Sagittal Research Articles

Explainable AI for Interpretation of Ovarian Tumor Classification Using Enhanced ResNet50.

Deep learning architectures like ResNet and Inception have produced accurate predictions for classifying benign and malignant tumors in the healthcare domain. This enables healthcare institutions to make data-driven decisions and potentially enable early detection of malignancy by employing computer-vision-based deep learning algorithms. These CNN algorithms, in addition to requiring huge amounts of data, can identify higher- and lower-level features that are significant while classifying tumors into benign or malignant. However, the existing literature is limited in terms of the explainability of the resultant classification, and identifying the exact features that are of importance, which is essential in the decision-making process for healthcare practitioners. Thus, the motivation of this work is to implement a custom classifier on the ovarian tumor dataset, which exhibits high classification performance and subsequently interpret the classification results qualitatively, using various Explainable AI methods, to identify which pixels or regions of interest are given highest importance by the model for classification. The dataset comprises CT scanned images of ovarian tumors taken from to the axial, saggital and coronal planes. State-of-the-art architectures, including a modified ResNet50 derived from the standard pre-trained ResNet50, are implemented in the paper. When compared to the existing state-of-the-art techniques, the proposed modified ResNet50 exhibited a classification accuracy of 97.5 % on the test dataset without increasing the the complexity of the architecture. The results then were carried for interpretation using several explainable AI techniques. The results show that the shape and localized nature of the tumors play important roles for qualitatively determining the ability of the tumor to metastasize and thereafter to be classified as benign or malignant.

Parathyroid Adenoma Orientation for Gland Embryologic Origin on Ultrasonography

Accurate preoperative localization is critical to success in targeted parathyroidectomy for primary hyperparathyroidism. To determine if the association between the long axis of a parathyroid adenoma (PTA) candidate and strap musculature on sagittal ultrasonography (US) can be used to predict the embryologic origin of the gland. This diagnostic study was performed using the Stanford Research Repository. Patients 18 years or older with primary hyperparathyroidism who underwent parathyroidectomy between January 2009 and October 2021 were considered. Additional inclusion criteria were having clear sagittal view of the adenoma candidate on US, confirmation of the gland of origin intraoperatively, and confirmation of hypercellular parathyroid on final pathology. Data were analyzed from October 2021 to June 2022. B-mode US and surgical parathyroidectomy. The index test was using US to measure the angle between the long axis of an adenoma candidate and the strap musculature in the sagittal plane. This angle was used to test whether inferior and superior PTAs could be accurately assigned. The hypothesis was formulated prior to data collection. A total of 426 patients (mean [range] age, 61.1 [20-96] years; 316 [74.2%] female) with 442 adenomas met inclusion criteria. Of the 442 adenomas, 314 (71.0%) had measurable angles, of which 204 (46.2%) were assigned a superior origin, 238 (53.8%) were assigned an inferior origin, and 128 (29%) were indeterminate. Of the surgically identified superior PTAs, 144 (70.6%) had a definable angle, and of the surgically identified inferior PTAs, 170 (71.4%) had a definable angle. The receiver operating characteristic analysis found 94° as the optimized angle for differentiating true negatives from true positives, with an overall sensitivity of 74% and specificity of 72%. This supported using 90° as a break point for US review. True positives were considered superior adenomas with an angle greater than 90°; true negatives were inferior adenomas with an angle less than 90°. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of angulation analysis for determining PTA origin were 72.2% (95% CI, 64.9%-79.5%), 73.5% (95% CI, 66.9%-80.1%), 69.8% (95% CI, 62.5%-77.1%), 75.8% (95% CI, 69.3%-82.3%), and 72.9%, respectively. A subgroup analysis of 426 adenomas using the posterior carotid artery border on transverse US as a surrogate for predicting gland origin showed the following for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy: 49.5% (95% CI, 42.6%-56.4%), 82.3% (95% CI, 77.3%-87.3%), 71.4% (95% CI, 63.9%-78.9%), 64.6% (95% CI, 59.1%-70.1%), and 66.9%, respectively. This diagnostic study showed that PTA angulation on sagittal plane US can be used to predict gland of origin and guide surgery. The relationship between adenoma and posterior carotid artery border on transverse US can also be used to predict gland origin. These easy-to-apply US-based tests can be used in conjunction with other imaging modalities to guide targeted parathyroidectomy.

