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BackgroundCervical epidural steroid injection is associated with rare but potentially catastrophic complications. The contralateral oblique (CLO) view may be a safe and feasible alternative to the lateral (LAT) view for fluoroscopic-guided cervical epidural steroid injection. However, evidence for the clinical usefulness of the CLO view for cervical epidural steroid injection is lacking. We assessed the clinical usefulness of the CLO view for cervical epidural steroid injection in managing cervical herniated intervertebral discs.MethodsPatients were randomly assigned to receive fluoroscopic-guided cervical epidural steroid injection under LAT view or CLO view at 50±5° degrees groups. The primary outcome was the needling time comparison between the two groups. Secondary outcomes were comparison of first-attempt success rate, needle tip visualization and location, total number of needle passes, final success rate, crossover success rate and false-positive/negative loss of resistance. Complications and radiation dose were also compared.ResultsThe needling time significantly decreased in the CLO than in the LAT group. The first-attempt success rate was significantly higher in the CLO compared with the LAT group. The needle tip was clearly visualized (pConclusionThe CLO view may be recommended for fluoroscopic-guided cervical epidural steroid injection, considering its better clinical usefulness over the LAT view.

The ideal root canal preparation is where the original canal morphology is maintained during the biomechanical preparation. Preparation of curved canals has always been a challenge to clinicians. Better results have been suggested for a single NiTi instrument with reciprocating motion than the conventional continuous rotation method in the preparation of curved root canals. Although the Neoniti rotary system is not suggested to be used with reciprocal motion, running a pilot study, we found that it could be possible. The present study aimed to investigate if shaping curved canals using the Neoniti rotary system with reciprocal motion leads to better results in terms of root canal transportation. One hundred acrylic j-shape canal simulator endoblocks were used in this study. Five preparation sequences were applied: GPS followed by A1#20 (GPS + A1#20), GPS followed by A1#20 and then A1#25 (GPS + A1#20 + A1#25), GPS followed by A1#25 (GPS + A1#25), hand file followed by A1#20 (hand file + A1#20), and GPS followed by A1#20 (with reciprocal motion) (GPS + A1#20(reciprocal)). Pictures were taken from blocks once before and once after preparation from two dimensions. Before-and-after pictures were superimposed in Photoshop software. Measurements were performed in Digimizer. The number of autoreverses and pecking motions was recorded after reviewing the recorded videos. Data were analyzed in SPSS, version 26. Apvalue of less than 0.05 was considered statistically significant. The group GPS + A1#20 + A1#25 had more transportation compared with the others, at apical, middle, and coronal thirds not only in the frontal view but also in the lateral view. Other groups were not significantly different. The number of peckings and autoreverses was significantly less when A1#25 was used after GPS and A1#20. When A1#20 was used with reciprocal motion, it had less peckings compared with the same file with continuous rotation, and no autoreverses were observed in that group. Using Neoniti files with reciprocal motion might result in less instrument fatigue and favorable results, with respect to canal anatomy preservation. Using A1#20 before A1#25 also will decrease the stress on the instrument during preparation. However, this may lead to significantly more canal transportation.

Background: The purpose of this study was to compare the accuracy of anatomic reconstruction of three different humeral head designs after anatomic total shoulder arthroplasty. Methods: Postoperative radiographs of 117 patients who underwent anatomic total shoulder arthroplasty with three different implant designs (stemmed spherical, stemless spherical, and stemless elliptical) were analyzed for landmarks that represented the prearthritic state and final implant position. We assessed the change in center of rotati7on and humeral head height on the anteroposterior view and the percentage of prosthesis overhang on the axillary lateral view. A modified anatomic reconstruction index, a compound score that rated each of the 3 parameters from 0 to 2, was created to determine the overall accuracy of the reconstruction. Results: Excellent modified anatomic reconstruction index scores (5 or 6 points) were achieved by 68.1% of the cases in the stemless elliptical group compared with 33.3% of the cases in the stemless spherical group and by 28.3% of the cases in the stemmed spherical group (P = .001).The mean difference in restoration of humeral head height (P

SUMMARY The intermediate cleft tip rhinoplasty is frequently performed during childhood to address nasal tip anomalies in cleft patients before the most critical period of psychosocial development. The authors previously described the component restoration intermediate cleft tip rhinoplasty technique for the unilateral cleft nose, which was developed to systematically address the lining deficiency, cleft lower lateral cartilage malpositioning, and cleft lateral cartilage weakness using a combination of lower lateral cartilage release, lateral cartilage repositioning, and placement of an auricular composite chondrocutaneous graft. In this work, the authors evaluate the utility of this technique to the bilateral cleft nose. Preoperative and postoperative (mean ± SD, 18.6 ± 10.8 months) photographs of bilateral cleft patients treated with the component restoration intermediate cleft tip rhinoplasty (n = 7) were evaluated using photogrammetric measurements and aesthetic assessments. From preoperatively to postoperatively, the columella length-to-alar width ratio on basal photographs increased (0.19 ± 0.05 versus 0.28 ± 0.05; p = 0.001). On lateral view, the columella-labial angle decreased from preoperatively to postoperatively [138 degrees (interquartile range, 132 to 144 degrees) versus 123 degrees (interquartile range, 122 to 139 degrees); p = 0.04]. Aesthetic ratings performed by four blinded observers also improved from preoperatively to postoperatively (1.6 ± 0.8 versus 2.4 ± 0.7; p = 0.004). As a comparison, bilateral cleft nose patients who did not undergo intermediate cleft tip rhinoplasty (n = 3) of similar ages were subjected to the same photogrammetric and aesthetic analyses, which showed no differences from preoperatively to postoperatively. In combination, the current work suggests that the component restoration technique in the bilateral intermediate cleft tip rhinoplasty improves nasal tip support and aesthetic outcomes.

