Lateral Projections Research Articles

The correct tibial slope? Comparison of measuring methods

From a biomechanical point of view, the tibial slope plays a significant role in relation to the loading of the ligament structures in the knee joint. Currently, there are various methods of measurement for the tibial slope, which makes it difficult to compare the measurement results obtained. These differences can be decisive factors for the indication and the extent respectively of the correction of the tibial slope. The aim of this work is to present the differences in results between the measurement methods, and to compare these with the posterior tibial slope (PTS). By means of a comparative analysis, six measurement techniques for the tibial slope were examined. Using six parameters (correlation coefficient, range, deviation of the average slope value, correction coefficient, difference in the corrected measurements, range of the corrected measurements), these results were compared with the PTS. In this prospective study, the PTS was measured in 107 (49 male, 58 female, age 42.6 ± 23.4 years) strictly lateral plain radiological projections of the tibia with the talocrural joint in comparison with the measurement methods according to Han, Brazier, Moore and Harvey, Pietrini and LaPrade and a supratuberosity measurement. The posterior slope was observed at a mean value of 6.9° (± 8.6°). Compared with the PTS, tibial slope values were increased in 55.5 % of all measurements examined and decreased in 42.4 %. In 2 % the values were identical to those of PTS. The deviations observed were significant at up to +2.9° (± 1.7°) and -2.3° (± 1.5°) respectively in comparison with the measured PTS (p < 0.001). 25.9 % of the results showed a slope value more than 2°too high and 17.6 % one less than -2° too low. Thus, in 43 % of the results clinically relevant results that were too high or too low were observed for the tibial slope compared with the PTS (p < 0.001). The correlation analyses showed very high linear connections with PTS (p < 0.001) for all methods, from r2 = 0.88 (in Moore and Harvey) up to r2 = 0.98 (in Han). The ranges varied between 13.90° (Moore and Harvey) and 18.30° (Han). Depending on the measurement method, the slope values obtained should be individually evaluated, in order to draw the correct clinical conclusions. In principle, the radiological assessment of the whole lower leg is essential, so that concomitant pathologies in the area of the entire tibia can be detected. In everyday clinical practice, the measurement according to Han etal., and thus a shorter X‑ray projection, makes it possible to draw optimal conclusions about the PTS. LOE: Prospective diagnostic study, LevelII.

A case series on a new reference in mandibular angles harmonization: the Frontozygomatic-Infraorbital Line (FZ-IOL)

the aim of this paper, is to propose a new reference line: the Frontozygomatic-Infraorbital Line (FZ-IOL). This reference line can guide the surgical team planning mandibular angle harmonization, based on the patient's skeletal proportion. The Frontozygomatic-Infraorbital Line has been adopted for symmetrization surgery, masculinization surgery, and in unsatisfactory results of previous orthognathic surgery.From March 2021 to December 2022, 3 patients were treated for severe facial asymmetry affecting mainly the lower third of the face. All cases were planned with the reference FZ-IOL. Patients were treated in the same center, at the Orthognathic Surgery Department of the Instituto Portugues da Face, Lisbon, Portugal. The Frontozygomatic-Infraorbital Line is designed virtually using software to reconstruct a 3D image from a digital imaging and communications in medicine (DICOM) file obtained from a cone beam computer tomography (CBCT). , connecting the two orbital rims. Then, a vertical line, the frontozygomatic line perpendicular to the IOL and passing through the outmost lateral portion of the frontozygomatic suture is drawn.The proposed line demonstrated how establishing appropriate reference lines is crucial for the success of the surgery. The selection of reference lines should be based on the patient's anatomy, the symmetrization process's complexity, and the surgery's desired outcome. The Frontozygomatic-Infraorbital Line represents an adequate reference line for managing mandibular angle lateral projection, improving lower third of the face symmetrization.

