Transverse Diameter Research Articles

Effects of pedicle subtraction osteotomy on aortic morphology and hemodynamics in ankylosing spondylitis with kyphosis: a finite element analysis study

Osteotomy can correct kyphosis, restore the spinal sequence, and restore the healthy appearance of a patient. However, the aorta is stretched during pedicle subtraction osteotomy (PSO), and some surgeons are concerned about aortic injury. We used finite element analysis to construct an aortic model to simulate hemodynamic changes during osteotomy. 16 patients with ankylosing spondylitis kyphosis who had undergone a two-level osteotomy at the L1 and L3 levels was included in this study. Aortic computed tomography angiography (CTA) was performed, and a 3D image model was constructed. The length, transverse diameter, and curvature of the aorta were used to evaluate morphological changes. Finite element analysis was used to analyze the changes in aortic fluid dynamics. Blood pressure, wall shear stress, and blood flow velocity were compared pre- and postoperatively. The overall length of the aorta before surgery was 424.3 ± 42.9 mm, and the overall length of the aorta after surgery was 436.2 ± 54.8 mm. The aortic curvature decreased from 0.27 ± 0.13 to 0.17 ± 0.09. The mean transverse diameter of the aorta did not change (19.3 ± 6.6 vs. 19.2 ± 7.4 mm, P > 0.05). The blood flow velocity (2.8 ± 1.1 vs. 1.5 ± 0.8 m/s, P < 0.05), blood pressure (6.6 ± 1.7 vs. 4.3 ± 1.2 Kpa, P < 0.05), and wall shear stress (47.6 ± 17.3 vs. 22.3 ± 8.6, P < 0.05) at the T10-L4 level decreased postoperatively. Changes in LL were significantly correlated with changes in ld, dc, blood flow velocity, blood pressure and wall shear stress (ld : r = 0.713, P < 0.001; dc: r = 0.626,P = 0.010; blood flow velocity: r= − 0.541, P = 0.041; blood pressure: r = − 0.601, P = 0.016; wall shear stress: r= − 0.594, P = 0.027). The aorta was stretched, and its curvature decreased. The mean transverse diameter of the aorta did not change. Blood flow velocity, blood pressure, and wall shear stress decreased after surgery. Our study provides hemodynamic support for the possible cardiovascular benefits of osteotomes.

Diagnostic performance of PET-CT and technical efficacy of ultrasound-guided core needle biopsy of small and intermediate size malignant supraclavicular lymph nodes

Aim: We aimed (1) to determine optimal PET-CT SUV and ultrasound (US) features associated for malignant smallintermediate size supraclavicular lymph nodes (SCN) and (2) to evaluate technical efficacy of core needle biopsy (CNB). Materials and methods: Between 2020 and 2023, CNB of SCN with short-axis less than 15 mm were included. PET-CT was evaluated for optimal SUV cut-off value. Multivariate logistic regression was performed for US features. Technical efficacy of CNB (success rate) was calculated, and US features were compared between satisfactory CNB specimen and unsatisfactory CNB specimen.Results: Eighty-four SCN per 80 patients (age 64.0±17.2 years, 45.2% female) were included. The optimal SUV cut-off value was 1.1 with diagnostic accuracy of 89.8%. US features associated with malignancy were anteroposterior dimension ≥9 mm and absence of hilum. The overall CNB success rate was 94%, and unsatisfactory specimen demonstrated shorter transverse diameter (12 mm vs 5 mm, p&lt;0.001), and non-parallel orientation (20.3% vs. 100%, p&lt;0.001).Conclusion: CNB should be considered for small-intermediate size SCN with SUV exceeding 1.1, anteroposterior dimension ≥9 mm, and absence of hilum. SCN with shorter transverse diameter and non-parallel orientation may result in unsatisfactory CNB specimen.

Quantitative anatomy of the infraspinatus muscle in the human fetus.

