Posterior Diameter Research Articles

Rater reliability of postnatal urinary tract dilation consensus classification.

A multidisciplinary urinary tract dilation (UTD) classification system was published in 2014 to standardize definitions and renal/bladder ultrasound image interpretation. To evaluate intra- and inter-rater reliability of this system on postnatal RBUS. Renal/bladder US of 60 infants (<12months) with urinary tract dilation were anonymized, retrospectively reviewed and scored twice using the UTD classification system by a pediatric urologist and four pediatric radiologists. Exams included supine and prone images of each kidney. Raters recorded the anterior posterior renal pelvis diameter in each position; and when present calyceal dilation (central and peripheral), ureteral dilation, parenchymal and bladder abnormalities. A UTD score was given to each kidney based on these components. Intraclass correlation (ICC) of anterior posterior renal pelvis diameter measures was 0.99 (P<0.001). Intra-rater reliability for the anterior posterior renal pelvis diameter of each kidney was high, with ICC >0.95 (P<0.001). Inter-rater kappa values for UTD scores of both kidneys ranged from 0.60 to 0.77 (P <0.001). Intra-rater kappa values for UTD scores of both kidneys ranged from 0.74 to 0.92 (P <0.001). Of the six categories comprising the UTD score, discrepancy between raters was highest for interpretation of central and peripheral calyceal dilation. Present inter- and intra-rater reliability findings were similar to those previously reported for grading systems for urinary tract dilation. Across these studies, kappa values are generally lower than the 0.8 cut-off advocated for medical measures. Here, calyceal dilation commonly determined the kidney UTD score and was also the source of greatest discrepancy between raters. Improving consistency of calyceal dilation interpretation may improve UTD consensus score reliability.

Evaluation of the facet joints with magnetic resonance images in the patients with disc degeneration and spondylolisthesis.

We aimed to research in detail the morphology of the facet orientation (FO) and tropism (FT) in degenerative diseases. This study consisted of patients with disc degeneration (DD) and with lumbar spondylolisthesis (LS) as well as a control group without these two diseases. The group of patients with DD was separated by DD grades. Vertebral body and intervertebral discs' (IVDs) morphometric values, facet joint osteoarthritis (OA) grading, FO and FT were examined in all the groups. All measurements were applied to MRIs of 353 patients. There was a significant difference in facet angle values between the groups at L4-L5 (FO: p = 0.001). There was a significant negative correlation between FO at L4-L5 and L4 vertebral body anterior posterior diameter and L5 mid-vertebral body height, in 353 patients (p = 0.003; p = 0.010). Facet joint OA grading scores were lower in the control group than in the disc degeneration patient (DDP) and LS groups (p < 0.05). Sagittal FO was seen with the increase of facet joint OA scores at L4-L5 in the control and DDP groups (control: p = 0.001; DDP: p = 0.40). Facet joints can show different orientation values in LS and DDP groups at L4-L5. The presence of FT is a risk factor for an LS patient at L4-L5. Sagittal FO is seen with vertebral slip at L5-S1. FO is affected by the morphometric changes of the vertebral body at L4-L5. Discussions in this regard need to be resolved through further research.

Study on the cephalopelvic relationship with cephalic presentation in nulliparous full-term Chinese pregnant women by MRI with three-dimensional reconstruction.

To analyze the relationship between fetal head size and maternal pelvis size using magnetic resonance imaging (MRI) with a 3-D reconstruction technique. A total of 301 nulliparous full-term Chinese pregnant women with cephalic presentation were enrolled and received MRI examinations before labor onset. Data were collected and imported into Mimics software to reconstruct the maternal pelvis and fetus. Of 301 pregnant women, 212 underwent vaginal delivery and 32 received cesarean section. The body mass index (BMI) was significantly different between the vaginal delivery group and the suspected cephalopelvic disproportion (CPD) group; the larger the BMI, the higher was the risk of CPD. The transverse diameter of the pelvic inlet and the posterior sagittal diameter of the midpelvis were significantly larger in the vaginal delivery group, compared with the suspected CPD group. Fetal weight > 3.5kg could be used as a diagnostic indicator for CPD. BMI is a risk factor for CPD, and fetal weight < 3.5kg is an important diagnostic indicator for natural delivery in Chinese pregnant women.

