Lateral Ridge Research Articles

Combined PVI and LAAC is feasible using RFA or PFA in a canine model despite acute tissue edema in PFA versus RFA

Abstract Background Combined procedure with pulmonary vein isolation (PVI) using thermal energy followed by left atrial appendage closure (LAAC) has been used in select patient populations with positive results. Pulsed field ablation (PFA) is a novel non-thermal ablation modality that ablates cardiac tissue by irreversible electroporation. The effect of PFA on cardiac tissue and its interaction with a LAAC device in a single procedure has not been studied. Purpose To evaluate using transesophageal echo (TEE) imaging the acute tissue response following ablation by PFA compared to radiofrequency ablation (RFA) and its interaction with the WATCHMAN FLX Pro LAAC device when used in a combined procedure in a healthy canine model. Methods Nine mongrel canines underwent PVI using either circumferential PFA (FARAPULSE) energy application (n=6) or RFA energy (n=3). TEE imaging was obtained at the time of the procedure before and immediately after ablation energy application. The general appearance and echogenicity of the left lateral ridge was assessed and the os of the left atrial appendage (LAA) was measured in the four standard TEE views (0, 45, 90, and 135 degrees). Decisions about device sizing were made accordingly. PVI was evaluated by entry and exit block in all veins except the right inferior pulmonary vein (RIPV), which was not ablated. Following ablation, the LAAC device was implanted using TEE and fluoroscopic guidance in all animals and the percentage of compression measured. PASS criteria were assessed before the release of each device. All animals received dual antiplatelet therapy post implant. Results PVI was confirmed in all animals (except RIPV which was not targeted for ablation) using PFA and RFA. LAA dimensions (at device landing site) did not change substantially after RF ablation. With PFA, there was evidence of more diffuse edema and decrease in LAA diameter (Table). The LAAC device was implanted successfully after meeting PASS criteria in all animals within 30 minutes post ablation. The device size was decreased following PFA in two (2/6) animals, whereas there was no deviation from baseline measurements in device size for any of the RFA animals. Average LAAC device compression was higher for PFA versus RFA animals (Table). TEE post implant confirmed absence of any peri-device leaks in all animals. Conclusion Concomitant PVI using PFA (FARAPULSE) and LAAC (WATCHMAN FLX Pro) is feasible with 100% success and no residual acute peri-device leak. In the canine model, PFA is associated with more diffuse edema compared to RFA, which might affect device sizing. Long term consequences of this acute edema need to be evaluated in serial imaging and future larger clinical trials.Table

Reliability and Validity of an Ultrasound-Derived Measure for Axial Patellofemoral Alignment

Background: Axial extensor mechanism alignment is routinely assessed in patients with patellofemoral instability.Although many of these assessments are described using magnetic resonance imaging, it is plausible that ultrasound (US) imaging could be utilized to provide similar information in a more cost-effective and time-efficient manner. Purpose: To (1) describe and assess the reliability of a novel measure of extensor mechanism alignment of the patellofemoral joint using musculoskeletal US and (2) establish the construct validity of this measure through comparison of patients with and without patellar instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with (n = 24; 14.2 ± 3.1 years; 83% female) and without (n = 26; 14.7 ± 2.8 years; 69% female) a clinical history of patellofemoral instability (PFI) participated. Extensor mechanism alignment was assessed bilaterally on US, measuring the distance between the midpoint of the patellar tendon to the lateral trochlear ridge (MPT-LTR). Interrater reliability of the measurements was assessed using the intraclass correlation coefficient (ICC), with a minimum of 1 week between measurements for test-retest reliability. Differences between limbs were assessed using paired-samples t tests, and between-group differences were compared using independent-samples t tests. Results: Patients with PFI demonstrated a significantly smaller MPT-LTR distance than healthy controls on both their involved (8.1 ± 3.6 vs 12.6 ± 2.6 mm) and uninvolved (8.9 ± 3.4 vs 12.9 ± 2.4 mm) limbs ( P < .001 for both), indicating greater lateralization of the patellar tendon relative to the trochlea. There were no differences found between limbs for either patients with PFI ( P = .26) or controls ( P = .46). Interrater reliability was good (ICC = 0.785; 95% confidence interval [CI], 0.579-0.890), and test-retest reliability (n = 8) was excellent (ICC = 0.958; 95% CI, 0.790-0.992). Conclusion: The US-based MPT-LTR distance demonstrated good-to-excellent reliability. When compared with controls, the MPT-LTR distance was smaller in patients with PFI, indicating greater lateralization of the extensor mechanism.

