Anterior-posterior Research Articles

Chest CT-based automated vertebral fracture assessment using artificial intelligence and morphologic features.

Spinal degeneration and vertebral compression fractures are common among the elderly that adversely affect their mobility, quality of life, lung function, and mortality. Assessment of vertebral fractures in chronic obstructive pulmonary disease (COPD) is important due to the high prevalence of osteoporosis and associated vertebral fractures in COPD. We present new automated methods for (1) segmentation and labelling of individual vertebrae in chest computed tomography (CT) images using deep learning (DL), multi-parametric freeze-and-grow (FG) algorithm, and separation of apparently fused vertebrae using intensity autocorrelation and (2) vertebral deformity fracture detection using computed vertebral height features and parametric computational modelling of an established protocol outlined for trained human experts. A chest CT-based automated method was developed for quantitative deformity fracture assessment following the protocol by Genant etal. The computational method was accomplished in the following steps: (1) computation of a voxel-level vertebral body likelihood map from chest CT using a trained DL network; (2) delineation and labelling of individual vertebrae on the likelihood map using an iterative multi-parametric FG algorithm; (3) separation of apparently fused vertebrae in CT using intensity autocorrelation; (4) computation of vertebral heights using contour analysis on the central anterior-posterior (AP) plane of a vertebral body; (5) assessment of vertebral fracture status using ratio functions of vertebral heights and optimized thresholds. The method was applied to inspiratory or total lung capacity (TLC) chest scans from the multi-site Genetic Epidemiology of COPD (COPDGene) (ClinicalTrials.gov: NCT00608764) study, and the performance was examined (n=3231). One hundred and twenty scans randomly selected from this dataset were partitioned into training (n=80) and validation (n=40) datasets for the DL-based vertebral body classifier. Also, generalizability of the method to low dose CT imaging (n=236) was evaluated. The vertebral segmentation module achieved a Dice score of.984 as compared to manual outlining results as reference (n=100); the segmentation performance was consistent across images with the minimum and maximum of Dice scores among images being.980 and.989, respectively. The vertebral labelling module achieved 100% accuracy (n=100). For low dose CT, the segmentation module produced image-level minimum and maximum Dice scores of.995 and.999, respectively, as compared to standard dose CT as the reference; vertebral labelling at low dose CT was fully consistent with standard dose CT (n=236). The fracture assessment method achieved overall accuracy, sensitivity, and specificity of 98.3%, 94.8%, and 98.5%, respectively, for 40,050 vertebrae from 3231 COPDGene participants. For generalizability experiments, fracture assessment from low dose CT was consistent with the reference standard dose CT results across all participants. Our CT-based automated method for vertebral fracture assessment is accurate, and it offers a feasible alternative to manual expert reading, especially for large population-based studies, where automation is important for high efficiency. Generalizability of the method to low dose CT imaging further extends the scope of application of the method, particularly since the usage of low dose CT imaging in large population-based studies has increased to reduce cumulative radiation exposure.

The influence of smoothness and speed of stand-to-sit movement on joint kinematics, kinetics, and muscle activation patterns.

Stand-to-sit (StandTS) is an important daily activity widely used in rehabilitation settings to improve strength, postural stability, and mobility. Modifications in movement smoothness and speed significantly influence the kinematics, kinetics, and muscle activation patterns of the movement. Understanding the impact of StandTS speed and smoothness on movement control can provide valuable insights for designing effective and personalized rehabilitation training programs. How do the smoothness and speed of StandTS movement affect joint kinematics, kinetics, muscle activation patterns, and postural stability during StandTS? Twelve healthy younger adults participated in this study. There were two StandTS conditions. In the reference condition, participants stood in an upright position with their feet positioned shoulder-width apart on the force plate. Upon receiving a visual cue, participants performed StandTS at their preferred speed. In the smooth condition, participants were instructed to perform StandTS as smoothly as possible, aiming to minimize contact pressure on the seat. Lower leg kinetics, kinematics, and coordination patterns of muscle activation during StandTS were measured: (1) angular displacement of the trunk, knee, and hip flexion; (2) knee and hip extensor eccentric work; (3) muscle synergy pattern derived from electromyography (EMG) activity of the leg muscles; and (4) postural sway in the anterior-posterior (A-P), medio-lateral (M-L), and vertical directions. Compared to the reference condition, the smooth condition demonstrated greater eccentric knee extensor flexion and increased joint work in both the knee and hip joints. Analysis of specific muscle synergy from EMG activity revealed a significant increase in the relative contribution of hip joint muscles during the smooth condition. Additionally, a negative correlation was observed between knee extensor and vertical postural sway, as well as hip extensor work and M-L postural sway. Smooth StandTS facilitates enhanced knee eccentric control and increased joint work at both the hip and knee joints, along with increased involvement of hip joint muscles to effectively manage falling momentum during StandTS. Furthermore, the increased contributions of knee and hip joint work reduced postural sway in the vertical and M-L directions, respectively. These findings provide valuable insights for the development of targeted StandTS rehabilitation training.