Repeatability and intra and interrater reproducibility of the DIPA-S eHealth© capture and analysis system for clinical assessment of scoliosis.

To assess the repeatability, intra and interrater reproducibility of the DIPA-S eHealth© system for capturing and measuring clinical variables of scoliosis, including frontal trunk imbalance (FTI), sagittal trunk imbalance (STI), and angle of trunk rotation (ATR). Patients were photographed using the DIPA-S eHealth Capture© mobile application by family members, physiotherapists, or surgeons. Three photos were taken in each position: standing in the frontal and sagittal planes and in the axial plane in forward bending position of the trunk. The photos were analyzed by three independent evaluators using the DIPA-S eHealth Analysis© software. For repeatability, each photo was analyzed twice consecutively by the three evaluators. For intrarater reproducibility, only one evaluator reanalyzed the first photo from each plane with a 5-day interval. For interrater reproducibility, the three evaluators analyzed the first photo from each plane. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were used (p < 0.05). The sample comprised 262 images (n = 30). Repeatability was excellent for all three evaluators in all three planes (ICC 0.94 to 1.00). Intrarater reproducibility was excellent in all three planes (ICC 0.88 to 0.99). Interrater analysis was excellent for the frontal and axial planes (ICC 0.98 and 0.93), respectively. However, it was weak in the sagittal plane ICC 0.32. The SEM ranged from 0.02 to 17.6 and MDC from 0.03 to 34.6. The DIPA-S eHealth© Capture and Analysis system demonstrates reproducibility for use in the clinical assessment of scoliosis through teleconsultations.

Analysis of Variation in Sagittal Curvature of the Femoral Condyles.

In designing femoral components, which restore native (i.e., healthy) knee kinematics, the flexion-extension (F-E) axis of the tibiofemoral joint should match that of the native knee. Because the F-E axis is governed by the curvature of the femoral condyles in the sagittal plane, the primary objective was to determine the variation in radii of curvature. Eleven high accuracy three-dimensional (3D) femur models were generated from ultrahigh resolution CT scans. The sagittal profile of each condyle was created. The radii of curvature at 15 deg increments of arc length were determined based on segment circles best-fit to ±15 deg of arc at each increment. Results were standardized to the radius of the best-fit overall circle to 15 deg-105 deg for the femoral condyle having a radius closest to the mean radius. Medial and lateral femoral condyles exhibited multiradius of curvature sagittal profiles where the radius decreased at 30 deg flexion by 10 mm and at 15 deg flexion by 8 mm, respectively. On either side of the decrease, radii of segment circles were relatively constant. Beyond the transition angles where the radii decreased, the anterior-posterior (A-P) positions of the centers of curvature varied 4.8 mm and 2.3 mm for the medial and lateral condyles, respectively. A two-radius of curvature profile approximates the radii of curvature of both native femoral condyles, but the transition angles differ with the transition angle of the medial femoral condyle occurring about 15 deg later in flexion. Owing to variation in A-P positions of centers of curvature, the F-E axis is not strictly fixed in the femur.

Patellar articular overlap is better associated with patellar alignment during weight-bearing than traditional measures of patellar height

BackgroundA consequence of a high riding patella is reduced osseous stability and malalignment of the patella (i.e., lateral patellar tilt and displacement). Although quantification of patellar height is a routine part of the radiographic examination of the patellofemoral joint, it is not clear which measure of patellar height is best associated with patella alignment. Hypothesis/PurposeTo determine if patellar articular overlap (PAO) is better associated with lateral patellar tilt and lateral patellar displacement compared to traditional measures of patellar height. Study Design: Cross-sectional. MethodsMagnetic resonance images were obtained from 50 female participants (21 with patellofemoral pain and 29 healthy controls) under loaded conditions (25–35% bodyweight) at 15–20 degrees of knee flexion. Measurements of lateral patellar tilt and displacement as well as the PAO, Insall-Salvati ratio (ISV), Caton Deschamps-index (CD-index), or the Blacburn Peel-index (BP-index) were obtained from sagittal and axial plane images. ResultsThe PAO was found to significantly correlated with lateral patellar tilt (r = −0.77, p < 0.001). In contrast, the ISV, CD-index, or the BP-index were not found to be associated with lateral patellar tilt (r = 0.13, p = 0.34; r = −0.14, p = 0.33; r = −0.08, p = 0.56, respectively). Both the PAO and ISV were found to be significantly correlated with lateral patellar displacement (r = −0.52, p < 0.001; r = 0.43, p = 0.002, respectively). Conversely, the CD-index and BP-index were not found to be associated with lateral patellar displacement (r = 0.03 p = 0.83; r = 0.05 p = 0.74, respectively). ConclusionOf the measures of patellar height evaluated, the PAO was found to provide the greatest association with lateral patellar tilt and displacement.

