Radiological Measurements Research Articles

Comparison of codes for calculation of projocted radiation-induced cancer risks.

The lifetime attributable risk (LAR) of cancer caused by radiation exposure is crucial when deciding on radiological protection measures or protective actions for nuclear emergency preparedness and response. Although a model for estimating LAR among the Japanese population has been developed based on epidemiological data from A-bomb survivors, a flexible projection code implementing this model must be developed. This study investigated existing codes to contribute to the development of a projection code. Based on these investigations, we compared their LAR calculation results and explored the causes of their differences.

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.

Postoperative Grip Strength and Range of Motion Correlated with Better Patient-Reported Outcomes Following Surgical Management of Distal Radius Fractures

Abstract Background The common methods for assessing postoperative outcomes in patients with distal radius fractures (DRFs) are mostly observational. In contrast to these traditional assessment tools, postoperative assessments based on patient-reported outcomes (PROs) are becoming more popular. The aim of this study was to analyze the postoperative radiological measurements and physical examination measures as predictive measures for patient-reported satisfying outcomes defined by the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Gartland and Werley score. Purpose The aim of this study was to inspect whether postoperative radiological and physical examination measurements are associated with better PROs. This correlation would be beneficial to assess surgery's success and predict patient's recovery process, helping with coordination of patient's expectations postsurgery. Study Design This is a retrospective cohort study. Methods Eligible patients were those who underwent Open Reduction Internal Fixation (ORIF) of DRFs and answered the DASH and Gartland and Werley questionnaires with a minimal follow-up period of 6 months and a 2-year median follow-up time; during follow-up, physical examination measures and radiographic measures were taken. Results This study has found that older patients have a higher probability to achieve better PROs postsurgery and ROM has been found as a factor correlated with DASH score and Gartland and Werley score. A model combining grip strength, supination, and extension was able to predict the DASH score with 63% of variance: DASH score = 88.864–(0.288 × grip strength) – (0.371 × supination) – (0.270 × extension). Conclusions Due to the high prevalence of DRFs and their debilitating effect on patients' functionality, a credible assessment tool must be defined to predict postsurgery patient satisfaction and help in the patient selection process. Level of Evidence III.

Consensus definition of a radiologically healed fistula on magnetic resonance imaging in perianal Crohn’s disease: an international Delphi study

IntroductionPerianal fistulising Crohn’s disease (pfCD) is a distinct and debilitating phenotype seen in around one-third of patients with CD. Clinical trials in pfCD are increasingly using magnetic resonance imaging (MRI) criteria as a primary endpoint, but there is heterogeneity in the radiological definition of a healed perianal fistula that currently limits our ability to perform meaningful meta-analyses of studies. Our aim is to standardise outcomes through the generation of an international consensus definition of a radiologically healed fistula.Methods and analysisThis international Delphi consensus study employs a two-part strategy.The first is a systematic review to identify a longlist of variables used to define radiological healing in pfCD. MRI-based indices used to score fistula severity and healing will be assessed for their methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). The systematic review protocol will be conducted using COSMIN methodology and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses.The second part will be an online Delphi consensus, guided by the results of the systematic review. Radiologists, gastroenterologists and colorectal surgeons with expertise in the management of pfCD will be invited to take part in two to three rounds of online surveys. Once an a priori threshold of >80% agreement is reached on individual radiological components used to define ‘healing’ and ‘healed’, a final meeting of key stakeholders will be organised to generate a consensus definition of a healed fistula.Ethics and disseminationThe study has been deemed exempt from a formal Research Ethics Committee review as no patients will participate directly in the consensus process, given the technical nature of the research question. The study is registered with the local R&D department (Reference RD24/007). Publication of this study will help standardise radiological endpoint measurement in clinical trials of pfCD and improve the synthesis and meta-analysis of comparative studies.PROSPERO registration numberCRD42024504334.

