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BACKGROUND: Computer-aided design and three-dimensional printing have been used in various clinical and fundamental medicine fields, especially in surgery. For example, in the preoperative period, the correspondence of printed products to the anatomy can play an important role in evaluating pathological changes and correction methods. However, determining dimensional deviations of printed models involves ethical and technical difficulties associated with defining a reference and taking many measurements, respectively. Therefore, we propose to use a geometric object with known dimensions as a reference and estimate linear deviations using the Iterative Closest Point algorithm for each of the vertices of the prototyped polygonal mesh. AIMS: To evaluate the geometric deviations associated with creation of bone-like physical objects from computed tomography data using computer-aided design and additive manufacturing. MATERIALS AND METHODS: The source object was created using the FreeCAD application; Blender and Meshmixer software was used for polygon meshes correction and transformation. The 3D printing was carried out on an Ender-3 printer with copper-impregnated polylactide plastic BFCopper. Scanning was performed using a 128-slice tomograph Philips Ingenuity CT. A series of tomographic images were processed in 3DSlicer software to create virtual models by semiautomatic segmentation with threshold values of 500 HU, 0 HU, 500 HU, 750 HU, and manual segmentation. Reproduced and reference polygon meshes were compared using the Iterative Closest Point algorithm in CloudCompare software. RESULTS: The volume of reproduced models exceeded the volume of respective reference models by 1%27%. The average point cloud linear deviation values of reproduced models from the reference ones were 0.030.41 mm. A significant correlation between integral sums of linear deviations and changes in the volume of reproduced models was shown using Spearman's rank correlation coefficient ( = 0.83; temp = 5.27, p=0.05). CONCLUSION: The geometry of the reproduced object changes inevitably, while the linear deviations depend more on the chosen segmentation method than on the overall size of the model or its structures. The manual segmentation method can lead to greater linear deviations, though it saves all the necessary anatomical structures.

Objectives To compare the geometric accuracy and measurement reliability of 3-dimensional (3D) reconstructed models of the mandible created from cone beam computed tomography (CBCT) images obtained with 0.2-mm and 0.4-mm voxel sizes with the reference standard model and compare the accuracy of the CBCT-based models to each other. Study design The reference standard 3D model of a dry human mandible was obtained using a white light scanner. The mandible was scanned with CBCT 10 times at each voxel size. The models created from the CBCT data were compared with the reference standard by using a point-based rigid registration algorithm where the distance differences between the superimposed CBCT models and the reference standard model were recorded. The measurements derived from the 2 CBCT-based scans were also compared. Results Mean deviations from the reference standard for 0.2-mm and 0.4-mm voxel scans were 0.4342 mm and 0.4580 mm, respectively (P ≥ .16). The CBCT scans with both 0.2-mm and 0.4-mm voxels produced good measurement reliability and did not significantly differ from each other (P ≥ .20). Conclusions CBCT scans with 0.2-mm and 0.4-mm voxel sizes delivered similarly accurate models. Larger voxels can be used to minimize radiation exposure.

Background Angiography-derived physiological assessment of coronary lesions has emerged as an alternative to wire based assessment aiming at less-invasiveness and shorter procedural time as well as cost effectiveness in physiology-guided decision making. However, current available image-derived physiology software have limitations including the requirement of multiple projections and are time consuming.Methods/Design The ReVEAL iFR (Radiographic imaging Validation and EvALuation for Angio-iFR) trial is a multicenter, multicontinental, validation study which aims to validate the diagnostic accuracy of the Angio-iFR medical software device (Philips, San Diego, US) in patients undergoing angiography for Chronic Coronary Syndrome (CCS). The Angio-iFR will enable operators to predict both the iFR and FFR value within a few seconds from a single projection of cine angiography by using a lumped parameter fluid dynamics model. Approximately 440 patients with at least one de-novo 40% to 90% stenosis by visual angiographic assessment will be enrolled in the study. The primary endpoint is the sensitivity and specificity of the iFR and FFR for a given lesion compared to the corresponding invasive measures. The enrollment started in August 2019, and was completed in March 2021.Summary The Angio-iFR system has the potential of simplifying physiological evaluation of coronary stenosis compared with available systems, providing estimates of both FFR and iFR. The ReVEAL iFR study will investigate the predictive performance of the novel Angio-iFR software in CCS patients. Ultimately, based on its unique characteristics, the Angio-iFR system may contribute to improve adoption of functional coronary assessment and the workflow in the catheter laboratory.

Purpose: To measure and compare the accuracy of the linear dimensions of implant sites recorded from cone beam computed tomography (CBCT) images using Blue Sky Plan, coDiagnostiX, and RadiAnt. Materials and Methods: Five human dry skulls were imaged with a CBCT device then sectioned to obtain sample transverse cross-sections of the edentulous ridges, and the height and width of the ridge were measured with a digital caliper to provide the gold standard measurements. The CBCT datasets were exported in DICOM format and imported into the three test software programs which were used to obtain reformatted sectional images corresponding to the sample transverse cross-sections, and the height and width of the edentulous ridge was recorded using the linear measurement tool. Reliability of the measurements were measured using the intraclass correlation coefficient. One-sample t-test (test value: zero) was used to test the statistical significance of the mean of the absolute errors for each software program. Analysis of Variance with Repeated Measures was used to test the statistical significance of the difference between the means of the absolute errors obtained by the different software programs. Statistical significance was set at a p-value of 0.05. Results: The reliability of the gold standard and image measurements were excellent. All three software programs demonstrated a statistically significant mean absolute measurement error of between 0.43 and 0.56 mm (p-value

OBJECTIVES To measure in vivo 3D accuracy of backward-planned partially guided implant surgery (PGIS) based on dental magnetic resonance imaging (dMRI). MATERIAL AND METHODS Thirty-four patients underwent dMRI examinations. Tooth-supported templates were backward planned using standard dental software, 3D-printed, and placed intraorally during a cone beam computed tomography (CBCT) scan. Treatment plans were verified for surgical viability in CBCT, and implants were placed with guiding of the pilot drill. High-precision impressions were taken after healing. The 3D accuracy of 41 implants was evaluated by comparing the virtually planned and definitive implant positions with respect to implant entry point, apex, and axis. Deviations from the dMRI-based implant plans were compared with the maximum deviations calculated for a typical single implant. RESULTS Twenty-eight implants were placed as planned in dMRI. Evaluation of 3D accuracy revealed mean deviations (99% confidence intervals) of 1.7 ± 0.9mm (1.2-2.1mm) / 2.3 ± 1.1mm (1.8-2.9 mm) / 7.1 ± 4.8° (4.6-9.6°) for entry point / apex / axis. The maximum deviations calculated for the typical single implant surpassed the upper bounds of the 99% CIs for the apex and axis, but not for the entry point. In the 13 other implants, dMRI-based implant plans were optimized after CBCT. Here, deviations between the initial dMRI plan and definitive implant position were only in part higher than in the unaltered group (1.9 ± 1.7 mm [0.5-3.4 mm] / 2.5 ± 1.5 mm [1.2-3.8 mm] / 6.8 ± 3.8° [3.6-10.1°] for entry point / apex / axis). CONCLUSIONS The 3D accuracy of dMRI-based PGIS was lower than that previously reported for CBCT-based PGIS. Nonetheless, the values seem promising to facilitate backward planning without ionizing radiation.

