To validate the Zürich Composite Measure Pain Scale (ZCMPS) for assessing postoperative pain in cattle undergoing abomasal displacement surgery. Prospective, randomised, blinded study. A total of 14 video recordings from 11 cows that underwent laparotomy for abomasal displacement were included. A group of six veterinarians with different levels of experience independently assessed the 14 videos. Videos were recorded 2, 6, 12 or 24 hours after surgery. The study consisted of four phases: training and phases I, II and III. In phases I and II, observers scored pain using the ZCMPS. In phase III, they applied a visual analogue scale (VAS) and indicated whether rescue analgesia was required (no/yes) based on clinical judgement. Real-time scoring by two additional observers was used for comparison against video-based assessments. Statistical analyses included intraclass correlation coefficients (ICCs) for inter- and intra-observer reliability, Spearman correlation between ZCMPS and VAS, Mann-Whitney U tests for video versus real-time scoring and receiver operating characteristic curve analysis to evaluate the ability of the ZCMPS to identify cows requiring analgesia. The ZCMPS demonstrated excellent inter- and intra-observer reliability (ICC > 0.9, p < 0.001). Significant correlation was found between ZCMPS and VAS scores (rho = 0.7, p < 0.001), supporting construct validity. Sensitivity and specificity of the ZCMPS were 70% and 77%, respectively, when applying a threshold of ≥ 4/15 for rescue analgesia. Video-based scoring was comparable with real-time assessments, indicating robustness of the scale when applied remotely. The ZCMPS is a reliable and valid tool for assessing abdominal pain in cattle with abomasal displacement. It can be used by observers with varying experience levels.

Developmental dysplasia of the hip (DDH) represents a wide range of abnormalities affecting the acetabulum and femoral head. Traditional diagnostic tools such as anteroposterior pelvic radiographs are limited in evaluating the three-dimensional morphology of the acetabulum, especially in pediatric populations. This study introduces novel measurement parameters that include both angular and dimensional metrics for a comprehensive assessment of acetabular morphology. It also compares these parameters between normal and dysplastic hips in pediatric population. Computed tomography scans of 35 children with unilateral DDH, aged between four and 48 months, were analyzed, comparing dysplastic and normal hips. Parameters measured included anterior and posterior acetabular indexes and lengths, anterior and posterior coverage angles, lengths, and posterior coverage area, dome length and dome coverage. Statistical analyses evaluated differences between groups. Dysplastic hips exhibited higher anterior and posterior acetabular index values and reduced anterior and posterior acetabular lengths, reflecting global elongation and shallowness. Anterior coverage angle was significantly greater, while posterior coverage angle and posterior coverage parameters were reduced, highlighting posterior wall deficiencies. Dome coverage was also significantly decreased. All measurements showed good to excellent interobserver and intraobserver reliability (0.68-0.94 and 0.76-0.92, respectively). Our findings suggest that DDH involves global acetabular deficiencies, including posterior insufficiency, challenging the traditional focus on anterolateral deficiencies. The introduced parameters provide a reproducible method for evaluating pediatric acetabular morphology, offering valuable insights for diagnosis and treatment planning. Future studies should validate these findings and explore MRI for enhanced diagnostic accuracy.

The purpose of this systematic review was to compare the inter- and intra-observer reliability of Kellgren-Lawrence (KL) grading versus minimum joint space width (mJSW) measurement on knee radiographs, and to examine the influence of rater type, radiographic view and atlas-based training. A systematic search of PubMed/MEDLINE, Embase, Scopus and Web of Science was conducted through July 2025 following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting inter- and/or intra-observer reliability for KL or mJSW on standard knee radiographs were included. Extracted data included kappa (κ) and intraclass correlation coefficient (ICC) values, rater expertise, radiographic view and atlas usage. Raters were categorized as expert, trainee/non-expert or artificial intelligence (AI)-assisted/automated. Twenty-four studies (10,394 radiographs) met the inclusion criteria. Inter-observer reliability was generally higher for mJSW (mean ICC = 0.82 ± 0.17) compared with KL (mean k = 0.72 ± 0.17), with similar trends observed for intra-observer reliability. Experts and AI-assisted systems outperformed trainees/non-experts for both metrics. Reliability improved with semiflexed posteroanterior/Rosenberg views and atlas-guided training. This systematic review demonstrates that mJSW measurement generally shows higher reproducibility than KL grading. Reliability improved with expertise, standardized imaging and structured training, and AI-assisted approaches performed comparably to expert raters. Quantitative mJSW should complement KL grading, particularly when combined with alignment measures, to enhance consistency and clinical relevance of radiographic assessment. Level III.