Procrustes analysis of a shape of pediatric supracondylar humerus fractures

Shape of supracondylar fracture of the humeral of pediatric patients is analysed with Procrustes method. XR-images of fractures are considered both in anterio-posterior (AP) view and in a lateral (L) view. Applying Procrustes method for both views mean images are constructed and compared. Variability of shapes is quantified with a shape principal component analysis. Possibility of predictions of typical shape of humeral fracture and its variability using statistical shape analysis offers additional information on injury characteristics important in preoperative planning. Non-parametric tests (permutational and bootstrap) do not indicate statistical difference between Procrustes mean shapes in anterio-posterior and lateral projections. It is shown, however, that AP and L shapes of humeral fractures differ in their variability quantified by shape principal components.

Cardiac evaluation in free-ranging giant anteaters (Myrmecophaga tridactyla) in the Brazilian Cerrado

The giant anteater (Myrmecophaga tridactyla) is classified as a Vulnerable species, but these animals are regularly brought into rescue centers and are also kept in zoos around the world. They occupy a highly specialized dietary niche with a feeding ecology that is difficult to replicate under human care. This can lead to numerous nutrition-related health problems, including frequent cardiomyopathies. Establishing reference parameters for free-ranging animals is an important tool to assess the health of animals under human care. For this reason, a cardiac assessment through plasma troponin I concentrations, vertebral heart score (VHS) based on thoracic radiographs, and echocardiographic parameters were established for 11 free-ranging giant anteaters in the Cerrado savanna of Mato Grosso do Sul, Brazil. The troponin I concentrations were all lower than 0.2 ng/ml, the cutoff limit for detection in the assay used. The mean VHS in the right lateral projections was 7.49, a value almost identical to cats (7.5) and lower than dogs (9.7). A complete echocardiographic assessment is provided and compared with previous case reports. This paper validates the diet-related origin hypothesis for common dilated cardiomyopathy in giant anteaters. This is the first published study with radiographic and echocardiographic parameters for free-ranging giant anteaters, providing important reference parameters for future giant anteater in situ and ex situ conservation initiatives. This work highlights the benefits of veterinary research comparing health parameters for animals living under and outside of human care.

A new marine tardigrade species (Heterotardigrada: Batillipedidae) from the southeast coast of India

A new marine tardigrade species, Batillipes chandrayaani sp. nov. is described from the sandy mid littoral region of the southeast coast of India. This novel species can be distinguished from all its congeners by the presence of a dorsal indentation in the anterior cephalic region, shape of primary clavae, presence of secondary clavae, segmented dorsal body due to the presence of transverse cuticle folds, shape of leg IV sensory organ with the presence of two van der Land’s organs, long hook shaped lateral body projections on the caudal segment and the presence of a semi-circular cuticular projection on the coxal region of leg II and leg III.

Preoperative Angiographic Protocol for the Surgical Management of Spinal Dural Arteriovenous Fistulas: A Technical Nuance for Safe Minimally Invasive Surgery

BackgroundInterruption of the fistoulus point is the goal of the treatment of spinal dural arteriovenous fistula (dAVFs). Microsurgery still represents a highly efficient treatment in terms of complete occlusion with the lowest risk of recurrence rate. It is reported that the hardest step consists in finding the fistulous site itself, potentially extending surgical access and time, and increasing potential post-operative surgical-related complications. The accurate preoperative detection of the shunt and spinal level together is crucial for guiding optimal, fast and safe microsurgical treatment. MethodsIn the present paper, the authors describe a preoperative angiographic protocol for achieving a safe and simple resection of spinal dAVFs based on a six-year Institutional experience of forty-two patients who underwent minimally invasive. Two illustrative cases are also included in order to support the technical descriptions. ResultsThe suspected artery associated to the vascular malformation of interest is studied in our angiographic protocol through non-subtracted selective acquisitions in the lateral projection. The resulting frames are reconstructed with 3D Rotational Angiography. The implementation of the preoperative angiographic protocol allowed 100% of intraoperative identification of the fistoulus point in all cases with the use of minimally invasive approach. ConclusionsNowadays, neurosurgeons advocate for minimally invasive procedures and low morbidity risk procedures for the treatment of spinal dAVFs.Our preoperative approach for accurate angigoraphic localization of the fistoulus point through non-subtracted and 3D reconstructed angiography allowed to achieve safe and definitive occlusion of the shunt.

Finite Element Analysis of Postoperative Stability of Transverse Scaphoid Waist Fracture.