Assessment of Inferior Thyroid Artery by Color Doppler Ultrasound in Diffuse Toxic GoiterExperience at NINMAS

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to compare the B mode ultrasonography findings of thyroid gland and peak systolic velocity of inferior thyroid artery by color Doppler application, in patients with diffuse toxic goiter at the time of diagnosis and 6-8 months after radioiodine 131-I therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This was a prospective observational study conducted in National Institute of Nuclear Medicine &amp;amp; Allied Sciences (NINMAS) between June 2015 and October 2016. Forty consecutive diagnosed diffuse toxic goiter patients were selected at the time of diagnosis prior to radioiodine therapy. An ultrasonography evaluation of thyroid gland (measurement of anterior posterior diameter for convenience) and measurement of peak systolic velocity of inferior thyroid artery in both sides of thyroid gland were performed before and after 131-I therapy (6-8 months). The examination was performed in thyroid division of NINMAS by advanced ultrasound machine with a linear transducer (5-12 MHz). The patients were divided into two groups. Group A-diffuse toxic goiter prior to radioiodine therapy and group B- same patients 6-8 months after radioiodine therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A reduction in the anterior –posterior diameter of the thyroid gland was observed from pre to post treatment evaluation, performed at 6 and or 8 months after radioiodine therapy. Color Doppler showed increased parenchymal vascularity at the time of diagnosis which gradually declined after radioiodine therapy. Thyroid blood flow, as assessed by PSV of ITA, was significantly higher in Group A than in Group B respectively (70.5 ± 15.5 cm/ sec versus 22.2 ± 12.9 cm/sec). PSV was measured in 10 healthy euthyroid adults &amp;amp; their PSV ranged 13-20 cm/Sec. Parenchymal vascularity of the thyroid gland was higher in hyperthyroid patients than in euthyroid patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Assessment of thyroid gland by B-mode ultrasound and blood flow by color Doppler study (CDS) is an effective marker in the initial diagnosis of diffuse toxic goiter.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 20(1): 41-44, January 2017&lt;/p&gt;

Early detection of congenital anomalies of the kidney and urinary tract: cross-sectional results of a community-based screening and referral study in China

ObjectiveTo establish an effective screening model of congenital anomalies of the kidney and urinary tract (CAKUT) using ultrasound among neonates in Shanghai, China.DesignCross-sectional study.SettingA three-level screening model for CAKUT in...

Bayesian modeling predicts age and sex are not required for accurate stature estimation from femoral length

Despite the recognized flaws in applying traditional stature estimation equations such as those of Trotter and Gleser (1952) [5] to a contemporary population, there are currently no available alternatives for stature estimation in Australia that address these limitations. Post mortem computed tomography (PMCT) DICOM scans of the left and right femora were acquired from 76 Australian deceased individuals aged 17–76 years for metric analysis. Femoral bicondylar length, femoral epicondylar breadth and anterior–posterior (AP) diameter, medial-lateral (ML) diameter, circumference and cortical area at the femoral midshaft were measured on three-dimensional (3D) models to build statistical models for estimating stature. In addition, Australian individuals aged 16–63 years (n=111) were measured in standing and supine positions to aid in the adjustment of supine stature of deceased individuals utilized in this study to standing stature. The results of this preliminary evaluation strongly indicate that the optimal model for estimating stature includes bicondylar femoral length and epicondylar breadth, that the effect of sex as an independent variable is very low, and there is limited practical benefit in including age in the estimation of stature. Our study indicates that the Australian population sampled represents a small yet significant shift in stature from the original Trotter and Gleser sample. Additionally, in the case of fragmentary remains, it was found that epicondylar breadth and AP diameter had the highest probability of accurate stature estimation in the absence of bicondylar femoral length. As stature forms a significant component of a biological profile and therefore aids in the personal identification of human remains, it is important that forensic anthropologists utilize the most accurate methodologies available. Stature estimation of Australian individuals is therefore achieved with higher accuracy through utilizing the femoral equations proposed in this study.