Occurrence of Body Posture Abnormalities in Overweight and Obese Children Aged 5-6 Years-Pilot Study.

The study aimed to assess the occurrence of body posture disorders and their changes under the influence of a physioprophylactic program in children depending on body weight. In the examined children, the general and segmental body composition and body posture were determined using a physiotherapeutic assessment based on the Kasperczyk method. Mass, overall, and segmental body composition were determined using the bioelectrical impedance method using a TANITA body composition analyzer. The study group of 76 children was divided due to body weight disorders into Group I (n = 51), in which BMI and fat mass values were within the normative limits for age and gender, and Group II (n = 19), comprising children whose body weight exceeded the norm and/or fat mass exceeded normative values. The examined children underwent a physioprophylactic. The program was conducted by qualified physiotherapists for 12 weeks, once a week for 30 min. The therapeutic program was focused on physioprevention of being overweight and the correction of body posture. A distal distribution of fat mass was observed in the examined group. Asymmetry in the sagittal plane was found in 35% of children. No statistically significant differences were found in the presence of asymmetry in the sagittal plane between the groups. No statistically significant differences were found in the occurrence of posture irregularities between the groups. There were no changes in the weight and body posture of the examined children under the influence of the physiotherapy program. The lack of correlation in the examined group between body weight and posture irregularities in 5-6-year-olds may suggest the acquisition of posture defects as a consequence of the persistence of overweight or obesity.

A new computed tomography-based approach to quantify swallowing muscle volume by measuring tongue muscle area in a single slice.

Measuring the swallowing muscle mass with volume measurements is complex and time intensive; therefore, it is not used in clinical practice. However, it can be clinically relevant, for instance, in the case of sarcopenic dysphagia. The aim of the study was to develop a feasible and clinically applicable method to measure swallowing muscle mass. Data from 10 head and neck cancer patients were collected from the Oncological Life Study data-biobank of the University Medical Center Groningen. The pharyngeal constrictor, genioglossus, mylohyoid and geniohyoid complex muscles, as well as the tongue complex muscles, were delineated manually on routinely performed head and neck computed tomography scans. Axial and sagittal planes were used for volume and area measurements, respectively. Muscle density measurements were performed with and without Hounsfield unit thresholding. Correlations were assessed by Pearson correlation coefficients, and interobserver reliability was measured using intra-class correlation coefficients (ICCs). Significant differences were observed between sagittal area measurements with and without Hounsfield unit thresholds for pharyngeal constrictor, tongue complex and the sum of the swallowing muscles (t>6; P-value<0.001). Stronger correlations emerged without Hounsfield unit thresholding. Strong positive and significant correlations were found between the total swallowing muscle mass volume and the sagittal area of the tongue complex muscles (r=0.87, P-value<0.05) and the sum of the sagittal areas of the pharyngeal constrictor and tongue complex muscles (r=0.85, P-value<0.05). The use of the Hounsfield unit threshold weakened correlations. Interobserver reliability was assessed and found to be fair to good for the pharyngeal constrictor muscle (ICC=0.68, P-value<0.05), excellent for the tongue complex muscles (ICC=0.98, P-value<0.05) and excellent for the total swallowing muscle area (ICC=0.96, P-value<0.05). Single-slice delineation of the sagittal area of tongue complex muscle and pharyngeal constrictor muscle is a promising, fast, simple and clinically applicable method for measuring the total volume of the swallowing muscle mass in head and neck cancer patients without Hounsfield unit thresholding. These advancements and findings would help in the early and accurate diagnosis of definitive sarcopenic dysphagia.

