Axis Deviation Research Articles

Risk Factors for Rebound After Correction of Genu Valgum in Skeletal Dysplasia Patients Treated by Tension Band Plates.

Growth modulation using tension band plates (TBPs) is increasingly important for lower limb deformity correction in patients with skeletal dysplasia (SKD). Development of rebound deformity is a concern after TBP removal. Data regarding this complication are rare; therefore, we evaluated the prevalence and risk factors for rebound deformity in children with SKD undergoing correction of genu valgum using TBP. All patients with SKD with genu valgum treated by TBP at the distal femur or/and proximal tibia at a single center were reviewed. Inclusion criteria were: (1) minimum 2-year follow-up after TBP removal or having revision surgery for rebound deformity and (2) implant removal age for girls 14 years and below and boys 16 years and below. Exclusion criteria were any femoral/tibial osteotomies during TBP treatment or follow-up. A change of ≥3 degrees of mechanical lateral distal femoral and/or medial proximal tibial angle was accepted as rebound deformity and analyzed statistically. Thirty-three patients (59 limbs; 52 femur and 29 tibia physes) met our criteria. Mean follow-up after implant removal was 43.7 months. Rebound deformities were seen in 43 limbs (39 femurs and 13 tibias). Boys had more rebound than girls; however, this was not influenced by body mass index. Femurs had more rebound than tibias. Patients in the rebound group were younger than the nonrebound group. Time from application to removal of TBP was shorter in the rebound versus nonrebound group. Overcorrected limbs had more rebound deformity than not overcorrected. The difference in growth velocity of lower limbs in the rebound versus nonrebound group was statistically significant. Patients with epiphyseal dysplasia had more rebound than metaphyseal dysplasia, but this was not statistically significant. Risk factors for developing a rebound deformity after correction of genu valgum using TBP in SKD included male sex, TBP surgery at a young age, short duration of TBP implantation, overcorrected extremity (mechanical axis deviation ≤1), and high percent growth velocity after TBP removal. Level IV-retrospective study.

“Cardiac Remodeling after Surgical Patch Closure of Adult Congenital Atrial Septal Defects: Perspective of Bangladesh”

Introduction: Atrial septal defect is one of the congenital heart diseases. An atrial septal defect (ASD) represents a communication between the left and right atrium leading to left to right shunt. It makes up about 10% of all congenital heart diseases after delivery and up to 30—40% of heart defects diagnosed in patients aged over 40 years. Objectives: To identify the status of cardiac remodeling after surgical patch closure of adult congenital atrial septal defects. Methodology: The descriptive and observation study was carried out atDepartment of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to April 2015. The patients both male and female undergoing surgical closure of atrial septal defect, Department of Cardiac Surgery, BSMMU, Dhaka, Bangladesh. Total sixty (60) patients were studied, thirty (30) in each group. Group A: Thirty (30) patients of surgical closure of ASD at or before age of 25 years. Group B: Thirty (30) patients of surgical closure of ASD at or after age of 25 years. A purposive sampling technique was used for sample selection. The sample size was determined by using the standard formula for comparison between two proportions. To make it more convenient and reduce the error sample size of this study was fixed at 60 (30 in each group). Careful history regarding the complaints of Exerttional dyspnoea, Palpitation, Fatigability, General weakness, Electrocardiography (ECG), Chest X ray, Echocardiography (Echo), Left atrial diameter (LA), -Left ventricular internal diameter at the end of diaslole (LVIDd), -Left ventricular internal diameter at the end of systole (LVIDs), Interventricular septal thickness (IVST), Posterior wall thickness (PWT), Fractional shortening (FS), Ejection fraction (EF) were measured. Results: From the result it was found that exertional dyspnoea in 60.0%, palpitation in 70.0%, fatigue in 66.6% and general weakness in 53.33% in group A and in group B exertional dyspnoea in 80.0%, palpitation in 73.33%, fatigability in 63.33% and general weakness in 80.0%. There was no significant difference in presenting complaints distribution in between two groups. From the ECG findings between two study groups it was found that arrhythmia in 13.33%, left axis deviation in 10.0%, right axis deviation 23.330% and in group B arrhythmia in 16.67%, left axis deviation in 13.33%, right axis deviation 36.67%. There were differences between two groups regarding ECG findings. In early age group there was few complains but complains are more in late age group. From the types of ASD between two study groups it was revealed that septum secundum defect is 66.67%, Septum primum 20 % and sinous venosus defect in 13.33 % in group A. In group B septum secundum defect is 76.67%, Septum primum 13.33 % and sinous venosus defect in 10 %. There was no significant difference in type of ASD in between two groups. Conclusion: This study concluded that cardiac remodeling occurs after surgical closure of atrial septal defect in all age group and degree of cardiac remodeling was better in early age group (up to 25 years) compared with late age group (>25 years).

