Inferior Point Research Articles

Accuracy Evaluation of a Novel Spinal Robotic System for Autonomous Laminectomy in Thoracic and Lumbar Vertebrae: A Cadaveric Study.

The main function of robots in spine surgery is to assist with pedicle screw placement. Laminectomy, which is as important as pedicle screw placement, lacks a mature robot-assisted system. The aims of this study were to introduce the first autonomous laminectomy robot, to explore the feasibility of autonomous robotic laminectomy, and to validate its accuracy using a cadaveric model. Forty vertebrae from 4 cadavers were included in the study; 7 thoracic and 3 lumbar vertebrae were randomly selected in each cadaver. The surgeon was able to plan the laminectomy path based on computed tomographic (CT) data before the surgical procedure. The robot performed the laminectomy autonomously, and a postoperative CT scan was made. The deviation of each cutting plane from the plan was quantitatively analyzed, and the accuracy and safety were qualitatively evaluated. The time required for the laminectomy was also recorded. Cuts were performed in 80 laminectomy planes (56 for thoracic vertebrae and 24 for lumbar vertebrae). The mean time for 1-sided laminectomy was 333.59 ± 116.49 seconds, which was shorter for thoracic vertebrae (284.41 ± 66.04 seconds) than lumbar vertebrae (448.33 ± 128.65 seconds) (p < 0.001). The mean time for single-level total laminectomy was 814.05 ± 302.23 seconds, which was also shorter for thoracic vertebrae (690.46 ± 165.74 seconds) than lumbar vertebrae (1,102.42 ± 356.13 seconds) (p = 0.002). The mean deviation of the cutting plane from the plan was 0.67 ± 0.30 mm for the most superior cutting point and 0.73 ± 0.31 mm for the most inferior point. There were no significant differences in the deviation between thoracic vertebrae (0.66 ± 0.26 mm) and lumbar vertebrae (0.67 ± 0.38 mm) at the superior cutting point (p = 0.908) and between thoracic vertebrae (0.72 ± 0.30 mm) and lumbar vertebrae (0.73 ± 0.33 mm) at the inferior cutting point (p = 0.923). In the qualitative analysis of the accuracy of the 80 laminectomy planes, 66 (83%) were classified as grade A, 14 (18%) were grade B, and none was grade C. In the safety analysis, 65 planes (81%) were considered safe and the safety of the other 15 planes (19%) was considered uncertain. The results confirmed the accuracy of this robotic system, supporting its use for laminectomy of thoracolumbar vertebrae. Therapeutic Level V . See Instructions for Authors for a complete description of levels of evidence.

Anterior occipital condyle screw placement through the endonasal corridor: proof of concept study with cadaveric analysis.

Odontoidectomy for ventral compressive pathology may result in O-C1 and/or C1-2 instability. Same-stage endonasal C1-2 spinal fusion has been advocated to eliminate risks associated with separate-stage posterior approaches. While endonasal methods for C1 instrumentationand C1-2 trans-articularstabilization exist, no hypothetical construct for endonasal occipital instrumentation has been validated. We provide an anatomic description of anterior occipital condyle (AOC) screw endonasal placement as proof-of-concept for endonasal craniocervical stabilization. Eight adult, injected cadaveric heads were studied for placing 16 AOC screws endonasally. Thin-cut CT was used for registration. After turning a standard inferior U-shaped nasopharyngeal flap endonasally, 4 mm × 22 mm AOC screws were placed with a 0° driver using neuronavigation. Post-placement CT scans were obtained to determine: site-of-entry, measured from the endonasal projection of the medial O-C1 joint; screw angulation in sagittal and axial planes, proximity to critical structures. Average site-of-entry was 6.88mm lateral and 9.74mm rostral to the medial O-C1 joint. Average angulation in the sagittal plane was 0.16° inferior to the palatal line. Average angulation in the axial plane was 23.97° lateral to midline. Average minimum screw distances from the jugular bulb and hypoglossal canal were 4.80mm and 1.55mm. Endonasal placement of AOC screws is feasible using a 0° driver. Our measurements provide useful parameters to guide optimal placement. Given proximity of hypoglossal canal and jugular bulb, neuronavigation is recommended. Biomechanical studies will ultimately be necessary to evaluate the strength of AOC screws with plate-screw constructs utilizing endonasal C1 lateral mass or C1-2 trans-articular screws as inferior fixation points.