Quality of Life in Patients with Vestibular Schwannomas Following Gross Total or Less than Gross Total Microsurgical Resection: Should We be Taking the Entire Tumor Out?

The goal of microsurgical removal of a vestibular schwannoma is to completely remove the tumor, to provide long-term durable cure. In many cases, less than gross total resection (GTR) is performed to preserve neurological, and especially facial nerve function. To analyze long-term quality of life (QoL) in a cohort of patients who received either GTR or less than GTR. Patients operated for vestibular schwannoma less than 3.0 cm in posterior fossa diameter at 1 of 2 international tertiary care centers were surveyed using generic and disease-specific QoL instruments. A total of 143 patients were analyzed. GTR was performed in 122, and 21 underwent less than GTR. QoL was assessed at a mean of 7.7 yr after surgery (interquartile range: 5.7-9.6). Patients who underwent GTR had smaller tumors; otherwise, there were no baseline differences between groups. Patients who underwent GTR, after multivariable adjustment for baseline features and facial nerve and hearing outcomes, reported statistically significantly better Short Form Health Survey-36 (SF-36) physical and mental scores, Patient-Reported Outcomes Measurement Information System (PROMIS-10) physical and mental scores, and Penn Acoustic Neuroma Quality of Life (PANQOL) facial, energy, general health, and total scores compared to patients receiving less than GTR. GTR is associated with better QoL using the general QoL measures SF-36 and PROMIS-10 and the disease-specific PANQOL, even after controlling for baseline and outcome differences. This is especially significant in the assessment of mental health, indicating there may indeed be a psychological advantage to the patient that translates to overall well-being to have the entire tumor removed if microsurgical resection is undertaken.

Cardiac size and systolic function of HIV-infected Lagos children accessing routine care: a pilot study

Background: Previous studies have reported high, though declining, prevalence of HIV-associated cardiac dysfunction globally. However, there is relative paucity of data on the prevalence and pattern of HIV-associated cardiac disorders in Nigerian children. The index study aimed to conduct a pilot evaluation of the frequency and pattern of cardiac dysfunctions in HIV-infected children in a tertiary health facility in Lagos, Nigeria. Methods: Thirty-nine HIV-infected children, with 41 age- and sex-matched controls, were prospectively recruited in a cross-sectional study. Subjects had echocardiography to obtain measures of cardiac dimensions and function. Subjects’ anthropometry, blood pressure and clinical profile were also obtained. Results: HIV-infected children had significantly thicker interventricular septal diameter (IVSD) (P=0.0018) and larger left atrial diameter (P=0.003) and aortic root diameter (P=0.023); other parameters (right ventricular diameter, left ventricular diameter, left ventricular posterior wall diameter, left ventricular mass (LVM), ejection fraction, fractional shortening) were similar between both groups. There was no significant difference in the prevalence of LVH between those on zidovudine-based regimen compared to those on non-zidovudine-based regimen (P=0.703). Conclusions: The prevalence of subclinical echocardiographic abnormalities was high and was more in those below five years of age. In a setting of limited resources, this age group may be prioritized for serial monitoring of cardiac abnormalities.

Transperineal ultrasound imaging of the pelvic floor muscles in women with pelvic floor dysfunction symptoms: A cross-sectional study

Abstract Objective Transperineal ultrasound (TPUS) assessment of the pelvic floor muscle (morphological and dynamic function) in women with pelvic floor dysfunction symptoms. Study design A cross-section study, 73 women complaining of any of the pelvic floor disorder symptoms. Digital palpation of the puborectalis muscle using modified Oxford score grading system (MOS), 2 D and 3 D TPUS were done at rest, maximum contraction, and at valsalva. Levator ani defects, and/or avulsion were identified. Levator urethral gap (LUG) was measured. Ultrasound measurements were correlated to MOS, and presence of symptoms Results The mean percentage decrease in the antro posterior hiatal diameter (LHap) during contraction was significantly lower in women with UpfmC than those with NpfmC as assessed by MOS. A cut-off percentage decrease in LHap at contraction 2% predicted UpfmC; area under the curve 0.81, sensitivity 38.5%, specificity 81% and accuracy 50.6%. LUG was significantly longer in UpfmC. All cases of ultrasound diagnosed avulsion had an UpfmC by MOS. MOS had a strong positive correlation with percentage decrease LHap (contraction), and a strong negative correlation with the percentage increase in LHap (Valsalva), and LUG. Conclusion Ultrasound is clinically valuable, reasonable, allows morphological and dynamic evaluation of the function of PFM in women with pelvic floor dysfunction symptoms, and correlated well with MOS. LUG increased its validity for diagnosis of levator avulsion.