No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy.

The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting. Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The influence of morphologic factors of the femur [centrum-collum-diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated. Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10-17°). In the frontal plane, mLDFA changed a mean of 0.1° (-0.06 to 0.3°) (n.s.) and -0.3° (-0.5 to -0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°-23°). mLDFA changed a mean of -0.2° (-0.5° to 0.2°) (p < 0.006) and 0.2° (0-0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (-2.3 to 1.3) (p < 0.01) and 0.5° (-1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to influence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5mm in both the frontal and sagittal plane (p < 0.001). In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction. IV.

Development and validation of a prediction model to estimate risk of acute pulmonary embolism in deep vein thrombosis patients

Venous thromboembolism (VTE), clinically presenting as deep vein thrombosis (DVT) or pulmonary embolism (PE). Not all DVT patients carry the same risk of developing acute pulmonary embolism (APE). To develop and validate a prediction model to estimate risk of APE in DVT patients combined with past medical history, clinical symptoms, physical signs, and the sign of the electrocardiogram. We analyzed data from a retrospective cohort of patients who were diagnosed as symptomatic VTE from 2013 to 2018 (n = 1582). Among them, 122 patients were excluded. All enrolled patients confirmed by pulmonary angiography or computed tomography pulmonary angiography (CTPA) and compression venous ultrasonography. Using the LASSO and logistics regression, we derived a predictive model with 16 candidate variables to predict the risk of APE and completed internal validation. Overall, 52.9% patients had DVT + APE (773 vs 1460), 47.1% patients only had DVT (687 vs 1460). The APE risk prediction model included one pre-existing disease or condition (respiratory failure), one risk factors (infection), three symptoms (dyspnea, hemoptysis and syncope), five signs (skin cold clammy, tachycardia, diminished respiration, pulmonary rales and accentuation/splitting of P2), and six ECG indicators (SIQIIITIII, right axis deviation, left axis deviation, S1S2S3, T wave inversion and Q/q wave), of which all were positively associated with APE. The ROC curves of the model showed AUC of 0.79 (95% CI, 0.77–0.82) and 0.80 (95% CI, 0.76–0.84) in the training set and testing set. The model showed good predictive accuracy (calibration slope, 0.83 and Brier score, 0.18). Based on a retrospective single-center population study, we developed a novel prediction model to identify patients with different risks for APE in DVT patients, which may be useful for quickly estimating the probability of APE before obtaining definitive test results and speeding up emergency management processes.

A new approach for crooked nose: Separated spreader graft “puzzle graft”

IntroductionThe nasal septum takes an important role in nasal shape and function. The term “crooked nose” is commonly used for all of the clinical conditions involving deviation of the nasal axis from the midline. This situation leads to both aesthetic concerns and breathing problems. In this study, we describe a new method in order to nasal dorsum on the midline and improving airway function in crooked nose patients, that will be contribute to the literature. Materials and methodsThis study enrolled 50 (fifty) patients who had undergone open septorhinoplasty operation were included in our study. The puzzle graft, which was prepared as a spreader graft consisting of three separate parts, was used to correct crooked nose in all patients. Anterior rhinoscopic examination, photographs and Nasal Obstruction and Septoplasty Effectiveness (NOSE) scores for the pre-operative and post-operative 1 year were compared and evaluated in this study. ResultsThe new approach was used successfully in all of the patients. Anterior rhinoscopic and 1 year photographic evaluations revealed a significantly correction of external appearance post-operatively. None of the patients had any additional complaints and complications during the post-operative period. We observed that NOSE scores, with which the post-operative nasal obstruction was evaluated, were significantly better in all 50 patients. ConclusionCrooked nose deformity is one of the most difficult problems in rhinoplasty. There is no absolute true technique for solving this situation. Each method works properly in appropriate cases. Sometimes we should use more than one technique in the same operation to correct the pathology. Our purpose is to present a new option to help surgeons in “crooked nose”; to provide a new method that can work safe and effective in convenient conditions.

