Direct Signs Research Articles

The Effect of Lane Direction Pavement Markings on Driving Performance and Safety: A Driving Simulator Study.

A driving simulator study was conducted to test the effect of directions pavement markings (DPMs) on drivers' performance. The perception of traditional direction signs may be less efficient than that of DPMs because drivers allocate more attentional resources to the road than to any other location. Two experimental conditions of DPMs were tested: (a) the name of the lane's destination town, inscribed in white letters; (b) red and white shields enclosing the name of the lane's destination town. In both conditions, the name or shield was preceded by a white arrow and traditional road signs were presented as well. The experimental conditions were compared to a baseline condition, which consisted of traditional road signs only. Various scenarios of three-lane highways were simulated and the number of vehicles on the road was manipulated, forming a 2 × 3 design (two load conditions × three experimental conditions). Twenty-two participants took part in the experiment. Pavement markings in both configurations were highly beneficial. Compared with the baseline condition, in both experimental conditions, the drivers noticed the correct lane sooner and moved to the correct lane earlier. Results also suggested that white markings are more beneficial than shield markings; however, this finding should be further confirmed. Lane DPMS are desirable as they are likely to improve traffic safety at relatively low cost. Regulations demanding the presence of DPMs, at the very least in low visibility decision sites, would increase traffic safety.

Clinical and Angiographic Imaging Features of Isolated Cortical Venous Thrombosis

Background Cerebral venous thrombosis usually presents as dural sinus thrombosis. More rarely, it occurs in an isolated form (isolated cortical vein thrombosis; ICoVT). ICoVT is poorly recognized and underdiagnosed, and noninvasive imaging remains nebulous. The digital subtraction angiographic (DSA) patterns of ICoVT are neither well known nor documented. We present clinical and imaging details of the largest series of ICoVT, with all cases demonstrating both noninvasive imaging findings, along with angiographic confirmation. We propose a preliminary compilation of the DSA patterns of ICoVT. Methods We identified all patients with cerebral venous thrombosis at our institution between January 2013 and June 2019. Only patients in whom ICoVT was diagnosed and/or suspected with computed tomographic venography and/or magnetic resonance imaging/MR venogram with subsequent DSA confirmation were included. DSA imaging was reviewed for direct and indirect signs. Clinical data, outcomes, and follow‐up imaging were analyzed. Results We identified 109 patients with cerebral venous thrombosis; in 21 patients ICoVT was suspected on noninvasive imaging and eventually had DSA confirmation. Headache and focal neurological deficit were the most common presentations (each 67%). Ten patients (47%) presented with parenchymal changes due to ICoVT and 15 patients (71%) presented with subarachnoid hemorrhage. We identified 5 DSA patterns of ICoVT (3 direct; 2 indirect). Filling defects in cortical veins and the regional absence of cortical veins and decreased subcortical opacification were the most common patterns (52% and 90%, respectively). Sixteen patients (76%) were anticoagulated. Eighteen patients were discharged without disability or minor disability (84%). No deaths occurred. Conclusions Catheter angiography/venography may be important in diagnosing ICoVT, especially when magnetic resonance imaging/MR venogram is unclear. The angiographic patterns of ICoVT are presented.

Using Smartphones for Indoor Fire Evacuation.

Fire smoke reduces the visibility of emergency direction signs, rendering them ineffective for providing appropriate guidance along evacuation routes in a fire situation. This is problematic because civilians may select evacuation routes that expose them to smoke or fire in a burning building. This study proposed using a smartphone voice-guided evacuation system (SVGES) to provide alternative evacuation routes for civilians trapped at a fire scene. To verify the efficacy of the SVGES, experiments were conducted with 26 participants in a simulated fire scenario. The experimental results showed that when using the SVGES, the participants chose the safest evacuation route with a 100% successful evacuation rate.

An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review).

(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.

MRI and Adenomyosis: What Can Radiologists Evaluate?

Uterine adenomyosis is a common benign condition defined by the presence of heterotopic endometrial glands and stroma within the myometrium. Adenomyosis is often related to infertility and other adverse pregnancy outcomes. Modern imaging techniques allow the non-invasive diagnosis of adenomyosis and, in this framework, Magnetic Resonance Imaging (MRI) has assumed a central role due to its high diagnostic accuracy in the detection of adenomyosis. Currently, there is still a lack of international consensus on adenomyosis diagnostic criteria and classification, despite the fact that an agreed reporting system would promote treatment outcomes and research. This review aims to emphasize the important contribution of MRI to the diagnosis of adenomyosis and to highlight how, thanks to the great tissue differentiation provided by MRI, it is possible to identify the main direct (cystic component) and indirect (junctional zone features) signs of adenomyosis and to distinguish its various subtypes according to different MRI-based classifications. We also explored the main MRI criteria to identify the most common pitfalls and differential diagnoses of adenomyosis, whose features should be considered to avoid misdiagnosis.