Artificial intelligence and orthopaedic

Artificial intelligence is the next big thing in human history. It is set to affect large and small industries, entertainment, agriculture, literature, research, and healthcare. The field of Artificial intelligence includes machine learning and deep learning, which denote an increased level of specialization. These changes are also set to influence orthopedic trauma, from diagnostics, clinical assessment, surgical intervention, rehabilitation, and outcome prediction. Some of these fields will be affected more than others. We carried out a narrative review of artificial intelligence and orthopaedic surgery to provide an updated overview of the current and future applications. AI is set to revolutionize radiological diagnostics, outcome measurement, and rehabilitation in orthopedic trauma. However, concerns about clinical decision-making and intervention remain. Ethical concerns, regulation, and superiority over traditional methods of treatment also need to be assessed. Until then, the role of AI in orthopaedic trauma remains in the realm of possibilities.

Risk Factors for Adjacent Vertebral Fractures Following Cement Vertebroplasty: The Clinical Significance of Multiple Preexisting Vertebral Compression Fractures.

A retrospective cohort study. The study retrospectively analyzed the factors associated with the development of adjacent vertebral fractures. Adjacent vertebral fractures (AVF) may occur following cement vertebroplasty, and several risk factors have been reported with controversies. A total of 123 patients, with a mean age of 79.2 years, who underwent single-level vertebroplasty were included in the investigation. We systematically collected data encompassing baseline demographics, osteoporosis parameters, surgical details, radiologic measurements, and Hounsfield unit (HU) values in the lumbar spine. Subsequently, univariable, followed by multivariable logistic regression analyses, were employed to identify the risk factors of AVFs. Thirty of 123 patients had AVFs within 6 months following vertebroplasty. The AVF group exhibited a higher percentage of multiple preexisting vertebral compression fractures (P=0.006), a greater volume of injected cement (P=0.032), and a more pronounced reduction in local kyphosis (P=0.007). Multivariable logistic regression analysis revealed multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees were independent risk factors for AVFs (P=0.008 and 0.003, respectively), with odds ratios of 3.78 (95% confidence interval: 1.41-10.12) and 4.16 (95% CI: 1.65-10.50), respectively. Subgroup analysis showed that patients with multiple preexisting vertebral compression fractures (VCFs) had significantly lower bone mineral density Z-score, T-score, and HU values compared with those without preexisting VCFs (P<0.05). Conversely, there were no significant differences in T-score or HU values between patients with no VCFs and those with a single VCF. This study demonstrated that both bone strength and local alignment are key factors associated with adjacent vertebral fractures. Specifically, having multiple preexisting vertebral compression fractures and a reduction in local kyphosis exceeding 8 degrees are independent risk factors. The presence of more than one previous vertebral compression fracture serves as a significant clinical indicator of advanced bone density reduction in patients with osteoporosis, offering a quick and straightforward method for identifying high-risk patients. Patients exhibiting these risk factors should be monitored more closely for favorable clinical outcomes. Level III-retrospective nonexperimental study.

Quantified Deltoid Muscle Stiffness Can Predict Improved Muscle Strength for Elevation Following Reverse Shoulder Arthroplasty.

Objective: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). Methods: Sixty-five patients who underwent RSA over a 12-month follow-up period were included. Patient characteristics and clinical and radiologic measurements were recorded. Preoperatively and at 3, 6, 9, and 12 months after surgery, deltoid muscle stiffness and muscle strength for scapular-plane abduction were sequentially measured using SWE and a portable dynamometer. In each quarterly period (3-6, 6-9, and 9-12 months), patients were assessed for an improvement in muscle strength and separated into two groups: improved and non-improved. To assess the risk of lack of improvement in each quarterly period, the variables were compared between the groups. Results: Improvement in muscle strength was observed in 52 patients (80%) at 3-6 months, 46 patients (71%) at 6-9 months, and 39 patients (60%) at 9-12 months. Notably, SWE measurements at the beginning of each period showed significantly greater values in the non-improved group than in the improved group during the subsequent quarterly period. A receiver operating characteristic (ROC) curve analysis suggested that SWE values >45.1-50.0 kPa might be associated with a lack of muscle strength improvement over 3 months with 73-87% specificity and 73-85% sensitivity. Conclusions: Our study demonstrated that increased deltoid muscle stiffness negatively correlated with an improvement in muscle strength following RSA. According to our results, a postoperative assessment with SWE may be useful for not only improving muscle strength after RSA but also facilitating postoperative improvement by preventing excessive stiffness in the deltoid muscle.

