Subjective Grading System Research Articles

Better operating room efficiency and reduced staff demand: Individualised versus off-the-shelf total knee arthroplasty.

The purpose of this pilot cross-sectional study was to compare the operating room (OR) efficiency and intraoperative staff task load when performing individualised versus off-the-shelf (OTS) total knee arthroplasty (TKA). A consecutive series of 28 patients randomised (1:1) to receive either OTS TKA or individualised TKA were included. The OR staff workload was assessed with the NASA Task Load Index (TLX), a subjective grading system assessing mental demand, physical demand, temporal demand, performance, effort and frustration on a scale from 0 (very low) to 20 (very high). The time for patient preparation, surgical time, closureand total OR time was recorded to assess OR efficiency. Effect sizes of differences between OTS and individualised TKA were expressed as mean differences (MDs) with 95% confidence intervals (CIs). Patients in both cohorts were similar in age (OTS vs. individualised TKA (median [IQR]), 67 [63-76] vs. 71 [68-79]; p = 0.207) and body mass index (BMI) (29 [24-33] vs. 29 [26-31]; p = 0.807), and there were no significant differences in other preoperative characteristics. The OR staff perceived individualised TKA as less demanding than OTS TKA: Individualised TKA was rated significantly better across the six domains of the NASA TLX: mental demand by 5.6 points, physical demand by 6.3 points, temporal demand by 5.3 points, performance by 3.6 points, effort by 5.9 pointsand frustration by 5.8 points. Individualised TKA resulted in statistically significantly shorter mean total OR time (MD, 10 min; p = 0.018). The staff in the OR found that individualised TKA is less mentally, physicallyand temporally demanding than OTS TKA. The average total time spent in the OR during individualised TKA is 10 minless than during OTS TKA. This study constitutes a part of a larger registered randomised controlled trial comparing patient satisfaction following OTS versus individualised TKA (NCT04460989). Level III.

MP68-09 VALIDATION OF AN OBJECTIVE PRESSURE TEST FOR URETHROVESICAL ANASTOMOSIS IN A NON-BIOHAZARDOUS ROBOT ASSISTED RADICAL PROSTATECTOMY SIMULATION MODEL

You have accessJournal of UrologyCME1 Apr 2023MP68-09 VALIDATION OF AN OBJECTIVE PRESSURE TEST FOR URETHROVESICAL ANASTOMOSIS IN A NON-BIOHAZARDOUS ROBOT ASSISTED RADICAL PROSTATECTOMY SIMULATION MODEL Nathan Schuler, Alexis Steinmetz, Kit Yuen, Lauren Shepard, Tyler Holler, Christopher Wanderling, and Ahmed Ghazi Nathan SchulerNathan Schuler More articles by this author , Alexis SteinmetzAlexis Steinmetz More articles by this author , Kit YuenKit Yuen More articles by this author , Lauren ShepardLauren Shepard More articles by this author , Tyler HollerTyler Holler More articles by this author , Christopher WanderlingChristopher Wanderling More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethrovesical Anastomosis (UVA) is a critical step within Robot Assisted Radical Prostatectomy (RARP) which directly influences postoperative complication and continence recovery. The current standard for assessing UVA proficiency is mainly through the Robotic Anastomosis Competency Evaluation (RACE), a subjective video-based grading system. We have previously validated embedded force sensors within realistic RARP models as an objective method to measure torque during nerve sparing. Herein, we developed an adjacent pressure test with parallels to common urodynamic testing as an objective metric to evaluate UVA integrity in our RARP simulation. METHODS: 48 simulated robotic UVA were completed by urologists with varying experience levels: 6 experts (EXP), 16 intermediates (IM) and 26 novices (NOV)). Following simulation, bladders were dissected from surrounding tissue and subjected to a pressure leak test. Bladders were filled to predetermined volumes at a constant rate. Internal volume when leakage at the UVA site started and at end of filling were measured, then used to calculate maximum internal pressure (Pmax) and pressure at leakage start (Pleak). Flow Fractionation (FF) was calculated by allowing free fluid flow through both UVA site and urethra onto separate, tared scales and recorded throughout the test. RACE scores were assigned by two blinded expert video reviewers. RESULTS: EXP showed higher Pmax, FF, and Pleak versus NOV (p=.0009; p=.005; p=.011) as well as EXP vs IM (p=.028; p=.047; p=.047), however IM vs NOV lacked significance. Multivariate analysis found significant positive correlations between Knot Tying (KT), Suture Placement (SP) and Tissue Approximation (TA) with FF (p=.017; p=.051; p=.0007) and Pmax (p=0.01; p=.087; p=.0005). TA and KT had significant correlations with Pleak (p=.0027; p=.085) (Figure 1). CONCLUSIONS: The bladder pressure test and its parameters we have developed represent three objective metrics that can be used to assess the ability of a trainee to complete a UVA that would succeed in an intraoperative leak test. Stratification of test difficulty towards the upper end of the RACE score spectrum offers more granularity by which intermediates can assess performance vs experts. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e956 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Schuler More articles by this author Alexis Steinmetz More articles by this author Kit Yuen More articles by this author Lauren Shepard More articles by this author Tyler Holler More articles by this author Christopher Wanderling More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

