Normal Dimensions Research Articles

Airway Growth in Preoperative Patients with Crouzon Syndrome.

Background: Obstructive sleep apnea is common in patients with Crouzon syndrome, yet it may be caused by multiple factors. This study aims to investigate the natural history of airway development in preoperative Crouzon patients, from infants to adults. Methods: Preoperative computed tomography (CT) scans (Crouzon syndrome, n = 73; control, n = 87) were divided into five age subgroups. CT scans were measured using Materialise software. Results: Before 6 months of age, nasal airway volume in patients with Crouzon syndrome was smaller than normal by 37% (p = 0.002), and the cross-sectional area at the choana reduced by 45% (p < 0.001). The reduction of nasal airway volume and cross-sectional area reached their nadir at 2 years of age, with shortening of 44% and 63% (both p < 0.001), respectively. They gradually caught up to normal dimensions after 6 years of age. Between 2 and 6 years, the pharyngeal airway in patients with Crouzon syndrome reduced 44% (p = 0.011) compared with controls. However, the airway cross-sectional area at condylion and gonion levels was less than normal, before 6 months (35%, p = 0.024) and (44%, p = 0.006) after 2 years of age, respectively. This reduction remains into adulthood. Conclusion: Nasal airway volume is more limited in children with Crouzon syndrome who are younger than 2 years of age. Whereas after 2 years of age, the pharyngeal airway develops significant volume restriction, leading to timing and specific treatment area foci based on the site of temporal maximal constriction.

TRICUSPID VALVE REGURGITATION IN PATIENTS UNDERGOING ENDOCARDIAL LEADS PLACEMENT

Objective: To assess prospectively the presence and degree of tricuspid regurgitation (TR) after right ventricular (RV) lead placement utilizing 2-dimensional and doppler echocardiography in a group of patients implanted with Permanent pace-maker or implantable cardioverter defibrillator (ICD).&#x0D; Study Design: Descriptive cross sectional study.&#x0D; Place and Duration of Study: Study was conducted at OPD of AFIC/NIHD Rawalpindi from Jan to Jun 2019.&#x0D; Methodology: One hundred patients after cardiac stimulation system implantation were included in this study. Patients with severe valve disease, heart failure, congenital heart disease, pre-existing pulmonary hypertension and presence of moderate or severe tricuspid regurgitation were excluded. M-mode, 2 –dimensional and doppler echocardiographic studies were performed. Continuous-wave doppler measurements were made from apical four-chamber view in order to obtain maximum tricuspid flow velocities. A complete echocardiographic study was performed following device implantation. Echocardiographic measurements were repeated at 6-months of follow-up period. Those patients who developed tricuspid regurgitation were further assessed by color doppler, taking into account density and contour of the jet on continuous-wave doppler. Tricuspid regurgitation severity was classified into three groups: mild, moderate and severe according to the recommendations for non-invasive evaluation of native valvular regurgitation by the American Society of Echocardiography. The collected data was analysed by using SPSS-23.&#x0D; Results: Out of 100 patients, 67 (67%) were males and 33(33%) were females with the mean age of 65.29 ± 12.02 years. All the patients had normal chambers dimensions before the procedure. 65 (65%) had leads screwed to RV apex while 35 (35%) had through RV septum. 83 (83%) patients received a dual chamber device, while 17 (17%) patients got single chamber (ventricular) device implanted. Following device implantation after 6 months mild TR was noted in 4 (4%), moderate TR in 4 (4%) and severe TR 2 (2%) in cases.&#x0D; Conclusion: Tricuspid incompetence following endocardial leads implantation is not rare and occurred in approximately 10% of our patients. This complication may be preventable, because it is likely due to the interference of the endocardial lead with the TV.

