Sagittal Area Research Articles

Holistic shape variation of the rib cage in an adult population.

Traumatic injuries to the thorax are a common occurrence, and given the disparity in outcomes, injury risk is non-uniformly distributed within the population. Rib cage geometry, in conjunction with well-established biomechanical characteristics, is thought to influence injury tolerance, but quantifiable descriptions of adult rib cage shape as a whole are lacking. Here, we develop an automated pipeline to extract whole rib cage measurements from a large population and produce distributions of these measurements to assess variability in rib cage shape. Ten measurements of whole rib cage shape were collected from 1,719 individuals aged 25-45years old including angular, linear, areal, and volumetric measures. The resulting pipeline produced measurements with a mean percent difference to manually collected measurements of 1.7% ± 1.6%, and the whole process takes 30s per scan. Each measurement followed a normal distribution with a maximum absolute skew value of 0.43 and a maximum absolute excess kurtosis value of 0.6. Significant differences were found between the sexes (p < 0.001) in all except angular measures. Multivariate regression revealed that demographic predictors explain 29%-68% of the variance in the data. The angular measurements had the three lowest R2 values and were also the only three to have little correlation with subject stature. Unlike other measures, rib cage height had a negative correlation with BMI. Stature was the dominant demographic factor in predicting rib cage height, coronal area, sagittal area, and volume. Subject weight was the dominant demographic factor for rib cage width, depth, axial area, and angular measurements. Age was minimally important in this cohort of adults from a narrow age range. Individuals of similar height and weight had average rib cage measurements near the regression predictions, but the range of values across all subjects encompassed a large portion of their respective distributions. Our findings characterize the variability in adult rib cage geometry, including the variation within narrow demographic criteria. In future work, these can be integrated into computer aided engineering workflows to assess the influence of whole rib cage shape on the biomechanics of the adult human thorax.

Correlation analysis of airway space and condylar morphology in bilateral idiopathic condylar resorption patients.

To evaluate the airway space in bilateral idiopathic condylar resorption (ICR) patients and analyse the correlation between the morphological characteristics of the condyles and airway parameters. In all, 35 female patients with bilateral ICR (mean age: 21.6 years) and 35 age-matched female controls (mean age: 21.3 years) were included. Airway parameters were measured using CBCT. Independent T-tests were used to analyse the differences between the bilateral ICR group and the control group, and then the correlation between airway parameters and condylar parameters was detected using Pearson correlation analysis. p < .05 was considered statistically significant. Patients with bilateral ICR showed a significant decrease in airway volume, minimum axial area and sagittal sectional area (p < .05). The bilateral condylar axial angle positively correlated with airway volume and sagittal sectional area (p < .05). In contrast, the bilateral condylar neck angle negatively correlated with sagittal sectional area (p < .05). None of the condylar parameters showed a correlation with minimum axial area of the airway in the bilateral ICR group (p > .05). Bilateral ICR significantly affects patients' airway space. The condylar axial angle and neck angle correlate with airway parameters.

Ultrasonographic Assessment of the Thymus Among Neonates Admitted in a Special Newborn Care Unit of a Medical College Hospital in Eastern India.

The thymus is essential for the maturation of T-lymphocytes, crucial for adaptive immunity. In neonates, thymic development is influenced by factors such as gestational age, birth weight, birth length, etc. Ultrasonography offers a non-invasive method to assess thymic size and morphology. However, there is limited research on thymic ultrasonography among neonates in Eastern India. This study aimed to investigate the ultra-sonographic characteristics of the thymus in neonates admitted to a Special Neonatal Care Unit (SNCU) in Eastern India and its correlation with certain clinical and anthropometric variables. Conducted from May to July 2024, this cross-sectional observational study involved 80 neonates admitted to the SNCU at the College of Medicine & Sagore Dutta Hospital. Thymic ultrasonography, using an Esaote MylabX7 ultrasound machine with a 3-11 MHz linear probe (Esaote, Genoa, Italy), measured thymic length, width, anteroposterior (AP) dimension, sagittal area, and thymic index. Clinical data, including gestational age, birth weight, birth length, and antibiotics received, were collected from medical records. Pearson's correlation coefficient and linear regression analysis were used to examine correlations and predictors of thymic dimensions. The cohort consisted of 45 boys (56%) and 35 girls (44%). The average birth weight was 2,626 grams for boys and 2,639 grams for girls. The median gestation period was 38 weeksfor both groups. Thymic measurements did not significantly differ by gender. Correlation analysis revealed significant relationships between thymic dimensions and neonatal anthropometric measurements. Birth weight showed a strong positive correlation with thymic length (r = 0.486) and width (r = 0.233). Linear regression identified birth weight as a significant predictor of the thymic index (p < 0.001), explaining 21.2% of the variance. This study provides insights into the factors associated with thymic size in neonates, highlighting the critical role of birth weight in thymic development. Future research should explore additional variables influencing thymic size and consider larger sample sizes to enhance model explanatory power and its potential role in immunity.

