Computed Topography Scan Research Articles

Poster 243: TT-TG Measurements Obtained in Weight Bearing and Non-Weight Bearing States are Different- Positioning in CT Scan Affects Treatment Selection

Objectives: There are multiple aspects of lower extremity alignment that can contribute to patellar instability. Physicians regularly consider TT-TG distance when planning treatment for patients with patellar instability. TT-TG has been classically measured on non-weight bearing magnetic resonance imaging (MRI) or computed topography (CT) scans, but more recently clinicians have been obtaining these measurements on weight bearing CT scans. Literature has not previously compared TT-TG measurements obtained in weight bearing and non-weight bearing positions. This study compares TT- TG measurements performed in weight-bearing vs. non-weight bearing positions of the same knees. Methods: The images of patients with patellar instability who obtained weight bearing and non-weight bearing CT scans between the dates of January 1st, 2014 and December 31st, 2021 were measured for TT-TG distance. A paired two sample t test for means was utilized to compare the measurements. Results: Thirty knees had both a weight bearing and non-weight bearing TT-TG length CT scan performed that could be used to measure TT-TG distance. The weight bearing group, with an average of 15.2 mm, was significantly greater than the non-weight bearing group, averaging 10.2 mm (p=<.0001). Additionally, the variance in measurements for knees under the weight bearing positions (37.6 mm) was more than twice as large as the variance for measurements obtained in the non-weight bearing position (16.5 mm). Conclusions: TT-TG distance is routinely used while diagnosing and planning treatment of patients with patellar instability. In this study, TT-TG distance was found to be significantly greater in the weight bearing position compared with the non-weight bearing position of the same knee. This fact is both critical to understand and useful in planning the appropriate instability procedure. Dynamic motion, rotation and axial loading play a role in patellar instability and need to be evaluated to arrive at the appropriate treatment algorithm.

Review of novel shoulder arthroplasty planning technologies and potential conflicts of interest

Preoperative planning software is intended to improve surgical planning and patient outcomes in shoulder arthroplasty. Three-dimensional computed topography (CT) scans allow for a more accurate depiction of glenoid erosion than traditional 2-dimensional CT scans. Patient-specific instrumentation and computer-assisted navigation are newer technologies that were invented to improve implant positioning. The literature on these newer technologies is often published by authors with conflict of interest. In this article, we review perioperative planning software, 3-dimensional CT scans, patient-specific instrumentation, and computer-assisted navigation with a primary goal to evaluate if these novel technologies are improving implant positioning, patient specific outcomes, and cost effectiveness while evaluating conflict of interest in the published literature.

Life Threatening Bleeding Tuberculosis Cecal Ulcer Managed with Hemostatic Clipping – A Case Report

Massive life threatening lower gastrointestinal bleeding in adolescent is rarely being reported. Although mostly all life threatening lower gastrointestinal bleeding end up with laparotomy and hemicolectomy, however, few literatures have reported successful management using endoscopic modalities such as achieving hemostasis by endoscopic hemoclip. We are presenting a case report of a 14-years-old Sabahan girl who presented with acute life threatening massive lower gastrointestinal bleeding. We had investigated her with a computed topography scan (CT) of abdomen and pelvis which confirmed active bleeding from the ascending colon, and suspicious features of tuberculosis (TB) of the colon. The patient was treated successfully via colonoscopy with deployment of hemostatic clipping and adrenaline injection on the cecal ulcer done under a controlled environment in the operating theatre. She subsequently progressed well and completed treatment of 6-month anti-tuberculosis. The patient was stable and reported no further symptoms during follow-up time for 1 year.

Orthotopic Heart Transplant with Concurrent Supracoronary Ascending Aortic Replacement

We report a case of successful orthotopic heart transplant with concurrent supracoronary ascending aortic replacement (SCAAR) using a vascular conduit. An orthotopic heart transplant was performed on a 29-year-old White man with idiopathic dilated cardiomyopathy and reduced ejection fraction (20%). During the revision of the donor heart, a wall defect was detected in the ascending part of the donor aorta that could not be corrected. It was decided to perform a SCAAR using a 22-mm polytetrafluoroethylene vascular conduit and double-patch sandwich technique with Teflon patches. Two months later postoperative computed topography scan demonstrated sufficient patency of the vascular conduit and aorta with an improvement in the general somatic and functional state of the patient, and normal systolic and diastolic function of the transplanted heart. Our clinical case is unique in the complexity of the procedure with potential high intraoperative and early postoperative risks as well as the fact that SCAAR was performed immediately after heart transplant. In this clinical case, reconstruction of the ascending aorta with a vascular conduit is a strategically correct solution in the event of aortic defects that cannot be corrected with a suture technique.