Effects of sedentary behaviour and long-term regular Tai Chi exercise on dynamic stability control during gait initiation in older women.

Background: Sedentary behaviour has been associated with an increased risk of falls among older adults. Although gait initiation (GI) is a promising tool used to assess fall risk, it has yet to be quantitatively evaluated for dynamic stability in sedentary populations. Tai Chi exercise is believed to be effective in preventing falls in older adults, but its effect on GI stability has not been quantified. This study aims to compare the stability of GI in sedentary older individuals versus those who are long-term Tai Chi exercisers by using a quantitative approach. Methods: This study included 17 sedentary older women without exercise habits (age: 65.59 ± 3.66 years, average daily sitting time: 8.735 ± 1.847h/day) and 19 older women who regularly engage in Tai Chi exercise (age: 65.58 ± 3.63 years, years of exercise: 9.84 ± 3.48 years). Every participant underwent five trials of self-paced GI walking tests. Eight cameras and four force plates were used to obtain kinematic and kinetic parameters. The trajectory of the centre of mass (CoM) and the position of the foot placement were recorded. The anterior-posterior (A-P) and medio-lateral (M-L) dynamic stability at the onset and end moments of the single-legged support was calculated using CoM and gait spatiotemporal parameters. The stepping dynamic stability and foot placement positions of both groups were compared. Results: The Tai Chi group had greater stability in the M-L directions at the swing leg's toe-off moment and in the M-L and A-P directions at the heel-strike moment, as well as significantly larger step length, step width and step speed during locomotion than sedentary older women. However, the stability in the A-P directions at the swing leg's toe-off moment and the foot inclination angle was not statistically different between the two groups. Conclusion: Long-term regular Tai Chi exercise can enhance the dynamic stability of GI in older women, and effectively improve their foot placement strategy during GI. The findings further confirm the negative effect of sedentary on the stability control of older women and the positive role of Tai Chi in enhancing their gait stability and reducing the risk of falls.

A PAK family kinase and the Hippo/Yorkie pathway modulate WNT signaling to functionally integrate body axes during regeneration

Successful regeneration of missing tissues requires seamless integration of positional information along the body axes. Planarians, which regenerate from almost any injury, use conserved, developmentally important signaling pathways to pattern the body axes. However, the molecular mechanisms which facilitate cross talk between these signaling pathways to integrate positional information remain poorly understood. Here, we report a p21-activated kinase (smed-pak1) which functionally integrates the anterior-posterior (AP) and the medio-lateral (ML) axes. pak1 inhibits WNT/β-catenin signaling along the AP axis and, functions synergistically with the β-catenin-independent WNT signaling of the ML axis. Furthermore, this functional integration is dependent on warts and merlin-the components of the Hippo/Yorkie (YKI) pathway. Hippo/YKI pathway is a critical regulator of body size in flies and mice, but our data suggest the pathway regulates body axes patterning in planarians. Our study provides a signaling network integrating positional information which can mediate coordinated growth and patterning during planarian regeneration.