The study presents one of the six scapulohumeral muscles, which occupies most of the osteofibrous infraspinatus compartment. Along with the supraspinatus, teres minor and subscapularis muscles, the infraspinatus muscle contributes to the rotator cuff. It protects the posterior aspect of the articular capsule of the shoulder joint, adducts and externally rotates the arm. The aim of the study was to perform the quantitative analysis of the infraspinatus muscle in human fetuses and to elaborate growth dynamics for its morphometric parameters. Using anatomical dissection, digital image analysis (NIS Elements AR3.0) and statistics (Student's t-test, regression analysis), the vertical, transverse and oblique diameters, muscle circumference and projection surface area of the infraspinatus muscle were measured in 36human fetuses of both sexes (17♂, 19♀) aged 18-30weeks. The infraspinatus muscle revealed neither sex nor laterality differences. All examined morphometric parameters of the infraspinatus muscle increased commensurately in accordance with the following linear functions: y=-4.024 + 0.903×Age ± 0.621 (R²=0.96) for transverse diameter, y=-3.089 + 1.321×Age ± 0.897 (R²=0.97) for vertical diameter, y=-1.161 + 0.632×Age ± 0.444 (R²=0.97) for oblique diameter, y=-13.575 + 3.851×Age ± 1.938 (R²=0.98) for muscle circumference and y=-293.512 + 23.228×Age ±19.650 (R²=0.95) for projection surface area.

A preliminary investigation of the left atrial suspended cord and its significance as revealed by coronary CT angiography: an observational study with a systematic literature review

BackgroundThe occurrence of suspended cords of the left atrium (SCLA) is rare and has seldom been described. The purpose of this study was to summarize the cases of SCLA accidentally detected by coronary CT angiography (CCTA), describe their imaging features, conduct a preliminary analysis of their clinical significance, and review relevant literature.MethodsA total of 10,796 patients who underwent CCTA examinations from July 2020 to November 2021 were consecutively selected. The original and three-dimensional reconstruction images were reviewed to identify patients with SCLA. A control group was selected in a 1:2 ratio based on age, BMI, sex, and education level. The imaging characteristics and clinical data of the two groups were collected and compared. The case group was divided into two subgroups based on the starting and ending positions of the SCLA: Group 1 with the SCLA between the free wall and free wall, and Group 2 with the SCLA between the septum wall and free wall. The clinical features of these subgroups were compared. Furthermore, a review of literature on SCLA published in the past fifteen years that includes its clinical and imaging features was conducted.ResultsIn this study, a total of 35 patients were found to have SCLA, resulting in an incidence rate of approximately 0.32%. After excluding 1 patient for whom clinical features could not be obtained, the case group included a total of 18 males and 16 females, with a male-to-female ratio of 1:1 and a median age of 57.00 (52.00–64.00) years. It was found that 19 (55.88%) cases of SCLA were located near the right superior pulmonary vein ostia, while no SCLA was found near the left lower pulmonary vein orifice. A significant difference in the incidence of atrial arrhythmia between the two groups was observed (p = 0.009). Additionally, 3 patients (8.82%) in the SCLA group had a history of transient cerebral ischemic attack (TIA), which was significantly different from that in the control group (p = 0.035). The anteroposterior and transverse diameters of the left atrium were longer in the case group than in the control group (p < 0.05), but there was no significant change in left atrial volume. Subgroup analyses found no significant difference in the incidence of cerebral infarction, atrial arrhythmia, or other intracardiac structural malformations, although there was a significant difference in cord length (p = 0.013), with the length of SCLA in Group 1 and Group 2 being 2.64 ± 0.99 cm and 3.39 ± 0.68 cm, respectively. Notably, only 1 of these 34 patients was diagnosed based on echocardiography, whereas all cases were perfectly visualized using CCTA.ConclusionSCLA is rare. CCTA can accurately detect and depict this abnormal structure as compared to echocardiography. SCLA may be linked to a higher incidence of atrial arrhythmias or transient ischemic attacks. It is important for radiologists and cardiovascular experts to recognize this structure, and further investigation is necessary to determine its clinical significance.

Prediction of poor prognosis using the peak systolic velocity and early diastolic velocity of the central retinal artery in patients with post‐cardiac arrest syndrome

AbstractIntroductionMonitoring intracranial pressure (ICP) in patients with post‐cardiac arrest syndrome (PCAS) is crucial for effective management and prognosis assessment. However, continuous ICP monitoring is rarely practiced. Increased ICP is often associated with the impairment of brain autoregulation. This study investigated whether central retinal artery (CRA) flow velocity, autoregulation status according to mean arterial pressure (MAP), and the optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio could predict poor prognosis related to increased ICP in PCAS patients.MethodsIn this multicenter prospective observational study, transocular ultrasonography of the optic nerve sheath was performed on 38 PCAS patients treated with targeted temperature management from December 2021 to November 2022. CRA peak systolic velocity (PSV), early diastolic velocity (eDV), MAP, CRA‐PSV changes following MAP changes (autoregulation), and ONSD/ETD ratio were measured repeatedly from days 0 to 4 post‐admission.ResultsUnivariable analysis indicated that CRA‐PSV, nonpositive or flat CRA‐eDV, and disrupted autoregulation correlated with a poor prognosis (Cerebral Performance Category 4 or 5). In multivariable analysis, nonpositive CRA‐eDV or disrupted autoregulation was the most significant predictor of poor prognosis (odds ratio, 40.576; p = 0.002), with an area under the curve of 0.774. The ONSD/ETD ratio did not show a significant correlation.ConclusionsNonpositive CRA‐eDV, CRA‐PSV and disrupted autoregulation can predict poor prognosis in PCAS patients. Transocular Doppler ultrasonography of the CRA and autoregulation assessment may aid in ICP monitoring and management in PCAS patients.