Since its initial description in 1996 by Yii and Niranjan, the internal pudendal perforator flap (also known as the Singapore flap, the gluteal fold flap, and the lotus petal flap) has become a workhorse in perineal soft tissue reconstruction. In 2001, Hashimoto described the presence of three to five perforators in the perineal anogenital triangle. The ischial tuberosity has thus become a useful anatomic landmark for the safe boundary of medial dissection during flap elevation, in order to avoid damaging the perforator vessels. The objective of the present study was to evaluate the perforators’ positions within the anogenital triangle by using color Doppler ultrasound. In a study of 15 subjects in the lithotomy position, we identified a total of 24 perforator vessels with a diameter greater than 5 mm. We noted the vessels’ positions using orthonormal measurements, according to the distance from the midline and the distance on a straight line between the two ischial tuberosities (i.e. consistent bony anatomic landmarks that are independent of the patient's height and body mass index). The mean distance between the ischial tuberosity and the internal pudendal perforator was 27.3 mm. Based on our present results, we consider that routine ultrasound identification and dissection of the perforators is not always required before pudendal flap harvesting. This decreases the operating time and simplifies the flap harvesting procedure.

Background: Home blood pressure monitoring is increasingly used for pregnant individuals; however, there are no guidelines on such monitoring in this population. We assessed current practices in the prescription and use of home blood pressure monitoring in pregnancy. Methods: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We conducted a structured search through the MEDLINE (from 1946), Embase (from 1974) and CENTRAL (from 2018) databases up to Oct. 19, 2020. We included trials comparing office and home blood pressure monitoring in pregnant people. Outcomes included patient education, home blood pressure device, monitoring schedule, adherence, diagnostic thresholds for home blood pressure, and comparison between home and office measurements of blood pressure. Results: We included in our review 21 articles on 19 individual studies (1 RCT, 18 observational) that assessed home and office blood pressure in pregnant individuals (n = 2843). We observed variation in practice patterns in terms of how home monitoring was prescribed. Eight (42%) of the studies used validated home blood pressure devices. Across all studies, measurements were taken 3 to 36 times per week. Third-trimester home blood pressure corresponding to office blood pressure of 140/90 mm Hg after application of a conversion factor ranged from 118 to 143 mm Hg (systolic) and from 76 to 92 mm Hg (diastolic), depending on the patient population and methodology. Systolic and diastolic blood pressure values measured at home were lower than office values by 4 (95% confidence interval [CI] −6 to −3) mm Hg and 3 (95% CI −4 to −2) mm Hg, respectively. Interpretation: Many issues related to home blood pressure monitoring in pregnancy are currently unresolved, including technique, monitoring schedule and target values. Future studies should prioritize the use of validated home measuring devices and standardized measurement schedules and should establish treatment targets. PROSPERO registration: CRD42020147352

Purpose Vitamin D (VitD) is a pleiotropic hormone with effects on a multitude of systems and metabolic pathways. Consequently, the relevance of a sufficiently high VitD serum level becomes self-evident. Methods A rapid immunofluorescence assay designed for the point-of-care measurement of serum VitD3 solely was tested. Inter- and intra-assay validation, double testing and result comparison with a standardized laboratory method were performed. Results An overall linear correlation of r = 0.89 (Pearson, 95% CI 0.88–0.92, p r = 0.91, 95% CI 0.86–0.94, p r = 0.86, 0.82–0.89, p Conclusion This novel, innovative, and controlled study indicates that the evaluated rapid point of care VitD assay is reliable, accurate, and suited for clinical practice.

Objectives To quantitatively evaluate the impact of virtual monochromatic images (VMI) on reduced-iodine-dose dual-energy coronary computed tomography angiography (CCTA) in terms of coronary lumen segmentation in vitro, and secondly to assess the image quality in vivo, compared with conventional CT obtained with regular iodine dose. Materials and methods A phantom simulating regular and reduced iodine injection was used to determine the accuracy and precision of lumen area segmentation for various VMI energy levels. We retrospectively included 203 patients from December 2017 to August 2018 (mean age, 51.7 ± 16.8 years) who underwent CCTA using either standard (group A, n = 103) or reduced (group B, n = 100) iodine doses. Conventional images (group A) were qualitatively and quantitatively compared with 55-keV VMI (group B). We recorded the location of venous catheters. Results In vitro, VMI outperformed conventional CT, with a segmentation accuracy of 0.998 vs. 1.684 mm2, respectively (p < 0.001), and a precision of 0.982 vs. 1.229 mm2, respectively (p < 0.001), in simulated overweight adult subjects. In vivo, the rate of diagnostic CCTA in groups A and B was 88.4% (n = 91/103) vs. 89% (n = 89/100), respectively, and noninferiority of protocol B was inferred. Contrast-to-noise ratios (CNR) of lumen versus fat and muscle were higher in group B (p < 0.001) and comparable for lumen versus calcium (p = 0.423). Venous catheters were more often placed on the forearm or hand in group B (p < 0.001). Conclusion In vitro, low-keV VMI improve vessel area segmentation. In vivo, low-keV VMI allows for a 40% iodine dose and injection rate reduction while maintaining diagnostic image quality and improves the CNR between lumen versus fat and muscle. Key Points • Dual-energy coronary CT angiography is becoming increasingly available and might help improve patient management. • Compared with regular-iodine-dose coronary CT angiography, reduced-iodine-dose dual-energy CT with low-keV monochromatic image reconstructions performed better in phantom-based vessel cross-sectional segmentation and proved to be noninferior in vivo. • Patients receiving reduced-iodine-dose dual-energy coronary CT angiography often had the venous catheter placed on the forearm or wrist without compromising image quality.

Summary Introduction The quantitative assessment of facial appearance and function is critical in the process of restoring normality and thus minimising morbidity in patients with facial deformities. Three-dimensional (3D) scanners have increasingly been applied in clinical settings to circumvent the issues associated with standard approaches, namely, subjectivity. This study aimed to summarise the current literature on the accuracy, reliability, and usability of 3D scanning technologies for soft-tissue facial assessment. Methodology Medline, EMBASE, and Web of Science were searched for studies assessing the accuracy, reliability, and/or clinical usability of 3D scanners in assessing facial morphology. All results were filtered by title, abstract, and finally by full text for relevance. Results Eight hundred and thirty-seven results were filtered down to 41 articles that were included in this review. Articles were categorised depending on the 3D visualising principle of the scanner being tested: laser-based scanning, stereophotogrammetry, structured-light scanning, or RGB-D (red, green, blue-depth) sensors. Discussion Of the traditional 3D scanners evaluated in the literature, stereophotogrammetric systems most consistently demonstrate excellent accuracy and reliability in the collection of 3D facial scans. Due to their cost, size, and complexity, these systems are often unsuitable for incorporation into clinical environments with limited availability of resources, space, and time. Recently developed RGB-D sensors can collect accurate static and dynamic 3D facial scans without many of these disadvantages. Still, further improvements in their technical specifications and a greater focus on the development of automated facial assessment software is needed before RGB-D sensors can be universally accepted as a new gold-standard for soft-tissue facial assessment.