Postural control during gait termination and prehension

BackgroundChallenges to postural stability emerge in the transition from locomotion to a standing posture as during gait termination, often accompanied by another task (e.g., opening a door), which may complicate control. However, less is known about postural control during terminating gait while engaged in a secondary manual task. Research questionWhat are the changes in postural control when terminating gait with and without a prehension task? MethodsIn a cross-sectional design, 15 healthy young adults (M=8, F=7; 27±2 years; 69±13 kg; 171±8 cm) underwent both a single task gait termination (GTO) and dual task (gait termination plus reaching; GTR). Postural Time-to-Contact (TtC) was measured using Center of Pressure (CoP) and the sternum position in anterior-posterior (AP) and medial-lateral (ML) directions over two different phases: preparatory phase and stabilization phase. Five successful trials were recorded to obtain a mean TtC. For statistical analysis of TtC, a two-tailed paired t-test was used (p =.05) as normality was satisfied. ResultsFor the preparatory phase, there were no differences for the CoP, but TtC of the sternum position in AP was shorter in GTR than GTO (p =.001). Meanwhile, for the stabilization phase, TtCs of both the CoP and sternum position were longer in GTR in both AP and ML directions (p’s <.001). SignificanceWe suggest that for the preparatory phase, the shorter TtC of the sternum position with intact TtC of the CoP in GTR indicates that healthy young individuals are flexible, in that they smoothly integrate CoP control with the upper body demands required to also perform the prehension task. Meanwhile, for the stabilization phase, the longer TtC in dual termination and prehension task indicates that the perturbation imposed by the prehension movement did not result in reduced stabilization when returning to an upright posture.

Exploring the Influence of Facet Orientation and Tropism on Neutral Zone Properties.

Lumbar spine pathologies have been linked independently to both neutral zone (NZ) properties and facet joint anatomical characteristics; however, the effect of facet joint orientation (FO) and tropism (FT) on NZ properties remains unclear. The aim of the present study was to investigate how axial plane FO and FT relate to NZ range and stiffness in the human lumbar spine and porcine cervical spine. Seven human lumbar functional spine units (FSUs) and 94 porcine cervical FSUs were examined. FO and FT were measured, and in vitro mechanical testing was used to determine anterior-posterior (AP) and flexion-extension (FE) NZ range and stiffness. FO and FT were found to have no significant relationship with AP and FE NZ range. Increases in FT were associated with greater FE and AP NZ stiffness in human FSUs, with no FT-NZ stiffness relationship observed in porcine specimens. A significant relationship (p < 0.001) between FO and FE NZ stiffness was observed for both porcine and human FSUs, with a more sagittal orientation of the facet joints being associated with decreased FE NZ stiffness. Given the link between NZ stiffness and pathological states of the lumbar spine, further research is warranted to determine the practical significance of the observed facet joint anatomical characteristic-NZ property relationship.

Quality of occlusal outcome in adult class II patients after maxillary total arch distalization with interradicular mini-screws

BackgroundThe aim of the investigation was to evaluate if a Class II malocclusion in adult patients can be successfully corrected by maxillary total arch distalization with interradicular mini-screws in combination with completely customized lingual appliances (CCLA).MethodsTwo patient groups were matched for age and gender to determine differences in the quality of final treatment outcome. The treatment results of 40 adult patients with a Class I malocclusion (Group 1) were compared with those of 40 adult patients with a moderate to severe Class II malocclusion (Group 2). All patients had completed treatment with a CCLA (WIN, DW Lingual Systems, Bad Essen, Germany) without overcorrection in the individual treatment plan defined by a target set-up. To compare the treatment results of the two groups, 7 measurements using the American Board of Orthodontics Model Grading System (ABO MGS) and linear measurements for anterior-posterior (AP) and vertical dimensions were assessed at the start of lingual treatment (T1), after debonding (T2B), and compared to the individual target set-up (T2A).ResultsA statistically significant AP correction (mean 4.5 mm, min/max 2.1/8.6, SD 1.09) was achieved in Group 2, representing 99% of the planned amount. The planned overbite correction was fully achieved in both the Class I and Class II groups. There was a statistically significant improvement in the ABO scores in both groups (Group 1: 39.4 to 17.7, Group 2: 55.8 to 17.1), with no significant difference between the two groups at T2B. 95% of the adult patients in Group 1 and 95% in Group 2 would meet the ABO standards after maxillary total arch distalization with a CCLA and interradicular mini-screws.ConclusionsCCLAs in combination with interradicular mini-screws for maxillary total arch distalization can successfully correct moderate to severe Class II malocclusions in adult patients. The quality of the final occlusal outcome is high and the amount of the sagittal correction can be predicted by the individual target set-up.