Method of adjusting carrier-envelope offset frequency based on electro-optic-crystal Mach-Zehnder interferometer

Electro-optic-modulator (EOM) based Mach-Zehnder (M-Z) interferometer is a novel method of controlling the carrier envelope offset frequency (&lt;i&gt;f&lt;/i&gt;&lt;sub&gt;0&lt;/sub&gt;). It is achieved by adjusting the envelop of the pulse, while keeping the carrier frequency unchanged. In this paper, the polarization control device involved in this method is simulated, and the influences caused by the deviation of the optical axis of the wave plate on the polarization direction and the degree of output laser are analyzed. An optical axis calibration method is proposed to reduce the influence caused by the deviation of optical axis of wave plate. The effects of pump current and EOM based M-Z interferometer on &lt;i&gt;f&lt;/i&gt;&lt;sub&gt;0&lt;/sub&gt; and the beat note (&lt;i&gt;f&lt;/i&gt;&lt;sub&gt;b&lt;/sub&gt;) between the comb and the laser are compared with each other. The experimental results show that the effect of changing the pump current on &lt;i&gt;f&lt;/i&gt;&lt;sub&gt;b&lt;/sub&gt; is 7 MHz, when the &lt;i&gt;f&lt;/i&gt;&lt;sub&gt;0&lt;/sub&gt; adjustment quantity is 9 MHz. Under the same &lt;i&gt;f&lt;/i&gt;&lt;sub&gt;0&lt;/sub&gt; adjustment quantity, the influence of EOM based M-Z interferometer on&lt;i&gt; f&lt;/i&gt;&lt;sub&gt;b&lt;/sub&gt; is 0.2 MHz, which is only 1/35 of the influence of pump current. Therefore, it is verified that EOM based M-Z interferometer can effectively reduce the interference to &lt;i&gt;f&lt;/i&gt;&lt;sub&gt;b&lt;/sub&gt;. It provides a technical means to narrow the line width of optical comb by using &lt;i&gt;f&lt;/i&gt;&lt;sub&gt;b&lt;/sub&gt; to lock repetition rate (&lt;i&gt;f&lt;/i&gt;&lt;sub&gt;r&lt;/sub&gt;) .

Deflection of mini implants from its intended path of placement on varying bone densities.

Knowledge of bone density in maxilla and mandible will allow the clinician to plan the anchorage strategies and placement of implants with necessary precautions. The study aims to evaluate the deflection changes of titanium alloy self-drilling mini implants from the intended path that occurs during placement in varying bone densities. 63 titanium alloy self-drilling mini implants of the lengths 6mm, 8mm, and 10mm with diameter of 1.3mm were placed in three homogenous solid rigid polyurethane foam (saw bone) with bone densities of 20pcf, 30pcf, and 40pcf simulating anatomic sites in maxilla and mandible. 7mini implants of each length in all bone densities were tested for study. The implants were inserted perpendicularly into artificial bone block held in a custom made stand. The bone blocks were then radiographically exposed and the deviation of the long axis of the implantfrom a true vertical line was measured. There was a decrease in deflection of the mini implant with increase in density. On the other hand, increase in length resulted in increase in the amount of deflection. Longer mini implants can be used in less dense bone as in maxilla, whereas shorter mini implants can be used in high dense bone as in mandible to increase the stability and success rate of implants. Bone density and implant length play a role in deflection of mini implant from its intended path of insertion. Key words:Orthodontic Mini implants, deflection, bone density, anchorage.