To compare the prevalence and patterns of salivary gland ultrasonographic (SGUS) abnormalities in patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) using the OMERACT scoring system, and to investigate their associations with clinical manifestations, serological markers, and patient-reported dryness. This cross-sectional study enrolled 70 patients (35 SLE fulfilling ACR/EULAR 2019 criteria; 35 RA fulfilling ACR/EULAR 2010 criteria) and 30 healthy controls. Primary outcome was SGUS positivity rate (OMERACT score ≥ 2 in any gland or ≥ 4 total). Secondary outcomes included individual gland grading, Power Doppler signals, and ESSPRI dryness burden. Participants underwent comprehensive assessment including disease activity scores (SLEDAI-2K for SLE, DAS28-ESR for RA), anti-Ro/anti-La antibodies, and bilateral salivary gland ultrasonography. Intra-observer reliability was assessed on 15% of scans (ICC = 0.89). Multivariable logistic regression adjusted for age, disease duration, and CRP. Primary outcome significance was set at p < 0.05; secondary outcomes were interpreted with correction for multiple comparisons (Bonferroni-adjusted threshold, p < 0.007). SLE patients were younger (33.08 ± 10.84 vs 43.82 ± 8.95 years, p = 0.001) with numerically shorter disease duration (6.72 ± 7.25 vs 10.58 ± 9.28 years, p = 0.056). Unadjusted SGUS positivity was similar (SLE 62.8% vs RA 57.1%, p = 0.62), both exceeding controls (13.3%, p < 0.001). After adjusting for age, disease duration, and CRP, the association remained non-significant (OR = 1.26, 95% CI 0.48-3.31, p = 0.64). Submandibular glands showed preferential involvement (Grade ≥ 1: left SMG 97.1% SLE, 85.7% RA). Power Doppler signals were more prevalent in SLE left SMG (77.1% vs 57.2%, p = 0.02), however this did not remain significant after correction for multiple comparisons. RA patients reported higher dryness scores (7.0 ± 1.83 vs 5.68 ± 1.92, p = 0.001) despite comparable structural findings. Anti-Ro/anti-La antibodies did not correlate with SGUS positivity in either group. SGUS showed no consistent correlation with disease activity measures and demonstrated moderate discriminative ability for ESSPRI-defined dryness ≥ 5 (AUC = 0.77, 95% CI 0.68-0.87). SLE and RA patients exhibit comparable rates of salivary gland structural abnormalities independent of age, disease duration, and systemic inflammation. The discordance between ultrasonographic findings and patient-reported dryness, along with the lack of association with anti-Ro/anti-La antibodies, suggests heterogeneity in mechanisms of glandular involvement. SGUS provides objective assessment of glandular structure but should be interpreted alongside clinical evaluation and objective measures of gland function. Longitudinal studies incorporating objective salivary flow assessment are needed to clarify the clinical significance of ultrasonographic abnormalities.

