Axis Deviation Research Articles

A vision-based error identification method for separating geometric errors of rotating axes in five-axis platforms

In this paper, a programmable identification method for visually measuring and identifying position-independent and position-dependent geometric errors (PIGEs and PDGEs) of rotary axes in compact five-axis platforms is presented. Firstly, the kinematic model of the five-axis platform is established via screw algebraic theory. Then, considering the measurement data diversity, the orientation errors identification mechanism for PIGEs is proposed. The mechanism optimally integrates the coordinate search and the least-squares method. Additionally, a least-squares sample regression model is developed to identify the positional deviation of the rotation axis. After identifying PIGEs, the PDGE sources are identified based on the right multiplication principle. Furthermore, the error estimation accuracy of the proposed method is investigated. Finally, a five-axis dispensing platform is employed to validate the identification accuracy and evaluate its feasibility.

A Review of Left Ventricular Non-compaction Cardiomyopathy (LVNC).

Left ventricular non-compaction (LVNC) is a rare congenital phenotype defined by the presence of prominent left ventricular trabeculae, deep intertrabecular recesses (continuous with the ventricular cavity), and a thin compacted layer. The most common presentation of LVNC is dyspnea (60%), followed by palpitations (18%), chest pain (15%), syncope (9%), and prior stroke (3%). LVNC presenting with acute myocardial infarction (MI) has rarely been reported in the literature. A forty-one-years old female presented with substernal chest pain and exertional dyspnea. On physical examination, she was alert without any distress, her lungs and heart examination were within normal limits. Peripheral pulses were palpable and regular, and +1 peripheral pitting edema was noted. EKG showed normal sinus rhythm with premature atrial contractions (PACs), left axis deviation, and ST-segment and T wave changes suggestive of inferior wall ischemia. Troponin I level was found to be elevated, which peaked within 24 hours, Troponinmax 110.08 ng/ml. Transthoracic echocardiography showed moderate LV dilatation with severely reduced EF (15-20%), and diffuse LV hypokinesis with a grade III restrictive pattern. There was heavy trabeculation of LV involving 2/3rd LV endocardium and wall thickness with sinusoidal tunnels perpendicular to LV wall. These morphological findings met the diagnostic criteria of LVNC/NCM. LVNC presenting with acute myocardial infarction (MI) can be related to poor outcomes, however, more data is needed to establish the clinical implication of this presentation. Asymptomatic LVNC can be observed while symptomatic LVNC should be treated with standard guidelines of HF.

Abstract 10262: High Output Cardiac Failure Due to Kratom

Introduction: Kratom use has been known to the natives of Malaysia to increase energy and to treat pain. Over the recent past there has been an increase in Kratom usage in the U.S. with the ease of access. Case Summary: A 24-year-old male presented to the emergency department due to progressive shortness of breath and pedal edema over one month. The patient reported a history of daily Kratom use for the past 2 years. His vitals upon presentation were BP: 90/50 mmHg, HR 101 bpm, O2 saturation 100% and was afebrile. Relevant abnormal labs were: sodium 114 mEq, and a BNP of 2,747 pg/mL. Other labs including TSH and urine drug screen were unremarkable. Initial ECG showed normal sinus rhythm, right axis deviation and QTc of 552 ms. Chest X ray revealed a prominent pulmonary conus. After being admitted to the ICU, he had an appropriate gradual increase in sodium level over the next 4 days. The transthoracic echocardiogram showed an LVEF of 70-75% and multiple findings suggestive of severe pulmonary hypertension and severe tricuspid regurgitation (Fig. 1 parts A and B). His estimated PASP was 95 mm Hg. Right heart catheterization demonstrated the following pressures (in mmHg): RA 5/6, PA 52/26 (37), mean PCWP 7. Cardiac output and index were 8.9 L/min and 5 L/min/m2 by Fick, 7.7 L/min and 4.3 L/min/m2 by thermodilution. Four weeks after cessation of Kratom use he underwent a transthoracic echocardiogram which showed complete normalization of abnormal findings shown in Fig. 1 parts C and D. His RVSP normalized to 26 mm Hg. Conclusion: Previously reported adverse cardiovascular events from Kratom use include tachycardia, hypertension, chest pain, conduction defects, QTc prolongation as well as cardiac arrest. We present previously unknown complications of Kratom use, namely combined pre and post capillary pulmonary hypertension and high output heart failure.