Uncertainty and Sensitivity Analysis of Significant Parameters for Superlarge Diameter Shield Excavation

Excavation of a superlarge diameter tunnel by tunnel boring machine (TBM) is different from that of a shield tunnel with normal dimension, in which the control system of the superlarge TBM is very complicated and difficult to operate. Hence, it is very important to focus on the control and management of significant parameters to ensure excavation stability under uncertainty. In this paper, we (i) utilize a BIM‐based big data platform (BIM‐BDP) to manage the essential construction data of tunnel project in digital format; (ii) adopt the global sensitivity analysis (SA) to recognize significant parameters for shield excavation based on polynomial chaos expansion (PCE)–extended Fourier amplitude sensitivity test (eFAST) model; and (iii) employ the uncertainty analysis (UA) to discover the correlation between significant parameters from the data of the BIM‐BDP. This research contributes to (i) the body of knowledge of proposing a more appropriate research methodology that can cope with aleatory and epistemic uncertainty and support uncertainty and sensitivity analysis (UA/SA) processes based on data from BIM‐BDP and (ii) the state of practice by providing a data‐driven surrogate model to simulate system behaviors of shield excavation with high reliability and to reduce dependency on domain experts. Here, we pay close attention to the most influential parameters that require priority parameter control, which can help administrators optimize the management of shield parameters during tunnel excavation.

Cyclosporine reduces the spleen dimensions in rabbits.

ABSTRACTPurposeTo assess the influence of prolonged cyclosporine use on the macro- and microscopic morphology of the spleen.Methods16 adult rabbits were divided into two groups (n = 8): group 1 – a placebo group, which was followed-up over a period of nine months; group 2 – which had taken an oral dose of cyclosporine (10 mg·kg–1·day–1) over nine months. At the end of this period, the splenic histoarchitecture of all animals was evaluated and the splenic corpuscles were measured.ResultsThe spleens of the first group presented normal characteristics and dimensions. The second group, however, had a reduction in all dimensions and its tissue texture had become soft. The white pulp and the perivascular sheath had become reduced in size and the number of lymphoid follicles had also fallen (p = 0.002), manifesting less splenic corpuscles (p = 0.0012) and lymphocyte nuclear pigments (p = 0.03).ConclusionsProlonged use of cyclosporine reduces the spleen size, transforming it into a soft organ associated with a decrease in white pulp, perivascular sheath, lymphoid follicles and nuclear pigments in rabbits.

Anatomical considerations of intercondylar notch dimensions of femur in cadavers with intact anterior cruciate ligament

Background: The femoral intercondylar notch is an anatomic site of interest since it houses the anterior cruciate ligament which is one of the importantstructure stabilizing knee. The configuration of the intercondylar notch is related to the active functioning of the cruciate ligaments. Objective: The primary objective of the study was to measure the intercondylar notch dimensions of femur in cadavers with intact ACL and its correlation. Materials and Methods: The study was done on 30 cadaveric knees provided by department of Anatomy. The measurements of intercondylar notch like width at the base of the notch, width in the middle of the notch, width at the top of the notch, height of the notch were measured using a digital vernier callipers with knee in 90 degree flexion. Results: Among the 30 cadaveric knees whose intercondylar notch dimensions were measured, 20 were male and 10 were female. All the 30 knees were categorized into A-, U, and W-shaped notch knees. A shaped intercondylar notch was accounted for 13, U shaped 16 and W shaped 1 knee. There was a significant difference (P = 0.048) in notch width at base in A-, U-, and W-shaped notches. The highest is of W followed by A- and U-shaped notches. Conclusion: This study shreds light on the normal intercondylar notch dimensions of femur and its correlation with different notch shapes. This study would help for the comparison of notch dimensions and finding out the causal reason for ACL insufficiency.

Clinical and Radiological Evaluation of Normal Liver Sizes in Malnourished Children: Gazi-Pulsam Liver Scale

Background: Malnutrition is a serious childhood problem and has been shown to have negative effects on organ sizes in animal studies. Hence, specific size ranges must be determined for solid organs such as the liver in malnourished children. We observed that liver dimensions were interpreted within normal limits radiologically in malnourished children with hepatomegaly on physical examination. Thus, we aimed to show the possibility of differences in clinical and radiological interpretations in malnourished children and to establish the normal radiological dimensions of the liver according to the degree of malnutrition. Methods: Our study was conducted in patients aged 3 months to 3 years with malnutrition and imaging records between January 2008 and March 2020. Interpretations of physical examination results and radiological organ sizes were compared in malnourished children who had hepatomegaly on physical examination. Findings: We identified the inconsistency between the physical examination and radiological findings in detecting hepatomegaly in malnourished patients with hepatomegaly on physical examination. In our study, malnourished children with hepatomegaly but no liver-related diseases were examined, and new percentage values were determined for the radiological dimensions of the liver to be used in evaluating such children (The Gazi-PULSAM Liver Scale). Interpretation: No study has compared physical examination and imaging methods in malnourished children. The normal ranges of liver sizes were defined radiologically using the The Gazi-PULSAM Liver Scale for malnourished children. The Gazi-PULSAM Liver Scale has been shown to be more sensitive in terms of radiological evaluation of hepatomegaly in malnourished children with hepatomegaly on physical examination. Funding: None to declare. Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: This study was approved by Gazi University Clinical Research Ethics Committee.