Photoacoustic/ultrasonic dual-mode imaging for monitoring angiogenesis and synovial erosion in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by the formation of new vessels, synovial proliferation and destruction of articular cartilage. However, characteristic early diagnostic and therapeutic monitoring methods are still lacking. We report a study using a photoacoustic/ultrasound (PA/US) dual-mode imaging for RA disease. By establishing a collagen-induced (CIA) RA mouse model to classify disease states based on a subjective grading system, PA/US imaging allows real-time assessment of synovial erosion and vascular opacification within the knee joint in different disease states at high spatial resolution. The system also quantitatively monitors subcutaneous vascular physiology and morphology in the hind paw of mice, measuring the area and photoacoustic signal intensity of vascular proliferation and showing a positive correlation with disease grading. Compared to traditional subjective scoring of arthritis severity, the PA/US imaging is more sensitive i.e., vascular signals and synovial erosion can be observed early in the course of arthritis.

Integrated radiomics, dose-volume histogram criteria and clinical features for early prediction of saliva amount reduction after radiotherapy in nasopharyngeal cancer patients

PurposePreviously, the evaluation of xerostomia depended on subjective grading systems, rather than the accurate saliva amount reduction. Our aim was to quantify acute xerostomia with reduced saliva amount, and apply radiomics, dose-volume histogram (DVH) criteria and clinical features to predict saliva amount reduction by machine learning techniques.Material and methodsComputed tomography (CT) of parotid glands, DVH, and clinical data of 52 patients were collected to extract radiomics, DVH criteria and clinical features, respectively. Firstly, radiomics, DVH criteria and clinical features were divided into 3 groups for feature selection, in order to alleviate the masking effect of the number of features in different groups. Secondly, the top features in the 3 groups composed integrated features, and features selection was performed again for integrated features. In this study, feature selection was used as a combination of eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) to alleviate multicollinearity. Finally, 6 machine learning techniques were used for predicting saliva amount reduction. Meanwhile, top radiomics features were modeled using the same machine learning techniques for comparison.Result17 integrated features (10 radiomics, 4 clinical, 3 DVH criteria) were selected to predict saliva amount reduction, with a mean square error (MSE) of 0.6994 and a R2 score of 0.9815. Top 17 and 10 selected radiomics features predicted saliva amount reduction, with MSE of 0.7376, 0.7519, and R2 score of 0.9805, 0.9801, respectively.ConclusionWith the same number of features, integrated features (radiomics + DVH criteria + clinical) performed better than radiomics features alone. The important DVH criteria and clinical features mainly included, white blood cells (WBC), parotid_glands_Dmax, Age, parotid_glands_V15, hemoglobin (Hb), BMI and parotid_glands_V45.

Objectively quantifying facial erythema in rosacea aided by the ImageJ analysis of VISIA red images.

Facial erythema, a prominent characteristic of rosacea, causes concern to both the patient and doctor. In clinical practice, commonly used erythema severity subjective assessment tools lack objectivity and are less comprehensive. Even with images taken by the VISIA® system, diffused erythema is difficult to segment and evaluate fully due to the automatic threshold segmentation method. This study aimed to explore a more objective and scientificerythema quantification tool with the aid of the ImageJ software analysis of the red area images taken by the VISIA® system. Patients with rosacea were enrolled and assessed for the clinical severity of their illness using various stools-the standard grading systems (SGS) for rosacea, investigator's global assessment (IGA), and clinician's erythema assessment (CEA). Facial images in the red area mode of the VISIA® system were further analyzed by the ImageJ for the relative intensity of redness and percentage of erythema area; the correlation with the scores of the subjective grading systems was evaluated. This study included 201 patients (195 females and 6 males). The relative intensity of redness was positively correlated to the SGS, IGA, and CEA scores (0.688, 0.725, and 0.718, respectively) (p < 0.001). The percentage of erythema area was positively correlated to the SGS, IGA, and CEA scores (0.615, 0.666, and 0.656, respectively) (p < 0.001). We demonstrated a more objective and precise method of assessing the severity of facial erythema rosacea, which could comprehensively assess the severity by both the area and intensity of facial erythema.