Assessment of pleural effusion quantity, assistance for quality, and management by clinical examination, sonography, and laboratory parameters in a super specialty hospital

Introduction: This study is the easiest and fastest; patient and observer comfort level increase with the convenience of evaluation of pleural effusion (PE) qualification, and assessment of quality and guidance for management is taken into consideration. Four plus one formula are taken for the existing literature, and the patient imaging evaluation and all the four plus one measurement are taken and calculated and kept for comparison. Later, the patient has aspirated patient PE catheter drainage done and calculated with the above four plus one measurement, and statistical analysis correlation is done. Aim: The aim of this study was to find the quantity, quality, and nature of PE in planning the management. Objectives: Primary objective - study to assess the nature of PE by clinical, sonography laboratory results. Secondary objective - To decide the mode of management and follow-up by diagnostic, therapeutic, closed pleural biopsy, pleuroscopy, video-assisted thoracoscopic surgery, and surgical decortication. Need of the Study: Because of the shape of pleural space and its anatomy, the PE volume variability in the estimation of actual quantity is complex subjectively even for an experienced clinician estimation or by computed tomography scan and sonography. Hence, instead of many available complicated clinical estimation and imaging formulae, the sonography formulae showed a wide spectrum of values in measuring the actual PE amount. This observational study was performed utilizing and comparing the available references and formulae. Sonography is modified to give the best comfort to patients and the most accessible and fastest sonographic t estimation and comparison with other groups of studies and to arrive at a consensus value for the purpose of our institutional uniformity. Study Site: Department of Radiology and Imaging Sciences and Department of Pulmonary Medicine, Apollo Hospitals, Chennai-06. Study Design: This was an observational, cross-sectional study. Study Duration: The duration of the study was March 2020–September 2021. Inclusion Criteria: patients with clinical suspicion of PE are taken up for study. Exclusion Criteria: patients with noncooperation and restless severe hydropneumothorax. The total number of patients is 181, both male and female, Equipment: High-end EPIQ-7G, PHILIPS ULTRASOUND machine with advanced feature and with broadband convex C5-1 transducer used, and all parameters are recorded systematically. If the fluid is beyond the image frame, we utilized a panoramic software view for any length of fluid, heightens the advantage in the study. Results: Balick et al. and our single measurement study were correlated, and we found in this study stresses on any axis, longest single measurement and position of the patient made easier for the estimation utilizing, highest hand equipment, having panoramic view software. Conclusion: Single-free longest axis measurement in this study is useful with the standard deviation of the single-fixed axis of measurements of other studies.

Обґрунтування впливу зміни коефіцієнта міжосьового розподілу гальмівної сили на керованість легкового автомобіля

The article considers the change of the radius of the instantaneous center of rotation of a car moving along a curved trajectory during braking, taking into account the lateral input of the wheels of both axles of cars, both equipped with electronic tracking systems and not equipped with such. A criterion for assessing the controllability of cars moving on a curved trajectory in a braked state, by comparing the ratio of the current speed of the car to the longitudinal base with the ratio of the coefficients of lateral tire input to the product of the longitudinal base of the car, mass and cosines. It is established that the radius of instantaneous rotation of the longitudinal axis of the car moving along a curved trajectory during braking depends on the speed of the center of mass of the car, the coefficient of axle distribution of braking force, physical characteristics of applied tires, steering wheel angle and design and weight parameters. As a result, it allows you to set controllability. The authors obtained dependences that will create new algorithms for the operation of modern electronic control systems for stabilizing the longitudinal axis of a braked car, taking into account the speed of the car, its design and weight characteristics, the main characteristics of its braking system (coefficient of axle braking force distribution), physical characteristics used tires on wheels and connect them to the angles of the steered wheels, controlling the deviation of the longitudinal axis, which allows the driver to maintain the possibility of quite sharp maneuvers directly in the braking process, moving along a curved trajectory.

High-Throughput Extraction of Seed Traits Using Image Acquisition and Analysis.

Seed traits can easily be assessed using imageprocessing tools to evaluate differences in crop variety performances in response to environment andstress. In this chapter, we describe a protocol to measure seed traits that can be applied to cropswith small grains, including legume grains with little modification. The imaging processing tool can be applied to process a batch of images without human intervention. The method allows evaluation of geometric and color features, and currently extracts 11 seed traits that include number of seeds, seed area, major axis, minor axis, eccentricity, and mean and standard deviation of reflectance in red, green, and blue channels fromseedimages. Protocols or methods, including the one described in this chapter, facilitate phenotyping seed traits in a high-throughput and automated manner, which can be applied in plant breeding programs and food processingindustry to evaluate seed quality.

CORONAL PLANE GROWTH MODULATION FOR GENU VALGUM IN SKELETAL DYSPLASIA.

