Search

OBJECTIVE The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. DESIGN A single-center, prospective, randomized, single-blinded, controlled study. SETTING This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. PARTICIPANTS Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. INTERVENTIONS Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. MEASUREMENTS AND MAIN RESULTS The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. CONCLUSION With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.

BACKGROUND In repaired tetralogy of Fallot (rTOF), right ventricular (RV) enlargement leads to poor outcomes. However, evaluating the RV has limitations; cardiac magnetic resonance (CMR) and 3D echocardiography have barriers including cost and accessibility. Traditional echocardiography is limited given the complex geometry and anterior location of the RV. We propose a novel echocardiographic evaluation of RV volume using 2 separate views. METHODS This is a retrospective study of rTOF patients with echocardiogram, CMR, and exercise tests. By echocardiogram, we collected RV length in parasternal long axis (PLAX), area in 4-chamber (4C) view, and measurements per standard guidelines. RV end-diastolic and end-systolic volume (RVEDV and RVESV) were calculated as 5/9 (4C area * PLAX length). RESULTS Forty-five patients with 66 sets of CMR, echocardiogram, and exercise tests were included (mean age 13.3 ± 3.2 years). The echocardiographic RVEDV and RVESV showed strong correlation with CMR parameters (r = 0.81 and 0.72; p≤ 0.0001), and moderate correlation with peak oxygen pulse (0.63 and 0.49; p≤0.0001). Guideline measurements had no significant correlation. Echocardiographic RVEDV and RVESV were higher in those requiring subsequent pulmonary valve replacement. Indexed echocardiographic RVEDV of 93 ml/m2 had 92% sensitivity and 50% specificity (area under curve 0.75 (p = 0.001)) in predicting CMR RV/LV EDV ratio > 2, which is an early indicator for pulmonary valve replacement. CONCLUSIONS This novel technique correlates strongly with CMR, better than traditional parameters. While echocardiogram will not replace CMR, this method would be useful in predicting the RV volume, progression of dilation, and timing of CMR.

Background Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition. Method This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush. Results No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators’ diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p Conclusion RVI-PLAX view should not be used for guidewire detection. CEUS using D50% and RVI-PLAX view are potentially useful tools in detecting central venous catheter malposition. Further studies comparing them with conventional methods are needed.

Anterior cruciate ligament (ACL) injuries often involve sudden single leg loading with directional changes. Trunk and lower extremity (LE) load transfer and muscle power are directly coupled during these movements. The effect of trunk and LE long-axis rotation training on forward single leg drop jump landing and stabilization (FSLDJLS) was studied.Using block randomization (gender), 36 (18 men, 18 women) subjects were assigned to experimental (nine, 20 min exercise sessions) and control groups with equal subject number. Ground reaction force (1000 Hz), kinematic (60 Hz) and LE EMG (1000 Hz) data were synchronously collected. Statistical analysis compared pre- and post-test neuromuscular control mean change differences (MCD), and hip flexion-LE peak EMG % maximum volitional isometric contraction (%MVIC) (expressed as decimal equivalents), mean change difference (MCD) relationships.The experimental group had greater landing knee flexion (3.5 ± 3.6° vs. -0.4 ± 3.3°,Increased dynamic LE stiffness, increased hip muscle EMG amplitude and decreased hip and knee muscle activation duration MCD in the experimental group suggests improved LE neuromuscular control.

Objectives Terrain park riders use contact features such as fun boxes and rails. Typical fun box and rail features have a design characteristic that can be changed to improve safety. Fun box edge coping and edges of rails are typically constructed of soft steel. Ski/snowboard edges (HRC50) can easily become engaged in the softer metal, causing a chip to develop, suddenly stopping the rider, probably causing a fall and possible injury. The aim of the study is to examine the effect of terrain park running surface hardness on chip development. Design Testing on steel specimens was performed to research chip development generated by a ski/snowboard edge on steel used in the construction of contact features and on steel that is proposed for such use. An apparatus was constructed to simulate a ski/snowboard edge moving perpendicular to the long axis of coping or rail edge. Methods The author performed observation, photographic documentation, metallurgical testing and environmental testing of various contact features at different ski area terrain parks. Several steel specimens of varying hardness were tested at various load levels to study the propensity of chip development by ski/snowboard edges. Results Testing of steel samples showed that increasing the hardness of the rail steel or coping steel reduced the propensity for a ski/snowboard edge to engage in the coping or rail. Conclusions Increasing steel coping and rail contact surface hardness to HRC 50 and above will likely reduce engagement by steel snowboard/ski edges, which in turn is expected to reduce the chance of a fall and injury.

Primary hypertension is one of the most well-known risk factors for cardiovascular disease. Currently, there is still no ideal indicator for left ventricular end-diastolic pressure.73 hypertension patients and 37 healthy people were enrolled in this study. Each member was examined with conventional echocardiography including multiple indicators such as Peak mitral valve flow velocity (E, A), E/A, left atrial volume index (LAVl), tissue Doppler (PW-TDI) peak velocities during early and late diastolic mitral valve flow (e '), E/e ', and GLS. We have collected clinical data from all enrolled members. The above cardiac ultrasound indicators were obtained before the antihypertensive treatment, one month and three months after treatment.Left ventricular end-diastolic pressure (LVEDP) was positively correlated and negatively correlated with GLS (r = 0.638,The GLS improvement rate was significantly higher than those of e', E/e' after one and three-month treatment. Therefore, GLS might be a potential ideal index for patients with anti-hypertension treatment. The results obtained in this study provide useful information for further study.

Background: Ultrasound-guided central venous catheter placement has significantly improved the success rate of punctures and reduced the risk of complications. However, catheterizing the internal jugular vein under ultrasound guidance in neonates remains challenging. Methods: Ninety-six patients were screened for eligibility in this randomized controlled trial between November 2018 and October 2019. After meeting the inclusion criteria, 90 term neonates undergoing cardiothoracic, general, or neurosurgery procedures were randomly assigned to the modified dynamic needle tip positioning short-axis ( n = 45) or long-axis groups ( n = 45) using a computer-generated random numbers table. The primary outcome was the first-attempt success rate. The secondary outcomes included the total success rate, cannulation time, and incidence of cannulation-related complications, including hematoma, accidental arterial puncture, or pneumothorax. Data were compared between the two groups. Results: The success rate for the first attempt was higher (88.9% vs 64.4%; p = 0.001; relative risk, 1.4; 95% confidence interval, 1.1–1.8), while the cannulation time was shorter (171.0 ± 47.8 s vs 304.4 ± 113.5 s; p = 0.001; estimated difference, −133.4; 95% confidence interval, −170.1 to −96.7), in the modified dynamic needle tip positioning short-axis group compared with the long-axis group. Six hematomas and two common carotid artery punctures were identified in the long-axis group, while none were identified in the modified dynamic needle tip positioning short-axis group. Conclusions: The modified dynamic needle tip positioning short-axis out-of-plane technique enhanced the procedural efficacy and safety of internal jugular vein catheterization in neonates.