Evaluation of the Effectiveness of Endovascular Treatment of Type 2 Endoleaks

Endovascular abdominal aortic aneurysm repair (EVAR) is a safe and minimally invasive alternative to open surgical repair for infra renal aortic aneuvrysm. EVAR requires lifelong post-procedural surveillance. Endoleaks represent the main complication. Type II endoleaks (EL2) are the most frequent and tend to be indolent. Most practitioners do not treat in EL2 as long as they are associated with stable aneurysm diameter. European guidelines recommend treatment in case of aneurysm growth. Several techniques can be offered, such as transarterial embolization and translumbar embolization. This study reports the experience and results of a single center for EL2 endovascular treatment. The aim of this study was to determine more precisely the efficacity of embolization for type 2 endoleaks treatment. A single center cohort of patients treated for EL2 with endovascular technique between 1998 and 2018 was formed to perform a descriptive analysis. Preoperative sizing, risk factors of endoleaks and intraoperative data were collected. Computed topography (CT) scans were regularly performed after EVAR to detect endoleak recurrence. Clinical recurrence was defined as the persistence of aneurysm sac growth and radiological recurrence was defined as the occurrence of EL2 on a post-embolization CT scan. Data related to reintervention, overall mortality and aneurysm related mortality were also collected. Kaplan-Meier survival analyses were used to determine the rates of reoperation-free survival and recurrence-free survival. Six hundred seven patients underwent an endovascular treatment for abdominal aorta aneurysm between 1998 and 2018. One hundred forty-five type 2 endoleaks occurred during this period. Nineteen patients (median age 76years), underwent endovascular treatment for EL2, with immediate success on 15 patients (8 transarterial embolization, 8 direct sac puncture and 3 combined procedures). During follow-up, 5 patients required a new translumbar embolization and 6 required an open surgery for recurrence of the EL2. Six patients died, 2 of them of causes related to the aneurysm. At 59,6months median follow-up, 53% of the patients presented a radiologic recurrence, with a sac growth of more than 5mm since last procedure in 4 patients (24%). Long term clinical recurrence of type 2 endoleaks treated by endovascular procedures appear to be frequent in our experience, leading to several deaths and requiring open surgical treatment.

Cadaveric study of anatomical measurement of isthmus parameters of lumbar spine to guide cortical bone screw placement.

SUMMARYOBJECTIVE:To reduce surgical exposure and improve accuracy, this study evaluated the anatomical distance parameter D (including D1, D2, and D3) of the lumbar isthmus for cortical bone screw insertion.METHODS:A total of 25 structurally complete lumbar dry specimens were used for lumbar anatomy measurements. The six cadaver specimens were divided into upper and lower parts on the plane of the T11–T12 vertebrae, and we use the lower parts. Therefore, six lumbar wet specimens and another four complete lumbar dry specimens were selected. The lumbar isthmus tangent point was considered a coordinate origin, and the insertion point was determined through translating the distance of D1 value to the midline of the vertebral body horizontally and then vertically moved toward inferior board of the transverse process with the distance of D3 value.RESULTS:In four dry and six wet intact lumbar specimens, cortical bone screws were placed according to the average value of the isthmus parameter D. A total of 100 trajectories were verified in specimens by X-ray and computed topography scan to evaluate the safety, accuracy, and feasibility of the surgical use of isthmus parameter D. Using this parameter, the rates of excellent screw placement were 95% (38/40) in four dry specimens and 88.7% (53/60) in six wet specimens.CONCLUSION:The isthmus parameter D is easier to use by the operator, which can improve surgical accuracy and reduce operation time.LEVEL OF EVIDENCE:Level IV, prospective study.