Normative assessment of renal dimensions from computed tomography

BACKGROUND: The values measured by ultrasound for normal renal dimensions in adults are well established, but not much is known about the normal renal size of Nepalese subjects from computed tomography (CT). This study aimed to establish normal CT values for kidney dimensions from patients undergoing contrast-enhanced CT (CECT) abdomen examination. MATERIALS AND METHODS: This was a cross-sectional study carried out in patients undergoing CECT scan with different clinical history excluding abnormalities with the urinary system. The study consisted of the measurement of 212 bilateral kidneys in 106 adults. The kidney length (KL) from pole to pole, kidney width (KW), and cortical widths (CW) at the upper, middle, and lower pole were measured. For measuring length, axes were adjusted for each kidney in double oblique sagittal planes, for the width of kidney and cortex in double oblique coronal planes using a 3D-software available in the scanner (Neosoft). Analyses for normal distribution, t-tests, and correlation were performed using SPSS version 20 (IBM, USA). RESULTS: KL was 95.52 ± 8.91 mm for the right kidney (RK), and 98.22 ± 8.85 mm for the left kidney (LK). CW at the upper, middle, and lower poles on RK was 5.33 ± 0.97 mm, 5.29 ± 0.97, and 5.03 ± 0.88 mm, whereas on the LK was 5.30 ± 0.94 mm, 5.19 ± 0.97, 5.03 ± 0.96 mm, respectively. The KW was 49.15 ± 5.76 mm and 49.11 ± 5.52 mm on RK and LK, respectively. The most significant independent factors for KL and KW were age, body surface area (BSA), gender, height, and weight and were found to be statistically significant (P CONCLUSIONS: We established the normal references of various renal measurements which provide the radiologists and the referring clinicians an insight about the normal range of different renal parameters. Since there are several influencing factors on kidney size, the assessment should be made individually. The major influencing factors found are BSA, height, gender, age, and weight.

Magnetic resonance imaging scan of the dimensions of normal lumbar intervertebral foramina - An observational study

Background: Intervertebral foramen (IVF) is an oval, round, or inverted teardrop shaped bilateral fibro osseous window throughout the entire vertebral column through which neurovascular structures pass. The lumber canal stenosis due to variations of narrowing of intervertebral foramina causes compression of exiting spinal nerve or other foraminal components, for which normal IVF dimensions must be known and understood thoroughly. Aims and Objectives: Although computed tomography scan remains very effective in the evaluation of osseous tissues, but being a fibro osseous canal, intervertebral foramina can be better evaluated by magnetic resonance imaging (MRI) scan for superior resolution. Materials and Methods: Normal morphometric database of right and left lumber IVF of 195 normal adult males (96) and females (99) from different age groups (20–69 years) has been taken to draw conclusions from the data relevant to clinical practice and future research. MRI scan in the sagittal plane gives a complete view of the fibro osseous canal, whereas horizontal imaging (axial view) does not demonstrate the entire IVF on a single image. That's why all the measurements were taken from the sagittal plane. Results: All the values are evaluated with the subjects' age, sex, weight, height, and also with the left versus right sides. The development of this normal database should further allow for more meaningful evaluation of the dimensions of the IVFs in pathologic states. Although diagnosis can be suspected from the history and physical findings, knowledge of the specific anatomy of this clinically significant area with radiological support is very important in the differential diagnosis which helps in proper management. Conclusion: Therefore, it is really convincing that, with regard to morphometry of the spine by means of MRI, the future is very promising.

