Sagittal Research Articles

Artificial Intelligence and Image Analysis-Assisted Diagnosis for Fibrosis Stage of Metabolic Dysfunction-Associated Steatotic Liver Disease Using Ultrasonography: A Pilot Study

Purpose: Elastography increased the diagnostic accuracy of liver fibrosis. However, several challenges persist, including the widespread utilization of equipment, difficulties in measuring certain cases, and the influence of viscosity factors. A rough surface and a blunted hepatic margin have long been acknowledged as valuable characteristics indicative of hepatic fibrosis. The objective of this study was to conduct an image analysis and quantitative assessment of the contour of the sagittal section of the left lobe of the liver. Methods: Between February and October 2020, 486 consecutive outpatients underwent ultrasound examinations at our hospital. A total of 214 images were manually annotated by delineating the liver contour to create annotation images. U-Net was employed for liver segmentation, with the dataset divided into training (n = 128), testing (n = 42), and validation (n = 44) subsets. Additionally, 43 Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) cases with pathology data from between 2015 and 2020 were included. Segmentation was performed using the program developed in the first step. Subsequently, shape analysis was conducted using ImageJ. Results: Liver segmentation exhibited high accuracy, as indicated by Dice loss of 0.044, Intersection over Union of 0.935, and an F score of 0.966. The accuracy of the classification of the liver surface as smooth or rough via ResNet 50 was 84.6%. Image analysis showed MinFeret and Minor correlated with liver fibrosis stage (p = 0.046, 0.036, respectively). Sensitivity, specificity, and AUROC of Minor for ≥F3 were 0.571, 0.862, and 0.722, respectively, and F4 were 1, 0.600, and 0.825, respectively. Conclusion: Deep learning segmentation of the sagittal cross-sectional contour of the left lobe of the liver demonstrated commendable accuracy. The roughness of the liver surface was correctly judged by artificial intelligence. Image analysis showed the thickness of the left lobe inversely correlated with liver fibrosis stage.

Comparative Computer-Aided Analysis of Three-Dimensional Carpal Alignment in Scapholunate Advanced Collapse and Healthy Wrists.

Scapholunate dissociation frequently results in malalignment and scapholunate advanced collapse (SLAC). Previous analyses have relied on visual observations of carpal angles among the scaphoid, lunate, and capitate on lateral radiographs. However, the 3-dimensional carpal alignment during SLAC progression remains unclear. The purpose of this study was to analyze 3-dimensional carpal malalignment in SLAC wrists. Using computer-aided cone-beam computed tomography analysis software based on segmentation and numerical modeling, we defined three-dimensional carpal axes and examined alignment and carpal height ratio in 18 SLAC wrists along the radial coordinate (positive in palmar and ulnar directions). These results were compared with previously reported normal alignment values obtained from 121 healthy wrists. In the sagittal plane, mean scapholunate, lunotriquetral, lunocapitate, and capitometacarpal angles were -100° (SD, 11°); 20° (SD, 11°); 7° (SD, 12°); and 18° (SD, 8°); respectively, whereas the angles were -58° (SD, 9°); 12° (SD, 8°); -17°(SD, 11°); and 8° (SD, 6°); respectively, in healthy wrists. The sagittal scapholunate angle exhibited the highest area under the receiver operating characteristic curve (0.999), with a threshold value of ≤-76°, indicating pathology. In the coronal plane, the carpal alignment of SLAC wrists remained unchanged, excluding a minimal ulnar tilt of the capitate. Carpal malalignment in SLAC wrists not only affects the radio- and midcarpal joints, but also extends to the third carpometacarpal joint, with malalignment evident in both the sagittal and coronal planes. In SLAC wrists, the sagittal lunotriquetral angle increases in the positive direction, due to the lunate angulating more than the triquetrum. These findings have potential to contribute to the development of computer-aided diagnostic tools for 3-dimensional imaging technology. In the future, such tools could highlight abnormal values and minimize diagnostic errors in clinical practice.

Effect of experimental knee pain location on gait kinematics.