Correlation of Radiological and Pedobarographic Evaluations in the Presence of Foot Sole Pain

Objective: One of the reasons for foot pain is the changes in the structure of the medial longitudinal arch. Assessment of medial longitudinal arch height is often made with foot radiographs and pedobarographic measurements. The relationship between these methods in the presence of foot sole pain has not been examined yet. This study aims to investigate the relationship among these measurement methods in adults with foot sole pain. Materials and Methods: 60 adults with foot sole pain were included in this study. The talohorizontal, talocalcaneal, talo1.metatarsal, and calcaneal inclination angles were measured in the lateral weight bearing foot radiographs. The arch index was calculated in static, dynamic pedobarographic measurements. The agreement of radiological and pedographic measurements among themselves and with each other was determined. Results: The mean age of 60 participants was 45.32 ±13.64. Agreement among foot classifications of radiologic measurements was poor Gwet’s agreement coefficient =-0.198 with a 95% confidence interval (-0.315,-0.080); percent agreement = 0.167 with a 95% confidence interval (0.099,0.234) and Kappa =-0.047 with a 95% confidence interval (-0.083,-0.01) were found. The agreement between pedobarographic classifications was fair Gwet’s agreement coefficient =0.486 with a 95% confidence interval (0.355,0.617); percent agreement =0.65 with 95% confidence interval (0.563,0.737) and Kappa=0.453 with a 95% confidence interval (0.324,0.583) were found. Among radiological measurements, the calcaneal inclination angle showed the highest coefficients of agreement with pedobarographic measurements. The extent of its agreement was fair. Conclusion: Pedobarography is a simple, reliable, inexpensive, and noninvasive method. The calcaneal inclination angle which is used in radiological imaging can give an idea about the height of the medial longitudinal arch.

A Short-term clinical and radiologic outcomes of reverse total shoulder arthroplasty with navigation system in Asian population: A retrospective comparative study

BackgroundIn reverse total arthroplasty (rTSA), glenoid component positioning is a critical factor for outcomes especially in Asian population with smaller glenoid. The purpose of this study was to compare the clinical and radiologic outcomes of rTSA with and without the navigation system with a minimum follow-up of two years in Asian population. MethodsThis was a retrospective comparative study of 33 rTSA with the navigation system (NAV group) and 40 conventional rTSA (CON group). Radiologic measurements regarding the position of the glenoid component, glenoid vault perforation by the central cage, and scapular notching, as well as clinical outcomes including range of motion (ROM), functional scores and complications were compared. Number, length, and angulation of screws were assessed. ResultsThe mean age was 73.9 ± 5.9 years with a mean follow-up of 30.1 ± 6.4 months. The NAV group more frequently utilized augmented baseplate (P < 0.001), showed less superior inclination (P = 0.030) and had lower incidence of glenoid vault perforation (P = 0.040). The length of superior (P = 0.001) and inferior screws (P = 0.045) was longer in the NAV group. In the NAV group compared to the CON group, more inferior orientation of superior screws (P < .001), more anterior orientation for inferior screws (P = 0.031), and anterior screws (P = 0.003) were observed. The NAV group showed significantly less penetration into the suprascapular fossa by a superior screw (P = 0.007). Final ROM, functional scores, and complications showed no significant differences between two groups. ConclusionIn short-term follow-up, the use of a navigation system in rTSA showed no significant difference in clinical outcomes and complications compared to conventional implantation. However, it enabled a lower superior inclination and a reduced glenoid vault perforation by the central cage, simultaneously allowing for the insertion of longer peripheral screws in a safer direction compared to conventional implantation.