A Study in Pituitary Neuroendocrine Tumors (PitNETs): Real-Life Data Amid Baseline and Serial CT Scans.

We aimed to evaluate CT-related PIs diameters following 3 aspects: a cross-sectional analysis based on the age' groups at first PI diagnosis and on the gender distribution and a longitudinal analysis in PIs with <0.5 cm versus ≥0.5 cm as the largest diameter at baseline. A retrospective, real-life, multi-centric study in adults with NF micro-PIs was performed. 208 subjects (92.79% females) were included (average age 43.18 ± 12.58 y). The mean largest diameter (between transversal and longitudinal diameters) was 0.55 ± 0.16cm, and 44.71% of the PIs were located on the right part of the pituitary gland. The patients were divided into 10 age-groups (21 to 70 y), and no difference was observed between the mean largest diameters of these groups (p = 0.693). Females and males had a similar age at PIs diagnosis (p = 0.353), transverse diameter (p = 0.910), longitudinal diameter (p = 0.229), and PI location (p = 0.368). Serial CT scans (2 to 4 per patient) included a median (Q1-Q3) of 20 (12-36) months for the second CT scan, 58 (36-84) for the third CT scan, 78 (53-118) for the fourth CT scan, and a total follow-up between baseline and last CT scan of 40 (13-72) months. The initial largest diameter correlated with the diameter change between the baseline and the last CT (r = -0.575, p = 0.000). The largest PI diameter was similar between each serial CT scan (p = 0.840). According to the cut-off value of 0.5 cm diameter (for initial largest tumor diameter), group A (N = 78, 37.50%, <0.5 cm) and group B (N = 130, 62. 50%; ≥0.5 cm) had similar age at baseline (43.83 ± 12.72 versus 42.79 ± 12.54 y, p = 0.565) and PIs locations (right, left, median). The largest PI diameter remained smaller in group A versus B amid the second CT scan (p = 0.000) and the last CT scan (p = 0.009). The largest diameter change from the first to the last CT scan showed an increase in group A (median of +0.10 cm, p = 0.000) and a decrease in group B (median of -0.01 cm, p = 0.002); this diameter change was different in group A versus B (p = 0.000). The cumulative probability of tumor-growth-free survival showed different survival functions (log rank p = 0.000): group A exhibited a more gradual decrease versus B; at 60 months, the cumulative probability was 0.32 ± 0.08 for group A versus 0.75 ± 0.07 for B. During follow-up, all PIs remained NF, and no hypopituitarism was noted (as limits, we mention that dynamic hypopituitarism testing was selectively performed). NF micro-PIs in adults showed a similar age and sex distribution. During follow-up, PIs with a largest diameter < 0.5 cm increased after a median of 40 months but remained <1 cm, while in PIs with ≥0.5 cm, the largest diameter decreased. This highlights a lower predictability in tumor behavior than expected, particularly in larger micro-PIs that, overall, remained without relevant clinical implications after surveillance.

Digital image analysis of vertebral body L4 and its ossification center in the human fetus.

Using a Siemens-Biograph 128 mCT camera the morphometric analysis of the L4 vertebral body and its ossification center were done in 55human fetuses aged 17 to 30weeks. No sex differences were found. The mean height, transverse and sagittal diameters of L4 vertebral body followed the logarithmic functions: y = -11.797+ 5.208 × ln(age) ± 0.372, y = -23.462 + 9.428 × ln(age) ± 0.702, y = 2.770 + 13.521 × ln(age) ± 1.722, respectively. The mean cross-sectional area of L4 vertebral body followed the linear function: y = -30.683 + 1.976 × age ± 2.701. The mean volume of L4 vertebral body followed the second-degree polynomial function: y = -93.983+ 0.385 × (age)² ± 23.707. The mean transverse and sagittal diameters of the ossification center of L4 vertebral body followed the natural logarithmic function: y = -27.106 + 10.178 × ln(age) ± 0.769 and y = -13.345 + 5.458 × ln(age) ± 0.424, respectively. The mean cross-sectional area and the volume of the ossification center of L4 vertebral body followed the linear function: y = -30.683 + 1.976 × age ± 2.701 and y = -43.214 + 2.760 × age ± 4.085, respectively.

