Anatomical Appearance Research Articles

Forces at the Anterior Meniscus Attachments Strongly Increase Under Dynamic Knee Joint Loading

Background: The anatomic appearance and biomechanical and clinical importance of the anterior meniscus roots are well described. However, little is known about the loads that act on these attachment structures under physiological joint loads and movements. Hypotheses: As compared with uniaxial loading conditions under static knee flexion angles or at very low flexion-extension speeds, more realistic continuous movement simulations in combination with physiological muscle force simulations lead to significantly higher anterior meniscus attachment forces. This increase is even more pronounced in combination with a longitudinal meniscal tear or after total medial meniscectomy. Study Design: Controlled laboratory study. Methods: A validated Oxford Rig–like knee simulator was used to perform a slow squat, a fast squat, and jump landing maneuvers on 9 cadaveric human knee joints, with and without muscle force simulation. The strains in the anterior medial and lateral meniscal periphery and the respective attachments were determined in 3 states: intact meniscus, medial longitudinal tear, and total medial meniscectomy. To determine the attachment forces, a subsequent in situ tensile test was performed. Results: Muscle force simulation resulted in a significant strain increase at the anterior meniscus attachments of up to 308% (P < .038) and the anterior meniscal periphery of up to 276%. This corresponded to significantly increased forces (P < .038) acting in the anteromedial attachment with a maximum force of 140 N, as determined during the jump landing simulation. Meniscus attachment strains and forces were significantly influenced (P = .008) by the longitudinal tear and meniscectomy during the drop jump simulation. Conclusion: Medial and lateral anterior meniscus attachment strains and forces were significantly increased with physiological muscle force simulation, corroborating our hypothesis. Therefore, in vitro tests applying uniaxial loads combined with static knee flexion angles or very low flexion-extension speeds appear to underestimate meniscus attachment forces. Clinical Relevance: The data of the present study might help to optimize the anchoring of meniscal allografts and artificial meniscal substitutes to the tibial plateau. Furthermore, this is the first in vitro study to indicate reasonable minimum stability requirements regarding the reattachment of torn anterior meniscus roots.

Total Knee Arthroplasty Design and Kinematics: Past, Present, and Future.

Total knee arthroplasty has undergone significant improvement in design and clinical application over the past 45 years. Unfortunately, 15-20% of patients are not satisfied with their result. While the explanation for this discrepancy is multifactorial, prosthetic design and the motion of the knee in space has come under greater scrutiny. The early designs attempted to copy the anatomic appearance of the knee joint without considering how the knee would move. Kinematics is now considered to be of paramount importance and may be the key to the future of knee arthroplasty.

3D-printed anatomical models of the cystic duct and its variants, a low-cost solution for an in-house built simulator for laparoscopic surgery training.

To explore a method to create affordable anatomical models of the biliary tree that are adequate for training laparoscopic cholecystectomy with an in-house built simulator. We used a fused deposition modeling 3D printer to create molds of Acrylonitrile Butadiene Styrene (ABS) from Digital Imaging and Communication on Medicine (DICOM) images, and the molds were filled with silicone rubber. Thirteen surgeons with 4-5-year experience in the procedure evaluated the molds using a low-cost in-house built simulator utilizing a 5-point Likert-type scale. Molds produced through this method had a consistent anatomical appearance and overall realism that evaluators agreed or definitely agreed (4.5/5). Evaluators agreed on recommending the mold for resident surgical training. 3D-printed molds created through this method can be applied to create affordable high-quality educational anatomical models of the biliary tree for training laparoscopic cholecystectomy.

Next-Generation Prosthetic Hand: from Biomimetic to Biorealistic.