In this study, we investigated whether experimental knee pain alters lower limb kinematics and knee arthrokinematics during gait, and if this motor adaptation depends on the spatial characteristics of the painful stimulus. Twenty-one participants walked on a treadmill for 60-s trials, either without stimulation or while experiencing painful electrical stimulation in the medial, lateral or anterior region of the knee. Perceived pain location was analyzed using pain drawing. Gait spatiotemporal parameters, lower limb kinematics, and dispersion of the knee helical axes on the sagittal plane were quantified for each trial and compared between conditions using ANOVAs with repeated measures or Friedman tests. Pain perception was localized in the area the stimulation was applied to. Compared to walking without pain, participants demonstrated reduced knee extension (1.5 ± 1.5 degrees, p = 0.002) and reduced hip extension (0.8 ± 1.1 degrees, p = 0.037) when pain was induced in the anterior region, but not medially or laterally. Anterior knee pain increased the mean distance of the helical axes during late stance (0.7 [0.3, 1.4], p = 0.010), while medial pain increased both mean distance (0.3 [0.1, 0.5], p = 0.037) and mean angle (1.2 ± 1.4, p = 0.010) during early swing. Acute, experimental knee pain alters gait kinematics and increases the dispersion of the helical axis. These adaptations depend on the spatial characteristics of the painful stimulus. These adaptations may reflect an attempt of the central nervous system to protect the painful tissue while searching for a less painful movement strategy.

Effect of different corrective force directions applied by spinal orthoses on the patients with adolescent idiopathic scoliosis.

Spinal orthoses are commonly prescribed for adolescent idiopathic scoliosis (AIS), yet their three-dimensional correction was not fully understood. The amount of deformity control largely depends on the corrective forces applied, which remain empirically based due to a lack of consensus on optimal force application. This study investigated the effects of different corrective force directions exerted by spinal orthoses on patients with AIS. A retrospective analysis was conducted on 78 subjects. The trunk was segmented into four quadrants using coronal and sagittal planes from a top-down perspective. Each left or right posterolateral quadrant (with 90°) was further subdivided into zones 1-4, from the sagittal to coronal planes. Based on the zone where the resultant corrective force direction fell, the subjects were categorized into Group 1 (zone 1), Group 2 (zone 2), Group 3 (zone 3), or Group 4 (zone 4). The direction of the corrective force was estimated using modified models of the subjects' bodies, designed through a computer-aided design and manufacturing system integral to the orthosis fabrication process. The effects of corrective forces in different zones on scoliotic spine were assessed. Among the subjects, 3 were in Group 1, 17 in Group 2, 52 in Group 3, and 6 in Group 4. Due to the limited number of subjects, data from Groups 1 and 4 were not analysed. Groups 2 and 3 showed significant reductions in Cobb angle in the coronal plane and plane of maximum curvature (PMC) following orthosis fitting (p < 0.05). Group 2 displayed a significant decrease > 5º in thoracic kyphosis (p < 0.05). Both Groups 2 and 3 exhibited significant reductions in lumbar lordosis. PMC orientation remained unchanged over time (p > 0.05) but was notably higher in Group 2 after orthosis fitting (p < 0.05). Corrective forces applied by spinal orthoses in zones 2 and 3 effectively controlled lateral curve progression. Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of scoliotic spine from the sagittal plane. Further research is needed to validate and expand upon these results.

Intra-rater and inter-rater reliability of the fixed plumb line for postural and scoliosis assessment in the sagittal plane: a pilot study

