Given the cellular and regional heterogeneity of the brain, this would require pooling many samples which would impede biological applications that are limited by numbers of available animals. To overcome this obstacle, we have adapted a method of chromatin profiling known as Cleavage Under Targets and Tagmentation (CUT&Tag-Direct) to profile histone modifications associated with regional differences in gene expression throughout the brain reward system. Consistent with previous studies, we find that transcriptional profiles of microglia vary by brain region. However, here we report that these regional differences also exhibit transcriptional network signatures specific to each region. Additionally, we find that these region-dependent network signatures are associated with differential deposition of H3K27ac and H3K7me3, and while the H3K27me3 landscape is remarkably stable across brain regions, the H3K27ac landscape is most consistent with the anatomical location of microglia which explain their distinct transcriptional profiles. Altogether, these findings underscore the established role of H3K27me3 in cell fate determination and support the active role of H3K27ac in the dynamic regulation of microglial gene expression. In this study, we report a molecular and computational framework that can be applied to improve our understanding of the role of epigenetic regulation in microglia in both health and disease, using as few as 2,500 cells per histone mark.

Optics-free Spatial Genomics for Mapping Mouse Brain Aging.

Spatial transcriptomics has revolutionized our understanding of cellular network dynamics in aging and disease by enabling the mapping of molecular and cellular organization across various anatomical locations. Despite these advances, current methods face significant challenges in throughput and cost, limiting their utility for comprehensive studies. To address these limitations, we introduce IRISeq (Imaging Reconstruction using Indexed Sequencing), a optics-free spatial transcriptomics platform that eliminates the need for predefined capture arrays or extensive imaging, allowing for the rapid and cost-effective processing of multiple tissue sections simultaneously. Its capacity to reconstruct images based solely on sequencing local DNA interactions allows for profiling of tissues without size constraints and across varied resolutions. Applying IRISeq, we examined gene expression and cellular dynamics in thirty brain regions of both adult and aged mice, uncovering region-specific changes in gene expression associated with aging. Further cell type-centric analysis further identified age-related cell subtypes and intricate changes in cell interactions that are distinct to certain spatial niches, emphasizing the unique aspects of aging in different brain regions. The affordability and simplicity of IRISeq position it as a versatile tool for mapping region-specific gene expression and cellular interactions across various biological systems.

Outcome of treatment with a 10-week COP protocol in cats with intermediate or large cell lymphoma: 27 cases (2014-2023).

The aim of this retrospective clinical study was to evaluate and report response to treatment with a 10-week maintenance-free COP (COP-10) protocol in a cohort of 27 cats with intermediate or large cell lymphoma. Additionally, to identify any potential prognostic factors for predicting the treatment response. The medical records of cats diagnosed with intermediate or large cell lymphoma in a single institution in the period 2014 to 2023 and treated with COP-10 as first-line treatment were reviewed. Twenty-seven cats were included in the study. The median age was 10 years, 67% of the cats were in stages I to II and the most common anatomical location was alimentary (37%). The overall response rate was 65%, with 38% of cats achieving complete remission and 27% partial remission. For cats achieving complete remission, the median progression-free interval and the median lymphoma-specific survival time were both 1,139 days. For cats in partial remission, the median progression-free interval and the median lymphoma-specific survival time were 53 and 210 days, respectively. Clinical stage was significantly related to treatment response and survival time. Treatment with the short protocol COP-10 resulted in remission rates and durable first remissions for cats achieving complete remission comparable to responses seen with longer-duration chemotherapy protocols. The results from this study may impact economic and logistic decisions for owners, as well as the quality of life for patients in the future.

Activation of the G protein-coupled sulfakinin receptor inhibits blood meal intake in the mosquito Aedes aegypti.

Little is known about the blood-feeding physiology of arbovirus vector Aedes aegypti although this type of mosquito is known to transmit infectious diseases dengue, Zika, yellow fever, and chikungunya. Blood feeding in the female A. aegypti mosquito is essential for egg maturation and for transmission of disease agents between human subjects. Here, we identify the A. aegypti sulfakinin receptor gene SKR from the A. aegypti genome and show that SKR is expressed at different developmental stages and in varied anatomical localizations in the adult mosquito (at three days after eclosion), with particularly high expression in the CNS. Knockingdown sulfakinin and sulfakinin receptor gene expression in the female A. aegypti results in increased blood meal intake, but microinjection in the thorax of the sulfakinin peptide 1 and 2 both inhibits dose dependently blood meal intake (and delays the time course of blood intake), which is reversible with receptor antagonist. Sulfakinin receptor expressed ectopically in mammalian cells CHO-K1 responds to sulfakinin stimulation with persistent calcium spikes, blockable with receptor antagonist. These data together suggest that activation of the Gq protein-coupled (i.e., calcium-mobilizing) sulfakinin receptor inhibits blood meal intake in female A. aegypti mosquitoes and could serve as a strategic node for the future control of A. aegypti mosquito reproduction/population and disease transmission.