Integrating a prosthetic hand to amputees with seamless neural compatibility presents a grand challenge to neuroscientists and neural engineers for more than half century. Mimicking anatomical structure or appearance of human hand does not lead to improved neural connectivity to the sensorimotor system of amputees. The functions of modern prosthetic hands do not match the dexterity of human hand due primarily to lack of sensory awareness and compliant actuation. Lately, progress in restoring sensory feedback has marked a significant step forward in improving neural continuity of sensory information from prosthetic hands to amputees. However, little effort has been made to replicate the compliant property of biological muscle when actuating prosthetic hands. Furthermore, a full-fledged biorealistic approach to designing prosthetic hands has not been contemplated in neuroprosthetic research. In this perspective article, we advance a novel view that a prosthetic hand can be integrated harmoniously with amputees only if neural compatibility to the sensorimotor system is achieved. Our ongoing research supports that the next-generation prosthetic hand must incorporate biologically realistic actuation, sensing, and reflex functions in order to fully attain neural compatibility.

Anatomically based radiological classification of thumb basal joint arthritis

The numerous surgical techniques proposed for treating thumb basal joint arthritis (osteotomy of the first metacarpal, trapezial osteotomy, simple trapeziectomy, trapeziectomy with implant, total joint prosthesis, arthroplasty by interposition, etc.) necessitate an anatomically based radiological evaluation of the different pathological forms of thumb basal joint arthritis. Here, the author defines three parameters: narrowing of the trapeziometacarpal (TM) joint space: TMA; TM instability and subluxation: TM I; scaphotrapeziotrapezoid damage: STT. Four stages of TM osteoarthritic deterioration are defined: TMA0: no joint narrowing (painful and unstable joint); TMA1: narrowing <50%; TMA2: narrowing>50%; TMA3: disappearance of the joint space, bone erosions. For TM instability/subluxation: TMI 0: reducible subluxation (unstable and painful TM); TMI 1: reducible subluxation but with imperfect reintegration; TMI 2: non-reducible subluxation <1/3; TMI 3: subluxation>1/3. For STT damage, STT 0: radiograph is normal but anatomical damage is visible intraoperatively; STT 1: joint space narrowing <50%; STT 2: joint space is barely visible; STT 3: presence of erosion, sclerosis, irregularities. He outlines the shortcomings of the often-used Dell and Eaton-Littler classifications. A prospective study involving multiple cases having the same anatomical and radiological appearance that are assessed with sufficient follow-up is needed to standardize the modalities of surgical treatment.

A PROBIOTIC APPLICATION OF Lactobacillus acidophilus HT1 FOR THE TREATMENT OF SOME SKIN PATHOGENS

The present study was designed to investigate the possibility of using Lactobacillus as a skin probiotic. For this purpose, 63 isolates of Lactobacillus sp. were collected from dairy products and human mouth samples. The isolates were screened for bacteriocin production by primary and secondary screening against three common skin pathogens. The results showed that the isolate Lactobacillus HT1give the highest productivity of bacteriocin (320AU/ml), the efficient isolate was identified through molecular detection using 16S ribosomal RNA gene. In addition, result showed that L. acidophilus HT1 was un encapsulated; has no capability to produce biofilm and was susceptible to amoxicillin–clavulanic acid, vancomycin and chloramphenicol. Moreover, the infectious dose of L. acidophilus HT1 was studied and results revealed that mice were remained in a healthy condition including all vital processes such as breathing, consuming food and water as well as external and anatomical appearance. Next, an emul gel formula contained L. acidophilus HT1 biomass was prepared which already examined in vitro and in vivo. Our results confirmed the efficacy of the formula via inhibiting the growth of pathogenic isolates and through several points included: viability of L. acidophilus HT1 cells, its ability to produce bacteriocin, and its releasing from the formula to the external environment without trapping or interaction among bacteriocin and any component of formula. In vivo results approved the affectivity of L. acidophilus HT1 biomass to treat the wounds infected with different bacterial pathogens during seven days after the onset of treatment compared with the control groups.