Background The plumb line (PL) is a common tool for assessing the sagittal curvatures of the spine, but its accuracy depends on the ability of the physician to use it correctly. This study aimed to present a fixed plumb line (FPL) no longer held by a physician but fixed to a support, evaluating the reliability in posture assessment, comparing it with PL in both adolescent with and without scoliosis. Methods The study evaluated the sagittal distances of the spine using a PL and a FPL in 80 young adults aged between 28.7 ± 7.2 and 55 adolescents aged between 12.4 ± 2.3, with and without scoliosis. Two expert and two novice clinicians tested the patients to evaluate the intra-rater and inter-rater reliability of FPL. Each clinician assessed participants twice on the same day, with a predetermined time interval (&gt;1 h) to reduce recall bias. Multi-factor multivariate analysis of variance and two-way analysis of variance assessed the statistical significance, while intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) validated FPL consistency. Results FPL provided an ICC coefficient &gt;0.90 for all the measures, while PL an average of 0.70. On AIS patients, PL and FPL showed a significant difference for C7 p &lt; 0.001 and T12 p &lt; 0.001. The measured parameters were sensitive to gender and age for the FPL, furthermore, the C7 and L3 measurements were statistically different between PL and FPL (p &lt; 0.001). Intra-rater reliability results for FPL ranged from 0.94 to 0.98 across various parameters, while the SEM and MDC values underscore the valuable precision of the FPL with changes exceeding 1 cm being meaningful. These findings suggest that FPL could be a reliable and accurate tool for measuring sagittal distances of the spine in both scoliotic and non-scoliotic patients.

Tibial Malalignment is an Independent Predictor of Nonunion After Intramedullary Nailing of Tibial Shaft Fractures.

This study aimed to assess the relationship between postoperative alignment and nonunion in patients with tibial shaft fractures treated with intramedullary nailing. Design: Retrospective case-control study. Single academic trauma center. Adult patients with closed or open tibial shaft fractures (42A-C) treated with intramedullary nailing from 2007 to 2018. Case patients with nonunion were compared to control patients with radiographic evidence of healing in terms of the postoperative tibial alignment measured in the coronal and sagittal planes. Of the 192 included patients (median age, 38 years; 76% male), 51 patients had a nonunion, and 141 patients had united fractures and served as the control group. A strong association between postoperative tibial malalignment in one plane and nonunion (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1 to 8.3; P = 0.03) was demonstrated. This association was even greater for malalignment in both coronal and sagittal planes (OR, 5.7; 95% CI, 2.1 to 16.1; P < 0.001) after controlling for confounders. After controlling for confounding factors, postoperative malalignment in the coronal or sagittal plane was associated with significantly increased odds of tibial shaft nonunion after intramedullary nailing. Therapeutic, Level III. See Instructions for Authors for a complete description of levels of evidence.

Thoracic posture-related morphological changes in patients with pectus excavatum vs healthy controls.

Cases of severe pectus excavatum presenting with worsening cardiopulmonary symptoms in the upright position have been reported. However, the underlying mechanism remains unclear. We evaluated posture-related morphological changes of the thorax in patients with pectus excavatum. Chest morphology was evaluated preoperatively using upright and supine computed tomography in 21 patients with pectus excavatum and 35 healthy volunteers. The minimum anterior-posterior thoracic diameter, depression depth, and Haller index on horizontal sections, as well as the T6-12 plumb line distance on sagittal sections, were compared between the two positions. In patients with pectus excavatum (median age, 22 years; 18 males and 3 females), the minimum anterior-posterior diameter was smaller (4.5 vs 5.1 cm, P < 0.001) and the Haller index was greater (10.1 vs 6.4, P < 0.001) in the upright position than in the supine position. The T6-T12 plumb line distance was longer in the upright position (2.4 vs 0.8 cm, P < 0.001), while the depression depth showed no significant difference. Healthy volunteers exhibited similar changes. The degree of spinal curvature increased in the upright position due to the anterior shift of the lower thoracic vertebrae, resulting in a shorter anterior-posterior diameter, irrespective of chest wall deformity. One patient with dyspnoea only in the upright position exhibited compression of the right inferior pulmonary vein only on upright computed tomography. The minimum anterior-posterior diameter is shorter in the upright position. This may explain the worsening of cardiopulmonary symptoms in patients with severe pectus excavatum when in an upright position. UMIN000036438 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041519.

Septum of the penis - dissection, anatomical description and functional relevance.