Effects of Different Weeding Methods on Soil Physicochemical Properties, Root Morphology, and Fruit Economic Traits in Camellia oleifera Abel. Plantations

Soil physicochemical properties, root characteristics, and fruit economic traits were determined in Camellia oleifera plantations under spontaneous vegetation + mowing (W1), spontaneous vegetation + glyphosate (W2), and no weeding (CK) treatments. Compared with CK, W1 reduced soil bulk density and increased total nitrogen, total phosphorus, ammonium nitrogen, nitrate nitrogen, and effective potassium content. W2 treatment resulted in higher bulk density than W1 and lower water-holding capacity, total nitrogen, total phosphorus, total potassium, ammonium nitrogen, nitrate nitrogen, and available potassium of the soil. Generally, both W1 and W2 inhibited weed morphological traits while favoring the C. oleifera root system, with the W1 treatment resulting in the greatest increase. Fruit transverse diameter, longitudinal diameter, yield, and oil yield were higher in W1 than in CK and W2 treatments. Weed root systems and C. oleifera root systems ultimately affect oil production and yield by affecting bulk density, ammonium nitrogen, nitrate nitrogen, fruit transverse diameter, seed yield, and seed kernel oil content. In summary, W1 treatment improved the physicochemical properties, root growth, fruit growth, and soil quality in C. oleifera plantations.

Systemic investigation of pelvimetric profile in three strains of Deoni cattle

The present research work was designed to establish baseline data of the pelvimetric profile in Deoni Cattle. Deoni cattle (270) of three strains, i.e. Wannera, Balankya and Shevera were selected and divided into six age groups: Group I (12 to 24 months), II (25 to 36 months), III (37 to 48 months), IV (49 to 60 months), V (61 to 72 months) and VI (73 to 84 months) with 45 animals in each group. Body weight along with different pelvimetric parameters such as distance between two angles of haunch (A), distance between two ischial tuberosities (B), distance between level of croup and hip joint (C) and distance between tuber coxae and tuber ischia (D) were measured to determine the transverse and vertical diameter of pelvic inlet and outlet which were used to calculate pelvic area of inlet and outlet. The pelvic area values for both inlet and outlet showed highly significant differences within groups, but no significant difference was observed between the three strains of each group. From the results of the study, it can be concluded that the pelvic area of Deoni cattle increases with the age and it has significant positive correlation with the parity and body weight. Thus, pelvimetric profile can be used as a marker for selection of young Deoni heifers and cows for breeding purposes to lower dystocia incidences.

PROsthetic MEsh Reinforcement in elective minimally invasive paraesophageal hernia repair (PROMER): an international survey.

The optimal treatment for paraesophageal hiatus hernia (PEH) is controversial. While crural buttressing with mesh shows promises in reducing recurrences, the decision to use mesh during minimally invasive PEH repair is largely subjective. Due to these uncertainties, we conducted a survey to examine current clinical practices among surgeons and to assess which are the most important determinants in the decision-making process for mesh placement. Thirty-five multiple-choice Google Form-based survey on work-up, surgical techniques, and issues are considered in the decision-making process for mesh augmentation during minimally invasive PEH repair. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Consensus was defined as > 70% of participants agreed (agree or strongly agree) on a specific statement. Overall, 292 surgeons (86% from Europe) participated in the survey. The median age of participants was 42years (range 29-69). The median number of PEH procedures was 25/year/center (range 5-400), with 67% of participants coming from high-volume centers (> 20 procedures/year). Consensus on use of mesh was reached for intraoperative findings of large (> 50% of intrathoracic stomach) PEH (74.3%), crural gap with > 4cm distance between right and left crus (77.1%), and/or crural atrophy with < 0.5cm thickness of one or both pillars (73%), and for redo surgery (71.9%). Further, consensus was reached in defining recurrence as a combination of refractory symptoms and anatomical/radiological evidence of > 2cm hernia. This survey shows that large PEH, wide crural transverse diameter, fragile crura, and redo surgery are the most influential issues driving the decision for mesh-reinforced cruroplasty.

