Anatomic Risk Factors Research Articles

Artificial Intelligence to Predict Quality-of-Life Outcomes for Vascular Intervention of the Leg.

Artificial intelligence (AI) tools created to enhance decision-making may have a significant impact on treatment algorithms for peripheral arterial disease (PAD). A Markov-based AI model was developed to predict optimal therapy based on maximization of calculated quality of life (cQoL), a patient-centered system of assessment designed to report outcomes directly linked to health-related quality of life. The AI model was prospectively interrogated immediately after individual interventions for PAD over a 12-year period to test predictive performance. Patient cQoL was determined at each patient follow-up visit. A total of 1,143 consecutive patients were evaluated, with a median follow-up of 18 months. Observed mean annualized cQoL was higher than predicted by the model (0.85 ± 0.38 vs 0.79 ± 0.18, p < 0.0001). Of 5 potential clinical outcomes, the AI model correctly predicted final status in 71.3% of patients, with insignificant model performance deterioration over time (-0.15% per month, r = -0.49, p = 0.063). The chance of having the condition predicted by the model was 0.57 ± 0.32, compared with a theoretical maximum of 0.70 ± 0.19 (p < 0.0001, mean ratio 0.79). The AI model performed better in patients with claudication than limb-threatening ischemia (75.5% vs 63.6%, p = 0.014) but equally well for open or endovascular intervention (69.8% vs 70.5%, p = 0.70). Graft or artery patency and amputation-free survival were better for patients with claudication and those treated with endovascular techniques. AI can successfully predict treatment for PAD that maximizes patient quality of life in most cases. Future application of AI incorporating better estimates of patient anatomic and physiological risk factors and refinement of model structure should further enhance performance.

Radiological diagnostics of patellofemoral instability and patellar dislocation

Patellofemoral instability (PFI) describes a(sub)luxation of the patella in the patellofemoral joint. Pathophysiologically, PFI is usually due to a nonphysiological movement of the patella, so-called maltracking, either due to acute trauma with injury to the supporting ligamentous apparatus or due to the presence of anatomical risk factors. Radiologically assessable risk factors for maltracking include trochlear dysplasia, patella alta, patellar tilt, lateralization of the tibial tuberosity, torsional deformity and genu valgum. This article presents the most commonly used and best validated measurement techniques. In addition, the characteristic injury pattern after lateral patellar dislocation is shown.

The tibial tubercle-to-trochlear groove distance changes in standing weight-bearing condition: An upright weight-bearing computed tomography analysis

BackgroundThe tibial tubercle-to-trochlear groove (TT-TG) distance and Insall-Salvati (I/S) ratio are widely used to determine the need for distal realignment in conjunction with medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent patellar dislocation. A TT-TG distance >20 mm and an I/S ratio >1.3 are significant anatomical risk factors for patellar instability. However, these parameters have traditionally been measured using non-weight-bearing (NWB) imaging modalities. As patellar dislocation occurs during weight-bearing actions, these two parameters should be measured under weight-bearing conditions. Thus, this study aimed to measure the TT-TG distance and I/S ratio using upright full-weight-bearing (FWB) computed tomography (CT) scans and compare the data with NWB CT scans. MethodsThis study included 49 knee joints of 26 healthy volunteers. CT images were obtained under both FWB and NWB standing conditions using a 320-detector row upright CT scanner. TT-TGs in the axial plane and I/S ratios in the sagittal plane were measured and compared. ResultsThe average FWB TT-TG distance was 20.3 ± 3.9 mm, whereas the average NWB TT-TG distance was 12.3 ± 4.7 mm. The TT-TG level was significantly higher in the FWB condition than that in the NWB condition (P < 0.001). The I/S ratios were comparable between the FWB and NWB conditions (P = 0.29). ConclusionsThe TT-TG distance in the standing weight-bearing condition was larger than the conventional TT-TG distance and surpassed the historical cutoff value of TT-TG, which may affect the indication of additional distal realignment in MPFL reconstruction for patellar instability.

Predictive Factors for First-Pass Intubation Failure in Trauma Patients.