Classification of Parkinson’s disease using Machine Learning Techniques

Biomarkers derived from human speech could be used to investigate neurological illnesses such as paralysis agitans (PD). PD is a neurodegenerative disease that affects about one million people. Clinicians have previously relied on subjective grading systems to determine the severity of Parkinson's disease. Due to difficulties with control, vocalization can be used to detect and diagnose Parkinson's disease. As a result of technology improvements and the widespread usage of audio gathering equipment in everyday life, healthcare providers may profit from less expensive and more accurate diagnosis. Using a medical data dataset obtained from people with and without Parkinson's disease, we provide evidence to support this theory. Decision Tree, Logistic Regression, and Naive Bayes are examples of Machine Learning algorithms, as are Deep Learning algorithms like Recurrent Neural Networks.

Cross-Cultural Adaptation and Measurement Properties of the Indonesian Kujala Score for Anterior Cruciate Ligament Tear Patients.

Introduction:There is an overwhelming need for worldwide applicable subjective grading systems for patients' anterior cruciate ligament (ACL) tear. The scoring system should be validated for their use in advance related measurements. For the Indonesian language speaking population, only the Kujala Patellofemoral Score (KPS) questionnaire has been translated and validated into the Indonesian language for diseases related to knee pain, but none for ACL tears. The present study aims at cross-cultural adaption to measure the validity and reliability of the Kujala patellofemoral score Indonesian version (KPS-I) specifically for ACL tear patients.Material and methods:The responses of 106 ACL tear patients on two questionnaires comprising the KPS-I and Short Form (SF)–36 were examined by determining the validity and reliability. We conducted the validity construct and content, so the reliability was evaluated by test-retest reliability, internal consistency and measurement error. In addition, the research utilised the Bland and Altman method to explore absolute agreement.Results:The construct and content validity were good, where all hypotheses were confirmed, and the floor or ceiling effect did not occur. The reliability proved excellent between test and retest (ICC=0.99). An internal consistency showed a good Cronbach α of 0.86. The standard error of measurement (SEM), minimal detectable change at the individual (MDCind), and minimal detectable change at the group (MDCgrp) were determined to be 2.1, 5.8, and 0.7, respectively. The application of the Bland and Altman plot method revealed no bias in this study.Conclusion:The validation procedure shows that the KPS-I is a good evaluation instrument for Indonesian patients with ACL tear. However, it is suggested that this score be used for follow-up of patients after ACL reconstruction procedure, especially with anterior knee pain related to the original objective of the Kujala score.

A deep learning framework for automated detection and quantitative assessment of liver trauma

BackgroundBoth early detection and severity assessment of liver trauma are critical for optimal triage and management of trauma patients. Current trauma protocols utilize computed tomography (CT) assessment of injuries in a subjective and qualitative (v.s. quantitative) fashion, shortcomings which could both be addressed by automated computer-aided systems that are capable of generating real-time reproducible and quantitative information. This study outlines an end-to-end pipeline to calculate the percentage of the liver parenchyma disrupted by trauma, an important component of the American Association for the Surgery of Trauma (AAST) liver injury scale, the primary tool to assess liver trauma severity at CT.MethodsThis framework comprises deep convolutional neural networks that first generate initial masks of both liver parenchyma (including normal and affected liver) and regions affected by trauma using three dimensional contrast-enhanced CT scans. Next, during the post-processing step, human domain knowledge about the location and intensity distribution of liver trauma is integrated into the model to avoid false positive regions. After generating the liver parenchyma and trauma masks, the corresponding volumes are calculated. Liver parenchymal disruption is then computed as the volume of the liver parenchyma that is disrupted by trauma.ResultsThe proposed model was trained and validated on an internal dataset from the University of Michigan Health System (UMHS) including 77 CT scans (34 with and 43 without liver parenchymal trauma). The Dice/recall/precision coefficients of the proposed segmentation models are 96.13/96.00/96.35% and 51.21/53.20/56.76%, respectively, in segmenting liver parenchyma and liver trauma regions. In volume-based severity analysis, the proposed model yields a linear regression relation of 0.95 in estimating the percentage of liver parenchyma disrupted by trauma. The model shows an accurate performance in avoiding false positives for patients without any liver parenchymal trauma. These results indicate that the model is generalizable on patients with pre-existing liver conditions, including fatty livers and congestive hepatopathy.ConclusionThe proposed algorithms are able to accurately segment the liver and the regions affected by trauma. This pipeline demonstrates an accurate performance in estimating the percentage of liver parenchyma that is affected by trauma. Such a system can aid critical care medical personnel by providing a reproducible quantitative assessment of liver trauma as an alternative to the sometimes subjective AAST grading system that is used currently.