Background Accuracy of fetal weight estimation by ultrasound is essential in making decisions on the time and mode of delivery. There are many proposed formulas for fetal weight estimation such as Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard. What best applies to the Ugandan population is not known since no verification of any of the formulas has been done before. The primary aim of this study was to determine the accuracy of sonographic estimation of fetal weight using five most commonly used formulas, and analyze formula variations for different weight ranges. Methods This was a hospital based prospective cohort study at Mulago National Referral Hospital, Kampala, Uganda. A total of 356 pregnant women who consented and were within 3 days of birth were enrolled. Prenatal ultrasound fetal weight determined by measuring the biparietal diameter, head circumference, abdominal circumference, femoral length, and then was compared with actual birth weight. Results The overall accuracy of Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard formula were 66.9, 73.3, 77.3, 78.4 and 69.7% respectively. All Hadlocks showed significant mean difference between weight estimates and actual birth weight (p p-values > 0.05) mean difference between weight estimates and actual birth weight when the actual birth weight was ≥4000.0 g. Shepard weight estimates showed a none significant mean difference when actual birth weight was Conclusion All the five formulas were accurate at estimating actual birth weights within 10% accuracy. However, this accuracy varied with the fetal birth weight. Shepard was more accurate in estimating actual birth weights

OBJECTIVES The objective of this study was to systematically compare the transfer accuracy of conventional and digital implant impressions in patients using a new reference key-based method. MATERIAL AND METHODS Thirty-nine cases were included in the study (upper jaw 22 edentulous, 8 partially edentulous, average distance between implants 30.15 ± 11.18 mm; lower jaw 6 cases edentulous, 3 cases partially edentulous, average distance between implants 33.19 ± 14.85 mm). Individual reference keys were manufactured and reversibly fixed on implants. A conventional (CVI) and a digital (DI) implant impression was made. The implant positions (center points) of conventional and digital models were measured (coordinate-measuring machine/three-dimensional analysis software) and superimposed with the positions of the reference keys to compare the deviations of the conventional and digital models. For statistical analysis, ANOVA with MIXED procedure was applied (p

BACKGROUND: Accurate estimates of clinically important difference (CID) are required for interpreting the clinical importance of treatments to improve physical function, but CID estimates vary in different disease populations. AIMS: We determined the CID of 6-minute walking distance (6MWD) and physical function component (PF10) of Medical Outcomes Study Short Form-36 in mobility-limited older men using the Testosterone Trials (TTrials) data. METHODS: TTrials participants (n=429) with mobility limitation and gait speed

Objective This study aimed to evaluate the thickness of the remaining patellar bone stock following extra-articular knee resection (EKR) preserving the extensor mechanism in human cadaveric knee joints. Methods A total of 14 human cadaveric knee joints (8 men and 2 women) were dissected, and the patellar thickness from the joint capsule insertion to the anterior cortex of the patella was measured using an electronic caliper. The mean age of the cadavers was 37 years (range=28-50). Measurements were performed by an anatomist and an orthopedic surgeon. As the total number of the cadavers was not enough to show the patellar thickness with sampling (sex and age), we endeavored to supplement the content with magnetic resonance images (MRI). Accordingly, the patellar bone thickness was also measured on axial MRI scans of 100 adult and 25 pediatric knees of patients (71 women and 54 men; mean age=36 years; age range=7-67 years) admitted to our hospital in whom meniscal tears were suspected. The rate of specimens with remaining patellar thickness of less than 10 mm after presumed resection was evaluated. The macroscopic measurements in cadavers and MRI measurements in adult knees were compared statistically. Results The mean thickness of the residual patellar bone of the cadaver dissections following a presumed EKR preserving the extensor mechanism was 8.2 mm (range=3.4-15.8). Additionally, in 71.4% (10/14) of the cadaveric knees, the thickness of residual patellar bone was less than 10 mm. In MRI scans, the average thickness of residual patella after presumed resection was 8.6 mm (range: 3.6-16) in adult knees and 6.9 mm (range: 3.4-10) in pediatric knees, and the residual patellar thickness less than 10 mm after presumed resection was determined in 72% of all MRI scans. Macroscopic measurements in cadaveric knees were statistically similar to MRI scan measurements in adult knees (p=0.765, Mann-Whitney U test). Conclusion Evidence from this study revealed that the thickness of the remaining patellar bone stock after EKR preserving the extensor mechanism may be low. A preoperative assessment with MRI can guide the surgeon to select the appropriate method for knee resection in order to prevent from the complications of resected patella.

Background: Progressive hip displacement in children with cerebral palsy (CP) is monitored by measuring migration percentage (MP) on anteroposterior (AP) pelvis radiographs. Accurate measurement of MP requires the lateral margin of the ossified acetabulum to be identified for the placement of Perkin’s line. It has been suggested that when there is an erosion of the acetabular rim, described as a gothic arch, the midpoint of the arch be used for the placement of Perkin’s line. However, this requires that there be agreement on what constitutes a gothic arch. The purpose of this study was to evaluate the inter-rater and intrarater reliabilities of identifying a gothic arch on pelvis radiographs. Methods: An online survey with 100 AP pelvis images (200 hips) of children with CP was sent to international experts. Participants were asked to identify which hip(s) had a gothic arch (left, right, both, and neither). The Fleiss κ statistic for inter-rater reliability was calculated. Eight weeks later, the images were shuffled and redistributed to calculate intrarater reliability. Results: The initial survey was completed by 10 participants with 9 participants completing the second survey. The average inter-rater κ value was 0.18 [95% confidence interval (CI), 0.14-0.23] and 0.19 (95% CI, 0.14-0.24) for the 2 surveys, respectively. Among the pediatric orthopaedic surgeons subgroup, the κ values were 0.06 (95% CI, 0.02-0.1) and 0.08 (95% CI, 0.03-0.13). The average intrarater reliability κ value was 0.61 (95% CI, 0.2-1), ranging from 0.32 to 0.86. Conclusions: There were poor inter-rater and moderate intrarater reliabilities in identifying a gothic arch on AP pelvis radiographs in children with CP. Further characterization and clarification of what constitutes a gothic arch are required. The lack of agreement on the identification of a gothic arch may negatively impact the measurement of MP and referrals to a pediatric orthopaedic surgeon.