Prevalence and Characterization of Salmonella during Pork Sausage Manufacturing.

Pork carcasses and meat may harbor Salmonella and may contaminate other products during harvest and fabrication. Sources of contamination include manure on hides, environmental contamination, ingredients from external sources, and lymph nodes. Swine lymph nodes are often incorporated into ground meat, as their anatomical location makes removal labor prohibitive. A sausage processing plant in the midwestern United States was sampled monthly (except for December) from May 2021 to April 2022 to enumerate Salmonella and Enterobacteriaceae (EB) throughout the sausage manufacturing process to determine high-risk stages and efficiency of existing in-plant interventions. Salmonella serotypes and antimicrobial susceptibility were evaluated on a subset of isolates recovered at the end phases of sausage production. In each collection, samples were taken from the carcasses of eight sows through 11 stages of sausage manufacturing. A total of 830 samples were cultured. Thirty-four Salmonella were isolated from the final three production stages; of these, there were eleven serotypes. Three isolates displayed resistance to ampicillin, whereas the remainder of the isolates were pan-susceptible to the antimicrobials tested. Salmonella and EB were significantly reduced (p < 0.001) by acid washes at different stages of production, and the results point to the beneficial effects of interventions to lessen Salmonella concentrations in retail products.

Accuracy of ultrasound-guided iliopsoas tendon injection after total hip arthroplasty: a retrospective observational study.

To describe and characterize the accuracy and benefit of a technique for performing ultrasound-guided needle placement for iliopsoas peritendon or bursa injections as an alternative method to fluoroscopic guidance. Patients with a history of total hip arthroplasty who were referred by their orthopedic surgeon for iliopsoas peritendon or bursa corticosteroid injection for iliopsoas impingement syndrome between June 2017 and December 2019 were eligible for inclusion. Of these patients, 19 received a total of 26 ultrasound-guided needle placement followed by confirmatory fluoroscopic guidance prior to injection. Pre-injection and post-injection VAS scores were collected to monitor pain. Additionally, the patients were followed for 6months via chart review after their injection to assess for complications, need for repeat injections, and progression to surgical intervention. The accuracy of a longitudinal in-plane distal to proximal approach to ultrasound guided needle placement was then evaluated. Ultrasound guided needle placement using a longitudinal in-plane distal to proximal approach demonstrated spread of contrast material in the intended anatomic location with fluoroscopic confirmation in patients who underwent iliopsoas peritendon or bursa injection post total hip arthroplasty. Ultrasound guided needle placement using a longitudinal in-plane distal to proximal approach can be an effective alternative technique for diagnostic or therapeutic iliopsoas peritendon injection in patients with total hip arthroplasty.

Imaging in Musculoskeletal TB

AbstractTuberculosis (TB) remains a significant global health challenge, with musculoskeletal TB accounting for a notable proportion of cases. The spine is the most commonly affected site, followed by the hip, knee, and ankle joints. Prompt and accurate diagnosis is essential to prevent joint destruction, deformity, and neurological complications. Given the paucibacillary nature of musculoskeletal TB, imaging plays a pivotal role in diagnosis, guiding sampling procedures, and assessing treatment response. Contrast-enhanced magnetic resonance imaging has emerged as the preferred modality for diagnosing and monitoring both spinal and extraspinal TB. This review provides an in-depth analysis of imaging characteristics of musculoskeletal TB, highlighting key findings essential for early diagnosis and differentiation from similar pathologies. Through case-based illustrations, various anatomical locations of osteoarticular TB are discussed.

Benign bone tumors in North East Indian population – A hospital-based study

Background: Primary bone tumors are relatively uncommon and constitute only 0.2–0.5% of all tumors in all ages in most series reported worldwide. Benign bone tumors are more common than the malignant bone tumors. Not many studies on benign bone tumors in the North Eastern Indian population are published in the available literature. Aims and Objectives: The current study was done with the aim to find out the epidemiological data on benign bone tumors in patients of the North-East Indian population who were admitted to the orthopedic department of a teaching institute. Materials and Methods: A hospital-based retrospective study with prospective effect was conducted on benign bone tumors in patients admitted to the Department of Orthopedics at our teaching institute from 2016 to 2020. Patients of all ages and both sexes with suspicion of bone tumors based on history and clinical examination were subjected to roentgenographic evaluation, including computed tomography (CT) scan and/or magnetic resonance imaging. Pre-operative core needle biopsy under C-arm/CT guidance or incisional biopsy was done for histological diagnosis, followed by appropriate intervention. Soft-tissue tumors and malignant bone tumors were excluded. Patients were followed up for recurrence, complications, and functional recovery. Results: Forty patients of bone tumors were treated out of 2288 patients admitted to the department (incidence of 1.75%). 29 were benign bone tumors with an incidence of 1.27%. Of 10–20 years age group was most commonly affected. Male preponderance with M: F=6.25:1. Femur (n=16) was the most commonly affected bone. Presenting features were swelling (n=18), pain (n=11), and pathological fracture (n=5). osteochondroma (n=15) was most common followed by giant cell tumor of bone (n=6). Treatment ranged from intralesional steroid to wide marginal excision based on histopathological diagnosis, the extent of tumor, anatomical location, and presenting symptoms. All patients were rehabilitated to activities of daily living at the final follow-up. No recurrence or any long-term complications were reported. Conclusion: This study gives epidemiological data on benign bone tumors, which can be used for setting up or upgrading dedicated oncological or oncosurgery institutes. A multicentric study on a large population in the future is suggested to obtain a larger data bank.