Background: There is currently no established standard classification system for stratifying trochlear dysplasia (TD) severity. Many magnetic resonance imaging (MRI)-based classification systems focus on only a single axial level, even though the trochlear groove (TG) spans several axial levels. Evaluating multiple axial levels of the TG may allow a complete assessment. Hypothesis: A novel MRI-based TD severity classification system based on 4 axial levels will yield a more comprehensive assessment of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Pediatric patients were retrospectively categorized into 2 groups: those with recurrent patellar dislocations (RPDs; n = 106; mean age, 15.29 ± 2.45 years) and those with no history of patellar dislocations (controls; n = 98; mean age, 15.56 ± 1.40 years). Cartilaginous sulcus angle (SA) measurements were conducted at 4 consecutive axial levels on MRI starting at the proximal TG (SA1 = most proximal, SA2 = near-proximal, SA3 = near-distal, and SA4 = most distal). Cutoff values were identified using the Youden index. Patients were classified based on the number of elevated SA values: all 4 elevated values indicated grade 4 TD, 3 elevated values indicated grade 3 TD, 2 elevated values indicated grade 2 TD, 1 elevated value indicated grade 1 TD, and all normal values indicated grade 0 TD. Proportions were calculated, and the Fisher exact test was used to compare TD severity between the RPD and control groups. Results: Diagnostic cutoff values were as follows: SA1, 160°; SA2, 154°; SA3, 153°; and SA4, 148°. The RPD group was more likely to have grade 4 TD (58% vs 4%, respectively; P &lt; .001) and grade 3 TD (13% vs 4%, respectively; P = .03) compared with the control group. Conversely, the RPD group had less grade 0 TD (8% vs 68%, respectively; P &lt; .001). There was no difference in the proportions with grade 2 TD (13% vs 9%, respectively; P = .39) or grade 1 TD (8% vs 14%, respectively; P = .27) between the RPD and control groups. Intraobserver reliability was excellent for SA1 to SA4, and interobserver reliability was excellent for SA1 and SA4 and good for SA2 and SA3. Conclusion: The Multi-level Axial Patellofemoral Score for Trochlear Dysplasia (MAPS-TD) is a novel classification system that stratifies TD severity and has demonstrated accuracy and reliability in distinguishing patients with RPDs from controls. Its primary clinical utility lies in differentiating more extensive TD (especially grade 4) from mild TD (grades 1 and 2). The MAPS-TD may help guide surgical decision-making, possibly even in identifying candidates for surgical procedures (ie, trochleoplasty) among those with grade 4 TD.

To avoid the confusion of mechanism, tissue, morphology, and injury severity that resulted from previous modified AO, the Thoracolumbar Injury Classification and Severity Score (TLICS), the Thoracolumbar AO Spine Injury Score (TL AOSIS), and Load Sharing Classification (LSC), the integrated scoring system is devised for thoracolumbar junction (TLJ) injury that can better assist clinical decision-making strategy. We reviewed the literature of TLJ classification and TLICS 4-point treatment. Scoring and remedy strategies were proposed retrospectively. Patients included were validated with the change of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) after surgical treatment retrospectively. The interobserver and intraobserver reliability was also evaluated. Nerve, discoligamentous complex (DLC), and vertebral bone that are three main spinal structures are weighted as 5, 4, and 3 points, respectively. If nerve injury ≥ 3 and/or bone + DLC injury ≥ 4, surgical treatment is recommended. If nerve injury = 2, delayed surgery may be needed after close observation of consistent pain. If nerve injury ≤ 1 or the bone + DLC score < 4, conservative treatment is recommended. When LSC ≥ 7, it may require vertebrectomy and anterior/middle column instrumentation. In ADLC = 2 of LSC ≤ 6, the removal of the injured disc and interbody fusion is needed, or only posterior fixation without intervertebral fusion. The consistency of the integrated system indicated substantial reliability. This system showed substantial reliability and a desirable prognosis in TLJ patients. It could help differentiate injury morphology from severity and prevent the assignment of undue values to certain components, thereby providing a practicable decision-making strategy for TLJ injured patients.

To measure intra-observer and interobserver correlations and reading times for visual and artificial intelligence algorithm-assisted reading (innerve) of intraepidermal small nerve fiber density (IENFD) in skin biopsies. We retrospectively selected 40 skin biopsy slides with PGP9.5/col4 double-immunofluorescence labeling. The slides were scanned and read by two experienced observers (O1 and O2), on two occasions (visual reading 1 -VR1- and 2 -VR2-). They were then read after predetection with the Innerve algorithm (assisted reading -AR-). IENFD and reading time were evaluated to assess reliability and time saved. Intra-observer reliability was evaluated by calculating intraclass correlation coefficient (ICC). The ICC obtained were 0.95 (O1)/0.99 (O2) for the two VR and 0.96 (O1)/0.99 (O2) for VR1/AR. Inter-rater ICC between O1 and O2 was 0.88, 0.87, and 0.93 for VR1, VR2, and AR, respectively. AR reading time was 1.96 times faster for O1 and 1.03 times slower for O2. Subgroup analyses revealed an interobserver ICC significantly > 0.7 (p < 0.05), with ICC > 0.9 regardless of sex and skin pigmentation. Innerve is an innovative and reliable AI tool for IENFD determinations on skin biopsies, making such analyses-which were considered time-consuming and difficult-easier for small-fiber neuropathy diagnosis.