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.

Preoperative geniohyoid muscle mass in esophageal cancer patients is associated with swallowing function after esophagectomy.

Dysphagia often develops after esophagectomy. The geniohyoid muscle is involved in swallowing movements, but its significance in esophagectomy patients remains unclear. We investigated the relationship of preoperative geniohyoid muscle mass with post-esophagectomy swallowing function. We retrospectively analyzed 114 patients who underwent esophagectomy and gastric conduit reconstruction for esophageal malignancy. We evaluated preoperative geniohyoid muscle sagittal cross-sectional areas (cm2) using computed tomography. Median values for each sex were considered as cutoff values. Dysphagia severity was assessed using the Penetration-Aspiration Scale (PAS) during video-fluoroscopic swallowing studies performed 7-10 days postoperatively. The cross-sectional area was significantly larger in males than in females (3.2 ± 0.7 vs. 2.4 ± 0.5, p < 0.01: median in males: 3.2 cm2, and in females: 2.3 cm2). These values were used to define high and low cross-sectional area groups. The cross-sectional area correlated positively with grip strength (correlation coefficient (CC) = 0.530) and skeletal muscle index (CC = 0.541). Transthyretin levels (22.4 ± 6.8 vs. 25.4 ± 5.5, p = 0.03) and cross-sectional area (2.6 ± 0.7 vs. 3.2 ± 0.8, p < 0.01) were significantly lower in patients with (PAS score ≥6; 20%) than in those without aspiration during fluoroscopic swallowing studies. Recurrent laryngeal nerve palsy was significantly more frequent in those with than in those without aspiration during fluoroscopic studies (22% vs. 5%, p = 0.03). In the multivariate analysis, low cross-sectional area and recurrent laryngeal nerve palsy were both independent risk factors for aspiration during swallowing studies (odds ratio = 3.6, p = 0.03 and odds ratio = 6.6, p = 0.02, respectively). Preoperative geniohyoid muscle mass, evaluated using neck computed tomography, can predict dysphagia after esophagectomy.

Quantitative study of the ossification centers of the body of sphenoid bone in the human fetus

The aim of the present study was to examine the growth dynamics of the two ossification centers of the body of sphenoid bone in the human fetus, based on their linear, planar and volumetric parameters. The examinations were carried out on 37 human fetuses of both sexes aged 18–30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction and statistical methods, we evaluated the size of the presphenoid and postsphenoid ossification centers. The presphenoid ossification center grew proportionately in sagittal diameter, projection surface area and volume, and logarithmically in transverse diameter. The postsphenoid ossification center increased logarithmically in sagittal diameter, transverse diameter and projection surface area, while its volumetric growth followed proportionately. The numerical findings of the presphenoid and postsphenoid ossification centers may be considered age-specific reference values of potential relevance in monitoring the normal fetal growth and screening for congenital disorders in the fetus. The obtained results may contribute to a better understanding of the growing fetal skeleton, bringing new numerical information regarding its diagnosis and development.

Efficacy of the Sausage Technique in Rebuilding the Crestal Buccal Bone Thickness: A Retrospective Analysis.