The septum of the penis or the pectiniform septum (from Latina pecten) is a connective structure that separates the two corpora cavernosa of the penis. It is formed through the joining of the circular fibers of the tunica albuginea, which envelops the corpora cavernosa. The septum neither completely separates, nor entirely joins the two corpora cavernosa. We dissected the penile septum in 10 formalized bodies. The dissections were carried out using magnifying lenses, emphasizing the connective structures. We studied the structure of the septum using transverse and sagittal dissection planes. We identified the penile septum as a structure consisting of clusters of tendinous cords incompletely separating the two cavernous structures. The septum completely separates the two corpora cavernosa in its posterior segment. As we progress forward, the septum starts resembling the tendinous cords that attach to the papillary muscles of the heart. These cords are differentiated from the internal layer of the albuginea of each corpus cavernosum. We evaluated the opportunity of considering the anterior and posterior intercavernous ligaments as septal structures. In this type of construction, the septum maintains both the hemodynamic and mechanical coherence of the cavernous structures and allows penile movement more efficiently than a continuous septal structure. The septum enables the lengthening of the penis and simultaneous filling with blood of both its corpora cavernosa through the transseptal vascular anastomosis. This allows for penile deformation during erection to be avoided. Our study also provides a description of the way the corpora cavernosa attach to the bulbus of corpus spongiosum.

TMAA-net: tensor-domain multi-planal anti-aliasing network for sparse-view CT image reconstruction

Objective.Among various deep-network-based sparse-view CT image reconstruction studies, the sinogram upscaling network has been predominantly employed to synthesize additional view information. However, the performance of the sinogram-based network is limited in terms of removing aliasing streak artifacts and recovering low-contrast small structures. In this study, we used a view-by-view back-projection (VVBP) tensor-domain network to overcome such limitations of the sinogram-based approaches.Approach.The proposed method offers advantages of addressing the aliasing artifacts directly in the 3D tensor domain over the 2D sinogram. In the tensor-domain network, the multi-planal anti-aliasing modules were used to remove artifacts within the coronal and sagittal tensor planes. In addition, the data-fidelity-based refinement module was also implemented to successively process output images of the tensor network to recover image sharpness and textures.Main result.The proposed method showed outperformance in terms of removing aliasing artifacts and recovering low-contrast details compared to other state-of-the-art sinogram-based networks. The performance was validated for both numerical and clinical projection data in a circular fan-beam CT configuration.Significance.We observed that view-by-view aliasing artifacts in sparse-view CT exhibit distinct patterns within the tensor planes, making them effectively removable in high-dimensional representations. Additionally, we demonstrated that the co-domain characteristics of tensor space processing offer higher generalization performance for aliasing artifact removal compared to conventional sinogram-domain processing.

The fork sign: a new cortical landmark in the human brain

Abstract In the cerebral cortex, establishing the precise relationship between functional areas and the macroscopic anatomy of gyri and sulci has a paramount importance for the field of neuroimaging and neurosurgical interventions. The anatomical orientation should start with the identification of anatomical landmarks to set the anatomo-functional boundaries. The human central sulcus region stands out as a well-defined structural and functional unit housing the primary motor and sensory cortices and is considered as key region to be identified during brain surgery. While useful anatomical landmarks have been discovered, especially in the axial plane, the identification of this region in the sagittal plane remains sometimes difficult. Using cadaveric whole brains and multimodal analysis of MRI brain scans, we systematically observed a tuning fork shaped sulco-gyral configuration centered around the gyral continuum bridging the precentral gyrus with the middle frontal gyrus. We provide evidence that this “Fork sign” is a consistent morphological feature visible on the lateral surface of the brain and a reliable radioanatomical landmark for identifying central sulcus region structures on sagittal MRI images, including the motor hand area.