"Xenogeneic Bone Block in Lateral Ridge Augmentation: Where Are We Now?' A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to investigate the clinical outcomes of xenogeneic bone blocks (XBB) used for lateral ridge augmentation, specifically focusing on bone gain, graft survival, and implant survival. Data search was conducted in Pubmed, Embase, and ClinicalTrial.gov for randomized controlled trials (RCTs), and prospective cohort studies up to March 1, 2024. Horizontal bone gain (HBG), horizontal bone resorption (HBR), graft survival rate, and implant survival rate were analyzed. Cochrane Risk of Bias Tool 2 and Newcastle-Ottawa Scale were applied to assess the quality and risks of the included studies. Four RCTs and five prospective cohortstudies, comprised 120 graft sites and 141 implants in total were included for the meta- analysis. Non-comparative analysis resulted in a weighted mean horizontal bone gain (HBG) of 4.38 mm and horizontal bone resorption (HBR) of 0.85 mm. Comparative analysis with data from 4 RCTs that paired xenogeneic bone block (XBB) with autogenous bone block (ABB) exhibited a statistically significant greater HBG in XBB, with a mean difference of 0.72mm (95% CI=0.067 to 1.382, p=0.031, I2=28.2%). The weighted graft survival rate for XBB was 91.3% (95% CI = 76.6% to 97.1%, I2 = 58.0 %), and the weighted implant survival rate was 84.3% (95% CI = 72.6% to 91.6%, I2 = 31.6 %). Histologically, mean percentage of mineralized vital bone in XBB ranged from 11.6% to 29.8%, and the resorption rate ranged from 7.3% to 21%. The utilization of xenogeneic bone block for lateral ridge augmentation demonstrates an acceptable survival rate and yields an adequate volume of bone for subsequent implant therapy. Nonetheless, the survival rate of implants placed in ridges augmented with xenogeneic blocks is less favorable when compared to those augmented with autogenous block grafts.

Lateral Alveolar Ridge Augmentation with Autogenous Tooth Roots and Staged Implant Placement-5-Year Follow-Up Case Series.

Background/Objectives: Alveolar bone augmentation before implant placement is a safe and effective treatment option for the reconstruction of a deficient alveolar ridge. According to recent research, permanent teeth have been used as bone graft materials, with studies confirming their clinical and histological results. This study aimed to evaluate the efficacy of alveolar ridge augmentation with autogenous tooth roots and staged implant placement, and peri-implant tissue stability in augmented sites. Methods: A total of 20 augmentations with autogenous tooth roots on mandibular alveolar ridges in 15 patients were performed. After 6 months, the ridge width (RWa) and ridge width gain (RWg) were measured. Titanium dental implants were placed in grafted sites and loaded 10 weeks after placement. Clinical parameters (bleeding on probing-BOP; probing depth-PD; mucosal recession-MR; and clinical attachment level-CAL) were assessed 2 months (T1), 3 years (T2), and 5 years (T3) after implant loading. Results: The mean RWa was 6.71 ± 0.74 mm, and the RWg was 3.15 ± 0.54 mm, respectively. No statistically significant differences were observed for clinical parameters (BOP, PD, MR, and CAL) among different time points (p > 0.05). Conclusions: Autogenous tooth roots represent a viable solution for alveolar ridge augmentation and implant placement, providing a stable environment for peri implant tissues.

Predicting immune response targets in orthoflaviviruses through sequence homology and computational analysis.

Flaviviruses cause severe encephalitic or hemorrhagic diseases in humans. Its members, Kyasanur forest disease virus (KFDV) and Alkhumra hemorrhagic fever virus (ALKV), cause hemorrhagic fever and are prevalent in India and Saudi Arabia, respectively, while the tick-borne encephalitis virus (TBEV) causes a dangerous encephalitic infection in Europe and Asia. However, little information is available about the targets of immune responses for these deadly viruses. Here, we predict potential antigenic peptide epitopes of viral envelope protein for inducing a cell-mediated and humoral immune response. Using the Immune Epitope Database and Analysis Resource (IEDB-AR), we identified 13 MHC-I and two MHC-II dominant conserved epitopes in KFDV and ALKV and six MHC-I and three MHC-II epitopes in TBEV envelope proteins. Parallelly, we also predicted B-cell linear and discontinuous envelope protein epitopes for these viruses. Interestingly, the epitopes are conserved in all three viral envelope proteins. Further, the discontinuous epitopes are structurally compared with the available DENV, ZIKV, WNV, TBEV, and LIV envelope protein antibody structures. Overall structural comparison analyses highlight (i) lateral ridge epitope in the ED-III domain of E protein, and (ii) envelope dimer epitope (EDE) could be targeted for developing potent vaccine candidates as well as therapeutic antibody production. Moreover, existing structural and biochemical functions of the same epitopes in homologous viruses are predicted to have a reduced antibody-dependent enhancement (ADE) effect on flaviviral infection.