The goal was to evaluate the efficacy of the sausage technique in reconstructing the crestal buccal bone thickness, focusing on the distribution shape of the regenerated volume. Ten implants were placed in five patients with Cawood-Howell class IV defects. A cone beam computed tomography (CBCT) was executed at T0 (before surgery). Guided bone regeneration (GBR) with the sausage technique utilized a resorbable collagen membrane, made of a 50% autologous bone and a 50% anorganic bovine bone matrix (ABBM) mixture. After 6 months, a CBCT (T1) was performed before implant placement. Using CBCT software, a plane parallel to the implant axis intersected perpendicular planes every 1.5 mm from the crest level. T0 and T1 CBCT sections were analyzed, yielding 140 measurements. Statistical analysis via SPSS revealed a significant increase in thickness (average 2.82 ± 1.79 mm). Maximum gains occurred at 4.5 mm from the coronal crest line (3.8 ± 1.51 mm). The GBR sausage technique was effective with minimal post-operative complications, yielding the biggest gain at the mid-ridge sagittal area. Within the analysis limitations, it can be assumed that the sausage technique is effective for horizontal GBR in the maxilla, but a lesser volume might be achieved at the crestal level because it seems to follow a bowed regeneration shape.

Unveiling interactions between intervertebral disc morphologies and mechanical behavior through personalized finite element modeling.

Introduction: Intervertebral Disc (IVD) Degeneration (IDD) is a significant health concern, potentially influenced by mechanotransduction. However, the relationship between the IVD phenotypes and mechanical behavior has not been thoroughly explored in local morphologies where IDD originates. This work unveils the interplays among morphological and mechanical features potentially relevant to IDD through Abaqus UMAT simulations. Methods: A groundbreaking automated method is introduced to transform a calibrated, structured IVD finite element (FE) model into 169 patient-personalized (PP) models through a mesh morphing process. Our approach accurately replicates the real shapes of the patient's Annulus Fibrosus (AF) and Nucleus Pulposus (NP) while maintaining the same topology for all models. Using segmented magnetic resonance images from the former project MySpine, 169 models with structured hexahedral meshes were created employing the Bayesian Coherent Point Drift++ technique, generating a unique cohort of PP FE models under the Disc4All initiative. Machine learning methods, including Linear Regression, Support Vector Regression, and eXtreme Gradient Boosting Regression, were used to explore correlations between IVD morphology and mechanics. Results: We achieved PP models with AF and NP similarity scores of 92.06\% and 92.10\% compared to the segmented images. The models maintained good quality and integrity of the mesh. The cartilage endplate (CEP) shape was represented at the IVD-vertebra interfaces, ensuring personalized meshes. Validation of the constitutive model against literature data showed a minor relative error of 5.20%. Discussion: Analysis revealed the influential impact of local morphologies on indirect mechanotransduction responses, highlighting the roles of heights, sagittal areas, and volumes. While the maximum principal stress was influenced by morphologies such as heights, the disc's ellipticity influenced the minimum principal stress. Results suggest the CEPs are not influenced by their local morphologies but by those of the AF and NP. The generated free-access repository of individual disc characteristics is anticipated to be a valuable resource for the scientific community with a broad application spectrum.

Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus.

Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy-parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI>13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87mm2 exhibited 97% specificity for differentiating PSP from iNPH and 100% from all other conditions. All measures showed low sensitivity. Cerebellar atrophy did not differ significantly among groups. Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.

Correlation between oral cavity volume and upper airway changes in skeletal Class III patients undergoing bimaxillary orthognathic surgery: a pilot cone-beam computed tomography study.

To evaluate changes of the upper airway and oral cavity volumes in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery, and to analyze the correlation between postoperative upper airway decrease and the amount of jaw movement and oral cavity volume reduction. Thirty patients (16 males and 14 females) undergoing bimaxillary surgery were included. Three-dimensional reconstruction of the upper airway and oral cavity were performed using preoperative (T0) and postoperative (T1) (6 months) cone-beam computed tomography scans. The volume, sagittal area and minimum cross-sectional area of the upper airway were diminished (P < .001). The decrease in volume and minimum cross-sectional area in the oropharyngeal region of the upper airway were weakly correlated with B-point posterior movement (P < .05). Total oral cavity volume was decreased, with maxillary oral volume increasing and mandibular oral volume decreasing (P < .001). Upper airway decrease was highly correlated with total oral volume reduction and mandibular oral volume reduction, with the most significant correlation being with total oral volume reduction (P < .001). Class III bimaxillary surgery reduced the volume, sagittal area, and minimum cross-sectional area of the upper airway as well as oral cavity volume. Upper airway changes were weakly correlated with anterior-posterior mandibular movement but significantly correlated with oral cavity volume changes. Thus, oral cavity volume reduction is a crucial factor of upper airway decrease in patients with skeletal Class III malocclusion undergoing bimaxillary orthognathic surgery.