Contralateral breast radiation doses in breast cancer patients treated with helical tomotherapy.

We aimed to evaluate contralateral breast doses calculated with a Treatment Planning System (TPS) and verified with metal oxide semiconductor field effect transistor (MOSFET) detectors in patients with early-stage breast cancer (BC) who received helical tomotherapy (HT) after breast-conserving surgery. The dosimetric data of 30 patients (15 left-sided and 15 right-sided) with BC treated with 50.4 Gy to the whole breast and 64.4 Gy to the tumor bed in 28 fractions were analyzed. TPS doses were calculated and MOSFET doses were measured in the contralateral breast (CB) at cranial, caudal, and midpoint and 2 cm lateral to the central point. TPS and MOSFET doses were compared in the entire cohort as well as by tumor location (inner vs outer quadrant) and planning target volume of the breast (<1200 cc vs ≥1200 cc). The average doses at superior, inferior, central, and lateral points calculated with the TPS were 0.26 ± 0.15 cGy, 0.21 ± 0.09 cGy, 0.65 ± 0.14 cGy, and 0.50 ± 0.11 cGy, respectively, and were 0.37 ± 0.16 cGy, 0.34 ± 0.12 cGy, 0.60 ± 0.18 cGy, and 0.34 ± 0.15 cGy, respectively in MOSFET readings. Except for the central point, TPS-calculated doses and MOSFET readings were differed. The doses to the CB in patients with inner and outer quadrant tumors were not significantly different. In patients with large breasts, MOSFET doses were higher at superior and lateral points than TPS doses, but TPS doses were greater at inferior points. MOSFET readings were higher than TPS calculated doses in patients with inner or outer quadrant tumors in small or large breast volumes. The dose calculated by the TPS and that measured by MOSFET differed by a very small amount. The maximum dose to the CB administered at the midpoint was 1.8 Gy, as calculated using the TPS and confirmed using MOSFET detectors, in patients with early-stage BC undergoing breast-only radiotherapy with HT.

Comparison of Parallelism of Different Levels of Ala-Tragus Lines to Occlusal Plane in Dentate Subjects via Cephalometric Analysis: A Cross-sectional Study

Introduction: In prosthodontics, fabrication of Complete Denture (CD) is a challenging task because numerous factors have to be taken care of while rehabilitating the patients. The establishment of Occlusal Plane (OP) should be adaptable with the functional activity of the stomatognathic system. Aim: To ascertain the parallelism of different levels of ala-tragus lines to the OP in class 1 occlusion among dentate subjects via cephalometric analysis. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Ambala, February 2020 to September 2021. A total of 100 subjects were included in the study which included 50 males and 50 females. The various cephalometric parameters traced were Sella (S), Gnathion (Gn), OP, Anterior Nasal Spine (ANS). Metallic balls were placed on the lower border of ala of nose and tragus which was divided into 3 parts: superior, middle and inferior. Lateral cephalograms were shot for all subjects. The data collected was tabulated for easy interpretation and subjected to statistical analysis using Analysis of Variance (ANOVA), post-hoc test. Results: The mean angular measurement of angle I was highest followed by angle OP, angle M and least in angle S in both males and females. The comparison of the mean angle S was found to be significant (p&lt;0.001) when subjected to one way ANOVA test, there was non-significant difference observed between angle OP and Angle I in males (p-value 0.464), and Angle OP and Angle M in females (p-value 0.984). Conclusion: Clinically, from the present cephalometric study it can be suggested that in males, the inferior point on the tragus and in females, the middle point on the tragus can be used to mark the camper’s plane.

THE USE OF ADHESIVE RADIOPAQUE GRIDS IN GENICULAR NERVE BLOCK BY RADIOSCOPY.