Scaphoid waist fractures are often stabilised with compression screws, Kirschner wires (K-wires), or a combination of both. While clinical and bio-mechanical studies evaluating their utility are available, the ideal configuration of implant that would provide adequate stability to permit early use of the hand is debatable. We examined configurations of a single screw, one screw along with a K-wire, and two K-wires used for a transverse scaphoid waist fracture fixation aiming to assess the stability provided by each in the immediate postoperative period. Computer-aided design (CAD) models of the scaphoid, K-wire, and headless compression screw were created. A transverse fracture was created at the scaphoid waist, and the CAD models of the screw and K-wire were used to fix the fracture in different configurations in a distal to proximal direction. Finite Element Analysis (FEA) was used to examine the strength of configurations when they were subjected to compression and distraction forces. The total maximum deformation (TDef) and factor of safety (FoS) for each configuration were calculated and used as indirect indicators of postoperative stability. When a single screw was used, the configurations with the screw directed posteriorly from either centre or anterior had the best combined TDef and FoS values. For one screw and one K-wire, the configuration with screw and K-wire parallel to each other with the screw located along the long axis in the AP projection and anterior to the K-wire in the lateral projection had the best combined TDef and FoS values. When using two K-wires, configurations with the two wires diverging proximally on the lateral projection had the best combined TDef and FoS values. When fixing a transverse scaphoid waist fracture with a single screw, the screw directed posteriorly from either the centre or anterior aspect of the distal pole has the best stability, a parallel configuration has the best stability when fixing it using a screw and a K-wire, and divergent configuration has the best stability when fixing it with two K-wires only.

Comparative characteristics of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children

BACKGROUND: Sagittal balance of the spine has received considerable development in recent years. However, most studies focused on the assessment of vertebral–pelvic parameters. The cervical spine has long received insufficient attention from researchers, but this trend has been changing. The study of cervical sagittal balance in children with Down syndrome is beneficial in approaching the preconditions of atlantoaxial instability. AIM: To perform a comparative analysis of cervical sagittal balance parameters and atlantoaxial instability criteria in normal and Down syndrome children. MATERIALS AND METHODS: Radiographs of the cervical spine in the neutral position in lateral projection and postural radiographs of 110 pediatric patients were analyzed retrospectively. The patients were divided into two groups: group 1 (normal), 60 children aged 4–17 years without spinal pathology, and group 2 (Down syndrome), 50 children aged 4–17 years with Down syndrome. The parameters of cervical sagittal balance (Oc-C2, Oc-C7, C1-C2, C2-C7, C2-C7H, C7S, Th1S, TIA, NT) and criteria for atlantoaxial instability (Nakamura angle, ADI, SAC-C1, SAC-C1/SAC-C4) were obtained, and data was statistically analyzed. RESULTS: Significant differences in the parameters C7S, Th1S, and TIA increased in children with Down syndrome. These parameters are involved in cervical lordosis; however, no significant differences in cervical lordosis angles were found. Furthermore, significant differences were noted in the criteria of atlantoaxial instability ADI, SAC-C1, and SAC-C1/SAC-C4 toward their decreasing in children with Down syndrome. CONCLUSION: In patients with Down syndrome, the indices of cervical lordosis are statistically greater than those in normal children. Moreover, the parameters of cervical lordosis in patients with Down syndrome do not differ from those in normal children. Therefore, during flexion, subcompensation of the cervical spine is observed in children with Down syndrome. Given the statistically smaller indicators ADI, SAC-C1, SAC-C1/SAC-C4, low neck muscle tone, and ligamentous hypermobility, these abnormalities can be considered as congenital predisposition factors for atlantoaxial instability in children with Down syndrome.