Assessment of variations in the nasopalatine canal on CBCT: considerations from an anatomical point of view.

The nasopalatine canal (NPC) is one of the most significant anatomical markers in the anterior maxillary region. Its location is quite important, especially for implant placement. Therefore, the purpose of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphology, size, and anatomic variations of the NPC. A total of 150 individual CBCT images were assessed in various sections to evaluate the dimensions, morphology, and extent of the NPC. Reformatted sagittal images were chosen to classify the shape and course of the canal. The Student's t-test, the χ² test, and Pearson correlation coefficients were used. The NPC was longer in males than in females, and the mediolateral diameter of the canal was greater in older adults. In sagittal sections, the canal predominantly exhibits a cylindrical shape, while a spindle shape is the least common. In coronal sections, a single shape is most frequently observed, with a Y-shape being the least common. Regarding the orientation of the canal, slanted canals are more prevalent, whereas vertically curved canals are rare. Typically, 2 canal openings are observed, with 4 openings being the least common. The current study highlights the challenges associated with identifying the anatomical appearance and variations of the NPC. Consequently, possessing a thorough understanding of this anatomy is essential before undertaking any surgical procedures, such as implant placement. This knowledge helps prevent complications such as nerve injury-related loss of sensation, bleeding due to blood vessel injury, and the development of a nasopalatine duct cyst following trauma to the canal during surgery.

Evaluation of mandibular condyle position in Class III patients after bimaxillary orthognathic surgery: A cone-beam computed tomography study.

This retrospective study evaluated the mandibular condyle position before and after bimaxillary orthognathic surgery performed with the mandibular condyle positioned manually in patients with mandibular prognathism using cone-beam computed tomography. Overall, 88 mandibular condyles from 44 adult patients (20 female and 24 male) diagnosed with mandibular prognathism due to skeletal Class III malocclusion who underwent bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I performed using the manual condyle positioning method were included. Cone-beam computed tomography images obtained 1-2 weeks before (T0) and approximately 6 months after (T1) surgery were analyzed in three planes using 3D Slicer software. Statistical significance was set at P < 0.05 level. Significant inward rotation of the left mandibular condyle and significant outward rotation of the right mandibular condyle were observed in the axial and coronal planes (P < 0.05). The positions of the right and left condyles in the sagittal plane and the distance between the most medial points of the condyles in the coronal plane did not differ significantly (P > 0.05). While the change in the sagittal plane can be maintained as before surgery with manual positioning during the BSSRO procedure, significant inward and outward rotation was observed in the axial and coronal planes, respectively, even in the absence of concomitant temporomandibular joint disorder before or after the operation. Further long-term studies are needed to correlate these findings with possible clinical consequences.

Efficacy of shock wave therapy and ultrasound therapy in non-insertional Achilles tendinopathy: a randomised clinical trial.

Physiotherapists and physicians continue to seek effective conservative treatments for Achilles tendinopathy. This study aimed to subjectively and objectively determine the therapeutic efficacy of radial shock wave therapy (RSWT) and ultrasound therapy in non-insertional Achilles tendinopathy. Thirty-nine patients with non-insertional Achilles tendinopathy were randomly assigned to three experimental groups, i.e., RSWT (group A), ultrasound therapy (group B), and placebo ultrasound (group C) groups. Before the intervention and at weeks 1 and 6 after the treatment, the patients were assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire and posturographic measurements of step initiation performed on the force platforms under two different conditions (non-perturbed transit and perturbed transit). Six weeks after therapy, all groups exhibited significantly increased VISA-A scores against the measurement at week 1 after therapy. The post-therapy percentage changes in VISA-A scores were significantly greater in group A compared to group B. The three-way ANOVA demonstrated that treatment type affected sway range in the frontal plane and mean velocity of the centre of foot pressure displacements in the sagittal and frontal planes during quiet standing before step initiation. The Bonferroni post-hoc test showed that the means of all those variables were significantly smaller for group A than for group B patients. The three-way ANOVA revealed an effect of the platform arrangement on transit time and double-support period. The Bonferroni post-hoc test revealed statistically longer transit time for the perturbed vs. non-perturbed trials; a reverse relationship was observed for the double-support period. The VISA-A showed that RSWT was significantly more effective than sonotherapy for alleviation of pain intensity as well as function and activity improvement in patients with non-insertional Achilles tendinopathy. Therefore, RSWT therapy can be used in clinical practice by physiotherapists to alleviate the symptoms of non-insertional Achilles tendinopathy. Objective data registered by force platforms during quiet standing before and after step initiation did not prove useful for monitoring the progress of treatment applied to patients with non-insertional Achilles tendinopathy between consecutive therapy interventions.Clinical trial registration:https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617000860369, identifier (ACTRN12617000860369).