A cross-sectional study of musculoskeletal injuries related to exercise among gym members in Saudi Arabia in 2022: prevalence, common types, and predictor factors

BackgroundDespite the importance of enhancing exercise, exercising can cause injuries that lead to disability and increase the load on the medical sector. This study aimed to estimate the prevalence of exercise-related injuries among gym members in the Kingdom of Saudi Arabia (KSA) and evaluate the more common types of such injuries. It also investigated the association between injury prevalence and the factors selected.MethodsA cross-sectional study with a self-reported survey was conducted targeting members of Fitness Time gyms across the KSA. The survey consisted of three parts: part one concerns participant demographic data and part two contains four questions regarding the participants’ training experience. Part three contains ten questions targeting those with a history of injury. Descriptive statistical analysis was performed using frequencies and percentages for categorical variables. Crosstabs and chi-squared tests were used to assess the prevalence of exercise-related injuries when appropriate. Binary logistic regression was employed to investigate the association between injury prevalence and the potential associated factors. Odds ratios and their 95% confidence intervals were calculated and the threshold for statistical significance was set at p ≤ 0.05.ResultsA total of 713 subjects participated in the study. The mean age was 36.5 ± 11.2 years and (n = 422, 59.2%) of the participants were female. The study found a prevalence of injury among gym members of about (n = 404, ~57%). The most commonly reported types of injuries were muscle strain (n = 126, 37%) and bruising (n = 45, 13%). The most prevalent anatomical location of injury was the knee (n = 287, 84.3%), followed by the shoulder (n = 283, 83.3%), and the least common was the head/neck (n = 7, 2.1%). The present study suggests some factors associated with exercise-related injury. A significant statistical association (p < 0.5) was found between injury prevalence and age, gender, educational level, period of training, and presence of a trainer. However, no association was detected between injury prevalence and Body Mass Index (BMI), place of residence, or source of advice.ConclusionOver half of the participants of this study reported at least one exercise-related injury. This study identifies factors associated with injury prevalence related to exercise among gym participants. Promoting safety and minimizing the incidence of injuries are crucial.

Location-specific diagnostic efficiency of photodynamic diagnosis-guided biopsy in bladder mapping biopsies.

Photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumors (TURBT) has emerged as a promising complementary tool to white light (WL) cystoscopy, potentially improving cancer detection and replacing conventional mapping biopsies. This study aimed to investigate the diagnostic accuracy of PDD by anatomical locations in mapping biopsies through lesion-based analysis. PDD and WL findings were prospectively recorded in 102 patients undergoing mapping biopsies and PDD-assisted TURBT using oral 5-aminolevulinic acid. We evaluated 673 specimens collected from flat tumor or normal-looking lesions on WL cystoscopy, after excluding 98 specimens collected from papillary or nodular tumors. Among the 673 lesions, cancer was detected in 110 (16%) by lesion-based analysis. PDD demonstrated significantly higher sensitivity (65.5% vs. 46.4%, p < 0.001) and negative predictive value (92.5% vs. 89.5%, p < 0.001) compared to WL. The sensitivity of PDD findings varied by location: posterior (100%), right (78.6%), dome (73.3%), left (70.6%), trigone (58.8%), bladder neck (41.7%), anterior (40.0%), and prostatic urethra (25.0%). Incorporating targeted biopsies of specific locations (bladder neck, anterior, and prostatic urethra) into the PDD-guided biopsies, regardless of PDD findings, significantly increased the overall sensitivity from 65.5% to 82.7% (p = 0.001). This study first demonstrated the detection rate of location-specific mapping biopsies using PDD, revealing difficulties in accuracy assessment in areas susceptible to tangential fluorescence. While PDD-guided biopsy improves cancer detection compared to WL cystoscopy even for flat tumors or normal-looking lesions, more careful decisions, including mapping biopsies, may be beneficial for an assessment in these tangential areas.