The aim of the study was to determine the correlation between proximal caries and pulp canal obliteration (PCO) in maxillary molars using cone-beam computed tomography (CBCT). This retrospective observational study analyzed 162 CBCT scans of maxillary molars with proximal caries (mesial or distal) obtained from patients aged 18-49 years. Two calibrated endodontists independently assessed the mesiobuccal (MB), distobuccal (DB), and palatal roots for the presence of PCO in sagittal, coronal, and axial planes using CBCT (<0.2 mm voxel size). Inter- and intra-observer reliability was evaluated using Cohen's kappa. Associations between caries location and PCO were analyzed using Pearson's Chi-square test or Fisher's exact test and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated (P < 0.05). PCO was observed in 21.2% (n = 34/162) of maxillary molars. Root-wise prevalence was the highest in the DB root (42%), followed by the MB (19.8%) and palatal roots (1.9%). No statistically significant association was found between caries location and PCO (MB: OR = 0.88, 95% CI: 0.41-1.92, P = 0.757; DB: OR = 0.55, 95% CI: 0.29-1.04, P = 0.064; palatal: OR = 0.39, 95% CI: 0.03-4.43, P = 0.434). Within the limitations of the study, PCO was frequently observed in maxillary molars with proximal caries, predominantly affecting the DB root irrespective of caries location. Females had higher predilection compared to males.

The anteroposterior radiograph of the pelvis is essential for diagnosing hip pathologies. Radiograph-like projections reconstructed as cone-beam images from CT data correlate strongly with conventional radiographs. However, CT inherently uses parallel x-rays rather than a cone-beam geometry. This study aims to determine whether parallel-beam radiograph-like projections from CT provide comparable reference values to cone-beam reconstructions. 63 patients (126 hips) undergoing CT for symptomatic hip pathologies without prior hip surgery were included. From the same CT data, cone-beam and parallel-beam radiograph-like images were reconstructed using a standardized algorithm. Reference values, including lateral center-edge angle (LCEA), medial center-edge angle (MCEA), acetabular index (AI), acetabular arc (AA), extrusion index (EI), crossover sign, and posterior wall sign, were measured on both projection types, eliminating technical bias. Two observers performed all measurements twice to assess inter- and intra-observer reliability, and intraclass correlation coefficients (ICCs) were calculated. 126 hips were analyzed: 52 with LCEA <22° ("acetabular undercoverage"), 49 with LCEA 22°-33° ("normal coverage"), and 25 with LCEA >33° ("acetabular overcoverage"). ICCs between observers and between projection types demonstrated good to excellent reliability for all reference values (0.89-0.99). Parallel-beam radiograph-like projections demonstrate good to excellent reliability (ICCs: 0.89-0.99) for key reference values of hip pathologies compared to cone-beam radiograph-like projections from the same CT data. These findings suggest parallel beam projections can be reliably used with established reference values for conventional radiographs.

Computed tomography angiography (CTA) imaging is essential to evaluate and analyse complex abdominal and thoraco-abdominal aortic aneurysms. However, CTA analyses are labour intensive, time consuming, and prone to interphysician variability. Fully automatic volume segmentation (FAVS) using artificial intelligence with deep learning has been validated for infrarenal aorta imaging but requires further testing for thoracic and visceral aorta segmentation. This study assessed FAVS accuracy against physician controlled manual segmentation (PCMS) in the descending thoracic aorta, visceral abdominal aorta, and visceral vasculature. This was a retrospective, multicentre, observational cohort study. Fifty pre-operative CTAs of patients with abdominal aortic aneurysm were randomly selected. Comparisons between FAVS and PCMS and assessment of inter- and intra-observer reliability of PCMS were performed. Volumetric segmentation performance was evaluated using sensitivity, specificity, Dice similarity coefficient (DSC), and Jaccard index (JI). Visceral vessel identification was compared by analysing branchpoint coordinates. Bland-Altman limits of agreement (BA-LoA) were calculated for proximal visceral diameters (excluding duplicate renals). FAVS demonstrated performance comparable with PCMS for volumetric segmentation, with a median DSC of 0.93 (interquartile range [IQR] 0.91, 0.94), JI of 0.87 (IQR 0.84, 0.89), sensitivity of 0.99 (IQR 0.98, 0.99), and specificity of 1.00 (IQR 1.00, 1.00). These metrics are similar to interphysician comparisons: median DSC 0.93 (IQR 0.86, 0.93), JI 0.87 (IQR 0.76, 0.88), sensitivity 0.90 (IQR 0.86, 0.94), and specificity 1.00 (IQR 1.00, 1.00). FAVS correctly identified 99.5% (183/184) of visceral vessels. Branchpoint coordinates for FAVS and PCMS were within the limits of CTA spatial resolution (Δx -0.33 [IQR -1.70, 1.12], Δy 0.61 [IQR -1.25, 3.60], Δz 2.10 [IQR 0.37, 5.06] mm). BA-LoA for proximal visceral diameter measurements showed reasonable agreement: FAVS vs. PCMS mean difference -0.11 ± 5.23 mm compared with interphysician variability of 0.03 ± 5.27 mm. FAVS provides accurate, efficient segmentation of the thoracic and visceral aorta, delivering performance comparable to manual segmentation by expert physicians. This technology may enhance clinical workflows for monitoring and planning treatments for complex abdominal and thoraco-abdominal aortic aneurysms.