More anterior bone loss in middle vertebra after contiguous two-segment cervical disc arthroplasty

BackgroundContiguous two-segment cervical disc arthroplasty (CDA) is safe and effective, while post-operative radiographic change is poorly understood. We aimed to clarify the morphological change of the three vertebral bodies operated on.MethodsPatients admitted between 2015 and 2020 underwent contiguous two-level Prestige LP CDA were included. The follow-up was divided into immediate post-operation (≤ 1 week), early (≤ 6 months), and last follow-up (≥ 12 months). Clinical outcomes were measured by Japanese Orthopedic Association (JOA) score, visual analogue score (VAS), and neck disability index (NDI). Radiographic parameters on lateral radiographs included sagittal area, anterior-posterior diameters (superior, inferior endplate length, and waist length), and anterior and posterior heights. Sagittal parameters included disc angle, Cobb angle, range of motion, T1 slope, and C2-C7 sagittal vertical axis. Heterotopic ossification (HO) and anterior bone loss (ABL) were recorded.Results78 patients were included. Clinical outcomes significantly improved. Of the three operation-related vertebrae, only middle vertebra decreased significantly in sagittal area at early follow-up. The four endplates that directly meet implants experienced significant early loss in length. Sagittal parameters were kept within an acceptable range. Both segments had a higher class of HO at last follow-up. More ABL happened to middle vertebra. The incidence and degree of ABL were higher for the endplates on middle vertebra only at early follow-up.ConclusionOur findings indicated that after contiguous two-segment CDA, middle vertebra had a distinguishing morphological changing pattern that could be due to ABL, which deserves careful consideration before and during surgery.

Prognostic and morphological factors in pediatric cerebellar contusions.

Although uncommon, cerebellar contusions are associated with significant morbidity and mortality. Literature is lacking in the prognostic and morphological factors relating to their clinical picture and outcomes, especially within children. The objective of this study is to evaluate prognostic and anatomic factors in the clinical picture of cerebellar contusions, including effacement of the 4th ventricle and cisterna magna. This is a retrospective chart review over 11 years across two medical centers. Patients included were under 18 years who presented with a cerebellar contusion. Patients were stratified within the study group based on discharge Glasgow outcome scale (GOS) and reviewed for prognostic factors contributing to outcome. Mid sagittal area of the 4th ventricle and cisterna magna were measured using magnetic resonance imaging and compared within the groups. A total of 21 patients met the study criteria, of which 16 (76.2%) were male, with an average patient age of 8.65 years. Poor outcome at discharge (GOS <4) was associated with decreased admission Glasgow coma scale (P = 0.003), admission motor response (P = 0.006), pupil reactivity (P = 0.014), presence of concomitant subarachnoid hemorrhage (P = 0.010), contusion volume (P < 0.001), and decreased area of the cisterna magna (P = 0.012). Patients with poor outcomes were also more likely to require surgical intervention (P = 0.042). There are multiple prognostic factors associated with the overall outcome following cerebellar contusions. The rate of good outcomes in this study was superior to that in previous studies in adults.

Qualitative and Quantitative Measures in the Infrapatellar Fat Pad in Older Adults: Associations with Knee Pain, Radiographic Osteoarthritis, Kinematics, and Kinetics of the Knee