Background: The aim of this study was to assess the accuracy of clinical screening examination in newborns with dislocated hips compared with ultrasound scan (USS). Methods: Newborns, up to 3 months of age, with confirmed hip dislocations on USS were prospectively enrolled in a multinational observational study. Data from 2010 to 2016 were reviewed to determine pretreatment clinical examination findings of the treating orthopaedic surgeon as well as baseline ultrasound indices of developmental dysplasia of the hip (DDH). All infants had been referred to specialist centres with expertise in DDH, due to abnormal birth examination or risk factor. Results: The median age of the study population was 2.3 weeks and 84% of patients were female. Of the total 515 USS-confirmed dislocated hips included in the study, 71 (13.8%) were incorrectly felt to be reduced on clinical examination by the treating orthopaedist (P

Estimating the appropriate tendon length and associated skin incision needed to achieve a plantigrade foot without compromising function are essential steps in open Achilles tendon lengthening. Here we describe a technique using basic surgical instruments referencing anatomic landmarks without the need for radiographs. The center of ankle rotation in the sagittal plane is found referencing the tip of the medial malleolus. This point is translated to the plantar surface of the foot, and a straight instrument in line with the foot is used to make a mark at the posterior calcaneal fat pad. The straight instrument is then rotated (representing the plantar surface of the foot) as if dorsiflexing the ankle along the axis of the transposed tibiotalar joint from a plantar-flexed position to the desired final position and a second mark is made at the posterior heel. The distance between the marks is measured, representing the amount of Achilles lengthening required. The skin incision and tendon limb lengths area a sum of the operative correction and the amount of desired tendon overlap, typically 2 cm of tendon overlap is optimal to allow for suture fixation, ensure tendon healing, and maintain the integrity of the repair. A Z-type lengthening is then performed using this tendon limb length. This technique allows an accurate and simple approach to lengthening the Achilles tendon. In this way the ideal tendon limb length is selected to optimize function while minimizing incision length, associated wound complications, inadequate lengthening, and overlengthening. Level of evidence: Technical note, Level V.

Objectives: This study aims to investigate the usability and reliability of our new axis in a three-dimensional modelling work and demonstrate if it is a reproducible method for anteversion measurement that sufficiently correlates with other computed tomography (CT)-derived gold standards including transepicondylar axis (TEA) and posterior condylar axis (PCA). Patients and methods: Three-dimensional solid models were derived from left femoral CT data of 100 participants (50 males, 50 females; mean age 57 years: range, 21 to 86). The newly proposed popliteal surface axis (PSA) was compared with TEA and PCA in terms of anteversion measurement on these solid models. Results: Popliteal surface axis was found as a reproducible reference axis in our study as it could be measured in 99% of our sample. The mean value of PSA based anteversion was (-) 1.8 degrees which was 10.7 degrees and 4.4 degrees for PCA and TEA, respectively. Popliteal surface axis was perfectly correlated with PCA and TEA for anteversion measurements (p

Background The renal length and cortical echogenicity have shown correlation to the renal function and histological changes in CKD patients. The aim of this study was to assess the accuracy of crude and composite ultrasound parameters based on kidney measurements and cortical echogenicity to detect renal dysfunction and histological changes. Methods Kidney sonography and biopsy were performed in 112 patients. Histological changes were graded in 0, 50% of the sample. Cortical echogenicity was graded relative to liver or spleen parenchyma: less than, equal to and higher than the liver/spleen. Kidney length, the kidney length/body height ratio (KL/H) and cortical thickness were obtained. Each parameter was multiplied by a cortical echogenicity-weighting arbitrary factor: 1.17, 1 or 0.69 for cortex less than, equal to or higher than the liver, respectively. The GFR was estimated using the CKD-EPI formula. The accuracy of crude and composite parameters to identify patients with a high creatinine, a low GFR and histological changes were evaluated. Results The discriminative power of kidney length and cortical thickness for renal dysfunction and histological changes was improved after weighting for cortical echogenicity. However, the best discriminative was the kidney length to height ratio weighted towards renal echogenicity (w-KL/H). Conclusion w-KL/H exceeded the other parameters as a marker of renal impairment and histological changes in CKD. Calculation of the w-KL/H index may be of help as a non-invasive tool to identify patients with significant renal disease and might be useful to guide therapeutic decisions.

Objective Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.

Background Material extrusion is used to 3D print anatomic models and guides. Sterilization is required if a 3D printed part touches the patient during an intervention. Vaporized Hydrogen Peroxide (VHP) is one method of sterilization. There are four factors to consider when sterilizing an anatomic model or guide: sterility, biocompatibility, mechanical properties, and geometric fidelity. This project focuses on geometric fidelity for material extrusion of one polymer acrylonitrile butadiene styrene (ABS) using VHP. Methods De-identified computed tomography (CT) image data from 16 patients was segmented using Mimics Innovation Suite (Materialise NV, Leuven, Belgium). Eight patients had maxillary and mandibular defects depicted with the anatomic models, and eight had mandibular defects for the anatomic guides. Anatomic models and guides designed from the surfaces of CT scan reconstruction and segementation were 3D printed in medical-grade acrylonitrile butadiene styrene (ABS) material extrusion. The 16 parts underwent low-temperature sterilization with VHP. The dimensional error was estimated after sterilization by comparing scanned images of the 3D printed parts. Results The average of the estimated mean differences between the printed pieces before and after sterilization were − 0,011 ± 0,252 mm (95%CI − 0,011; − 0,010) for the models and 0,003 ± 0,057 mm (95%CI 0,002; 0,003) for the guides. Regarding the dimensional error of the sterilized parts compared to the original design, the estimated mean differences were − 0,082 ± 0,626 mm (95%CI − 0,083; − 0,081) for the models and 0,126 ± 0,205 mm (95%CI 0,126, 0,127) for the guides. Conclusion This project tested and verified dimensional stability, one of the four prerequisites for introducing vaporized hydrogen peroxide into 3D printing of anatomic models and guides; the 3D printed parts maintained dimensional stability after sterilization.

Background: Evaluation of segmented colon is one of the challenges in Computed Tomography Colonography (CTC). The objective of the study was to measure the segmented colon accurately using image processing techniques. Methods: This was a retrospective study, and the Institutional Ethical clearance was obtained for the secondary dataset. The technique was tested on 85 CTC dataset. The CTC dataset of 100–120 kVp, 100 mA, and ST (Slice Thickness) of 1.25 and 2.5 mm were used for empirical testing. The initial results of the work appear in the conference proceedings. Post colon segmentation, three distance measurement techniques, and one volumetric overlap computation were applied in Euclidian space in which the distances were measured on MPR views of the segmented and unsegmented colons and the volumetric overlap calculation between these two volumes. Results: The key finding was that the measurements on both the segmented and the unsegmented volumes remain same without much difference noticed. This was statistically proved. The results were validated quantitatively on 2D MPR images. An accuracy of 95.265±0.4551% was achieved through volumetric overlap computation. Through pairedt−test, at α=5%, statistical values were p=0.6769, and t=0.4169 which infer that there was no much significant difference. Conclusion: The combination of different validation techniques was applied to check the robustness of colon segmentation method, and good results were achieved with this approach. Through quantitative validation, the results were accepted at α=5%. Keywords: Euclidean space, Colon segmentation, Quantitative analysis, Spatial features, Volumetric overlap

Background and objectiveThe Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly.MethodsData from all births in Uruguay during 2010–2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21st standards for sex and gestational age, and compared by method of ascertaining gestational age.ResultsRounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (DiscussionRounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.