Проблематика. Метод групового урахування аргументів є доволі недооціненим інструментом для отримання високоточних прогностичних моделей. Перший варіант штучної нейронної мережі (які користуються величезною популярністю в світі машинного навчання) був отриманий в 1965 році українським вченим Олексієм Івахненко, який як раз використовував метод групового урахування аргументів для навчання мережі. Відомо, що даний підхід має місце фактично в будь-якій проблематиці, і не виключенням є задача розпізнавання ішемічної хвороби серця по відеоданим спекл-трекінг ехокардіографії. Вирішення подібної задачі є актуальним, оскільки це надасть можливість аналізувати ехокардіограми навіть якщо вони не оснащені технологією спекл-трекінг. Мета. Методом групового урахування аргументів за даними спекл-трекінг ехокардіографії побудувати класифікаційні алгоритми діагностики порушень кінематики скорочень лівого шлуночка серця у хворих на ішемічну хворобу серця в умовах стану спокою, та при застосуванні ехострестесту із добутаміновою пробою. Методика реалізації. Національним інститутом серцево-судинної хірургії імені М.М. Амосова були надані відеодані, отримані за допомогою методу спекл-трекінг ехокардіографії, яким було обстежено 56 пацієнтів з підозрою на ішемічну хворобу серця. Серед них лише у 16 пацієнтів патологію виявлено не було. Ехокардіографія реєструвалась у B-режимі за трьома позиціями: довгої вісі, 4-камерної та 2-камерної позиціях. Усього для дослідження було використано 6245 кадрів відео потоку: 1871 – без порушень серцевої діяльності, та 4374 – при наявності патології під час обстеження. Результати дослідження. Методом групового урахування аргументів було одержано 12 моделей класифікації з урахуванням доз добутаміну (0, 10, 20 і 40 мкг), точність яких на екзаменаційній вибірці варіювалась від 81.7% до 97.4%. Також були отримані 3 моделі класифікації без урахування доз добутаміну, які на екзаменаційній вибірці показали точність в межах 75.2-82.2%. Висновки. Отримані високоточні моделі класифікації методом групового урахування аргументів. Дані моделі можна буде застосувати для аналізу ехокардіограм, отриманих у B-режимі на обладнанні, яке не оснащене технологією спекл-трекінг. Background. Group method of data handling is a rather underestimated tool for obtaining highly accurate predictive models. The first version of an artificial neural network (which is very popular in the world of machine learning) was obtained in 1965 by the Ukrainian scientist Aleksey Ivakhnenko, who just used the group method of data handling to train the network. It is known that this approach takes place in almost any problematics, and the problem of recognizing coronary heart disease using video data from speckle-tracking echocardiography is not an exception. The solution to this problem is relevant, since it will allow analyzing echocardiograms even if they are not equipped with speckle-tracking technology. Objective. According to the data of speckle-tracking echocardiography construct classification algorithms by using the group method of data handling for diagnosing violations of the kinematics of left ventricular contractions in patients with coronary heart disease under conditions of rest, and when using echostresstest with dobutamine. Methods. National Institute of Cardiovascular Surgery provided video data obtained using the speckle-tracking echocardiography method, which examined 56 patients with suspected coronary heart disease. Among them, only 16 patients had no pathology. Echocardiography was recorded in B-mode in three positions: long axis, 4-chamber, and 2-chamber positions. In total, 6245 frames of the video stream were used for the study: 1871 – without cardiac abnormalities, and 4374 – in the presence of pathology during the examination. Results. Using the group method of data handling, 12 classification models were obtained, taking into account the doses of dobutamine (0, 10, 20, and 40 mcg), the accuracy of which on the examination sample varied from 81.7% to 97.4%. Also, 3 classification models were obtained without taking into account the doses of dobutamine, which on the examination sample showed an accuracy within 75.2-82.2%. Conclusions. The high-precision classification models were obtained by the group method of data handling. These models can be used to analyze echocardiograms obtained in B-mode on equipment, which is not using speckle-tracking technology. Проблематика. Метод группового учета аргументов является достаточно недооцененным инструментом для получения высокоточных прогностических моделей. Первый вариант искусственной нейронной сети (которые пользуются огромной популярностью в мире машинного обучения) был получен в 1965 году украинским ученым Алексеем Ивахненко, который как раз использовал метод группового учета аргументов для обучения сети. Известно, что данный подход имеет место практически в любой проблематике, и не исключением является задача распознавания ишемической болезни сердца по видеоданным спекл-трекинг эхокардиографии. Решение подобной задачи является актуальным, поскольку это позволит анализировать эхокардиограммы даже если они не оснащены технологией спекл-трекинг. Цель. Методом группового учёта аргументов по данным спекл-трекинг эхокардиографии построить классификационные алгоритмы диагностики нарушений кинематики сокращений левого желудочка сердца у больных ишемической болезнью сердца в условиях состояния покоя, и при применении эхостресстеста с добутаминовой пробой. Методика реализации. Национальным институтом сердечно-сосудистой хирургии имени Н.Н. Амосова были предоставлены видеоданные, полученные с помощью метода спекл-трекинг эхокардиографии, которым было обследовано 56 пациентов с подозрением на ишемическую болезнь сердца. Среди них только у 16 пациентов патологии выявлено не было. Эхокардиография регистрировалась в B-режиме по трем позициям: долгой оси, 4-камерной и 2-камерной позициях. Всего для исследования были использованы 6245 кадров видеопотока: 1871 – без нарушений сердечной деятельности, и 4374 – при наличии патологии во время обследования. Результаты исследования. Методом группового учета аргументов было получено 12 моделей классификации с учетом доз добутамина (0, 10, 20 и 40 мкг), точность которых на экзаменационной выборке варьировалась от 81.7% до 97.4%. Также были получены 3 модели классификации без учета доз добутамина, которые на экзаменационной выборке показали точность в пределах 75.2-82.2%. Выводы. Полученные высокоточные модели классификации методом группового учета аргументов. Данные модели могут быть применены для анализа ехокардиограм, полученных в B-режиме на оборудовании, не оснащенного технологией спекл-трекинг.

[Purpose] The purpose of this study was to describe the properties of muscle nodules (kinkoketsu) recognized by manual physical therapy practitioners. [Participants and Methods] A total of one hundred and thirty-three physical therapists, occupational therapists, judo therapists, and acupuncturists participated in this study. The shape, size, direction, depth, and hardness of muscle nodules, often treated in the buttocks, were investigated through the completion of a questionnaire. [Results] A total of 124 answer sheets were completed; 112 of these described the shape of muscle nodules as ellipsoidal. Of these 112 sheets, 97 effective sheets were analyzed. The results showed that the mean long axis length, short axis length, and thickness of the muscle nodules were 30.9 mm, 16.2 mm, and 9.3 mm, respectively. The most common responses on the long axis direction, depth, and hardness of the muscle nodules were the craniocaudal orientation, the second shallowest layer of 5 divisions, and the eraser level, respectively. [Conclusion] The typical muscle nodule found in the buttocks by manual physical therapy practitioners is roughly the shape of a large almond.

AIM: To evaluate the microleakage of newer bioceramic root-end filling materials. MATERIAL AND METHOD: Sixty freshly extracted human single-rooted mandibular premolar teeth were selected for the study. Teeth with fractured root, cracks, anddilacerations were rejected. All teeth were cleaned with ultrasonic scalers. Standard access opening was done and root canal treatment was performed with rotary files followed by obturation. After storing in saline for a week apical 3 ​mm of the root was resected at 900 angles to the long axis of the root. Retro cavity preparation was done with ultrasonic tips. The teeth were divided into four groups of 15 specimens each. Group I - Biodentin, GroupII–Bioaggregate, Group III – MTA Plus, and Group IV – MTA. After the restoration of retro cavities of all the teeth as per manufacture instructions, two coats of nail varnish were applied to leave apical 3 ​mm. All teeth were stored in 2% methylene blue for 72 ​h followed by emersion in 65% nitric acid for the next 72 ​h for Dye extraction. The obtained supernatant solution was then centrifuged and optical density or absorbance was measured with a UV spectrophotometer. RESULT: Microleakage was found to be increasing in this order: Biodentin ​ ​0.01). CONCLUSION: All materials exhibit some amount of microleakage. Biodentin shows the least microleakage among all the bioceramic material groups. Hence, Biodentin and bioaggregate are better material of choice for the retrograde filling to prevent microleakage.

The purpose of this study was to compare predicted anterior teeth intrusion measurements with the actual clinical intrusion measurements using cone-beam computed tomography. Understanding the precision of the software in anticipating changes may help practitioners predict the need for overcorrection.Twenty-two patients, with a mean age of 23.74 years, who underwent Invisalign (Align Technology, Santa Clara, Calif) clear aligners treatment for both arches only after having completed treatment with an initial series of aligners were included in this study. The pretreatment and posttreatment cone-beam computed tomography scans after the initial series were acquired by a single orthodontist practitioner. ClinCheck measurements were recorded with Align Technology. The long axis of the anterior tooth intrusion movement was measured in 142 teeth. A comparison between the predicted and actual measurements of anterior intrusion of the teeth was performed, and the intraclass correlation coefficients showed an almost perfect agreement in the linear measurements.A statistically notable difference between the predicted and actual measurements of anterior intrusion. The predicted intrusion movement of the maxillary canines (P = 0.001), maxillary lateral incisors (P 0.0001), and maxillary central incisors (P 0.0001) significantly differed from the actual values. Similarly, the intrusion movement in the mandibular teeth seemed to be inaccurate, with significant differences in the mandibular canines (P 0.0001) and mandibular lateral and central incisors (P 0.0001).The mean precision of true anterior intrusion with Invisalign clear aligners was 51.19%, and the mean amount of correction was 48.81%. The use of other supplementary methods of anterior teeth intrusion may be helpful to reduce the rate of midcourse corrections and refinements.