Solid particle deposition of indoor material combustion products

Heavy smoke emission during fires hampers evacuation of people and movement of rescue teams to a fire source. It is often pyrolysis and combustion products that cause deaths from fires in closed spaces. Fire sprinkler system activation does not always lead to efficient smoke deposition. Sometimes, a fire suppression liquid supply, on the contrary, deteriorates fire evacuation conditions. The study of smoke generation and deposition characteristics is an essential prerequisite for improving rescue technologies during fires. The purpose of this research was to define the characteristics of deposition of solid combustion product particles of a group of typical construction and finishing materials in closed spaces: wood, linoleum, rubber, etc. Solid particles (pyrolysis products) have been distributed by size and concentration. The smoke generation and extinction coefficients, as well as deposition rates of smoke aerosol particles with and without using water aerosol have been determined. The ranges of optical properties of smoke aerosol have been specified. The time of dispersed water impact on smoke aerosol was varied to evaluate its effect on the mass rate of deposition of solid combustion product particles. The characteristics of absorption of laser radiation with different wavelengths in flue gases have been defined to identify the most advantageous colors of reflector materials used to manufacture direction signs for the evacuation of people from the combustion zone.

How large should the next study be? Predictive power and sample size requirements for replication studies.

We use information derived from over 40K trials in the Cochrane Collaboration database of systematic reviews (CDSR) to compute the replication probability, or predictive power of an experiment given its observed (two‐sided) P‐value. We find that an exact replication of a marginally significant result with P=.05 has less than 30% chance of again reaching significance. Moreover, the replication of a result with P=.005 still has only 50% chance of significance. We also compute the probability that the direction (sign) of the estimated effect is correct, which is closely related to the type S error of Gelman and Tuerlinckx. We find that if an estimated effect has P=.05, there is a 93% probability that its sign is correct. If P=.005, then that probability is 99%. Finally, we compute the required sample size for a replication study to achieve some specified power conditional on the p‐value of the original study. We find that the replication of a result with P=.05 requires a sample size more than 16 times larger than the original study to achieve 80% power, while P=.005 requires at least 3.5 times larger sample size. These findings confirm that failure to replicate the statistical significance of a trial does not necessarily indicate that the original result was a fluke.

Optimization Of Traffic Management At The Bakauheni Ferry Port, Lampung Province

Bakauheni Ferry Port is the gateway to the southern part of Sumatra Island which connects Bakauheni Port (South Lampung) with Merak Port (Banten Province). In its implementation, it is necessary to optimize good crossing traffic management. This study aims to determine the zoning system at the Bakauheni Ferry Port based on the Regulation of the Minister of Transportation concerning Ferry Port Sterilization and the placement of supporting signs along with the traffic flow patterns of passengers and vehicles at the Bakauheni Ferry Port based on the Decree of the Director General of Land Transportation Number SK.242/HK.104 /DRJD/2010. The method used to collect data in this research is observation and problem identification, the data is divided into primary and secondary data, primary data in the form of observations and surveys, while secondary data in the form of institutional and literature. Analysis methods are used to analyze problems such as zoning system analysis, Vehicle Traffic Analysis and Analysis of Directional Signs Equipment. The result is that the lack of application of the zoning system at the Bakauheni Ferry Port causes service users to enter the prohibited zone and carry out activities there and the lack of precise placement of signs supporting the zone system at the Bakauheni Ferry Port. Meanwhile, in the management of vehicle traffic flow patterns at the Bakauheni Ferry Port, it is not in accordance with the Crossing Traffic Management Technical Guidelines.