Self- and proxy-reported outcomes after surgery in people with disorders/differences of sex development (DSD) in Europe (dsd-LIFE)

Surgery is performed in many individuals with disorders/differences of sex development (DSD). Irreversibility of some surgical procedures, lack of information about the procedures, and lack of follow-up care for physical and psychological outcomes, lead to wish for more knowledge from both surgeons and patients. After the consensus conference in 2006, multidisciplinary care is provided to a higher degree with psychological support and more restricted surgical procedures. Outcome studies after genital surgery often lack of patient's perspective. To describe surgical procedures in relation to diagnosis, to evaluate the outcomes of surgery through genital examination, and through patient's and observer's satisfaction with the anatomical and functional result after genital surgery. In a cross-sectional clinical study performed in six European countries in 2014/15, we have included 500 participants where surgery was performed, from a total of 1040 adolescents (≥16years) and adults with a DSD. Diagnoses included Turner syndrome (n=301), mixed gonadal dysgenesis (45,XO/46,XY; n=45), Klinefelter syndrome (n=218), XYY (n=1), 46, XY DSD (n=222) and 46, XX DSD (n=253). Study protocol included clinical report files, an optional gynecological or urological examination, patient reported outcomes including received surgical interventions, satisfaction with appearance and function after surgery, and impact of the surgical procedure on life. Five hundred participants had received genital or breast surgery, with the highest rate in 46, XY DSD and the lowest in Turner syndrome. Altogether; 240 participants had feminizing surgery, 112 had masculinizing surgery, and 217 underwent gonadectomy. Physicians evaluated anatomical appearance at genital examination as poor in less than 10%. Dissatisfaction with anatomical appearance was reported by 22% of the participants, dissatisfaction with function by 20%. Being (very) dissatisfied with anatomical appearance and function was reported by 13% of the study participants. Most participants reported no impact, or positive impact, of the surgical procedures on their lives, but 29% experienced a negative effect of gonadectomy on their life. There might be a selection bias and/or a recall bias for participating in our studies. Due to poor data quality about surgical procedures performed in the past, we also relied on participants memory about surgical procedures in their past. Ideally, patient reported outcomes should be evaluated both before and after surgical procedures. A vast majority are satisfied with appearance and function, but still genital or breast surgery have a long-lasting effect on patient's life. Self-reported satisfaction is usually lower than the observer's evaluation regarding both appearance and function.

Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications.

OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.

Olfactory Deprivation and Enrichment: An Identity of Opposites?

The effects of deprivation and enrichment on the electroolfactogram of mice were studied through the paradigms of unilateral naris occlusion and odor induction, respectively. Deprivation was shown to cause an increase in electroolfactogram amplitudes after 7 days. We also show that unilateral naris occlusion is not detrimental to the gross anatomical appearance or electroolfactogram of either the ipsilateral or contralateral olfactory epithelium even after year-long survival periods, consistent with our previous assumptions. Turning to induction, the increase in olfactory responses after a period of odor enrichment, could not be shown in CD-1 outbred mice for any odorant tried. However, consistent with classical studies, it was evident in C57BL/6J inbred mice, which are initially insensitive to isovaleric acid. As is the case for deprivation, enriching C57BL/6J mice with isovaleric acid causes an increase in their electroolfactogram response to this odorant over time. In several experiments on C57BL/6J mice, the odorant specificity, onset timing, recovery timing, and magnitude of the induction effect were studied. Considered together, the current findings and previous work from the laboratory support the counterintuitive conclusion that both compensatory plasticity in response to deprivation and induction in response to odor enrichment are caused by the same underlying homeostatic mechanism, the purpose of which is to preserve sensory information flow no matter the odorant milieu. This hypothesis, the detailed evidence supporting it, and speculations concerning human odor induction are discussed.