How useful is electrocardiography in children with cochlear implantation?

Hearing loss is an important health problem in children and cochlear implantation is used in its treatment. In addition, in children with hearing loss, accompanying renal, neurological, structural and cardiac conductive pathologies can often accompany. In this study, it was aimed to evaluate the electrocardiographic findings, especially QT duration in children who underwent cochlear implantation. The data were obtained from the medical records of our hospital, which is a tertiary referral cochlear implant center. All children who had cochlear implantation surgery due to sensorineural hearing loss and admitted to our hospital for speech therapy between 2019 and 2020 were evaluated with 12-channel ECG. Sixty children (15 girls and 45 boys) with a mean age of 6.5 years were analyzed. Children with a history of heart disease were excluded. In cardiac examinations, five (8.3%) had systolic murmur, four (6.6%) had mid systolic click, and two (3.3%) had stiffening in the first heart sound. Abnormalities were detected in 25% (n=15) of the electrocardiograms. The most common ECG abnormalities were prolonged QT in 4 cases, left ventricular hypertrophy in 3 cases, left axis deviation in 2 cases, and T wave changes in 2 cases. Long QT syndrome (3.3%) was diagnosed in 2 of the cases with long QT. This study demonstrates the need for electrocardiography and cardiac examinations in children undergoing cochlear implantation for hearing loss. These cases should be evaluated especially in terms of the presence of cardiac arrhythmias and potential for fatal ion channelopathy.

Conduction System Disease in Victims of COVID-19

Background: Electrophysiological-related manifestation of COVID-19 is a matter of debate in the literature nowadays. A wide spectrum of arrhythmias was observed among patients who have been infected with COVID-19. Objectives: This study discussed the prevalence of arrhythmias and conduction system disease in patients with COVID-19. Method: In this retrospective study, demographic and electrocardiographic data of 432 expired COVID-19 patients who had been admitted to Faghihi Hospital of Shiraz University of Medical Sciences from August 2020 until December 2020 were reviewed. Results: Atrioventricular nodal block (AVB) was found in 40(9.3%) patients. Furthermore, 28(6.5%) of them suffered from the first degree of AVB, and 12(2.8%) suffered from complete heart block (CHB). Among 189 cases (59.0%) ST-T changes agreed with myocardial infarction or localized myocarditis. Findings of myocardial injury including fragmented QRS and prolonged QTc were observed among 91 (21.1%) and 28 (6.5%) respectively. In victims of COVID-19, conduction disease was not related to any comorbidities. Fragmented QRS, axis deviation, presence of S1Q3T3, and poor R wave progression were significantly related to conduction system abnormalities in victims of COVID-19 (P-value > 0.05) Conclusion: Our findings can serve in future studies that aim to develop a risk stratification method for susceptible COVID-19 patients. The myocardial injury appears to role significantly in COVID-19 morbidity and mortality. Consequently, we recommend health policymakers consider separate catheterization laboratories that provide service only to COVID-19 patients.

Genetic Profile and Clinical Characteristics of Brugada Syndrome in the Chinese Population.