Two-view topogram-based anatomy-guided CT reconstruction for prospective risk minimization

To facilitate a prospective estimation of the effective dose of an CT scan prior to the actual scanning in order to use sophisticated patient risk minimizing methods, a prospective spatial dose estimation and the known anatomical structures are required. To this end, a CT reconstruction method is required to reconstruct CT volumes from as few projections as possible, i.e. by using the topograms, with anatomical structures as correct as possible. In this work, an optimized CT reconstruction model based on a generative adversarial network (GAN) is proposed. The GAN is trained to reconstruct 3D volumes from an anterior-posterior and a lateral CT projection. To enhance anatomical structures, a pre-trained organ segmentation network and the 3D perceptual loss are applied during the training phase, so that the model can then generate both organ-enhanced CT volume and organ segmentation masks. The proposed method can reconstruct CT volumes with PSNR of 26.49, RMSE of 196.17, and SSIM of 0.64, compared to 26.21, 201.55 and 0.63 using the baseline method. In terms of the anatomical structure, the proposed method effectively enhances the organ shapes and boundaries and allows for a straight-forward identification of the relevant anatomical structures. We note that conventional reconstruction metrics fail to indicate the enhancement of anatomical structures. In addition to such metrics, the evaluation is expanded with assessing the organ segmentation performance. The average organ dice of the proposed method is 0.71 compared with 0.63 for the baseline model, indicating the enhancement of anatomical structures.

Description of the larva of Cybisterlewisianus Sharp, 1873 (Coleoptera, Dytiscidae, Cybistrinae).

We describe for the first time, the larvae of Cybister (Cybister) lewisianus Sharp, 1873, an endangered species of diving beetle in Japan, emphasizing the chaetotaxy of the cephalic capsule, head appendages, legs, last abdominal segment, and urogomphi. Cybisterlewisianus larvae are characterized by a longer third article of antenna 3 than the sum of the first and second articles; rounded apex of parietal setae 1-3; labium seta 8 absent; elongated trochanter seta 4, not multi-branched; rounded apex of abdominal setae 1, 12, and 13 (instar I); narrow lateral projections of the frontoclypeus; pronotum without two dark-brown longitudinal stripes dorsally (instar III); and the base of the thick row of small setae on the inner edge of the mandible angulate and projecting medially (all instars).

Complications and outcomes of total hip arthroplasty in dogs with luxoid hip dysplasia: 18 cases (2010-2022).

To describe the complications and outcomes in dogs with luxoid hip dysplasia (LH) undergoing total hip arthroplasty (THA) and compare complication rates with THA in non-LH dogs. Retrospective study. Client-owned dogs (n = 217) undergoing primary THA (n = 238). Medical records (2010-2022) of dogs undergoing THA were reviewed, and LH was defined as complete dorsal displacement of the femoral head from the acetabulum on lateral projection radiographs. Major or catastrophic complications, revisions, and outcomes were recorded for all dogs and they were compared between LH and non-LH groups. Eighteen cases met the subcriterion for the LH group and 220 cases met the subcriterion for inclusion in the non-LH group. There were 14 complications in 13/18 dogs with LH; seven were intraoperative (femoral fissure/fracture) and seven were postoperative (dorsal luxation, n = 5; femoral fracture, n = 1; acetabular cup septic loosening, n = 1). Revisions were performed for all LH dogs that encountered complications; satisfactory outcomes were achieved in 12/13 dogs. Overall, LH dogs had a higher risk of developing complications (p < .001), including intraoperative fracture (p < .001) and postoperative dorsal luxation (p = .019) when compared with non-LH dogs. Luxoid hip dysplasia was associated with a higher risk of major complications following THA in dogs, specifically intraoperative fissure/fracture and postoperative dorsal luxation. Despite the increased risk, revisions typically yielded satisfactory outcomes. Luxoid hip dysplasia is an important risk factor for the development of major complications in dogs undergoing THA.

Fossil seeds of Passiflora L.: An Oligocene record of a new species and a Pleistocene record of a modern species from the Gulf of Mexico Coastal Plain