Assessment of mitral annulus and mitral leaflet in nonvalvular atrial fibrillation patients with various degrees of mitral regurgitation: Real time 3D transesophageal echocardiography.

To study the changes of mitral valve (MV) in patients with nonvalvular atrial fibrillation (NVAF)-related mitral regurgitation (MR) and the relationship between MV parameters and the enlarged left atrium (LA). A total of 43 patients with NVAF were divided into two groups: (1) the MR1 group with mild MR and (2) the MR2 group with moderate-to-severe MR. Real time 3D transesophageal echocardiography (TEE) was performed to detect the structure of MV. There were no significant differences in the basic characteristics among the three groups. As compared with the control group, anterolateral to posteromedial diameter of the annulus (DALPm), anterior to posterior diameter (DAP), three-dimensional circumference (C3D), two-dimensional area (A2D), three-dimensional area (A3D), exposed area of the leaflets (A3DE), and NPA (nonplanar angle) were significantly increased, whereas height and ellipticity were significantly decreased in the MR1 group and MR2 group. The overall longitudinal strain of left atrium (GLS) was significantly decreased in the MR1 and MR2 groups compared to the control group. Furthermore, GLS was inversely correlated with DALPm, DAP, C3D, A2D, A3D, A3DE, and NPA, whereas positively correlated with height, ellipticity, and the leaflet tenting height in both MR1 and MR2 groups. Even in NVAF patients with mild MR, the structure of MV was changed intensively with the expansion and deformation of the "saddle shape" structure. The deformation of MV was associated with the decreased function of LA. Our results may provide novel insight into evaluation risk factors leading to AF recurrence after ablation procedures.

Obstructive sleep apnea is associated with interdialytic weight gain and increased long-term cardiovascular events in hemodialysis patients.

Obstructive sleep apnea (OSA) is common in hemodialysis (HD) patients. The reasons for the high prevalence and whether OSA is associated with vascular impairment, end-organ damage, and prognosis are not completely clear. We evaluated patients with low cardiovascular risk on HD, not treated by CPAP. Laboratory tests, sleep questionnaires (Berlin and Epworth) and polysonography studies, echocardiography, and markers of arterial stiffness and atherosclerosis were performed. After the initial evaluation, patients were followed up until cardiovascular events, renal transplantation, or death. Fifty-five patients (49% male, 50 ± 9years, body mass index 24.7 ± 4.5kg/m2) were included. OSA (apnea-hypopnea index ≥ 5 events/h) occurred in 73% of the patients. The proportion of patients with interdialytic weight gain > 2kg was higher in patients with OSA than those without OSA (96 vs. 55%; p = 0.002). Left ventricular (LV) posterior wall thickness (10.0 ± 1.9 vs. 11.3 ± 1.8mm; p = 0.04) and LV diastolic diameter (48 ± 5 vs. 53 ± 5mm; p = 0.003) were higher in patients with OSA than in patients without OSA, respectively. Sleep questionnaires did not predict OSA. No significant differences were found in pulse wave velocity, carotid intima-media thickness, and ankle-brachial index between the groups. Multivariate analysis showed that interdialytic weight gain > 2kg and LV diastolic diameter were independently associated with OSA. On follow-up (median 45months), OSA was found to be associated with a higher incidence of cardiovascular (CV) events (28 vs. 7%, log-rank = 0.042). OSA was associated with increased risk of CV events. Significant (> 2kg) interdialytic weight gain was independently associated with OSA.

Impact of posterior urethral diameter/external urethral sphincter diameter as a new tool to predict detrusor pressure in the voiding phase.