Factors such as maternal demographics, anthropometrics, health status, and lifestyle are known to have direct associations with newborn birth weight. However, there is an indication that umbilical cord size measured using ultrasonography could potentially be a predictor of birth weight. This study, therefore, aimed to investigate the relationship between umbilical cord measurements and birth weight in Ghana. A prospective, cross-sectional, quantitative approach was adopted for this study. A total of 107 patients were purposively sampled with an attrition rate of 9.3%, leading to 97 (90.7%) partaking in the study, aged between 17 and 41 years. The patients were recruited between 34 and 37 weeks of gestation during their routine antenatal care visit. Data was collected using a data sheet with some key parameters recorded, being: maternal age, gravida, parity, umbilical cord diameter (UCD), umbilical cord circumference (UCC) and umbilical cord area (UCA), which were manually entered into the IBM SPSS version 26. The mean age recorded was 29.59 ± 4.83 years. The mean UCD, UCC and UCA were 1.53 ± 0.19 cm, 5.57 ± 0.41 cm and 1.86 ± 0.47 cm2, respectively. The Cronbach's alpha coefficient (α) was used to assess intra-observer reliability, and it showed strong consistency and precision. The mean birth weight was 3.13 ± 0.27 kg. There were moderate positive correlations between UCD and birthweight (r = 0.53, p < 0.01), UCC and birthweight (r = 0.331, p < 0.001) and UCA and birthweight (r = 0.52, p < 0.001). There were positive correlations between maternal demographics and UCD and maternal demographics and UCA. The study found no correlation between maternal demographics and UCC. Multiple regression analysis of the predictors of birth weights in the study population was conducted. The model as a whole was significant in predicting neonatal birth weights among the study participants at F (4, 92) = 20.731, p < 0.001. The final predictive equation of the model for predicting BW was given as: BW = 1.849 + 0.021 × maternal age + 0.031 × parity- 0.066 × UCC + 0.652 × UCD. The results suggest that umbilical cord size could be an important marker for fetal weight estimation. However, the less diverse small sample size and single-centre design of the study limit the generalizability of the findings.

The aim was to evaluate optimum site for insertion of orthodontic mini-implants at mandibular symphysis in patient with different mandibular growth patterns using cone-beam computed tomography (CBCT). The objectives were to evaluate and measure complete bone width (CBW) and cortical bone width (CtBW) in the symphysis area at various heights [2 mm, 4 mm, 6 mm, 8 mm, 10 mm, and 12 mm from cementoenamel junction (CEJ)] and at various angles (0º, 10º, 20º, 30º, 40º, 50º, and 60º to the occlusal plane), and to assess the effect of mandibular growth patterns (low, average, and high angle) on these measurements. The study sample included 45 patients aged 16-30 years. Patients were categorized into three groups (n=15) corresponding to the mandibular growth pattern for the assessment of CBW and CtBW. Individual data for each patient were entered into a master table in Microsoft Excel and subjected to statistical analysis using SPSS version 22.0. Analysis of variance was applied to investigate the influence of insertion location, facial type, insertion height and insertion angle on overall bone thickness and CtBW. A p-value <0.05 was considered statistically significant. Intra-observer reliability was assessed using the intraclass correlation coefficient. CBW was notably greater in patients with a low-angle mandibular growth pattern than in patients with other mandibular growth patterns at insertion heights of 8, 10, and 12 mm. CtBW was greater in cases with a low-angle mandibular growth pattern than in cases with other mandibular growth patterns. Similar results were observed for CtBW. The mandibular symphysis in patients with a low-angle growth pattern provides more favorable anatomical conditions for mini-implant placement. The ideal insertion site lies between 6 and 10 mm below the CEJ of the central incisors, with angulation ranging from 0° to 60° relative to the occlusal plane. CBCT assessment should be considered essential in treatment planning to customize implant positioning based on individual growth patterns, thereby enhancing implant stability and success.