Brugada syndrome (BrS) is an inheritable arrhythmia syndrome that can lead to sudden cardiac death in patients while the heart structure is normal. However, the genetic background of more than 65% of BrS probands remains unclear. The purpose of this study is to report the variant spectrum in a Chinese cohort with suspected BrS and to analyze their distinct clinical and electrocardiographic features. Patients with suspected BrS from Tongji Hospital between 2008 and 2021 were analyzed retrospectively. A total of 79 probands were included in this study. Patients with type 1 BrS electrocardiogram (ECG) had a prolonged QRS duration compared to patients with type 2/3 BrS ECG. Of them, 59 probands underwent genetic testing. Twenty-five patients (42.37%) showed abnormal genetic testing results, and eight of them (13.56%) carried pathogenic/likely pathogenic (P/LP) mutations. Mutation carriers presented much more prominent depolarization and repolarization abnormalities than non-carriers, including a prolonged P-wave duration, QRS duration, QTc interval, decreased QRS amplitude, and deviation of the electrocardiographic axes (T-wave axis and R-wave axis). Furthermore, our study identified four novel P/LP mutations: Q3508X in TTN, A990G in KCNH2, G1220E, and D372H (in a representative pedigree) in SCN5A. Our study showed the variant spectrum of a suspected Chinese BrS cohort, and we identified four novel P/LP mutations in TTN, KCNH2, and SCN5A.

A puzzling overnight change in the QRS morphology

Pacemakers set in a bipolar pacing mode often result in no discernible spikes on surface 12‑lead ECG registrations. In this situation, left axis deviation combined with wide QRS can help to identify the paced ECG morphology. We present a case of a non-pacemaker dependent patient whose normal atrioventricular conduction also appeared as atypical left axis deviation with wide QRS on the ECG. These two depolarization-repolarization morphologies, and the switch between the two raised differential diagnostic questions. The case also illustrates a paced ECG demonstrating the concept of Littmann: a close relationship between leads V2 and aVL.

Analytical Study on the Ground Settlement Induced by Pipe-roof Tunnelling Considering the Interaction between Socketed Pipes

Pipe-roof Pre-construction Method (PPM) is a pre-reinforcement method widely adopted in shallow large section tunnelling in the urban area. As one of the key indexes needed to be controlled, ground surface settlement and axis deviations induced by pipe-roof tunnelling attract increasing attention, but the interaction between socketed pipes (ISP), including shielding and constraint effects, has been lack of consideration in practice. By incorporating deformation coefficient and deviation coefficients, this paper proposed a new analytical method to account for the effect of ISP on the ground movement. Then, a numerical model to consider ISP and sequential jacking process was established and a series of simulations were carried out for a large pipe-roof tunnelling project. By comparing with the analytical results, the deviation coefficients were determined for the proposed model and the effect of ISP on the surface settlement was further revealed. Finally, the rationality and effectiveness of the proposed method were confirmed by contrasts with traditional methods and numerical calculations. The results show that an approximately 37% error rate could be reduced by the new method. This research is helpful for a better understanding of the effect of ISP, and therefore benefits the effective prediction and control of the surface settlement induced by pipe-roof tunnelling.

Field mechanical properties of large section concrete pipes during jacking in fractured moderately weathered siltstone

In the construction of pipe jacking, due to the effect of jacking force, slurry pressure, axis deviation, stoppage and geological conditions, the mechanical behaviors of pipe are very complex. Additionally, most of the calculation models of pressure around the pipes in the existing standards only consider water and earth pressure, which is different from the actual situation. Therefore, this work aims to reveal the mechanical properties of concrete pipe during jacking and explore the calculation method of jacking force and frictional resistance. Based on the field monitoring of the pipe jacking project for utility tunnel in Hubei, China, the variation law of the contact pressure, slurry pressure and pipe strain were analyzed, and the jacking force and frictional resistance were calculated through the above parameters. The results show that it is more appropriate to use the rock collapse height instead of Terzaghi theory to calculate the earth pressure at the pipe crown in fractured rock mass. There is a significant negative correlation between the slurry pressure around the pipe and the jacking force. In the stratum with high permeability, choosing an appropriate lubricant injection interval can effectively improve the lubrication efficiency and reduce construction cost. In addition, the axial strain of pipe can reflect the variation of the jacking force, and the frictional resistance calculated by the effective earth pressure is closer to measured value. The calculation methods and related conclusions proposed in this paper can provide a valuable guide for pipe jacking in fractured rock mass.