Retrospective evaluation of sensory neuropathies after extraction of mandibular third molars with confirmed “high-risk” features on cone beam computed topography scans

The objective of this study was to identify the incidence of inferior alveolar nerve (IAN) injury after extraction of mandibular third molars with confirmed "high-risk" features on cone beam computed topography scans and establish any risk factors that significantly increase the chances of sustaining an IAN injury. This study is a retrospective analysis of outcomes after surgical extraction of 500 mandibular third molars over a 5-year period. All teeth showed signs of contact with or compression of the IAN on cone beam computed topography scans. The overall incidence of IAN injury was 6.6%, with permanent neuropathies accounting for 1.8% within this high-risk cohort. Statistically significant factors shown to increase the risk of nerve injury included increasing age (P=.002), compression of the nerve evident on cone beam computed topography scan (P=.005), and buccal or interradicular position of the nerve (P=.042). Results indicate a low incidence of IAN injury, particularly given the high-risk nature of all teeth that were extracted. It highlights the benefits of cone beam computed topography scans in surgical planning. These data are an important contribution to the existing literature and valuable in the consent procedure for patients undergoing surgical removal of mandibular third molars in contact with the IAN.

Neuroimaging in an older adult inpatient psychiatric unit

AimsThis audit aimed to analyse the use of neuroimaging and its effect on treatment in an older adult inpatient psychiatry unit over the period of one year.BackgroundBrain imaging can be used as a diagnostic tool in psychiatry. According to NICE guidelines, structural imaging, such as magnetic resonance imaging (MRI) or computed topography (CT), can be used in the workup for dementia diagnosis in order to exclude non-dementia pathology and identify dementia subtype. This is important in the geriatric population where evidence of small vessel disease has an impact on treatment options and management of polypharmacy.MethodA list of patients from the past year (January to December 2019) was accessed. Patient records were then analysed to see if neuroimaging had been accessed during their admission at The Meadows Hospital, Surrey and Borders Partnership. This included imaging from prior to admission. Analysis was divided into type of imaging, comments and impact on diagnosis.ResultOverall numbers for the audit were small. A total of 74 patients were admitted onto the unit, of which 3 were readmissions. There was missing information for 8 patients, giving a total of 63 patients. CT scans were accessed for 35 patients (56% of total); 3 of these were done during the admission. MRI scans were completed for 21 patients (33%), with one requested during admission. A total of 9 patients (14%) had both CT and MRI scans. Neuroimaging results led to a change in diagnosis for 6 patients (10%). In all cases this reflected the finding of small vessel disease and a change of diagnosis to either vascular dementia or mixed dementia.Diagnoses were also analysed. The Meadows Hospital has 2 dementia wards (male and female) and 1 functional ward (for females). A total of 36 patients (57%) were diagnosed with dementia, of which the biggest groups were: Alzheimer's dementia (13 patients, 36%) and Vascular dementia (11 patients, 31%).ConclusionThe majority of the patients were admitted with established diagnoses and so only a small number had changes made following review of imaging. Good imaging results and reports help to differentiate types of dementia. Although neuroimaging is not gold standard in diagnosing dementia syndromes, it is now an important aspect in the diagnostic pathway. Getting the diagnosis correct will help with treating individuals appropriately and avoid unnecessary prescribing.

A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients’ mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.

Abstract WP427: Implementing an Algorithm Emphasizing Telestroke for Patients With an Acute Cerebrovascular Event in a Rural Setting

Background and Purpose: A stroke may occur without warning and deficits can range from mild deficits to death. Improved outcomes are associated with decreased time to revascularization of cerebral tissue. The time sensitive nature of stroke care contributes to the challenges associated with caring for individuals suffering from stroke who live far from a stroke center. The American Stroke Association (ASA) guidelines include a recommendation for the implementation of telestroke. The technology is preferred over telephone consults and is an effective method to determine eligibility of fibrinolytic therapy. Methods: The project was implemented in a stroke ready facility in a rural area and supported by an urban care center that is recognized as a comprehensive stroke center. Stroke education was provided to the rural site and an algorithm utilizing the telestroke technology was implemented. Times from door to CT (computed topography) scan, door to fibrinolytic therapy, and door to transfer time were tracked for 90 days to compare average times to baseline data using a one-tail t-test. Statistical significant was determined with a p-value <0.05. Results: There were 27 patients that presented during the collection period, with a baseline comparison of 39 patients over an 11-month period. Overall, each category had a decrease in time, with significant differences noted in door to CT and door to transfer time. The average door to CT time with telestroke decreased on average by 14.1 minutes from baseline data to a new average of 8.6 minutes. Door to transfer time with telestroke decreased by 42.2 minutes from baseline to a new average of 121.4 minutes. Additionally, during the collection period, fibrinolytic therapy initiation doubled, resulting in 48% receiving therapy. Due to the faster times, 35% of patients were able to receive a thrombectomy at the tertiary site. Conclusions: In conclusion, this study demonstrates promising results for the continuation of telestroke use in rural treatment sites for acute cerebrovascular events to decrease time to interventions for optimal outcomes.