Characterize the appearance of digital nerve injuries in different ultrasound planes and correlate the presence and size of neuromas with time from injury. Surgically confirmed nerve injuries were retrospectively evaluated. Appearances of the nerve injury in the available imaging planes were reviewed by two readers. Associations between presence and size of neuroma with time from injury were analyzed. Injuries of 29 digital nerves (3 incomplete lacerations, 17 complete lacerations, 6 with 7 stump neuromas, 3 neuromas-in-continuity) noted on ultrasound were surgically confirmed. Among the 20 lacerations, long-axis images were obtained in 15, of which 10 depicted the injury and 4 did not. Among the 10 depicting the injury in long axis, 2 showed a discrete gap, and 7 showed the nerve obscured by laceration tissue without a gap. In short axis, the nerve injury was visible in all 20, and nerve laceration was seen as a discrete gap in 2, and obscuration by laceration tissue in 14. Neuromas were hypoechoic and well-defined. There was a positive association between time and presence of neuroma (OR = 1.3, p = 0.002). Correlations between time and cross-sectional area (rs = 0.45) and volume (rs = 0.57) of neuromas were moderately positive. Ultrasound long axis may be less useful, and those short axis may be more reliable for assessing digital nerve injuries than previously reported. Neuromas are hypoechoic and well-defined, and their size can vary based on time from injury.

Purpose To dynamically assess for Hill–Sachs engagement with animated 3-dimensional (3D) shoulder models. Methods We created 3D shoulder models from reconstructed computed tomography (CT) images from a consecutive series of patients with recurrent anterior dislocation. They were divided into 2 groups based on the perceived Hill–Sachs severity. For our cohort of 14 patients with recurrent anterior dislocation, 4 patients had undergone osteoarticular allografting of Hill–Sachs lesions and 10 control patients had undergone CT scanning to quantify bone loss but no treatment for bony pathology. A biomechanical analysis was performed to rotate each 3D model using local coordinate systems to the classical vulnerable position of the shoulder (abduction = 90°, external rotation = 0-135°) and through a functional range. A Hill–Sachs lesion was considered “dynamically” engaging if the angle between the lesion’s long axis and anterior glenoid was parallel. Results: In the vulnerable position of the shoulder, none of the Hill–Sachs lesions aligned with the anterior glenoid in any of our patients. However, in our simulated physiological shoulder range, all allograft patients and 70% of controls had positions producing alignment. Conclusions The technique offers a visual representation of an engaging Hill–Sachs using 3D-animated reconstructions with open-source software and CT images. In our series of patients, we found multiple shoulder positions that align the Hill–Sachs and glenoid axes that do not necessarily meet the traditional definition of engagement. Identifying all shoulder positions at risk of “engaging,” in a broader physiological range, may have critical implications toward selecting the appropriate surgical management of bony defects. Level of Evidence level III, case-control study.

The purpose of this study was to evaluate the change in cross-sectional area (CSA) of bone-patellar tendon-bone (BTB) autografts up to 5 years after the anatomic rectangular tunnel (ART) anterior cruciate ligament reconstruction (ACLR). The changing pattern in CSA might be a potential indicator of the graft remodeling process. Ninety-six (62 males, 34 females, mean age 27.0 years) patients were enrolled in this study with a total of 220 MRI scans after ART BTB ACLR to evaluate the CSA of the ACL autografts. The patients with first time unilateral ACLR that consented to undergo MRI evaluations at postoperative periods were included in this study. Intraoperatively, the CSA of the graft was measured directly using a custom-made area micrometer at the midpoint of the graft. Postoperatively, using an oblique axial slice MRI that was perpendicular to the long axis of the graft, the CSA of the graft was measured with digital radiology viewing program “SYNAPSE” at the midpoint of the graft. The postoperative MRI scans were classified into seven groups according to the period from ACLR to MRI evaluation: Group 0–2 months (m.), Group 3–6 m., Group 7–12 m., Group 1–2 years (y.), Group 2–3 y., Group 3–4 y., and Group 4 y.-. The percent increase of the CSA was calculated by dividing the postoperative CSA by the intraoperative CSA. The postoperative CSA was significantly larger than the intraoperative CSA in each group, with the exception of Group 0–2 m. The mean percent increase of the CSA in Group 0–2 m., 3–6 m., 7–12 m., 1–2 y., 2–3 y., 3–4 y., 4 y.- was 101.8 ± 18.2, 188.9 ± 27.4, 190.9 ± 43.7, 183.3 ± 28.9, 175.2 ± 27.9, 163.9 ± 19.8, 164.5 ± 25.4% respectively. The percent increase in Group 3–6 m., 7–12 m., 1–2 y., 2–3 y., 3–4 y., and 4 y.- was significantly greater than that in Group 0–2 m. The CSA of the BTB autografts after the ART BTB ACLR increases rapidly by 3–6 months after ACLR, reached a maximum value of 190% at around 1 year, decreases gradually after that, and reaches a plateau at around 3 years. The current study might help clinicians to estimate an individual BTB autograft's remodeling stages when considering returning patients to sports. IV

Background: This study is to compare the efficacy of short-axis hydrodissection with long-axis hydrodissection for patients with mild-to-moderate carpal tunnel syndrome (CTS). Methods: Forty-seven patients with mild-to-moderate CTS were enrolled in a prospective, randomized, single-blinded, controlled trial (6 months follow-up). With ultrasound guidance, patients in both groups (short-axis or long-axis groups) were injected with normal saline (5 mL per session). Assessments were performed before and 2 weeks after the injection, as well as at 1, 3, and 6 months post-intervention. The primary outcome measure was the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score and secondary outcomes included the cross-sectional area of the median nerve and electrophysiological studies. Results: Forty-four patients (21 wrists in the short-axis group and 23 wrists in the long-axis group) completed the study. Compared with the baseline, both groups showed improved BCTQ and cross-sectional area at all follow-up assessments (p

Mandible is the only movable bone of the facial skeleton that forms almost the lower half of the face. In ontogeny, the mandible undergoes substantial morphological and dimensional changes. These changes are largely associated with development of primary and secondary dentition in the human.1 The present study was undertaken to evaluate the anatomical features of mandible i.e. position of mental and mandibular foramina in western Maharashtra and to compare these findings with earlier studies. The findings of this study, variations in size, shape and relationships of dental and lower facial skeletal structure might be useful in providing important data to anatomists, archaeologists, forensic legal experts and maxillo-facial surgeons. Measurements were made on one hundred and ten dry, macerated adult human mandibles of unknown sex from western Maharashtra. Measurements of mental and mandibular foramen from various mandibular anatomical landmarks were taken. In present study it was observed that the most common position of mental foramen is in the line of long axis of 2nd premolar tooth which is universally accepted. Accessory mental foramen was found in one mandible located in line with anterior margin of 1st molar. Keywords: Mandible, Mental foramen, Mandibular foramen, Accessory mental foramen, Dentulous, Edentulous.