Objective: This study aimed to investigate the relationship between the presence of nutrient canals and potential trabecular bone changes in jaws with or without cysts, using two different classification methods. Materials and Methods: CBCT images from 60 patients with unilateral jaw cysts located in either the maxilla or mandible were reviewed retrospectively. Cyst-affected sides with or without nutrient canals were grouped and compared to all unaffected sides combined. Trabecular bone quality was assessed both qualitatively (visual trabecular pattern classification) and quantitatively (modified Lekholm and Zarb classification based on HU ranges). Fisher’s Exact and Fisher-Freeman-Halton tests were used to compare frequencies between groups. Intra-observer reliability was assessed using Kappa statistics. Significance was set at p &amp;lt; 0.05.Results: Nutrient canals were significantly associated with sclerotic trabecular bone patterns in cyst-affected regions (p = 0.001), with nutrient canals more frequent in areas of “average” or “above-average” trabecular density. Nutrient canals also showed a significant association with the highest bone density category (Q1) in both cystic (p &amp;lt; 0.001) and non-cystic regions (p = 0.003). A significant association was observed between qualitative and quantitative classifications (p &amp;lt; 0.001). Intra-observer reliability was moderate for visual trabecular assessments and high for the quantitative classification.Conclusion: Sclerotic changes in the trabecular bone around jaw cysts are closely associated with occurrence of nutrient canals, potentially reflecting compensatory vascular adaptation. Nutrient canals should be clearly documented in CBCT reports. The modified Lekholm and Zarb classification may serve as a reliable alternative to visual methods for assessing bone quality on CBCT images.

Abstract Study Design Systematic review and meta-analysis. Introduction The Lenke system is widely used in AIS surgical planning. While initial reports showed excellent reproducibility, subsequent studies have yielded inconsistent results, particularly for lumbar and sagittal modifiers. We aimed to evaluate inter- and intra-observer reliability of the Lenke classification for adolescent idiopathic scoliosis (AIS) and identify methodological factors influencing agreement. Methods Following PRISMA guidelines, five databases (PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science) were searched to August 2025. Data on observer characteristics, imaging protocols, measurement methods, and statistical indices (κ, ICC) were extracted. Study quality was assessed with QAREL. Descriptive synthesis and random-effects meta-analysis were performed. Results Eleven studies (528 radiographs) met inclusion. Inter-observer reliability averaged κ = 0.76 (range 0.50–0.96); lumbar κ = 0.75 (0.53–0.92); sagittal κ = 0.79 (0.41–1.0). Pooled analysis of two studies with confidence intervals yielded κ = 0.69 (95% c.i. 0.56–0.82; I² = 21%). Intra-observer reliability was higher (κ≈0.82). Reliability improved with pre-measured radiographs, experienced observers, computer assistance, and short repeat intervals; it was lower with non-premeasured films, mixed cohorts, and longer intervals. Lumbar modifiers were relatively robust, whereas sagittal reproducibility was most vulnerable to methodological bias. One study illustrated the κ paradox, with high agreement but κ = 0.41 due to skewed distribution. Conclusions The Lenke classification is reliable under controlled conditions but less consistent in everyday practice. Reported κ values should be interpreted within their methodological context. Standardised protocols, transparent reporting, and digital tools may improve reproducibility.