Morphometric evaluation of the proximal tibiofibular joint among patients with knee joint pain: A pilot study and literature review

Objectives: The proximal tibiofibular joint (PTFJ) serves as a crucial stabilizing component of the entire knee joint complex. Morphometric analysis of the PTFJ can lead to clinically significant conclusions for orthopedic specialists and physiotherapists. The aim of the study was to assess the values of the inclination angle of the PTFJ in the sagittal and coronal planes using magnetic resonance imaging in patients with knee pain. Material and Methods: Measurements of the inclination angle were conducted on 48 patients divided into three groups: Those with damaged medial meniscus (M), those with knee joint cartilage damage (Ca), and the control group (C), in which no deviations from normality were observed in the analyzed imaging study. Results: The mean values of the tibiofibular joint inclination angle in the frontal plane were as follows: (C) 16.927° ± 1.778; (Ca) 16.822° ± 2.537; (M) 14.958° ± 1.760. In the sagittal plane, the corresponding values were: (C) 38.155° ± 1.524; (Ca) 39.392° ± 1.927; (M) 37.471° ± 1.165. Although the mean tibiofibular joint inclination angle was lowest in the group with medial meniscus injury when compared to the control group, these differences did not reach statistical significance. Conclusion: Measuring and observing the variety of PTFJ inclination angles among patients are conducive to better understanding its influence on knee pain. The differences in the PTFJ inclination angle between groups in our pilot study were not statistically significant. Consequently, the study necessitates replication within a substantial population cohort.

What is the difference between shooting technique and pointer kinematics in novice athletes? A study on the sport of Petanque

Petanque, as a sport, requires proficiency in shooting techniques and pointing kinematic movements. Understanding the distinctions between these two skills is crucial for novice athletes to excel in the sport. This study aimed to assess the kinematic motion of children practicing petanque pointing and shooting techniques. Employing a quantitative approach with a comparative design, the study utilized purposive sampling to select 21 male novice petanque athletes. Kinematic analysis using Kinovea Software 0.9.4 was conducted to observe throwing success in the sagittal plane. The kinematic data collected for both pointing and shooting techniques were categorized into four stages: backswing, zero position, release, and advanced throwing position. Results indicated significant differences in the backswing phase, particularly in shoulder extension and ball height (α &lt; 0.05). Several variables differed significantly between the two techniques across various phases. Shooting exhibited higher speed (10.94 ± 13.34 m/s) compared to pointing (5.290 ± 0.44 m/s). At the release stage, variables such as ball height, speed, and release angle differed significantly (α &lt; 0.05), with pointing generally resulting in higher ball height (92.53 ± 9.69 m) but slower speed (6.46 ± 0.43 m/s) compared to shooting (80.19 ± 10.74 m and 16.09 ± 5.18 m/s, respectively). Moreover, pointing involved a wider release angle (42.38 ± 5.85 o) compared to shooting (35.31 ± 7.26 o). Significant differences in body and knee flexion, maximum ball height, and ball speed were observed during the follow-through phase (α &lt; 0.05). Notably, ball speed during pointing was slower (4.90 ± 2.35 m/s) than shooting (13.01 ± 5.36 m/s). The study suggests that specific techniques in shooting and pointing can be tailored to enhance training methods for children, thereby improving their performance outcomes. Deep comprehension of the disparities between these techniques enables novice athletes to develop their skills effectively in petanque. Further research exploring various age groups and genders could provide additional insights into petanque throwing techniques.

Effect of bone-borne maxillary skeletal expanders on cranial and circummaxillary sutures: A cone-beam computed tomography study.

Miniscrew-assisted maxillary expansion devices are frequently used for patients with calcified midpalatal sutures. This study aimed to evaluate the effects of two bone-borne maxillary expansion appliances on the cranial and circummaxillary sutures by comparing cone-beam computed tomography (CBCT) images before and after transverse maxillary expansion. A total of 81 patients (women = 58, men = 23) were treated with either a C-expander (n = 44) or an ATOZ expander (n = 37). CBCT images were obtained before (T0) and after (T1) maxillary expansion, and the widths of 10 circummaxillary sutures were measured in the sagittal, coronal, and axial planes. The Wilcoxon signed-rank test was used to compare the changes in suture width between the C-expander and ATOZ groups, and statistical significance was set at P < 0.05. The frontonasal, frontomaxillary, pterygomaxillary, nasomaxillary, internasal, intermaxillary, and midpalatal suture widths increased significantly after maxillary expansion in both the ATOZ and C-expander groups (both P < 0.05). The frontozygomatic, zygomaticomaxillary, and temporozygomatic suture widths decreased in the C-expander group (P < 0.05), whereas the frontozygomatic suture width increased significantly in the ATOZ group (P < 0.05). The width changes of the frontozygomatic, zygomaticomaxillary, temporozygomatic, pterygomaxillary, internasal, intermaxillary, and midpalatal sutures differed significantly between the two groups (P < 0.05). Both the C- and ATOZ expanders affected the suture width in the naso-maxillozygomatic region. The C-expander decreased the circum-zygomatic suture widths, whereas the ATOZ expander widened the frontozygomatic suture with no effect on other circummaxillary sutures.