We describe two small, compressed seeds from the Gulf of Mexico Coastal Plain that display a reticulate-foveolate seed coat pattern as species of Passiflora subgenus Passiflora. One was obtained from the basal layer of the Catahoula Formation in Wayne County, Mississippi, and is late Oligocene in age (25–23.8 Ma), supported by planktonic foraminferal and nannofossil zones. The other is from a Pleistocene river terrace (luminescent dating of 85–82 ka) on the banks of the Mobile River in Alabama. The Oligocene seed is tridentate (consisting of a central apical appendage and well-displayed lateral protrusions to the sides of this appendage), symmetrical, and has a palisade seed coat structure with ruminate endosperm. Its characters allow tentative placement within supersection Laurifolia and series Tiliifolia. Extensive comparisons with seeds of extant species of Passiflora subgenus Passiflora serve as the basis for recognizing it as a new species, Passiflora axsmithii sp. nov. The Pleistocene seed is obovate, slightly asymmetrical, has a small crown around the base of the apical appendage, and insubstantial lateral projections. As the Pleistocene seed is geologically young and fits the description of seeds produced by the native extant species Passiflora incarnata (supersection Passiflora, series Passiflora), we consider it very likely to be a representative of that species. The Oligocene seed is the earliest reliable record, thus far, of genus Passiflora. The Pleistocene seed is likely the earliest record, to date, of the extant species P. incarnata.

Development and validation of a practical solution for detecting motion artefacts in the EOS X-ray system

The EOS™2D/3D system is a low-dose, 3D imaging system that utilizes two perpendicular X-ray beams to create simultaneous frontal and lateral images of the body. This is a useful modality to assess spinal pathologies. However, due to the slow imaging acquisition time up to 25 s, motion artifacts (MA) frequently occur. These artifacts may not be distinguishable from pathological findings, such as scoliosis, and may impair the diagnostic process. The aim of this study was to design a method to detect MA in EOS X-ray. We retrospectively analyzed EOS imaging from 40 patients wearing a radiopaque reference device during imaging. We drew a straight vertical line along the reference device. We measured deviations from it to quantify MA, presenting these findings through descriptive statistics. For a subset of patients with high MA, acquisitions were repeated after giving specific instructions to stand still. For these patients, we compared MA between the two acquisitions. In our study, a substantial proportion of patients exhibited MA ≥ 1 mm, with 80% in frontal projections and 87.9% in lateral projections. In the subjects who received a second acquisition, MA was significantly lower in the second images. Our method allows for a precise detection of MA on EOS images through a simple, yet reliable solution. Our method may improve the reliability of spine measurements, and reduce the risk of wrong diagnosis due to low imaging quality.

Integrated-mode proton radiography with 2D lateral projections

Integrated-mode proton radiography leading to water equivalent thickness (WET) maps is an avenue of interest for motion management, patient positioning, and in vivo range verification. Radiographs can be obtained using a pencil beam scanning setup with a large 3D monolithic scintillator coupled with optical cameras. Established reconstruction methods either (1) involve a camera at the distal end of the scintillator, or (2) use a lateral view camera as a range telescope. Both approaches lead to limited image quality. The purpose of this work is to propose a third, novel reconstruction framework that exploits the 2D information provided by two lateral view cameras, to improve image quality achievable using lateral views. The three methods are first compared in a simulated Geant4 Monte Carlo framework using an extended cardiac torso (XCAT) phantom and a slanted edge. The proposed method with 2D lateral views is also compared with the range telescope approach using experimental data acquired with a plastic volumetric scintillator. Scanned phantoms include a Las Vegas (contrast), 9 tissue-substitute inserts (WET accuracy), and a paediatric head phantom. Resolution increases from 0.24 (distal) to 0.33 lp mm−1 (proposed method) on the simulated slanted edge phantom, and the mean absolute error on WET maps of the XCAT phantom is reduced from 3.4 to 2.7 mm with the same methods. Experimental data from the proposed 2D lateral views indicate a 36% increase in contrast relative to the range telescope method. High WET accuracy is obtained, with a mean absolute error of 0.4 mm over 9 inserts. Results are presented for various pencil beam spacing ranging from 2 to 6 mm. This work illustrates that high quality proton radiographs can be obtained with clinical beam settings and the proposed reconstruction framework with 2D lateral views, with potential applications in adaptive proton therapy.