Catheter navigation and 3-dimensional (3D) cardiac mapping are essential components of minimally invasive electrophysiological procedures.The purpose of this study was to develop a novel 3D mapping system (KODEX - EPD, EPD Solutions, Best, The Netherlands) that measures changing electric field gradients induced on intracardiac electrodes to enable catheter localization and real-time 3D cardiac mapping.We first validated the accuracy of the system's measurement and localization capabilities by comparing known and KODEX - EPD-measured distances and locations at 12 anatomical landmarks in both the atria and ventricles of 4 swine. Next, in vivo images of 3D porcine cardiac anatomy generated by KODEX - EPD and widely used CARTO 3 system (Biosense Webster, Inc., Diamond Bar, CA) were compared with gold standard computed tomography images acquired from the same animals. Finally, 3D maps of atrial anatomy were created for 22 patients with paroxysmal atrial fibrillation (Dielectric Unravelling of Radiofrequency ABLation Effectiveness trial).First, the mean error between known and measured distances was 1.08 ± 0.11 mm (P.01) and the overall standard deviation between known and measured locations in 12 areas of the porcine heart was 0.35 mm (P.01). Second, an expert comparison of 3D image quality revealed that KODEX - EPD is noninferior to CARTO 3. Third, the system enabled 3D imaging of atrial anatomy in humans, provided real-time images of atrioventricular valves, and detected important anatomical variations in a subset of patients.The KODEX - EPD system is a novel 3D mapping system that accurately detects catheter location and can generate high-resolution images without the need for preacquired imaging, specialty catheters, or a point-by-point mapping procedure.

Purpose: To examine associations if any between changes in voiding function, hematuria, and bladder ultrasonography metrics in murine cyclophosphamide-induced chemical cystitis. Materials and Methods: Cystitis was induced in 6 female mice by an intraperitoneal injection of cyclophosphamide (300 mg/kg). Voiding frequency, void volume, hematuria assessment, and ultrasonographic measurements of the bladder were obtained at baseline, days 1 to 5, and days 9, 11, and 13. Voiding was induced with preferred sweet drinking solution and voiding data collected using an automated data collection system in 135 minute sessions. Bladder wall thickness, lumen volume, and vascular Doppler were acquired using a high definition ultrasound system. Spearman's correlation was used to analyze the association between the voiding changes, hematuria, and ultrasound findings. Results: Hematuria was present 24 hours after cyclophosphamide injection. All animals displayed increased bladder vascularity, bladder wall thickness, and void frequency that was associated with concurrent decreased total and average void volumes. Increased bladder wall vascularity was correlated with the presence of hematuria (r=0.59, p

Aims This study aimed to compare the diagnostic accuracy of stress myocardial perfusion imaging between cardiac magnetic resonance (CMR) and nuclear medical imaging, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET), for the diagnosis of hemodynamically significant coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard. Methods and results We searched PubMed and Embase for all published studies that evaluated the diagnostic accuracy of stress myocardial perfusion imaging modalities, including CMR, SPECT, and PET, to diagnose hemodynamically significant CAD with FFR as the reference standard. A total of 28 articles met the inclusion criteria and were included in the meta-analysis: 14 CMR, 13 SPECT, and 5 PET articles. The results demonstrated a pooled sensitivity of 0.88 (95% confidence interval [CI]: 0.80–0.93), 0.69 (95% CI: 0.56–0.79), and 0.83 (95% CI: 0.70–0.91), and a pooled specificity of 0.89 (95% CI: 0.85–0.93), 0.85 (95% CI, 0.80–0.89), and 0.89 (95% CI, 0.86–0.91) for CMR, SPECT, and PET, respectively. The area under the curve (AUC) of CMR, PET, and SPECT was 0.94 (95% CI, 0.92–0.96), 0.92 (95% CI, 0.89–0.94), and 0.87 (95% CI, 0.83–0.89), respectively. Conclusions CMR and PET both have high accuracy and SPECT has moderate accuracy to detect hemodynamically significant CAD with FFR as the reference standard. Furthermore, the diagnostic accuracy of CMR at 3.0 T is superior to 1.5 T.

Background: In pulmonary arterial hypertension (PAH), right ventricular (RV) failure is the main cause of mortality. Non-invasive estimation of ventricular-vascular coupling ratio (VVCR), describing contractile response to afterload, could be a valuable tool for monitoring clinical course in children with PAH. This study aimed to test two hypotheses: VVCR by cardiac magnetic resonance (VVCRCMR) correlates with conventional VVCR by right heart catheterization (VVCRRHC) and both correlate with disease severity.Methods and results: Twenty-seven patients diagnosed with idiopathic and associated PAH without post-tricuspid shunt, who underwent RHC and CMR within 17 days at two specialized centers for pediatric PAH were retrospectively studied. Clinical functional status and hemodynamic data were collected. Median age at time of MRI was 14.3 years (IQR: 11.1-16.8), median PVRi 7.6 WU x m(2) (IQR: 4.1-12.2), median mPAP 40 mm Hg (IQR: 28-55) and median WHO-FC 2 (IQR: 2-3). VVCRCMR, defined as stroke volume/end-systolic volume ratio was compared to VVCRRHC by single-beat pressure method using correlation and Bland-Altman plots. VVCRCMR and VVCRRHC showed a strong correlation (r = 0.83, p Conclusions: Non-invasively measured VVCRCMR is feasible in pediatric PAH and comparable to invasively assessed VVCRRHC. Both correlate with functional and hemodynamic measures of disease severity. The role of VVCR assessed by CMR and RHC in clinical decision-making and follow-up in pediatric PAH warrants further clinical investigation. (C) 2019 Elsevier B.V. All rights reserved.