Are 7 MM neoprene knee sleeves capable of modifying the knee kinematics and kinetics during box jump and front squat exercises in healthy CrossFit practitioners? An exploratory cross-sectional study

ObjectiveInvestigate whether wearing 7 mm neoprene knee sleeves during the front squat and box jump CrossFit exercises change the biomechanics of the knee joint. Designa cross-sectional exploratory study. SettingLaboratory-based. ParticipantsSeventeen male healthy CrossFit participants completed front squats and box jumps with knee sleeves (KS) and without knee sleeves (WKS). Main outcomes measuresKinematic and kinetic data of the knee in the sagittal, frontal and transverse planes were obtained for the two tasks and under the two experimental situations. The maximum load lifted on 1 MR test was recorded under KS and WKS conditions. The GROC scales were applied after each exercise and condition to assess participants' self-reported perception of stability. ResultsThe KS reduced the knee range of motion in the transverse plane during box jump (p = 0.029) and the peak knee external adduction moment (p = 0.047) during front squat compared to WKS. The 1RM during front squat increased in KS compared to WKS (p < 0.001). Most participants (94%) reported that they felt better stability using KS and all participants (100%) believed that knee sleeves would avoid knee pain. Conclusionneoprene knee sleeves have little impact on the biomechanics of the knee joint during CrossFit. However, participants reported improved knee stability.

Age-related and experience-related differences in selected motor cognitive abilities of soccer players

Background: Soccer players constantly experience rapidly changing situations that challenge them to receive and process stimuli, make fast and correct decisions, and perform actions at specific moments. The aim of the present study was to analyze age and experience-related differences in the level of brain speed, disjunctive reaction time, and reaction speed of soccer players. Methods: A total of 111 soccer players (x=12.414; s=1.921) divided by age and level of experience participated in the study. The diagnosis of brain speed and disjunctive reactivity was carried out with the BrainHQ Hawk Eye test and BrainHQ Agility test using the Witty Sem system. Reaction speed was diagnosed with the Fitro Agility Check test using the Fitro Agility system. The Mann-Whitney U test and the Kruskal-Wallis analysis of variance were used to determine the significance of age and experiencerelated differences in the level of brain speed, disjunctive reaction time, and reaction speed of the soccer players. Results and conclusion: Statistically significant differences (p&lt;0.01) in favor of older age categories were observed between disjunctive reaction time and brain speed. Younger soccer players showed significantly lower levels of lower limb reaction speed in both directions of the sagittal plane than older players (p&lt;0.01). Less experienced soccer players demonstrated significantly lower levels of lower limb reaction speed in both directions of the sagittal plane than more experienced counterparts and lower levels of brain speed and disjunctive reaction time (p&lt;0.01).

Circumferential correction of spinal deformity and instability secondary to bacterial spondylodiscitis