Imaging Findings and MRI Patterns in a Cohort of 18q Chromosomal Abnormalities.

The abnormalities of the long arm of chromosome 18 (18q) constitute a complex spectrum. We aimed to systematically analyze their MR imaging features. We hypothesized that there would be variable but recognizable white matter and structural patterns in this cohort. In this retrospective cohort study, we included pediatric patients with a proved abnormality of 18q between 2000-2022. An age- and sex-matched control cohort was also constructed. Thirty-six cases, median MR imaging age 19.6 months (4.3-59.3), satisfied our inclusion criteria. Most were female (25, 69%, F:M ratio 2.2:1). Fifty MR imaging studies were analyzed, and 35 (70%) had delayed myelination. Two independent readers scored brain myelination with excellent interrater reliability. Three recognizable evolving MR imaging patterns with distinct age distributions and improving myelination scores were identified: Pelizaeus-Merzbacher disease-like (9.9 months, 37), intermediate (22 months, 48), and washed-out pattern (113.6 months, 53). Etiologically, MRIs were analyzed across 3 subgroups: 18q deletion (34, 69%), trisomy 18 (10, 21%), and ring chromosome 18 (5, 10%). Ring chromosome 18 had the highest myelination lag (27, P = .005) and multifocal white matter changes (P = .001). Trisomy 18 had smaller pons and cerebellar dimensions (anteposterior diameter pons, P = .002; corpus callosum vermis, P < .001; and transverse cerebellar diameter, P = .04). In this cohort of 18q chromosomal abnormalities, MR imaging revealed recognizable patterns correlating with improving brain myelination. Imaging findings appear to be on a continuum with more severe white matter abnormalities in ring chromosome 18 and greater prevalence of structural abnormalities of the pons and cerebellum in trisomy 18.

A Real-World Longitudinal Study in Non-Functioning Pituitary Incidentalomas: A PRECES Micro-Adenomas Sub-Analysis.

Background. Incidentalomas have an increasing incidence all over the world due to a larger access to imaging assessments, and endocrine incidentalomas make no exception in this matter, including pituitary incidentalomas (PIs). Objective. Our objective was to analyse the dynamic changes amid a second computed tomography (CT) scan after adult patients were initially confirmed with a PI (non-functioning micro-adenoma). Methods. This was a multi-centric, longitudinal, retrospective study in adults (aged between 20 and 70 y) amid real-world data collection. We excluded patients who experienced baseline pituitary hormonal excess or deficiency or those with tumours larger than 1 cm. Results. A total of 117 adults were included (94.02% females) with a mean age of 43.86 ± 11.99 years, followed between 6 and 156 months with a median (M) of 40 months (Q1 Q3: 13.50, 72.00). At the time of PI diagnosis, the transverse diameter had a mean value of 0.53 ± 0.16 cm, the longitudinal mean diameter was 0.41 ± 0.13 cm, and the largest diameter was 0.55 ± 0.16 cm. No PI became functioning during follow-up, neither associated hypopituitarism nor increased >1 cm diameter. A total of 46/117 (39.32%) patients had a larger diameter during follow-up (increase group = IG) versus a non-increase group (non-IG; N = 71, 60.68%) that included the subjects with stationary or decreased diameters. IG had lower initial transverse, longitudinal, and largest diameter versus non-IG: 0.45 ± 0.12 versus 0.57 ± 0.17 (p < 0.0001), 0.36 ± 0.11 versus 0.43 ± 0.13 (p = 0.004), respectively, 0.46 ± 0.12 versus 0.6 ± 0.16 (p < 0.0001). IG versus non-IG had a larger period of surveillance: M (Q1, Q3) of 48 (24, 84) versus 32.5 (12, 72) months (p = 0.045) and showed similar age, pituitary hormone profile, and tumour lateralisation at baseline and displayed a median diameter change of +0.14 cm versus -0.03 cm (p < 0.0001). To conclude, a rather high percent of patients might experience PI diameter increase during a longer period of follow-up, including those with a smaller initial size, while the age at diagnosis does not predict the tumour growth. This might help practitioners with further long-term surveillance protocols.