Are Routine Postoperative Computer Tomography Scans Warranted for All Patients After Operative Fixation of Pelvic Ring Injuries?

To evaluate the efficacy of routine postoperative computed topography (CT) scan after percutaneous fixation of unstable pelvic ring injuries. Retrospective chart review. Level I Trauma Center. A total of 362 consecutive patients underwent operative fixation of unstable pelvic ring injuries during the study period. Postoperative CT scan of the pelvis was obtained in 331 (91%) of the 362 patients treated operatively for unstable pelvic ring injuries. Revision surgery based on routine postoperative CT scan. Two patients (0.55%) returned to the operating room on the basis of postoperative CT scans due to malpositioned implants. There were no significant differences of age, sex, body mass index, Injury Severity Score, mechanism of injury, smoking status, or diabetes status between those who did and did not undergo revision surgery. A dysmorphic pelvis was identified in 154 (47%) patients. Both patients undergoing revision surgery were determined to have a dysmorphic pelvis while no patients with normal pelvic anatomy returned to the operating room based on postoperative CT (2/154, 1.3% vs. 0/177, 0%, P = 0.22). Although there remains a role for postoperative CT scans in the appropriately selected patient, in the hands of experienced orthopaedic traumatologists, patients with adequate intraoperative fluoroscopy and a nondysmorphic pelvis may not require routine postoperative three-dimensional imaging. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Small bowel volvulus post gastric bypass

Small Bowel Volvulus (SBV) is an uncommon cause of Small Bowel Obstruction (SBO), which can be difficult to diagnose. However, it is very important to recognise and intervene in a timely manner due to the high risk of bowel ischemia. Unfortunately, SBV does not always have clinical features that differentiate it from other causes of mechanical obstruction. The most reliable investigation appears to be Computed Topography (CT) scan with around 50% of patients displaying the classic ‘whirl’ sign on CT. However, many remain undifferentiated SBO patients. Any of these patients who have any clinical or radiological suspicion of bowel ischemia, should be considered for surgery, as delays in diagnosis of bowel ischemia are associated with an increased risk of morbidity and mortality. In this case reported, author detailed a 55year female who presented with SBV had a CT scan which showed the classic ‘whirl’ sign and thus had timely surgical intervention and an uncomplicated recovery. Her history was significant for a subtotal colectomy, and a Rouxeny gastric bypass. This case highlights the importance of early recognition of SBV and also carries a reminder to consider rare causes of abdominal pain in patients who have had previous bariatric surgery. They have altered anatomy and thus are at increased risk of internal hernia and volvulus including SBV.

Surgical Anatomy of the Eustachian Tube for Endoscopic Transnasal Skull Base Surgery: A Cadaveric and Radiologic Study.

The endoscopic endonasal approach to the anatomically complex lateral skull base presents technical challenges. The use of the eustachian tube as a landmark to identify the petrous internal carotid artery has recently been reported, and this study aims to define the anatomic relationship between the eustachian tube and its surrounding structures using cadaveric dissection and radiologic analysis. To clarify the relationship of the eustachian tube with its surrounding structures, we performed endoscopic and microscopic dissection of 4 adult cadaveric heads and analyzed computed topography scans from 20 patients. The eustachian tube is divided into the osseous and cartilaginous parts. The cartilaginous part can be further subdivided into the posterolateral, middle, and anteromedial parts, based on its relationship to the skull base. The eustachian tube is closely related to the pterygoid process of the sphenoid bone, the foramen lacerum, and the petrosal apex and is directed away from the oblique sagittal plane almost parallel to the vidian canal at 12.2° ± 6.2° (mean ± standard deviation). The relationship between the course of the vidian canal and the eustachian tube can aid the estimation of the anatomic course of the horizontal segment of the petrous carotid artery. The eustachian tube is a useful landmark for predicting the course of the internal carotid artery when accessing the lateral skull base regions via an endonasal route. A profound understanding of the relationship between the eustachian tube and the surrounding skull base structures is important for endoscopic endonasal skull base surgeries.