Review and optimisation of foot radiography technique

IntroductionRadiography is an important tool in the diagnosis of trauma and diseases of the foot. Consistent image quality and anatomical appearances are essential to ensure that images are interpreted correctly and this study aims to evaluate current technique and use anthropomorphical phantoms in order to investigate the most optimal radiographic technique. MethodsA two part study was conducted. An electronic survey was administered in order to ascertain the current radiographic technique utilised within the United Kingdom (UK) National Health Service (NHS) and compare this with techniques published within radiographic positioning textbooks in common use within the UK. A phantom experiment also sought to identify the most appropriate angulation of the central beam to employ in order to optimally visualise the anatomy for standard non-trauma radiography of the foot. A relative visual grading analysis technique was used to assess radiographic quality. ResultsThe electronic survey was completed by 38% of departments (n = 69/182) and demonstrated wide inconsistencies in projections, centring points and beam angulations employed across the NHS. The most commonly employed techniques no longer match the majority of positions described in textbooks. The phantom experiment modelled the ability to accurately visualise anatomy with a variation of the central beam angulation. The results demonstrated that the most commonly described textbook techniques remain the most optimal for accurately visualising the anatomy of the foot. ConclusionThis study has validated the radiographic techniques of the foot described in many of the key texts, however self-reported current practice has diverged from this textbook description. Implications for practiceReinforcement of fundamental principles will benefit the patient with increased image quality, improved diagnosis and improved consistency of images, particularly when patient care is transferred between centres.

Pareidolia in Radiology Education: A Randomized Controlled Trial of Metaphoric Signs in Medical Student Teaching

A radiology sign that references a resemblance to something which is not actually present within an image has been termed a 'metaphoric' sign. Metaphoric signs are widely described in the literature and commonly used in teaching as a form of pattern recognition, or 'pareidolia'. However, the educational benefit of metaphoric signs has not been previously assessed. We aimed to assess the utility of metaphoric signs in medical student teaching. Fifteen radiology cases were prepared into two lecture formats for medical student education. A 'test' lecture utilizing metaphoric radiology signs to describe the appearance of the cases and a 'control' lecture where pathology was compared to normal anatomical appearances without reference to metaphoric signs. Forty-nine volunteer medical students were randomized with cluster sampling to receive either the test or control lecture. Four days later, students were quizzed to determine retention of knowledge and to assess interest in the lecture on a visual analogue scale from 0 to 100. The median interest level of the test group (69.5) was higher than the control group (50) (p = 0.001). The mean quiz score was higher in the test group (34.5) than in the control group (29) (Difference 5.5, 95% confidence interval 0.08-10.92, p = 0.047). The use of metaphoric signs in radiology education of medical students increased interest, descriptive ability and short-term knowledge retention, compared to the same material taught with normal anatomy correlation. Metaphoric signs should be considered as a useful radiology teaching tool.

Preclinical assessment of clinically streamlined, 3D-printed, biocompatible single- and two-stage tissue scaffolds for ear reconstruction.

Auricular reconstruction is a technically demanding procedure requiring significant surgical expertise, as the current gold standard involves hand carving of the costal cartilage into an auricular framework and re-implantation of the tissue. 3D-printing presents a powerful tool that can reduce technical demands associated with the procedure. Our group compared clinical, radiological, histological, and biomechanical outcomes in single- and two-stage 3D-printed auricular tissue scaffolds in an athymic rodent model. Briefly, an external anatomic envelope of a human auricle was created using DICOM computed tomography (CT) images and modified in design to create a two-stage, lock-in-key base and elevating platform. Single- and two-stage scaffolds were 3D-printed by laser sintering poly-L-caprolactone (PCL) then implanted subcutaneously in five athymic rats each. Rats were monitored for ulcer formation, site infection, and scaffold distortion weekly, and scaffolds were explanted at 8 weeks with analysis using microCT and histologic staining. Nonlinear finite element analysis was performed to determine areas of high strain in relation to ulcer formation. Scaffolds demonstrated precise anatomic appearance and maintenance of integrity of both anterior and posterior auricular surfaces and scaffold projection, with no statistically significant differences in complications noted between the single- and two-staged implantation. While minor superficial ulcers occurred most commonly at the lateral and superior helix coincident with finite element predictions of high skin strains, evidence of robust tissue ingrowth and angiogenesis was visible grossly and histologically. This promising preclinical small animal model supports future initiatives for making clinically viable options for an ear tissue scaffold.

Endarterectomy with "systematized" resection anastomosis of carotid bulb, about 240 cases.