The primary objective of this study was to elucidate risk factors for multiple intubation attempts (MIA) in trauma patients requiring emergent tracheal intubation (ETI). Risk factors for mortality, intensive care unit (ICU) admission, and prolonged ventilation were assessed as secondary outcomes. The association between multiple intubation attempts and adverse outcomes has been well described in the literature. Though previous studies have identified anatomical risk factors for difficult airways, no study to date has investigated predictors for MIA in a trauma setting. The retrospective study involved 174 adult patients who required ETI and who presented to a Level 1 Trauma Center's emergency department between January 2019 and December 2022. Comorbidities, demographic information, triage vitals, intubation characteristics, and patient outcomes were identified to ascertain predictive risk factors for MIA. Variables were assessed for statistical significance on unadjusted analysis. Significant variables were entered into multivariate logistic regression models to test for adjusted associations, with p≤.0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals. Twenty-six (14.9%) of the 174 patients required multiple intubation attempts. There were no significant associations between MIA and patient gender, age, BMI, race, injury mechanism, or specific body region injuries. On univariate analysis, the MIA group had a statistically significant elevation in mean systolic blood pressure (151.71 ± 45.96 vs 133.55 ± 32.11, p = 0.019) and heart rate (106.30 ± 34.92 vs 93.35 ± 24.82, p < 0.032) compared to subjects with first-pass success. Elevation in systolic blood pressure (SBP) (151.71 ± 45.96 vs 133.55 ± 32.11, aOR 1.03 (1.01-1.06), p < 0.015) was an independent predictor of multiple intubation attempts. Elevation in SBP was a significant predictor of multiple intubation attempts. Critical appraisal of patients requiring ETI with elevated SBP may mitigate risk in trauma settings.

Hereditary Anatomical Risk Factors for Anterior Cruciate Ligament Injuries.

Genetic and anatomical factors have been reported as risk factors for anterior cruciate ligament (ACL) injuries. This study aimed to investigate anatomical characteristics in family members sustaining ACL injuries, compared with age- and sex-matched patients with simple meniscus injuries. Medical records of 1548 patients who underwent ACL reconstruction were reviewed. Cases of ACL injury occurring in first-degree relatives were selected. Forty-one patients from 20 families were included in the study (F-ACL group). Fifty patients with meniscus injuries were included as controls. Anatomical factors comprising posterior-inferior tibial slope (PITS), notch width index (NWI), notch angle (NA), and intercondylar notch roof inclination angle (RA) were compared between groups. The correlation of these anatomical factors between parent and child or siblings was also investigated. The 41 patients (20 families) consisted of 12 parent-child pairs and 29 siblings (13 pairs and one trio). Injuries occurred during playing the same sport in 11 families (55%). PITS was significantly steeper in the F-ACL group (9.9 vs. 7.8 degrees). NWI and NA were significantly smaller in the F-ACL group (0.262 vs. 0.278 and 50.5 vs. 58.8 degrees). RA was significantly greater in the F-ACL group (130 vs. 126.9 degrees). A positive correlation in NA (r = 0.677) and a weak correlation in NWI and RA were observed between family members. Common anatomical risk factors of ACL injury exist within families, including intercondylar notch stenosis and steep posterior tibial slope. The findings suggest the potential for developing effective ACL injury prevention programs targeting these risk factors.

The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players

Background: Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR). Purpose: To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury. Results: The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively; P = .006) and higher rates of hypoechoic foci (57.9% vs 30.4%, respectively; P = .030). Players of both groups had similar dominant UCL thickness (P = .161), ulnohumeral joint space at rest (P = .321), space under stress (P = .498), and laxity (P = .796). Groups did not differ in terms of relative UCL thickness, ulnohumeral joint space under stress, or relative laxity. In the year before UCL injury, the UCLR cohort, compared with the matched healthy cohort, had a greater increase in mean dominant UCL thickness (0.94 vs –0.60 mm, respectively; P = .038) and a greater increase in relative median UCL thickness (1.35 vs –0.35 mm, respectively; P = .045). Players in the healthy cohort were statistically older than those in the UCLR cohort (23 vs 22 years, respectively; P = .004). No differences in ulnohumeral stress spacing or laxity were detected. Conclusion: SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players.