Morphometric indices and carpal tunnel syndrome: aradiological study in female patients.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy syndrome of the upper extremities. The carpal tunnel is an osteofibrous canal that is medially bordered by hamulus ossis hamati and pisiform bone, and laterally by scaphoid and trapezoid bones. In this retrospective case-control study, we investigated the relationship between radiologically measured morphometric indices and CTS in female patients. Clinical, radiological, and demographic data were collected for 55 hands of 40 female patients diagnosed with CTS and 58 hands of control subjects. Radiological measurements included various morphometric parameters derived from wrist and hand X-rays. Statistical analysis was conducted to assess associations between morphometric indices and CTS. Significant associations were observed between CTS and several morphometric indices, including carpal height, capitate length, palm length, and others. Notably, these values were lower in CTS patients, suggesting a potential link between reduced carpal tunnel volume and increased pressure due to synovial hypertrophy. Additionally, a newly introduced index, Scaphoid Pisiform Width Index (SPWI), showed promise in assessing the proximal part of the carpal tunnel. It was found that the values for Capitate length, Carpal height, Palm length, SPWI, and Palmar ratio were lower in the patient group. These results suggested that decreasing volume of the carpal tunnel allows for an easier increase in carpal tunnel pressure due to increased synovial hypertrophy and the carpal bone configuration affects the proximal part of the carpal tunnel, and influences the compression of the median nerve, in female patients.

Comparison of Clinical and Radiological Outcomes With Body Mass Index After Medial Patellofemoral Ligament Reconstruction.

Medial patellofemoral ligament (MPFL) reconstruction is a commonly employed surgical approach for recurrent patellar dislocation. However, the impact of elevated body mass index (BMI) on postoperative complication rates remains controversial. To compare the clinical, radiographic, and functional outcomes of patients with normal BMI (18.5-24.9 kg/m2) and those with elevated BMI (≥25 kg/m2) who underwent MPFL reconstruction for recurrent acquired lateral traumatic patellar dislocation. Cohort Study; Level of evidence, 3. A total of 70 patients who underwent MPFL reconstruction for recurrent patellar dislocation were included in this study. Patients with recurrent patellar dislocation were categorized into 2 groups based on their BMI: the normal BMI group and the elevated BMI group. Functional scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner, and Kujala scores) and radiological measurements (patellar tilt angle, patellofemoral trochlear congruence, lateral patellofemoral angle, and lateral patellar displacement) were evaluated both preoperatively and at the last follow-up. The occurrence of postoperative complications at the last follow-up was also recorded. Differences in functional scores and radiological parameters before and after surgery were analyzed with paired-samples t tests or Wilcoxon signed-rank tests. Comparisons between groups were conducted using independent-samples t tests or the Kolmogorov-Smirnov test. In the normal BMI group, there were 13 male patients and 27 female patients, with a mean follow-up duration of 26.15 ± 13.16 months. The mean age in this group was 21.93 ± 7.94 years. The elevated BMI group consisted of 12 male patients and 18 female patients, with a mean follow-up duration of 27.50 ± 15.79 months and a mean age of 23.30 ± 8.43 years. At the final follow-up, the incidence of surgical failure (patellar redislocation or subluxation and necessitating secondary surgery) was significantly higher in the elevated BMI group (6 out of 30 patients; 20.0%) compared with the normal BMI group (1 out of 40 patients; 2.5%) (P < .05). Both groups demonstrated significant improvement in postoperative Lysholm, IKDC, Tegner, and Kujala scores compared with the preoperative period (P < .05). Notably, the normal BMI group had significantly higher preoperative Lysholm and Tegner scores compared with the elevated BMI group (P < .05). Furthermore, the elevated BMI group exhibited less improvement in Tegner and Kujala scores compared with the normal BMI group (P < .05). Postoperative radiological parameters in both groups returned to the normal range (P < .05). There were no statistically significant differences between the 2 groups in terms of radiological parameters and their corresponding differences. Our study demonstrated statistically significant increases in postoperative clinical scores for both groups, although the intergroup differences varied. Specifically, patients with elevated BMI demonstrated poorer preoperative Lysholm and Tegner scores. The postoperative improvement in radiological parameters was equally good between the 2 groups.