Posterior endpoint determination of the lumbar pedicle central axis on the anterior–posterior fluoroscopic image for pedicle screw insertion

The transpedicular procedure has been widely used in spinal surgery. The determination of the best entry point is the key to perform a successful transpedicular procedure. Various techniques have been used to determine this point, but the results are variable. This study was carried out to determine the posterior endpoint of the lumbar pedicle central axis on the standard anterior–posterior (AP) fluoroscopic images. Computer-aided design technology was used to determine the pedicle central axis and the posterior endpoint of the pedicle central axis on the posterior aspect of the vertebra. The standard AP fluoroscopic image of the lumbar vertebral models by three-dimensional printing was achieved. The endpoint projection on the AP fluoroscopic image was determined in reference to the pedicle cortex projection by the measurements of the angle and distance on the established X–Y coordinate system of the radiologic image. The projection of posterior endpoint of the lumbar pedicle central axis were found to be superior to the X-axis of the established X–Y coordinate system and was located on the pedicle cortex projection on the standard AP fluoroscopic image of the vertebra. The projection point was distributed in different sectors in the coordinate system. It was located superior to the X-axis by 18° to 26° at L1, while they were located superior to the X-axis by 12° to 14° at L2 to L5. The projections of posterior endpoints of the lumbar pedicle central axis were located in different positions on the standard AP fluoroscopic image of the vertebra. The determination method of the projection point was helpful for selecting an entry point for a transpedicular procedure with a fluoroscopic technique.

A Simplified Preoperative Radiographic Assessment for Metatarsus Adductus Associated With Hallux Valgus.

Radiographic measurements for the assessment of metatarsus adductus (MTA) have a broad range of interpretation without a consensus regarding surgical indications. The "Plumbline" (PL) radiographic assessment method helps identify MTA and determines if physical space is available to align the first metatarsal to the longitudinal foot axis without the need to realign the lesser metatarsals. Forty-five neutral weight-bearing anterior-posterior (AP) radiographs of patients scheduled for surgical intervention for isolated hallux valgus (HV) or combined MTA/HV deformities were reviewed. The cohort was grouped based on the presence of MTA using a Sgarlato's angle (SA) of 15°, with 23 patients in the HV-only group and 22 patients in the MTA group. A mean preoperative SA of 8.7° (SD: 2.1; range: 5.4-13.4) and 26.6° (SD: 5.1; range: 18.2-36) were found in the HV-only and MTA groups, respectively. Subjects with an SA ≤ 15° (N = 22) were found to have a negative PL (100%) and subjects with an SA > 15° (N = 23) displayed a positive PL (100%). The PL technique provided a simple method and clear visual reference for determining the presence of MTA in HV patients without the need to measure traditional radiographic angles.Level of Evidence: Retrospective, Level IV, Diagnostic.

Miliary Tuberculosis in In Vitro Fertilization pregnancy: a series of three cases with a history of hypothyroidism

In Vitro Fertilization (IVF) pregnancy is associated with a higher risk of tuberculosis as compared to normal pregnancy. This increased risk remains unexplained. Most of the reports are based on small case series, and the risk profile is not well described. Hypothyroidism has not been described as a potential risk factor in any series. In this case series, we elaborate on the profile of three military tuberculosis cases of IVF pregnancies, all having hypothyroidism history as the common factor, and were referred to our super-specialty center with the onset of symptoms during the late first or mid-second trimester of pregnancy. All three cases were diagnosed on X-ray chest Posterior-Anterior (PA) view, showing miliary tuberculosis and a known case of hypothyroidism. Antitubercular treatment was started. In this report, we describe the clinical course and unfavorable outcomes of these three cases.

Anatomical Basis for Preservation of Cartilaginous Apophysis in Pediatric Patients Undergoing Iliac Crest Bone Graft Harvest: A Cohort Study.

Background The anterior iliac crest is the workhorse for the harvest of cancellous bone in children undergoing cleft alveolar bone grafting. However, the complexity of the anatomy makes the process of harvesting graft technique sensitive. The aim was todescribe the outcomes of the medially based trap door method of graft harvest in pediatric patients undergoing cleft alveolar bone grafting. Methods A cohort study was conducted, including all the patients in the age group of 8-12 years.Alveolar bone grafting was performed after harvesting a cancellous graft from the iliac crest bone grafting (ICBG) using a medially based trap door approach.Intraoperative time, average blood loss, and postoperative outcomes, including pain score, paresthesia, and gait disturbances, were recorded. Results A total of 28 patients were included in the study based on the inclusion and exclusion criteria. The volume of cancellous bone harvested was between 4-9 cc. The mean intraoperative time was 42 minutes, with an average blood loss of 36 to 48 ml.The average visual analog scale (VAS) score in the postoperative period was 3.5, 6, and 4 on the first, third, and seventh postoperative days. All the patients were ambulated on the second postoperative day, and none of them reported paresthesia. Long-term evaluation of the anterior illum revealed intact crestal morphology with a bone refill on the posterior-anterior (PA) pelvic X-ray. Conclusion A medially based modified trap door approach is more efficaciousand less morbid for the harvest of ICBG in pediatric patients.