Predictors of Crossing Failure in Femoropopliteal Lesions: The Importance of Length of the Lesion and Calcification

IntroductionEndovascular therapy is nowadays the first choice for most patients with peripheral artery disease. The most important cause of technical failure is failure to cross the lesion with a wire. In this retrospective study we explore possible risk factors of crossing failure. PatientsWe included all consecutive patients in whom the lesion could not be crossed in the period of the 1th January 2017 to 1th January 2022. The lesions of these patients were compared with patients in whom the lesion could be crossed (2:1). The following potential anatomical risk factors were compared: location of the lesion, occlusion length, lesion length, Peripheral Arterial Calcium Scoring Scale, Peripheral Academic Research Consortium, circumferential characterization classification and the TASC II classification. ResultsIn 71 patients the lesion could not be crossed, these patients were compared with 142 patients. There were significantly more patients with hypertension and hyperlipidemia in the group with crossing failure. The following factors were risk factors for crossing failure: occlusion length, lesion length, Peripheral Arterial Calcium Scoring Scale, Peripheral Academic Research Consortium and circumferential characterization classification. Discussions and conclusionAlthough conclusions should be carefully drawn from this retrospective study, calcification and length of the lesion are associated with crossing failure in the femoropopliteal segment. The Trans-Atlantic Inter-Society Consensus (TASC) II classification was the best predictor of crossing failure.

Risk factors for postpartum stress urinary incontinence: a prospective study

PurposePostpartum stress urinary incontinence (SUI) is a common occurrence in women, and it has a profound effect on women’s health and quality of life. This study aimed to investigate the risk factors for postpartum SUI and the relative importance of each factor, including pelvic floor ultrasound measurement data and clinical data.MethodPregnant women who delivered in our hospital from March 2021 to January 2022 were selected as the study population. The clinical and anatomical Data from women with SUI and those without SUI were collected and analyzed. The clinical and anatomical risk factors associated with postpartum SUI were identified using univariate and multivariate analyses.ResultsA total of 255 participants were recruited. Logistic regression analysis indicated that age (OR:1.215, 95% CI:1.097–1.346, P < 0.001), vaginal delivery (OR:3.05, 95% CI:1.328–7.016, P < 0.009), parity (OR:3.059, 95% CI:1.506–6.216, P < 0.002), bladder neck descent (OR:4.159, 95% CI: 2.010–8.605, P < 0.001), the angle of the internal urethral orifice funnel (OR:1.133, 95% CI:1.091–1.176, P < 0.001) were important independent risk factors for postpartum SUI (all P < 0.05). The AUC was 0.883 (95% CI: 0.839–0.926) in the model.ConclusionsAge, vaginal delivery, parity, bladder neck descent and the angle of the internal urethral orifice funnel are independent risk factors for postpartum SUI. To prevent the occurrence of postpartum SUI, high-risk factors of postpartum SUI should be identified as early as possible during pregnancy and after delivery, and postpartum pelvic floor rehabilitation training should be promoted.

Patellofemoral Instability in Pediatric and Adolescent Athletes: A Review of Risk Factors and Treatments.

Pediatric patellar instability can impair function and restrict activity participation. If left untreated, it can lead to a degenerative knee. The incidence of patellar dislocations is highest in adolescents between 10 and 17 years of age; more than half of all first-time patellar dislocations occur during sports. This article reviews the evidence of risk factors for traumatic patellar instability, surgical interventions, and return-to-sport (RTS) considerations for pediatric and adolescent athletes. Anatomic risk factors for patellar instability in pediatric and adolescent patients include trochlear dysplasia, elevated tibial tuberosity-trochlear groove (TT-TG) distance, patella alta, genu valgum, femoral anteversion and tibial torsion, and hyperlaxity.

MPFL Reconstruction and Implant-Mediated Guided Growth in Skeletally Immature Patients With Patellar Instability and Genu Valgum