МОРФОФУНКЦИОНАЛЬНЫЕ АСПЕКТЫ СТАРЕНИЯ, ОПРЕДЕЛЯЮЩИЕ ТЕЧЕНИЕ ЗАБОЛЕВАНИЙ ОРГАНОВ ДЫХАНИЯ В ПОЖИЛОМ И СТАРЧЕСКОМ ВОЗРАСТЕ

Aim. Based on an analysis of the medical literature, describe the key features of age-related organic and functional changes that potentially affect the course and therapy of respiratory diseases in elderly and senile people. Material and methods. A review of publications in the scientific and methodological literature on the problems of physiological and pathological aging, the epidemiology of somatic pathology and the peculiarities of its clinical manifestations and outcomes in the age aspect, including the relationship with the course of non-infectious and infectious respiratory diseases in elderly and senile people, is carried out. Results and discussion. The article provides relevant data on morbidity and mortality from respiratory pathology in old and senile age. A description is given of the mechanisms of aging of organs and systems, changes in the regulation of their functions, including changes in immunoreactivity from the standpoint of influence on the occurrence and course of respiratory diseases. Conclusion. When managing elderly and senile patients, it is necessary to take into account the age-related characteristics of the aging organism, the existing comorbid pathology and its therapy, take a differentiated approach to the assessment of the clinic, taking into account the direct signs of age-associated symptoms and manifestations of the «pharmacological cascade».

B-mode ultrasonography of herniated cervical discs in young people

The aim: to evaluate the possibilities of ultrasonography in the diagnosis of herniated cervical intervertebral discs in young people.
 Material and methods: an analysis of the results of USG in 29 patients with cervical IVD hernia revealed by MRI from 123 patients aged 18–44 years, with complaints of neck pain of varying intensity, duration, and irradiation. 23 (79.3 %) patients had clinical signs of cervical radiculopathy. The results of the ultrasonography (USG) were compared with MRI. USG was conducted on a Philips HD 11XE scanner using a 4–9 MHz frequency transducer; MRI – General Electric, Signa HDI, 1.5T.
 Results: in 13 (44.8±9.2 %) cases the hernia was registered in the C5-C6 disk, in 12 (41.4±9.0 %) – in the C4-C5 disk, in 2 (6.9±4.7 %) – in the disk C3-C4 and in 2 (6.9±4.7 %) – in the disk C6-C7. In discs C5-C6 and C4-C5 hernia was formed significantly (p<0.01 and p<0.001) more often than in discs C2-C3 and C6-C7. Paramedian hernia was diagnosed in 13 (44.8±9.2 %) cases, posterior – in 12 (41.4±9.1 %), median – in 4 (13.8±6.4 %). Paramedian and posterolateral hernias were registered significantly more often than median (p<0.01 and p<0.05).
 Conclusions: A direct sign of a herniated cervical intervertebral disc is its uneven protrusion with a discontinuous image of the fibrous ring into the lumen of the spinal canal and spinal nerve canal more than 4 mm. An indirect sign of a herniated cervical intervertebral disc is a local deformation of the anterior epidural space with the absence of its visualization. Ultrasonography is a reliable method for diagnosing herniated cervical intervertebral discs, both in segments and inside the spinal canal. The method can be used to find out the causes of neck pain in young people

Lattice simulations of the QCD chiral transition at real baryon density

State-of-the-art lattice QCD studies of hot and dense strongly interacting matter currently rely on extrapolation from zero or imaginary chemical potentials. The ill-posedness of numerical analytic continuation puts severe limitations on the reliability of such methods. Here we use the more direct sign reweighting method to perform lattice QCD simulation of the QCD chiral transition at finite real baryon density on phenomenologically relevant lattices. This method does not require analytic continuation and avoids the overlap problem associated with generic reweighting schemes, so has only statistical but no uncontrolled systematic uncertainties for a fixed lattice setup. This opens up a new window to study hot and dense strongly interacting matter from first principles. We perform simulations up to a baryochemical potential-temperature ratio of $\mu_B/T=2.5$ covering most of the RHIC Beam Energy Scan range in the chemical potential. We also clarify the connection of the approach to the more traditional phase reweighting method.

Diagnosis of joint invasion in patients with malignant bone tumors: value and reproducibility of direct and indirect signs on MR imaging