To assess whether the use of adhesive radiopaque grids reduce radiation exposure in these cases. This is a cross-sectional study conducted with 23 orthopedists in which needles were positioned in a model with and without the use of adhesive radiopaque grids. The number of fluoroscopy shots necessary for proper positioning in three points (superior lateral, superior medial, and inferior medial) were registered. A statistical difference was observed in the three blocking points studied. The number of radioscopies required for these three points were 12.1 ± 2.5 in the group without grid and 5.0 ± 1.8 in the group with grid. The superior medial point presented the greatest numerical difference and the inferior medial point the smallest. The use of adhesive radiopaque grids led to a statistically significant reduction in the number of radioscopies/fluoroscopies required to perform the genicular block. The use of this device increases the safety of the physician and patient by reducing radiation exposure in this procedure. Level of Evidence III, Level of Evidence II, Random Clinical Trial.

Methyl Aminolaevulinic Acid versus Aminolaevulinic Acid Photodynamic Therapy of Actinic Keratosis with Low Doses of Red-Light LED Illumination: Results of Long-Term Follow-Up.

Photodynamic therapy (PDT) treatment for multiple actinic keratosis (AK) has been found effective when lower doses of red light were used with methyl aminolaevulinic acid (MAL). The aim of this study was to compare the results of lower doses of red light conventional PDT (h-PDT, 16 J/cm2) with MAL and aminolaevulinic acid (ALA) in a long-term follow-up. Patients with more than five symmetrical AK on the scalp who were candidates for PDT were selected and divided randomly between MAL and ALA treatment and patients were followed at 3 and 12 months. The responses were assessed by counting the total AK and the AK per patient. Pain and adverse events were also compiled. A total of 46 patients were treated, 24 with MAL, and 22 with ALA. The two groups were comparable at baseline (p &gt; 0.005). No significant differences were found in the results of both treatments at 12 months, despite ALA exhibiting slightly better results at 3 months. No differences in pain and adverse events were assessed. Both ALA and MAL were effective when lower doses of red light were used in c-PDT. Long term efficacy was also documented. Further studies are necessary to determine the inferior point of red-light illumination without losing efficacy.

Effect of FFP2/N95 facemask wear on retinal and choroidal thickness profile in healthy subjects.

To investigate the influence of non-oil 95 (N95)/filtering facepiece 2 (FFP2) facemask wear on retinal thickness, choroidal thickness (CT), retinal nerve fiber layer thickness (RNFLT), and ganglion cell layer thickness (GCLT) in healthy subjects. In this prospective study, 53 healthy participants who used FFP2/N95 facemask were enrolled. Participants underwent optical coherence tomography imaging before and at 1 and 4h following FFP2/N95 facemask wear. The last imaging session was performed 1h after FFP2/N95 removal. Retinal thickness, CT, RNFLT, and GCLT were assessed at each session. Vital parameters were also assessed. The pulse rate of the subjects significantly decreased at 1 and 4h compared to baseline values (P<0.05). No significant changes in retinal thickness, RNFLT, and GCLT were observed in the study. CT profile showed a significant increase at all measured locations except 1-mm temporal, 1-mm inferior and 2-mm inferior points following FFP2/N95 wear which turned to baseline values after FFP2/N95 removal. Pulse rate and CT changes at 4h were significantly correlated (P<0.05). Parasympathetic activation during FFP2/N95 facemask wear might have a role on elevated CT measurements in healthy individuals by virtue of increased choroidal blood flow.

Abstract 15528: Indeterminate Cardiomyopathy in a Patient With Birt Hogg Dubé Syndrome and a Clinical Diagnosis of Scleroderma and Prior Atrial Tachy Arrhythmias: A Diagnostic and Therapeutic Dilemma