Background: Maxillary canines are important aesthetically and functionally, but impacted canines are more difficult and time consuming to treat. Moreover, impacted canines vary greatly in the inclination and location and can lead to resorption of neighboring incisors. Aim: To locate the impacted canine and compare resorption cases with non-resorption cases. Methods: Thirty -five 3 D CBCT scans were evaluated 17 presented with bilateral palatal impactions and 18 with unilateral impactions. Fifty –two canines were divided in two groups: group A: included impacted canines causing resorption to neighboring teeth and group B: impacted canines not causing resorption. Canine axis inclination, horizontal cusp location and distance to nearest adjacent tooth were recorded. T-tests (paired, student) determined the significance (P≤0.05) performed to evaluate the effect of resorption within and between each group. Results: Twenty–one canines caused resorption (40%) of the lateral incisor while there were 31 canines not causing resorption. Palatally impacted canines causing resorption to the adjacent teeth showed higher inclination of their axis to the midsagittal plane. Conclusions: Palatally impacted canines have high chance of causing resorption to adjacent teeth. As the canine is more medially located there is an increased chance of resorption especially when the cusp of the maxillary canine was positioned medially to the long axis of the lateral incisor. Highly significant correlation between palatally impacted canines in contact with neighboring teeth and resorption was found.

Recent meta-analysis comparing the success rates of various methods of arterial cannulation in adult patients found heterogeneity in the available data. Hence, we did this study to evaluate and compare the success rate of palpatory method with that of ultrasound guided methods of radial artery cannulation. The aim is to compare the first-attempt success rate of the palpatory method with that of ultrasound-guided radial artery cannulation techniques, namely, the short-axis out-of-plane and the long-axis in-plane methods.This is a prospective, randomized, parallel-arm study. Ninety patients aged from 18 to 50 years (presenting for various surgeries requiring radial artery cannulation for invasive blood pressure monitoring or frequent arterial blood gas analysis) were divided into 3 groups. Each group had one of the 3 techniques of radial arterial cannulation, namely palpatory, short-axis ultrasound method, and long-axis ultrasound method. The parameters analyzed were first-attempt success rate, number of attempts needed, cannulation time, need for crossover of technique, and incidence of complications. Multivariate analysis was done with one-way ANOVA, with Tukey's post hoc test. For categorical data, the chi-square test was used. The probability value of .05 was considered as a significant level.The first-attempt success rate was 76.7% in the long-axis method, 86.7% in the short-axis method, and 56.7% in the palpatory method. The short-axis method has been shown to have a shorter cannulation time, fewer attempts needed for successful cannulation, and lower need for crossover of techniques when the first 2 attempts fail.We conclude that the ultrasound-guided short-axis method of radial artery cannulation is associated with higher first-attempt success rate compared to the traditional palpatory method.

This study was carried out in 80 patients admitted in the ICU and OT of IGMC Shimla. They were divided into 2 groups of 40 patients each. Internal jugular venous cannulations were done using ultrasound guided techniques (short axis and long axis view). The complications encountered during cannulation were noted. All the patients from both the groups were successfully cannulated by the operator under ultrasound guidance. Artery punctures occurred in 3 patients which was successfully managed and the cannulations were reattempted and were successful. None of the cannulation was abandoned. Keywords: ultrasound guided internal jugular vein cannulation, central venous pressure, internal jugular vein cannulation

We have conducted our study in 80 patients admitted in the general ICU, requiring internal jugular vein cannulation. We formed 2 groups of 40 patients each that is:- Group 1 (short axis) and Group 2 (long axis). Under USG guidance, we cannulated the internal jugular vein with short axis view in group 1 and long axis view in group 2. Meanwhile the time taken to perform these cannulations was noted and then compared. After the study, we found that the internal jugular vein was cannulated much faster in short axis group as compared to the long axis group. Keywords: Central venous cannulation, internal jugular vein, USG guided approach, short axis versus long axis technique.

The study was carried out in 80 patients admitted in ICU and OT at IGMC Shimla. Patients were divided into 2 groups:- group A (short axis) and group B(long axis) of 40 patients each. Internal jugular vein cannulation was done under USG guidance using the two techniques. We were successfully able to cannulate all the patients. We obtained vascular access with higher first pass success and less number of needle passes using short axis approach compared to long axis. Keywords: internal jugular vein cannulation, USG guided approach, short axis versus long axis technique, Central vein catheterization

BACKGROUND Rapid central venous catheterization is critical for the rescue and perioperative management of premature infants requiring surgery. Ultrasound-guided dynamic needle tip positioning (DNTP) has been widely used as a very effective technique, especially in paediatric vascular puncture and catheterization. However, for low-weight premature newborns, central vein catheterization still poses greater difficulties for paediatricians and paediatric anaesthesiologists. This prospective randomized control study aimed to evaluate the efficacy of combined short- and long-axis (CSLA) internal jugular vein catheterization for premature newborns in comparison with the DNTP technique. METHODS A total of 90 premature newborns (gestational age

Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

Introduction Thoracic giant masses do not have a clear definition. In some publications, giant thoracic mass definition is used in tumors whose long axis is> 10 cm and in other publications covering more than 50% of the hemithorax. In this study, demographic data of patients with a massive resectable giant thoracic mass and the difficulties and experiences experienced in the peroperative process were reviewed with a general perspective. Materials and Methods 14 giant intrathoracic masses operated at the department of Thoracic Surgery, School of Medicine, Ankara University were included in the study. The masses occupying more than half of the hemithorax and mediastinal lesions with a long axis of 15 cm or larger radiologically were included and evaluated. Result 9 (64.3%) of our patients were male and 9 (35.7%) were female. The average age was 49.2 ± 17.1(between18-68). The tumor localizations of our patients were determined as 9 (64.2%) hemithorax and 5 (35.8%) mediastinal. When the radiological and intraoperative dimensions were examined separately, it was observed that the mean of long axis of CT image is average 18 ± 3.8 cm (between 12 cm and 26 cm), and the mean of long axis of specimen is average 18.14 ± 3.6 cm (between 15 cm and 23 cm). The heaviest mass was average 844 ± 473 g (350 g-2204 g). Conclusions The surgical maneuvers and hence the excision of giant masses become difficult to operate due to the narrow localization of the masses and the frequent invasions of adjacent vascular structures and nerve tissues. However, complete resection of these slowly growing and generally encapsulated masses can provide the cure.

Background and Objectives: One of the most universally accepted properties of a material is to have a good physical and mechanical properties to withstand the masticatory forces which is one of the major problem in dentistry. The objective of this study was to evaluate and compare the compressive strength of three different types of Tricalcium silicate based materials: (High plasticity repair mineral trioxide aggregate, ProRoot and Biodentine). Materials and methods: Ninety samples from studied materials (4mm diameter and 6mm height) were selected and divided into three equal groups according to the materials used then after each group was divided into three equal sub-groups according to the time (1 day, 1 week and 3 weeks). Compressive strength was evaluated in accordance with ISO 9917-1: 2007 recommendation. Specimens were crushed along their long axis using a universal testing machine. The load was recorded in mega Pascal. Statistical package for the social science (SPSS version 23) program was used to perform the statistical. Results: Biodentine showed significantly the highest compressive strength values than the other materials (P < 0.001), whereas High plasticity repair MTA have the lowest compressive strength values. There was no significant difference between ProRoot and HP Repair MTA-angelus. The compressive strength of ProRoot MTA was significantly lower than Biodentine but significantly higher than HP repair MTA Angelus. Conclusion: Biodentine and ProRoot have better in mechanical properties than the HP Repair MTA. The time had correspondingly effectively increased impact on the dental materials used in this study.

Objective In total hip arthroplasty (THA), surgeons attempt to achieve a physiological antetorsion. However, postoperative antetorsion of the femoral stem is known to show large variabilities. The purpose of this study was to assess whether postoperative antetorsion is influenced by stem design or cementation. Materials and methods This retrospective study included 227 patients with a hip prosthesis with five different stem designs (S1: short curved, S2 and S3: standard straight, S4: standard straight collared, S5: cemented straight), who had metal suppressed 1.5T-MRI of the hip between February 2015 and October 2019. Measurement of femoral antetorsion was done independently by two fellowship-trained radiologists on axial images by measuring the angle between the long axis of the femoral neck and the posterior condylar tangent of the knee. Measured angles in the different groups were compared using the t test for independent samples. Results The cementless collared stem S4 showed the highest antetorsion with 18.1° (± 10.5°; range –10°–45°), which was significantly higher than the antetorsion of the collarless S3 with 13.3° (± 8.4°; − 4°–29°) and the cemented S5 with 12.7° (± 7.7°; − 3°–27°) with p = 0.012 and p = 0.007, respectively. S1 and S2 showed an antetorsion of 14.8° (± 10.0°; 1°–37°) and 14.1° (± 12.2°; − 20°–41°). The torsional variability of the cementless stems (S1–4) was significantly higher compared with that of the cemented S5 with a combined standard deviation of 10.5° and 7.7° (p = 0.019). Conclusion Prosthesis design impacts the postoperative femoral antetorsion, with the cementless collared stem showing the highest antetorsion. Cemented stems demonstrated significantly lower variability, suggesting the lowest rate of inadvertent malrotation.