Review of Stroke: The 2nd International and the 8th National Iranian Stroke Congress : Shiraz, Iran

Dear reader,Stroke is a major health problem in Iran as other developing countries. Meanwhile, epidemiological characteristics of stroke in Iranian population are different with other countries. Both population-based and hospital-based studies showed that incidence and mortality of stroke in Iran is higher than most western countries [1,2]. Higher rates of patients with young-adult stroke in Iranian population are a prominent feature too [3]. In the same time, prevalence of cerebral venous sinus thrombosis is higher than western populations [4] but the frequency of the intracranial stenosis is more or less same as Europeans [5]. The high prevalence of atherosclerotic disease in Iran can be attributed to social and economic factors, including increased life span, changes in dietary habits and an increasingly sedentary lifestyle [6]. In the light of these changes, Iranian health policymakers should consider concerted primary and secondary preventive measures to reduce the impact of this increasingly problematic public health issue.Iranians who have had a stroke consider their social, financial and rehabilitative support to be inadequate. Moreover, awareness of the manifestations of stroke is poor in the Iranian general population [7]. Consequently, the clinical status of stroke patients by the time they are transferred to the referral center may be worse than it could have been. There is an urgent need for Iranian hospitals to develop better measures to manage acute stroke patients.The second international Iranian stroke congress was held from 23-25 September 2015 in Shiraz, Iran. This Conference was a joint effort of the Clinical Neurology Research Center of Shiraz University of Medical Sciences and Iranian Stroke Association.Here we presented some selected reviews from outstanding platforms of this congress. Ghandehari presented the epidemiology of stroke in Iran [8]. Safari et al presented a comprehensive review about immunology of stroke [9]. Abolhasani-Foroughi and Nazeri summarized the role of Computed topography scan for diagnosis and treatment planning of stroke patients [10].Lotfi discussed about pearls and pitfalls of color doppler sonography of cervical arteries [11]. We also have three reviews about clinical and radiologic aspects of cerebral venous sinus thrombosis [12-14]. Two reviews focused on importance of rehabilitation in new stroke era [15,16].

Joint registration of ultrasound, CT and a shape+pose statistical model of the lumbar spine for guiding anesthesia.

Facet joint injections and epidural needle insertions are widely used for spine anesthesia. Accurate needle placement is important for effective therapy delivery and avoiding complications arising from damage of soft tissue and nerves. Needle guidance is usually performed by fluoroscopy or palpation, resulting in radiation exposure and multiple needle re-insertions. Several ultrasound (US)-based approaches have been proposed but have not found wide acceptance in clinical routine. This is mainly due to difficulties in interpretation of the complex spinal anatomy in US, which leads to clinicians' lack of confidence in relying only on information derived from US for needle guidance. We introduce a multimodal joint registration technique that takes advantage of easy-to-interpret preprocedure computed topography (CT) scans of the lumbar spine to concurrently register a shape+pose model to the intraprocedure 3D US. Common shape coefficients are assumed between two modalities, while pose coefficients are specific to each modality. The joint method was evaluated on patient data consisting of ten pairs of US and CT scans of the lumbar spine. It was successfully applied in all cases and yielded an RMS shape error of 2.1mm compared to the CT ground truth. The joint registration technique was compared to a previously proposed method of statistical model to US registrationRasoulian etal. (Information processing in computer-assisted interventions. Springer, Berlin, pp 51-60, 2013). The joint framework improved registration accuracy to US in 7 out of 17 visible vertebrae, belonging to four patients. In the remaining cases, the two methods were equally accurate. The joint registration allows visualization and augmentation of important anatomy in both the US and CT domain and improves the registration accuracy in both modalities. Observing the patient-specific model in the CT domain allows the clinicians to assess the local registration accuracy qualitatively, which is likely to increase their confidence in using the US model for deriving needle guidance decisions.

How woodpecker avoids brain injury?

It has long been recognized that woodpecker is an excellent anti-shock organism, as its head and brain can bear high deceleration up to 1500 g under fast pecking. To investigate the mechanism of brain protection of woodpecker, we built a finite element model of a whole woodpecker using computed topography scanning technique and geometry modeling. Numerical results show that the periodical changing Young's modulus around the skull affects the stress wave propagation in head and makes the stress lowest at the position of the brain. Modal analysis reveals the application of pre-tension force to the hyoid bone can increase the natural frequency of woodpecker's head. The large gap between the natural and working frequencies enable the woodpecker to effectively protect its brain from the resonance injury. Energy analyses indicate the majority of the impact energy (99.7%) is stored in the bulk of body and is utilized in the next pecking. There is only a small fraction of it enters into the head (0.3%). The whole body of the woodpecker gets involved in the energy conversion and forms an efficient anti-shock protection system for the brain.