BackgroundSpinal deformity as a sequela of non-tuberculous spondylodiscitis is a rarely discussed clinical entity. Sagittal plane deformity, segmental instability, and persistently active infection overlap in these patients resulting in severe restriction in activity and quality of life. The presence of multiple medical co-morbidities restricts surgical options but nonoperative care may be ineffective and result in persistent, refractory discitis for years. We describe our experience with vertebrectomy and long-segment fixation for patients with post-infectious thoracic or lumbar deformity. MethodsA retrospective chart review of 23 consecutive patients who underwent vertebrectomy and long-segment fixation for thoracic or lumbar deformity secondary to nontuberculous bacterial spondylodiscitis was performed. Pre-, peri- and postoperative data is compiled and analyzed with a focus on the perioperative management algorithm to safely perform an extensive reconstruction in this very sick patient population. ResultsExtremely low preoperative quality of life was evident with 87% (20/23) of patients bedridden primarily due to pain despite 70% (16/23) of patients being strong enough to ambulate (Frankel D or E). Most patients (87%) already had an identified infection under adequate treatment either through blood cultures, prior biopsy or decompressive surgery. A single-stage posterior-only was the primary surgical approach utilized in the majority (83%) of cases. Complications were present in 100% of patients, most commonly perioperative anemia and hypotension requiring vasopressor support and aggressive blood product replacement. One in-hospital mortality occurred secondarily to pulmonary embolism. Mean preoperative segmental angle was 18±10 degrees of kyphosis which was corrected to 1±9 degrees of lordosis (p=0.001). The mean correction of the segmental angle was 19 degrees (standard deviation 23 degrees). Visual analogue scale scores improved from a pre-operative value of 8.8±0.9 to a post-operative value of 2.5±1.4 (p<0.001), which was obtained at the last outpatient follow-up (mean 631 days after surgery). Full self-care including ambulation was achieved in 18/23 (78%) patients, and the infection was successfully treated in 22/23 (96%) patients after long-term antibiotics. ConclusionsPatients with refractory spondylodiscitis on appropriate care and antibiotics are typically considered extremely poor surgical candidates despite non-operative care often being ineffective. Post-infectious deformity may also be so severe as to preclude a limited surgical treatment strategy. This study suggests that extensive circumferential reconstruction for deformity secondary to bacterial spondylodiscitis can be effective in restoring these extremely sick patients to self-care and ambulatory status.

Single versus double percutaneous pinning of pediatric distal radius fractures.

The aim of this study was to compare early clinical and radiographic results of single- versus double-pin fixation of unstable pediatric distal radius fractures. A total of 103 consecutive closed distal radius fractures treated with either single or double percutaneous pinning at a tertiary level I pediatric hospital were analyzed. All patients had open physes and had fractures that failed initial closed reduction and casting. Postoperative fracture displacement was assessed by measuring the difference in angulation of the radius in the anteroposterior and lateral views from intraoperative fluoroscopic images to postoperative radiographs taken on the day of pin removal. Complications were identified from the medical record review. In 103 operative distal radius fractures in 101 patients (70 males, 31 females), 52 and 51 distal radius fractures were treated with single and double pinning, respectively. The median [interquartile range (IQR)] age at the time of surgery was 12.1 (9.0-14.0) years, with the single-pinning group being younger by 1.9 years (P < 0.01). Median (IQR) postoperative angulation in the anteroposterior radiograph (coronal plane) was 2° (1-7°) with one pin versus 1° (0-2°) with two pins (P < 0.01). Median (IQR) postoperative angulation in the lateral radiograph (sagittal plane) was 3° (1-10°) with one pin versus 1° (0-2°) with two pins (P < 0.01). There were no significant differences in complications between the single- and double-pinning groups. Double-pin fixation resulted in a statistically significant, but clinically negligible, reduction in postoperative fracture displacement compared with single-pin fixation. Complication rates were similar in both groups. These findings suggest that either single- or double-pinning techniques can be effective, provided appropriate reduction and postoperative immobilization are achieved.

3D Lagrangian Particle Tracking In A Model Of The Human Airways

The three-dimensional flow field in the trachea of a physiologically correct model of the human respiratory tract from the nasal/oral cavities up to the 6th bronchi generation is investigated. The investigations comprise steady inflow conditions, i.e., steady inhalation and oscillatory flow combining inspiration and expiration to simulate calm breathing. A realistic breathing pattern is approximated by a sinusoidal waveform for two Womersley numbers of 3 and 4.5 and two Reynolds numbers of 400 and 1200. Due to the inherent three-dimensional and asymmetric nature of the flow field, 3D particle-tracking velocimetry (3D-PTV) measurements are performed using the Shake-The-Box (StB) algorithm to determine the influence of oral and nasal inhalation and exhalation on the flow field in the lower human airways. By using a refractive-index matched fluid consisting of water and glycerin, the complex flow structures inside the trachea are fully resolved. During oscillatory inhalation/exhalation, an integration window size of 6/40 pi was chosen as it can be considered short enough to assume a steady state. The PTV measurements confirm that the nasal and/or oral cavity must be taken into account when analyzing the flow field in the lower respiratory tract. Characteristic sets of velocity profiles in the sagittal and coronal plane of the trachea as well as contour plots evidence nearly identical flow structures for both oral and nasal inhalation, but also reveal that the presence of both cavities possesses a huge impact on the flow field compared to ideal, i.e., fully developed inflow conditions