Methodological approaches to assessing the genetic predisposition of osteochondrosis of the tarsocrural joint in the Pura Raza Española horses

Osteochondrosis (OC) is a developmental orthopaedic disease of significant concern in numerous sport horse breeds, with significant international relevance. Using digital radiographs, we assessed the occurrence of hock (tarsocrural joint) OC in 3 048 Pura Raza Española (PRE) horses which took part in a morpho-functional test, in three specific locations in the tarsus limbs: the Distal Intermediate Ridge of the Tibia (DIRT), the lateral trochlear ridges of the talus (LTT), and the medial trochlear ridges of the talus (MTT). An incidence rate of 13.3% was found for hock OC in the analysed sample, with the highest incidence rate observed in DIRT (10.0%) and the lowest in MTT (0.2%). Estimates of genetic predisposition to hock OC were carried out using three genetic approaches: 1a) a binomial threshold model based on the presence or absence of OC, 1b) a multinomial threshold model, on a scale from 0 (absence) to 3 (maximum), and 2) a linear model. The effects considered in the models included sex, genetic origin and stud class. All the analyses were based on the Bayesian inference methodology, using the THRGIBBS3F90 software. The binomial threshold model yielded the most suitable results, with an estimated heritability for Overall hock OC of 0.71 ± 0.055 on the underlying scale (0.53 on the observed scale), ranging in different locations from 0.48 ± 0.087 (LTT) to 0.66 ± 0.063 (DIRT) on the underlying scale (0.10 and 0.38 on the observed scale, respectively). The highest significative genetic correlation was observed between Overall and DIRT (0.97) for approach 1a, and the lowest significant genetic correlation was between Overall and LTT (0.49), for approach 2. This study contributes valuable insights into the genetic predisposition towards, as well as for the potential for selective breeding against, hock OC in PRE horses, and provides a basis for future research and breeding programmes aimed at minimising the occurrence of hock OC and promoting the overall health of this breed.

Determinants of joint effusion in tarsocrural osteochondrosis of yearling Standardbred horses.

Tarsocrural osteochondrosis (OCD) is a developmental orthopedic disease commonly affecting young Standardbreds, with different fragment localization and size. Clinically, it is characterized by variable synovial effusion in the absence of lameness, whose determinants are ill-defined. We hypothesized that localization and physical characteristics of the osteochondral fragments like dimensions, multifragmentation, and instability influence joint effusion and correlate with synovial markers of cartilage degradation and inflammation. Clinical data, synovial fluid and intact osteochondral fragments were collected from 79 Standardbred horses, aged between 12 and 18 months, operated for tarsocrural OCD. The severity of tarsocrural joint effusion was assessed semi-quantitatively. The osteochondral fragment site was defined radiographically at the distal intermediate ridge of the tibia (DIRT), medial malleolus (MM) of the tibia, and/or lateral trochlear ridge (LTR) of the talus. Size, stability, and arthroscopic appearance (unique or multi-fragmented aspect) of the fragments were determined intra-operatively. Synovial concentrations of C-terminal cross-linked telopeptides of type II collagen (CTX-II), leukotriene B4 (LTB4), and prostaglandin E2 (PGE2) were quantified. Tarsocrural synovial effusion was significantly affected by localization and stability of the fragments, with MM-located and unstable fragments being associated with highest joint effusion. Concentrations of CTX-II, LTB4, and PGE2 positively correlated with the severity of synovial effusion. This study underlines characteristics of the osteochondral fragments determining higher synovial effusion in OCD-affected tarsocrural joints and suggests both inflammation and extra-cellular matrix degradation are active processes in OCD pathology.

Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Regardless of Tibial Tubercle–Trochlear Groove Distance and Patellar Height: Minimum 5-Year Outcomes

Background: It remains unclear which subset of patients with recurrent patellofemoral instability would benefit from a concomitant bony realignment procedure in addition to a medial patellofemoral ligament (MPFL) reconstruction. Purpose: To provide midterm results for patients who underwent an isolated MPFL reconstruction as part of an ongoing prospective trial. Study Design: Case series; Level of evidence, 4. Methods: Patients with recurrent patellar instability were prospectively enrolled in an institutional registry beginning in March 2014. Exclusion criteria included history of a previous surgery for patellar instability, an off-loadable (inferior/lateral) chondral defect, anterior knee pain ≥50% of their chief complaint, and a “jumping J” sign. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomic characteristics. Patient-reported outcome measures (PROMs), episodes of recurrent instability, and ability to return to sport were obtained annually. Radiographic measurements of baseline radiographs and MRI were obtained at baseline. Results: A total of 138 patients underwent isolated MPFL reconstruction between March 2014 and December 2019. The mean radiographic measurements were tibial tubercle–trochlear groove, 15.1 ± 4.9 mm; Caton-Deschamps index, 1.14 ± 0.16; patellar trochlear index, 46.9% ± 15.1%; trochlear depth index, 2.5 ± 1.2 mm; tibial tubercle to lateral trochlear ridge, −8.4 ± 5.7 mm; and patellar tendon to lateral trochlear ridge, 5.7 ± 6.2 mm. Trochlear dysplasia, defined as a trochlear depth index <3 mm, was present in 79/125 (63%) patients. A total of 50 patients reached ≥5 years, of whom 40 (80%) completed follow-up PROMs. A total of 119 patients reached ≥2 years, of whom 89 (75%) completed follow-up PROMs. Six patients (5%) reported recurrent instability with a mean time of 2.97 years after surgery. All PROMs improved over time except for the Pediatric Functional Activity Brief Scale (Pedi-FABS), which had no change. At 2 years, the mean changes from baseline for Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale (QOL), Pedi-FABS, International Knee Documentation Committee (IKDC) score, KOOS Physical Function Short Form (PS), and Kujala score were 42.1, 0.6, 35.1, –23.5, and 32.3, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P > .999. At 5 years, the mean changes from baseline for KOOS-QOL, Pedi-FABS, IKDC, KOOS-PS, and Kujala score were 42.6, –2.8, 32.6, –21.5, and 31.6, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P > .453. In total, 89% of patients returned to sport with a mean of 9.1 months. Conclusion: Midterm outcomes for patients who underwent isolated MPFL reconstruction were favorable and were maintained at 5 years. Outcomes for the expanded cohort of patients with a minimum 2-year follow-up support previously published results.

Poster 291: Entry Point-Transition Point Angle as a Novel 3-Dimensional Metric of Patellar Instability

Objectives: Three-dimensional (3D) modeling has increasing utility in identifying differences in trochlear morphology in patients with patellar instability when compared to historical 2-dimensional (2D) attempts. Distortions in the proximal medial ridges of trochleas are a distinguishing feature of trochlear dysplasia. Recently, the entry-point to transition-point (EP-TP) angle was established as a novel 3D metric to quantify degree of dysplasia, as it captures the tracking of the patella within the trochlea. However, previous attempts relied on 3D prints, which are not widely accessible. The purpose of this study is to validate this new measurement and compare differences between patients with patellar instability and the general population. Methods: Forty-three patients with recurrent patellar dislocations who were treated by a single surgeon between January 2020 and July 2023 were included. The study received an institutional review board exemption. Individuals from the New Mexico Decedent Image Database with no history of patellar instability or patellofemoral pain were used to obtain computed tomography (CT) images from the general population. Stereolithography (STL) models of distal femurs in 3D were generated from CT images using ScanIP. Minimum and maximum principal curvature maps were taken as screenshots from maps generated in MeshLab. Two people independently conducted measurements using a custom measuring tool displaying anteroposterior views and curvature maps of the distal femur. The measurers were asked to locate the medial and lateral ridges, transition point, and apex of the trochlea groove for each femur. A Mann–Whitney U test was performed to evaluate whether the recurrent dislocators had higher EP-TP values. P values below 0.01 were regarded as significant. Interclass correlation for both raters (ICC (1, k), reliability of values within this study) and single rater (ICC (1,1), reliability of measurement within clinical practice) and the 95% CI thereof, was computed for the 2 independent measurements. Results: A total of 100 femurs were measured, including 43 recurrent dislocators and 57 population femurs. The recurrent dislocator cohort had a mean EP-TP of 40.9° with a standard deviation of 16.4°. The general population cohort had a mean EP-TP of 11.3° with a standard deviation of 12.3°. EP-TP for dislocators and general population was significantly different. (p &lt; 0.001). ICC (1, k) was 0.81 with a 95%-confidence interval of 0.72 to 0.87. ICC (1,1) was 0.69 with a 95% CI of 0.57 to 0.78. Conclusions: EP-TP angle is a novel metric that helps quantify trochlear dysplasia, which can help clinicians better understand patellar instability. In this study, we validate EP-TP angle by showing that EP-TP angle was significantly different between femurs of recurrent dislocators and the general population.

