Anterior-posterior Diameter Research Articles

Construction and validation of a risk prediction model for 3- and 5-year new-onset atrial fibrillation in HFpEF patients.

Patients with heart failure (HF) with preserved ejection fraction (HFpEF) are more prone to atrial fibrillation (AF) compared to those with heart failure with reduced ejection fraction (HFrEF). Nevertheless, a risk prediction model for new-onset atrial fibrillation (NOAF) in HFpEF patients remains a notable gap, especially with respect to imaging indicators. We retrospectively analyzed 402 HFpEF subjects reviewed at the Affiliated Hospital of Qingdao University from 2017 to 2023. Cox regression analysis was performed to screen predictors of NOAF. A nomogram was constructed based on these factors and internally validated through the bootstrap resampling method. A performance comparison between the nomogram and the mC2HEST score was performed. Out of the 402 participants, 62 (15%) developed atrial fibrillation. The risk factors for NOAF were finally screened out to include age, chronic obstructive pulmonary disease (COPD), hyperthyroidism, renal dysfunction, left atrial anterior-posterior diameter (LAD), and pulmonary artery systolic pressure (PASP), all of which were identified to create the nomogram. We calculated the bootstrap-corrected C-index (0.819, 95% CI: 0.762-0.870) and drew receiver operator characteristic (ROC) curves [3-year areas under curves (AUC) = 0.827, 5-year AUC = 0.825], calibration curves, and clinical decision curves to evaluate the discrimination, calibration, and clinical adaptability of the six-factor nomogram. Based on two cutoff values calculated by X-tile software, the moderate- and high-risk groups had more NOAF cases than the low-risk group (P < 0.0001). Our nomogram showed better 3- and 5-year NOAF predictive performance than the mC2HEST score estimated by the Integrated Discriminant Improvement Index (IDI) and the Net Reclassification Index (NRI) (P < 0.05). The nomogram combining clinical features with echocardiographic indices helps predict NOAF among HFpEF patients.

Rates of change of pons and middle cerebellar peduncle diameters are diagnostic of multiple system atrophy of the cerebellar type.

Definitive diagnosis of multiple system atrophy of the cerebellar type (MSA-C) is challenging. We hypothesized that rates of change of pons and middle cerebellar peduncle diameters on MRI would be unique to MSA-C and serve as diagnostic biomarkers. We defined the normative data for anterior-posterior pons and transverse middle cerebellar peduncle diameters on brain MRI in healthy controls, performed diameter-volume correlations and measured intra- and inter-rater reliability. We studied an Exploratory cohort (2002-2014) of 88 MSA-C and 78 other cerebellar ataxia patients, and a Validation cohort (2015-2021) of 49 MSA-C, 13 multiple system atrophy of the parkinsonian type (MSA-P), 99 other cerebellar ataxia patients and 314 non-ataxia patients. We measured anterior-posterior pons and middle cerebellar peduncle diameters on baseline and subsequent MRIs, and correlated results with Brief Ataxia Rating Scale scores. We assessed midbrain:pons and middle cerebellar peduncle:pons ratios over time. The normative anterior-posterior pons diameter was 23.6 ± 1.6 mm, and middle cerebellar peduncle diameter 16.4 ± 1.4 mm. Pons diameter correlated with volume, r = 0.94, P < 0.0001. The anterior-posterior pons and middle cerebellar peduncle measures were smaller at first scan in MSA-C compared to all other ataxias; anterior-posterior pons diameter: Exploratory, 19.3 ± 2.6 mm versus 20.7 ± 2.6 mm, Validation, 19.9 ± 2.1 mm versus 21.1 ± 2.1 mm; middle cerebellar peduncle transverse diameter, Exploratory, 12.0 ± 2.6 mm versus 14.3 ±2.1 mm, Validation, 13.6 ± 2.1 mm versus 15.1 ± 1.8 mm, all P < 0.001. The anterior-posterior pons and middle cerebellar peduncle rates of change were faster in MSA-C than in all other ataxias; anterior-posterior pons diameter rates of change: Exploratory, -0.87 ± 0.04 mm/year versus -0.09 ± 0.02 mm/year, Validation, -0.89 ± 0.48 mm/year versus -0.10 ± 0.21 mm/year; middle cerebellar peduncle transverse diameter rates of change: Exploratory, -0.84 ± 0.05 mm/year versus -0.08 ± 0.02 mm/year, Validation, -0.94 ± 0.64 mm/year versus -0.11 ± 0.27 mm/year, all values P < 0.0001. Anterior-posterior pons and middle cerebellar peduncle diameters were indistinguishable between Possible, Probable and Definite MSA-C. The rate of anterior-posterior pons atrophy was linear, correlating with ataxia severity. Using a lower threshold anterior-posterior pons diameter decrease of -0.4 mm/year to balance sensitivity and specificity, area under the curve analysis discriminating MSA-C from other ataxias was 0.94, yielding sensitivity 0.92 and specificity 0.87. For the middle cerebellar peduncle, with threshold decline -0.5 mm/year, area under the curve was 0.90 yielding sensitivity 0.85 and specificity 0.79. The midbrain:pons ratio increased progressively in MSA-C, whereas the middle cerebellar peduncle:pons ratio was almost unchanged. Anterior-posterior pons and middle cerebellar peduncle diameters were smaller in MSA-C than in MSA-P, P < 0.001. We conclude from this 20-year longitudinal clinical and imaging study that anterior-posterior pons and middle cerebellar peduncle diameters are phenotypic imaging biomarkers of MSA-C. In the correct clinical context, an anterior-posterior pons and transverse middle cerebellar peduncle diameter decline of ∼0.8 mm/year is sufficient for and diagnostic of MSA-C.