To investigate the efficiency and rates of correction by hemiepiphysiodesis using 8-plate to manage genu valgum deformity in children with skeletal dysplasia. Eleven children with skeletal dysplasia (three female, eight male; mean age = 10.5 years; age range = 7-13) who underwent temporary hemiepiphysiodesis using 8-plates for genu valgum deformity were retrospectively reviewed. There were nine bilateral cases and two unilateral cases. The mean follow-up time from the index surgery to the final follow-up was 45 (ranging from 24 to 72) months. Radiographical assessment including preoperative and final follow-up measurements of joint orientation angles and mechanical axis deviation (MAD) were conducted. Deformities were completely corrected in nine lower extremities (45%) and partially corrected in seven extremities (35%). In four extremities of two children with Morquio syndrome, MAD worsened. The correction rate of MAD was 1.25 ± 1.62 mm/mo. Though hemiepiphysiodesis using 8-plate requires a longer treatment period, it seems to be an effective treatment for correction of genu valgum in children with skeletal dysplasia. Level of Evidence IV, Case Series.

Intra-articular osteotomies for medial compartment osteoarthritis: Is adding an extra-articular osteotomy worthwhile?

Background and Aims: Medial compartment osteoarthritis (MCOA) of the knee presents with varus deformity arising from the upper tibia or lower femur. High tibial osteotomies relieve pain by correcting the varus and improving the mechanical axis deviation (MAD). Closing wedge, opening wedge, and dome osteotomies are popular choices in the upper tibial metaphysis. These are all extra-articular osteotomies (EAO). Recently, attention has turned to detection and treatment of intra articular deformity arising from the knee to treat MCOA. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy (IAO) which corrects the varus malalignment by elevating the medial tibial condyle and is usually fixed with a plate (Tibial condylar valgus osteotomy-plating [TCVO-P]). A second distal extra articular osteotomy, fixed with an Ilizarov fixator (tibial condylar valgus osteotomy-Ilizarov [TCVO-I]) is performed in some patients for better correction of the mechanical axis. The two groups were treated with different surgical approaches based on preoperative analysis of deformity. Hence this is a level IV study. We aimed to study the improvement in radiological parameters after TCVO in MCOA. We also compared the results between TCVO-P and TCVO-I. Patients and Methods: We performed 64 osteotomies in 55 patients over the last 7 years. 30 (33 tibiae) had a TCVO-P. 25 (31 tibiae) had a TCVO-I. The mean age in TCVO-P was 55 years, and in TCVO-I was 48 years. Results: The mean preoperative (bo) MAD was more in TCVO-I at –37.4% and improved to a mean postoperative MAD of 53.8%. TCVO-P had a lesser mean bo MAD of –7.4%, which corrected to 46.4%. MAD was better corrected by TCVO-I (P = 0.0058). Correction of medial proximal tibial angle, hip knee ankle angle, ankle joint line orientation improved significantly in both groups. The knee joint line orientation was improved by TCVO-I (P = 0.001), but not by TCVO-P (P = 0.075). Joint line convergence angle (JLCA), spine edge angle, and spine vertical distance were all significantly improved in both groups. Condylar plateau angle was not changed significantly in either group. Conclusion: TCVO is an Intra articular osteotomy which effectively corrects the varus deformity arising from the knee joint in MCOA. An isolated TCVO-P slightly under-corrects the mechanical axis. TCVO-I is better at restoring mechanical axis to beyond neutral and is better for younger patients and with intorsion deformities.

Correction of multiplanar deformities around the knee with monolateral external fixator

Introduction Angular deformities around the knee are common during childhood and most cases are a variation in the normal growth pattern. Uncorrected deformities change the biomechanics by disturbing stress distribution on the knee joint weight-bearing surface. Monolateral external fixator with osteotomy has shown better results being simple, and offers accurate correction, a low complication rate, the ability to correct valgus, varus, and rotational deformities, with early mobilization of the patient. Patient and methods A multicenter study case series prospective study was conducted from January 2020 to January 2021. A total of 30 patients with coronal plane deformities were included in the study. Of them, 15 patients (all cases were unilateral, 9 left limbs and 6 right limbs) presented with genu valgum with an age range between 10 and 16 years, and mean age was 10.5 years. Eight patients presented with genu varum only and six cases presented with genu varum and internal tibial torsion (all cases were unilateral, seven right limbs and eight left limbs) with an age range between 10 and 16 years and a mean of was 12.4 years. Results There is a statistically significant decrease of tibiofemoral angle (TFA) and mechanical axis deviation (MAD) after surgical correction of genu valgum among the included children with P value=0.001, and there is a statistically significant increase of lateral distal femoral angle (LDFA) after surgical correction of genu valgum with P value=0.001. There is a statistically significant increase of TFA, medial proximal tibial angle (MPTA), and MAD after surgical correction of genu varum among the included children with P value=0.001. Conclusion Correction of multiplanar deformities around knee using monolateral external fixator has good results in genu valgus with the improvement of LDFA and TFA, and with the improvement of MPTA and TFA in genu varum and with correction of MAD in both of the deformity after surgical correction, with rotation correction using the ability of direction of Schanz placement.