Carotid endarterectomy has traditionally been the strategy for the surgical management of carotid stenosis. Alongside the usual techniques, this study presents another technique: endarterectomy with systematized resection-anastomosis. A retrospective study from January 2006 to December 2018, included all patients managed for carotid stenosis at Meaux hospital with the "endarterectomy with systematized resection-anastomosis" technique. The perioperative death and stroke rate were evaluated according to the judgment criterion "homolateral ischemic stroke and any stroke or perioperative death". Statistical analysis of the data was performed using SPSS software. For 415 carotids operated, we identified 240 managed with this technique. The average age was 71.7±9.6 years, 70% men and 30% women. The main cardiovascular risk factor was hypertension (76.7%), 24.2% of patients had an ischemic heart disease history, 43.7% homolateral ischemic stroke and 29% transient ischemic attack. Bilateral lesions were diagnosed in 6.2% of patients and 7.5% had contralateral occlusion. Carotid stenosis was symptomatic in 52.9% of patients. The average stenosis rate observed was 82.9±8.1% on computed tomography angiogram and 83.7±7.7% on magnetic resonance angiogram. The shunt was used in 45.4% of procedures. The average length of stay was 5.9±2.3 days. All patients had satisfactory results in terms of patency and anatomical appearance on the 1st check. In the post-operative period during the first month, complications occurred in 12.5% of patients (1.6% acute coronary syndrome, 0.8% neurological event, 0.8% death, 0.4% infection, 12.1% hematoma, 1.6% recovery for bleeding). The overall perioperative death and stroke rate was 2.6%. Myocardial infarction and sepsis were the causes of death for the 2 patients in the peri operative period. The mean duration of follow-up was 21.2 months, without any restenosis or occurrence of neurological complications. One patient died beyond the 1st month of follow-up without established cause, and the overall mortality rate was 1.3%. Thromboendarterectomy with "systematized" anastomosis resection represents an angioplasty method for carotid stenosis surgical management under visual control.

Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

Introduction In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% ( n = 40/238), and this improved to 47.8% ( n = 77/161) post-intervention, but declined to 32.8% ( n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort ( p &lt; 0.001) and the late post-intervention group ( p = 0.002) but not in the examinations performed two weeks after staff education ( p = 0.239). Conclusion Assessment of image quality is critical for diagnosis and treatment monitoring. Yet poor compliance with standard anatomical principles was evident. A simple educational intervention resulted in a transient improvement in wrist positioning, but the impact was not sustained over time.

Endoscopic Multimodal Approach to the Treatment of Airway Venous Malformations.

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Vascular Repair for Prolongation of Life Span of Cadaveric Teaching Specimens

IntroductionCadaveric teaching specimens play a critical role in anatomy education at numerous levels (from undergraduate to doctoral studies, residents, fellows, professors, or visiting scholars/researchers). Due to exposure during teaching and other activities, it is not uncommon for cadaveric structures to sustain damage or normal wear and tear. Damaged or missing structures pose a problem to effective and accurate teaching of anatomy, and ultimately have negative downstream impact on the students’ general anatomic and clinical knowledge base. Additionally, excessive damage to cadavers is one of the leading reasons to retire a specimen from the teaching floor, reducing the number of cadavers available for anatomical study. At Michigan State University (MSU), the Human gross anatomy lab is heavily used for teaching purposes. The cadaveric specimens and body parts are all based on prosected models. Due to this heavy usage it is not uncommon to encounter damaged or missing structures (neurovasculature, muscles, tendons, ligaments, etc) in these specimens. All cadavers prosected at MSU are donors acquired through the university’s Willed Body Program. The generous gift of one’s body to anatomical education is invaluable. Therefore, out of moral obligation and respect to those who have made this gift, the maintenance and prolongation of the teaching lifespan of each donor or body part must be a priority.AimDevelopment of a protocol for anatomically accurate repair of damaged or missing structures of cadaveric specimens, with particular focus on vasculature.MethodsAll torn or cut arteries or veins were repaired using simple surgical techniques. Partially or totally severed vessels were apposed using either 3‐0 or 4‐0 silk sutures and appropriate suture pattern. Grafts of vessels harvested from other areas on the same donor were used to bridge truncated vessels. Similarly, fascia or membranous tissues were harvested and used to mask the repair sites, to prevent further damage and maintain normal anatomic appearances. For small vessels, glue was sufficient to help anastomoses cut ends or close lacerations.ResultsAnatomically accurate vascular repairs were completed on over 20 teaching specimens. Vessels repaired consisted of veins, arteries, lymphatics, and bile ducts. Through these repairs, we were able to restore damaged vascular structures to their appropriate forms and locations. The net outcome is the prolongation of the educational life of each cadaver or body part.Discussion and ConclusionOur protocol enabled us to accurately repair vascular tissues on multiple donors. Hence, with the establishment of this cadaveric vascular repair protocol we will prolong the teaching life for many donors and body parts in labs across all MSU campuses. Additionally, with this protocol in place, we hope to increase and sustain uniform maintenance of donors, ensuring accuracy and availability of human anatomic specimens for all levels of educational activities.