Normative Measurement of Orbital Structures in Computed Tomography

Introduction: Normal orbital dimensions are important for diagnosing orbital pathologies. Computed tomography (CT) of the orbit is an important modality offering high accuracy for precise measurements of orbit. The study was disbursed to ascertain criteria for the normative values of the various orbital dimensions using computed tomography in patients visiting Tribhuvan University Teaching Hospital, Kathmandu. Methods: Orbital volume, ocular diameter, length of the interzygomatic line (IZL), the distance of the posterior extent of the globe from the interzygomatic line, globe position, diameters of extraocular muscles (medial, lateral, superior group, and inferior rectus) and lens density were measured in each eye of 172 patients undergoing CT examination of paranasal sinuses. The correlations with age and sex were also analyzed. Results: Mean values (mean±SD) of orbital volume, ocular diameter, IZL, globe position and lens density were 24.54±2.57 cm3, 2.44±0.22 cm, 94.3±6.2 mm, 12.3±2.4 mm and 141.43±16.62 HU respectively. Mean diameters of extraocular muscles were 3.67± 0.52 mm, 3.36± 0.50 mm, 3.74±0.42 mm and 3.87±0.38 mm for medial rectus, lateral rectus, inferior rectus and the superior group respectively. There was no significant age and gender difference in most of the measurements. There was significant positive correlation of age with lens density, orbital volume and ocular diameter (p&lt;0.05). Conclusion: Normative data of different orbital measurements were obtained. The present result may help radiologists and ophthalmologists to accurately assess various orbital parameters, particularly in Nepalese populations.

Normative Measurement of Orbital Structures in Computed Tomography

Introduction Normal orbital dimensions are important for diagnosing orbital pathologies. Computed tomography (CT) of the orbit is an important modality offering high accuracy for precise measurements of orbit. The study was disbursed to ascertain criteria for the normative values of the various orbital dimensions using computed tomography in patients visiting Tribhuvan University Teaching Hospital, Kathmandu.&#x0D; MethodsOrbital volume, ocular diameter, length of the interzygomatic line (IZL), the distance of the posterior extent of the globe from the interzygomatic line, globe position, diameters of extraocular muscles (medial, lateral, superior group, and inferior rectus) and lens density were measured in each eye of 172 patients undergoing CT examination of paranasal sinuses. The correlations with age and sex were also analyzed.&#x0D; ResultsMean values (mean±SD) of orbital volume, ocular diameter, IZL, globe position and lens density were 24.54±2.57 cm3, 2.44±0.22 cm, 94.3±6.2 mm, 12.3±2.4 mm and 141.43±16.62 HU respectively. Mean diameters of extraocular muscles were 3.67± 0.52 mm, 3.36± 0.50 mm, 3.74±0.42 mm and 3.87±0.38 mm for medial rectus, lateral rectus, inferior rectus and the superior group respectively. There was no significant age and gender difference in most of the measurements. There was significant positive correlation of age with lens density, orbital volume and ocular diameter (p&lt;0.05).&#x0D; ConclusionNormative data of different orbital measurements were obtained. The present result may help radiologists and ophthalmologists to accurately assess various orbital parameters, particularly in Nepalese populations.

Bayesian principal component analysis of Nigerian indigenous normal feather chickens' body linear measurements

The indigenous chicken is a store house of unique genes that could be used in other parts of the world for improving other breeds. This study was carried out using bayesian principal component analysis and aimed objectively at determining the effect of sex on Nigerian indigenous normal feather chickens' body dimension, describing their body shape, and predicting their body weights from body measurements using orthogonal conformation traits derived from the principal components score. The parameters measured at 16 weeks of age were body weight, body length, breast girth, thigh length, shank length, shank diameter, keel length, wing length, wing span, and tail length on 233 randomly selected adult chickens. Sexual dimorphism was observed in all the traits with higher values recorded for males. Bayesian correlations among body weight and biometric traits were positive (r = 0.09 to 0.651 and 0.017 to 0.579 in male and female chickens respectively). The descriptive statistics showed that the mean body weight was 1.8085 ± 0.263 kg for males and 1.403 ± 0.226 kg for females. The first two principal components (PCs) were extracted for the males, both PCs components account for 72.21%. For the females, three PCs were extracted and they account for 77%. The first PC in each case accounted for the greatest percentage of the total variation. The use of orthogonal body shape characteristics derived from components' scores was more appropriate than the use of original traits in body weight prediction as multi-collinearity problems were eliminated. This led to simultaneous analysis of these body measurements rather than on individual basis. These components could be used as selection criteria for improving body weight of indigenous Nigerian chickens.