Birt Hogg Dubé (BHD) syndrome, tachycardia induced cardiomyopathy and scleroderma are three well defined diagnoses. A link between them has not been reported. We present a diagnostic and treatment challenge, of a patient with BHD, clinical scleroderma and prior tachycardia induced cardiomyopathy with persistent left ventricular dysfunction despite restoration of sinus rhythm. Mr. X medical history includes recurrent bilateral pneumothoraces and bullectomy, with a cystic lung disease. He was diagnosed with BHD syndrome in 2018. He was diagnosed clinically with scleroderma with myositis based on symptoms and clinical signs with paucity of inflammation on muscle biopsy and negative biomarkers. There has been a limited response to immunosuppressants. In 2020 he presented with symptomatic paroxysmal atrial fibrillation. CMRI showed biventricular dilatation with increased volumes with LVEF of 40%, ​RVEF of 25% in sinus bradycardia. LGE showed subendocardial signal in ​​the basal and mid segment of the lateral and posterolateral walls with small foci of myocardial ​​​signal at the basal and mid inferior RV-LV hinge points. A bespoke CRT-D (secondary to cavity size) was inserted following documented broad complex tachycardia, given the history of reduced ejection fraction despite medical therapy. Right and left heart catheterisations were normal. Endomyocardial biopsy showed no pathological features and no fibrosis or evidence of infiltrative disease. Genotype results are pending. BHD is a genetic disorder, affecting folliculin protein, associated with cystic lesions of the lung, kidney, and skin with an increased risk of renal cell carcinoma (1). There is no known link of BHD syndrome with cardiomyopathy. Studies have demonstrated folliculin has a role in cardiomyocyte generation (2). Given the cardiac biopsy result, not in keeping with scleroderma or tachycardia induced cardiomyopathy, he may have an independent cardiomyopathy, or a first case of cardiomyopathy secondary to BHD. Our challenge continues to be optimising available therapies ensuring the best quality of life, whilst balancing the potential need for cardiac transplant with lifelong immunosuppressant therapy in a condition which has a seven-fold increased risk of renal cancer.

Radiological analysis of maxillary artery relationships to key bony landmarks in maxillofacial surgery

The maxillary artery (MA) is a key structure at risk of injury in numerous oral and maxillofacial surgical (OMS) procedures. Knowledge of safe distances from this vessel to surgically familiar bony landmarks could improve patient safety and prevent catastrophic haemorrhage. Distances between the MA and bony landmarks on the maxilla and mandible were measured using CT angiograms on 100 patients (200 facial halves). The vertical height of the pterygomaxillary junction (PMJ) was mean (SD) measurement of 16 (3) mm. The MA enters the pterygomaxillary fissure (PMF) a mean (SD) distance of 29 (3) mm from the most inferior point of the PMJ. The mean (SD) shortest distance between the MA and medial surface of the mandible was 2 (2) mm (with the vessel directly contacting the mandible in 17% of cases). The branchpoint (bifurcation of the superficial temporal artery (STA) and MA) was directly in contact with the mandible in 5% of cases. The mean (SD) distances between this bifurcation point and the medial pole of the condyle were 20 (5) mm and 22 (5) mm, respectively. A horizontal plane through the sigmoid notch perpendicular to the posterior border of the mandible is a good approximation of the trajectory of the MA. The branchpoint is usually within 5 mm of this line and inferior in 70% of cases. Surgeons should take note that both the branchpoint and the MA contact the surface of the mandible in a significant number of cases.

The application value of cardiac magnetic resonance quantitative T1 mapping technique for risk stratification in patients with pulmonary arterial hypertension