Functional outcome of autologous platelet rich plasma injection in plantar fasciitis and tennis elbow

Recent developments in cellular and molecular biology have emerged as a potent tool in the management of orthopaedic illnesses and injuries. Upon binding to the target cell receptor, the growth factor from platelets triggers the activation of an intracellular signal transduction system, which results in a biological response that is essential for chemotaxis, cell proliferation, and osteoblastic differentiation. The aim of this study is to determine the efficacy and safety of autologous platelet-rich plasma injection in tennis elbow and plantar fasciitis. We conducted a prospective study with patients who were suffering from plantar fasciitis (n=37) or tennis elbow (n=23) and were given with autologous platelet-rich plasma injection. A short term follow up of all these cases were done at regular intervals for 1, 4, 8, and 12 weeks. The clinical outcomes were analyzed with severity of pain and movements of the pathological part. The functional outcomes were analyzed with VAS and AOFAS scoring for plantar fasciitis and VAS and Mayo’s elbow scoring for tennis elbow. All these patients were statistically analyzed by repeated measures ANOVA test. Our investigation found a statistically significant difference between pre-procedural and post-procedural scores in both the subjective (VAS) and functional (AOFAS and Mayo elbow score) grading systems used in this study. Patients who received an autologous platelet-rich plasma injection experienced a statistically significant (p &amp;#60;0.05) improvement in their ability to combat both of the musculoskeletal illnesses studied. Autologous platelet-rich plasma acts as a promising efficacious biological therapeutic agent for use in musculoskeletal disorders such as plantar fasciitis and tennis elbow without major complications upon its usage.

Diagnostics and Therapy of Idiopathic Facial Palsy (Bell's Palsy)

The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the treatment of Bell's palsy. This review is focusing on the acute phase of the disease. The chronic phase, with incomplete, incorrect or no recovery of the palsy, is described briefly. Treatment with prednisolone alone within 72 hours after onset still is the cornerstone of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough clinical trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the subjective severity of the disease and psychosocial impact of Bell's palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as studies on the role of salvage second line therapy after insufficient response to initial corticosteroid treatment. An international consensus on the outcome measures in diagnostics and follow-up is also needed.

A computed tomographic study of endodontic and apical changes in 81 equine cheek teeth with sagittal fractures.

Sagittal fractures of equine cheek teeth are commonly observed during oral examination. There are few reports on the apical and endodontic pathology associated with such fractures seen during computed tomographic (CT) examination. This study aimed to document the prevalence of CT changes indicative of apical disease in equine cheek teeth, which have suffered a sagittal fracture involving the clinical±reserve crown. This study is a retrospective case series. CT examinations of equine heads with sagittal fractures of cheek teeth present were reviewed: 81 teeth from 49 horses were identified to have a sagittal cheek tooth fracture. The images were evaluated for apical pathology including gas (in the endodontic system and periapically), widened periodontal space, periapical sclerosis, apical clubbing, cementoma/hypercementosis, lamina dura loss, associated sinusitis and sinus mucosal swelling. An apical infection grading system was created to give each tooth a score. Hounsfield units were used to measure the density of the endodontic, apical and periapical regions. The fracture length ratio was recorded. Statistical analysis was performed using a generalised estimating equation to evaluate predictors of apical infection and associations between clinical signs and CT abnormalities. Eighty-seven sagittal fractures (56 buccal, 17 palatal/lingual and 14 midline) from 81 teeth were recorded (74 maxillary and 7 mandibular). Apical infection was diagnosed in 73% (37/51, P=.05) of buccal, 55% (6/11, P=.07) of palatal/lingual, 100% (13/13) of midline, 100% (6/6) of multiple fractures and 96% (23/24, P=.008) of fractures involving infundibula. There was no significant relationship between apical infection and the presence of clinical signs associated with dental pathology (P=.4). There was no significant association between fracture length ratio and apical infection (P=1.0). Midline sagittal fractures were significantly associated with sinusitis when compared with all other maxillary fractures (odds ratio [OR] 5.92, 95% confidence interval [CI] 1.67-20.83, P=.006). Loss of the lamina dura was not significantly associated with apical infection (P=.5). There is a maxillary cheek tooth bias in the data set and the subjective grading system. A large proportion of fractured cheek teeth have evidence of apical infection on CT examination and therefore warrant treatment.