Energy conversion in woodpecker on successive peckings and its role on anti-shock protection of brain

To investigate the mechanism of brain protection of woodpecker, we built a finite element model of a whole woodpecker using computed topography scanning technique and geometry modeling. Dynamic analyses reveal: (i) 99.7% of the impact energy is converted into strain energy in the bulk of body and 0.3% is converted into strain energy in the head after three successive peckings, indicating the majority of the impact energy is stored in the bulk of body; (ii) the strain energy in brain is mainly converted into the dissipated energy, alleviating the mechanical injury to brain; (iii) the deformation and the effective energy dissipation of the beaks facilitate the decrease of the stress and impact energy transferred to the brain; (iv) the skull and dura mater not only provide the physical protection for the brain, but also diminish the strain energy in the brain by energy dissipation; (v) the binding of skull with the hyoid bone enhances the anti-shock ability of head. The whole body of the woodpecker gets involved in the energy conversion and forms an efficient anti-shock protection system for brain.

Yersinia enterocolitica: a rare cause of infected aortic aneurysm successfully treated with antibiotics and endovascular repair

Introduction: Yersinia enterocolitica is a Gram‐negative coccobacillus belonging to the family Enterobacteriaceae. We present a rare case of abdominal aortic aneurysm infected with Y. enterocolitica that was successfully managed using intravenous antibiotics and endovascular aneurysm repair. Case presentation: A 74‐year‐old male was admitted with a 1‐week history of feeling generally unwell with worsening abdominal pain radiating through to his back. Inflammatory markers were raised and blood cultures grew Y. enterocolitica biotype 2. A computed topography scan revealed a 50 mm infected abdominal aortic aneurysm. The patient was successfully treated with intravenous antibiotics and endovascular aneurysm repair. Conclusion: Whilst endovascular aneurysm repair has been increasingly used to treat aortic aneurysms infected with a variety of pathogens, this is, to our knowledge, the first reported case of an aortic aneurysm infected with Y. enterocolitica being treated by such a technique. Further research is required to establish the long‐term outcomes of patients undergoing endovascular repair of infected aneurysms.

The effect of various heights of high‐heeled shoes on foot arch deformation: Finite element analysis

Women are interested to wear high-heeled shoes to increase their attractiveness. High-heeled shoes might create harmful effects on the musculoskeletal system. Besides earlier studies proved that the function of foot and lower extremity will change due to wearing high-heeled shoes [1,2]. Because of limitations of the experimental methods, direct measurements of internal strains and stresses of the foot are inconceivable or invasive [3]. In this research the comparison of the effect of 3 different sizes of height of high-heeled shoes on foot bones and plantar fascia is the main objective. Von-Misses stresses, strain, and arch deformation of the foot during balanced standing in women are the parameters which are investigated in this research. The output of this research is describing the effect of increasing of heel height on foot bones stresses. Mimics and ABAQUS software are employed to create a finite element (FE) model of the human ankle. MIMICS used as the segmentation software and ABAQUS used for finite element analysis (FEA). A CT (Computed Topography) scan images from the right foot of a normal female subject was imported into MIMICS. The segmented surfaces were then imported into SolidWorks CAD (Computer aided design) system to create model assembly. In order to creating tetrahedral finite element meshes the solid models of foot bones and encapsulated soft tissue structures models established in MIMICS software is imported into ABAQUS. Contact interactions among the major joints were prescribed to allow relative bone movements. The soft tissue and orthotic material were defined as hyper elastic while other tissues were idealized as homogeneous, isotropic, and linearly elastic. The ground reaction and extrinsic muscles forces for simulating the stance phase of gait were applied at the inferior ground support as a boundary condition and at their corresponding points of insertion by defining contraction forces via axial connector elements. During the balance standing condition, on half of body weight is transferred from each foot to the ground [4]. The result of this study on the shoes with heel height 1.5 inches, 2.5 inches, and 3.5 inches shows that an increase in shoe heel height resulted in a decrease in arch deformation (Figure ​(Figure1).1). There was a common rise in a peak Von-Mises stress of foot bones with increasing shoe heel height (Figure ​(Figure2).2). With 2.5 inches high-heeled shoe, the strain and the total tensional force in the plantar fascia was minimum (Figure ​(Figure33). Figure 1 Foot arch deformations during balanced standing Figure 2 Von-Mises stress of foot bones for 3 different sizes of shoe heel heights Figure 3 Average of strain in plantar fascia

An Evidence-Based Review of Exercise and Metabolic Syndrome

An Evidence-Based Review of Exercise and Metabolic Syndrome