Focal dome condylar osteotomy: Early results of alignment of a combined intra- and extra-articular high tibial osteotomy

Background and Aims: Extra-articular high tibial osteotomies reliably treat varus deformities seen in medial compartment osteoarthritis of knee (MCOA). Recently, attention has turned to the detection and treatment of intra-articular knee deformity to treat MCOA. Tibial condylar valgus osteotomy (TCVO) is an intra-articular osteotomy (IAO) that corrects the varus by elevating the medial tibial condyle and is fixed with a plate. TCVO improves joint line convergence angle (JLCA), spine edge angle (SEA), and spine vertical distance (SVD), which measure intra-articular deformity. It may undercorrect the mechanical axis to <50%. Focal dome condylar osteotomy (FDCO) is recently described and claims to correct both the intra- and extra-articular deformities in MCOA. We aimed to study the immediate results of FDCO and compare its efficacy with TCVO. Patients and Methods: We performed ten FDCO procedures on ten patients over the last year. The mean age was 57 years. We compared the results with a similar retrospective cohort of ten TCVO patients. Results: The mean preoperative (bo) mechanical axis deviation (MAD) in FDCO was −13.8% and improved to 51.6%. TCVO group had a similar mean postoperative (po) MAD of 43.5% (P = 0.38). Although 6 of 10 FDCOs had MAD >50%, only two of TCVOs crossed the midline. The mean bo medial proximal tibial angle in FDCO was 85.9° and improved significantly po to 93°. Hip knee ankle angle, ankle joint line orientation, and knee joint line orientation improved significantly as did JLCA, SEA, and SVD. Condylar plateau angle did not change. Conclusion: FDCO is an IAO with a vertical limb that passes through the lateral tibial spine and a medial curved limb. This single osteotomy can correct the intra-articular and extra-articular varus deformity. Although there was no significant difference in the correction of intra- and extra-articular deformity parameters between FDCO and TCVO, we feel that it was part of our learning curve. FDCO has the potential for better correction of the mechanical axis along with intra-articular deformities.

Electrocardiographic features of patients with hypertrophic cardiomyopathy

Introduction. Hypertrophic cardiomyopathy is a disorder of the myocardium characterized by asymmetric or symmetric left ventricular hypertrophy. It is often an inherited disorder with an autosomal dominant pattern. The aim of this study was to evaluate the electrocardiographic characteristics of patients with hypertrophic cardiomyopathy, as well as to assess the accuracy of current electrocardiographic criteria for left ventricular hypertrophy used as indicators of hypertrophic cardiomyopathy. Material and Methods. This retrospective study was conducted using hospital medical records of 42 patients with the diagnosis of hypertrophic cardiomyopathy. Detailed electrocardiography analysis, apart from all the usual parameters, included the calculation of indices used to diagnose left ventricular hypertrophy including Sokolow augmented vector left, Cornell voltage, Cornell product, and Sokolow-Lyon index. Results. Sinus rhythm was present in 95.2% of patients, while atrial fibrillation was found in 4.8%. The majority of patients presented with left axis deviation. A slight positive correlation was found between the Sokolow augmented vector left index and posterolateral wall thickness (r = 0.475; p &lt; 0.05), and also between the Cornell voltage index and posterolateral wall thickness (r = 0.368; p &lt; 0.05). A borderline positive correlation was found between the Cornell product index and posterolateral wall thickness (r = 0.290; p = 0.063). Interventricular septum thickness showed no significant correlation with any of the electrocardiographic indices of left ventricular hypertrophy. Conclusion. In patients with hypertrophic cardiomyopathy, the Sokolow augmented vector left and Cornell voltage indices were the best indicators of posterolateral wall hypertrophy, whereas none of the examined indices correlated well with the interventricular septum thickness.