Circularly polarized slot antennas based on dual-mode elliptic substrate integrated waveguide (SIW) cavities are proposed in this letter. Current distribution on the dual-mode cavity is analyzed first to facilitate the layout design. The antennas are divided into three categories. For the first one, three unbalanced slots are etched on the upper surface of the cavity with a central rectangular slot placed perpendicularly to the arc-shaped slots on the two sides of the long axis. For the other two antennas, two pairs of symmetric arc-shaped slots are etched on the upper surface of the cavity. One of them has an additional shorting-pin in the center. Circular polarization is achieved by simultaneously exciting two quasi-TM110 cavity modes and combining them in the 5–6 GHz frequency range. The working principle of the dual-mode antennas is theoretically illustrated in detail and experimentally verified. The proposed antennas offer attractive features, including novel working principle, simple structure, low loss, low profile, low cost, and good gain, appearing as good candidates for indoor communication.

Background Several tape fixations for chest tube were proposed, although none have a clear scientific basis. We performed a multicenter survey study to investigate the fixation of chest tubes using an available adhesive tape. We evaluated the strength of tape fixation and the effect of the skin coating material used on the fixation strength. Methods A multi-center questionnaire survey was administered in hospitals with a thoracic surgery division. The net promoter score (NPS) was used to measure the medical staff's satisfaction with an adhesive tape fixation. Fixing strength was calculated as follows: a chest tube was fixed using each taping method to a polyethylene plate and was pulled out in the long axis direction. While pulling out, the maximum resistance force [Newton (N)] and total resistance force [Joule (J)] were measured to calculate the fixing strength. Results The doctors' NPS showed no significant difference between handmade tape fixation and Quickfix {7 [5-8] vs. 10 [5-10] points, P=0.34}. The nurses' NPS showed no significant difference between handmade tape fixation and Quickfix {5 [5-8] vs. 5 [5-7] points, P=0.72}. The average maximum resistance force was the highest for Quickfix (1.36 J, 65.4 N) and a type of handmade fixation (three sheets stuck with foundation tape plus Y-shape slit plus Ω-shape tape; 1.61 J and 54.0 N). The fixation strength of Quickfix did not decrease with a skin coating agent (from 1.24 to 1.11 J and 63.0 to 66.6 N), although that of a handmade tape fixation decreased (from 1.49 to 0.90 J, 52.6 to 38.1 N). Conclusions Quickfix provided secure fixation, regardless of the tube size or skin coating. Quickfix may be the best for standardized fixation because it is not only a stronger agent but is safe, simple, inexpensive, reliable, and can be used successfully by anyone.

Objectives: To compare the first pass success rate between long and short axis approaches in ultrasound guided IJV cannulation. Study Design: Prospective randomized controlled study. Setting: Department of Anesthesia and Intensive Care, Jinnah Hospital, Lahore. Period: Between 3rd Mar, 2016 to 2nd Sep, 2016. Material & Method: One hundred and ten patients admitted in the ICU were included in this study. Internal jugular vein was visualized ultrasonographically. In group A patients, long-axis view was used, while in group B patients, short-axis view was used to pass the needle. Under aseptic measures, US probe was placed on the neck and IJV viewed with either approach. During needle advancement if the needle penetrates the vein in the first attempt and blood flush-back is viewed, it was labeled as 1st pass success. This first pass success rate was noted. Results: One hundred and ten patients (55 in each group) were included in the study. The mean age of the patients was found to be 33.89 ± 13.35 years in group A and 35.90 ± 14.10 years in group B. The primary outcome of the study was to compare 1st pass success rate in both groups. The first pass success rate was 74.5% in group B (short-axis) and 61.8% in group A (long-axis); independent sample test showed non-significant (P=0.219). There is no difference in the frequency of 1st pass success rate in short axis approach and long axis approach for Ultrasound-guided IJV cannulation. Conclusion: Ultrasound-guided internal jugular venous cannulation with both approaches i.e. short-axis view and long-axis view have no significant difference in terms of first pass and therefore are equally successful.

Objectives The purpose of this in vitro study was to determine whether different storage conditions used during endodontic procedures affect the fracture resistance of extracted teeth used for pre-clinical dental education. Methods Freshly extracted mandibular incisors and canines were sterilised in an autoclave for 40 minutes at 24°F under a pressure of 20 psi and then stored in distilled water at 4°C until use. Specimens were randomly assigned to two groups based on the storage method used whilst undergoing endodontic procedures. Between endodontic sessions, teeth in the Wet Group (n = 16 incisors; n = 4 canines) were stored in distilled water and teeth in the Dry Group (n = 16 incisors; n = 4 canines) were stored in a dry container. All specimens were kept at room temperature and away from sunlight. Endodontic treatments were performed in 3 sessions over a 3-week period. The specimens were then brought to fracture under compressive forces along the long axis of the tooth in an Instron universal testing machine. The data were analysed using t tests (α = 0.05). Results None of the teeth fractured during endodontic procedures. However, the compressive load required to fracture teeth stored under wet conditions was significantly higher than the load needed for teeth stored dry (P Conclusions Fracture resistance is affected by storage conditions; teeth stored in water have a higher resistance to fracture than teeth that are stored dry. Fracture resistance was, however, not reduced enough to lead to tooth fracture during pre-clinical endodontic procedures.

Aim: The sealing ability of the retrograde material is greatly affected by the technique used for root end preparation. Advances in retrograde preparation techniques such as lasers has shown to provide an efficient outcome. The study was to evaluate and compare the effect of various techniques of retrograde cavity preparation on apical microleakage. Materials and Methods: Forty-five single rooted teeth were decoronated. Biomechanical preparation was carried out up to size F2 ProTaper system and obturated. Glass–ionomer cement was used as an access restorative material. The apical root resection was done at 3 mm from the apex at angulation of 90° to the long axis of the root. The allocation of the samples was done into three groups of 15 each. Group A: Retrograde cavities prepared using conventional round bur; Group B: Retrograde cavities prepared using ultrasonic retro preparation diamond tip; and Group C: Retrograde cavities prepared using “Erbium, chromium: yttrium, scandium, gallium, garnet” (Er,Cr:YSGG). The retrograde cavities hence prepared were filled with MTA Plus. Nail varnish was used to coat the samples except at the apical end. Samples were immersed in methylene blue for 24h. Stereomicroscope was used for examination of the sectioned teeth. The data were analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey test. Results: Results showed very highly significant difference between laser and bur (P value = 0.001). Conclusion: Retrograde preparation with Er,Cr:YSGG showed significantly less microleakage when compared to the use of ultrasonic retrotip and burs.

[Purpose] To compare the changes in the muscle cross-sectional area (MCSA) along the long axis of the lower leg muscles at rest and during ankle plantar flexors isometric contraction and to obtain basic information regarding the movement of lower leg muscles during ankle plantar flexors contraction. [Participants and Methods] Sixteen healthy young female participants (20.9 ± 1.2 years) were asked to sit with their ankles in a neutral ankle position. Images were obtained at rest and during isometric contraction of the ankle plantar flexors using gravity magnetic resonance imaging. The MCSAs of the triceps surae and tibialis anterior were measured. [Results] The middle region of the soleus muscle had a lower MCSA on contraction than at rest. In addition, the medial head of the gastrocnemius had a lower MCSA on contraction than at rest in the distal quarter. Moreover, the tibialis anterior had a lower MCSA at rest than on contraction in the middle region. [Conclusion] The area to be used as an indicator and the movement to be induced differ depending on the muscle during isometric contraction of the triceps surae.