To develop a nasal-tragus length (NTL)-based table for estimating the endotracheal tube (ETT) insertion depth. A prospective study of 110 Thai neonates was conducted in a NICU in Bangkok, Thailand. The correlation between the optimal insertion depth (Opt-Depth) and NTL was determined, and then an NTL-based table for estimating ETT depth was developed. The accuracy of using various methods in estimating ETT depth was compared. A strong correlation between Opt-Depth and NTL was found (r = 0.897, p

Objective To construct new reference values for biometrical measurements and sonographic estimated fetal weight (sEFW) in twin gestations and compare them to previously published normograms. Methods A retrospective analysis of sEFW evaluations of twin gestations was performed between 2011 and 2016 in a single university-affiliated medical center. sEFW was calculated using the Hadlock 1985 formula. To avoid selection bias, one evaluation per pregnancy was randomly selected. Following mathematical transformation to obtain normality of values, normograms were constructed using a best-fit regression model for estimation of mean and standard deviation at each gestational age (GA). Normograms were validated by applying all observations to ensure equal distribution at parallel percentiles. Our normograms were then compared to previously published sEFW normograms for twin gestations. Results A total of 864 sEFW evaluations were performed on 195 twin pregnancies at 22–39 gestational weeks. Of them, 390 entered the primary analysis. The rest were left for validation. Seventy percent of the cohort were dichorionic-diamniotic twins (136/195), 16% (32/195) were monochorionic-diamniotic twins and three (1.5%) were monochorionic-monoamniotic twins. Twenty-four fetuses lacked data on chorionicity. The rest were monochorionic twins or were of unknown chorionicity. Values corresponding to the 2.5th, 10th, 50th, 90th and 97.5th percentiles for sEFW are presented for every GA. Validation by applying all 864 evaluations on constructed normograms was achieved. Comparison to previously published twins’ sEFW normograms demonstrated wide variation between curves. Conclusion New reference values for biometrical measurements and sEFW in twin gestations are presented for clinical and research use. Comparison to other curves demonstrates the wide variability and need for further investigation on twin’s normal growth.

AIM This study aimed to establish and validate a quantitative evaluation method for pelvic floor muscles using magnetic resonance images (MRI) and to examine the morphological change of pelvic floor muscles with aging. METHODS Data from 369 consecutive patients (163 men, 206 women; median age 58 years; range 17-92 years) who underwent coronal T2-weighted pelvic MRI at Osaka General Hospital between January 2016 and December 2016 were retrospectively examined. MRI of the levator ani muscle was evaluated. The MRI image blinded the patient information and was evaluated by a radiology specialist with 22 years of experience. In coronal T2-weighted MRI of the pelvis, the levator ani muscle was evaluated using the slice; it showed the most upward and downward convexity. We measured the thickness of the levator ani muscle, and the distance at the most convex part from a straight line connecting the origin and insertion of the levator ani muscle on both the left and right sides. Upward and downward convexity was recorded in positive and negative values, respectively. RESULTS The levator ani muscle was able to be evaluated quantitatively in all cases. Both men and women showed thinning (men: mean 3.316 mm, r = -0.388, P

Purpose To evaluate the feasibility of iterative closest point (ICP) algorithm for assessing the accuracy between virtual surgical planning (VSP) and outcomes in orthognathic surgery. Materials and methods VSP and results of surface mesh (SM0 and SM1) from CBCT scans of 25 patients who had been undergone bi-maxillary orthognathic surgery were converted into STL-format files and then imported to Geomagic software for semi-automatic alignment. ICP algorithm was used to calculate mean deviations (MD) and root mean square (3D error) at different calibrations of ±2 mm (T1), ±5 mm (T2) and ±10 mm (T3), with workflow being performed by two evaluators. Colour maps were generated to assess the 3D congruence qualitatively. Linear regression analysis was used to estimate whether SM0 or SM1 could condition the ICP and t-tests were used to assess whether MD and 3D error values were ≤−2 mm and ≥2 mm. Descriptive statistics was used to assess the method's feasibility by comparing T2 to T1 and T3. Results High intra- and inter-rater correlations supported the workflow reproducibility with the software. SM0 conditioned the ICP algorithm regarding both evaluators, and t-tests demonstrated that MD and 3D error were >−2 mm and Conclusions ICP algorithm provided a reproducible method, but its feasibility was limited due to underestimation or overestimation of the results as they affect the validity of the actual deviations.

We compared the accuracy of magnetic resonance (MR) urethrography and X-ray urethrography with operative findings for urethral strictures and observed their effects on treatment. A total of 87 male patients (10–85 years of age) treated from January 2015 to December 2016 were included in the study. X-ray and MR urethrograms were performed for all patients to determine the location, length, and degree of urethral strictures and the organizational structure around the urethra, and the results were compared with the operative findings. One-way analysis of variance (ANOVA) was performed to compare the lengths of the urethral strictures determined by the two methods with the operative findings. A value of P

BACKGROUND: The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI–TCL challenging. OBJECTIVE: The purpose of this study was to investigate a novel maneuver to confirm the PPI–TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias. METHODS: We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI–TCL, the AH-corrected PPI–TCL, and estimated the PPI–TCL using “dual-chamber entrainment” calculated as [PPI(V) − TCL = Stim(A→V) + Stim(V→A) − PPI(A)]. RESULTS: The PPI–TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI–TCL (R(2) = 0.79 and 0.96, respectively; P 10 ms) decrement. CONCLUSION: Dual-chamber entrainment estimates the PPI–TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI–TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI–TCL value in challenging cases.

Background The target values for plasma glucose concentrations for the investigation and diagnosis of diabetes and impaired fasting glucose, and the realization that small incremental changes in glucose concentration increase the risk of adverse events, has led to greater focus on laboratory glucose results. Although analytical methods show acceptable precision, the control of preanalytical error due to the stability of glucose remains problematic. The aim of this study was to compare glucose concentrations in 3 different and commercially available blood tubes, with analysis and storage under current practices and conditions. Methods Blood samples for glucose were obtained from consenting patients attending the Diabetic Clinic at the Royal Victoria Hospital, Belfast. Blood was collected into BD Vacutainer® Barricor™ Lithium Heparin tubes, BD Vacutainer Fluoride EDTA tubes, and Greiner Vacuette® FC-Mix (sodium fluoride/citrate/Na2EDTA) tubes in that order. The Barricor tubes were immediately centrifuged at 4000g for 3 min. All samples were then sent to the Biochemistry Laboratory for analysis on the same day, and again the following day after storage at 4 °C. Results There was no significant difference in mean glucose concentrations between immediately centrifuged Barricor and FC-Mix tubes when analyzed on day 0. Both tube types demonstrated higher mean glucose concentrations than traditional fluoride EDTA (F/EDTA) samples. Conclusions Both immediately separated Barricor and citrated FC-Mix plasma preserve glucose concentrations to the same extent, and better than F/EDTA preservative. These newer technologies involved offer pragmatic solutions to improved glucose analysis, allowing laboratories to choose the best option given the source of their samples.