ObjectivesTo evaluate the performance and reproducibility of MR imaging features in the diagnosis of joint invasion (JI) by malignant bone tumors.MethodsMR images of patients with and without JI (n = 24 each), who underwent surgical resection at our institution, were read by three radiologists. Direct (intrasynovial tumor tissue (ITT), intraarticular destruction of cartilage/bone, invasion of capsular/ligamentous insertions) and indirect (tumor size, signal alterations of epiphyseal/transarticular bone (bone marrow replacement/edema-like), synovial contrast enhancement, joint effusion) signs of JI were assessed. Odds ratios, sensitivity, specificity, PPV, NPV, and reproducibilities (Cohen’s and Fleiss’ κ) were calculated for each feature. Moreover, the diagnostic performance of combinations of direct features was assessed.ResultsForty-eight patients (28.7 ± 21.4 years, 26 men) were evaluated. All readers reliably assessed the presence of JI (sensitivity = 92–100 %; specificity = 88–100%, respectively). Best predictors for JI were direct visualization of ITT (OR = 186–229, p < 0.001) and destruction of intraarticular bone (69–324, p < 0.001). Direct visualization of ITT was also highly reliable in assessing JI (sensitivity, specificity, PPV, NPV = 92–100 %), with excellent reproducibility (κ = 0.83). Epiphyseal bone marrow replacement and synovial contrast enhancement were the most sensitive indirect signs, but lacked specificity (29–54%). By combining direct signs with high specificity, sensitivity was increased (96 %) and specificity (100 %) was maintained.ConclusionJI by malignant bone tumors can reliably be assessed on preoperative MR images with high sensitivity, specificity, and reproducibility. Particularly direct visualization of ITT, destruction of intraarticular bone, and a combination of highly specific direct signs were valuable, while indirect signs were less predictive and specific.Key Points• Direct visualization of intrasynovial tumor was the single most sensitive and specific (92–100%) MR imaging sign of joint invasion.• Indirect signs of joint invasion, such as joint effusion or synovial enhancement, were less sensitive and specific compared to direct signs.• A combination of the most specific direct signs of joint invasion showed best results with perfect specificity and PPV (both 100%) and excellent sensitivity and NPV (both 96 %).

A robust and flexible pulse wave sensory array enabling real-time non-invasive blood pressure monitoring

Chronical cardiovascular decreases such as hypertension requires real-time and continuous monitoring of blood pressures (BPs). Pulse wave that contains critical and ample information on cardiovascular dynamics is a direct vital sign to extract BP and therefore an epidermal wearable device enabling real-time acquisition of pulse waves becomes necessary. In this work, we propose and study a flexible pulse wave sensory array aiming for real-time wearable pulse wave acquisition with robustness. A piezoelectric sensor together with a thin-film transistor-based sensor interface circuit is used to detect multiple pulse waveforms at the location of radial artery, which are input to a convolutional neural network for a deep-learning BP estimation model training. The estimated BPs are assessed by a correlation study with the BPs measured by conventional sphygmomanometers. Our study shows a reasonable accuracy of mean deviation and standard deviation of 2.84 ± 7.53 mmHg for systolic BP and 0.88 ± 7.06 mmHg for diastolic BP.

Sixth Nerve Palsy in Pediatric Inflammatory Multisystem Syndrome Temporally Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Sixth Nerve Palsy in Pediatric Inflammatory Multisystem Syndrome Temporally Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

The Diversity of Mammals in the Wehea-Kelay Landscape, East Kalimantan

The Wehea-Kelay landscape is an area with a tropical rainforest ecosystem which is the habitat for various types of mammals. Ecologically, the existence of mammal species plays role in maintaining the balance of the forest ecosystem, thus the balance of a forest ecosystem can be measured by the level of species diversity. The aim of this study is to determine the diversity, conservation status, relative abundance of mammal species, and the sepan conditions in the Wehea-Kelay landscape. The research was conducted from January to June 2020. The data collection method was the direct observation, signs searching, camera traps, and data analysis. The results of this study are 12 species, 9 families, and 4 orders of mammals were found. Based on the conservation status, 6 species as protected animals, 1 species is critically endangered, and 2 species are in appendix I. Overall, the highest relative abundance of mammals based on the presence frequency of the camera traps is M. muntjak and the lowest is T. kanchil. The species of mammals found based on the encounter rate in the Wehea Protected Forest were more than PT. Gunung Gajah Abadi, and the highest abundance of mammals is 1.67±1.529 individuals/km in Wehea Protected Forest and 1.00±1.00 individuals/km in PT. Gunung Gajah Abadi of H. malayanus. The feeding class of mammals found consisted of 9 species of Omnivores and 3 species of Herbivores. The sepan area in the Wehea Protected Forest is an area that must be conserved because it is a source of minerals for mammals.