Surgical Outcomes of Congenital Heart Disease in Down Syndrome: Tertiary CenterExperience-Focus on the Electrical Conduction System.

To document outcomes of cardiac surgical repair in Down syndrome (DS) patients with specific focus on the associated electrical conduction morbidities, ultimately leading to a higher incidence of pacemaker implantation (PMI). A retrospective study conducted between 2011 and 2020. A total of 167 DS patients undergoing 204 surgeries were included. The mean gestational age (GA) and mean weight were 37.3weeks and 5.5kg, respectively. Complete atrioventricular septal defect (AVSD) was the most common diagnosis. Pre-operative ECG revealed superior axis deviation (SAD) in 92 and 32% of patients with AVSD and isolated perimembranous ventricular septal defect (VSD), respectively (p < 0.01). Postoperative right bundle branch block (RBBB) was observed in 83 and 55% of patients with AVSD and following perimembranous VSD repair, respectively (p = 0.04). Ten patients underwent post-operative pacemaker implantation (PMI). Reintervention rate was around 8.9%. Three mortalities were encountered throughout the study period, 2 of which were in-hospital deaths. Low mortality was observed, however, a higher rate of PMI requirements noted with risk factors including lower age and weight.

Recurring Osteomyelitis Caused by Clostridium celerecrescens in an Adolescent After Motocross Trauma: The Importance of Multidisciplinary Care.