Background Procalcitonin (PCT) is an emerging biomarker for detecting sepsis. Recently, the US Food and Drug Administration cleared the expanded use of this biomarker for guiding clinicians regarding antibiotic treatment. To our knowledge, there are no published method validations for the Abbott Architect PCT assay. This article will discuss the process of method validation of the B·R·A·H·M·S PCT assay on the Abbott Architect platform. Methods We studied the precision, accuracy, and linearity of the Architect method following the guidance of the Clinical and Laboratory Standards Institute EP5-A2 document. Furthermore, we also tested the impact of major sources of interference from hemolysate, lipoproteins, and bilirubin. To validate the Architect method, we compared patients' serum PCT measurements with our previously established Mini VIDAS (bioMerieux) PCT assay. Results Statistical analysis showed that the 2 assays have good correlation (r > 0.99), slope of 1.023, and intercept of −0.760. The calculated bias is −7.435%. The Architect method showed good precision with %CV < 3.5% for both interassay and intraassay compared with %CV < 6.5% for Mini VIDAS, which was previously determined at our institution. No bias >10% was observed with the Architect method when pooled serum samples were spiked with interferants. The turnaround time for both platforms was the same (20 min); however, in contrast with Mini VIDAS, the Architect system has automated pipetting of samples and can perform multiple assays simultaneously. Conclusion These results showed that the Architect B·R·A·H·M·S PCT assay has analytical characteristics conducive for diagnostic use in clinical laboratories. Our method validation report will be beneficial for other institutions to adapt this assay on existing Abbott Architect i1000 immunoassay analyzers.

Background Critical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardiorespiratory failure in the ICU. Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. The goal of this study was to characterize the diagnostic accuracy of ccTEE. Methods This study was a two-center, retrospective comparison between TEE studies performed and interpreted by intensivists and cardiology-led TEE or transthoracic echocardiography (TTE) performed and/or interpreted by cardiologists. The study period was December 2012 to December 2016 for all consecutive ICU patients who received an initial ccTEE and either a cardiology TEE or TTE within 72 h. Using the cardiology-conducted examination as the gold standard, we reported sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ccTEE. Results Comparisons between ccTEE and cardiology TEE/TTE performed yielded 56 patients (five ccTEE vs cardiology TEE and 51 ccTEE vs cardiology TTE). The comparison between ccTEE and cardiology TEE showed 100% sensitivity, specificity, PPV, NPV, and accuracy for the primary diagnosis and other major findings. For the combined ccTEE and cardiology TEE/TTE comparison, there was a high sensitivity/specificity/PPV/NPV/accuracy for the primary diagnosis (90%-100% range), as well as other major diagnoses (88%-100% range). Conclusions This study showed that ccTEE has a high sensitivity, specificity, PPV, NPV, and accuracy compared with the gold standard cardiology TEE or TTEs in critically ill patients, when performed by advanced echocardiogram-trained/experienced intensivists.

Wireless sensor networks have become prolific in a wide range of industrial processes and offer several key advantages over their wired counterparts in terms of positioning flexibility, modularity, interconnectivity, and data routing. We demonstrate their utility in pharmaceutical lyophilization by developing a series of wireless devices to measure spatial variations in gas pressure and temperature during primary drying. The influence of shelf temperature, chamber pressure, excipient concentration, and dryer configuration are explored for various representative cycles using a laboratory-scale pharmaceutical lyophilizer. Pressure and temperature variations across the shelf for these cases are shown to vary up to 1.2 Pa and 10 °C, respectively. Experimental measurements are supported by computational fluid dynamics simulations to reveal the mechanisms driving the vapor flow. The measurements and simulation data are then combined to estimate the shelf-wise sublimation rate in the inverse sense to within a deviation of 3% based on comparison with gravimetric data. We then apply the sublimation rate profile to obtain the vial heat transfer coefficient and product mass transfer resistance for a 5% w/v mannitol formulation. Finally, these parameters are applied to a one-dimensional quasi-steady heat transfer model to predict the evolution of the product temperature over the course of primary drying. Thermocouple measurements of product temperature are compared directly to the simulated data and demonstrate accuracy comparable to existing published one-dimensional models.

With the advent of 3D printing technologies in dentistry, the optimization of printing conditions has been of great interest, so this study analyzed the accuracy of 3D-printed temporary restorations of different sizes produced by digital light processing (DLP) and liquid crystal display (LCD) printers. Temporary restorations of 2-unit, 3-unit, 5-unit, 6-unit, and full-arch cases were designed and printed from a DLP printer using NextDent C&amp, B or an LCD printer using Mazic D Temp (n = 10 each). The restorations were scanned, and each restoration standard tessellation language (STL) file was superimposed on the reference STL file, by the alignment functions, to evaluate the trueness through whole/point deviation. In the whole-deviation analysis, the root-mean-square (RMS) values were significantly higher in the 6-unit and full-arch cases for the DLP printer and in the 5-unit, 6-unit, and full-arch cases for the LCD printer. The significant difference between DLP and LCD printers was found in the 5-unit and full-arch cases, where the DLP printer exhibited lower RMS values. Color mapping demonstrated less shrinkage in the DLP printer. In the point deviation analysis, a significant difference in direction was exhibited in all the restorations from the DLP printer but only in some cases from the LCD printer. Within the limitations of this study, 3D printing was most accurate with less deviation and shrinkage when a DLP printer was used for short-unit restorations.

Objectives: Intraoral scanners have shown promising results when used as an adjunct or alternative to conventional impression techniques. This study compared the accuracy of digital impression taking using an intraoral scanner versus the conventional technique. Materials and Methods: In this in-vitro experimental study, a typodont molar tooth was prepared as the standard model and scanned by TRIOS intraoral scanner. Ten digital impressions were fabricated as such and intraoral scans were sent to the manufacturers. In the conventional method, using addition silicone impression material, a stone die was fabricated. Using a computer-aided design/computer-aided manufacturing scanner, the die was scanned, and the data were transferred to the software. After the fabrication of frameworks, the replica technique was used. The replicas’ thickness (indicative of the gap between the framework and the model and the accuracy of impression taking) was 12 points. The data were analyzed using student's t-test. Results: The mean thickness of replicas (gap between the internal surface of frameworks and the standard model) at the three points in the buccal, lingual, mesial, and distal sections in the digital impression technique was lower than that in the conventional technique (P

BACKGROUND It is challenging to entirely show the anterior talofibular ligament (ATFL) and accurately diagnose ATFL injury with traditional 2-dimensional (2D) magnetic resonance imaging (MRI). With the introduction of 3.0T MRI, a 3-dimensional (3D) MRI sequence can achieve images with high spatial resolution. This study aimed to evaluate the accuracy of 3D MRI and compare it with 2D MRI in diagnosing ATFL injury. MATERIAL AND METHODS This was a prospective study in which 45 patients with clinically suspected ATFL injury underwent 2D MRI, 3D MRI, and 3D model reconstruction followed by arthroscopic surgery between February 2018 and April 2019. Two radiologists who had over 11 and 13 years of musculoskeletal experience assessed the injury of ATFL in consensus without any clinical clues. Arthroscopic surgery results were the standard reference of MRI accuracy. RESULTS The 3D MRI results of ATFL injury showed the sensitivity of diagnosis of complete tears of 83% and specificity of 82%. The partial tears diagnosis sensitivity was 78%, and specificity was 100%. The sensitivity of diagnosis of sprains was 100%, and the specificity was 97%. The 3D MRI accuracy of diagnosis was 98% for no injury, 98% for sprain, 91% for partial tear, and 82% for complete tear. The difference in the diagnosis of sprain and partial tears by 3D MRI and 2D MRI was statistically significant (P