Background and Aims: The Ultrasound (USG)-guided internal jugular vein (IJV) cannulation can be performed using different approaches like short axis (SAX), long axis (LAX), oblique axis (OAX) or medial oblique axis (M-OAX). We aimed to determine which view was optimal for IJV cannulation. Methods: After ethical committee approval and written informed consent, this prospective, randomised, controlled trial was conducted on 108 patients. Patients were allocated into one of the three groups: A (SAX), B (LAX) and C (M-OAX approach) for USG-guided IJV cannulation. The number of needle passes, the success of IJV cannulation and its diameter, venous access time, guidewire time, catheterisation time and complications if any were recorded. Statistical analysis was performed by SPSS version 17.0. Results: First needle pass success rate was highest in M-OAX (97.2%) followed by SAX (88.9%) and then LAX (77.8%) but it was statistically insignificant among the groups. Mean venous access, guidewire insertion and catheterisation time were shortest in M-OAX followed by SAX and then LAX approach. It was statistically significant between LAX and SAX and between LAX and M-OAX group. (P < 0.001). The carotid puncture was noticed in two patients in the LAX group. The overall success rate and the number of needle passes were comparable among the groups. Conclusion: The M-OAX approach is a safe and effective technique for USG-guided IJV cannulation when compared to SAX and LAX approaches.

Objective This study was conducted to characterize the effects of the changes in the condylar long axis and position on temporomandibular symptoms with respect proximal segment position after intraoral vertical ramus osteotomy (IVRO). Study Design Twenty Japanese patients with diagnosed jaw deformity underwent IVRO without internal fixation. Long-term changes in condylar long axis and position were assessed during postoperative follow-up examinations by using computed tomography, and t tests were performed for comparison. In addition, changes in temporomandibular symptoms were examined. Results The degree of axial rotation of the proximal segment changed significantly when the proximal segment was located laterally. Downward changes in condylar position significantly differed when the proximal segment was located posterolaterally. Forward changes in condylar position significantly differed when the proximal segment was located laterally; moreover, when the proximal segment was located laterally, temporomandibular symptoms disappeared. Conclusions Lateral location of the proximal segment may be an important factor in the positive effects of IVRO, with respect to temporomandibular symptoms.

Acro-osteolysis (synonym phalangeal osteolysis) refers to the resorption of one or more of the distal phalanges of the hands or feet.1 Two characteristic radiologic variants have been described, and may coexist in the same patient.2 In the transverse type, linear bands of resorption are evident in the shaft of the distal phalanx, perpendicular to its long axis. In the longitudinal type, there is resorption of the tuft of the distal phalanx. Although case reports tend to emphasize these radiologic findings, little attention is paid to nail changes. We report idiopathic acro-osteolysis in an otherwise healthy 10-year-old girl presenting to our dermatology service with nail dystrophy. We performed a literature review for similar cases and for nail changes previously reported in acro-osteolysis.

Lateral crural cephalic malposition (LCCM) is a well-known deformity of the nasal tip which contributes to functional disturbances of the external nasal valve. Accurate diagnosis of this deformity helps surgeons plan for better outcomes. A total of 176 candidate patients for primary rhinoplasty underwent standard 2D medical photography of the face. Senior authors analyzed photography results and differentiated the patients with LCCM. In addition, we measured the angle between the dorsal septum and lateral end of the long axis of the alar cartilage in the operation room. Ninety-five patients were diagnosed with LCCM on photography. As much as 31.3% (55) of all the patients had LCCM in intraoperative measurements. The sensitivity and specificity of 2D photography for diagnosing LCCM were 0.7924 and 0.5391, respectively. The main surgical techniques for correction of LCCM were alar repositioning (34.3% in total, 56% in LCCM patients) and lateral crural strut graft (43.8% in total, 69% in LCCM patients). LCCM is overdiagnosed via 2D photography, and this method lacks sensitivity. The overall frequency of LCCM seems to be lower than the previously reported frequency. For optimal results in rhinoplasty, surgeons must focus on the best contouring and function rather than solely correcting angles and rotations.

Background Assessment of intracardiac flows and turbulence has acquired rising significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have shown that alterations in intracardiac fluid dynamics can be helpful to identify abnormalities in cardiac function. Purpose This study investigates the additional information provided by the quantitative assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods Sixty-one patients with severe AS (33 females) and 38 healthy sex- and BSA-matched controls (CTRL) (15 females) were prospectively included and underwent echocardiographic assessment of intracardiac flow dynamics. Echocardiographic measurements were performed on apical three chamber views. The HyperDoppler software adapted to the echo-scanner without contrast injection was used to assess intracardiac vortex properties. The following parameters were obtained: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Inter-rater variability was measured using intraclass correlation coefficients (ICCs) between two independent operators. Results Patients with severe AS (mean gradient: 47,5±13,9 mmHg; aortic valve area: 0.7±0.2 cm2; ejection fraction: 53±7%) had increased LV wall thickness (p0.001, respectively) were significantly higher in AS patients compared with CTRL. Among those who underwent TAVR, we observed a significant difference in the delta values of VA and VL pre-postTAVR in patients with and without significant paravalvular leak (p Conclusions The newly defined VA, VL and VD, quantitative indices of vortical flow, were significantly increased in the LV cavity of patients with severe AS compared to normal subjects. These indices, whose measurement was feasible and reliable, might provide complementary information to standard echocardiography, useful for the further diagnostic and prognostic characterization of the heterogeneous population of patients with severe AS. Funding Acknowledgement Type of funding sources: None.

Pleomorphic adenoma of the accessory salivary glands represents 60% of oral salivary tumors. Clinically it presents as a slow growing, painless swelling covered by a healthy mucosa. Its preferential location in the accessory salivary glands is the palate region. We report the case of a 61-year-old female patient who was referred for a swelling of the palate. The swelling measured approximately 40 mm in long axis, was firm to elastic, painless, did not bleed on contact and was covered by a healthy mucosa. The radiographic examination revealed an isodense, homogeneous, well-limited tissue process in the palatal vault and concluded that it was a palatal tumor measuring 47x35x24mm with benign characteristics. The removal of the encapsulated tumor was performed under general anesthesia. The postoperative course was simple. A prosthetic rehabilitation was performed two months later. No recurrence was observed after six months.

Background and purpose Artificial intelligence (AI) has the potential to greatly improve efficiency and reproducibility of quantification in echocardiography, but to gain widespread use it must both meet expert standards of excellence and have a transparent methodology. We developed an online platform to enable multiple collaborators to annotate medical images for training and validating neural networks. Methods Using our online collaborative platform 9 expert echocardiographers labelled 2056 images that comprised the training dataset. They labelled the four points from where the standard parasternal long axis (PLAX) measurements (interventricular septum, posterior wall, left ventricular dimension) would be made. Using these labelled images we trained a 2d convolutional neural network to replicate these labels. Separately, we curated an external validation dataset of the systolic and diastolic frames of 100 PLAX acquisitions. Each of these images were labelled twice by 13 different experts, and the average of the 26 measurements was taken as the consensus standard. We then compared the individual experts and the AI measurements on the external validation dataset to the consensus standard, and calculated the precision standard deviation (SD) of the signed differences from the consensus standard. Results For diastolic septum thickness, the AI had a precision SD of 1.8 mm (ICC 0.81; 95% CI 0.73 to 0.97), compared with 2.0 mm for the individual experts (ICC 0.64; 95% CI 0.57 to 0.72). For diastolic posterior wall thickness, the AI had a precision SD 1.4 mm (ICC 0.54; 95% CI 0.38 to 0.66), and the individual experts 2.2 mm (ICC 0.37; 95% CI 0.29 to 0.46). The AI's precision SD for left ventricular internal dimension was 3.5 mm (ICC 0.93, 95% CI 0.90 to 0.94), and for individual experts was 4.4mm (ICC 0.82, 95% CI 0.78 to 0.95). Both the experts and AI performed better in diastole than systole (precision SD AI 2.5mm vs 4.3mm, p Conclusions AI trained by a group of echocardiography experts was able to perform PLAX measurements which matched the reference standard more closely than any individual expert's own measurements. This open, collaborative approach may be a model for the development of AI that is explainable to, and trusted by clinicians. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperil BRC ITMATDr Howard was additionally funded by Wellcome. Online collaborative platformResults of AI and experts