The effects of Tai Chi on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude.

Tai Chi has proved to be an effective therapy for balance performance and cognition. However, non-consistency exists in the results of the effect of Tai Chi training on standing balance control in older adults. This study aimed to use traditional and non-traditional methods to investigate the effect of Tai Chi on standing balance in older adults. Thirty-six Tai Chi practitioners (TC group) and thirty-six older adults with no Tai Chi practice (control group) were recruited in this study. A Nintendo Wii Balance Board was used to record the center of pressure (COP) during standing balance over 20 s in the condition of eyes closed with three repetitions. The wavelet analysis, multiscale entropy, recurrence quantification analysis, and traditional methods were used to evaluate the standing balance control in the anterior-posterior (AP) and mediolateral (ML) directions. (1) Greater sway mean velocity in the AP direction and sway Path length were found in the TC group compared with the control group; (2) lower Very-low frequency band (0.10-0.39 Hz) and higher Moderate frequency band (1.56-6.25 Hz) in the AP and ML directions were found in the TC group compared with the control group; (3) greater complexity index (CI) and lower determinism (DET) in the AP and ML directions were observed in the TC group compared with control group; (4) greater path length linked with smaller Very-low frequency band in the AP and ML directions and higher Moderate frequency band in the AP direction in both groups; (5) greater path length linked with lower DET and higher CI in the AP direction only in the TC group. Long-term Tai Chi practice improved sensory reweighting (more reliance on the proprioception system and less reliance on the vestibular system) and complexity of standing balance control in older adults. In addition, greater sway velocity may be as an exploratory role in standing balance control of TC older adults, which correlated with greater complexity, but no such significant relationship in the control group. Therefore, the effects of Tai Chi practice on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude.

Advancing pediatric head CT dose prediction: correlating patient size metrics with AP and LAT dimensions in Moroccan population

This study aims to establish comprehensive relationships between patient size, focusing on effective diameter (Deff) and water-equivalent diameter (Dw), in conjunction with anterior-posterior (AP) and lateral (LAT) dimensions. The primary goal is to refine precise patient dose estimations in pediatric head computed tomography (CT) examinations. Our examination involved a dataset of 105 pediatric head CT images sourced from a Moroccan pediatric university hospital. These images, selected from the central scanning range, underwent quantification for LAT, AP, Deff, and Dw, with measurements carried out using RadiAnt Dicom Viewer for lateral and anteroposterior dimensions. Our analytical approach encompassed modeling Deff and Dw as functions of LAT, AP, and combined AP + LAT dimensions. Additionally, Dw was modeled as a function of Deff and calculated Size Specific Dose Estimates (SSDE) based on Dw was compared to SSDE computed from one single dimension. The outcomes revealed strong correlations among Deff, Dw, and fundamental geometric dimensions (LAT, AP, and AP + LAT), as indicated by consistently high coefficients of determination (R² > 0.8). SSDE calculated from Dw shows impressive correlation with SSDE computed from a single dimension (R² > 0.9). This study offers insights into the relationships between patient size and critical dimensions, identifying high correlations that can represent a significant advancement in predicting doses for pediatric head CT examinations. This introduces the potential for streamlining the determination of head diameter and dose by relying on a single dimension, thereby enhancing the efficiency of dose predictions by facilitating the monitoring of radiation exposure of this population in clinical routine.

Titanium versus stainless steel alloy bridge plates for distal femur fractures: Does callus form earlier with titanium?