Cephalometric Evaluation of the Relationship Between Cervical Vertebral Morphology and Anomalies and the Cranial Base Angle in Different Facial Types and Skeletal Classes

This study examines the morphology and common anomalies of the cervical vertebrae in different skeletal classes and facial types. This cross-sectional study was conducted on 137 lateral cephalometric images of patients aged 18-55 years. The images were evaluated for fusion and posterior arch deficiency as the two most common anomalies along with cervical vertebral morphology (dense angle, the height of the posterior arch of the atlas, the external anterior posterior diameter of the atlas, and the cranial base angle). Data were categorized into three skeletal classes based on the Wits analysis and the ANB angle and also three facial types based on the SN-MP angle. These calculations were performed in SPSS 22 at the significance level of P&lt;0.05. The height of the posterior arch of the atlas was directly and significantly related to age and increased with it. The mean external anterior posterior diameter of C1 was higher in men and in the hypodivergent group. As for the other factors, including cervical spine anomalies, no significant relationship was observed with age, sex, skeletal classes, facial types, and the cranial base angle. Moreover, the mean morphology of the cervical spine was not significantly associated with skeletal classes. Based on the results, the height of the posterior arch of the atlas was associated with age and increased along with it. Moreover, the mean external anterior posterior diameter of the atlas was greater in men and in hypodivergent individuals.

CT measurements of the proximal femoral medullary cavity in healthy adults: a cross-sectional study

Objective: To analyse the proximal femoral morphology on three-dimensional reconstructed imagery to explore the factors influencing the relevant parameters. Method: The cross-sectional study was conducted at Peking University Third Hospital in northern China from January 2019 to August 2020, and comprised healthy adults who underwent computed tomography scanning. Three-dimensional computed tomography reconstruction of the proximal femoral medullary cavity was performed using Mimics 22. The anatomical parameters related to total hip arthroplasty were measured to examine the relationship among gender, age and femoral length. Data was analysed using SPSS 20. Results: Of the 63 adults, meaning 126 hips, 21(33.3%) were males, meaning 42(33.3%) hips, and 42(66.6%) were females, meaning 84(66.6%) hips. The overall mean age was 51.5±23.1 years (range: 23-68 years). The inflection point of the medullary cavity curved at 5-10mm distal to the lesser trochanteric line. Most horizontal plane parameters significantly differed between men and women (p&lt;0.05), with the mean medullary cavity being wider in men than women. There was a significant difference between the genders in the sagittal anterior-posterior diameter of the canal flare index (p&lt;0.05). Age was negatively correlated with the coronal medial-lateral diameter and coronal lateral diameter of canal flare index. In the coronal and sagittal planes, there was a positive correlation between the metaphysis and diaphysis, and the coronal and sagittal planes were positively correlated with the orthogonal plane. Conclusions: Femoral morphology could be influenced by gender and age. Morphological changes of the proximal femoral medullary cavity were not present in a single plane, but were affected by multiple planes. When the diameter of one plane became larger, its orthogonal plane concomitantly increased. Key Words: Proximal femoral, Morphology, CT measurement, Correlation.

Effects of lung resection on heart structure and function: A tissue Doppler ultrasound survey of 43cases.

Changes in heart structure and function after lung resection in patients with lung cancer are challenging to manage. Therefore, a non-invasive and reliable measurement tool to gauge such changes is critical. The purpose of the present study was to compare cardiological changes before and after lung resection using tissue Doppler imaging (TDI). A total of 43 patients (19 men and 24 women) with primary non-small cell lung cancer (n=37) and metastatic cancer in the lungs (n=6) were enrolled in the study.nTDI was used to determine the thickness of the ascending aorta, the open size of the ascending valve, the anterior-oposterior diameters of the left atrium and left ventricle, and the thickness of the ventricular septum and right ventricle before and after lung resection. Left ventricular (LV) ejection fraction (EF), pulmonary valve flow rate, tricuspid annular or mitral leaflet tip early (E) peak/late (A) diastolic blood flow velocities, tricuspid regurgitation flow, the lateral mitral annulus early (e') diastolic velocity and mitral E/e' ratio were used to determine LV filling pressure. Results revealed no significant differences between male and female patients in terms of the open size of the ascending valve, the anterior-posterior diameter of the left ventricle and the mitral E/e' ratio. Significant differences were found in the width of the ascending aorta, anterior-posterior diameter of the left atrium, width of the LV septum and right ventricular (RV) diameter before and after lung resection. Finally, there were significantchanges in EF and tricuspid pressure. The results indicated that TDI was useful as a non-invasive method for assessing left and right heart function following lung resection. The LV and RV dimensions were affected, but LV filling pressure was preserved after lobectomy.