An analysis of radiologic and anatomical parameters associated with medial osteochondral lesions of the talus in non-traumatic cases

The study aimed to provide a comprehensive analysis of radiological and anatomical measurements in patients with medial osteochondral lesions of the talus (OLT), particularly those without a history of trauma. The retrospective cross sectional study evaluated 23 medial OLT individuals aged 18–45 with no history of trauma who were identified by magnetic resonance imaging (MRI) between 2016 and 2020. The control group consisted of 27 individuals between the ages of 18 and 45 who did not have OLT and applied for other reasons. Measurements were performed with 16 parameters from anteroposterior (AP) and lateral weight-bearing ankle conventional radiographs (CR). All individuals' demographic data were assessed. A total of 50 patients aged 18–45 years, including 26 males and 24 females with a mean age of 30.28±4.46 years, were evaluated in the study. No significant differences in age or gender were found between the groups (P>0.05). Analysis of both the OLT and control groups revealed a significant association of decreased talar declination angle (P<0.001) and Meary-Tomeno's angle (P = 0.003) with medial OLT. There was no relationship between other radiological parameters and medial OLT development. In conclusion, a decreased talar declination angle and a decreased Meary-Tomeno's angle appear to have significant relationship with development of medial OLT in individuals without a history of trauma. These findings also indicate that a possible cause of medial OLT is a lower-angled positioning of the talus relative to the ground and the first metatarsus in the sagittal plane.Level of Clinical Evidence: Level 3 cross sectional study

Hypothalamic Gliosis is Associated With Multiple Cardiovascular Disease Risk Factors.

Hypothalamic gliosis is mechanistically linked to obesity and insulin resistance in rodent models. We tested cross-sectional associations between radiologic measures of hypothalamic gliosis in humans and clinically relevant cardiovascular disease risk factors, as well as prevalent coronary heart disease. Using brain MRI images from Framingham Heart Study participants (N=867; mean age, 55 years; 55% females), T2 signal intensities were extracted bilaterally from the region of interest in the mediobasal hypothalamus (MBH) and reference regions in the amygdala (AMY) and putamen (PUT). T2 signal ratios were created in which greater relative T2 signal intensity suggests gliosis. The primary measure compared MBH to AMY (MBH/AMY); a positive control ratio (MBH/PUT) also assessed MBH whereas a negative control (PUT/AMY) did not. Outcomes were BMI, HDL-C, LDL-C, fasting triglycerides, and the presence of hypertension (n=449), diabetes mellitus (n=66), metabolic syndrome (n=254), or coronary heart disease (n=25). Dietary risk factors for gliosis were assessed in a prospective analysis. Statistical testing was performed using linear or logistic regression. Greater MBH/AMY T2 signal ratios were associated with higher BMI (β = 21.5 [95% CI, 15.4-27.6]; P<0.001), higher fasting triglycerides (β = 1.1 [95% CI, 0.6-1.7]; P<0.001), lower HDL-C (β = -20.8 [95% CI, -40.0 to -1.6]; P=0.034), and presence of hypertension (odds ratio, 1.2 [95% CI, 1.1-1.4]; P=0.0088), and the latter two were independent of BMI. Findings for diabetes mellitus were mixed and attenuated by adjusting for BMI. Metabolic syndrome was associated with MBH/AMY T2 signal ratios (odds ratio, 1.3 [95% CI, 1.1-1.6]; P<0.001). Model results were almost uniformly confirmed by the positive control ratios, whereas negative control ratios that did not test the MBH were unrelated to any outcomes (all P≥0.05). T2 signal ratios were not associated with prevalent coronary heart disease (all P>0.05), but confidence intervals were wide. Self-reported percentages of macronutrient intake were not consistently related to future T2 signal ratios. Using a well-established study of cardiovascular disease development, we found evidence linking hypothalamic gliosis to multiple cardiovascular disease risk factors, even independent of adiposity. Our results highlight the need to consider neurologic mechanisms to understand and improve cardiometabolic health.