To the Editors: A 15-year-old male adolescent was presented to the emergency department of the trauma unit with a type II open fracture of the left lower arm caused by an accident during a cross-country motorcycle race (Fig. 1A,B). He had gotten off track and lost control of this motorcycle, thereby crashing on to dry meadow soil. The patient presented hemodynamically stable and was prepared for debridement and elastic stable intramedullary nailing. He was started on intravenous cefuroxime. White blood counts and C-reactive protein (CRP) were unremarkable, except for a brief postoperative increase in CRP. Microbiological cultures of the intraoperative swabs yielded Bacillus thuringiensis and Pseudomonas koreensis (both on an aerobic medium), upon which the treatment was changed to meropenem according to susceptibility results (Table S1, Supplemental Digital Content 1, https://links.lww.com/INF/E809). After 9 days, treatment was stopped, and the patient was discharged.FIGURE 1.: Radiographic and computed tomography findings of a left radius type II open fracture of a 15-year-old male adolescent; (A,B) before the first surgery; (C,D) after external fixation; (E) follow-up visit 15 months after discharge.After 5 weeks, he presented again with pain in the lower arm on rotation and with slight wound discharge. MR imaging of the left arm showed the presence of an inflammatory process of the radius with subperiostal abscess formation. The patient underwent surgical revision, including removal of the nailing, wound debridement and external fixation. Intravenous cefuroxime was re-initiated. Tissue and swab cultures revealed Clostridium celerecrescens and Clostridium sphenoides from an anaerobic medium, and Paenibacillus macerans from an aerobic medium. Clindamycin was added before susceptibility testing was finished. Upon final susceptibility results (Table S1, Supplemental Digital Content 1, https://links.lww.com/INF/E809), a multidisciplinary team consisting of trauma surgeons, pediatric infectious diseases specialists, and clinical microbiologists was formed to discuss the case. Based on the susceptibility testing results, the decision was made to start ampicillin-sulbactam and metronidazole. After 7 days, the patient underwent surgical revision and repeat sampling. Cultures again revealed C. celerecrescens. Three-dimensional reconstruction computed tomography of the left arm yielded a suspicious lesion compatible with bone sequestration (Fig. 1C,D), upon which the decision for another surgical revision was made, 7 days after the previous revision. Intraoperatively, two avital bone fragments of approximately 2.8 cm were removed. Follow-up cultures revealed no bacterial growth. Intravenous ampicillin-sulbactam and metronidazole were continued for a total of 5 weeks. On discharge, the patient was switched to oral sultamicillin and metronidazole for another 4 weeks. No side effects related to the antibacterial therapy were reported. After 2 months, the external fixator was removed after imaging confirmed sufficient fracture healing. On regular follow-up visits, the patient presented in a good general state without functional compromise, whereas radiologic findings showed a 17° axis deviation of the radius (Fig. 1E). Anaerobic osteomyelitis is a rare event in children and adolescents but can occur in the presence of predisposing factors such as decubital ulcers, vascular disease, peripheral neuropathy, bites or trauma.1 The most frequently described pathogens in pediatric anaerobic osteomyelitis are Peptostreptococcus spp., Prevotella spp., Fusobacterium spp., Bacteroides fragilis group and Clostridium spp.1 However, aerobic pathogens can be involved as well, for example, Staphylococcus aureus.2,3 Only a few cases of human infections caused by C. celerecrescens have been reported (Table S2, Supplemental Digital Content 1, https://links.lww.com/INF/E809).4–6 There are some features of our case that deserve discussion. First, cefuroxime was started initially and then changed to meropenem. The presence of microorganisms indicating contact with soil may have been suggestive of further pathogens, particularly spore-forming, ubiquitous bacteria. Therefore, meropenem may have been more appropriate than cefuroxime. However, the 9-day-course was longer than currently recommended for open fractures.7 Yet, apparently it did not suffice to prevent a relapse. Second, imaging turned out to be pivotal in showing the presence of bone sequestrations that prompted another revision and led to ultimately decisive source control, alongside the appropriate antibacterial therapy. Third, the detection of multiple bacteria should not be discarded per default as contamination in patients with open fractures and potential inoculation of soil microorganisms. Last, our case demonstrates the importance of a multidisciplinary approach in the care of patients with complicated post-traumatic bone and joint infections. In conclusion, relapses due to spore-forming bacteria such as Clostridium spp. can occur several weeks to months after the initial open fracture. Therefore, a high level of suspicion should be maintained in these patients even after a clinically inapparent follow-up interval. ACKNOWLEDGMENTS We thank the patient and his mother for their consenting to this report. Written informed consent was obtained from both the patient and the parent before any data was used for this case report. This case report has been presented at the 2021 annual meeting of the German Society for Pediatric Infectious Diseases.

Risk stratification for systemic lupus erythematosus associated pulmonary hypertension by simplified ESC/ERS guidelines: data from SOPHIE registry