Measurement of anatomical parameters of anterior transpedicular root screw intervertebral fusion system of cervical spine

ObjectiveThis study aims to investigate the feasibility of the anterior transpedicular root screw (ATPRS) intervertebral fusion system for the cervical spine and provide a basis for the design of the ATPRS intervertebral fusion system.MethodsA total of 60 healthy adult cervical spine CT images examined from our hospital were selected, including 30 males and 30 females, with an average age of 39.6 ± 4.8 years. The image data was imported into Mimics 21.0 software in DICOM format for 3D model reconstruction. Simulated screw insertion was performed on both sides of the midline of the intervertebral space. The entry point (P1) was determined when the upper and lower screw paths did not overlap. When the screw was tangent to the medial edge of the Luschka joint, the insertion point was determined as the entry point (P2). Measurements were taken and recorded for the following parameters: distance from the screw entry point to the midline of the intervertebral space (DPM), the simulated screw length, inclination angle, cranial/caudal tilted angle, the anterior–posterior (AP) and mediolateral (ML) diameters of the cervical intervertebral space, the heights of the anterior, middle, and posterior edges of the cervical intervertebral space, and the curvature diameter of the lower end plate of the cervical vertebral body. Statistical analysis was performed on the measurement results.ResultsThe screw entry area (P1P2) showed an increasing trend from C3-C7 in both male (2.92–6.08 mm) and female (2.32–5.12 mm) groups. There were statistical differences between men and women at the same level (P < 0.05). The average screw length of men and women was greater than 20 mm, and the upper and lower screw lengths showed an increasing trend from C3 to C7. In the area where screws could be inserted, the range of screw inclination was as follows: male group upper screw (47.73–66.76°), lower screw (48.05–65.35°); female group upper screw (49.15–65.66°) and lower screw (49.42–63.29°); The range of cranial/caudal tilted angle of the screw was as follows: male group upper screw (32.06–39.56°), lower screw (29.12–36.95°); female group upper screw (30.97–38.92°) and lower screw (27.29–37.20°). The anterior–posterior diameter and mediolateral diameter of the cervical intervertebral space showed an increasing trend from C3 to C7 in both male and female groups. The middle height (MH) of the cervical intervertebral space was greater than the anterior edge height (AH) and posterior edge height (PD), with statistical differences (P < 0.05). ConclusionsThrough the study of CT images of the cervical spine, it was determined that the ATPRS intervertebral fusion system has a feasible area for screw insertion in the cervical intervertebral space.

A feasibility study of adaptive radiation therapy for postprostatectomy prostate cancer

Postoperative prostate radiotherapy requires large planning target volume (PTV) margins to account for motion and deformation of the prostate bed. Adaptive radiation therapy (ART) can incorporate image-guidance data to personalize PTVs that maintain coverage while reducing toxicity. We present feasibility and dosimetry results of a prospective study of postprostatectomy ART. Twenty-one patients were treated with single-adaptation ART. Conventional treatments were delivered for fractions 1 to 6 and adapted plans for the remaining 27 fractions. Clinical target volumes (CTVs) and small bowel delineated on fraction 1 to 4 CBCT were used to generate adapted PTVs and planning organ-at-risk (OAR) volumes for adapted plans. PTV volume and OAR dose were compared between ART and conventional using Wilcoxon signed-rank tests. Weekly CBCT were used to assess the fraction of CTV covered by PTV, CTV D99, and small bowel D1cc. Clinical metrics were compared using a Student's t-test (p < 0.05 significant). Offline adaptive planning required 1.9 ± 0.4 days (mean ± SD). ART decreased mean adapted PTV volume 61 ± 37 cc and bladder wall D50 compared with conventional treatment (p < 0.01). The CTV was fully covered for 96% (97%) of fractions with ART (conventional). Reconstructing dose on weekly CBCT, a nonsignificant reduction in CTV D99 was observed with ART (94%) compared to conventional (96%). Reduced CTV D99 with ART was significantly correlated with large anterior-posterior rectal diameter on simulation CT. ART reduced the number of fractions exceeding our institution's small bowel D1c limit from 14% to 7%. This study has demonstrated the feasibility of offline ART for post-prostatectomy cancer. ART facilitates PTV volume reduction while maintaining reasonable CTV coverage and can reduce the dose to adjacent normal tissues.

Longer Screws Decrease the Risk of Radiographic Pseudarthrosis Following Elective Anterior Cervical Discectomy and Fusion.