Distal femur fractures account for 3-6% of all femur fractures. Internal fixation of most distal femur fractures with an anatomic lateral locking plate should permit some motion at the metaphyseal portion of the fracture when secondary bone healing is planned by the operating surgeon. While several studies have been performed evaluating union rates for distal femur fractures with stainless steel and titanium plates, the timing of callus formation between stainless steel and titanium implants used as bridge plates for distal femur fractures (AO/OTA 33-A and -C) has been investigated to a lesser extent. We hypothesize that callus will be visualized earlier with post-operative radiographs with titanium versus stainless steel bridge plates. We retrospectively reviewed a consecutive cohort of patients over 18 years of age with acute AO/OTA 33-A and 33-C fracture patterns treated with an isolated stainless steel or titanium lateral bridge plate within 4 weeks of injury by a single fellowship-trained orthopedic trauma surgeon from 2011 to 2020 at one academic Level 1 trauma center. An independent, fellowship-trained orthopedic trauma attending surgeon reviewed anterior-posterior (AP) and lateral radiographs from every available post-operative clinic visit and graded them using the Modified Radiographic Score for Tibia (mRUST). Twenty-five subjects were included in the study with 10 with stainless steel and 15 with titanium plates. There were no significant differences in demographics between both groups, including age, sex, BMI, injury classification, open versus closed, mechanism, and laterality. Statistically significant increased mRUST scores, indicating increased callus formation, were seen on 12-week radiographs (8.4 vs. 11.9, p = 0.02) when titanium bridge plates were used. There were no statistically significant differences in mRUST scores at 6 or 24-weeks, but scores in the titanium group were higher in at every timepoint. In conclusion, we observed greater callus formation at 12 weeks after internal fixation of 33-A and 33-C distal femur fractures treated with titanium locked lateral distal femoral bridge plates compared to stainless steel plates. Our data suggest that titanium metallurgy may have quicker callus formation compared to stainless steel if an isolated, lateral locked bridge plate is chosen for distal femur fracture fixation.

The Effects of Optical Flow Perturbations on Standing Balance in People With Multiple Sclerosis.

Multiple sclerosis is a neurodegenerative disease that causes balance deficits, even in early stages. Evidence suggests that people with multiple sclerosis (PwMS) rely more on vision to maintain balance, and challenging balance with optical flow perturbations may be a practical screening for balance deficits. Whether these perturbations affect standing balance in PwMS is unknown. Therefore, the purpose of this study was to examine how optical flow perturbations affect standing balance in PwMS. We hypothesized that perturbations would cause higher variability in PwMS compared with matched controls during standing and that standing balance would be more susceptible to anterior-posterior (A-P) perturbations than medial-lateral (M-L) perturbations. Thirteen PwMS and 13 controls stood under 3 conditions: unperturbed, M-L perturbation, and A-P perturbations. A-P perturbations caused significantly higher A-P trunk sway variability in PwMS than controls, although both groups had similar center-of-pressure variability. Both perturbations increased variability in A-P trunk sway and center of pressure. Trunk variability data supported the hypothesis that PwMS were more susceptible to optical flow perturbations than controls. However, the hypothesis that A-P perturbations would affect balance more than M-L perturbations was partially supported. These results suggest potential for optical flow perturbations to identify balance deficits in PwMS.

Evaluating 3D Simulation Accuracy for Breast Augmentation Outcomes: A Volumetric and Surface Contour Analysis in Chinese Patients.

The use of three-dimensional imaging in breast augmentation with silicone implants has revolutionized the surgery planning process by providing detailed visualizations of expected post-surgical outcomes. This technology enhances the decision-making process, enabling patients to choose their implants with greater confidence and ultimately leading to higher satisfaction with the postoperative outcome. This study aims to assess the accuracy of 3D imaging simulations using the Canfield Vectra XT 3D system in predicting breast augmentation outcomes in Chinese patients, focusing on volume, surface contour, breast anterior-posterior (AP) Projection, and breast internal angle. Our study analyzed female patients who received breast augmentation, documenting their preoperative and three-month postoperative conditions with 3D Vectra XT system images. Exclusions were made for patients undergoing concurrent breast surgeries or those with tuberous or ptotic breasts, due to limitations of the imaging system. Implants used were either round textured or anatomically shaped cohesive silicone gel, inserted subpectorally through trans-axillary or inframammary incisions, based on personalized evaluations. A detailed comparison between preoperative simulations and actual postoperative outcomes was conducted, focusing on volume, surface contour, AP projection, and internal angle variations. Statistical significance was determined through paired T tests, P < 0.05. In the analysis of preoperative simulations for determining postoperative outcomes in breast surgery, our study involving 42 Chinese patients, a total of 84 breasts, was conducted. The results indicated a mean volumetric discrepancy of 21.5 ± 10.3 (SD) cubic centimeters between the simulated and actual postoperative outcomes, achieving an accuracy rate of 91.9%. The root mean square deviation for the breast surface geometry was calculated to be 4.5 ± 1.1 (SD) millimeters (mm), demonstrating a low variance between the predicted and observed outcomes. The investigation found no significant variations across any specific areas of the breast surface, highlighting the uniform accuracy of the simulations across the entire breast. Additionally, the mean differences in Anterior-Posterior (AP) projection and internal angle were determined to be 8.82 ± 5.64 mm and 0.48 ± 1.91 (SD) degrees, respectively. These findings collectively attest to the efficacy of preoperative simulations in accurately predicting the postoperative physical appearance of breasts, thereby providing a valuable tool for surgical planning and improving the consultation process for patients. The Canfield Vectra XT 3D system has proven to be remarkably accurate in predicting the volumetric outcomes of breast augmentation surgery, with an accuracy rate exceeding 91.9%. It stands as a valuable tool for surgeons and patients alike, enhancing the preoperative planning process by offering a realistic preview of surgical results. This advancement not only facilitates a deeper understanding and setting of realistic expectations for patients but also strengthens the communication between patients and surgeons, ultimately leading to higher satisfaction rates with the surgical outcomes. It also emphasizes the significance of detailed documentation and consent processes in protecting against legal repercussions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography.