Background/Introduction In some patients, detecting and visualizing left atrial appendage (LAA) thrombus (especially at fundus level) seems to be challenging. Thus looking for indirect signs such as morphology, size and function may be of use. Purpose Finding echocardiographic signs suggesting presence of LAA thrombus using 3D TEE & pulse wave doppler. Methods We collected data via transesophageal echocardiography (TEE) from different set of patients with diseased heart (valvular especially mitral stenosis, congenital, pre-cardiac conversion for atrial fibrillation). And that by using EPIQ7 echo machine by Phillips. With each patient, we acquired pulse wave doppler determining the maximum (telesystolic) emptying velocity at mid LAA (MEV-LAA), and maximum long axis surface area of LAA (LAA-SA) using Xplan modality or multiplanar reconstruction from gated 3D acquisitions of LAA. Doing so we tried to assess the relationship between LAA thrombus and its morphology (2D/3D) using the 04 shapes classification (windsock, cauliflower, chicken wing, cactus), measuring LAA-SA considering a cutoff of 6cm2 or above a dilated LAA. A MEV-LAA considered diminished if less than 25cm/s. Finally we calculated the ratio of LAA-SA/MEV-LAA. Results We assessed a group of 55 patients. LAA thrombus was visualized in 10 of them. The predominant morphology was windsock 50.9% then equally chicken wing and cauliflower 14.5%, cactus 11%. Thrombus occurred in major part with cauliflower type with 50% of all patients with the same shape. LAA was dilated in 25 patients in whom 7 had LAA thrombus (Se: 70% Sp: 60% PPV: 22%). LAA maximum emptying velocity was reduced in 18 patients in whom 10 had LAA thrombus (Se: 100% Sp: 82.2% PPV: 36%). We found that 7 patients with a ratio LAA-SA/MEV-LAA Cauliflower morphology has the highest occurrence of thrombus as demonstrated in the literature. LAA-SA is the least reliable criteria associated with LAA thrombus. MEV-LAA is has the most sensible value of the three measurements. The ratio LAA-SA/MEV-LAA seems to have the highest specificity and positive predictive value in terms of association with thrombus (in cauliflower type this ratio seems to be less specific). Some limitations of this study was the limited number of patients assessed, no comparison in terms of sex (LAA size is different in men and women according to literature), sinus rhythm versus atrial fibrillation (LAA maximum emptying velocity), no correlation with CT-scan of LAA concerning dimensions and thrombus. Conclusion 3D transesophageal echocardiography and pulse wave doppler study of the LAA seems to be associated with thrombus formation especially indirect signs and indexed values (ratio LAA-SA/MEV-LAA), that tends to push the diagnostic power of TEE. Promptly this will lead to more investigations on a large scale number of patients in different sub-type groups. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Mustapha Pacha University Hospital Center, department of Cardiology A2 3D TEE of LAA and Mitral prosthesisXplan on LAA, cauliflower type

PurposeCurrently, the American Heart Association (AHA) 17-segment model is the preferred clinical method to define and quantify left ventricle (LV) myocardial infarction (MI) size. This method is subjective and can be inaccurate given that segmental approximation assumes a specific percent of infarcted tissue when compared to reference standard post-mortem histopathology. To improve the accuracy and reproducibility of infarct volume quantification we propose a novel measurement technique based on cardiac MRI images from a porcine model of myocardial infarction. Data were collected from serial MRI exams of Yucatan mini swine over 6 months and endpoint organ harvesting for histopathologic analysis. MethodsTwo observers evaluated four infarct sizing methods: myocardial contouring of post-mortem heart slices, contouring using cardiac MRI, AHA 17-segment model analysis and novel long-axis MRI infarct sizing. ResultsLV infarct sizes ranges were 1.6% - 25.8% (n=10) using reference standard histopathologic infarct sizing. Intraclass correlations (ICC) were calculated between two observers and averaged due to high similarity, ICC > .900. A t-test of .0006 and Bland-Altman plots show statistically significant differences in 17-segment model infarct size compared to histopathologic analysis while no significant difference was found when compared to our new novel method with 0.8198. Linear correlation showed an R 2 of 0.9111 between MRI contoured infarct size and our novel MRI infarct sizing model to predict infarct size as a percentage while the R 2 of the 17-Seg model is 0.8197. ConclusionsThe 17-sgement model provides an inferior quantitative assessment of LV infarct size compared to the proposed long-axis infarct sizing suggesting it maybe a robust and easily implementable quantitative assessment of LV infarct size in advanced imaging.

Background: COVID-19 lung segmentation using Computed Tomography (CT) scans is important for the diagnosis of lung severity. The process of automated lung segmentation is challenging due to (a) CT radiation dosage and (b) ground-glass opacities caused by COVID-19. The lung segmentation methodologies proposed in 2020 were semi- or automated but not reliable, accurate, and user-friendly. The proposed study presents a COVID Lung Image Analysis System (COVLIAS 1.0, AtheroPoint™, Roseville, CA, USA) consisting of hybrid deep learning (HDL) models for lung segmentation. Methodology: The COVLIAS 1.0 consists of three methods based on solo deep learning (SDL) or hybrid deep learning (HDL). SegNet is proposed in the SDL category while VGG-SegNet and ResNet-SegNet are designed under the HDL paradigm. The three proposed AI approaches were benchmarked against the National Institute of Health (NIH)-based conventional segmentation model using fuzzy-connectedness. A cross-validation protocol with a 40:60 ratio between training and testing was designed, with 10% validation data. The ground truth (GT) was manually traced by a radiologist trained personnel. For performance evaluation, nine different criteria were selected to perform the evaluation of SDL or HDL lung segmentation regions and lungs long axis against GT. Results: Using the database of 5000 chest CT images (from 72 patients), COVLIAS 1.0 yielded AUC of ~0.96, ~0.97, ~0.98, and ~0.96 (p-value &lt, 0.001), respectively within 5% range of GT area, for SegNet, VGG-SegNet, ResNet-SegNet, and NIH. The mean Figure of Merit using four models (left and right lung) was above 94%. On benchmarking against the National Institute of Health (NIH) segmentation method, the proposed model demonstrated a 58% and 44% improvement in ResNet-SegNet, 52% and 36% improvement in VGG-SegNet for lung area, and lung long axis, respectively. The PE statistics performance was in the following order: ResNet-SegNet &gt, VGG-SegNet &gt, NIH &gt, SegNet. The HDL runs in &lt, 1 s on test data per image. Conclusions: The COVLIAS 1.0 system can be applied in real-time for radiology-based clinical settings.

Backgrounds: The aims of this study were to; Evaluate the amount of in-vitro microleakage of three different types of pit and fissure sealants (Vertise Flow, Kerr), (Helioseal-F, IvoclarVivadent), (GC Fuji TRIAGE, GC corporation) and the effect of occlusal preparation on the leakage value.Methods: Sixty extracted human premolars randomly divided into 6 groups (n=10/group). Teeth fissures of three non-invasive groups (1, 3, 5) left intact, fissures of other three invasive groups (2, 4, 6) were opened up with ¼ round bur. Teeth fissures in group (1, 2) sealed with self-adhesive Vertise Flow, group (3, 4) Helioseal-F, while group (5, 6) fissures sealed with Glass Ionomer GC Fuji TRIAGE. The teeth thermocycled between 5±2°C and 55±2°C for 500 cycles with a dwell time of 30 seconds; All teeth sealed apically and coated within 1.5 mm of the sealant margin with two layers of nail varnish, then immersed in 1% Methylene blue solution. Subsequently, two buccolingual sections were made parallel to the long axis of tooth yielding 3 sections and 4 surfaces per tooth for microleakage analysis. The surfaces were scored 0 to 3 for the extent of microleakage using a binocular microscope at 25X magnification. Microleakage was analyzed by using paired t-test and ANOVA.Results: Invasive technique produced significantly less microleakage than Non-Invasive groups (P