Hospital-based study of cervical rib/ribs and its association with neurological complication

Introduction: Cervical rib is an additional rib which is the costal element of seventh cervical vertebra. Hence cervical ribs may first be revealed by nervous (particularly on eighth cervical and first thoracic spinal nerve) and vascular symptoms. Cervical rib is more often unilateral and somewhat more frequent on the right. In 90% of cases cervical rib probably causes no trouble. So the present study addresses the prevalence of cervical rib/ribs among both adult male and female and Radiological measurement of costal elements and its association with neurological involvements. Aim: the main aim of this study is to find out the prevalence and relation of length of costal process of 7th cervical rib with neurological symptoms among KPC Medical College outdoor patients. Methods: A prospective study has been carried out using technically adequate cervical spine AP and chest x rays PA view taken in department of Radiology, KPC Medical College and Hospital. Results: In this study all numerical and nonnumeric data of 495 patients has been plotted in Excel of Office 13. Observed 13 cases of cervical rib/ribs in which 7 were unilateral and 6 bilateral. Out of these 13 cases 12 cases had rudimentary cervical ribs.

Primary Total Knee Arthroplasty for Treating Osteoarthritic Knees with Neglected Patellar Dislocation.

Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures.

Assessing masseter muscle volume and activity in relation to craniofacial morphology: a 3D CBCT study.

Understanding the factors influencing craniofacial structure growth is crucial for addressing craniofacial deformities. This study evaluates masseter muscle volume, activity, and maximum bite force across different skeletal malocclusion groups and aims to evaluate the masseter muscle volume, activity, and maximum bite force (BF) according to different skeletal malocclusion groups. This study aimed to assess masseter muscle volume, activity, and maximum bite force (BF) across different skeletal malocclusion groups in 60 young adults (18-30 years) seeking treatment at Kirikkale University Faculty of Dentistry. Cone-Beam Computed Tomography (CBCT) imaging, radiological measurements, surface electromyography (sEMG), and force sensor measurements were employed. Results revealed significant differences in sEMG measurements based on sagittal classification. Vertical direction groups showed notable results in muscle volume and BF, though no significant differences were observed in sEMG values. A correlation was identified between BF and sEMG, but no correlation was found between muscle volume and other parameters. The findings obtained in this study suggest that the significant relationship between EMG and sagittal skeletal classification could be a valuable diagnostic tool. However, concerns about reliability were raised due to uneven distribution in muscle volume and BF among vertical direction groups. The lack of significant results in muscle volume, sEMG, and BF was attributed to CBCT limitations in soft tissue imaging and the small sample size, emphasizing caution in interpreting the findings.

The Relationship between Treatment Response and Overall Survival in Borderline, Non-Resectable and Resectable Pancreatic Cancer Patients Treated with Neoadjuvant FOLFIRINOX.

Background: The National Comprehensive Cancer Network (NCCN)-recommended treatment for patients with borderline-resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) involves a combination of neoadjuvant FOLFIRINOX chemotherapy and the curative surgical resection of the tumor. This study seeks to identify the clinical, radiological, laboratory, and pathologic predictors that can anticipate the oncological outcomes of patients. Methods: In this study, we conducted a retrospective analysis of patients who had undergone curative surgical resection for BRPC, LAPC, or resectable disease with high-risk features after receiving neoadjuvant FOLFIRINOX at two institutions. We evaluated by means of multivariate analysis whether clinical and laboratory response, tumor markers, radiological response, and pathologic tumor response grade correlated with overall survival (OS) and disease-free survival (DFS). Results: The study enrolled a total of 70 patients with BRPC, LAPC, and resectable disease with high-risk features who underwent resection after neoadjuvant FOLFIRINOX. Age above 65 years and fewer than nine cycles of chemotherapy (OR 4.2; 95% CI 1.4-12.0; p-value 0.007); locally advanced tumors after neoadjuvant treatment (NAT) (OR 7.0; 95% CI 1.9-25.7; p-value 0.003); and lymph node disease and histological tumor regression grade 2 and 3 (OR 4.3; 95% CI 0.9-19.2; p-value 0.05) were risk factors linked to adverse OS and DFS. The median OS and DFS were 33 (22-43.9) months and 16.5 (11.3-21.6) months, respectively. Conclusions: Classification as a LA tumor after NAT was the only preoperative radiological factor that predicted adverse survival in patients undergoing curative surgery after NAT. Other clinical, biochemical, and radiological measures of response were not found to predict OS. Patient age, the cumulative administration of more than eight cycles of chemotherapy, and a significant pathological response were associated with better OS. The results of this study are important for treatment decision-making and prognostication in patients with BRPC and LAPC.