The shape of the labrum is strongly correlated with outcomes of developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) is the generally preferred imaging technique for observing the labrum. We aimed to find a correlation between the labrum shape and anterior-posterior (AP) pelvic measurements in children with DDH. Preoperative AP pelvic x-ray radiographs and MRI of patients with DDH from January 2019 to December 2021 were retrospectively collected and divided into three groups by labrum shape on MRI: everted, partly inverted, and inverted. The acetabular length ratio (RAL) in patients with unilateral DDH and the ratio of acetabular length to interpedicular distance (RALI) in all patients were calculated. T-tests were used to analyze differences between the groups. Receiver operating characteristic curve (ROC) analysis was performed between the everted group and the partly inverted and inverted groups. We found significant differences in RAL between the everted and partly inverted groups, everted and inverted groups, and everted and combined groups. The ROC analysis showed that the best cutoff value for RAL was 0.945 between the everted and combined groups, with an area under the curve (AUC) of 88.4%. The sensitivity at the best RAL value was 0.783, and the specificity was 0.887. Moreover, we observed a significant difference in RALI between the everted, partly inverted, and inverted groups, as well as between the everted and combined groups. The optimal cutoff value for RALI between the everted and combined groups was 0.575, with an AUC of 74.5%. The sensitivity at the best RALI value was 0.765, and the specificity was 0.674. The RAL or RALI values on pelvic AP radiographs can be used to predict the shape of the labrum. III.

Maximum flexion and lateral rollback revealed better patient satisfaction after total knee arthroplasty

IntroductionPatient satisfaction is an important outcome of total knee arthroplasty (TKA). However, we cannot predict how and why patients are satisfied or dissatisfied with TKA. The hypothesis of this study was that patient-reported outcomes (PROs) correlate with in vivo kinematics after TKA.Materials and methodsOne hundred knees were analyzed after TKA. The in vivo kinematics of deep knee bending motion were estimated from single-plane fluoroscopy using a two-to-three-dimensional registration technique. Active knee flexion, femoral rotation and rollback were evaluated. The PROs were obtained after surgery using the 2011 Knee Society Scoring System (KSS), and their relationship with in vivo kinematics was determined.ResultsThe average minimum and maximum flexion were −2.4 ± 7.3° and 113.2 ± 13.6°, respectively. The average femoral rotation was 7.4 ± 3.4°, and the average medial and lateral rollback were 2.4 ± 4.8 mm and 7.2 ± 5.6 mm, respectively. The multiple regression analysis revealed that the maximum flexion angle significantly contributed to symptoms and satisfaction. In addition, lateral rollback was also a significant factor affecting patient satisfaction. Lateral rollback and lateral Anterior-Posterior (AP) position at maximum flexion were correlated with the maximum flexion angle, whereas femoral rotation did not correlate with flexion angles.ConclusionsMaximum flexion and lateral rollback are important for better patient satisfaction after TKA. To obtain the maximum flexion angle, it was necessary to perform the normal kinematic pattern with a large amount of lateral rollback.

Use of a Triaxial Accelerometer to Measure Changes in Gait Sway and Related Motor Function after Corrective Spinal Fusion Surgery for Adult Spinal Deformity.