Morphometric analysis of pituitary gland using magnetic resonance imaging in Indian subjects

Background: Before the advent of magnetic resonance imaging (MRI), the radiological assessment of the hypothalamic-pituitary region relied on plain radiographs and computed tomography scans. However, contemporary medical practice now widely recognizes MRI as the preferred imaging modality for this purpose. The objective is to investigate variations in size and morphology of the pituitary gland associated with age and gender. Aims and Objectives: (a) The aims of this study were as follows: To establish normative measurements of pituitary gland in South Indian population. (b) To evaluate the relationship between gender, weight, height, and body mass index in different patients using conventional MRI sequences. Materials and Methods: This cross-sectional study, approved by the Institutional Review Board, included the enrolment of 140 normal individuals. The dimensions of the pituitary gland were assessed in 140 individuals exhibiting apparently normal pituitary gland function. The height and length of the pituitary gland were measured utilizing mid-sagittal T1-weighted images (T1-WI) obtained through MRI. The width of the pituitary gland was determined using coronal T1-WI, and the pituitary gland volume was subsequently calculated. Results: This study comprised 98 females and 102 males. The anteroposterior dimension, height, and volume of the pituitary gland showed statistically significant correlations with age (P&lt;0.05), while the transverse dimension did not show a significant correlation with age (P&gt;0.05). The shape of the pituitary gland was found to have statistically significant correlations with age and gender. Conversely, the transverse diameter, height, and volume of the pituitary gland showed no significant correlations. Conclusion: The findings underscore the importance of considering pituitary size, shape, and volume in the evaluation of neuroendocrine disorders.

The effect of Scheuermann's kyphosis on rib cage morphology: A skeletal study

BackgroundEvolutionary changes in human rib cage morphology rendered it prone to pathologies like Scheuermann's kyphosis (SK). However, the impact of SK on rib cage morphology is unclear. PurposeThis study aimed to examine differences in rib cage morphology (e.g., ribs and sternum) between SK patients and a control group. MethodsMeasurements of the vertebral body, transverse process angle, sternum, and rib size were taken from the skeletons of SK patients (76) and a control group (96). Statistical tests were carried out to examine differences between the study and control groups and between the right and left sides. Correlations were obtained to examine the associations between the extent of the kyphosis (kyphosis angle) and rib cage variables. ResultsThe SK group yielded significantly longer and flatter ribs than the control group in both sexes. However, males had the largest differences in the 9th rib and females in the upper ribs (5-7). Inconsistency in symmetry results was found between the sexes. In summary, SK patients had a larger anteroposterior diameter in relation to the transverse diameter than the control group. Discussion and ConclusionsSK affects the morphology of the entire thorax and changes rib proportions similarly in males and females. These changes might have a role in bipedal stability and locomotion efficiency. Moreover, understanding the unique anatomy of SK patients is essential when performing an anterior release and anterior fusion operative approach. Finally, it provides insights into respiratory complications and poor prognosis related to individuals suffering from severe hyperkyphosis.

Evaluation of the effect of endoscopic CO₂laser arytenoidectomy on re-operation for failed posterior cordotomy

Objective:To analyze the efficacy of endoscopic CO₂ laser arytenoidectomy in treating bilateral vocal cord paralysis. Methods:Ninety-five patients who underwent endoscopic CO₂ laser arytenoidectomy for bilateral vocal cord paralysis at the First Affiliated Hospital of Naval Medical University（Changhai Hospital） of Shanghai from January 2009 to December 2022 were included in this study. Among them, 59 patients underwent endoscopic CO₂ laser arytenoidectomy as their first glottic enlargement surgery（Group A）, while 36 patients, who had previously undergone two unsuccessful CO₂ laser-assisted posterior cordotomies, underwent endoscopic CO₂ laser arytenoidectomy as a subsequent surgery（Group B）. Swallowing function, electronic laryngoscopy, perceptual voice evaluation, and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy. Results:The extubation rate after the first surgery was 84.75% in Group A and 86.11% in Group B, with total extubation rates of 94.92% and 94.44%, respectively. There were no significant differences between the two groups in preoperative and postoperative swallowing function, glottic size, or various voice evaluation indicators（P>0.05）. Within-group comparisons showed that postoperative swallowing function, glottic closure during phonation, perceptual evaluations of G（grade of hoarseness）, A（asthenia）, and B（breathiness） significantly worsened, with increased grades. The maximum transverse diameter of the posterior glottis during inspiration significantly increased, and the VHI-10 score was significantly higher postoperatively. Jitter, shimmer, and the harmonics-to-noise ratio significantly deteriorated, and maximum phonation time significantly shortened（P<0.05）. No significant differences were observed in postoperative R（roughness） and S（strain） compared to preoperative values（P>0.05）. Conclusion:Endoscopic CO₂ laser arytenoidectomy can impair voice quality to some extent but effectively alleviates breathing difficulties in patients with bilateral vocal cord paralysis. For patients who did not achieve successful extubation with CO₂ laser-assisted posterior cordotomy, endoscopic CO₂laser arytenoidectomy is an effective reoperative method, ensuring a high extubation rate while preserving certain voice functions.