Unilateral biportal endoscopic versus microscopic transforaminal lumbar interbody fusion for degenerative lumbar spinal stenosis in China: study protocol for a prospective, randomised, controlled, non-inferiority trial

IntroductionDegenerative lumbar spinal stenosis is a common cause of low back or leg pain and disability in the elderly population. Patients with spinal stenosis who fail to respond to conservative...

Assessing the Adequacy of Orbital Reconstruction With Titanium Mesh Using Clinical and Radiological Measures.

Background Orbital reconstruction aims to restore the original orbit volume and correct diplopia, enophthalmos, and ocular motility of the fractured orbit. This study aimed to assess the adequacy of orbital reconstruction using radiological and clinical factors. Methods In this retrospective study, patients with orbital blowout fractures meeting clinical or radiographic criteria underwent orbital reconstruction with titanium mesh. The orbital volume and anteroposterior displacement were calculated pre- and post-operatively using computed tomography. Diplopia, inferior orbital nerve examination, and ocular movement were also evaluated. Pre- and post-operative orbital volumes of the fractured and contralateral unfractured orbits were compared. Statistical analysis was performed using MS Excel (Redmond, USA) and STATA BE (Texas, US). Results There was a significant reduction in the difference in volumes between fractured and normal orbits postoperatively (p-value <0.001). The mean difference between the reconstructed orbital floor fracture and the contralateral normal orbit was 0.55 cm3, which is within the normal anatomic variation. Enophthalmos was corrected postoperatively in our patients per radiological parameters as a result of a reduction in the mean posterior displacement. Infraorbital nerve hypoesthesia was not resolved postoperatively. Conclusion Our study highlights the restoration of the normal anatomical variation in volume differences between the fractured and contralateral orbits post-surgery using CT-guided analysis, thereby improving clinical outcomes.

The relationship between imaging-based body composition parameters and disease prognosis in patients with endometrial cancer.

Obesity is known as a risk factor for endometrial cancer (EC). Only a few studies investigate the relationship between sarcopenia and sarcopenic obesity and EC. In this study, our aim was to investigate the relationship between the cross-sectional imaging-based body composition parameters and the disease prognosis in low-grade (LG) and high-grade (HG) EC. We conducted a retrospective study in women diagnosed with low and high-grade EC between January 2014 and May 2022 who had abdominal MRI and thorax CT as a part of routine staging workup. We used the skeletal muscle index (SMI) at the level of the third lumbar vertebra to assess sarcopenia on CT. The T2-weighted sequence at the level of the L2-L3 intervertebral disc is used for visceral fat area (VFA), subcutaneous fat area (SFA), and total fat area (TFA). Two radiologists in consensus, calculated the parameters. A total of 250 EC patients (144 low-grade EC, 106 high-grade EC).Sarcopenia was observed in 122 (48.8%) patients, and sarcopenic obesity was found in 82 (32.8%) patients. Although there was an increase in VFA in cases with high-grade EC, there was no significant difference in terms of SFA. Additionally, the frequency of sarcopenia and sarcopenic obesity was higher in cases with high-grade EC. There was no association between sarcopenia and age, histological type, FIGO staging, or comorbidity in the univariate analysis. However, BMI was found to be associated with sarcopenia. Quantitative radiological measurement of sarcopenia, sarcopenic obesity, and body fat composition can be used as novel parameters in the prediction of disease prognosis in endometrial cancer.