Background: Adult spinal deformity is a complex condition that causes lower back pain, causing spinal imbalance and discomfort in activities of daily life. After corrective spinal surgery, patients' gait and balance abilities might not revert to normalcy and they might be at increased risk of falling. Therefore, early evaluation of such a risk is imperative to prevent further complications such as a fall, or even worse, fractures in post-surgery ASD patients. However, there has been no report of an investigation of such early changes in gait sway before and after ASD surgery. This is a prospective to investigate changes in gait sway before and following ASD surgery, using accelerometers, and also to examine motor function related to postoperative gait sway. Methods: Twenty patients were included who underwent corrective surgery as treatment for ASD, from October 2019 to January 2023. Measurement parameters included a 10 m walking test and the timed up-and-go test (TUG), gait sway was evaluated using accelerometers (root mean square; RMS), and hip flexion and knee extension muscle strength were tested. RMS included RMS vertical: RMSV; RMS anterior posterior: RMSAP; RMS medial lateral: RMSML. The radiographic spinopelvic parameters were also evaluated preoperatively and postoperatively. p < 0.05 was noted as remarkably significant. Results: Preoperative and postoperative RMSV were 1.07 ± 0.6 and 1.31 ± 0.8, respectively (p < 0.05). RMSML significantly decreased from 0.33 ± 0.2 to 0.19 ± 0.1 postoperatively (p < 0.01). However, RMSAP did not change postoperatively (0.20 ± 0.2 vs. 0.14 ± 0.1, p > 0.05). Patients' one-month postoperative hip flexor muscle strength became significantly weaker (0.16 ± 0.04 vs. 0.10 ± 0.03 kgf/kg, p = 0.002), but TUG was maintained (11.6 ± 4.2 vs. 11.7 s, p = 0.305). RMSV was negatively correlated with quadriceps muscle strength and positively with TUG. RMSAP was negatively correlated with quadriceps muscle strength. All spinopelvic parameters became normal range after surgery. Conclusions: After corrective spinal fusion for ASD patients, the gait pattern improved significantly. Iliopsoas (hip flexor) and quadriceps femoris (knee extensor) muscles may play important roles for gait anterolateral and vertical swing, respectively.

The associations between lumbar proprioception and postural control during and after calf vibration in people with and without chronic low back pain.

The relationships of lumbar proprioception with postural control have not been clarified in people with chronic low back pain. This study aimed to compare the associations between lumbar proprioception and postural control in response to calf vibration in individuals with and without chronic low back pain. In this study, we recruited twenty patients with chronic low back pain (CLBP group) and twenty healthy control subjects (HC group) aged between 18 and 50 years. This study was a cross-sectional study and completed from May 2022 to October 2022. The passive joint repositioning sense (PJRS) test for two positions (15° and 35°) were used to assess lumbar proprioception and expressed as the mean of reposition error (RE). Postural control was tested by adding and removing calf vibration while standing on a stable force plate with eyes closed. The sway velocity in the anterior-posterior (AP) direction of center of pressure (COP) data with a window of 15s epoch at baseline, during and after calf vibration was used to evaluate postural control. Mann-Whitney U-tests were used to compare the difference of lumbar proprioception between two groups, and the independent t-tests were used to compare the difference of postural control at baseline and during vibration, and a mixed design ANOVA was used to compare the difference of postural control during post-perturbation. In addition, to explore the association between postural control and lumbar proprioception and pain intensity, Spearman's correlations were used for each group. The major results are: (1) significantly higher PJRS on RE of 15° (CLBP: 95% CI [2.03, 3.70]; HC: 95% CI [1.03, 1.93]) and PJRS on RE of 35° (CLBP: 95% CI [2.59, 4.88]; HC: 95% CI [1.07, 3.00]) were found in the CLBP group; (2) AP velocity was not different between the CLBP group and the HC group at baseline and during calf vibration. However, AP velocity was significantly larger in the CLBP group compared with the HC group at epoch 2-14 after calf vibration, and AP velocity for the CLBP group took a longer time (23 epochs) to return to the baseline after calf vibration compared with the HC group (9 epochs); (3) lumbar proprioception represented by PJRS on RE of 15°correlated negatively with AP velocity during and after vibration for the HC group. Within the CLBP group, no significant relationships between PJRS on RE for two positions (15° and 35°) and AP velocity in any postural phases were found. In conclusion, the CLBP group has poorer lumbar proprioception, slower proprioceptive reweighting and impaired postural control after calf vibration compared to the HC group. Lumbar proprioception offers different information on the control strategy of standing control for individuals with and without CLBP in the situations with proprioceptive disturbance. These results highlight the significance of assessing lumbar proprioception and postural control in CLBP patients.