Abstract Background Lateral ankle pain can be caused by various pathologies, including those involving the peroneal tendons. The spatial arrangement of the peroneal tendons within the trimalleolar groove remains underexplored in the literature. Objective The objective of this study is to propose a new classification to describe and categorize the spatial relationship between the peroneal brevis and peroneus longus tendons at the level of the retro malleolar groove. Patients and Methods A retrospective analysis of the ankle joint anatomy on Magnetic Resonance Imaging (MRI) was conducted on 100 consecutive patients undergoing foot and ankle imaging . A musculoskeletal radiologist and orthopaedic surgeon meticulously evaluated the spatial relationship between the peroneus longus and peroneus brevis tendons in axial plane and subsequently categorized as follows:Type 1: PB tendon is deep to PL tendonType 2: PB tendon is less than 50% medial to PL tendonType 3: PB tendon is more than 50% medial to PL tendonType 4: PB tendon adjacent to PL tendon Descriptive statistics was performed of the cohort and intraclass correlation for interobserver reliability. Results In our study, the most common variant seen was type 1 (40% of cases) followed by type 2. There was good intraobserver reliability with intraclass correlation of 0.8. Conclusions Our study successfully introduces a novel classification system that effectively delineates and categorizes the spatial relationship between the peroneus brevis and peroneus longus tendons within the retromalleolar groove. This may be of clinical value during tendon repair and reconstruction.

Abstract Periprosthetic joint infection (PJI) is a serious complication after total knee arthroplasty (TKA). Effective preoperative skin antisepsis is essential for prevention, yet the influence of knee positioning during preparation remains poorly studied. This prospective, single-centre study evaluated whether maximal knee flexion improves antiseptic coverage and thoroughness compared with full extension. Ten healthy adult volunteers underwent standardised anterior knee preparation in both positions. Fluorescent dye (UV Germ lotion) was applied and removed using an alcohol-based chlorhexidine solution. Ultraviolet photography and ImageJ software quantified residual dye as a surrogate for antiseptic coverage. Two independent investigators performed all preparations, each repeating their image analyses to allow intra-observer reliability assessment. The primary outcome was percentage residual dye; intra- and inter-observer agreement were measured using intraclass correlation coefficients (ICC). Eighty preparations (40 flexion, 40 extension) were analysed. Pooled median residual dye was significantly lower in flexion (1.7%, interquartile range [IQR] 0.1–7.2%) than in extension (9.8%, IQR 2.6–19.0%; P &amp;lt; 0.0001). Investigator-specific medians showed the same pattern. Intrarater reliability was moderate to excellent (ICC 0.67–0.89), whereas interrater reliability was poor (ICC 0.07–0.35). No adverse events occurred. Maximal knee flexion during preparation significantly improves anterior surface antiseptic coverage compared with full extension, likely by exposing skin folds concealed in extension. As a simple, cost-neutral modification, flexion-based preparation has been adopted in our institution. Further studies should assess its impact on bacterial load and clinical infection rates in diverse TKA populations. Keywords: Total knee arthroplasty, periprosthetic joint infection, skin antisepsis, knee positioning, ultraviolet imaging

Residual equinus is an important indicator for deciding the need for tenotomy and checking for recurrence of clubfoot deformity. This study aims to validate a novel, radiologic marker-the Talar Index-for objective assessment of residual equinus in clubfoot. A cross-sectional observational study was conducted on infants with idiopathic clubfoot treated using the Ponseti protocol, assessed just before percutaneous Achilles tenotomy. The validity of the talar index was tested against the unaffected feet. A positive talar index was defined as the presence of residual equinus. Receiver operating characteristic (ROC) analysis and logistic regression were performed between positive talar index and lateral tibiocalcaneal angle and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Interobserver and intraobserver reliability of the talar index was assessed using Cohen's kappa. A total of 70 feet (49 affected and 21 unaffected) were evaluated. The talar index correctly identified residual equinus in 94.3% of feet, with a sensitivity of 95.9% and specificity of 90.5%. There was a strong association between a positive talar index and increased tibiocalcaneal angle (AUC: 0.929, P=0.001). Sensitivity, specificity, PPV, and NPV of the positive talar index were found to be 84%, 90.5%, 77.9%, and 93.4%, respectively. Logistic regression showed a significant model fit (P<0.001, R²=0.82). Inter (κ=0.84) observer and intra (κ=0.97) observer reliability was excellent. The talar index is a valid, reliable, and easily interpretable radiologic marker for assessing residual equinus in clubfoot. Its simplicity and high diagnostic accuracy make it particularly suitable for routine clinical use, including in resource-limited and high-volume settings. Level III.