Retrospective cohort study. In patients undergoing elective anterior cervical discectomy and fusion (ACDF), we sought to determine the impact of screw length on: (1) radiographic pseudarthrosis, (2) pseudarthrosis requiring reoperation, and (3) patient-reported outcome measures (PROMs). A single-institution, retrospective cohort study was undertaken from 2010-21. The primary independent variables were: screw length (mm), screw length divided by the anterior-posterior vertebral body diameter (VB%), and the presence of any screw with VB% < 75% vs all screws with VB% ≥ 75%. Multivariable logistic regression controlled for age, BMI, gender, smoking, American Society of Anesthesiology grade, number of levels fused, and whether a corpectomy was performed. Of 406 patients undergoing ACDF, levels fused were: 1-level (39.4%), 2-level (42.9%), 3-level (16.7%), and 4-level (1.0%). Mean screw length was 14.3 ± 2.3mm, and mean VB% was 74.4 ± 11.2. A total of 293 (72.1%) had at least one screw with VB% < 75%, 113 (27.8%) had all screws with VB% ≥ 75%, and 141 (34.7%) patients had radiographic pseudarthrosis at 1-year. Patients who had any screw with VB% < 75% had a higher rate of radiographic pseudarthrosis compared to those had all screws with VB% ≥ 75% (39.6% vs 22.1%, P < .001). Multivariable logistic regression revealed that a higher VB% (OR = .97, 95%CI = .95-.99, P = .035) and having all screws with VB% ≥ 75% (OR = .51, 95%CI = .27-.95, P = .037) significantly decreased the odds of pseudarthrosis at 1-year, with no difference in reoperation or PROMs (all P > .05). Longer screws taking up ≥75% of the vertebral body protected against radiographic pseudarthrosis at 1-year. Maximizing screw length in ACDF is an easily modifiable factor directly under the surgeon's control that may mitigate the risk of pseudarthrosis.

Influence of device generations on alternations of mitral annulus after transcatheter edge-to-edge repair: a real-time three-dimensional transesophageal echocardiography study

Abstract Background Alternation of the mitral annulus (MA) after transcatheter edge-to-edge mitral valve repair (TEER) is reported to be associated with a reduction of mitral regurgitation (MR). However, the influence of the new device system with 4 device size options (MitraClip G4) on MA geometry compared to the conventional device (G2) remains unknown. Methods and results A total of 129 patients (mean age 79±10 years, male 66%) including 38 primary MR and 91 secondary MR who underwent TEER guided with three-dimensional (3D) transesophageal echocardiography (TEE) were included. MA area, anterior-posterior (AP) diameter, inter-commissure (CC) diameter, and MA ellipticity before and after MitraClip implantation were measured using 3D TEE images assessed by dedicated software. MitraClip G4 was used in 54 cases (42%). In patients with secondary MR, greater changes in MA area, AP diameter, and MA ellipticity were observed in patients treated with G4 compared to G2 (P=0.001, 0.003, and 0.39, respectively). In contrast, patients with primary MR had no differences in the change of MA parameters between G2 and G4. Patients with significant residual MR had less increase of MA ellipticity after device implantation in secondary MR (P=0.014), but not in primary MR (P=0.062). Conclusion In patients with secondary MR, MitraClip G4 made greater changes in MAA, AP diameter, and MA ellipticity compared to MitraClip G2, but not in CC diameter. The change of ellipticity was associated with a reduction of MR after device implantation in secondary MR. These findings indicated that MitraClip G4 may lead favorable MA alternation than G2, especially in secondary MR.

Single-port-plus-one robot-assisted laparoscopic modified Lich-Gregoir direct nipple ureteral extravesical reimplantation in children with a primary obstructive megaureter.

To introduce a new technique of single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation and ascertain its validity in the treatment of pediatric primary obstructive megaureter. Between January 2021 and November 2021, we retrospectively analyzed the clinical data of 12 children with primary obstructive megaureter who were admitted to the Department of Pediatric Surgery of Fujian Provincial Hospital. All 12 children were treated with single-port-plus-one robotic laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation. Five of them were female and seven were male, including nine cases were simple obstructive type, while the remaining three cases were obstructive with reflux type. The mean age of the children was 17.33 ± 6.99 (10-36) months and the mean follow-up time was 14.16 ± 1.75 (12-17) months. Changes in preoperative and first-year postoperative parameters were compared. The mean operative time for all 12 children was 123.58 ± 10.85 (110-145) min, with a mean internal operative time of 101.42 ± 0.85 (90-120) min, a mean operative bleeding time of 2.42 ± 0.67 (2-4) ml, and a mean hematuria duration of 16.08 ± 1.44 (14-19) h. The mean indwelling catheterization time was 2.25 ± 0.45 (2-3) days and the mean hospitalization time was 3.83 ± 0.39 (3-4) days. At the postoperative first year, the ureteral diameter, calyceal diameter, and anterior-posterior renal pelvic diameter were found to be significantly smaller than at the preoperative period (18.83 ± 3.21 mm vs. 6.83 ± 1.27 mm, 13.99 ± 3.58 mm vs. 3.5 ± 2.90 mm, and 34.92 ± 4.25 mm vs. 10.08 ± 1.88 mm, P < 0.001). There was a significant increase in renal cortical thickness and the percentage of differential renal function (3.63 ± 1.66 mm vs. 5.67 ± 1.88 mm, 33.75 ± 2.77 mm vs. 37.50 ± 1.31 mm, P < 0.001). The resolution rate of obstruction was 100% and no child developed DeNovo vesicoureteral reflux. The technique of modified Lich-Gregoir direct nipple ureteral extravesical reimplantation can help maintain the physiological direction of the ureter and at the same time enhance the effectiveness of antirefluxing in robotic surgery. The design of a single-port-plus-one wound can produce a cosmetic appearance by concentrating and hiding the wound around the umbilicus. This modified reimplantation procedure has the potential to become a promising technique in the robot-assisted treatment of primary obstructive megaureter.