Skull Abnormalities in Cadavers in the Gross Anatomy Lab.

Background The skull encompasses and houses one of the most important organs in the body—the brain—and like all tissues in the body, it is comprised of living cells that are constantly remodeling as this maintains the strength and homeostasis of the bone. In the present study, abnormal bone growth patterns were observed and the possible causes of said findings were investigated in multiple cadaver skulls dissected during head and neck anatomy courses at Detroit Mercy Dental over the past year. There are many factors, both intrinsic and extrinsic, with differences in stimulation to the skull resulting in skull abnormalities. Materials and Methods. For this study, skull abnormalities were examined from 65 formalin-embalmed cadaver heads, obtained from the Gross Anatomy Laboratory at the University of Detroit Mercy School of Dentistry between the years 2016 and 2019. We have recorded the age, sex, and previous chief medical issues of all lab specimens used in the study. Skulls were later evaluated for possible indications of bone disease such as hypertosis frontalis interna (HFI) or Paget's disease. Results Among the sixty-five specimens provided to the Detroit Mercy Dental cadaver lab, 19 specimens (29%) were found to present with irregular, undulating, thickening of the frontal bone internal surface. The findings located on the skulls closely resembled the gross anatomic appearance of HFI or Paget's disease; however, a conclusive diagnosis of these skull abnormalities cannot be made without a pathologist biopsy and radiological examination. Twelve of the nineteen specimens that displayed possible bone disease, approximating 63% prevalence, were females; their ages ranged from 68 to 95 years old. Thus, seven of the nineteen specimens exhibiting features of skull abnormalities, approximating 36% prevalence, were males with ages ranging from 70 to 103 years old. In addition, five of these nineteen specimens collected (26% prevalence) had been diagnosed with neurological disorders, including Alzheimer's, dementia, depression, and Parkinson's disease. In the current study, the proportion of specimens exhibiting skull abnormalities was higher compared to the overall prevalence observed in previous studies. Conclusion Possible causes of observed anatomical abnormalities in the skull of cadavers of a gross anatomy laboratory were investigated, and it was determined that hypertosis frontalis interna (HFI) may contribute to such abnormalities. This is a condition that affects bone growth in the frontal skull. Our numbers of skull abnormalities were higher than previous studies and might be due to the fact that HFI was predominately present as an incidental finding during imaging of postmenopausal females or observed postmortem in cadavers. In addition, Paget's disease or hormonal imbalances could also result in similar features, and thus cannot be ruled out as a plausible cause. Paget's disease causes the bone to deposit at a faster rate than normal, which will result in thick and brittle bone. Studies that will involve further examination of new cadavers for the presence of HFI is needed, either using biopsy specimens and/or radiological examination to explore possible causes for the abnormal bone growth in the frontal bone.