Synthetic interpolated DSA for radiation exposure reduction via gamma variate contrast flow modeling: a retrospective cohort study

BackgroundDigital subtraction angiography (DSA) yields high cumulative radiation dosages (RD) delivered to patients. We present a temporal interpolation of low frame rate angiograms as a method to reduce cumulative RDs.MethodsPatients undergoing interventional evaluation and treatment of cerebrovascular vasospasm following subarachnoid hemorrhage were retrospectively identified. DSAs containing pre- and post-intervention runs capturing the full arterial, capillary, and venous phases with at least 16 frames each were selected. Frame rate reduction (FRR) of the original DSAs was performed to 50%, 66%, and 75% of the original frame rate. Missing frames were regenerated by sampling a gamma variate model (GVM) fit to the contrast response curves to the reduced data. A formal reader study was performed to assess the diagnostic accuracy of the “synthetic” studies (sDSA) compared to the original DSA.ResultsThirty-eight studies met inclusion criteria (average RD 1,361.9 mGy). Seven were excluded for differing views, magnifications, or motion. GVMs fit to 50%, 66%, and 75% FRR studies demonstrated average voxel errors of 2.0 ± 2.5% (mean ± standard deviation), 6.5 ± 1.5%, and 27 ± 2%, respectively for anteroposterior projections, 2.0 ± 2.2%, 15.0 ± 3.1%, and 14.8 ± 13.0% for lateral projections, respectively. Reconstructions took 0.51 s/study. Reader studies demonstrated an average rating of 12.8 (95% CI 12.3−13.3) for 75% FRR, 12.7 (12.2−13.2) for 66% FRR and 12.0 (11.5−12.5) for 50% FRR using Subjective Image Grading Scale. Kendall’s coefficient of concordance resulted in W = 0.506.ConclusionFRR by 75% combined with GVM reconstruction does not compromise diagnostic quality for the assessment of cerebral vasculature.Relevance statementUsing this novel algorithm, it is possible to reduce the frame rate of DSA by as much as 75%, with a proportional reduction in radiation exposure, without degrading imaging quality.Key points• DSA delivers some of the highest doses of radiation to patients.• Frame rate reduction (FRR) was combined with bolus tracking to interpolate intermediate frames.• This technique provided a 75% FRR with preservation of diagnostic utility as graded by a formal reader study for cerebral angiography performed for the evaluation of cerebral vasospasm.• This approach can be applied to other types of angiography studies.Graphical

Comprehensive Analysis of Pediatric Elbow Radiographic Lines and Angles.

The study aimed to determine relevant radiographic lines and angles of children's elbow. A retrospective cross-sectional study. Tertiary pediatric trauma center. X-rays of healthy children's elbows 0-18 years of age in whom the radiographic image of the elbow in 2 projections was read without signs of fracture and possible indirect signs of fracture, whereas the exclusion criterion was a clearly visible poor image projection. Gender, age [patients were divided into 6 groups-group 1 (0-3 years), group 2 (4-6 years), group 3 (7-9 years), group 4 (10-12 years), group 5 (13-15 years), group 6 (16-18 years)], side, intersection of the radiocapitellar line in the anteroposterior (AP) projection, intersection of the radiocapitellar line in the lateral projection, intersection of the anterior humeral line, Baumann angle, carrying angle, lateral capitellohumeral angle, shaft condylar angle, intersection of the coronoid line and radioulnar overlap. Two hundred elbows were evaluated. The radiocapitellar line in AP and lateral projections passed through the middle third of the capitellum in 74.5% and 93%, respectively. The anterior humeral line passed through the middle third of the capitellum in 88.5% of cases. When observing the proportion of radiocapitellar lines passing through the middle third of the capitellum in the AP, with increasing age an increasing proportion of lines pass through the middle third of the capitellum [from 8.3% in group 1 (0-3 years) to 94.1% in group 6 (16-18 years), P = 0.001] and lateral projection (from 50% in group 1%-100% in group 6, P = 0.023) and anterior humeral line (from 25% in group 1%-100% in group 6, P = 0.0001). The mean Baumman angle, carrying angle, lateral capitellohumeral angle, shaft condylar angle were 71.59 degrees, 10.97 degrees, 50.84 degrees, and 55.31 degrees, respectively. With age, the shaft condylar angle records the greatest increase (from 41.6 degrees in group 1-68.2 degrees in group 6, P = 0.000). A correlation was observed between Baumann angle and carrying angle (r = -0.674) and between Baumann angle and radioulnar overlap (r = 0.542). Considering the anatomical variability of children's elbow, radiologic measurements and their interpretation, in the context of timely diagnostics, must be approached with great caution, especially in younger age groups, because it is with them that the largest proportion of lines and angles do not follow established principles. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Hidden in the caves: a new troglobitic species of Spaeleoleptes and the type species redescription (Opiliones, Laniatores)