Laparoscopic strategies in complex upper urinary tract obstruction

We enumerate the various laparoscopic strategies to resolve upper urinary tract (UUT) obstruction in the context of variations in anatomy and report their outcomes. Retrospective review of primary laparoscopic UUT reconstructions performed between May 2012 and May 2021. Anomalies included: malrotated kidney (MRK), horseshoe kidney (HSK), duplex kidney (DK), pure intrarenal pelvis (IRP) and mid-ureteric stenosis (MUS). Success was defined by postoperative resolution of symptoms, improvement of anterior-posterior renal pelvic diameter (APD) on US and drainage on Mag3. Complications were categorised by Clavien-Dindo grading. Outcomes compared using the student's t-test with P<0.05 considered statistically significant. Of the 214 laparoscopic primary UUT reconstructions, 37 (17.2%) were: 13-MRK, 12-HSK, 4-DK, 4-IRP and 4-MUS. Median age at surgery was 5-years (range 0.3-15). Dismembered pyeloplasty: 8; pyeloplasty with renal sinus dissection: 8; neo-PUJ anastomosis: 8; primary ureterocalycostomy: 7; pyeloureterostomy: 2; and uretero-ureterostomy: 4. Median follow-up was 43-months (range 8-108) with a success rate of 94.5% (35/37). Complete resolution of symptoms in 20/21 patients; improvement of hydronephrosis on US in 35/37 patients (median pre-operative APD 27mm vs. median postoperative APD 8mm) [P<0.001]; improvement of drainage on diuretic renogram in 32/34 kidneys and stable/improved DRF in 34/35 kidneys (median preoperative DRF - 45% vs. median postoperative DRF - 47%) [P>0.05]. Postoperative complications managed medically (II Clavien) included urinary tract infections - 2 patients (5%), stent-related symptoms in 2 (5%) and umbilical port site collection in 1 patient (3%). Recurrent pelvi-ureteric junction obstruction PUJO occurred in one patient (3%) requiring redo surgery (IIIb Clavien), renal stones in 1 (3%) which resolved with ESWL (IIIb Clavien); in 1 (3%) patient with a HSK there was complete loss of ipsilateral kidney function but this was managed conservatively up to date (I Clavien). Laparoscopic transperitoneal approach allows the prompt recognition of in-situ anatomical variants. UUT obstruction in such settings calls for a variety of strategies with excellent outcomes.

Analysis of the characteristics and clinical significance of pelvic floor electrophysiology and imaging changes in female patients with MFPP

ObjectiveChronic Pelvic Pain (CPP) is a very common disease. Studies have found that some female patients with CPP have a myofascial trigger point for pain, which has classified as myofascial pelvic pain (MFPP). This study intends to compare the changes of pelvic floor electrophysiology and imaging between female patients with MFPP and normal women by measuring pelvic floor muscle potential, tension and two-dimensional and three-dimensional ultrasound, and then to explore the characteristics and significance of the changes. MethodsA total of 49 MFPP patients were randomly selected as the study group and 41 healthy women were randomly selected as the control group. Vaginal muscle potential was detected by pelvic floor muscle potential tester. The electronic tensioner was used to measure the muscle tension and the pelvic floor muscle contraction force of 5o and 10o, respectively. The parameters of the two groups were detected by transperineal 2D ultrasound and transvaginal 3D ultrasound respectively. Results1. The resting muscle potential and maximum muscle potential of the study group were higher than those of the control group. 2. The static tension, dynamic tension and contractile force of pelvic floor muscle in the study group were higher than those in the control group when the tensioner was opened for 5o. 3. In resting state, BND, BSD and anterior-to-posterior diameter of genital tract hiatus in the study group were smaller than those in the control group. The anal Angle in Valsalva state was greater in study group than in control group. 4. At rest, the hiatus area, anterior-posterior diameter, transverse diameter and defect score of the levator anal muscle in the study group were smaller than those in the control group. ConclusionMFPP presents a state of continuous spasm and loss of coordination of pelvic floor muscle fascia.

Anatomical Analysis of Foramen Magnum: A 3D Slicer CT Study

Aim: To analyze the anatomical structure of foramen magnum in healthy individuals according to age/gender.&#x0D; Material and Methods: Cranial Computed Tomography (CT) images of 130 healthy individuals (60 female, 70 male) the 18-84 age were included in our study. Using the 3D Slicer software package on these images, the Anterior-Posterior Diameter (APD), Transverse Diameter (TD), perimeter, area, angle between the posterior edge of the foramen magnum and the clivus (FMC) value, and index were found. The shapes of the foramen magnum were analysed.&#x0D; Results: There was no statistical significance between age, FMC, and foramen magnum index values in both genders (p&gt;0.05). APD, TD, perimeter, and area values of males were statistically higher (p0.05). Seven shapes of foramen magnum have been seen. The most common was the oval shape (27.7%) and the least common was the pentagon (1.5%).&#x0D; Conclusion: Knowing the anatomical structure of the foramen magnum is important in terms of identity and ethnicity. We also think that our results may contribute to the surgical treatment of the foramen magnum and adjacent structures.

Assessment of the bearing-down manoeuvre in pregnancy and detection of paradoxical levator ani muscle contraction using 2D transperineal ultrasound and vaginal palpation: a concurrent validity and inter-rater reliability study.