PERBEDAAN INFORMASI CITRA ANATOMI SEKUEN DIFFUSION WEIGHTED IMAGING (DWI) ANTARA PENGGUNAAN PROPELLER DENGAN TANPA PROPELLER PADA PEMERIKSAAN MRI BRAIN DENGAN KASUS STROKE

Background: Stroke is a brain disease where an acute nerve function is occurred due to the cerebral vascular disorders. To establish a diagnosis the stroke, it can be identified by employing the Diffusion Weighted Imaging (DWI) sequence in the MRI examination. Artifacts still exist on the MRI image which in turn reduce the resolution when using the DWI sequence. Adding the PROPELLER data acquisition method in the DWI sequence possibly improves the quality of brain images. The purpose of this study is to know the difference on the quality of anatomical image information between the DWI sequences with PROPELLER and without PROPELLER methods, and to determine adequate anatomical image appearance that created in amongst of the two methods, specifically for the stroke disease.Methods: this research is quantitative research with experimental approach. This study was conducted using MRI 1.5 T at Bethesda Hospital Yogyakarta. Data were 16 images from 8 patients using DWI sequences using PROPELLER without PROPELLER on MRI Brain examination with stroke. The results of the image were evaluated on 7 criteria: cortex cerebri, basal ganglia, thalamus, pons, cerebellum, stroke (infarction) and artifacts using questionnaires given to 3 respondents. Data analysis was done by Wilcoxon test to know the difference of anatomical image information on DWI sequence using PROPELLER without PROPELLER and to know better anatomical image information from both sequences seen from mean rank value.Results: The results shown, there is a significant difference on the quality of anatomical image information and the artifacts between the use of DWI sequence with and without PROPELLER methods ( 0.05). Based on the mean rank results, the DWI PROPELLER sequence has a higher mean rank value 4.50 compared to the DWI sequence without PROPELLER 0.00.Conclusions: The DWI PROPELLER sequence has better image results compared to the DWI sequence without PROPELLER.

Associations between maternal serum and urinary metal concentrations and birthweight

Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07–11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05–2.77 and OR 2.74, 95% CI 1.12–6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07–11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction.Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.

Comparison of the clinical and radiographic appearance of the cervical vertebrae with histological and anatomical findings in an eight-month old warmblood stallion suffering from cervical vertebral stenotic myelopathy (CVSM)

BackgroundCervical vertebral stenotic myelopathy (CVSM) remains one of the most important abnormalities of the cervical spine resulting in neurological deficits in horses. The aim of the following study was to compare the results of the clinical and neurological examination, the results of myelography and the post mortem anatomical and histological appearance of the spinal cord and cervical vertebrae in a horse with CVSM.Case presentationThe following study describes a clinical case of an eight-month-old stallion with ataxia. Plain cervical radiographs indicated narrowing of the spinal canal. Conservative therapy using NSAIDs did not result in any improvement in the gait of the horse. Due to economic constraints, surgical intervention was excluded. The owner chose to humanely euthanise the horse. Immediately after euthanasia, post mortem myelography was performed, and measurements of the myelographic dye column were taken. They revealed a 67% DMC reduction and a 64% DD reduction at the C3/C4 level. Afterwards, an anatomical dissection was performed. The cervical vertebrae and vertebral canal were macroscopically inspected and measured and indicated a 44% narrowing of the canal at the C3/C4 level. The spinal cord was removed and underwent histological evaluation after staining. Microscopic lesions were visible at the level of the compression and included axonal degeneration with partial or complete loss of myelin in the white matter of the lateral and dorsal funiculi as well as the formation of dysfunctional so-called “spongy structures”. An increase in the number of microglial cells and collagen was also observed. The formation of glial scars was excluded. Immunohistochemical studies revealed a negative transmembrane glycoprotein CD68(−) – monocyte response and a negative tumor necrosis alpha TNFα (−) reaction.ConclusionsCVSM may be difficult to diagnose, even for experienced veterinary surgeons. Currently, an ex vivo histopathologic examination of the spinal cord is thought to be the gold standard in the diagnosis of CVSM. Our histological examination revealed no CVSM-specific glial scar formation and a CD68(−) negative and TNF-α negative reaction, which have not been previously reported. Histological lesions in CVSM may vary depending show inter-individual variability and on the treatment, which further hinders ex-vivo diagnostics.