Анализ распределения видов флоры по высотным поясам бассейна реки Аргун

The Argun River is the largest river in the Sunzha basin. It originates on the Main Caucasian Ridge near the Chokismta-Matura peak (3189.7 m) in Georgia (historical region of Khevsureti). Before crossing the Lateral Ridge, it receives a large right tributary of the Andaki River (31 km long), whose sources are also on the Main Ridge near the Mal. Barbalo peak (3136 m). The length of the Argun River is 148 km, the total area of the basin is 3390 km2, it flows into the Sunzha River, a right tributary of the Terek River. In the upper reaches before the confluence with the right tributary, the Sharo-Argun River is historically called Chanty-Argun. Materials and methods. Materials and methods of research. Flora species and floristic complexes with different habitats within the Argun River basin were selected as the object of study. The material for the study was obtained during expeditionary trips for observations and herbarium collections in the period 2020–2023 in various altitudinal zones of the Argun River basin. Results and discussion. As a result of the research carried out in the Argun. Results. River basin, we recorded three groups of floras in the study area: plain-foothill, mid-mountain and high-mountain, the uneven distribution of floristic complexes in which made it possible to distinguish 6 floristic regions; More than half of the flora territory is located in the protected area system (2 reserves of republican significance, one of federal significance), 116 species are listed in the Red Books of the federal and regional levels, and another 16 species are proposed for protection. Discussion. The presence of narrow-local endemics in the flora also emphasizes its originality. It is advisable to include the entire Itum-Kalinsky floristic region in the territory of the Sovetsky biological reserve. Thus, many “Red Book” species, most of which are found only in this area, will be taken under real protection. These are Astracantha denudata, Berberis vulgaris, Сeltis glabrata, Cerasus incana, Cladochaeta candidissima Clenmatis integrifolia, Colutea orientalis, Cotynus coggygria, Crambe grandiflora, Dianthus daghestanicus, Ephedra procera, Fumana procumbens, Galanthus caucasicus, Gentiana grossheimii, Hippophaer hamnoides, Iris pumila, Gladiolus tenuis, Juniperus oblonga, Mandenovia komarovii, Medicago daghestanica, Notholaena maranthae, Omphalodes rupestris, Scabiosa rotata, Stipa caucasica, S. pennata, S. pulcherrima, Xanthobrychys majorovii. Conclusions. The total number of flora elements is significantly greater than the number of species in this area, since many of them are ecologically flexible and can be found in two or three vegetation zones, less often in four. Most species are confined to the steppe and forest zones, where the highest percentage of ruderal-segetal and alien species is observed, i.e. the quantitative composition is associated with anthropogenic impact on natural phytocenoses. The least number of species is in the subnival zone, where only petrophytes live, mostly endemics and subendemics.

Exogenic Relief-forming Processes in the Azerbaijani Part of Greater Caucasus

This paper presents the results of various studies conducted in the highlands of the Azerbaijani part of the Main Caucasus and the Lateral Ridges of the Greater Caucasus, utilizing materials from field surveys and the interpretation of satellite images. These findings, in conjunction with an analysis of previous research, allowed for the characterization of highland natural conditions, the identification of highly degraded mountain landscape areas, and the determination of optimal strategies for preserving the natural environment.

Patellar osteochondritis dissecans:maturation-dependent patellofemoral joint characteristics.

The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions. To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans. MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups. Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types whencompared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31mm vs. 2.89 ± 4.69mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees weresignificantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%). In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.

Alterations in Sphenoid Anatomy in Craniosynostosis: Implications for Fronto-Orbital Advancement.

Fronto-orbital advancement involves removal of the fronto-orbital bandeau. Visualization of the saw blade is lost as it passes through the fronto-orbital-sphenoid junction (FOSJ), placing the temporal lobe at risk of injury. We aim to provide a 3D analysis of the space surrounding this osteotomy to differentiate various types of craniosynostoses. Retrospective cohort. Institutional. Thirty patients with isolated unicoronal synostosis, nonsyndromic bicoronal synostosis, metopic synostosis, Apert syndrome, Crouzon syndrome, and Muenke syndrome. CT scans conducted between 2 months to 2 years of age were 3D reconstructed to compare craniometrics against normal controls. Craniometrics. The mean bone thickness of the FOSJ at the level of the supraorbital rim was significantly small for the Apert, unicoronal and bicoronal groups. The mean vertical height of the middle cranial fossa from the lesser sphenoid wing was significantly greater in the unicoronal group. The mean vertical height of the tip of the temporal lobe from the lateral sphenoid ridge was greater in the unicoronal, isolated bicoronal, and Apert groups. The mean corneal protrusion beyond the lateral orbital rim was significantly greater in the Apert and unicoronal groups. The mean horizontal depth of the orbit was smallest in the Apert group. The mean vertical distance between the dacryon and the foramen cecum, and the mean volume of temporal lobe beneath the sphenoid shelf were the largest in the Apert group. Patients with Apert syndrome have the most unfavorable morphology of the anterior and middle cranial fossae.