To examine the concurrent validity and inter-rater reliability of vaginal palpation as a measure of the quality of the bearing-down manoeuvre (BDM) and the detection of a paradoxical levator ani muscle contraction (LAM) in pregnant women, compared with 2D transperineal ultrasound (TPUS). Concurrent validity and inter-rater reliability study. Physiotherapy clinic. Twenty pregnant women in their third trimester. The anterior posterior diameter (APD) was measured during the BDM using TPUS by one experienced physiotherapist. An APD that shortened by >2 mm from rest was described as LAM shortening, an APD that moved by 0-2 mm was described as no change and an APD that lengthened by >2 mm was described as LAM lengthening. Vaginal palpation described the LAM during the BDM as no movement, shortening or lengthening. Participants were allowed two attempts and the best attempt was measured. APD using TPUS and the assessor's subjective description of LAM during the BDM using vaginal palpation. TPUS detected more paradoxical LAM contractions during the BDM than palpation. Agreement between vaginal palpation and TPUS assessment for BDM was poor. The Fleiss kappa coefficients were 0.457 (90% CI 0.16-0.71) between TPUS and one assessor and 0.326 (90% CI 0.01-0.6) between TPUS and the other assessor. In addition, inter-rater reliability was poor between observers palpating the BDM, with a Fleiss kappa coefficient of 0.375 (90% CI 0.13-0.64). This study did not find vaginal palpation of the BDM in pregnant women to have concurrent validity or inter-rater reliability. Clinicians should be aware of potential inaccuracies when palpating the BDM, and, where possible, seek an assessment via TPUS.

Fetal cortical development and neurosonographic findings in obese pregnant women: a case control study from a tertiary hospital.

To investigate the effect of obesity on fetal cortical development. This prospective cross-sectional study was conducted with 91 pregnant women. Fetal neurosonography scans were performed in the third trimester, and according to body mass index (BMI) values, the patients were evaluated in two groups: obese (BMI ≥ 30kg/m2) and normal weight (BMI < 30kg/m2). During neurosonography, fetal insular depth and Sylvian fissures, parieo-occipital and cingulate fissure depth, frontal lobe length, and the sizes of the corpus callosum and cavum septum pellucidum were measured using a transvaginal approach. Fetal cortical development and Sylvian fissure operculization were graded. The number of patients with grade 2 fetal cortical development was significantly higher among the pregnant women in the obese group compared to the normal weight group (n = 17, 41.5% and n = 8, 16.0%, respectively; p = 0.007). In the obese group, the number of pregnant women with grade 4 or below fetal Sylvian fissure operculization was significantly higher (n = 13, 31.7%), and the number of those with grade 9 or above operculization was significantly lower (n = 1, 2.5%) (p = 0.003). The fetal insular depth, frontal lobe anterior-posterior diameter, cingulate fissure depth, and corpus callosum thickness were lower in the obese group, albeit with no significant difference. Parieto-occipital depth significantly decreased in the obese group [6.8 (6) mm)] compared to the control group [10.5 (7.2) mm)] (p = 0.008). The fetal Sylvian fissure ratio and the cavum septum pellucidum ratio were found to be similar between the groups. The data obtained from this study showed that obesity caused fetal cortical changes in pregnant women.

The correlation between clinical symptom and morphological parameters on magnetic resonance imaging in patients with spondylolisthesis levels L4/L5 and L5/S1.

Spondylolisthesis is one of the common causes of spinal pain. There is currently a lack of studies on the correlation between magnetic resonance imaging (MRI) and clinical symptoms of patients with spondylolisthesis. This study is aimed to find the correlation between clinical symptoms of L4/L5, L5/S1 lumbar spondylolisthesis, and imaging parameters on MRI. A retrospective study on 100 patients who were diagnosed with lumbar spondylolisthesis at the L4/L5, L5/S1 levels from August 2022 to February 2023. Parameters on MRI are measured the cross-sectional area of the dural sac (DSA), the cross-sectional area of the spinal canal (SCA), the ligamentum flavum cross-sectional area (LFA), and ligamentum flavum thickness (LFT), anterior-posterior diameter (APD), sliding distance (SD) at the spondylolisthesis level. Clinical symptoms were investigated according to the Visual Analogue Scale (VAS) for grading of pain and the subjective disability was assessed by the Oswestry Disability Index (ODI). There was no statistically significant difference between SD, APD, SCA, DSA, LFA, and LFT between the mild and moderate pain VAS and severe pain VAS groups. No correlation was found between VAS and SD, APD, SCA, DSA, LFA, and LFT. There is a negative correlation between ODI and APD, SCA, and DSA. The statistically significant difference in APD, SCA, and DSA indexes in the two groups with mild/moderate disability (ODI ≤40%) and the group with severe disability (ODI >40%). A higher DSA and SCA, APD are associated with lower ODI. Decreased APD, SCA, and DSA are all suggestive of decreased spinal function. However, the MRI findings did not correlate with the patient's clinical pain level.