Evaluating corneal changes after corneal collagen cross-linking in keratoconus by optical coherence tomography

Purpose The aim of this study was to evaluate the corneal changes after corneal collagen cross-linking (CXL) in progressive keratoconus using anterior segment optical coherence tomography. Patients and methods This prospective interventional noncomparative case-series study was conducted on 30 eyes of 18 patients of both sexes with a mean age of 23.11±4.06 years diagnosed as progressive keratoconus patients with clear central cornea. All eyes underwent epithelium-off accelerated CXL. Anterior segment optical coherence tomography and Scheimpflug camera imaging were done to all cases preoperatively and at 1, 3, and 6 months, postoperatively. Results The demarcation line (DL) was detected in all eyes 1 month postoperatively, and was still detected at 3 and 6 months, postoperatively. However, it was accurately measured until 3 months postoperatively. At 6 months, it was barely visible, so measuring its depth was difficult to be done. There was a statistically significant positive correlation between the thinnest corneal thickness and the central corneal DL depth (r=0.480, P=0.006). There was no statistically significant correlation between the maximum keratometric reading (K-max) and the depth of central corneal DL (r=−0.253, P=0.17). In addition, there was no statistically significant correlation between corneal densitometry and the depth of central corneal DL (r=−0.68, P=0.715). Conclusions The DL is a direct clinical sign of corneal CXL and can be found within 6 months after the treatment, being most clearly visible at 1 month after CXL. However, the line starts to be less visible after 3 months and becomes barely visible after 6 months postoperatively, making it difficult to measure its depth at that time.

Характеристика аллергического компонента воспалительных инфильтратов при хроническом среднем отите

The article presents data characterizing the inflammatory process in the chronic otitis media (COM) from the standpoint of parameters related to the development of the allergic component of inflammatory infiltrates, regardless of the exudate nature. For comparison, cases with acute otitis media (AOM) were taken. They were obtained as a result of histomorphometric study. Both in acute and chronic otitis media, direct and indirect signs of allergic inflammation were revealed. Of particular interest is the significant predominance of eosinophils in the COM group, which may indicate their more important role in the chronic process, including an increase in their number at the wall edge in the microcirculation vessels. Thus, the study results show that in chronic otitis media, the allergic component plays a significant role in the pathogenesis of the inflammatory process. An important factor in this case is the anatomical and physiological relationship of the tissue structures of the middle ear with the Eustachian tube and the nasopharynx. This fact must be taken into account when constructing the treating tactics of chronic otitis media, an important element of which could be the use of drugs not only with anti-inflammatory and immunosuppressive, but also anti-allergic properties, especially of prolonged action, as well as herbal preparations with similar properties.

Seasonal distribution and habitat use preference of Barking deer (Muntiacus vaginalis) in Murree-Kotli Sattian-Kahuta National Park, Punjab Pakistan.

Microhabitat factors associated with the habitat of barking deer (Muntiacus vaginalis) were examined and compared between summer and winter seasons. Habitat characteristics and preferred habitat were measured by locating direct and indirect signs. To quantify the habitat utilization of barking deer, each selected study site was sampled for floral diversity from 2015 to 2017. Quadrats were deployed along transect lines to determine seasonal distribution. Barking deer were not evenly distributed across vegetation types in the study area; they occurred more often in the broad-leaved forest than in Chir pine forest, at an elevational range of 550-850 m, in thick vegetation on steep slopes. The most preferred habitat included trees and shrubs with 30% and 69% cover, respectively. Barking deer avoided thicker tree cover, possibly as it hinders movement and escape from predators. No significant difference (χ2 = 6.37, df = 3, p = 0.19) in seasonal vegetation cover was recorded.

Prevalence and Pattern of Lateral Impingements in the Progressive Collapsing Foot Deformity