Developing new diagnostic imaging methods that provide detailed visualization of the histoanatomy of tissues and organs requires precise histomorphometric evaluation. With a particular focus on bowel, this study aimed to develop and validate a computer program for reliable and efficient assessment of bowel wall histomorphometry. A MATLAB-based computer program was developed in-house to manually delineate and automatically calculate mean layer thickness of the muscularis propria layers, submucosa and mucosa in histopathology images of bowel wall specimens from patients operated on for Hirschsprung’s disease. Validation included assessment of inter- and intra-observer reliability and agreement for generated mean thicknesses, as well as comparison with manual measurements (mean of 10 thickness measurement points). Reliability was assessed through intraclass correlation coefficient (ICC) (good > 0.75) and agreement through Bland-Altman analysis (good= mean close to zero and spread within 2 standard deviations). The program allowed for import of histopathology images for bowel wall layer analysis. After manual layer delineation, the program automatically calculated mean layer thickness (mm) ± standard deviation based on approximately 3000 measurement points. For the inter-observer analyses the reliability was moderate to good in the majority of the histoanatomic layers (ICC range 0.6–0.9) and agreement was similarly good based on the Bland-Altman analyses. Also, the intra-observer reliability ranged between good and excellent in the majority of histoanatomic layers (ICC range 0.7-1.0). The high-precision layer delineation and mean thickness extraction per image took 15 min, compared to 60 min for manual measurement. The developed computer program enables precise and time-efficient measurements of histoanatomic layer thicknesses in histopathology images of bowel wall, with good reliabilities and agreements between examinators. The program’s application is useful in histomorphometric evaluations for advancing diagnostic imaging techniques.

The lunocapitate angle is a radiological parameter that can be used to identify midcarpal malalignment. This study aimed to determine the reproducibility of a measurement method for the lunocapitate angle on plain lateral wrist radiographs and to determine the normal values. The lunocapitate angle was measured in a standardized manner by three observers. Inter- and intra-observer variabilities were first tested on 18 radiographs. The lunocapitate angle was measured on lateral wrist radiographs of 172 patients with a mean age of 30 years (range, 20-40). Forty-nine percent of the patients were men and in 56% the left wrist was involved. The interobserver variability was good with an intraclass correlation coefficient (ICC) of 0.89. The intraobserver reliability was excellent for all three investigators, with ICCs of 0.93, 0.93 and 0.91, respectively. The mean lunocapitate angle was 15° (SD 10; range, -18 to 43°) 95% CI -3 to 34°. The mean lunocapitate angle was 17° in women and 13° in men (p = 0.005). In this study, a reproducible method is presented to measure the lunocapitate angle on plain radiographs and normal values were established that can be used as a reference. IV.

A critical component of patient care for osteogenesis imperfecta patients is understanding the development of union following fracture and osteotomy surgery. Studies evaluating the criteria of bony union in this population have varied. An objective standardized method for fracture healing was developed as the radiographic union score for tibial fractures (RUST), and subsequently revised to the modified RUST (mRUST). The RUST score has been shown to have excellent interobserver and intraobserver reliability in a single-center investigation in an OI population. The purpose of the study was to evaluate the mRUST reliability in a multicenter investigation. Thirty OI patients with tibial fractures or osteotomy radiographs were identified. Nine observers from 3 institutions measured on 2 separate occasions. Four cortices were scored with the following classification: 1=no callus; 2=callus present; 3=bridging callus; and 4=remodeled, fracture not visible. The modified RUST score ranges from 4 to 16. Interclass and intraclass coefficients (ICC) of 95% CIs were used for interobserver and intraobserver reliabilities. Interobserver reliability ICC representing the interobserver reliability for the first and second scores was the following, respectively, 0.926 (0.864-0.962) and 0.915 (0.845-0.957). Three reviewers' intraobserver reliability for series 1 and series 2 measurements were 0.860 (0.707-0.934), 0.994 (0.986-0.997), and 0.974 (0.946-0.988). Excellent interobserver and intraobserver reliability was demonstrated for the mRUST in the setting of OI bone, indicating the precision of the mRUST for OI tibia healing. Modified RUST application and routine use may help standardize the evaluation of osteotomy and fracture healing in the OI population with further work necessary for it to help make clinical decisions. Level III-retrospective study of nonconsecutive patients.