Assessment of reliability and validity of the 5-scale grading system of the point-of-care immunoassay for tear matrix metalloproteinase-9

We evaluated the reliability and validity of the 5-scale grading system to interpret the point-of-care immunoassay for tear matrix metalloproteinase (MMP)-9. Six observers graded red bands of photographs of the readout window in MMP-9 immunoassay kit (InflammaDry) two times with 2-week interval based on the 5-scale grading system (i.e. grade 0–4). Interobserver and intraobserver reliability were evaluated using intraclass correlation coefficients. The interobserver agreements were analyzed according to the severity of tear MMP-9 expression. To validate the system, a concentration calibration curve was made using MMP-9 solutions with reference concentrations, then the distribution of MMP-9 concentrations was analyzed according to the 5-scale grading system. Both intraobserver and interobserver reliability was excellent. The readout grades were significantly correlated with the quantified colorimetric densities. The interobserver variance of readout grades had no correlation with the severity of the measured densities. The band density continued to increase up to a maximal concentration (i.e. 5000 ng/mL) according to the calibration curve. The difference of grades reflected the change of MMP-9 concentrations sensitively, especially between grade 2 and 4. Together, our data indicate that the subjective 5-scale grading system in the point-of-care MMP-9 immunoassay is an easy and reliable method with acceptable accuracy.

Retrieval Analysis of Polyethylene Components in Rotating Hinge Knee Arthroplasty Implants

BackgroundThis study examined a cohort of retrieved rotating hinge (RH) total knee arthroplasty implants of four different designs with emphasis on the surface damage observed on the polyethylene components. Our purpose was to determine if differences in polyethylene damage existed among the designs, and if those differences could be explained by differences in design characteristics. Materials and MethodsSeventy-two RH implants from four manufacturers (DePuy LPS/SROM, Zimmer NexGen, Stryker Howmedica MRH, and Biomet Finn-OSS) removed at the time of revision performed between 2002 and 2017 were identified in our institutional retrieval registry. Damage to the surfaces of the polyethylene was assessed using a subjective grading system and evaluated in multiple zones. Design characteristics that were evaluated included the following: location of the dwell point on the polyethylene component, posterior position of the axle, and amount of hyperextension and rotation allowed by the implant. ResultsThere were no differences in total damage scores between the four implant groups (P = .45). The Stryker Howmedica MRH group showed the least backside wear of all implants but significantly more articular-sided wear compared with two of the other three groups. All implants except NexGen showed increased total damage scores in implants revised for mechanical (vs nonmechanical) reasons and in implants with a longer duration of implantation. ConclusionNo single implant design emerged as superior in terms of minimizing polyethylene wear damage. Polyethylene damage existed in various locations but was not different in severity across designs, suggesting that there is no clear superior RH design that minimizes overall articular surface wear compared with other designs.

Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis

Background: The pivot-shift test is used to assess for rotatory knee laxity in the anterior cruciate ligament (ACL)-deficient knee and ACL-reconstructed knee; however, the pivot shift uses a subjective grading system that is limited by variability between examiners. Consequently, quantified pivot shift (QPS) test software (PIVOT iPad application) has been developed and validated to measure the magnitude of rotatory knee laxity during the positive pivot-shift test. Purpose: To employ intraoperative QPS (iQPS) to assess for differences in residual rotatory knee laxity after ACL reconstruction (ACLR) versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET), and to employ iQPS to determine if ACLR and/or ACLR + LET result in overconstrained knee kinematics when compared with the contralateral knee. Study Design: Cohort study; Level of evidence, 2. Methods: iQPS was performed in 20 patients by a single surgeon on both the operative and contralateral knees before ACLR. ACLR was augmented with a LET if the lateral compartment tibial translation measured during QPS was greater than or equal to double the amount of lateral tibial compartment translation measured for the contralateral knee. After each reconstruction (ACLR or ACLR + LET), iQPS measurements were performed. iQPS data were compared with the preoperative QPS measurements of the operative and contralateral knees. Postoperative iQPS data were compared with both the preoperative QPS measurements of the operative and contralateral knees with paired samples t tests. Categorical variables were compared using the Fisher exact test. Results: The mean age in the cohort was 17.3 years (range, 15-24 years). There were no significant differences between the groups in terms of the proportion of male patients (ACLR: 5 male, 5 female vs ACLR + LET: 4 male, 6 female) or age (ACLR: 17.7 ± 3.3 years; 95% CI, 15.4-24.0 vs ACLR + LET: 16.8 ± 2.8 years, 95% CI, 14.8-22.0; P = .999). There were no significant differences between the groups with respect to preoperative QPS performed during examination under anesthesia (ACLR: 4.7 ± 2.0 mm; 95% CI, 3.3-6.1 vs ACLR + LET: 3.6 ± 1.8 mm; 95% CI, 2.3-4.9; P = .2). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity when compared with preoperative QPS measurements (ACLR: –3.4 ± 1.7 mm; 95% CI, −4.6 to −2.2; P < .001: ACLR + LET: –2.6 ± 1.9 mm; 95% CI, −3.9 to −1.3; P < .002). Moreover, when compared with isolated ACLR, ACLR + LET did not result in a significantly smaller magnitude of change in iQPS between the pre- and postoperative states (P = .3). Conclusion: Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee laxity. The augmentation of ACLR with LET did not change the constraint of the knee with respect to lateral compartment translation as measured during iQPS.

Prognostic value of a three-dimensional dynamic quantitative analysis system to measure facial motion in acute facial paralysis patients

BackgroundTo investigate the prognostic value of a three-dimensional dynamic quantitative analysis system to measure facial motion (3D ASFM) in acute facial palsy patients and compare it with subjective grading methods and electroneurography.MethodsWe continuously recruited 37 patients with acute (< 1 month) Bell’s palsy. An integrated evaluation of facial palsy was performed for each patient. The integrated evaluation included the House-Brackmann grading system (H-BGS), Sunnybrook Facial Grading System (SFGS), electroneurography and three-dimensional objective measurements. Then, the entire set of evaluations were repeated for each patient 1 month later. The patients were followed up monthly until recovery or for up to more than 6 months. We adopted the SFGS and H-BGS as the representative subjective grading system and final criteria for recovery. Poor recovery was defined as an SFGS score less than 70 or H-BGS score higher than II.ResultsMultiple regression analysis was performed to find the best prognostic indicators. In less than 1 month from onset, ENoG had the highest prognostic value. However, in the second month from onset, the results of SFGS and 3D ASFM were identified as the best prognostic parameters, and a prediction formula with a determination coefficient of 0.673 was established. The receiver operating characteristic curves revealed that a gross score of the 3D ASFM less than 31 in the first evaluation and 49 in the second evaluation had higher sensitivity and specificity to predict poor recovery.ConclusionsIn different phases of Bell’s palsy, the best predictor of prognosis is different. ENOG is the most effective predictor of the prognosis in the first month after onset. In the second month after onset, the combination of SFGS and 3D ADSM is considered to be the best prognostic predictor.

Plus Tree Selection of Quercus salicina Blume and Q. glauca Thunb. and Its Implications in Evergreen Oaks Breeding in Korea

This study was conducted to select plus trees of two evergreen oaks, Quercus salicina and Q. glauca, in Korea. Evergreen oaks are distributed in subtropical region in Korea and have recently emerged as one of the alternative tree species against climate change. Accordingly, a tree breeding program is underway to foster evergreen oaks as a reforestation species for the future. Through intensive survey on the distribution range, 15 stands (8 for Q. salicina, 3 for Q. glauca, and 4 for both species) were selected as base populations. To select candidate trees, we developed a subjective grading system with six characteristics in three categories and introduced a weighted generalized value (GVIw) to compare superiority of candidate trees. The candidate trees were screened using baseline value ‘0’, i.e., if GVIw &gt; 0, then accepted and if GVIw &lt; 0, then rejected. After then, adjustment was conducted to avoid biasing the selection of plus trees for a particular location. Through this process, 44 candidate trees in Q. salicina and 41 candidate trees in Q. glauca were selected as plus trees. Finally, the results and implications were discussed in relation to evergreen oak breeding in Korea.