Cranial bone microarchitecture in a mouse model for syndromic craniosynostosis.

Crouzon syndrome is a congenital craniofacial disorder caused by mutations in the Fibroblast Growth Factor Receptor 2 (FGFR2). It is characterized by the premature fusion of cranial sutures, leading to a brachycephalic head shape, and midfacial hypoplasia. The aim of this study was to investigate the effect of the FGFR2 mutation on the microarchitecture of cranial bones at different stages of postnatal skull development, using the FGFR2C342Y mouse model. Apart from craniosynostosis, this model shows cranial bone abnormalities. High-resolution synchrotron microtomography images of the frontal and parietal bone were acquired for both FGFR2C342Y/+ (Crouzon, heterozygous mutant) and FGFR2+/+ (control, wild-type) mice at five ages (postnatal days 1, 3, 7, 14 and 21, n = 6 each). Morphometric measurements were determined for cortical bone porosity: osteocyte lacunae and canals. General linear model to assess the effect of age, anatomical location and genotype was carried out for each morphometric measurement. Histological analysis was performed to validate the findings. In both groups (Crouzon and wild-type), statistical difference in bone volume fraction, average canal volume, lacunar number density, lacunar volume density and canal volume density was found at most age points, with the frontal bone generally showing higher porosity and fewer lacunae. Frontal bone showed differences between the Crouzon and wild-type groups in terms of lacunar morphometry (average lacunar volume, lacunar number density and lacunar volume density) with larger, less dense lacunae around the postnatal age of P7-P14. Histological analysis of bone showed marked differences in frontal bone only. These findings provide a better understanding of the pathogenesis of Crouzon syndrome and will contribute to computational models that predict postoperative changes with the aim to improve surgical outcome.

Feasibility of a new endoscopic suturing device: a first Western experience (with video)

Endoscopic hand suturing (EHS) is a new technique for the closure of mucosal defects in the GI tract. Although this method was tested for wound closure after endoscopic submucosal dissection (ESD) in Japan, a feasibility test in a Western setting is lacking. In this study, we present our first experience with EHS for different indications and in different anatomic locations. The technical success of EHS and suturing speed were retrospectively determined for all available EHS cases in our center. Technical success was defined as complete closure of the mucosal defect or visually tight fixation of the target. A total of 19 EHS procedures were performed in 17 patients (mean age, 54.9 years; standard error of the mean [SEM], 4.2 years; male, 53% [n= 9]). Technical success was achieved in 78.9% (n= 15). Total EHS operation time was 40.0 minutes (SEM, 3.1 minutes) with 3.3 minutes (SEM, 0.2 minutes) per single stitch. In a constant team of endoscopist and assistant, mean stitch times declined significantly from the first 4 to the second 4 of 8 cases (4.0 [SEM, 0.6] vs 2.3 [SEM, 0.2] minutes, P= .02). EHS was technically feasible and applicable in different anatomic locations. Further studies may elucidate a possible effect on adverse event rates of endoscopic resections.

Technical Feasibility and Outcome of Cryoablation of Aneurysmal Bone Cysts in Pediatric Patients

PurposeTo evaluate the clinical and imaging outcome of aneurysmal bone cysts (ABCs) in children using percutaneous cryoablation as the sole treatment. Materials and MethodsThis retrospective study included 7 children with a mean age of 8.7 years (range, 3.0–11.9 years) who underwent at least 1 cryoablation for ABC. Cryoablation needles were placed and guided by computed tomography (CT). Imaging follow-up and clinical examination were performed by radiography 1 and 6 months after the procedure and magnetic resonance (MR) imaging was performed 3 and 12 months after the procedure. Additional cryoablation was performed in case of MR imaging–detected recurrence. Data were analyzed by anatomical location, measurement of lesion volume, numbers of intralesional cysts, grade of mineralization (5-point Likert scale), pain (0 [none] to 4 [severe]), and grade of fluid-fluid levels (FFLs; 4-point Likert scale). ResultsFourteen cryoablations were performed. Patients showed volume reduction, with 1 showing a complete response and 6 showing partial response. Following treatment, there was a substantial reduction in lesion volume compared with baseline, leading to a mean volume decrease of 81.9% (range, 66.8%–100%). The grade of mineralization (3.2 [SD ± 1.2] after therapy vs 1.1 [SD ± 0.3] at baseline), grade of FFL (1.6 [SD ± 0.5] after therapy vs 3.4 [SD ± 1.1] at baseline), and pain (0.29 [SD ± 0.4] after therapy vs 1.86 [SD ± 0.7] at baseline) significantly improved after therapy (all P < .05). One severe adverse event occurred. ConclusionsCryoablation is an effective treatment option for ABC in children. Further research is needed to compare it with other techniques.