Epicardial fat and left atrial appendage thrombosis in patients with persistent atrial fibrillation

BACKGROUND: Excessive deposition of the epicardial adipose tissue (EAT) plays a role in the development of a number of cardiovascular diseases, including ischemic stroke. As more than half of strokes in patients with atrial fibrillation (AF) are cardioembolic, and the source of thromboembolic complications is the left atrial appendage (LAA), it can be assumed that excess EAT contributes to the development of LAA thrombus. The literature does not present the results of a study of the relationship between the amount of EAT and LAA thrombus in patients with AF, which makes it relevant to study this issue.AIM: to study the effect of EAТ on LAA thrombosis and the emptying flow velocity from the LAA in patients with persistent AF.MATERIALS AND METHODS: The patients with persistent AF underwent transesophageal and transthoracic echocardiography before the planned cardioversion. The transesophageal echocardiography measured the emptying flow velocity from the LAA, and the thickness of the interatrial septum and the left lateral ridge, the average value of which was used to estimate the amount of left atrial EAT. The thickness of the anterior wall of the right ventricular EAT was measured by transthoracic echocardiography.RESULTS: The LAA thrombus was detected in 42 (8.6%) patients of 486 patients with persistent AF (age 64.0 [59.0; 70.0] years, men 58.0%). Patients with thrombus had greater thickness of the left atrial EAT (9.30 [9.05; 9.55] vs. 7.70 [7.03; 8.28] mm, p&lt;0.001) and of the right ventricular EAT (8.05 [7, 90; 8.90] versus 7.80 [7.20; 8.40] mm, p = 0.001), but the emptying flow velocity from the LAA is lower (20.0 [14.0; 26.0] versus 32.0 [26.0; 39.0] cm/s, p&lt;0.001). Area under the receiver operator characteristic curve for the thickness of the left atrial EAT, as a predictor of the LAA thrombosis, was significantly larger than for the thickness of the right ventricular EAT: 0.947 (0.923–0.965) versus 0.661 (0.617–0.703), p&lt;0.001. The thickness of the left atrial EAT more than 8.6 mm increases the chances of LAA thrombosis by 70.1 (24.1–204.2) times. Analysis of multiple linear regression did not reveal an independent effect of the thickness of the left atrial EAT (b = -0.0951±0.6163, p = 0.877) and of the right ventricular EAT (b = 0.6764±0.4383, p = 0.124) on the emptying flow velocity from the LAA.CONCLUSION: The increased of the thickness of EAT increases the chances of developing LAA thrombosis in patients with persistent AF, but does not affect on the emptying flow velocity from the LAA.

Associations of the left atrial epicardial fat thickness with the thrombosis prevalence and left atrial appendage flow velocity in patients with persistent non-valvular atrial fibrillation

Aim. To study the associations of the left atrial epicardial fat (LAEF) thickness with the thrombosis prevalence and left atrial appendage (LAA) flow velocity in patients with persistent non-valvular atrial fibrillation (AF).Material and methods. Transesophageal echocardiography in 475 patients with persistent non-valvular AF (men 58,9%, age 64,0 (58,3-70,0) years) assessed LAA flow velocity, interatrial septum and left lateral ridge thickness. Their average thickness was used to estimate the LAEF volume.Results. LAA thrombus was detected in 42 (8,8%) patients. LAA flow velocity without thrombus was 32,0 (26,0-39,0) cm/s, with thrombus — 20,0 (14,0-25,8) cm/s (p&lt;0,0001). Depending on the LAEF thickness, patients were divided into 3 tertile groups: group 1 (n=168) — 5,6-7,4 mm, group 2 (n=154) — 7,45-8,2 mm, group 3 (n=153) — 8,25-10,9 mm. In group 1, no thrombus was detected, in group 2, thrombus was detected in 2 (1,3%) patients, in group 3 — in 40 (26,0%) patients (p&lt;0,0001). In the absence of LAA thrombus, flow velocity in the selected groups did not differ (32,0 (26,0-39,0) cm/s, 31,0 (26,0-7,8) cm/s and 31,5 (25,0-40,0) cm/s, (p=0,9514)).Conclusion. EFL thickness, calculated as the average of interatrial septum and left lateral ridge thickness, can be used to study the relationship between epicardial obesity and LAA thrombosis in patients with AF. In patients with persistent non-valvular AF with a LAEF thickness &gt;8,2 mm, LAA thrombosis occurs more than 40 times more often than in patients with a lower LAEF thickness. The influence of LAEF thickness on LAA flow velocity was not revealed in the pre­sent study.