We measured posterior urethra diameter (PUD) and external urethral sphincter diameter (EUSD), which can also be measured by voiding cystourethrography (VCUG) and investigated the relationship between PUD/EUSD and detrusor pressure (Pdet) during voiding by videourodynamics (VUDS). Sixty-three children, who were 3years old or less and underwent VUDS, were enrolled in the present study. We measured PUD and EUSD in addition to detrusor pressure at the time of the widest EUS during voiding (Pdet-voiding) by VUDS, and PUD/EUSD was investigated compared to Pdet-voiding. Seventy-eight VUDS were performed in 63 patients, and the median age at VUDS was 10.2months. These studies revealed a significant correlation between PUD/EUSD and Pdet-voiding (r=0.641, p<0.001). However, a significant correlation was not observed between PUD/EUSD and age (r=0.180). We defined Pdet-voiding of more than 80cmH2O as a high voiding pressure, and a PUD/EUSD of 2.4 was a good predictor for the cutoff value for high voiding pressure. Pdet-voiding was significantly higher in children with a PUD/EUSD of≥2.4 (p<0.001). In 19 children who had neurological diseases, a significant correlation was found between PUD/EUSD and Pdet-voiding (r=0.842, p<0.001), and a PUD/EUSD of 2.4 was a useful cutoff value for high voiding pressure. PUD/EUSD is a valuable tool to predict high voiding pressure in pediatric patients. A PUD/EUSD of≥2.4 in VCUG indicates the need to perform more invasive tests, such as VUDS, in pediatric patients aged 3 and under with neuropathic diseases.

MIGRATION D’UN GUIDE DE SONDE DE PACE MAKER REVELANT UN ANEVRISME DE L’AORTE ABDOMINALE SOUS RENALE : à propos d’un cas.

We present the case of a 63-years-old-man. He had as a cardiovascular risk factors, hypertension and active smoking at 80 packsyear, not weaned. He was sent to us for an an extraction of a guide from a temporary pacemaker probe. During the assessment for localize the guide, the thoraco-abdominal CT-scan revealed an infrarenal aorta aneurysm, uncomplicated which maximal antero- posterior diameter was measured to 42mm. Concomitantly we extracted the guide and cured the aneurysm grafting of a Dacron tube. The suites were unremarkable. The patient left hospital on D12 postoperatively. He had been followed regurlarly since then. He remains asymptomatic. For small (40- 49mm) asymptomatic aneurysms , the approach is not codified. However, their natural leads toward low-noise growth and significant risk of rupture. The therapeutic decision-making (open surgery, EVAR) in infrarenal aorta aneurysms, must be discussed in such small diameter cases. KEYWORDS: Aneurysm; Infrarenal Aorta; Rupture; Surgery; Endovascular treatment.

Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair

BackgroundPostprocedural mitral stenosis (MS) is a main limitation for MitraClip™ (Abbot Vascular, Inc., Santa Clara, CA, USA) procedure. The purpose of this study was to detect the preprocedural predictors of high transmitral pressure gradient (TMPG) after MitraClip™ implantation, which indicated postprocedural mitral stenosis (MS). MethodsWe studied 79 patients who were implanted with MitraClip™ in our institute. Before the procedure, mitral valve orifice area (MVOA), and anterior–posterior (AP) and medial-lateral (ML) mitral annular diameters were measured at diastole using three-dimensional (3D) transesophageal echocardiography (TEE) data set. After the procedure, the mean TMPG was assessed using continuous-wave (CW) Doppler by periprocedural TEE. ResultsPreprocedural MVOA, and AP and ML diameter of left ventricular (LV) inflow orifices were larger in patients with mean TMPG ≤4mmHg than in patients with TMPG >4mmHg after 1-and 2-clip implantation. The large MVOA and ML diameter of LV inflow orifice strongly correlated with the low TMPG after 1- and 2-clip implantation. As a result of the receiver operating characteristic curve analysis, the preprocedural MVOA predicted the low postprocedural TMPG more accurately than the ML diameter of LV inflow orifice after 1-clip implantation either in the degenerative or functional mitral regurgitation (MR) patients. After 2-clip implantation, however, the preprocedural ML diameter of LV inflow orifice predicted it more accurately than the MVOA in the degenerative and functional MR patients. Conclusions3D TEE derived MVOA predicts the postprocedural MS after 1-clip implantation, however, preprocedural ML diameter of LV inflow orifice is more useful to predict after 2-clip implantation.