Effect of a Subjective Grading System and Blending with Polyester on Selected Wool and Yarn Characteristics of Subtropical Egyptian Barki Sheep

Seven-hundred kilograms of subtropical Barki wool was collected to study the effect of a subjective grading system and blending with polyester on selected wool and yarn characteristics. Wool was graded subjectively into coarse, fine and raw; then each grade was blended with 0%, 15%, 25%, 35% and 45% of polyester. Staple and yarn strengths were higher in both coarse and fine grades compared with raw wool. Staple elongation of the fine grade reached 3 times that of coarse grade and twice as much as raw grade. Also, in the 100% wool blend, yarn elongation of the fine grade was twice as much as both coarse and raw grades. The fine grade had the highest yarn friction, followed by other grades. Generally, adding polyester to coarse and fine grades led to an improved yarn strength compared with the raw grade. Adding 15% polyester caused the highest improvement among other percentages. Correlations among traits were also discussed.

Lateral Extra-Articular Tenodesis Does Not Affect Rotatory Knee Instability in Anatomic ACL Reconstruction

Objectives: Single-bundle, anatomic anterior cruciate ligament reconstruction (ACLR) may not fully restore rotatory knee stability, and the addition of a lateral extra-articular tenodesis (LET) has been proposed as means for reducing residual rotatory knee instability. However, the magnitude of the in vivo, time zero effects of these procedures on rotatory knee instability remain poorly defined. The pivot shift test is used to assess for rotatory knee instability; however, it is a subjective grading system with limited generalizability and ability to predict clinical outcomes. Consequently, a quantified pivot shift (QPS) test software application, PIVOT iPad, has been developed and validated to measure the magnitude of rotatory knee laxity. The objective of this study was use intraoperative QPS (iQPS) to assess for differences in residual rotatory knee instability after ACLR versus ACLR augmented with lateral extra-articular tenodesis (ACLR + LET.) Methods: During examination under anesthesia (EUA), QPS was performed on both the operative and non-operative knees prior to ACLR (Figure 1A) Three, yellow ¾ inch markers were attached to skin overlying bony landmarks: lateral epicondyle, Gerdy’s tubercle and 3 cm posterior to Gerdy’s tubercle. The PIVOT software application was used to measure lateral compartment translation (Figure 1B) ACLR were randomly augmented with a LET if the lateral compartment translation measured during QPS was greater than or equal to double the amount of lateral compartment translation measured for the unaffected knee. iQPS measurements were subsequently performed after either ACLR or ACLR + LET with sterile markers (Figure 1C) iQPS data were recorded and compared to both the preoperative QPS measurements of the affected and unaffected knees. Based upon normative QPS data established from a database of &gt;150 previously performed ACLR at our institution, it was determined that 8 patients in each group would be required to achieve 80% power with an effect size of 1.2 mm and an alpha level of 0.05. Post-procedure iQPS data were compared to preoperative QPS measurements with paired samples t-tests. Results: iQPS measurements were performed in 20 ACLR (10 ACLR and 10 ACLR + LET). The mean age in the cohort was 17.3 years old (range: 17-24 years old.). Both ACLR and ACLR + LET resulted in significant decreases in rotatory knee instability when compared to preoperative QPS measurements (pre-ACLR: 4.7 ± 1.9 v. post-ACLR: 1.3 ± 0.70, P &lt; 0.001; pre-ACLR +LET: 3.6 ± 1.8 v. post-ACLR + LET: 0.9 ± 0.5, P &lt; 0.001.) When comparing isolated ACLR to ACLR + LET, no significant differences were observed in the magnitude of change in iQPS between the pre and post-intervention states (ACLR: - 3.5 ± 1.6 mm v. ACLR + LET: -1.5 ± 3.1 mm, P = N.S.) Furthermore, there were no significant differences in lateral compartment translation between the operative knees and non-operative knees (ACLR: -0.1 ± 0.9 mm v. ACLR + LET: -0.5 ± 1.0 mm, P = N.S.), suggesting that neither ACLR nor ACLR + LET led to over-constrained kinematics. Conclusion: In this randomized control study, both ACLR and ACLR + LET resulted in significant decreases in rotatory knee instability. However, there were no significant differences in time-zero, rotatory knee instability detected between isolated ACLR versus ACLR combined with LET in patients. The utility of combining a LET with ACLR remains unclear, and future research is necessary to refine the indications for LET in patients with high-grade rotatory knee instability.