Dominant epitopes of cross-reactive anti-domain III human antibody response change from early to late convalescence of infection with dengue virus.

Cross-neutralizing activity of human antibody response against Dengue virus complex (DENV) changes importantly over time. Domain III (DIII) of the envelope protein of DENV elicits a potently neutralizing and mostly type-specific IgG response. We used sera from 24 individuals from early- or late convalescence of DENV1 infection to investigate the evolution of anti-DIII human IgG with the time lapse since the infection. We evaluated the correlation between the serotype-specific reactivity against recombinant DIII proteins and the neutralization capacity against the four serotypes, and examined its behavior with the time of convalescence. Also, we use a library of 71 alanine mutants of surface-exposed amino acid residues to investigate the dominant epitopes. In early convalescence anti-DIII titers and potency of virus neutralization were positively associated with correlation coefficients from 0.82 to 1.0 for the four serotypes. For late convalescence, a positive correlation (r = 0.69) was found only for DENV1. The dominant epitope of the type-specific response is centered in the FG-loop (G383, E384, and K385) and includes most of the lateral ridge. The dominant epitope of the anti-DIII cross-reactive IgG in secondary infections shifts from the A-strand during early convalescence to a site centered in residues E314-H317 of the AB-loop and I352-E368 of the DI/DIII interface, in late convalescence. An immunoassay based on the detection of IgG anti-DIII response can be implemented for detection of infecting serotype in diagnosis of DENV infection, either primary or secondary. Human dominant epitopes of the cross-reactive circulating antibodies change with time of convalescence.

Anterior Cruciate Ligament Tear Treated with Arthroscopic Primary Repair - A Case Report and Literature Review

Anterior cruciate ligament (ACL) tear is one of the most common injuries encountered in Orthopaedics worldwide1. ACL is a vital ligament attached on the medial wall of the lateral femoral condyle, the lateral intercondylar ridge marking its anterior border, proximally. Distally, it attaches between the intercondylar eminences on the anterior tibia.It consists of two bundles, anteromedial and posterolateral. Primarily, it prevents the anterior translation of the tibia on the femur2. In the extended knee, the posterolateral bundle is tight and the anteromedial bundle is lax. As the knee is flexed, the anteromedial bundle tightens and the posterolateral bundle relaxes. The anteromedial bundle is the primary restraint against anterior tibial translation while the posterolateral bundle stabilizes the knee in full extension especially against rotatory loads. The nerve supply to the ACL originates from the tibial nerve serving as vasomotor, sensory and proprioceptive functions. The blood supply to the ACL originates from branches of the middle genicular artery which form a network around the ligament.

Responses of small mountain glaciers in the Maritime Alps (south-western European Alps) to climatic changes during the Last Glacial Maximum

We present new chronological data and Equilibrium Line Altitude (ELA) information for palaeoglaciers in the Maritime Alps during the Last Glacial Maximum (LGM) and the early deglaciation. Three relatively small catchments were investigated to test if the response of small (1–10 km2) glaciers to LGM climatic forcing was distinguishable from that of larger glacial systems. Palaeoglacier geometries and ELAs were reconstructed using geomorphological evidence and toolboxes in a geographic information system. Chronological control was provided through 10Be surface exposure dating of erratic boulders located on frontal and lateral moraine ridges. Our data indicate two phases of glacier advance or stabilisation in the Maritime Alps, the first occurring at ca. 25 to 24 ka and the second at ca. 20.5 to 19 ka. This is consistent with ages that have been reported from larger outlet lobes along the south-western Alpine fringe, where the second LGM advance is usually preserved in the form of a recessional moraine. Within the uncertainty of the dating technique, there are no distinguishable differences between the responses of small and large Alpine glaciers to the LGM climate. The reconstructed ELAs for palaeoglaciers in the Maritime Alps indicate a considerable variability, which appears to be linked to differences in received solar radiation, from ca. 1600 m a.s.l. for north-facing cirque glaciers to almost 2000 m a.s.l. for glaciers with a southerly aspect. We argue that such influence of solar radiation needs to be considered when using ELAs for palaeoclimatic inferences at regional scales. The calculated ELAs are up to 450 m higher than those in the northern Apennines or the Corsican mountains, indicating a relatively dry LGM climate on the Italian side of the Maritime Alps.