Association between RS Time in Electrocardiogram and Right Ventricular Functions in Patients with Chronic Obstructive Pulmonary Disease

Objective: The occurrence of right ventricular (RV) dysfunction in chronic obstructive pulmonary disease (COPD) results in an increased risk of mortality. We aimed to study the diagnostic value of RS time in the recognition of COPD patients with RV dysfunction. Methods: 120 consecutive COPD patients were divided into two groups, patients with and without RV dysfunction, and compared them in terms of parameters including RS time. RS time was defined as the longest interval from the beginning of the QRS complex to the nadir of the S- or S′-wave in the inferolateral leads on an electrocardiogram. Results: RV dysfunction was observed in 36% of consecutive COPD patients with a mean age of 63.4 ± 9.8 years (83.3% male) and a mean forced expiratory volume in 1 s of 1.51 ± 0.62 lt. The heart rate, right QRS axis deviation frequency, S1S2S3 pattern frequency, and RS time (p < 0.01) were significantly higher in the patients with RV dysfunction than in those without. Body surface area, heart rate, and RS time (p < 0.001) were independent predictors of an RV dysfunction. An ROC analysis showed that the best RS time cutoff value for the prediction of RV dysfunction was 60 ms with a sensitivity of 81.4% and a specificity of 74.0%. Conclusion: In patients with COPD, RS time prolongation, which can be easily and quickly determined from the electrocardiogram, may be a marker for RV dysfunction.

Splinter hemoragije kao mogući znak infarkta miokarda i plućne embolije

Introduction/Objective Subungual splinter haemorrhages (SSH) are a common non-specific clinical sign which is easy to recognize. They can occur in conjunction with many medical conditions of various significance. They present as painless black longitudinal lines towards the distal part of the nail bed. The objective of this article is to present a patient with newly acquired chest pain, a differential diagnostic dilemma between acute myocardial infarction (AMI) and pulmonary embolism (PE) whose fingers show signs of SSH. Case report An emergency medical team (HMP) was dispatched to a location where a 58-year-old man was experiencing chest pain. They found the patient in a sitting position, reporting sudden onset of stabbing chest pain with no propagation and lasting a few hours. He stated that he had never before had similar symptoms. Upon examination, the patient was afebrile, hypertensive (180/100 mmHg), mildly tachycardic (84/min), and blood oxygen saturation was within normal limits (97% on room air). ECG: sinus rhythm, left axis deviation, S1 in D1, ST elevation ≤ 1mm in D2, D3 and aVF, ST depression from V4 to V6. The physical examination revealed SSH located on the nail beds of the hands distally. The patient was transported to cardiology where he was continuously monitored. Rising values of troponin T (310, 2628, 1507 ng/l) and creatine kinase (934, 1228 U/l) were noted. However, based on the rising values of D dimer and pulmonary artery multislice computer tomography (MSCT) findings, there were reasons to consider the possibility of pulmonary embolism (PE) as well. Conclusion Future research should aim at defining the connection between SSH and AMI and/or PE. This would be crucial in making a prehospital diagnosis, especially in countries that have huge cardiovascular disease public health problems, such as ours. A quick and simple exam of nailbeds on the hands of patients with symptoms of AMI/PE, but without significant ECG findings, could help with the differential diagnosis if SSH were found to be present.

Evaluation of permissible amplitudes of external impact on free-of-platform inertial navigation systems