Background: There is a higher rate of failure of isolated MPFL reconstruction in skeletally immature patients with patellar instability compared to skeletally mature patients. Genu valgum is a known risk factor for patellar instability. There is potential for concomitant surgical correction of genu valgum to achieve better clinical outcomes and to decrease failure rates of MPFL reconstruction. Purpose: To evaluate outcomes of combined medial patellofemoral ligament (MPFL) reconstruction and implant-mediated guided growth (IMGG) in skeletally immature patients with patellar instability and genu valgum. Study Design: Case series; Level of evidence, 4. Methods: In a multicenter study, all skeletally immature patients with recurrent patellar instability and genu valgum who underwent MPFL reconstruction using hamstring graft and IMGG using a transphyseal screw or tension band plate for the distal femur and/or proximal tibia were included. The knee valgus angle and mechanical axis were measured on full-length radiographs and anatomic risk factors were measured on MRI. Patients were followed until correction of their lower limb alignment and implant removal or until skeletal maturity. Clinical outcomes, including complications, were analyzed. Results: A total of 31 patients (37 knees) were included in the study. The mean age and skeletal age of the cohort were 12.4 and 12.9 years, respectively. Simultaneous MPFL reconstruction and IMGG were performed in 26 of 37 knees; 11 underwent staged procedures. Twenty knees had transphyseal screws and 17 knees had tension band plates for IMGG. The knee valgus corrected from a mean of 12.4° to 5.1° in 12.1 months. Implants were removed from 22 of 37 knees once genu valgum was corrected. There was no significant difference (P = .65) in the correction rate between plates (0.7 deg/month) and screws (0.6 deg/month). Ten complications occurred in 4 patients (7 knees) and included 5 patellar redislocations, 2 rebound valgus, 1 varus overcorrection, 1 knee arthrofibrosis, and 1 implant loosening. For children <10 years of age, 3 of 6 (50%) knees had patellar redislocations and 5 of 6 knees had a complication. This was statistically significant (P = .003) compared with patients >10 years of age. Similarly, for patients with bilateral knee involvement, 5 of 12 (42%) knees had patellar redislocations and a total of 8 complications occurred in this subset. This was statistically significant (P < .001) compared with patients with unilateral involvement. Conclusion: IMGG with plates or screws in the setting of combined MPFL reconstruction improves genu valgum. Children <10 years of age and those with bilateral instability with genu valgum remain difficult subsets to treat with higher complication rates.

Magnetic Resonance Image Findings and Potential Anatomic Risk Factors for Chodromalacia in Children and Adolescents Suffering from Non-Overload Atraumatic Knee Pain in the Ambulant Setting.

To evaluate magnetic resonance image (MRI) findings in children and adolescents suffering from knee pain without traumatic or physical overload history and to identify potential anatomic risk factors. A total of 507 MRIs of 6- to 20-year-old patients (251 males; 256 females) were evaluated with regard to detectable pathologies of the knee. The results were compared to a control group without pain (n = 73; 34 males; 39 females). A binary logistic regression model and t-tests for paired and unpaired samples were used to identify possible risk factors and significant anatomic differences of the study population. In 348 patients (68.6%), at least one pathology was detected. The most commonly detected finding was chondromalacia of the patellofemoral (PF) joint (n = 205; 40.4%). Chondral lesions of the PF joint occurred significantly more often in knee pain patients than in the control group (40% vs. 11.0%; p = 0.001), especially in cases of a patella tilt angle > 5° (p ≤ 0.001), a bony sulcus angle > 150° (p = 0.002), a cartilaginous sulcus angle > 150° (p = 0.012), a lateral trochlear inclination < 11° (p ≤ 0.001), a lateralised patella (p = 0.023) and a Wiberg type II or III patella shape (p = 0.019). Moreover, a larger patella tilt angle (p = 0.021), a greater bony sulcus angle (p = 0.042), a larger cartilaginous sulcus angle (p = 0.038) and a lower value of the lateral trochlear inclination (p = 0.014) were detected in knee pain patients compared to the reference group. Chondromalacia of the PF joint is frequently observed in children and adolescents suffering from non-overload atraumatic knee pain, whereby a patella tilt angle > 5°, a bony sulcus angle > 150°, a cartilaginous sulcus angle > 150°, a lateral trochlear inclination < 11°, a lateralised patella and a Wiberg type II or III patella shape seem to represent anatomic risk factors.

Measurement of TT-TG can change with sequential MRIs due to variations in tibiofemoral rotation in patellofemoral instability patients.