Abstract Background The ESC/ERS guideline has established a diagnostic algorithm for pulmonary hypertension (PH) based on the peak velocity of tricuspid regurgitation, clinical history of left heart disease, chest radiography, and other chest radiological techniques. Unfortunately, due to the medical resource limitations, not all patients can receive the comprehensive inspections listed above. Purpose The purpose of the study was to sort out the practical predicting factors and evaluate the efficacy of the simplified diagnostic algorithm derived from the 2015 ESC/ERS clinical guidelines. Methods According to the ESC/ERS guideline, patients in the intermediate or high echocardiographic probability of PH group and further satisfied the following risk stratification criteria (anti-RNP (+), Raynaud phenomenon (+), 6MWD &amp;lt;440 meters, and SVR &amp;gt;1500 wood) were considered to have the intermediate (IR), and high risk (HR) of PH. Patients with a low echocardiographic probability of PH and those with intermediate or high probability of PH without satisfied the risk stratification algorithm were categorized into the low risk (LR) of the PH group. Results 1005 patients were categorized into the LR group, 30 patients in the IR group, and 19 in the HR group. Precisely, patients in the LR group were relatively younger (49.9±0.4) than that of the IR group (57.8±2.3, p=0.001) and the HR group (56.0±3.0, p=0.035). Raynaud phenomenon was occurred more frequently in the IR group (50.0%) or HR group (47.4%) compared to that of the LR group (24.1%). The occurrence of anti-RNP positive was higher in the HR group, taken up for 57.9% compared to 31.5% in the LR group (p=0.013). The incidence of right axis deviation (RAD) was increasing in the IR group (17.2%) and HR group (16.7%) compared to the LR group (3.6%). In addition, patients in IR and HR group have reduced lung volume parameters, including forced vital capacity (FVC%), forced expiratory volume at the first second (FEV1%), FEV1/FVC ratio, and forced expiratory flow at 50% of forced vital capacity (FEF50%) when compared to the LR group. Multivariate analysis was performed in four different modes to sort out the independent predictors of PH. Anti-RNP (OR=10.5, CI: 1.9, 56.5) and RAD (OR=21.9, CI: 5.2, 92.2) in mode 1, RVH (OR=10.4, CI: 1.9, 56.3) in mode 2, RAD (OR=10.3, CI: 2.0, 50.7) and FEF50% (OR=1.0, CI: 0.90, 0.97) in mode 3, and RVH (OR=56.8, CI: 6.9, 467.5) and FEF50% (OR=1.0, CI: 0.90, 0.97) in mode 4 were identified as the independent predictors of PH for SLE patients. Conclusions This registry has provided main clinical characteristics and phenotypes of Hong Kong Chinese patients with SLE and has demonstrated that Anti-RNP, RAD, RVH, or FEF50% was independent predictors of pulmonary hypertension in patients with SLE. Funding Acknowledgement Type of funding sources: None.

COMMUNITY-TO-INSTITUTION ATHLETIC CARDIOVASCULAR SCREENING: VALIDATION OF AN ELECTROCARDIOGRAM WORKFLOW MODEL

COMMUNITY-TO-INSTITUTION ATHLETIC CARDIOVASCULAR SCREENING: VALIDATION OF AN ELECTROCARDIOGRAM WORKFLOW MODEL

The Effectiveness and Rotational Stability of Vertical Implantation of the Implantable Collamer Lens for the Treatment of Myopia.

To explore the effectiveness and rotational stability of vertical implantation of the Implantable Collamer Lens (ICL) (STAAR Surgical) to treat myopia. This was a prospective, randomized, controlled study, including 78 eyes from 46 patients with myopia who underwent ICL implantation. The patients were randomly divided into vertical and horizontal implantation groups. At 1 day, 1 week, 1 month, and 3 months after surgery, rotational stability was evaluated using the postoperative axis deviation from the intended axis by the digital anterior segment photograph. The vault, crystalline lens rise, anterior chamber depth, manifest refraction spherical equivalent, intraocular pressure, and visual acuity values were obtained before and after surgery. A 3-month follow-up period showed significant differences between the efficacy indexes in the horizontal (1.11 ± 0.02) and vertical (1.13 ± 0.02) groups (P = .455). No significant difference was observed in the postoperative manifest refraction spherical equivalent between the horizontal (-0.27 ± 0.18 diopters) and vertical (0.01 ± 0.08 diopters) groups (P = .151). Also, no statistically significant difference was observed in the corneal endothelial cells and intraocular pressure between groups (P = .555, P = .464). The rotation angle of the horizontal group was greater at 1 week, 1 month, and 3 months (3.14° ± 2.13°, 2.97° ± 2.01°, 3.27° ± 2.12°, respectively) compared to that of the vertical group (1.30° ± 1.29°, 1.85° ± 1.60°, 1.74° ± 1.33°, respectively) (P < .001 for all). From 1 week to 3 months, the changing angle of horizontal (0.31° ± 1.86°) and vertical (0.49° ± 1.33°) ICL rotation displayed a positive correlation with the changing vault of horizontal (48.41 ± 86.02 mm) and vertical (39.64 ± 78.43 mm) ICL rotation (r = 0.242, 0.335, P = .033, .037). The study supports great efficacy and safety in both vertical and horizontal implantation, with the vertical implantation group displaying better stability. [J Refract Surg. 2022;38(10):641-647.].