Objective: To explore the application value of cardiac magnetic resonance (CMR) native T1 mapping for risk stratification in patients with pulmonary arterial hypertension (PAH). Methods: A total of 59 patients with diagnosed PAH and clear-documented risk status in Peking Union Medical College Hospital and underwent CMR examination between January 2019 and December 2021 were retrospectively included, which including 12 males and 47 females, aged from 4 to 77 (31±13) years. Those patients were subdivided into two groups based on the clinically-assessed risk status: low-risk group (n=30) and intermediate-/high-risk group (n=29). Twenty-five healthy individuals were included as controls. Base, midventricular, and apical inferior right ventricular insertion point (IRVIP) native T1 values on short axis images were measured. Native T1 values in PAH patients and control group, in low-risk group and intermediate-/high-risk group were compared, respectively, and receiver operating characteristics (ROC) curves with area under the curves (AUC) were calculated to evaluate the application value of native T1 values for risk stratification in PAH patients. Results: Base, midventricular and apical IRVIP native T1 of PAH patients were all significantly increased as compared to controls [Base:(1 439.31±129.96) vs (1 282.36±37.18) ms;midventricular:(1 450.32±111.55) vs (1 287.56±53.16) ms;apical:(1 444.12±109.15) vs (1 266.36±75.31) ms](all P<0.001). The midventricular IRVIP native T1 values were significantly higher in patients in intermediate-/high-risk status as compared to those in low-risk status [ (1 493.24±126.32) vs (1 428.50±85.73) ms,P=0.026]. The AUC of mid ventricle IRVIP native T1 for distinguishing patients in intermediate-/high-risk status was 0.741. The base [(1 458.21±134.96) vs (1 421.03±104.75) ms, P=0.241] and apical [(1 465.90±125.36) vs (1 423.07±87.87) ms,P=0.136] IRVIP native T1 values in patients in intermediate-/high-risk group were also numerically higher as compared with patients in low-risk status, however, without statistical significant (both P>0.05). Conclusion: Midventricular IRVIP native T1 value might have a role for assisting in risk stratification in PAH patients, which was clinically significant for facilitating the work-up and prognosis improvement of PAH patients.

Regret-Based Nash Equilibrium Sorting Genetic Algorithm for Combinatorial Game Theory Problems with Multiple Players.

We introduce a regret-based fitness assignment strategy for evolutionary algorithms to find Nash equilibria in noncooperative simultaneous combinatorial game theory problems where it is computationally intractable to enumerate all decision options of the players involved in the game. Applications of evolutionary algorithms to non-cooperative simultaneous games have been limited due to challenges in guiding the evolutionary search toward equilibria, which are usually inferior points in the objective space. We propose a regret-based approach to select candidate decision options of the players for the next generation in a multipopulation genetic algorithm called Regret-Based Nash Equilibrium Sorting Genetic Algorithm (RNESGA). We show that RNESGA can converge to multiple Nash equilibria in a single run using two- and three- player competitive knapsack games and other games from the literature. We also show that pure payoff-based fitness assignment strategies perform poorly in three-player games.

The predictive value of fast semi-automated left atrial long-axis strain analysis for atrial fibrillation in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) patients are closely related to LA functional impairment. Left atrial (LA) strain provides more insight into LA function. The study aimed to investigate the left atrial dysfunction of HCM patients by rapid semi-automatic method and determine the predictive value of left atrial long-axis strain (LAS) for atrial fibrillation (AF). We enrolled 372 HCM patients and 100 healthy participants to assess the LA functional parameters. LAS was obtained by semi-automated tracking of the distance between the mid-posterior point of LA wall which is defined as the intersection of the LA long axis and the posterior wall, and the origins of the mitral valve. The inferior and anterior mitral valve annular insertion points on the 2-chamber view and the lateral and septal insertion points on the 4-chamber view were chosen as the origins of the mitral valve. The clinical outcome was defined as detecting the onset of AF. The LA strain values were analyzed as 20.8 ± 7.48% for εs, 9.81 ± 5.09% for εe, and 10.91 ± 4.24% for εa in HCM patients, which decreased significantly compared with normal controls. Significant correlations were detected between LV functional parameters and LA strain. During a median follow-up of 61 months, 44 (11.8%) patients developed AF. In the Cox regression analysis, LA strain was identified as a significant predictor of the onset of AF. HCM patients had impairment of LA strain before LA enlargement and reduced EF. LA-LAS can be used as a predictive value for predicting the occurrence of AF in HCM patients. • Fast semi-automated long-axis strain analysis by CMR is feasible and effective for evaluating the LA longitudinal function. • Hypertrophic cardiomyopathy patients show significant impairment of left atrial strain before LA enlargement. • The left atrial long-axis strain was an independent predictor of atrial fibrillation in hypertrophic cardiomyopathy.