Modified Low-Field NMR Method for Improved Pore Space Analysis in Tight Fe-Bearing Siliciclastic and Extrusive Rocks

Abstract Understanding the filtration and storage properties of tight reservoirs is crucial for efficient resource exploitation, particularly in unconventional formations. This study presents two low-field nuclear magnetic resonance (LF-NMR) techniques: standard cut-off and modified differential approaches combined with mercury injection capillary pressure (MICP) and X-ray diffraction (XRD) studies to evaluate porosity and pore size distribution (PSD) in such formations. The differential technique involves subtracting the dry sample signal from a 100% water-saturated one, allowing the chemically bound water compound to be eliminated and facilitating PSD analysis. Through the application of the percolation theory, we established a power–law relationship between LF-NMR transverse relaxation time (T2) and MICP pore-throat diameter, enabling the derivation of PSD and pseudo capillary pressure curves. Our methodology was validated on a sample set representing tight sandstones, conglomerates, and extrusive rocks with high clay and iron mineral content, demonstrating the superior accuracy of the modified differential method in estimating effective porosity and absolute PSD in comparison with the standard approach. While the use of the percolation theory in PSD conversion was successful for rocks with unimodal distributions, it often failed for rocks with larger voids. The study also revealed that the relationship between the LF-NMR transverse relaxation times and MICP pore sizes is both nonlinear and challenging to describe with a universal equation, especially in the presence of para- and ferro-magnetic elements in the rock matrix. Despite obstacles to the complete elimination of the influence of these minerals on the T2 distribution, employing the modified differential LF-NMR method significantly mitigated this effect and offered a precise and noninvasive way of characterizing the petrophysical properties of tight reservoir rocks. Consequently, our studies offer a significant step toward a more precise assessment of pore structures in unconventional reservoirs that could be translated into more efficient strategies for locating geothermal heat and hydrocarbon resources.

Morphometric analysis of the skull base and palatal regions for gender identification using CBCT: a retrospective study.

The objectives of this study were to evaluate the accuracy of morphometry of skull base and palate in gender discrimination using cone beam computed tomography (CBCT) scanning and to assess the accuracy of the results among a sample of the Arab population. Using CBCT scans, a cross-sectional analysis was conducted on 142 consented patients who underwent various dental procedures at the University Dental Hospital, Sharjah (UDHS). Of these patients, 70 were females and 72 were males, with respective means of 38.5 and 36.2 years. Eleven parameters related to skull base and palatal region were measured on the CBCT scans by two expert radiologists followed by statistical analysis. There was significant gender-based difference in the mean palatal width (PW) (p=0.001), mean palatal height (PH) (p=0.005). Among other skull base region parameters that were significant in term of gender-based difference like; the clivus length (CL) (p<0.001), occipital condyle height (OCH) (p<0.001), basal angle (BA) (p=0.006) and transverse diameter of foramen magnum (p=0.003). Only palate variables showed a significant age difference. Discriminant analysis related to gender showed that occipital condyle height was the most accurate and best discriminator among the skull base region parameters. The use of discriminant analysis in CBCT based on skull base and palatal region variables provides an efficient method for determining gender, which is particularly valuable in forensic science and anthropological research. Accurate gender identification is crucial in forensic investigations, and the skull base region, being a stable and sexually dimorphic anatomical feature, can serve as a reliable marker for this purpose.

Phenotypic Diversity and Seed Germination of Elaeagnus angustifolia L. in Relation to the Geographical Environment in Gansu Province, China