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different.

Glucocorticoids (GC) are an important risk factor for bone fragility in children with serious illnesses, largely due to their direct adverse effects on skeletal metabolism. To better appreciate the natural history of fractures in this setting, over a decade ago the Canadian STeroid-associated Osteoporosis in the Pediatric Population (“STOPP”) Consortium launched a 6 year, multi-center observational cohort study in GC-treated children. This study unveiled numerous key clinical-biological principles about GC-induced osteoporosis (GIO), many of which are unique to the growing skeleton. This was important, because most GIO recommendations to date have been guided by adult studies, and therefore do not acknowledge the pediatric-specific principles that inform monitoring, diagnosis and treatment strategies in the young. Some of the most informative observations from the STOPP study were that vertebral fractures are the hallmark of pediatric GIO, they occur early in the GC treatment course, and they are frequently asymptomatic (thereby undetected in the absence of routine monitoring). At the same time, some children have the unique, growth-mediated ability to restore normal vertebral body dimensions following vertebral fractures. This is an important index of recovery, since spontaneous vertebral body reshaping may preclude the need for osteoporosis therapy. Furthermore, we now better understand that children with poor growth, older children with less residual growth potential, and children with ongoing bone health threats have less potential for vertebral body reshaping following spine fractures, which can result in permanent vertebral deformity if treatment is not initiated in a timely fashion. Therefore, pediatric GIO management is now predicated upon early identification of vertebral fractures in those at risk, and timely intervention when there is limited potential for spontaneous recovery. A single, low-trauma long bone fracture can also signal an osteoporotic event, and a need for treatment. Intravenous bisphosphonates are currently the recommended therapy for pediatric GC-induced bone fragility, typically prescribed to children with limited potential for medication-unassisted recovery. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of intravenous bisphosphonate therapy, may not completely rescue the osteoporosis in those with the most aggressive forms, opening the door to novel strategies.

Study of fetal kidney size by ultrasonography at different gestational age

Normal fetal kidney dimensions are necessary to diagnose fetal kidney abnormalities. The maximum fetal renal growth occurs during 26-34 weeks gestation. Fetal kidney length correlates well with gestational age. Aim of the present study is to measure fetal kidney size at 30 and 38 weeks of gestation in singleton pregnancy. No statistically significant difference was found in the mean parameters of right and left kidney at a particular gestational age (p?0.05) in this study. The mean length in mm of fetal kidneys was slightly longer than the approximate gestational age in weeks. Keywords: Fetal kidney, Ultrasound, Gestational age.

Frequency and Determinants of Spontaneous Conversion to Sinus Rhythm in Patients Presenting to the Emergency Department with Recent-onset Atrial Fibrillation: A Systematic Review.

The exact frequency and clinical determinants of spontaneous conversion (SCV) in patients with symptomatic recent-onset AF are unclear. The aim of this systematic review is to provide an overview of the frequency and determinants of SCV of AF in patients presenting at the emergency department. A comprehensive literature search for studies about SCV in patients presenting to the emergency department with AF resulted in 25 articles – 12 randomised controlled trials and 13 observational studies. SCV rates range between 9–83% and determinants of SCV also varied between studies. The most important determinants of SCV included short duration of AF (<24 or <48 hours), low number of episodes, normal atrial dimensions and absence of previous heart disease. The large variation in SCV rate and determinants of SCV was related to differences in duration of the observation period, inclusion and exclusion criteria and in variables used in the prediction models.

Echocardiographic assessment in cardiogenic shock.

Echocardiography is the most helpful diagnostic modality in cardiogenic shock, the management of which still remains challenging despite advances in therapeutic options. The presence of cardiogenic shock portends high mortality rates. Therefore, rapid recognition, identification of the underlying cause, and evaluation of the severity of hemodynamic dysfunction are vital for correct management. Whether the cause of shock is unknown, suspected, or established, echocardiography is utilized in its diagnosis and management as well as to monitor progress. It is recommended as the modality of first choice. No other investigative bedside tool can offer comparable diagnostic capability, allowing for exact targeting of the underlying cardiac and hemodynamic problems. Echocardiography can promptly provide an impression of the etiology of shock and the potential line of treatment. Normal left ventricular and right ventricular systolic function, normal cardiac chamber dimensions, absence of any significant valvular pathology, and absence of any pericardial effusion virtually rule out acardiac cause of shock. This review discusses the role of echocardiography as adecision-making tool in the evaluation and management of cardiogenic shock.