The genus Spaeleoleptes was proposed by H. Soares in 1966 to accommodate the first Brazilian troglobitic species of harvestmen, Spaeleoleptes spaeleus H. Soares, 1966. In this work, we redescribe this species, including digital images of the type material and drawings of the male genitalia. Since its description, Spaeleoleptes has remained monotypic, and after 56 years, herein is described the second species of the genus, the troglobitic Spaeleoleptes gimli sp. nov. Both species share sexually dimorphic legs I and II with modified regions and swelling on the tibiae and patellae I and II; a penis with robust conductors covering all or part of the capsula interna and a capsula interna with two lateral projections. They are clearly separated by the shape of the modified region of the tibia; by the presence of an apical projection on the apical lamina of the pars distalis in S. spaeleus; and the lateral projections of the capsula interna, which is flattened in S. gimli. Spaeleoleptes gimli greatly increases the distributional range of the genus, as it is now recorded from caves located in two Brazilian phytophysiognomies from the Cerrado of Minas Gerais to the Caatinga of Bahia.

Cone-beam computed tomography in the diagnosis of flatfoot deformity: prospective study: a prospective study

INTRODUCTION: Flat deformities are one of the most common pathological changes of the feet. Flatfeet is a disease with high social significance, since it not only affects on the quality of life, but is also an important factor in classification of fitness for military service. The main method of diagnosis of these diseases is radiography of the feet in a lateral projection in the standing position. Despite numerous publications describing various methods for assessing the ratio of the bones of the foot, there is no consensus in the scientific community about the exact criteria for flatfoot and its degrees. At the same time, it is noted that the final conclusion is influenced not only by the method of evaluating the finished image, but also by the method of conducting the study. The construction of modern digital X-ray systems in most cases is not adapted for classical X-ray podography, and the study without special devices and the impossibility of strict adherence to the methodology lead to significant distortions of the results. It follows from this that specialized equipment is required for the diagnosis of flatfoot deformities, which allows developing a unified methodology for conducting research and limiting the possibilities of simulations and aggravations.OBJECTIVE: To determine the possibilities of cone-beam computed tomography in the diagnosis of flatfoot deformities in a standing position with a natural load.MATERIALS AND METHODS: This study included 100 patients underwent examination at the S.M.Kirov Military Medical Academy. All patients were examined using the classical radiography and using the cone-beam computed tomograph (CBCT) «ATRISS» (Electron, Russia). Tomograms were evaluated by two methods: using an averaged image and using a thin slice. The study was conducted by two doctors with the determination of the height and angle of the arch of the foot, followed by an assessment of the degree of flatfoot. Statistics. Statistical analysis was performed using Medcalc software (version 18.2.1). The absolute results of measurements for longitudinal and transverse flatfoot obtained by various methods were compared, as well as the time spent on the study (Wilcoxon and Friedman criteria), the degree of correlation between measurements (Spearman’s criterion), as well as the degree of consistency of the conclusions of two experts to identify longitudinal and transverse flat feet (Kappa-Cohen coefficient). RESULTS: Angle measurements in absolute values did not differ significantly between all the methods used (p=0.1803). There were significant differences between measurements of the height of the arch of the foot between the X-ray method and CBCT (p&lt;0.01). In a comparative analysis of radiography and CBCT, two experts noted a high consistency of research results. CBCT made it possible to perform studies with less time (p&lt;0.01). The effective dose for CBCT is significantly higher than for radiography (p&lt;0.01), but does not exceed 0.12 mSv.DISCUSSION: According to the results of the study, it was found that the effectiveness of CBCT in the diagnosis of flatfoot deformities is not worse than classical radiography. At the same time, the CBCT allows you to avoid positioning errors, stacking and cases of attempted simulation. The effective dose for CBCT allows using the technique as a preventive study. Also, CBCT has a high throughput and allows you to get significantly more information in one scan than with radiography.CONCLUSION: CBCT in a standing position with a natural load is not worse then classical radiography techniques in the accuracy of diagnosis of flatfoot deformities. At the same time, the CBCT has extensive postprocessing capabilities, higher throughput, low radiation load, and also reduces the likelihood of methodological errors and cases of aggravation. CBCT is promising in the consciousness of a universal methodology for measuring and classifying of flatfoot with a more precise formulation of setting points for measuring the angles of the arch and deviation of the hallux.