Pelvic inclination correction system for magnetic resonance imaging analysis of pelvic organ prolapse in upright position

Introduction and hypothesisPelvic organ prolapse quantification by means of upright magnetic resonance imaging (MRI) is a promising research field. This study determines the angle for the pelvic inclination correction system (PICS) for upright patient position, which is hypothesized to deviate from the supine PICS angle. The necessity of different PICS angles for various patient positions will also be discussed.MethodsMagnetic resonance scans of 113 women, acquired in an upright patient position, were used to determine the upright PICS angle, defined as the angle between the sacrococcygeal–inferior pubic point (SCIPP) line and the horizontal line. The difference and correlation between the upright and supine PICS angles were calculated using the paired Student’s t-test and the Pearson’s correlation coefficient (r) respectively. The effect of the difference between the upright and supine PICS angle on the measured pelvic organ extent was calculated using goniometry.ResultsThe mean (interquartile range) PICS angles were 29° (26–35°) for the upright and 33° (30–37°) for the supine patient position. They were significantly different (p<0.001) and very strongly correlated (r = 0.914, p<0.001). The 4° difference between the average upright and supine PICS angle results in an average underestimation of the measured cervix height of approximately 0.5 cm for patients scanned in upright position.ConclusionsThe PICS angle for the upright patient position is 29°. The use of a dedicated PICS angle for different patient positions allows for more accurate pelvic organ extent analysis in patients with prolapse.

Anterior transtemporal endoscopic selective amygdalohippocampectomy: a virtual and cadaveric feasibility study.

Selective amygdalohippocampectomy (SelAH) is one of the most common surgical treatments for mesial temporal sclerosis. Microsurgical approaches are associated with the risk of cognitive and visual deficits due to damage to the cortex and white matter (WM) pathways. Our objective is to test the feasibility of an endoscopic approach through the anterior middle temporal gyrus (aMTG) to perform a SelAH. Virtual simulation with MRI scans of ten patients (20 hemispheres) was used to identify the endoscopic trajectory through the aMTG. A cadaveric study was performed on 22 specimens using a temporal craniotomy. The anterior part of the temporal horn was accessed using a tubular retractor through the aMTG after performing a 1.5cm corticectomy at 1.5cm posterior to the temporal pole. Then, an endoscope was introduced. SeIAH was performed in each specimen. The specimens underwent neuronavigation-assisted endoscopic SeIAH to confirm our surgical trajectory. WM dissection using Klingler's technique was performed on five specimens to assess WM integrity. This approach allowed the identification of collateral eminence, lateral ventricular sulcus, choroid plexus, inferior choroidal point, amygdala, hippocampus, and fimbria. SelAH was successfully performed on all specimens, and CT neuronavigation confirmed the planned trajectory. WM dissection confirmed the integrity of language pathways and optic radiations. Endoscopic SelAH through the aMTG can be successfully performed with a corticectomy of 15mm, presenting a reduced risk of vascular injury and damage to WM pathways. This could potentially help to reduce cognitive and visual deficits associated with SelAH.

High correlation between inner and outer glenoid circle diameters and its clinical relevance.

The majority of methods for measuring glenoid bone loss in shoulder instability use the best-fit circle following the inferior glenoid rim. However, there is no precise method on how to draw this circle, particularly in case of a missing rim segment. Defining the radius is a source of substantial error. It was hypothesized that there is a relationship between the best-fit inferior circle (inner circle), defined by Sugaya, and the circle tangent to the supra- and infra-glenoid tubercles (outer circle), defined by Itoi, thus allowing a more consistent appreciation of the paleo-glenoid. Ninety-five normal dry scapulae were examined. The specimens were digitally photographed obtaining perpendicular images of the glenoid cavity. Using HOROS® imaging software, a best-fit inferior circle (inner circle) and a second circle fitting the most inferior and superior points of the glenoid (outer circle) were drawn by two investigators. The diameters and areas of the circles were recorded. Two-way random-effects intra-class correlation coefficients (ICC) were used to measure intra- and inter-observer agreement. A Bayesian measurement-error regression model was used to determine the relationship between outer and inner circle measurements. The mean glenoid height was 35.1mm and the glenoid width 25.6mm. The mean diameter of the outer circle was 35.7 ± 4.2mm and the mean diameter of the inner circle was 26.8 ± 3.2mm. ICC showed excellent inter- and intra-observer agreement for both the outer circle diameter (ICC ≥ 0.95) and inner circle diameter (ICC ≥ 0.93). The two diameters demonstrated a very strong significant Pearson correlation (0.92, p < 0.001) and the regression showed excellent model fit R2 = 0.87. The areas of the two circles were also highly and significantly correlated (r = 0.94; p < 0.001). The ratio of inner circle to outer diameters was 0.74. There is a strong correlation between the inner and outer glenoid circle diameters. This study sets the base for the use the combined outer and inner circle and its ratio to better appreciate the paleo-glenoid morphology and thus obtain a more reliable bone loss estimation. Application of this method aids in a more reliable estimation bone loss with potential benefit in surgical decision-making.