The right intercostobronchial trunk: anatomical study in respect of posterior intercostal artery origin and its clinical application.

The right bronchial artery usually arises from the descending thoracic aorta as a common trunk with the right intercostal artery and forms the right intercostobronchial trunk. Both, the third right posterior intercostal artery and the right intercostobronchial trunk, are described as the most constant vessels. The focus of the study was to determine the characteristics of the right intercostobronchial trunk regarding the origins of the posterior intercostal arteries from the thoracic aorta. Posterior intercostal arteries and the right bronchial arteries were dissected in 43 human cadavers, preserved after Thiel's embalming method with intraarterial infusion of red colored latex. Postmortem examination gave valued information on the right intercostobronchial trunk present in 58% of cases. The right intercostobronchial trunk was mapped and new classification regarding the origin of the posterior intercostal arteries from the thoracic aorta suggested type A, B and C, the latter ones into subtypes 1 and 2. Type A was proportional to the origin level of the PIA and its corresponding intercostal space. Size of outer diameter at the origin did not indicate the right bronchial artery branch. In subtype 2 of type B the proximal posterior intercostal artery diameter that gave off right bronchial artery was thicker than distal one. The right bronchial artery originates from the second to the fifth posterior intercostal artery forming the right intercostobronchial trunk. Various origin and types of origin, diameter and course of the right intercostobronchial trunk described and analyzed in the study offer valuable information on the procedures involving the right intercostobronchial trunk.

Teratogenic Effects of Chlorantraniliprole on chick embryos (Gallus gallus domesticus)

The present study was designed to assess the teratogenic effects of Chlorantraniliprole on chick embryos (Gallus gallus domesticus). Different doses of commercial Chlorantraniliprole (0.1, 0.5, 1.0 and 1.5µl/1000µl/egg, in four experimental groups B, C, D, and E respectively) were injected into the yolk sac of eggs before incubation. Embryos were recovered at day 12 of incubation. The mortality rate gradually increased from lower to higher doses. A total of twelve morphometric parameters viz., wet body weight, crown rump length, anterior posterior head diameter, eye diameter, beak length, neck length, humor length, radius and ulna length, metacarpus length, femur length, fibula length and metatarsus length were recorded and compared with control group. These quantitative parameters indicated significant (p&gt;0.05) decreases in all treated groups compared to control group. While the qualitative anomalies such as microcephaly, hydrocephaly, edematous swelling, hematoma formation, abnormal body coloration, microphthalmia, deformed beak, agnathia, micromelia, amelia, omphalocele and ectopia cardis were also observed in treated groups as compared to untreated groups. Therefore it is concluded that Chlorantraniliprole has potentially harmful effects on the development of avian embryos even at very low dose concentration. Hence, due to toxicity of this pesticide it can be used with utmost caution.

Foramen magnum, occipital condyles and hypoglossal canals morphometry: anatomical study with clinical implications.