Generational Changes in Lumbar Spinal Canal Dimensions: Findings from a Sample U.S. Population

Evaluation of lumbar canal dimensions in a Chicago population born in 2 different decades. This is a retrospective chart review analyzing computed tomography reconstruction from patients born between 1940 and 1949 (older group) and 1970 and 1979 (younger group). The cross-sectional area (CSA) and anterior-posterior diameter (APD) of the lumbar bony canal was measured at each lumbar level at the level of the pedicle. Our study includes 918 patients, 372 in the young group and 546 in the older group. Older patients have significantly larger CSA and APD at all lumbar levels compared with younger patients. Further, CSA and APD comparisons between ethnicities demonstrate significant differences between individuals of Caucasian, Asian, Hispanic, African American, and Other ethnicities. Lastly, there were no differences in CSA or APD compared with factors known to affect bone health (smoking, steroid use, osteoporosis, cancer history). As seen in European cohorts, our data suggest that patients born in the 1940s have both larger canal area and larger anterior-posterior diameter compared with the younger generation. These data suggest that significant differences exist between ethnicities. These differences highlight the importance of studying normal anatomical dimensions within different geographical populations and the importance of studying non-modifiable factors as they relate to spinal dimensions and spine patients. Furthermore, spinal canal growth seems to be negatively influenced in younger generations, a rather unexpected but worrying finding.

Bi-atrial thrombosis in a patient with SARS-CoV-2 infection: a case report.

BackgroundCoronavirus disease 2019 (COVID-19) is a rapidly spreading pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is a multisystemic disease associated with micro- and macrovascular thrombo-embolic complications, including intracardiac thrombosis, which has not been previously reported in the literature.Case summaryWe report a case of a 68-year-old woman with COVID-19 admitted to our intensive care unit with acute respiratory distress, undifferentiated shock, hyperkalaemia, acute kidney injury, and coagulopathy. She received crystalloid infusion, broad-spectrum antibiotics, hydroxychloroquine, insulin–dextrose, calcium gluconate, sodium bicarbonate, and i.v. vasopressors. Continuous renal replacement therapy (CRRT) was started for refractory hyperkalaemia and metabolic acidosis. Transthoracic echocardiogram obtained for concern of pulmonary embolism found bi-atrial thrombosis with normal bi-ventricular dimensions and function. Systemic anticoagulation was provided, but this was stopped soon afterwards due to worsening coagulopathy and bleeding. Despite intensive measures and supportive therapy, the patient developed worsening hypoxia, refractory shock, and multiorgan failure. After discussion of goals of care with her family, a decision was made to initiate hospice care. The patient died within 72 h of hospital admission.DiscussionInfection with SARS-CoV-2 is a multisystemic disease that primarily affects the lungs, but also predisposes to rare thrombo-embolic phenomena such as intracardiac thrombosis.

Long-term follow-up of patients with Chagas cardiomyopathy living in a non-endemic area: moving towards identification of early markers of disease progression