Elaeagnus angustifolia L. is a highly adaptable urban ornamental plant, playing a key role in dry land and saline-alkali protective forests. The diverse geographical and climatic conditions in Gansu Province have resulted in variations in its distribution and growth. This study assesses the phenotypic diversity of fruits and seeds, and the seed germination characteristics of 82 E. angustifolia plants from nine populations in Gansu Province, exploring their relationship with geographical and climatic factors. We measured 12 phenotypic traits and five germination indices. This study included germination tests under standard conditions, statistical analysis of phenotypic differences, and Pearson and Spearman correlation analyses to examine relationships between traits and geo-climatic factors. Principal component and cluster analyses were also performed to identify key traits and classify populations. The findings were as follows: (1) Significant differences were observed in phenotypic traits and germination characteristics among populations. Single fruit weight showed the highest variation (27.56%), while seed transverse diameter had the lowest (8.76%). The Lanzhou population exhibited the greatest variability (14.27%), while Linze had the lowest (6.29%). (2) A gradient change pattern in traits was observed, primarily influenced by longitude and a combination of geographical and climatic factors. Seed germination was positively correlated with altitude, annual precipitation, and relative humidity, but negatively affected by latitude and traits such as fruit weight. (3) Principal component analysis identified germination rate, germination index, seed shape index, and fruit shape index as primary factors, contributing 27.4%, 20.6%, and 19.9% to the variation, respectively. Cluster analysis grouped the 82 plants into four clusters, not strictly based on geographical distance, suggesting influence from factors such as genotype or environmental conditions. In conclusion, this study lays a foundation for understanding the genetic mechanisms behind the phenotypic diversity and germination characteristics of E. angustifolia. It offers insights into how geo-climatic factors influence these traits, providing valuable information for the species’ conservation, cultivation, and management.

The value of computed tomography angiography for evaluation of left atrial enlargement in patients with persistent atrial fibrillation

BackgroundThe post-processing technology of CTA offers significant advantages in evaluating left atrial enlargement (LAE) in patients with persistent atrial fibrillation (PAF). This study aims to identify parameters for rapidly and accurately diagnosing LAE in patients with PAF using CT cross-sections.MethodsLeft atrial pulmonary venous (PV) CT was performed to 300 PAF patients with dual-source CT, and left atrial volume (LAV), left atrial anteroposterior diameter (LAD1), left atrial transverse diameter (LAD2), and left atrial area (LAA) were measured in the ventricular end systolic (ES) and middle diastolic (MD). LA index (LAI) = LA parameter/body surface area (BSA). Left atrial volume index (LAVIES) > 77.7 ml/m2 was used as the reference standard for the LAE diagnosis.Results227 patients were enrolled in the group, 101 (44.5%) of whom had LAE. LAVES and LAVMD (r = 0.983), LAVIES and LAVIMD (r = 0.984), LAAES and LAVIES (r = 0.817), LAAMD and LAVIES (r = 0.814) had strong positive correlations. The area under curve (AUC) showed that all measured parameters were suitable for diagnosing LAE, and the diagnostic efficacy was compared as follows: LAA/LAAI> LAD> the relative value index of LAD, LAD2> LAD1. LAA and LAAI demonstrated comparable diagnostic efficacy, with LAA being more readily available than LAAI.ConclusionsThe axial LAA measured by CTA can be served as a parameter for the rapid and accurate diagnosis of LAE in patients with PAF.

Zygomaticofacial foramen in dry adult human skulls: a morphological study.

A wide range of medical procedures in the zygomatic region in maxillofacial surgery, implantology, and aesthetic medicine requires a detailed study of the zygomaticofacial foramen (ZFF) due to the high risk of damage to its contents during manipulation.This study aimed to estimate the shape, diameter, and location of ZFF and their relationships with anatomical landmarks. A studywas conductedon 53 dry adult human skulls. Standard morphometric measurementswere takenusing sliding calipers.The number, diameter, shape, and location of ZFF were notedon both sides, andthe distances between the ZFF and surrounding anatomical landmarks were measured.Conventional statistical methods were usedto evaluate the data. Out of 106 sides, no ZFFwas noticedin 2.8%, one foramen was found in 40.6%, two foramina were found in 39.6%, threein 10.4%, four in 4.7%, andfive in 1.9%. The vertical diameter was 0.98 ± 0.35 mm, while the transverse diameter was 0.87 ± 0.31 mm. The shape of the ZFF was oval in 67%, round in 26.2%, semilunar in 4.9%, and irregular in 1.9%. The distance from the ZFF to the infraorbital margin was 6.63 ± 2.09 mm, tothe frontozygomatic suture was 26.24 ± 3.49 mm, tothe zygomaticomaxillarysuture,was 19.75 ± 3.55 mm, tothe zygomaticotemporal suture was 22.31 ± 3.98 mm and, to the most prominent point of the zygomatic bone was 8.03 ± 2.64 mm. The variations in the number and location of ZFF mustbe consideredwhile performing regional blockanesthesia,and surgical or aesthetic procedures in the zygomatic region.