Current study examines morphometric alterations of the foramen magnum (FM), occipital condyles (OCs) and hypoglossal canals (HCs) and highlights all the morphometric parameters of the FM area that present side asymmetry, gender dimorphism and are affected by the ageing. One hundred and forty-one (73 male and 68 female) Greek adult dry skulls were examined. Short and long OCs were detected in 27.7% and 26.2%. A combination of short OCs and long HCs was presented in 27.5%. A complete septum was found in 23.6% of the HCs and osseous spurs in 12.9%. Side asymmetry was detected regarding the HCs length (p = 0.046), the maximum extracranial (p = 0.001) and minimum intracranial (p = 0.001) diameters. Mean FM anteroposterior and transverse diameters, FM perimeter and FM surface area were significantly larger in male than in female skulls (p = 0.001 for each parameter). Similarly, the OCs length (right, p = 0.004 and left, p = 0.024) and width (right, p = 0.008 and left, p = 0.006) the left distance HC-OC posterior border (p = 0.048), the anterior (p = 0.011) and posterior (p = 0.001) intercondylar distances and the HCs right length (p = 0.046) were significantly greater in males. A significant decrease was observed with ageing in FM anteroposterior diameter (p = 0.038), FM surface area (p = 0.05), anterior intercondylar distance (p = 0.014) and HC-OC posterior border (p = 0.013). The study confirmed that only specific HC dimensions showed side asymmetry (HCs maximum extracranial and minimum intracranial diameters and HCs length), gender dimorphism (HCs right length and left distance HC-OC posterior border) and age influence (HC-OC posterior border and HC left extracranial minimum diameter) among young, adults and elderly individuals. FM and OCs dimensions presented gender dimorphism and the age influenced only FM anteroposterior diameter and surface area and the anterior intercondylar distance. The safe zone of OCs drilling in Greeks, calculated by the distance HC-OC posterior border represents the maximum HC depth and is among the lowest values reported in the literature. The significant decrease of this distance with ageing confirms the existence of a drilling safe zone for young, adults and elder individuals. Regarding OCs length, the same probability exists dealing with a short or a long OC during condylectomy. Before planning a transcondylar approach, the coexistence of short OCs and long HCs should be taken into account. These outcomes will be useful for a safe surgery in the craniocervical region in Greeks.

Features of rheumatic mitral valves and a grading system to identify suitable repair cases in China.

We aimed to assess the pathological characteristics of rheumatic mitral valve disease in Chinese patients and formulate a pathological grading system to identify cases suitable for rheumatic mitral valve repair (rMVP). Nearly 5 years of follow-up data on patients who underwent rMVP were analysed. A Kaplan-Meier survival curve for freedom from reoperation and valve failure was constructed. A pathological grading system of rheumatic mitral valve lesions (PGSRMVL) was developed based on the pathological characteristics of rheumatic mitral valve disease and tested by receiver operating characteristics (ROCs) curve analysis. Predictors of endpoints for rheumatic repair were analysed. From January 2012 to June 2016, 179 patients underwent rMVP in our centre. The mean follow-up duration was 24±14 months. A left atrial anterior and posterior diameter >60 mm was an independent predictor for the 16 endpoints [hazard ratio (HR) =3.884, P=0.029]. Between 2015 and 2016, 126 consecutive pathological characteristics of rheumatic mitral valve were evaluated (61 and 65 repair and replacement cases, respectively). The ROCs area under the curve was 0.891 for the correlation between the pathological score and successful repair (cut-off point, 17.5; sensitivity, 78%; specificity, 85.2%). Seven lesions had higher ratios in the replacement group than the repair group. Commissural fusion/calcification and main chordae tendineae fusion/calcification were the most common severe pathological lesions. The main pathological characteristics of rheumatic mitral valve disease in Chinese patients are commissure and sub-valvular apparatus lesions. Most patients can be appropriately treated via commissurotomy and leaflet thinning. Severe calcification of the commissure and sub-valvular apparatus can considerably decrease the odds of a successful repair. The median follow-up results of rheumatic mitral repair are considered satisfactory for the pathological characteristics in Chinese patients.

Electrophysiological characteristics of pressure overload-induced cardiac hypertrophy and its influence on ventricular arrhythmias.