There are various anatomic risk factors for patellofemoral instability (PFI) that help guide surgical treatment, including the tibial tubercle to trochlear groove (TT-TG) distance. However, no study has analysed the temporal changes in TT-TG prior to surgical intervention. This study sought to understand the variations in TT-TG over time for pediatric patients suffering from PFI prior to surgical intervention. The authors hypothesised that the TT-TG would substantially change between time points. Patients undergoing medial patellofemoral ligament (MPFL) reconstruction between 2014 and 2019 by one of two fellowship-trained orthopaedic surgeons were identified. Patients were included if they had two preoperative magnetic resonance imaging (MRI) performed on the same knee within 7.5 months of each other prior to any surgical intervention and had an initial TT-TG greater than 10 mm. After considering 251 patients for inclusion, 21 patients met the final inclusion criteria. The mean age was 14.5 ± 2.5 years and 61.9% were female. TT-TG was initially noted to be 15.1 ± 1.8 mm. At mean time aftersequential MRIs of 5.0 ± 1.9 months, TT-TG was noted to be 16.7 ± 3.2 mm. The differences between initial and subsequent TT-TG ranged from a 21.2% decrease to a 61.1% increase, with a mean difference of an 11.3% increase. Comparison between initial and subsequent TT-TG values demonstrated a significant difference (p = 0.017). Change in tibiofemoral rotation ranged from -9.2° to 7.5°. When comparing the change in TT-TG to change in tibiofemoral rotation, a significant correlation was found (p = 0.019). Despite only a mean time between MRIs of 5 months, variations in TT-TG ranged from a decrease of 21.2% to an increase of 61.1%. The significant relationship between the changes in TT-TG and changes in tibiofemoral rotation between MRIs suggest that TT-TG measurements may vary due to variations in tibiofemoral rotation at the time of individual MRIs. Level IV.

Fighter Pilot Syndrome: A Bow Hunter Syndrome Variant Identified With Dynamic Cerebral Angiography

Background Dynamic compression of extracranial arteries in the cervicocerebral circulation is a rare phenomenon of ischemic stroke. Methods Retrospective chart review. Results Here, we present a young fighter pilot who presented with recurrent embolic strokes of undetermined source. He endorsed flying fighter jets for 6 years, during which he was subject to high G‐force loads and extensive in‐flight head maneuvers. Extensive workup identified dynamic arterial compression of his right vertebral artery, which entered the transverse foramen at the C4 level. Dynamic cerebral angiography was used to reveal the specific vessel location and provocative maneuver leading to dynamic occlusion of his right vertebral artery. Conclusion This case highlights the utility of dynamic cerebral angiography in identifying previously unexplored causes of arteriogenic emboli formation, particularly in patients with predisposing anatomic and clinical risk factors.

Evaluation of host factors leading to the progression of urinary tract infections to urosepsis: a retrospective analysis from a tertiary care centre in Southern India

Context: Urinary tract infections (UTIs) are one of the recurrently occurring disease caused by bacteria that poses a major public health concern globally. Among the well studied host factors that predispose to urosepsis are the anatomical risk factors of the urinary tract including stones, tumours and interventions involving the urogenital tract such as an indwelling catheter or transrectal prostate biopsy. Aims: To evaluate the host factors leading to the progression of UTI to urosepsis. Settings and design: Clinical and laboratory data available from patient records as per the inclusion criteria were analysed retrospectively by using a detailed proforma. Methods and materials: Patient records were screened using the ICD code provided from the Medical Records department. Data of patients with clinically confirmed UTI were retrieved and included in the study. Statistical analysis used: Patient data was analysed using SPSS software version 20. Categorical and continuous data were summarized as percentages and means ± SD or median (P25, P75) respectively. Univariate analysis was performed using the chi-square test or Fisher's exact test for categorical variables. Results: A total of 94 patient records were included in the study. Demographic data showed that majority (53.19%) of the patients (n = 94) were female individuals. The results of univariate analysis showed that gender, frequent UTI, diabetes mellitus, presence of an indwelling urinary catheter and hospitalization more than 6 months were significantly associated with urosepsis. In addition, results of multivariate analysis identified the independent risk factors for urosepsis associated with urinary tract pathogens. Conclusion: This study showed that there is significant association between risk factors that determine the outcome of UTI and its progression to urosepsis.

Management of patellar instability in skeletally immature patients.