Regional distribution prevalence of heterotopic ossification in the elbow joint: a 3D study of patients after surgery for traumatic elbow injury

BackgroundHeterotopic ossification (HO) is a common complication after elbow fracture surgery and can lead to severe upper extremity disability. The radiographic localization of postoperative HO has been reported previously. However, there is no literature examining the distribution of postoperative HO at the three-dimensional (3D) level. This study aimed to investigate 1) the distribution characteristics of postoperative HO and 2) the possible risk factors affecting the severity of postoperative HO at a 3D level. MethodsA retrospective review was conducted of patients who presented to our institution with HO secondary to elbow fracture between 13 January 2020 and 16 February 2023. CT scans of 56 elbows before elbow release surgery were reconstructed in three dimensions (3D). HO was identified using density thresholds combined with manual identification and segmentation. The elbow joint and HO were divided into six regions according to three planes: the transepicondylar plane (TEP), the lateral ridge of the trochlear plane (LTP), and the radiocapitellar joint and coronoid facet plane (RCP). The differences in the volume of regional HO associated with different initial injuries were analyzed. ResultsPostoperative HO was predominantly present in the medial aspect of the capsule in 52 patients (93%), in the lateral aspect of the capsule in 45 patients (80%), in the medial supracondylar in 32 patients (57%), and in the lateral supracondylar, radial head, and ulnar region in the same number of 28 patients (50%). The median and interquartile range (IQR) volume of total postoperative HO was 1683 (777∼4894) mm3. The median and IQR volume of regional postoperative HO were: 584 (121∼1454) mm3 at medial aspect of capsule, 207 (5∼568) mm3 at lateral aspect of capsule, 25 (0∼449) mm3 at medial supracondylar, 1 (0∼288) at lateral supracondylar, 2 (0∼478) at proximal radius and 7 (0∼203) mm3 at the proximal ulna. In the subgroups with Injury Severity Score (ISS) >or= 16, Gustilo–Anderson II, normal uric acid levels, elevated alkaline phosphatase (ALP), and Body Mass Index (BMI) >or= 24, the median HO volume exceeds that of the respective control groups. ConclusionThe medial aspect of the capsule was the area with the highest frequency and median volume of postoperative HO among all initial elbow injury types. Patients with higher Gustilo-Anderson grade, ISS, ALP or BMI had higher median volume of postoperative HO.

Relationship between the extent of vascular injury and the evolution of surgically induced osteochondrosis lesions in a piglet model.

Ostechondritis dissecans (OCD) is an orthopaedic disease characterized by formation of osteochondral defects in developing joints. Epiphyseal cartilage necrosis (osteochondrosis [OC]) caused by focal failure of vascular supply is the known precursor lesion of OCD, but it remains to be established how the severity of vascular failure drives lesion healing or progression. In the current study we have implemented a novel piglet model of induced osteochondrosis of the lateral trochlear ridge of the femur to determine the role that the extent of ischemia plays in the development and progression of OC/OCD lesions. Ten 4-week-old Yorkshire piglets underwent surgical interruption of the vascular supply to the entirety (n = 4 pigs) or the distal half (n = 6 pigs) of the lateral trochlear ridge of the femur. At 2, 6, and 12 weeks postoperatively, distal femora were evaluated by magnetic resonance imaging (MRI) to determine the fate of induced OC lesions. At 12 weeks, piglets were euthanized, and the surgical sites were examined histologically. After complete devascularization, lesion size increased between the 6- and 12-week MRI by an average of 24.8 mm2 (95% CI: [-2.2, 51.7]; p = 0.071). During the same period, lesion size decreased by an average of 7.6 mm2 (95% CI: [-24.5, 19.4]; p = 0.83) in piglets receiving partial devascularization. At 12 weeks, average ± SD lesion size was larger (p<0.001) in piglets undergoing complete (73.5 ± 17.6 mm2) vs. partial (16.5 ± 9.8 mm2) devascularization. Our study demonstrates how the degree of vascular interruption determines lesion size and likelihood of healing in a large animal model of trochlear OC.