Simultaneous Mandibular Anterior Segmental Osteotomy and Genioplasty: A Novel Technique.

The current standard approach to treat class II malocclusion is orthodontic preparation followed by a mandibular advancement through bilateral sagittal split osteotomy associated or not with a genioplasty. However, when a malocclusion with an important incisors' axis deviation is associated with a chin malposition, an alternative technique can be considered: simultaneous mandibular anterior segmental osteotomy and genioplasty. This technique is performed without a bony bridge between osteotomies. Care must be taken not to wound the lingual mucosa. If preserved, this technique is safe. The result is stable and predictable.

Lower limb alignment in patients with primary valgus ankle arthritis: A comparative analysis with patients with varus ankle arthritis and healthy controls

BackgroundWhile it is commonly acknowledged that the combined effect of lower limb orientation and ankle and hindfoot alignment play a fundamental role in ankle arthritis, supramalleolar/lower limb alignment has received less attention in valgus ankle arthritis. The purpose of this study was to analyze the lower limb alignment of patients with valgus ankle arthritis with primary origin, compared to that of varus ankle arthritis and normal controls. We hypothesized that patients with valgus ankle arthritis would have the opposite pattern of lower limb alignment as those with varus ankle arthritis. MethodsA retrospective radiographic analysis was performed on 61 patients (62 ankles, mean age, 59.3 ± 12 years) with primary valgus ankle arthritis. On preoperative radiographs, seven parameters, including talar tilt angle, medial distal tibial angle (MDTA), talar center migration, anterior distal tibial angle, talo-first metatarsal (Meary's) angle, hindfoot moment arm (HMA), and mechanical axis deviation (MAD), were measured and compared to those of primary varus ankle arthritis (n = 55; mean age, 59.7 ± 8.1 years) and control patients (n = 59; mean age, 29.3 ± 7.3 years). ResultsThe valgus group had a significantly lower mean MDTA than the control group (p < 0.0001), indicating a varus distal tibial plafond in comparison to the control group. Meary's angle and HMA were significantly lower in the valgus group compared to the varus group (p < 0.05 and p < 0.0001, respectively), indicating a lower medial longitudinal arch and valgus hindfoot alignment. On whole limb radiographs, the valgus group showed a greater MAD than the control group, indicating varus lower limb alignment (p < 0.05). However, the MAD did not differ significantly between the valgus and varus groups (p = 0.7031). ConclusionOur findings indicate that a significant proportion of ankles with primary valgus arthritis have a varus tibial plafond and a varus lower limb mechanical axis. This study contributes to our understanding of primary valgus ankle arthritis and suggests that lower limb alignment should be analyzed and considered throughout valgus ankle arthritis realignment procedures.

An Incidental Discovery of a Serious Complication

An Incidental Discovery of a Serious Complication

Varus Knee Limits Pain Relief Effects of Laterally Wedged Insoles and Ankle-Foot Orthoses in Medial Knee Osteoarthritis.