A rare presentation of OEIS variant with a recto-bladder neck fistula: A case report and literature review.

IntroductionOmphalocele, bladder extrophy, imperforate anus and spinal defect (known as OEIS) is a very rare congenital anomaly with an unknown etiology. In this report we describe a case of an OEIS variant associated with a wide pubic diastasis, bladder extrophy with a recto-bladder neck fistula and a high ano-rectal malformation. This work has been reported in line with the SCARE 2020 criteria.Presentation of the caseA 30-year-old mother delivered a male baby at 39 weeks through a normal vaginal delivery. Examination revealed multiple congenital anomalies in the form of an Omphalocele, extrophied bladder, imperforate anus, ambiguous genitalia and a large pelvic diastasis. Fecal matter was noted at the most inferior point of the extrophied bladder, raising the suspicion of a recto- vesical fistula.An exploratory laparotomy showed a fistula between the rectum and the neck of the extrophied bladder. A sigmoid colostomy was carried out in addition to a mucous fistula. The fascial defect of the Omphalocele was approximated to the upper border of the extrophied bladder.At the age of 2 years, the baby underwent a bladder extrophy repair, a posterior sagittal anorectoplasty and bilateral osteotomies.DiscussionOEIS complex has been reported to occur with a wide variety of associated anomalies, and this necessitates a thorough investigation in order to formulate an appropriate treatment plan. A prenatal diagnosis of OEIS complex can be made by ultrasound stressing the importance of antenatal follow up and a multidisciplinary approach in management.ConclusionWe described a rare variant of an OEIS complex and management of such anomalies requires a multidisciplinary input.

Evaluation of the posterior reference point of ala tragus line in relation to occlusal plane and Frankfort horizontal plane through cephalometry in Sangareddy (Telangana) population

The Occlusal plane (OP) inclination is determined by paralleling the ala- tragus line to the occlusal plane. The location of the ala-tragus line is unclear because the exact location of the posterior reference tragal point is controversial. Additionally, morphological variations are observed between different ethnic groups. Therefore, evaluation of the exact reference point on the tragus is important. The study aimed to determine the most reliable posterior reference point on the ala‑tragus line that forms the most parallel line with the natural OP among the dentate Sangareddy volunteers from Telangana. Prosthodontically related craniofacial reference lines and angles of lateral cephalometric radiographs were analyzed for 25 dentate volunteers. Stainless steel balls were attached to the ala of the nose (A) and three points corresponding to the inferior (I), middle (M), and superior (S) points on the tragus. The angle formed by each line (IA, MA, and SA planes) with the OP and Frankfort horizontal (FH) plane were measured on cephalometric tracings.

Scleral Thickness in Steroid-Induced Central Serous Chorioretinopathy.