Category:Hindfoot; Midfoot/ForefootIntroduction/Purpose:Lateral impingements, subdivided into Sinus Tarsi (STI), Talo-Fibular (TFI), and Calcaneo-Fibular (CFI) impingements, appear to be associated with the Peritalar Subluxation (PTS) component of the Progressive Collapsing Foot Deformity (PCFD). This is not yet confirmed, as the chronological place of the different types of lateral impingements in PTS is unknown. It is also unclear whether STI are associated with PTS or Midfoot Abduction. Our primary objective was to assess the amount of PTS in STI, TFI and CFI. Our secondary objective was to determine the position of STI among the PTS and Midfoot Abduction deformities. We hypothesized that STI and TFI will be associated with a lower amount of PTS than CFI and that STI will be part involved in both PTS and Midfoot Abduction deformities.Methods:A retrospective study including 72 PCFD assessed with Weight Bearing Computed Tomography (WBCT) was realized. Patients under 15 or with a previous history of surgery were excluded. Lateral impingements were assessed on WBCT images and subdivided as STI, TFI and CFI. Both direct and indirect signs of impingement were considered positive. The amount of PTS was assessed by the percentage of uncoverage and the incongruence angle of the Middle Facet (MF). Midfoot-Abduction was assessed by Talonavicular coverage angle and global foot deformity by Foot and Ankle Offset (FAO). These data were collected by two independent observers and one performed a blinded second assessment. Interobserver and Intraobserver reliabilities were determined using unweighted Cohen's kappa values for lateral impingements and using intraclass correlation coefficients for the measurements. Impingement groups were compared using Student's T-tests for normal, and Mann-Whitney for non-normal variables.Results:Interobserver and Intraobserver reliabilities ranged from substantial to almost perfect for all assessments. STI was present in 84.7%, TFI in 65.2% and CFI in 19.4% of PCFD cases. PCFD with STI showed significant increases of MF uncoverage (p=0.0001), FAO (p=0.0008) and Talonavicular coverage angle (p=0.0197) compared to PCFD without STI. PCFD with TFI did not show significant difference on measurements compared to PCFD without TFI. PCFD with CFI had associated STI in 100% and TFI in 64.2% of cases. PCFD with CFI showed significant decreases of MF incongruence (p=0.0398) and significant higher FAO (p=0.0058) compared to PCFD without CFI. PCFD with both STI and CFI showed significant decreases of MF incongruence (p=0.032) and significant higher FAO (p=0.028) compared to PCFD with isolated STI.Conclusion:Our hypotheses have not been confirmed. STI was associated with both PTS and Midfoot Abduction deformities but neither TFI nor CFI were associated with PTS considering MF subluxation. Conversely, CFI was associated with a reduction of the MF incongruence angle despite being associated with a higher global deformity. STI may be associated with earlier PCFD with a concentration of the malignment forces in the subtalar joint whereas CFI may occur later and be associated with a failure of the deep layer of the deltoid ligament and a talar tilt. This could explain the relative reduction of the PTS in CFI.

Surgical management of os odontoideum: An Algerian center experience.

ABSTRACTBackground:Os odontoideum (OO) is a craniovertebral junction malformation of unknown origin. In most times, this lesion is highly unstable demanding surgical management. We present our series of OO surgical management and we discuss clinical, radiological, and management aspects of this pathology via our experience and literature opinions.Methods:This is a retrospective study of patients operated on at our department between May 2014 and May 2021 for OO. All patients were explored with plane X-rays and computed tomography (CT). In some cases, magnetic resonance imaging (MRI) was necessary. Posterior C1–C2 or C1-C3 fixation with polyaxial screws and rod fixation was used. In postoperative, the patient is asked to put Philadelphia collar for 3 months. Hospitalization periods vary between 3 and 7 days. After discharge, all our patients are followed up regularly in consultation. Control radiographs of the occipito cervical region were performed. After 3 months postoperatively, the CT scan is performed on all our patients to assess the quality of fusion. Patient's follow-up ranges from 4 months to 6 years.Results:Fifteen patients were included in this study; nine males (60%) and six females (40%); with mean age of 32.5 years old. Ten patients (67%) presented motor weakness, three patients (20%) with neck pain, one patient (6.5%) with torticollis, and one patient (6.5%) presented vertigo. No notable cervical trauma was present in six patients (40%) and in nine patients (60%), a remote history of traumatism was noted. All cases of our series presented mobile OO. Normal thickness of the C2 pedicle was noted in nine patients (60%). In two patients (13%), there was hypoplasia of one pedicle and in four patients (27%) both pedicles. MRI showed direct signs of spinal cord aggression: simple compression, myelomalacia, strangulation, or hypotrophy. C1 lateral mass screw fixation was performed in all patients; and according to C2 morphology: nine patients underwent C1-C2 pedicular fixation, in one patient, bilateral crossing C2 laminar screws technique, in three patients, we skipped C2 to perform a C1-C3 articular fixation, and in two patients, C1-C2-C3 fixations were performed. All patients improved clinically. In one patient, we noted an infection resulting in bad wound healing this infection was successfully treated with no complications. In the patient with bilateral crossing C2 laminar screws technique, CT control objectified 4 mm exceeding of one screw; the patient was reoperated and the screw was slightly pulled back. No other complications were noted.Conclusion:Congenital origin of OO is always evoked. C1-C2 fixation according to Goel and Harms technique with grafting proved its safety, providing high fixation quality with the acceptable biodynamic outcome. Once treated, the prognostic of OO is in general good, and improvement is observed in most patients with few complications.