Coronal plane laxity of valgus osteoarthritic knee.

Balanced soft tissues are important to total knee arthroplasty (TKA) outcomes. Surgical algorithms for balancing are potentially varied in varus and valgus osteoarthritic (OA) knees. While coronal plane varus knee laxity has been documented, no study has objectively defined the medial and lateral laxity of the valgus OA knee. The lower limb was manipulated at the time of TKA using computer navigation, prior to surgical releases, to allow the limb weight-bearing axis to pass through the knee center in maximum extension, 20° and 90° of flexion. The hip-knee-ankle-angle was documented at this position. Coronal plane laxity was then measured in 30 valgus (7.9 ± 4.0°) knees as medial and lateral displacement from this point and compared to published values for healthy subjects. In maximum knee extension, lateral contracture was present in 26.6% (8/30) of subjects, and abnormally lax medial tissue was present in 46.6% (14/30). Six patterns of medial versus lateral laxity were documented in maximum extension. In maximum knee extension, mean medial laxity was 7.1° (±3.8°) compared to 2.7° (±2.7°) laterally. In 20° of knee flexion, mean medial laxity was 8.5° (±3.5°) compared to 3.0° (±2.6°) laterally. In 90° of knee flexion, mean medial laxity was 3.7° (±1.3°) and 7.5° (±3.0°) laterally. A highly significant difference ( p < 0.0001) in mean laxity was demonstrated when comparing medial versus lateral values at each measurement angle and for medial versus medial and lateral versus lateral values for maximum extension and 90° of flexion. The valgus knee at the time of TKA demonstrates significant preoperative mediolateral and flexion-extension imbalance. In maximum extension, medial tissue is significantly laxer whereas in flexion this reverses and the lateral tissue is significantly laxer. We documented more patterns of medial and lateral laxity in maximum extension than advocated in prior subjective grading systems. These findings demonstrate the challenges of valgus OA knee balancing during TKA but provide, for the first time, objective measures for the starting point of this process.

Interobserver Reliability of Spinal Adverse Events Severity System - Neuro (SAVES-N): A Prospective Adverse Event Reporting System for Neurosurgical Cases

The reporting of adverse events (AEs) in neurosurgery uses inconsistent definitions and subjective grading systems. A standardized system for recording and describing AEs would allow valid comparisons to be drawn between different institutions, using different technologies, at different times. The Spinal Adverse Events Severity System - Neuro (SAVES-N) system is a modification of the well-validated SAVES-V2 system that encompasses complications from both cranial and spinal surgery. The objective of this study was to assess the interobserver reliability of SAVES-N in spinal and cranial neurosurgery. Ten vignettes, including cranial and spinal neurosurgical cases, were assessed by groups of consultant neurosurgeons (n= 5) and neurosurgical registrars (n= 5) using the SAVES-N system. Interobserver reliability for the presence of AEs, the type of AE, and the SAVES severity grade of the AE were calculated using Gwet's AC2 and Fleiss' kappa and were interpreted using the thresholds described by Landis and Koch. Neurosurgeons had almost-perfect agreement (Gwet AC2= 0.93), whereas registrars had substantial agreement (Gwet's AC2= 0.74) in determining the presence or absence of AEs. Both neurosurgeons (Fleiss' kappa= 0.78) and registrars (Fleiss' kappa= 0.70) demonstrated substantial agreement within their groups as to the type of AE. Similarly, neurosurgeons (Gwet's AC2= 0.94) and registrars (Gwet's AC2= 0.81) both graded the severity of the AE with almost perfect agreement. The results of this study demonstrate that the scope of the well-validated SAVES-V2 system maybe broadened to cranial neurosurgical cases by SAVES-N with substantial to almost-perfect interobserver reliability.