Surgical intervention is the treatment of choice for recurrent lateral patellar instability. Surgery should be considered for first time lateral patella dislocations with osteochondral fractures or underlying anatomical risk factors. Primary repair and nonanatomical imbrications/reconstructions have fallen out of favor due to abnormal biomechanics and high rates of recurrence. Anatomical reconstruction of the MPFL using a variety of auto and allograft tissues have yielded good outcomes and low redislocation rates. Physeal sparing MPFL reconstruction techniques under radiological control are safe and do not cause growth disturbance. Allografts may be indicated for hyperlax patients. Although no clear cutoff points exist, correction of valgus and excessive femoral anteversion should be considered when indicated. Osteochondral and chondral injuries are common and should be addressed during surgery for instability.

Update on Patellofemoral Anatomy and Biomechanics

The patellofemoral joint experiences substantial physiologic loads with normal daily activity. Anatomic risk factors can place certain patients at risk for patellofemoral pathology including patellar instability. Stability and load capacity of the joint are a result of numerous factors including the unique configuration of osseous and cartilaginous structures, static and dynamic soft tissue stabilizers, and global lower limb alignment. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is required to identify patient-specific sources of dysfunction and to tailor individualized treatment specific to a given patient's anatomy. Identification and correction of patient specific risk factors must form the basis for successful treatment strategies. Using novel imaging techniques, dissection methods, and technology for biomechanical evaluation, our understanding of the patellofemoral joint has continued to evolve and in turn help improve patient specific treatment and outcomes for patellar instability.

Patient-specific computer modelling to predict anatomical risk factors preventing post transcatheter aortic valve implantation coronary re-access in bicuspid aortic valve; a modelling study

Abstract Background Post Transcatheter aortic valve implantation (TAVI) coronary re-access is predicted to become more common as TAVI expands into lower risk cohorts. The use of a self-expanding valve (SEV) has been recognised as an independent predictor for unsuccessful coronary cannulation. Other predictors include reduced transcatheter heart valve (THV) to coronary distance and small sino-tubular junction. Despite this however a patient cohort remains in which the use of a SEV is preferable due to anatomical complexity or extensive calcification. Purpose Using patient-specific computer modelling, we aimed to assess how the deployment of different sized THVs and at different depths affected the distance from valve to coronary and valve to sino-tubular junction in bicuspid aortic valve cases. Methods In this modelling study we have used pre-procedural, CT-derived, patient-specific finite element analysis computer models to predict the eventual valve result. We studied two anatomical measures for both right and left coronary sinuses. The distance from coronary ostium to nearest structure, either THV or displaced native leaflet – Sinus of Valsalva (SoV) free space. The second distance was from the STJ to THV – STJ free space. THVs were modelled at both high and medium implant positions. THV size was based upon annular dimensions. Where the annular dimensions fell near an anatomical grey-zone, a second size THV was modelled. For each patient and measure, a mean of all distances was calculated, in addition to both minimum and maximum distances. Results The free space SOV left main coronary artery (LMCA) mean was 6.39 mm (4.87-7.91 mm). The difference between maximum and minimum was 0.9461 mm (0.54–1.36 mm), p&amp;lt;0.01. The largest patient-specific difference between minimum and maximum was 2.41 mm, using the same THV size but at different depths. The free space SOV right coronary artery (RCA) mean was 5.73 mm (4.17-7.30 mm). The difference between maximum and minimum was 0.789 mm (0.49-1.09 mm), p&amp;lt;0.01. The STJ free space LMCA mean was 4.3 mm (2.35–6.27 mm), The difference between maximum and minimum was 0.99 mm (0.63-1.35 mm), p&amp;lt;0.01. The STJ free space RCA mean was 3.76 mm (2.2-5.32 mm).The difference between maximum and minimum was 1.18 mm (0.9-1.56 mm), p&amp;lt;0.01. The largest patient-specific difference between minimum and maximum was 2.02 mm, using the same valve size but at different depths. Data presented as mean (95% confidence intervals), n=16 patients/48 models. Conclusions This modelling study has indicated a significant difference in all four measured parameters when different THVs are modelled at different depths. Note some of the largest differences are seen with the same size THV but at a different depth. We would highlight the small mean effect size seen across the results, however in cases where the difference is &amp;gt;2mm, this could have an effect on coronary re-access and warrants further investigation.