ObjectiveThe purpose of this study is to delineate cross-sectional associations between qualitative and quantitative measures of the infrapatellar fat pad (IPFP) and knee symptoms, structure, kinematics, and kinetics in older adults. MethodsNinety eligible subjects (90 knees, mean age 54.0 years, 68.9% female) were examined at our centre. We used T2-weighted fat-suppressed magnetic resonance imaging (MRI) to evaluate signal intensity alteration, maximum sagittal area, and depth of the IPFP. Symptomatic osteoarthritis (SOA) was a pain subscale score greater than 0 on the Western Ontario McMaster Osteoarthritis Index. A Kellgren-Lawrence grade ≥ 2 identified incident radiographic osteoarthritis (iROA). Three-dimensional gait data were employed to analyze knee joint kinematics and kinetics. Correlation and regression analyses assessed associations between IPFP measurements and SOA, iROA, kinematics, and kinetics. ResultsThere were strong and positive associations between IPFP signal intensity alteration and both SOA and iROA in multivariable regression analyses [OR (95% CI): 2.849 (1.440 to 5.636), 2.356 (1.236 to 4.492), respectively]. Conversely, a significant negative correlation was observed between IPFP maximum area and flexion angle [B (95%CI): -1.557 (-2.549 to -0.564)]. Moreover, adjusting for covariates did not reveal any significant correlation between IPFP parameters and other indicators (P > 0.05, respectively). ConclusionIPFP signal intensity alteration and area were associated with knee clinical symptoms, structural abnormalities, and flexion angle in adults over 40, respectively. These findings suggest that IPFP may be a crucial imaging biomarker in early and middle knee osteoarthritis.

Virtual Surgical Guidance Improves Quality of Life Following Scapular Free-Flap Reconstruction of Maxillary Defects

BackgroundThe best way for maxillary reconstruction remains the subject of debate, with negative impacts on the patient’s quality of life (QOL). PurposeThis study was designed to evaluate the QOL outcomes following maxillary reconstruction using a scapular-free flap, with and without the computer-aided design and computer-aided manufacturing (CAD/CAM) technique. Study design and patientsA prospective randomized controlled clinical trial was performed following the CONSORT checklist. To be included, patients suffering from maxillary defects without previous surgery or lymph node involvement were selected. Patients with poor oncological prognosis, deficient performance status, preoperative chemotherapy, or radiotherapy, besides vascular contraindications, were excluded. Predictor variableThe predictor variable was the reconstruction technique, grouped into two equal categories. Patients were randomly assigned to reconstruction with a scapular-free flap, with the control group not utilizing a guide and the study group utilizing a CAD/CAM-customized guide. Outcome variableThe primary outcome variable was the various domains of QOL, measured using the University of Washington-QOL (UW-QOL) score, 12 months after reconstruction. Covariatesage; sex; scapular flap side; and maxillary defect tumour type, histopathology, side, length, class, sagittal, and axial differential areas were considered. AnalysesShapiro-Wilk and Kolmogorov-Smirnov tests were performed for normality. For comparisons between the two groups, Student’s t-test and Mann-Whitney test were used. The category variables were compared using the chi-square test. p ≤ 0.05 was considered statistically significant. ResultsThe sample was composed of twenty-two eligible patients, eleven in each group. The mean age of the control group was (50.09±17.14) years, and 45.45% were male, while in the study group, the mean age was (48.36±14.14) years, with 36.36% male. All the patients were evaluated, showing statistically significant differences between control and study groups in terms of pain, appearance, chewing, swallowing, speech, and shoulder (p ≤ 0.05), indicating that the scapular-free flap with a CAD/CAM osteotomy guide had improved the patient's QOL. ConclusionsThe findings of this study indicate that VSP with a CAD/CAM customized osteotomy guide using a scapular-free flap can improve QOL in maxillary reconstruction in terms of pain, appearance, chewing and swallowing food, pronouncing words, and shoulder QOL outcomes.

Morphological and functional changes of the geniohyoid muscle in elderly patients after hip fracture surgery: Comparison of ultrasound images with a focus on swallowing function.

The purpose of this study was to clarify, using ultrasound imaging, (1) whether the area and contraction of GH change in elderly patients after hip fracture surgery and (2) whether the changes in the area and contraction of GH are related to decline in swallowing function. The participants were 21 female patients over 65 years of age who underwent hip fracture surgery. The patients were divided into two groups based on the results of swallowing assessment by water drinking: One with normal swallowing function (NSF) and the other with suspected decline in swallowing function (DSF). Sagittal cross-sectional area (SA) of GH at rest and the shortening rate (SR) of GH upon contraction during swallowing were compared at two time points: immediately and 2 weeks after surgery. Wilcoxon signed-rank test was used for intra-group comparisons, and Mann-Whitney U-test was used for between-group comparisons. SA of GH decreased significantly at 2 weeks after surgery in both groups, regardless of their swallowing function. In the intra-group comparison, SR significantly decreased (worsened) only in DSF group. SR at 2 weeks after surgery was significantly higher in NSF than in the DSF. In the inter-group comparison, DSF showed a significantly smaller (worse) change of SR than NSF in 2 weeks after surgery. Decrease in muscle mass, or atrophy, of GH observed in both NSF and DSF, did not coincide with the post-operative change in GH contraction of the two groups. The results suggest the importance of continuous swallowing assessment in the elderly individuals during their perioperative period.