ObjectiveTo explore the cardiac electrophysiological characteristics of cardiac hypertrophy and its influence on the occurrence of ventricular tachyarrhythmias.MethodsAdult C57BL6 mice were randomly divided into a surgery group and a control group. Thoracic aortic constriction was performed on mice in the surgery group, and cardiac anatomical and ultrasonic evaluations were performed to confirm the success of the cardiac hypertrophy model 4 weeks after the operation. Using the Langendorff method of isolated heart perfusion, monophasic action potentials (MAPs) and the effective refractory period (ERP) at different parts of the heart (including the epi- and endo-myocardium of the left and right ventricles) were measured, and the induction rate of ventricular tachyarrhythmias was observed under programmed electrical stimulus (PES) and burst stimulus. Whole-cell patch-clamp was used to obtain the I-V characteristics of voltage-gated potassium channels in cardiomyocytes of different parts of the heart (including the epi- and endo-myocardium of the left and right ventricles) as well as the channels’ properties of steady-state inactivation and recovery from inactivation.ResultsThe ratio of heart weight to body weight and the ratio of left ventricular weight to body weight in the surgery group were significantly higher than those in the control group (P < 0.05). Ultrasonic evaluation revealed that both interventricular septal diameter (IVSD) and left ventricle posterior wall diameter (LVPWD) in the surgery group were significantly larger than those in the control group (P < 0.05). Under PES and burst stimuli, the induction rates of arrhythmias in the surgery group significantly increased, reaching 41.2% and 23.5%, respectively. Both the QT interval and action potential duration (APD) in the surgery group were significantly longer than in the control group (P<0.01), and the changes showed obvious spatial heterogeneity. Whole-cell patch-clamp recordings demonstrated that the surgery group had significantly lower potassium current densities (IPeak, Ito, IKur, Iss, and IK1) at different parts of the heart than the control group (P < 0.01), and there were significant differences in the half-inactivation voltage (V1/2) and the inactivation-recovery time constant (τ) of Ito and IKur at different parts of the heart (P < 0.01) between the surgery group and the control group. In addition, the surgery group had significantly lower densities of IPeak, Ito, and IKur in cells of the endo-myocardium (P < 0.05), and the changes showed obvious spatial heterogeneity.ConclusionChanges in the current density and function of potassium channels contributed to irregular repolarization in cardiac hypertrophy, and the spatially heterogeneous changes of the channels may increase the occurrence of ventricular arrhythmias that accompany cardiac hypertrophy.

Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography

The traditional history and physical (H&P) is a poor screening modality to identify athletes at risk for sudden cardiac death. Although better than H&P alone, electrocardiograms (ECG) have also been found to have high false-positive rates. A limited portable echocardiogram by a frontline physician (PEFP) performed during preparticipation physical examination (PPE) allows for direct measurements of the heart to more accurately identify athletes with structural abnormalities. Therefore, it is worthwhile to assess the feasibility of incorporating limited PEFP as part of PPEs. The aim of this study was to investigate the feasibility of incorporating limited screening PEFP into routine PPEs. Thirty-five Division I male collegiate athletes were prospectively enrolled in the study after informed consent was obtained. Each athlete underwent screening with H&P, ECG, and limited PEFP. The H&P was performed based on the 2007 twelve-element preparticipation cardiovascular screening guidelines from the American Heart Association. The ECGs were interpreted using the 2013 Seattle Criteria. The limited echocardiographic (ECHO) measurements were obtained in the parasternal long axis view. End-diastolic measurements were recorded for the left ventricular diameter (LVD), left ventricular posterior wall diameter (LVPWd), interventricular septal wall diameter (IVSWd), aortic root diameter, and ascending aorta. The length of time of each screening station was recorded and reported in seconds (sec) and compared by one-way repeated-measures of analysis of variance with pairwise Bonferroni correction. A priori alpha level was set as 0.05. The length of time for screening was significantly shorter with limited PEFP (137.7 ± 40.4 seconds) compared with H&P (244.2 ± 80.0 seconds) and ECG (244.9 ± 85.6 seconds, P < 0.01). The screening time did not differ between H&P and ECG (P = 0.97). Six athletes had a positive finding in H&P screening and 3 athletes had positive ECG findings. One athlete had both a positive H&P and screening ECG. All 3 athletes with positive ECGs had negative limited PEFP screens. One athlete had a borderline posterior wall thickness (1.49 mm) on the limited screening PEFP evaluation and another was found to have a borderline IVSWd-to-LVPWd ratio (1.28). All 3 athletes with positive ECG findings and both athletes with a borderline finding on limited PEFP were referred for formal evaluation with a cardiologist. None of the 5 athletes were disqualified from competition after cardiac evaluation, but 1 of the athletes with a positive screening-limited ECHO needs annual monitoring. Incorporating limited PEFP into PPEs has the potential to limit the number of false-positive and false-negative cardiac screens. Limited PEFP was the fastest screening modality compared with traditional H&P and ECG methods. Based on the time-driven activity-based paradigm of cost analysis, limited PEFP as part of the PPE yields the highest value: the most accurate and reliable information and the lowest dollar/time expenditure.