PurposeTo evaluate and compare the scleral thickness of patients with idiopathic central serous chorioretinopathy (iCSC) and steroid-induced central serous chorioretinopathy (sCSC) using anterior-segment OCT.DesignRetrospective, comparative study.ParticipantsOne hundred ten eyes of 110 patients with central serous chorioretinopathy.MethodsWe classified the patients into iCSC and sCSC groups and compared age, sex, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness. We measured scleral thickness 6 mm posterior to the scleral spur in 4 directions.Main Outcome MeasureScleral thickness in sCSC eyes.ResultsWe enrolled 96 and 14 eyes in the iCSC and sCSC groups, respectively. The sCSC group included a greater proportion of women than the iCSC group (42.9% and 13.5%, respectively; P = 0.020). We observed no between-group differences in age, spherical equivalent, axial length, or SCT. Univariate analysis revealed that the sCSC group had a significantly thinner sclera at the superior (423.4 μm vs. 346.6 μm; P < 0.001), temporal (440.1 μm vs. 399.4 μm; P = 0.020), inferior (450.1 μm vs. 395.3 μm; P = 0.001), and nasal (436.6 μm vs. 391.9 μm; P = 0.002) points than the iCSC group. Multivariate analyses revealed that female sex (odds ratio, 4.322; 95% confidence interval, 1.025–18.224; P = 0.046) and mean scleral thickness (odds ratio, 0.972; 95% confidence interval, 0.955–0.990; P = 0.002) were significantly associated with sCSC.ConclusionsThe scleral thickness of eyes in the sCSC group was significantly thinner than that in the iCSC group. This suggests that the sclera has less involvement in the pathogenesis of sCSC than in that of iCSC.

Clinical use of magnetic resonance imaging in buttock augmentation with silicone implants: a retrospective analysis.

BackgroundThe objective of the current study was to retrospectively examine the morphological magnetic resonance imaging (MRI) characteristics of the gluteus maximus of buttock augmentation at levels of predetermined anatomic points.MethodsThe present study was a retrospective cross-sectional study. Adult women who underwent high-quality MRI scanning at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to January 2021 were included in this work. The transverse MRI data measured at the inferior point of the sacroiliac joint, just above the femoral head, and at the ischial tuberosity were collected and statistically analyzed.ResultsFifty-two cases (104 sides of female gluteus maximus) were included in the final analysis. The A point (surgery starting point) were 54.4±6.34 mm, 54.91±5.57 mm, and 73.91±5.57 mm away from the posterior midline at the level of inferior point of the sacroiliac joint, just above the femoral head, and at the ischial tuberosity, respectively. Accordingly, the thickness of the muscle at these locations was 16.0±4.17 mm, 23.4±4.40 mm, and 24.6±7.58 mm, respectively. The diameter of the implant did not exceed 14.18±1.22 cm. In addition, the gluteus maximus at the lowest point of the sacroiliac joint and above the femoral head exhibited an arc structure, which needs to be tilted to the deep plane during separation.ConclusionsDissimilar from previous experience of blind dissection, the gluteus maximus muscle can be more scientifically and reasonably dissected using the indexes for gluteus augmentation supplied in this study.

Clinicoradiographic comparison of sagittal condylar guidance angle determined by dynamic and radiographic methods

Aim: This in vivo study was conducted to compare sagittal condylar guidance angle measured (SCGA) using cone-beam computed tomography (CBCT) panoramic-section and CBCT cross-section and extraoral Gothic arch tracing method (EGTM) in completely edentulous patients.Materials and Methods: Based on the inclusion and exclusion criteria, 30 completely edentulous individuals were evaluated. Radiologically, two modalities of CBCT imaging were used to record SCGA, i.e., CBCT panoramic section view and CBCT cross-sectional view. After recording, the CBCT of the patient SCGA was measured using the Frankfort horizontal reference line and mean curvature line. The most superior and most inferior points of the curvature were identified to determine the mean curvature line. SCGA was measured in the clinical method using EGTM with Hight tracers for the same patients. Data obtained using three methods were subjected to statistical analysis.Results: The mean right and left SCGA using CBCT panoramic view was 29.33 and 29.52, respectively. The mean right and left SCGA using CBCT cross-sectional view was 31.24 and 31.63, respectively. The mean right and left SCGA using extraoral Gothic arch method was 26.67 and 27, respectively. The SCGA differed significantly among the groups.Conclusion: There was a significant difference in values of SCGA when evaluated using the three techniques. The radiographic methods (CBCT panoramic section view and CBCT cross-sectional view) were comparable but varied significantly from extraoral Gothic arch tracing technique.