Ideal chest compression site for cardiopulmonary resuscitation in fontan circulation patients with dextrocardia

BackgroundWe aimed to identify the ideal chest compression site for cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery.MethodsThe most recent stored chest computed tomography images of all patients with a single ventricle who underwent Fontan surgery were retrospectively analysed. We reported that the ideal chest compression site is the largest part of the compressed single ventricle. To identify the ideal chest compression site, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures.Results58 patients (67.2% male) were analysed. The mean right deviation from the midline of the sternum to the ideal compression site was similar to the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal site, the area fraction of the single ventricle significantly increased by 7%, which was greater than that of conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, P < 0.05).ConclusionsWhen performing CPR on a patient with Fontan circulation with dextrocardia, right-sided chest compression may be better than the conventional location.

Pilot multicenter study to determine the utility of point-of-care ultrasound to predict difficulty of tracheal intubation using videolaryngoscopy with the McGrath™ Mac videolaryngoscope.

Clinical airway screening tests used to predict difficulties during airway management have low sensitivity and specificity. Point-of-care airway ultrasound has described measurements related to problems with difficult direct laryngoscopy. Nevertheless, the correlation between ultrasound parameters and videolaryngoscopy has not been published yet. The aim of this multicenter, prospective observational pilot study was to evaluate the applicability of clinical parameters and ultrasound measurements to find potential tracheal intubation difficulties when videolaryngoscopy is used. Preoperatively, six clinical airway assessments were performed: (1) modified Mallampati score, (2) thyromental distance, (3) sternomental distance, (4) interincisal distance, (5) upper lip bite test, and (6) neck circumference. Six ultrasound parameters were measured in awake patients: (1) distance from skin to hyoid bone, (2) distance from skin to epiglottis, (3) hyomental distance in neutral head position, (4) hyomental distance in head-extended position, (5) distance from skin to the deepest part of the palate, and (6) sagittal tongue area. And finally, there was one ultrasound measure obtained in anesthetized patients, the compressed sagittal tongue area during videolaryngoscopy. The difficulty for tracheal intubation using a McGrath™ Mac videolaryngoscope, the percentage of glottic opening, and Cormack-Lehane grade were also assessed. In this cohort of 119 subjects, tongue dimensions, particularly the sagittal tongue area, showed a robust association with increased intubation difficulty using videolaryngoscopy. A multiparametric model combining the following three ultrasound variables in awake patients: (a) the distance from skin to epiglottis, (b) the distance from skin to the deepest part of the palate, and (c) the sagittal tongue area, yielded a sensitivity of 92.3%, specificity of 94.5%, positive predictive value of 82.8%, and negative predictive value of 97.8% (p < 0.001). Point-of-care airway ultrasound emerges as a more useful tool compared to traditional clinical scales to anticipate possible challenges during videolaryngoscopic intubation.

The impact of novel inflammation-preserving treatment towards lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical outcomes study.

We performed a prospective one-year multi-imaging study to assess the clinical outcomes and rate of disc resorption in acute lumbar disc herniation (LDH) patients undergoing inflammation-preserving treatment (i.e. no NSAIDS, steroids). All patients received gabapentin to relieve leg pain, 12 sessions of acupuncture. Repeat MRI was performed, every 3months, after 12 sessions of treatment continued for those without 40% reduction in herniated disc sagittal area. Disc herniations sizes were measured on sagittal T2W MRI sequences, pre-treatment and at post-treatment intervals. Patients were stratified to fast, medium, slow, and prolonged recovery groups in relation to symptom resolution and disc resorption. Ninety patients (51% females; mean age: 48.6years) were assessed. Mean size of disc herniation was 119.54 ± 54.34mm2, and the mean VAS-Leg score was 6.12 ± 1.13 at initial presentation. A total of 19 patients (21.1%) improved at the time of the repeat MRI (i.e. within first 3months post-treatment). 100% of all patient had LDH resorption within one year (mean: 4.4. months). There was no significant difference at baseline LDH between fast, medium, slow, and prolonged resorption groups. Initial LDH size was weakly associated with degree of leg pain at baseline and initial gabapentin levels. Surgery was avoided in all cases. This is the first study to note inflammation-preserving treatment, without conventional anti-inflammatory and steroid medications, as safe and effective for patients with an acute LDH. Rate of disc resorption (100%) was higher than comparative recent meta-analysis findings (66.7%) and no patient underwent surgery.