Abstract Background The number of patients with Chagas disease residing in Europe has increased significantly due to migration flows. Globally, Chagas cardiomyopathy has worse prognosis than other types of dilated cardiomyopathies and about 30% of patients develop cardiac involvement after a variable latency period (10–30 years). However, there is lack of data regarding the evolution of patients with Chagas disease living in a non-endemic area and potential early predictors of disease progression. OBJETIVE To describe the natural course of Chagas disease, the incidence rate of transformation into cardiac form and to assess if early predictors of myocardial involvement translate into a worse long-term prognosis in our non-endemic cohort. Methods Clinical and echocardiographic follow-up was performed in 202 individuals from endemic areas of Chagas disease. At baseline, electrocardiogram, BNP and a comprehensive echocardiography including diastolic function and longitudinal myocardial strain were performed. Four different groups were defined: healthy controls (N=77); Chagas indeterminate form (positive serology, normal ECG and left ventricle (LV) dimensions and LV ejection fraction (&amp;gt;50%) and no segmental abnormalities, N=92); Chagas patients with abnormal ECG but normal LV dimensions and motility (N=15); and Chagas patients with LV diameter&amp;gt;55 mm or LV ejection fraction&amp;lt;50% or segmental abnormalities (N=18). The primary clinical outcome included advanced atrioventricular block, sustained ventricular tachycardia, heart failure, heart transplant, death or progression of cardiac disease defined as LV systolic dysfunction or new segmental abnormalities. Kaplan Meier with Long rank test and Cox regression analysis was used. Results Mean age was 37±9 and 34% were male. Median follow-up was 69 months (range 1 to 147). The primary endpoint occurred in a total of 17 (8.4%) individuals: 5 (5.4%) in the Indeterminate group; 3 (20%) in the abnormal ECG group; and 9 (50%) in the group with abnormal LV dimension or motility, with no events among controls (long-rank test&amp;lt;0.01, Figure 2). Six patients evolved from the indeterminate phase to cardiac involvement (2 with isolated ECG changes and 4 with abnormal echocardiography without previous changes in ECG (Figure 1). On echocardiography, there were no differences regarding changes in LV dimensions or LV ejection fraction between Chagas patients with normal baseline echo and controls, but a significantly reduction of Em was observed (−1.6±3.0 vs. 0.2±1.0) in the former. Excluding patients with abnormal echo at baseline, BNP (HR=1.03, p=0.001), Em (HR=0.78, p=0.05) and left atrial diameter (1.23, p=0.01) were predictors of the combined event. Conclusions Conversion from the indeterminate to Chagas cardiomyopathy in our cohort was approximately 1.1%/year, but it may happen directly with contractility disturbances. BNP and comprehensive echocardiography may help to early detect disease progression. Figure 1. Distribution of patients and KM curves Funding Acknowledgement Type of funding source: None

Tri-Modal Tactile Display and Its Application Into Tactile Perception of Visualized Surfaces.

Tactile representation on touchscreens plays an important role in improving realism and richness of users' interaction experience. The dynamic lateral force range and the efficient feedback dimensions are very critical in determining the fidelity of tactile displays. This article develops a tri-modal Electrovibration, Ultrasonic Vibration, and Mechanical Vibration (EUMV) tactile display integrating three types of representative principles, which enhances the dynamic lateral force range by leveraging electrostatic and ultrasonic vibrations stimuli, and induces the normal feedback dimension by utilizing mechanical vibration stimulus. Then, a tactile perception scheme with the EUMV display is proposed for simultaneously rendering contour and texture roughness features of visualized surfaces, in which the contour gradient-lateral force model and the texture gradient-perceived roughness model are determined respectively. Objective and subjective evaluations with 20 participants show that the novel scheme establishes significant improvements in both correct recognition ratios of geometric shapes and tactile perception realism of visualized images than the previous studies.

Spleen-left kidney ratio and liver-right kidney ratio: novel measures of normal liver, spleen, and kidney dimensions in Southwestern Nigerian children.

Figures can sometimes be difficult to handle when considering whether the ultrasound dimensions of the liver, spleen, and kidneys of children are within normal limits in a typical clinical setting. Therefore, it is imperative to think of a simple measure that can be easily adopted when the question of whether these organs are enlarged or reduced in size is to be answered by a sonologist. We hypothesize that the liver-right kidney ratio and spleen-left kidney ratio are constant, regardless of age and sex among children, provided that the reference organ is not diseased. This observational, cross-sectional study was carried out in public primary schools in the Ogbomoso metropolis. A total of 1000 apparently healthy children aged 5-13 were subjected to abdominal sonography from July 2016 to December 2016. The length of the liver, spleen, and both kidneys as well as the anthropometric parameters of each subject were obtained and correlated. Data were analyzed using SPSS version 20. The SPL:LKL (spleen to left kidney length) ratio varies with age, and this is statistically significant in female subjects (p = 0.042), but not in males (p = 0.360). The RLL:RKL (right lobe of the liver to right kidney length) ratio of 1.19 ± 0.18 does not significantly vary with age or sex (p = 0.337). The SPL:LKL ratio of 1.11 ± 0.18 can be only used as a measure of normality of organ dimensions in males. On the contrary, the RLL:RKL of 1.19 ± 0.18 can be used in all children, regardless of sex, provided that the reference organ is normal.