Associations between less knee kinematic variability and worse patient-reported outcomes following anterior cruciate ligament reconstruction

ABSTRACT Individuals with anterior cruciate ligament reconstruction (ACLR) exhibit less knee kinematic variability while walking than uninjured controls, associated with deleterious changes in cartilage composition linked to an increased risk for early knee osteoarthritis (KOA). It is unknown whether less knee kinematic variability is also associated with worse knee-related patient-reported outcomes (PROs) consistent with KOA development. This study examined associations between kinematic variability during gait and PROs in individuals post-ACLR. Gait kinematics and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from 45 participants 6-months post-ACLR (67% Females; 21.45 ± 4.56 years). Overground gait biomechanics using 3D motion capture were collected, and knee kinematics were extracted for post-processing. Sample entropy (SampEn) was used to calculate knee kinematic variability. Pearson’s product-moment correlations were conducted to determine the associations between SampEn and KOOS sub-scores. Additionally, independent samples t-tests were performed to evaluate potential differences in SampEn outcomes between individuals with and without clinically relevant symptoms (defined in the introduction). Less sagittal plane kinematic variability is associated with greater pain (r = 0.37, p = 0.01) and symptoms (r = 0.32, p = 0.03). Symptomatic participants demonstrated less sagittal plane knee kinematic variability compared to asymptomatic participants (p = 0.01). The findings suggest less variable gait patterns 6-months post-ACLR may be linked to KOA-related symptoms.

Safety and reliability of ultrasound-assisted reduction in the conservative management of completely displaced paediatric distal radius fractures.

To assess the efficacy of ultrasound-assisted reduction in the conservative management of completely displaced pediatric distal radius fractures. The efficacy of ultrasound-assisted reduction versus conventional reduction was compared in a single-centre, retrospective, cross-sectional study involving 51 consecutive paediatric patients with completely displaced distal radius fractures, following manual reduction, from May 2021 to May 2023. The study group received ultrasound-assisted reduction (n = 24), while the control group underwent conventional blind manual reduction (n = 27). Comparative analysis included general clinical data, initial reduction success rates, frequency of exposure to radiation during reduction, post-reduction alignment rates, post-reduction angulation, re-displacement rates, conservative treatment failure rates, pain scores, and wrist joint scores at the last follow-up. All enrolled cases underwent manual reduction and conservative management. In the study group, all 24 patients underwent successful initial reduction procedures, with only one exposure to radiation during the entire process. Notably, no patient experienced re-displacement while in plaster, and the conservative treatment proved effective. The reduction and positioning rates were impressive, with success rates of 86.63 ± 3.65% in the coronal plane and 94.79 ± 3.06% in the sagittal plane. Furthermore, the post-reduction angulation was only 3.58 ± 0.65 degrees in the coronal plane and 8.70 ± 1.45 degrees in the sagittal plane. By contrast, within the control group comprising 27 patients, only 15 achieved successful initial reductions. Unfortunately, 12 patients required multiple exposure to radiation throughout the procedure. Furthermore, nine patients underwent re-displacement while in plaster and seven did not achieve successful conservative treatment. The alignment rates of the control group were similar to those of the study group (84.67 ± 4.35% in the coronal plane and 82.56 ± 5.45% in the sagittal plane). Similarly, the post-reduction angulation remained consistent, measuring 3.93 ± 0.87 degrees in the coronal plane and 12.03 ± 1.32 degrees in the sagittal plane. There were no statistically significant differences in pain scores during the process of fracture reduction and in wrist joint function scores at the final follow-up (P > 0.05). Ultrasound-assisted reduction in the conservative management of completely displaced paediatric distal radius fractures can enhance the initial reduction success rate, decrease the risk of subsequent redisplacement, minimize patient exposure to radiation, and yield favorable clinical outcomes. It is a safe and reliable approach.