ObjectiveTo investigate the impact of varus malalignment of the knee on pain reduction achieved by an ankle-foot orthosis and a laterally wedged insole in patients with medial knee osteoarthritis.DesignSecondary analysis of a randomized, clinically prospective cross-over study.PatientsTwenty-eight participants with medial knee osteoarthritis.MethodsAll participants wore a 5-mm laterally wedged insole and an ankle-foot orthosis for a period of 6 weeks each in a randomized order. Pain was reported on a numerical rating scale and was correlated with limb alignment, as defined by the mechanical axis deviation in full-leg standing radiographs.ResultsInsole and orthosis use reduced pain compared with baseline (median knee pain change: insole –0.5 (–5 to +6), orthosis –1.5 (–7 to +5). A higher mechanical axis deviation (greater varus) correlated significantly with smaller pain reduction for both aids (insole p = 0.003, orthosis p < 0.001). A cut-off to predict pain response was found at a mechanical axis deviation of 14–15 mm for both aids, i.e. > 3° knee varus.ConclusionThere is a correlation between varus malalignment and pain reduction. There seems to be a mechanical axis deviation cut-off that predicts the response to treatment with the aids with good sensitivity.LAY ABSTRACTOsteoarthritis of the knee can be treated using orthoses and insoles to unload the most damaged and painful inner (medial) part of the knee. However, patients do not benefit equally from these devices and there is not enough scientific data to predict which patients will benefit from an orthosis or insole. This study investigated whether the genu varum (degree of bow-leggedness) correlates with pain reduction when using an insole or an ankle-foot orthosis. A total of 28 patients with knee osteoarthritis received both aids, each for a period of 6 weeks, in random order. They documented knee pain before and after using the devices. Radiographs of the leg were analysed to determine the degree of genu varum. Statistical analysis showed that patients with straighter legs experienced better pain reduction with both aids than did bow-legged patients. In conclusion, ankle-foot orthoses and insoles are less effective in bow-legged patients.

Tibial Lengthening along Submuscular Plate with Simultaneous Acute Tibial Deformity Correction by High-Energy Osteotomy: A Comparative Study.

Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten patients received tibial lengthening with acute knee angular deformity correction using high-energy osteotomy (Group 1), and nine patients received tibial lengthening only with osteotomy using multiple drills and osteotome (Group 2). Radiographic parameters retrieved before and after the operation included leg-length discrepancy, tibial length, length gained, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). There were significant differences between groups in terms of external fixator index (EFI) (p = 0.013) and healing index (HI) (p = 0.014), but no significance in the length gained (p = 0.356). The latest postoperative mLDFA (p = 0.315), MPTA (p = 0.497), and MAD (p = 0.211) of Group 1 were not distinguishable from Group 2. The functional outcomes were excellent, and there were no permanent complications. Despite showing a longer healing time, this alternative lengthening procedure which combines fixator-assisted plate lengthening in the tibia with simultaneous surgical intervention of acute tibial deformity correction using an oscillating saw is appropriate for patients with leg-length discrepancy and angular deformity of the tibia.

Prevalence and Clinical Impact of Electrocardiographic Abnormalities in Patients with Chronic Kidney Disease.

Chronic kidney disease (CKD) is a strong risk factor for cardiovascular disease. An electrocardiogram (ECG) is a basic test for screening cardiovascular disease. However, the impact of ECG abnormalities on cardiovascular prognosis in patients with CKD is largely unknown. A total of 2442 patients with CKD (stages 3–5) who underwent ECG between 2013 and 2015 were selected from the electronic health record database of the Korea University Anam Hospital. ECG abnormalities were defined using the Minnesota classification. The five-year major adverse cerebrocardiovascular event (MACCE), the composite of death, myocardial infarction (MI), and stroke were analyzed. The five-year incidences for MACCE were 27.7%, 20.8%, and 17.2% in patients with no, minor, and major ECG abnormality (p < 0.01). Kaplan–Meier curves also showed the highest incidence of MI, death, and MACCE in patients with major ECG abnormality. Multivariable Cox regression analysis revealed age, sex, diabetes, CKD stage, hsCRP, antipsychotic use, and major ECG abnormality as independent risk predictors for MACCE (adjusted HR of major ECG abnormality: 1.39, 95% CI: 1.09–1.76, p < 01). Among the detailed ECG diagnoses, sinus tachycardia, myocardial ischemia, atrial premature complex, and right axis deviation were proposed as important ECG diagnoses. The accuracy of cardiovascular risk stratification was improved when the ECG results were added to the conventional SCORE model (net reclassification index 0.07). ECG helps to predict future cerebrocardiovascular events in CKD patients. ECG diagnosis can be useful for cardiovascular risk evaluation in CKD patients when applied in addition to the conventional risk stratification model.