Abstract 13405: Cardiac Computed Tomography Variables for Prediction of New-Onset Heart Failure: Multi-Ethnic Study of Atherosclerosis

Introduction: Heart failure (HF) prediction models utilize clinical variables. The purpose of this study was to determine if addition of cardiac computed tomography (CT) variables could improve discrimination of HF prediction scores. Methods: Participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort between 45 to 84 years old and free of clinical cardiovascular disease at baseline, with complete clinical data and cardiac CT were included to evaluate new-onset HF during the follow-up period. Cardiac CT variables analyzed included left ventricular size index (LVSi) and calcification of the coronary arteries (CAC), aortic valve (AVC), mitral valve (MVC), and thoracic aorta (TAC). We evaluated if CT variables improved the Pooled Cohort equations to Prevent HF (PCP-HF) score (an internally and externally validated model of 33,010 patients predicting 10-year risk of new-onset HF). Results: Among 6,667 MESA participants (52.7% female), 426 events of new-onset HF occurred during the follow-up period. After the Cox model was adjusted for cardiac CT and PCP-HF score variables, CAC (HR 1.10; 95% CI 1.05-1.15; p&lt;0.001), AVC (HR 1.08; 95% CI 1.03-1.13; p=0.002), MVC (HR 1.06; 95% CI 1.01-1.12; p=0.015), and LVSi (HR 1.14; 95% CI 1.10-1.18; p&lt;0.001) were all significantly associated with new-onset HF. After using time-dependent ROC and stratifying by sex, AUC discrimination of new-onset HF with the PCP-HF score was improved by the inclusion of cardiac CT variables. In females, the AUC for 10-year risk of new-onset HF improved from 0.80 to 0.86 with the addition of cardiac CT variables. In males, the AUC for 10-year risk of new-onset HF improved from 0.77 to 0.84 with the addition of cardiac CT variables. Conclusions: In addition to traditional clinical risk factors, cardiac CT variables provide anatomic risk factors that improve the prediction of new-onset HF. Coronary and valvular calcification may signal poorly controlled clinical risk factors that are often associated with HF. LVSi may reflect left ventricular remodeling associated with HF. More studies are needed to further elucidate the relationship between cardiac CT anatomic risk factors and HF.

Anterior talofibular ligament plastic in patients with chronic ankle instability (literature review)

Ankle joint injury is one of the leading nosologies in the general structure of the musculoskeletal system lesions, not only among professional athletes, but also among the adult population in general. In case of conservative therapy ineffectiveness, chronic instability of the ankle joint develops, which can significantly reduce the patient’s quality of life, in this situation, the surgical treatment becomes uncontested. The choice of the surgical intervention method is determined not only by the nature of the injury, but also by the ligamentous-tendon apparatus condition. In addition, to a large extent, surgical tactics is chosen based on the preferences of the individual surgeon. The article describes the anatomical and physiological features and risk factors that determine the occurrence of acute the ankle joint instability and its transition to a chronic state, as well as the main methods of the anterior talofibular ligament plastic surgery and their common modifications. Special attention is paid to the effectiveness evaluating methods of surgical techniques on cadaveric ligamentous material. An analysis of the literature shows that the study of the issue remains insufficient. New clinical data obtaining will increase the effectiveness of the surgical technique for ankle instability treating and significantly improve the quality of life of patients.

Emerging findings for the assessment and treatment of pediatric deep neck abscesses.

The purpose of this review is to summarize new literature regarding the description, diagnosis, and treatment of pediatric deep neck abscesses. Providers should include multi-inflammatory syndrome in children (MIS-C) in a differential diagnosis in children suspected of having a retropharyngeal abscess. MRI may guide the proper management of children with deep neck abscesses by more accurately detecting free fluid compared to computed tomography imaging. Factors that may predict the need for surgical management include elevations in white blood cell counts and abscess size more than 3 cm. However, future investigation is necessary to establish consistent guidelines. Medical management is effective in many children, with a new study indicating success using a combination of cefotaxime and rifampicin. Anatomical and age-related risk factors predispose children to the development of deep neck abscesses. Findings from recent studies may aid providers in making an accurate diagnosis and providing proper medical or surgical management of children with these infections.