BackgroundTo establish reference ranges of fetal facial profile markers and study their correlations with crown-rump length (CRL) during the first trimester (11 ~ 13+ 6weeks’ gestation) in a Chinese population.MethodsUltrasonographic images of measuring fetal nuchal translucency (NT) were retrospectively selected randomly in normal fetuses whose parents were both Chinese. The facial markers included inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA) and profile line (PL) distance. These markers were measured through ViewPoint 6 software by two experienced sonographers.ResultsThree hundred and eighty fetuses were selected. The ICCs (95 % CI) of intra-operator 1 reproducibility of IFA, MNM angle, FMA, PL distance were 0.944 (0.886 ~ 0.973), 0.804 (0.629 ~ 0.902), 0.834 (0.68 ~ 0.918) and 0.935 (0.868 ~ 0.969), respectively. The ICCs (95 % CI) of intra-operator 2 reproducibility of IFA, MNM angle, FMA, PL distance were 0.931 (0.857 ~ 0.967), 0.809 (0.637 ~ 0.904), 0.786 (0.600 ~ 0.892) and 0.906 (0.813 ~ 0.954), respectively. The ICCs (95 % CI) of inter-operator reproducibility of IFA, MNM angle, FMA, PL distance were 0.885 (0.663 ~ 0.953), 0.829 (0.672 ~ 0.915), 0.77 (0.511 ~ 0.891) and 0.844 (0.68 ~ 0.925), respectively. The average ± SD of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively. IFA and PL distance significantly decreased with CRL, while MNM angle and FMA significantly increased with CRL.ConclusionsIt was feasible to measure fetal facial markers during the first trimester. In Chinese population, the reference ranges of IFA, MNM angle, FMA and PL distance were 80.2°±7.25°, 4.17°±1.19°, 75.36°±5.31°, 2.78 ± 0.54 mm, respectively, and the measurements were found to correlate with CRL.

Summary Introduction Infrared thermography allows the detection of infrared radiation which can be reliably associated with skin temperature. Modern portable thermography devices have been used to identify the location of skin perforators by detecting subtle differences in skin temperature. The aim of this study is to conduct a diagnostic accuracy systematic review to determine the specificity and sensitivity of infrared thermography. Materials and Methods A PRISMA-compliant systematic review and meta-analysis was conducted, scrutinising PUBMED and EMBASE databases for diagnostic studies measuring the accuracy of infrared thermography for perforator identification. Article screening, review and data gathering was conducted in parallel by two independent authors. Eligible studies were subject to a formal risk of bias was assessment using the QUADAS2 instrument. Results A total of 254 entries were obtained, of which 7 satisfied our pre-established inclusion criteria. These studies reported a total of 435 perforators in 133 individuals. The most commonly investigated locations were the antero-lateral thigh and abdominal wall. Reported sensitivity values ranged from 73.7% to 100%. A meta-analysis demonstrated a cumulative sensitivity of 95%. Specificity was not routinely reported. All studies presented a moderate to high risk of bias according to QUADAS2. Discussion Affordable infrared thermography devices are an interesting alternative to traditional preoperative investigations for perforator mapping. They are sensitive enough to reliably identify a large proportion of perforators as “hot-spots”. However, there is limited evidence to estimate the specificity of this technology, as studies have failed to report true negative values associated with “cold-spots”.

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum–tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth.Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2).Results A total of 167 infants (22–42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of Conclusion The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of

The aim of this study was to verify the effectiveness of alternative techniques for measuring the linear dimensional change of molds obtained by different impression materials. A stainless-steel die containing three lines was used to get the impressions. The impression materials were handled according to the manufacturers' instructions. After gelation/polymerization time, the molds (n=12) were stored for 30 minutes and the lines were subsequently measured using: a microscope (Olympus Measuring Microscope STM; Olympus Optical Co) with a 30x magnification (MM, control group), a digital caliper (Mitutoyo Digimatic; Kawasaki) (DC) and digitization using a digital camera (Canon EOS Rebel 3Ti; Canon) (DI). For each mold, a mean of the length of the lines was obtained. For each impression material, the difference in the length between the metallic matrix and the mold was considered as linear dimensional change (%). The data were submitted to the non-parametric Kolmogorov-Smirnov test, followed by one-way Analysis of Variance (ANOVA) for each material, and the means were compared by the Tukey test (α=0.05). The DI group promoted values of dimensional accuracy without significant differences with the control group (MM), except for the putty-body condensation silicone. The DC group showed significant differences for MM and DI groups for all impression materials tested. The DI group showed to be a reliable methodology (Standard error of the mean

Average facial soft-tissue thickness (FSTT) databanks are continuously developed and applied within craniofacial identification. This study considered and tested a subject-specific regression model alternative for estimating the FSTT values for oral midline landmarks using skeletal projection measurements. Measurements were taken from cone-beam computed tomography scans of 100 South African individuals (60 male, 40 female; Mage = 35 years). Regression equations incorporating sex categories were generated. This significantly improved the goodness-of-fit ( r2-value). Validation tests compared the constructed regression models with mean FSTT data collected from this study, existing South African FSTT data, a universal total weighted mean approach with pooled demographic data and collection techniques and a regression model approach that uses bizygomatic width and maximum cranial breadth dimensions. The generated regression equations demonstrated individualised results, presenting a total mean inaccuracy (TMI) of 1.53 mm using dental projection measurements and 1.55 mm using cemento-enamel junction projection measurements. These slightly outperformed most tested mean models (TMI ranged from 1.42 to 4.43 mm), and substantially outperformed the pre-existing regression model approach (TMI = 5.12 mm). The newly devised regressions offer a subject-specific solution to FSTT estimation within a South African population. A continued development in sample size and validation testing may help substantiate its application within craniofacial identification.

OBJECTIVES: The objective of the study is to determine the impact of changing reference standards (RS), namely spirometry vs. whole-body plethysmography (WBP), on estimation of the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) and clinical signs and symptoms (CSS) as index tests regarding asthma diagnosis. STUDY DESIGN AND SETTING: This was a diagnostic study conducted in 393 patients attending a private practice of pneumologists with complaints suspicious of asthma. First, the index tests were compared with the diagnostic results of spirometry in terms of forced expiratory volume in the first second (FEV1) responsiveness. Second, the index tests were compared with the results of WBP in terms of specific airway resistance and FEV1 responsiveness. Areas under the curve (AUC) were compared with a generalized estimating equation approach based on binary logistic regression. RESULTS: FeNO values and CSS 'wheezing' and 'allergic rhinitis' showed higher specificities (P