In modern aerospace technology, strapdown inertial navigation systems (SINS) are widely used, using fiber-optic (FOG) or ring laser (CLG) gyroscopes. During the operation of such systems, the sensitivity axes are rotated relative to the basic coordinate system. The resulting angles between the axes of the base coordinate system and the axes of sensitivity of the navigation system (non-orthogonality) are one of the factors leading to an increase in the measurement errors of the device, which affects the measurement accuracy. During operation, the system is affected by vibrations of various nature, the impact of which can contribute to the appearance of non-orthogonality. The purpose of this work is to determine the maximum permissible vibration amplitudes affecting the SINS body according to the permissible values ​​of the deviation of the FOG sensitivity axes for two variants of the SINS layout. An approach to determining the permissible amplitudes of an external harmonic impact on the unit of a strapdown inertial navigation system based on fiber-optic or ring laser gyroscopes is considered. A design scheme, mathematical and finite element models for calculating natural frequencies and forced oscillations of a strapdown inertial navigation system unit have been developed. In various frequency ranges, numerical calculations have determined the boundary values ​​of the amplitudes of the external harmonic impact on the base of specific configurations of the SINS assembly. It has been established that dangerous states take place in the region of the 1st natural frequency of the system, as well as near higher frequencies. Comparison of the results for design options 1 and 2 allows us to conclude that in order to weaken the effect of vibrations on the accuracy of the SINS unit, it is advisable that the lowest natural vibration frequencies for the SINS assembly be as high as possible (more than 1000 Hz).&#x0D; Key words: vibration; fiber optic gyroscope; strapdown inertial navigation system; finite element method; natural frequencies and modes of vibration.

CURATIVE BENEFIT OF SUBMUCOPERICHONDRIAL RESECTION OPERATION ON PULMONARY AR

Objective: We aimed at establishing a correlation between deviated nasal septum and pulmonary artery hypertension in patients reporting in Otorhinolaryngology (ENT) clinic at Combined Military Hospital Quetta, and evaluating the beneficial impact of sub mucoperichondrial resection (SMR) operation on right heart myocardial function, primarily related to Pulmonary Arterial Pressures of these patients of longstanding nasal septal deviation.&#x0D; Study Design: Descriptive; hospital-based cross-sectional survey.&#x0D; Place and Duration of Study: Departments of Otorhinolaryngology &amp; Cardiology, Combined Military Hospital, Quetta, from Sep 2019 to Apr 2021.&#x0D; Methodology: Electrocardiographic and 2-Dimensional Echocardiographic parameters of 87 randomized patients suffering from symptomatic longstanding deviated nasal septum (DNS) who had consented to undergo sub mucoperichondrial resection (SMR) operation were compared and studied for any change in status of probability of pulmonary arterial hypertension before and two months after their surgery. Probability of pulmonary hypertension was estimated using probability criteria from updated European Society of Cardiology Pulmonary Hypertension Guidelines 2019. Patients were classified into low, intermediate and high probability depending upon the number of criteria fulfilled by echocardiographic parameters.&#x0D; Results: Two (2.3%) patients suffering from deviated nasal septum presented with p-pulmonale. Twelve (13.8%) reported with right bundle branch block, and 7 (8%) patients demonstrated right axis deviation on electrocardiography. Overall high probability to develop pulmonary hypertension was discovered in 2 (2.3%) patients. We observed a significant improvement in pulmonary artery pressures in patients suffering from long term upper airway obstruction, two months following sub mucoperichondrial resection operation, in terms of maximum velocity and peak tricuspid regurgitation, right ventricle/left..........

Follow-Up Study of Electrocardiographic Indices in 252 Children with Ventricular Septal Defect after Minimally Invasive Transthoracic Closure.

The aim of this study was to explore the efficacy and safety of minimally invasive transthoracic closure (MITC) in treating ventricular septal defect (VSD). A total of 252 children with VSD were investigated between August 2013 and March 2015. Their electrocardiographic indices were monitored at different time points (before surgery [T0], immediately after surgery [T1], and 3 days/7 days/1 month/3 months/6 months after surgery [T2-6]) and followed up every year. Related adverse events also were recorded. All children with VSD successfully underwent MITC. The average follow-up time was 5 years, during which no changes in the heart rate or corrected QT interval were found. The PR and QRS intervals were prolonged in the early postoperative period (T3); the SV1+RV5 amplitude decreased significantly at T6, and the left axis deviation significantly recovered at T6 (P < 0.05). A total of 32 patients developed arrhythmia within 3 days after surgery; however, no severe arrhythmia, including ventricular tachycardia, ventricular fibrillation, second-and third-degree atrioventricular block, complete left or right bundle branch block, and delayed arrhythmia, occurred during the follow-up period. Binary multivariate logistic regression revealed that the longer the surgery time and the larger the VSD diameter, the higher the risk of arrhythmia. The incidence of long-term arrhythmia after MITC is low, and the outcomes are good.