Use of Weight-Bearing Computed Tomography (WBCT) Imaging in the Assessment of the Achilles Tendinopathy: A Prospective Comparative and Controlled Study

Category: Hindfoot; Sports Introduction/Purpose: Insertional and non-insertional Achilles tendinopathy (AT) are prevalent diseases in the active, working-age population. Ultrasound (US) and magnetic resonance imaging (MRI) are frequently utilized in the assessment and grading of AT. Use of these imaging modalities are limited by operator interpretation/variability and costs, respectively. Also, these assessments are performed in the non-weight bearing positioning of the lower extremity, thus poorly evaluating the functional position of the loaded tendon. Validation of weight-bearing computed tomography (WBCT) for Achilles tendon imaging could provide a novel and functional means of quantifying tendon pathology. The study’s purposes were to: 1) Correlate Achilles tendon tissue structural findings when assessed by WBCT and US imaging, and 2) Compare WBCT Achilles tendon tissue changes between AT patients and controls. Methods: This was a prospective-comparative IRB-approved cohort study including 10 adults with AT (Age = 54.7 ± 10.3 years, BMI = 40.65 ± 10.07 kg/m2, 8F/2M), 10 age-matched controls (Age = 54.6 ± 11.33 years, BMI = 37.9 ± 9.55 kg/m2, 8F/2M), and 4 younger controls (Age = 32.25 ± 8.3 years, BMI = 24.32 ± 5.14 kg/m2, 2F/2M). WBCT scans (Curvebeam HiRise/PedCAT) and US imaging (Butterfly iQ+) of the Achilles tendon were collected. Tendons were manually segmented in WBCT images (3D Slicer software) and tendon thickness was measured at the maximum anterior-posterior (AP) diameter of the tendon (insertion and midportion regions). Radiodensity was quantified by the average Hounsfield Units (HU) of each tendon region and normalized to the radiodensity of each participant’s talus (segmented using Disior Bonelogic). US measures of the tendon thickness were similarly completed by independent observers who were blinded to the WBCT measurement. Intraclass correlation coefficient (ICC) assessed correlation between WBCT and US findings. Paired T-tests compared WBCT HU between patients and controls. P-values &lt; 0.05 were considered significant. Results: There was excellent correlation (ICC= 0.83-0.94, Table 1) between WBCT and US imaging regarding tendon thickness, with WBCT overestimating thickness by only 0.27-0.55mm (4-9% of total tendon thickness). These findings could be explained by decreased US tendon thickness measurements secondary to the tendon’s compression by the US probe. WBCT imaging demonstrated a higher radiodensity (HU) within the Achilles tendon (for both insertion and midportion regions) in AT patients when compared to controls (Table 2), with p-values of 0.009 and 0.001 for insertional and midportion regions, respectively. Findings are consistent with tendinopathic differentiation of the Achilles tendon substance in the AT patients. Color-coded maps demonstrating HU distributions across the Achilles tendon were created to facilitate interpretation of tissue characteristics (Fig. 1). Conclusion: In this prospective, comparative, and controlled study, we observed a high correlation between US and WBCT imaging in the assessment of Achilles tendon thickness in AT patients and controls. We also found that WBCT HU distribution in the Achilles tendon was significantly increased in the AT patients when compared to controls. Findings are likely explained by tendinopathic tissue changes in the diseased tendons, potentially related to the well-known chondroid metaplasia observed in Achilles tendinopathy pathological process. WBCT imaging and color-coded maps can represent a promising tool in the assessment of AT patients.

Preheating Thermoplastic Membrane Reduce Setup Error in Patients with Thoracic Cancer Undergoing Radiation Therapy: A Prospective Randomized Controlled Study

Thermoplasticfilm routinely placed in the treatment room always led to uncomfortable feeling in patients receiving thorax radiation therapy because of significant temperature difference between thermoplastic film and body surface. Therefore, it may result in setup error and further affect accuracy of radiation therapy. Here, we designed a randomized controlled study to investigate the efficacy of preheat thermoplastic film to reduce setup error in patients receiving thorax radiotherapy. Patients with thoracic cancer receiving radiotherapy once daily with five fraction per week were enrolled in this study from October 2022 to January 2023. All participants were randomly assigned into room-temperature group and preheating group in a 1:1 ratio. For the preheating group, the thermoplastic film was preheated for 10 minutes in a 37°C thermostat before it was used for patients' setup. For controlled group, the thermoplastic film with room-temperature was used for patients' setup. The cone beam computed tomography (CBCT) was used to evaluate setup errors once a week. The setup errors in translational directions X, Y and Z were recorded based on CBCT image. to measure the left-right as well as anterior-posterior diameter of the thorax in cross-section to observe whether there was any difference in thorax size from that at positioning. A modified Likert questionnaire was conducted to investigate the setup comfort level between two groups before radiotherapy and Day 5 of radiotherapy. A total of 34 patients were enrolled in this study. Patient characteristics were well balanced in both arms. The setup errors in the X, Y, and Z axes in group A were 1(-1,1) mm, 0(-1,2.75) mm and 0(-1,1) mm, respectively, while those in group B were 0(-2,2) mm, 1(-1.25,3) mm, and -1(-2,1) mm in the X, Y, and Z axes, respectively. Setup error in preheating group was smaller than room-temperature group in the X-axis direction (Z = 2.04, P = 0.042), but no significant differences were detected in Y and Z axes. Comparison of changes in anteroposterior thoracic diameter between the two groups. The preheated group was smaller than the normothermic group (-0.19 ± 0.48 vs -0.38 ± 0.36, P < 0.01). The total comfort scale scores of the two groups were 30.88 ± 3.39 vs 30.59 ± 3.34 (p = 0.42) before treatment and 32.125 ± 4.31 vs 31.06 ± 3.15 (p = 0.80) after treatment. Among the eight sub-items, only the fourth dimension of temperature was statistically different (pre 3.12 ± 0.48 vs 2.88 ± 0.60, P = 0.218; post 4.12 ± 0.78 vs 2.94 ± 0.43, P < 0.01). Ourcenter proposed the first method of heating the mold for postural fixation during patient radiotherapy. Compared with room-temperature thermoplastic film, our study found preheating thermoplastic film with 37°C could significantly reduce setup error in the X direction with less effect on the anterior-posterior diameter change of the thorax and higher patient temperature comfort satisfaction.