Diffusion-Weighted Imaging Reveals Impaired Glymphatic Clearance in Idiopathic Intracranial Hypertension.

The pathophysiology underlying idiopathic intracranial hypertension (IIH) remains incompletely understood. While one theory postulates impaired cerebral glymphatic clearance in IIH, there is a paucity of methods to quantify glymphatic activity in human brains. The purpose of this study was to use advanced diffusion-weighed imaging to evaluate the glymphatic clearance of IIH patients and how it may relate to clinical severity. DWI was used to separately evaluate the diffusivity along the cerebral perivascular spaces and lateral association and projection fibers, with the degree of diffusivity used as a surrogate for glymphatic function (diffusion tensor image analysis along the perivascular space. Patients with IIH were compared with normal controls. Glymphatic clearance was correlated with several clinical metrics, including lumbar puncture opening pressure and Frisen papilledema grade (low grade: 0-2; high grade: 3-5). In total, 99 patients with IIH were identified and compared with 6 healthy controls. Overall, patients with IIH had significantly lower glymphatic clearance based on DWI-derived diffusivity compared with controls (P = .005). Additionally, in patients with IIH, there was a significant association between declining glymphatic clearance and increasing Frisen papilledema grade (P = .046) but no correlation between opening pressure and glymphatic clearance (P = .27). Furthermore, healthy controls had significantly higher glymphatic clearance compared with patients with IIH and low-grade papilledema (P = .015) and high-grade papilledema (P = .002). Lastly, patients with IIH and high-grade papilledema had lower glymphatic clearance compared with patients with IIH and low-grade papilledema (P = .005). Patients with IIH possess impaired glymphatic clearance, which is directly related to the extent of clinical severity. The DWI-derived parameters can be used for clinical diagnosis or to assess response to treatment.

Comparison of CBCT radiation doses with conventional radiographs in TMJ imaging using Monte Carlo simulations.

Three-dimensional imaging methods are widely used for evaluation of bony changes of temporomandibular joint (TMJ). Besides, lateral and posterio-anterior TMJ projections in both closed- and open-jaw positions for each temporomandibular joint are used as two-dimensional diagnostic tools. The purpose of the present study was to compare effective and mean organ absorbed doses of plain radiography techniques with those of different modalities of cone beam computed tomography (CBCT) scanning of an adult's temporomandibular joint. PCXMC 2.0 software was used to calculate mean organ and effective doses. A NewTom CBCT device (Newtom 5G XL; QR systems; Verona, Italy) was simulated at 360° rotation using a 6 × 6cm2 FOV in standard and high-resolution modes. Lateral and posterio-anterior TMJ plain projections were simulated according to recommendations of the manufacturer of the Planmeca ProMax® 2D S3 device. Doses for both projections were simulated with Monte Carlo methods and the International Commission on radiological protection adult reference computational phantoms. The highest mean organ absorbed doses occurred in bone surfaces, salivary glands, and skull for posterio-anterior TMJ and lateral TMJ, and for CBCT scanning in all examinations. The effective doses of posterio-anterior and lateral TMJ plain radiographs were found to be higher than those of the Standard Mode-Eco Scan CBCT. Therefore, the lowest effective dose was calculated in Standard Mode-Eco Scan CBCT. It is concluded that NewTom 5G XL Standard Mode-Eco Scan CBCT can be used instead of plain radiographs (lateral and posterio-anterior TMJ) in temporomandibular joint imaging as it allows visualizing the three-dimensional structure of the temporomandibular joint as an advantage.