Enhancing positioning accuracy in adjuvant radiotherapy for left breast cancer using cervical-thoracic integrated bracket combined with deep inspiration breath holding.

This study aimed to investigate the accuracy of three fixation methods in patients with left breast cancer receiving whole breast radiotherapy: conventional breast bracket (BB), breast bracket combined with deep inspiration breath holding (DIBH), and cervical-thoracic integrated bracket (CTIB) combined with DIBH. From January 2023 to September 2023, 84 patients who underwent left breast cancer radiotherapy with supraclavicular radiation after conservative surgery were included in this study, of which 25 patients were fixed by conventional BB, 34 patients by BB & DIBH, and 25 patients by CTIB & DIBH. Image registration was conducted around the treatment area, using the sternoclavicular joint and acromioclavicular joint as landmarks. Systematic and random errors were calculated to assess the accuracy of these fixation methods. Compared to the conventional BB group, the CTIB & DIBH group demonstrated significant improvements in accuracy across multiple dimensions, including left-right, superior-posterior, and anterior-posterior directions, as well as rotational errors in the sagittal and coronal planes. The CTIB & DIBH group showed a significant reduction of setup error in the anterior-posterior direction compared to the BB & DIBH group. The displacement of the acromioclavicular joint varied, with the CTIB & DIBH method showing more favorable outcomes. DIBH method exhibited lower setup errors and more effective fixation of the acromioclavicular joint, especially when combined with CTIB, making it a recommended fixation method in adjuvant radiotherapy following breast-conserving surgery.

Subtask-Based Usability Evaluation of Control Interfaces for Teleoperated Excavation Tasks

This study aims to experimentally determine the most suitable control interface for different subtasks in the teleoperation of construction robots in a simulation environment. We compare a conventional lever-based rate control interface (“Rate-lever”) with two alternative methods: rate control (“Rate-3D”) and position control (“Position-3D”), both using a 3D positional input device. In the experiments, participants operated a construction machine in a virtual environment and evaluated the control interfaces across three tasks: sagittal plane excavation, turning, and continuous operation. The results revealed that “Position-3D” outperformed others for sagittal excavation, while both “Rate-lever” and “Rate-3D” were more effective for turning. Notably, “Position-3D” and “Rate-3D” can be implemented on the same input device and are easily integrated. This feature offers the possibility of a hybrid-type interface suitable for operators to obtain optimized performance in sagittal and horizontal tasks.

Anatomical assessment of the Kambin's triangle for percutaneous posterolateral transforaminal endoscopic surgery of lumbar intervertebral discs: a magnetic resonance imaging based study.

The aim of the present study was to utilize magnetic resonance imaging (MRI) as a noninvasive tool for evaluation of the Kambin's triangle safe zone. Lumbar MRIs of 67 healthy subjects were analyzed. On the coronal plane, the distance from the superior endplate to the nerve root exiting from the dura (distance a), the distance from the lateral aspect of the dura to the medial aspect of the nerve root (distance b), and the angle between the nerve root and plane of the corresponding disc (angle α) was measured. On the axial plane, the vertical distance from the upper facet surface to the exiting nerve root and root-disc distance was also measured. On the sagittal plane, foraminal height, diameter, nerve root-disc distance, and nerve root-pedicle distance were measured. On the coronal plane, right and left α angle was 50.78±4.43 (range, 48.52-51.84 degrees) and 51.07±4.08 (range, 49.25-51.91) degrees, respectively. Distance of right 'a' was 17.86±3.86 mm (range, 10.56-24.84 mm) and left 'a' was 18.03±3.73 mm (range, 10.98-24.82 mm), distance of right 'b' was 15.57±2.61 mm (range, 10.54-20.70 mm) and left 'b' was 15.46±2.68 mm (range, 10.93-19.23 mm). All these measurements increased as the spine level went down. Foraminal height and diameter decreased caudally. Nerve root-facet distance did not show change as the level went down. The study indicated that radiologic measurement is feasible to evaluate the anatomy of the Kambin's triangle. At lower lumbar levels, the exiting nerve root is at risk of injury.