Anatomic Assessment of L1-S1 Neuroforaminal Dimensions Using Computed Tomography in 1,000 Patients: A Follow-Up Study.

While the radiographic criteria for diagnosing central lumbar stenosis are well described, criteria for diagnosing neuroforaminal stenosis (NFS) are unclear. Prior research has utilized magnetic resonance imaging (MRI) to characterize neuroforaminal dimensions (NFDs). However, this approach has inherent limitations that can adversely impact measurement accuracy. Existing literature on the use of computed tomography (CT) to investigate normal NFDs is limited. The purpose of the present study was to describe normal lumbar NFDs that would aid in the establishment of objective quantitative criteria for the diagnosis of NFS. This study evaluated CT imaging of 494 female and 506 male subjects between 18 and 35years of age to determine normal NFDs, specifically the sagittal anteroposterior width, craniocaudal height, and area. Statistical analyses were performed to assess differences in NFDs according to variables including sex, height, weight, body mass index, and ethnicity. Without differentiating between sides or disc levels, mean NFDs were 8.71mm for sagittal anteroposterior width, 17.73mm for craniocaudal height, and 133.26mm2 for area (n = 10,000 measurements each). Male subjects had larger NFDs than females at multiple levels. Asian and Caucasian subjects had larger NFDs than Hispanic and African American subjects at multiple levels. There were no associations between NFDs and anthropometric factors. The present study describes normal lumbar NFDs in young, healthy patients. NFDs were influenced by sex and ethnicity but not by anthropometric factors.

Study on articular surface morphology of atlantoaxial lateral mass based on differential manifold

ObjectivesTo propose a surface reconstruction algorithm based on a differential manifold (a space with local Euclidean space properties), which can be used for processing of clinical images and for modeling of the atlantoaxial joint. To describe the ideal anatomy of the lateral atlantoaxial articular surface by measuring the anatomical data.MethodsComputed tomography data of 80 healthy subjects who underwent cervical spine examinations at our institution were collected between October 2019 and June 2022, including 46 males and 34 females, aged 37.8 ± 5.1 years (28–59 years). A differential manifold surface reconstruction algorithm was used to generate the model based on DICOM data derived by Vision PACS system. The lateral mass articular surface was measured and compared in terms of its sagittal diameter, transverse diameter, articular surface area, articular curvature and joint space height.ResultsThere was no statistically significant difference between left and right sides of the measured data in normal adults (P > 0.05). The atlantoaxial articular surface sagittal diameter length was (15.83 ± 1.85) and (16.22 ± 1.57) mm on average, respectively. The transverse diameter length of the articular surface was (16.29 ± 2.16) and (16.49 ± 1.84) mm. The lateral articular surface area was (166.53 ± 7.69) and (174.48 ± 6.73) mm2 and the curvature was (164.03 ± 5.27) and (153.23 ± 9.03)°, respectively. The joint space height was 3.05 ± 0.11mm, respectively. There is an irregular articular space in the lateral mass of atlantoaxial, and both upper and lower surfaces of the articular space are concave. A sagittal plane view shows that the inferior articular surface of the atlas is mainly concave above; however, the superior articular surface of the axis is mainly convex above. In the coronal plane, the inferior articular surface of the atlas is mostly concave above, with most concave vertices located in the medial region, and the superior articular surface of the axis is mainly concave below, with most convex vertices located centrally and laterally.ConclusionA differential manifold algorithm can effectively process atlantoaxial imaging data, fit and control mesh topology, and reconstruct curved surfaces to meet clinical measurement applications with high accuracy and efficiency; the articular surface of the lateral mass of atlantoaxial mass in normal adults has relatively constant sagittal diameter, transverse diameter and area. The distance difference between joint spaces is small, but the shape difference of articular surfaces differs greatly.