Vascular Blush Size Reduction, Technical Success and Safety of Intra-Arterial Embolization for Glomus Jugular Tumors: A Retrospective Cohort Study

Background: Glomus jugulare tumors are slow-growing neuroendocrine paragangliomas located in the temporal bone. Surgical excision, the standard treatment option, carries a high risk of intraoperative bleeding due to the vascular nature of these lesions. To mitigate this risk, current practice involves performing intra-arterial embolization prior to surgery. Objectives: The objectives of this study were to assess postintervention safety, technical success, and the rate of vascular blush size reduction in a group of patients with Glomus jugulare tumors who were planned for surgery and underwent pre-surgical intra-arterial embolization of the lesion. Patients and Methods: In this retrospective cohort study, all patients who underwent intravascular embolization for Glomus jugulare tumors from 2017 onwards were included. The study comprised 61 patients scheduled for surgery following embolization. All embolizations were completed in one session and were primarily performed via external carotid artery branches using polyvinyl alcohol (PVA). The size of the vascular blush was measured before and after embolization in coronal, supero-inferior sagittal, and antero-posterior sagittal planes, and the rate of blush size reduction was calculated. Procedure complications, including post-embolization pain, were recorded. In the statistical analysis, vascular blush size was compared between pre- and post-embolization times. Results: Pain after embolization was reported in 11 patients (18%). There were no other complications among the patients, indicating a high level of safety. All procedures were technically successful. The mean pre-embolization vascular blush diameter in the coronal plane was 29.1 ± 13.3 mm, which decreased to 16.8 ± 7.1 mm after embolization, representing an average diameter reduction of 38.5% (P &lt; 0.001). Conclusions: The findings of this retrospective cohort study suggest that intra-arterial embolization for Glomus jugulare tumors is safe, technically successful, and effective in reducing vascular blush before surgery.

Spinal posture, mobility, and position sense in adolescents with chest wall deformities: a comparison of pectus excavatum, pectus carinatum and healthy peers

PurposeThe study aimed to compare spinal posture, mobility, and position sense in adolescents with pectus excavatum (PE), pectus carinatum (PC), and healthy control (HC).Methods22 with PE, 22 with PC, and 21 HC were included in the study. The spinal posture (thoracic kyphosis, lumbar lordosis, pelvic tilt, thoracic, lumbar, pelvic lateral tilt angles) and mobility (thoracic, lumbar, hip/sacral, and overall, in the sagittal and frontal plane) with the spinal mouse, and spinal position sense (repositing errors) with the inclinometer were assessed.ResultsThe thoracic kyphosis angle of PE and PC was higher than in HC (p < 0.001; p = 0.001). Hip/sacral mobility in the sagittal plane was lower in the PE and PC than control, respectively (p < 0.001; p < 0.001). Overall sagittal spinal mobility (p:0.007) and hip/sacral mobility in the frontal plane (p:0.002) were lower in the PC than in HC. Overall frontal spinal mobility was lower in the PE and PC than in HC (p:0.002; p:0.014). The PE and PC repositing errors were higher (p < 0.001; p:0.014).ConclusionThe study found that adolescents with PE and PC had decreased spinal mobility, spinal alignment disorders, and a decline in spinal position sense. It is important not to overlook the spine during physical examinations of adolescents with chest wall deformities. In clinical practice, we suggest that adolescents with chest deformities should undergo a spine evaluation and be referred for physical therapy to manage spinal disorders.

Low-dose, standard, and high-resolution cone beam computed tomography for alveolar bone measurements related to implant planning: An exvivo study in human specimens.