Ankle Taping Does Not Affect Running Kinematics During a Treadmill Protocol in Well-Trained Runners: A Secondary Analysis from a Randomized Cross-Over Controlled Trial

Background: The purpose of this randomized cross-over controlled trial was to evaluate the biomechanical effects of ankle taping using rigid tape (RT) or kinesiotape (KT) compared to no taping during treadmill running in well-trained amateur runners. Methods: A total of 22 participants (15 men and 7 women) completed three running sessions on a treadmill, each lasting 30 min, under different conditions: no taping (CG), RT, and KT. Sagittal and frontal plane kinematics were analyzed using the Kinovea software to assess the ankle dorsiflexion, knee flexion, hip extension, tibial angle, foot strike pattern, heel eversion, and pelvic drop across three intervals (0–10, 10–20, and 20–30 min). Results: The results demonstrated no significant differences in sagittal plane variables (ankle dorsiflexion, knee flexion, hip extension, and cadence) or frontal plane variables (heel eversion and pelvic drop) between the CG, RT and KT groups at any time point. Although heel eversion significantly increased over time due to fatigue, the taping conditions did not affect running kinematics. Conclusions: These findings suggest that neither RT nor KT alters running biomechanics in well-trained runners over prolonged treadmill running. The study highlights that taping, commonly used to prevent ankle injuries, does not significantly modify lower limb kinematics in the absence of injury. Further research is needed to evaluate the effects of taping in novice or injured runners and under more demanding conditions, such as overground running.

Ex vivovalidation of non-invasive phase correction for transspine focused ultrasound: model performance and target feasibility.

To evaluate the feasibility of transspine focused ultrasound using simulation-based phase corrections from a CTderived ray acoustics model. &#xD;Approach. Bilateral transspine focusing was performed in ex vivo human vertebrae with a spine-specific ultrasound array. Ray acoustics-derived phase correction was compared to geometric focusing and a hydrophonecorrected gold standard. Planar hydrophone scans were recorded in the spinal canal and three metrics were calculated: target pressure, coronal and sagittal focal shift, and coronal and sagittal Sørensen-Dice similarity to the free field. Post hoc analysis was performed in silico to assess the impact of windows between vertebrae on focal shift.&#xD;Main results. Hydrophone correction reduced mean sagittal plane shift from 1.74 ± 0.82 mm to 1.40 ± 0.82 mm and mean coronal plane shift from 1.07 ± 0.63 mm to 0.54 ± 0.49 mm. Ray acoustics correction reduced mean sagittal plane and coronal plane shift to 1.63 ± 0.83 mm and 0.83 ± 0.60 mm, respectively. Hydrophone correction increased mean sagittal similarity from 0.48 ± 0.22 to 0.68 ± 0.19 and mean coronal similarity from 0.48 ± 0.23 to 0.70 ± 0.19. Ray acoustics correction increased mean sagittal and coronal similarity to 0.53 ± 0.25 and 0.55 ± 0.26, respectively. Target pressure was relatively unchanged across beamforming methods. In silico analysis found that, for some targets, unoccluded paths may have increased focal shift. &#xD;Significance. Gold standard phase correction significantly reduced coronal shift and significantly increased sagittal and coronal Sørensen-Dice similarity (p < 0.05). Ray acoustics-derived phase correction reduced sagittal and coronal shift and increased sagittal and coronal similarity but did not achieve statistical significance. Across beamforming methods, mean focal shift was comparable to MRI resolution, suggesting that transspine focusing is possible with minimal correction in favorable targets. Future work will explore the mitigation of acoustic windows with anti-focus control points.&#xD.