In silico prediction of maximum perineal muscle strain during vaginal delivery by design of experiment

Background and objectiveThe prevalence of pelvic floor muscle injuries induced by childbirth is higher than 23 % in the general women population. Such injuries can lead to prolapses and other pathologies in future female life. Leveraging computational biomechanics, the study implements an advanced female pelvic floor model for computing the maximum pelvic muscle strain, which serves as an injury risk indicator. The design of experiment method, abbreviated as DoE, is used to compute the maximum strain for boundary values of bony pelvis dimensions, namely the anterior-posterior diameter (abbreviated as APD) and the transverse diameter (abbreviated as TD). This is done in combination with small, medium and large percentiles of fetal head circumference (abbreviated as HC). MethodsWe utilized a previously developed finite element model of a female pelvic floor, as a reference, and enhanced it with new features, including a more detailed tissue geometry and advanced constitutive material models. The APD and TD dimensions were sourced from the set of MRI of 64 nulliparous women. This data was used to estimate the boundary dimensions of the female bony pelvis, combining both small and large values of APD and TD. Together with the 10th and the 95th percentiles for HC, a three-dimensional domain was constructed to assess the maximum pelvic muscle strain. In boundary cases, the maximum pelvic muscle strain was computed across 8 full-factorial design models (each situated at one corner of the domain, thereby combining the minimum and the maximum values of APD, TD and HC). This was done to define a response surface that predicts the maximum pelvic muscle strain within the domain. The accuracy of this response surface prediction was validated using 15 additional intermediate design models. These models were placed at the center of the domain (1 point), the centres of the domain boundary surfaces (6 points), and midway along each domain boundary edge (8 points). ResultsThe maximum strain results for 8 combinations of APD, TD, and HC were employed to construct a linear response surface as a function of APD, TD, and HC. Tests at an additional 19 domain points served to evaluate the efficiency of the response surface prediction. The response surface demonstrated strong predictability, with an absolute average error of 1.52 %, an absolute median error of 1.52 %, and an absolute maximum error of 11.11 %. HC emerged as the most influencing dimension, accounting for 16 % of influence. ConclusionsThe reference finite element pelvic floor model was scaled to 8 full-factorial female-specific pelvic floor models, which represent the combination of boundary values for APD, TD, and HC. The maximum pelvic floor muscle strain from these 8 models was used to design a response surface. When implementing the DoE approach to construct the response, there was consistent predictability for the maximum perineal muscle strain, as validated by the additional 19 intermediate design models. As a result, the response surface methodology can serve as an initial predictor for potential childbirth-induced pelvic floor muscle injury.

Predictors for postoperative cranial nerve complications in carotid body tumor resection: a retrospective cohort study.

Carotid body tumors (CBTs) are slow-growing benign tumors. Therefore, surgical resection is considered in case of tumor growth. The timing of surgery is of the utmost importance as the risk of iatrogenic surgical complications increases when resecting larger tumors, whereas on the other hand, resections for asymptomatic small CBT should be prevented. The primary aim of this study was to identify which tumor size or dimension is most accurate to predict nerve injury in patients undergoing resection of a CBT. This retrospective cohort study included patients who underwent surgical resection of CBT at the university hospital in South-Holland. Baseline patient characteristics and tumor measurements were retrieved from the medical records. The authors assessed how the different methods of measuring the size of the tumor were interrelated using Pearson correlation. Logistic regression was used to assess which variables were independently associated with nerve injury, including age at surgery, Shamblin classification, and those dimensions that captured different aspects of tumor size (rather than measuring the same as shown by high correlations) as possible independent variables. In 125 patients, 143 CBTs were resected whereof in 35 cases cranial nerve injury occurred, (transient in 16 cases and permanent in 19 cases). The risks for nerve injury increased with larger tumor size and the Shamblin classification. Logistic regression analysis showed that the anterior-posterior (AP) diameter significantly increased the odds of a nerve injury, a doubling for every 1cm increase in AP diameter [odds ratio (95% CI) 2.12 (1.29-3.48), P =0.003]. This study shows that measured tumor size in the AP plane is a strong predictor for postoperative nerve injury of a CBT resection. This predictor can be used in the daily clinic to give insight in operative risks. More research is needed in order to select the most appropriate time window for CBT resection.