To evaluate the performance of low-dose cone beam computed tomography (CBCT) protocols with regard to linear bone measurements in the posterior mandible for implant planning compared with higher dose protocols. Forty-two edentulous posterior sites in human cadaveric mandibles were imaged in three CBCT scanners using three or four protocols with varying exposure parameters to achieve lower dose. Co-registration was performed to generate sagittal and cross-sectional image sections representative of the implant site. Three observers measured bone height, from the alveolar crest to the mandibular canal, and width, three mm from the top of the alveolar crest. Intra- and interobserver reproducibility were assessed for the cases rated as nonmeasurable as well as for completed measurements. The measurements were analyzed using paired t-tests for differences among the CBCT protocols and the frequency distribution of nonmeasurable cases with a Pearson Chi-square test. Reproducibility for registering nonmeasurable cases varied among observers; however, no consistent significant differences were found in the frequency distribution of these cases among observers, units, and protocols. Intraclass correlation coefficients (ICC) were >0.9 for all measurements of bone height and width. Mean differences of <0.5 mm were found regardless of protocol; however, one observer did in some cases produce larger differences. Linear bone measurements did not differ significantly and could be performed with excellent reliability, using low-dose CBCT protocols compared with standard and high-resolution ones. Varying approaches for rating nonmeasurable cases were found, indicating differences in diagnostic strategies related to implant planning among observers.

Exploring the Relationship Between Subcutaneous Fat Index and Neck Pain in Patients with Spinal Cervical Spondylosis: A Retrospective Cohort Study

Retrospective Cohort Study. This study measures the subcutaneous fat index (SFI) of the cervical spine in patients with spinal cervical spondylosis using cervical magnetic resonance imaging and explores its relationship with neck pain in patients with spinal cervical spondylosis. In this single-center retrospective study, 298 patients hospitalized for spinal cervical spondylosis between January and June 2021 were initially considered. After applying inclusion and exclusion criteria, 93 patients were enrolled. The cervical magnetic resonance imaging data for these patients were analyzed using A-Site software. The SFI was measured at the median sagittal plane on T2-weighted images. Patients were categorized into 2 groups based on their admission complaints: those with cervical pain and those without it. Differences between these groups were then statistically analyzed. The mean SFIs with standard deviations for the neck and non-neck pain groups were 36.4%±7.7% and 27.0%±7.9%, respectively, with a significant difference (P < 0.0001). The SFI was consistently higher across all neck segments in the neck pain group compared to the nonneck pain group (P < 0.05). The 2 groups had no statistically significant difference in the body mass index. The SFI provides a more precise assessment of muscle and fat distribution in the posterior cervical region than body mass index and is generally higher in patients with spinal cervical spondylosis who experience neck pain. These findings suggest the importance of early functional exercises postsurgery for potentially improving surgical outcomes in this patient population.

The Influence of Medial and Lateral Forefoot Height Discrepancy on Lower Limb Biomechanical Characteristics during the Stance Phase of Running

Previous research has predominantly focused on the biomechanical effects of anterior–posterior foot motion during running, with comparatively less attention given to medial–lateral foot motion and its impact on lower limb biomechanical characteristics. We recruited 18 healthy runners who wore five different types of running shoes: regular shoes (NS), those with a 6 mm and 9 mm medial–lateral height difference in the forefoot (M6, M9), and those with a 6 mm and 9 mm lateral–medial height difference (L6, L9). Biomechanical parameters of lower limb joints during the stance phase of running, including range of motion, peak angular velocity, peak moment, power, and work, were analyzed. We used paired-sample t-tests and one-dimensional statistical parametric mapping (SPM1D) to compare joint biomechanics between shoes with varying height differences and NS. Under the L6 condition, notable differences occurred in the hip and knee flexion–extension moments during landing and push-off, accompanied by a significant increase in ankle dorsiflexion work and a significant decrease in inversion–eversion work. In contrast, the M9 condition resulted in decreased hip flexion–extension peak moment, power, and work in the sagittal plane. These findings indicate that varying forefoot medial–lateral height differences in running shoes significantly impact lower limb joint dynamics during the stance phase, particularly the L6 condition, potentially reducing knee injury risk and aiding gait improvement for overpronators. The findings offer valuable insights for sports injury prevention and athletic footwear design. However, further research is needed to understand the underlying mechanisms and practical implications for sports injury prevention and performance enhancement.