Background: The femoral intercondylar notch type and the alpha angle (the angle between the femoral notch roof and the long axis of the femur) are easily measured in clinical settings; however, their associations with anterior cruciate ligament (ACL) injury remain unclear. Hypothesis/Purpose: The purpose was to determine if the alpha angle and the femoral notch type are associated with noncontact ACL injury univariately and in combination with previously identified knee geometric risk factors. We hypothesized that the alpha angle and the femoral notch type are associated with noncontact ACL injury and that the association differs between men and women. Study Design: Case control study; Level of evidence, 3. Methods: The alpha angle and the femoral notch type were measured via 3T magnetic resonance imaging (MRI) acquired from 61 women and 25 men with a first-time noncontact ACL injury. Each injured patient was matched with a control participant based on age, sex, and participation on the same sports team. A conditional logistic regression was used to assess univariate associations with ACL injury as well as multivariate associations using MRI-based risk factors of knee geometry identified in previous analyses: femoral intercondylar notch width at the anterior outlet, femoral intercondylar notch anteromedial ridge thickness, volume of the ACL, tibial plateau lateral compartment subchondral bone slope, lateral compartment middle articular cartilage slope, lateral compartment meniscus-cartilage height, lateral compartment meniscus-bone angle, and medial tibial spine volume. Results: For female athletes, the alpha angle (odds ratio, [OR], 1.82 per 1-degree increase; P = .001), the tibial lateral compartment articular cartilage slope (OR, 1.25 per 1-degree increase in the posterior-inferior directed slope; P = .022), and the femoral notch anteromedial ridge thickness (OR, 3.36 per 1-mm increase; P = .027) were independently associated with ACL disruption. For men, no other variables entered the models after the alpha angle was inputted as the first step (OR, 2.19 per 1-degree increase; P = .010). Conclusion: For women, ACL injury was most strongly associated with increased alpha angle, increased tibial plateau slope, and increased femoral notch ridge thickness. For men, increased alpha angle was the most significant factor associated with ACL injury. The mechanism of injury might be associated with a combination of impingement of the ACL against the bone and increased ligament loading.

Objectives: To investigate changes in right ventricular (RV) strain after pulmonary valve replacement (PVR) in repaired tetralogy of Fallot (TOF) by applying a novel postprocessing technique to conventional short-axis cine MRI to measure RV strains before and after PVR.Methods: Twenty-four patients with repaired TOF who underwent PVR and 16 healthy controls were enrolled. Global maximum and minimum principal strains (GPSmax, GPSmin) and global circumferential and longitudinal strains (GCS, GLS) were measured from short-axis cine images reconstructed radially along the long axis. Strain parameters before and after PVR were compared using paired t-tests. One-way ANOVA with Tukey post-hoc analysis was used for comparisons between the before and after PVR groups and the control group. Results: There were no differences in strain parameters before and after PVR. The GPSmax before PVR was lower than that in the control group (P=0.002). Before and after PVR, GCSs were higher and GLSs were lower than those in the control group (before and after GCSs: P=0.002 for both, before and after GLSs: PP=0.0003). Conclusions: RV strains from radially reconstructed short-axis cine images revealed impaired myocardial motion after PVR. When compared to the control group, changes in GCS and GLS in TOF patients before and after PVR might be due to RV remodeling.

Different ultrasound approaches have been proposed to evaluate the distal biceps brachii tendon, such as lateral, posterior, medial, and anterior, all allowing good visualization of the distal biceps tendon and its pathologic appearances. Here we describe a new method of ultrasound evaluation of the distal biceps tendon insertion with the patient in the so-called crab position. The crab position is used to evaluate the posterior compartment of the elbow but also the lateral and medial compartments. This position allows for coverage of 75% the elbow in a single position, with less discomfort for the patient and a fair amount of saved time. In this position, after the evaluation of the common extensor tendon in the long axis, turning the transducer 90° and moving it distally allows for optimal visualization of the distal biceps brachii tendon in the axial plane. It is a simple, quick approach that allows for excellent visualization of the insertion of the distal biceps brachii tendon while avoiding an anisotropic effect.

Background The purpose of the present study was to describe the CT imaging findings of normal incisive canals and incisive canal cysts and propose cut-off values to differentiate between them. Methods A total of 220 normal subjects and 40 patients with incisive canal cysts on multi-detector row computed tomography (MDCT) were retrospectively analyzed. The shapes, sizes, anatomic variations, Hounsfield scale values, and so on of maxillary incisive canals and the sizes and Hounsfield scale values of maxillary incisive canal cysts were analyzed. Results A significant difference in sizes of maxillary incisive canals in normal subjects was found between males and females. The sizes of maxillary incisive canals were significantly wider during aging, but shapes, anatomic variations, and Hounsfield scale values in the maxillary incisive canals were not significantly different with aging. A significant difference in sizes but not Hounsfield scale values was found between normal maxillary incisive canals and maxillary incisive canal cysts. Based on a cut-off of over 6 mm in the width of incisive canals, maxillary incisive canal cysts could not be appropriately diagnosed for subjects over 60 years of age. Over 60 years of age, maxillary incisive canal cysts could be appropriately diagnosed based on a cut-off of over 7.1 mm in width of incisive canals. When maxillary incisive canals of the hourglass types were seen on sagittal sections, significantly more patients had maxillary incisive canal cysts than other types. Conclusion In coincidentally diagnosing asymptomatic incisive canal cysts on imaging, we should apply different cut-offs for the size of the maxillary incisive canal for patients over and under 60 years of age. Specifically, the cut-offs for the long axis of maxillary incisive canal cysts were 7.1 mm for patients over 60 years of age and 6.0 mm for those under 60 years of age. In addition, we should pay attention to wider canals with hourglass shapes as indicative of cystic change of maxillary incisive canals.

Introduction: A rise in acidic products consumption has led to an increase in the percentage of eroded enamel and dentin. A new remineralization method is the consumption of green tea, which suspected to have remineralization properties.Aim of the work: This study determined the impact of green tea on enamel remineralization of immersed teeth in pepsi.Materials and Methods: After clinical and radiographic examinations, 30 sound permanent posterior teeth that were newly extracted for orthodontic purposes were chosen. Each tooth was sectioned into 4 quadrants at right angle to the root long axis. We choose cervical region for the present research. Sectioned teeth were grouped into 3 sets; 40 specimens for each. Group I: served in artificial saliva. Group II: specimens immersed in Pepsi beverages. Group III: specimens were demineralized by Pepsi drink for 3 hours and then immersed in green tea. All samples have been evaluated after 4 weeks using scanning electron microscopyResults: The application of green tea has considerably reduced the roughness of the enamel surface, improving the capacity for enamel remineralization.Conclusions: Green tea is effective in preventing the erosion of enamel and a promising remineralization material

Objective: The purpose of this study was to investigate the alveloar palatine bone thickness of the maxillary central incisors using cone-beam computed tomography (CBCT). Material and Methods: This study used the CBCT images of 480 patients (240 male – 240 female). In order to determine bone thickness, measurements were made on the program perpendicularly to the long axis of the tooth at 3 points selected from the 3, 6 and 9 mm apical or the enamel-cement border in parallel to the long axis of the central teeth. Results: For the left central teeth, the mean palatine bone thickness was found for the coronal, medial and apical regions as 1.48 mm, 3.09 mm and 5.13 mm, respectively, while these values were respectively 1.35 mm, 2.95 mm and 5.10 mm for the right side. Conclusion: Considering that there should be a bone of at least 1 mm thickness on socket walls for immediate implantation, it was determined that palatine bone thickness is not sufficient by itself for immediate implantation. As a result of the analysis, it was seen that the palatine alveloar bone thickness that was observed in women was thinner than that in men. How to cite this article: Üner DD, İzol BS. Analysis of whether or not the alveloar palatine bone thickness of the central incisors is sufficient for implants of 3 mm and 3.5 mm thickness using cone-beam computed tomography. Int Dent Res 2019;9(2):51-7. Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.