ResumoAs lesões na região carpometacarpal (CMC) podem passar despercebidas em mais da metade dos casos. O diagnóstico precoce é determinante para o tratamento. Embora clinicamente o paciente já possa demonstrar que de fato ocorreu a lesão, radiografias apropriadas, principalmente na incidência em perfil, são fundamentais para o diagnóstico. A lesão mais comum afeta as articulações de 4° e 5° dedos. O tratamento vai depender do tipo da lesão e o grau de envolvimento das articulações. Geralmente, é necessária redução e fixação.Quando apenas um raio é acometido, habitualmente o 5°, pode ser feita redução fechada e fixação com fios de Kirschner. Nos casos complexos, faz-se necessária a redução aberta e fixação, sendo os fios de Kirschner os materiais mais comumente usados. Após a retirada dos fios, intensifica-se a reabilitação.Se foi alcançada uma redução apropriada, esperam-se resultados funcionais e radiográficos satisfatórios.

Aim of the study: We retrospectively searched for cases of transvenous embolisation for cavernous sinus dural arteriovenous fistulas. Materials and methods: Twenty-five cases underwent transvenous embolisation via the inferior petrosal sinus (IPS). IPS was probed using a standard 0.035-inch guidewire for microcatheter navigation, which was successful in all cases. Results: IPS was occluded in 17 cases (68%). Only one case experienced a complication, where the approach was changed to the contralateral side because of internal jugular vein injury. The relationship between the external auditory canal and the IPS route was reviewed in 18 cases using digital angiography (lateral view). The guidewire passed across, above, or below the external auditory canal in 10 (56%), six (33%), and two (11%) cases, respectively. Clinical implications: No previous reports have analysed the relationship between the external auditory canal and the IPS route. We present a safe and successful technique for approaching the cavernous sinus via the IPS.

Treatment of proximal femoral fractures in the supine position poses has certain challenges, especially due to difficulties in lateral imaging of the femoral neck in cases where there is no fracture table, such as prolonging the surgery time and increasing the dose of radiation exposure. The purpose of this study is to present the lateral imaging technique of the femoral neck by fluoroscopy on the conventional operating table in the treatment of proximal femoral fractures. We applied proximal femoral nail by positioning the healthy leg in a semilithotomy position to facilitate lateral imaging of the femoral neck by fluoroscopy while the patients were in the supine position.The study analyzed 22 patients (12 women, 10 men) with femoral pertrochanteric and basicervical fractures with the following types of fractures (9 patients had AO type 31-A1, 9 patients had AO type 31-A2, 4 patients had AO type 31-B2.1), and with a mean age of 62.1 years (33-75 years). The preparation time of the supine-semilithotomy position was about 2 minutes, and the reduction was finished within 9 intraoperative fluoroscopy exposure times. No patient suffered from a postoperative complication. The mean surgery time was 20 minutes (18-22 minutes), the average number of scopy shots was 8 (7-9), and the mean hospital stay duration was 2 days (2-2 days). We believe that the supine-semilithotomy technique is a suitable treatment option for proximal femoral intramedullary nailing and cannulated screw application. Since the lateral view of the femoral neck is obtained quickly and clearly with this technique, fluoroscopy does not need to be performed repeatedly, so fluoroscopy time and the number of shots are reduced, and the time spent by the patient and the surgical team in the surgery is shortened. [Med-Science 2020; 9(4.000): 1061-4]

A new myxobolid species, Myxobolus zaikae n. sp., was found in the connective tissue near the kidney and liver blood vessels of the common roach Rutilus rutilus, while fish myxosporean fauna were being investigated in Lake Baikal, Russia. The parasites were studied on the basis of spore morphology as well as with histological and molecular methods. Mature spores of M. zaikae n. sp. are round or ellipsoidal in the frontal view and lemon-shaped in the lateral view, measuring 11.37 ± 0.11 µm (10.2-14.0 µm) in length, 10.29 ± 0.10 µm (9.6-11.0 µm) in width, and 6.3 ± 0.08 µm (5.8-7.1 µm) in thickness (mean ± SD; n = 50). Polar capsules are equal and pyriform, measuring 4.5 ± 0.07 µm (3.4-5.2 µm) in length and 2.9 ± 0.03 µm (2.6-3.3 µm) in width. Polar capsules contained polar filaments coiled with 5 to 6 turns. Phylogenetic analysis showed that this newly described species clusters with other myxobolid species infecting the connective tissue of different organs from Palearctic cyprinid fish.

This study assessed the diagnostic utility of different X-ray radiological methods on syndesmosis malreduction. Thirteen fresh ankle specimens were used to make a syndesmotic separation model. The specimen was fixed in the anatomic position and in malreduction positions, including internal rotation 10° (IR10°), IR20°, external rotation 10° (ER10°), and ER20°. The tibiofibular clear space (TCS), tibiofibular overlap (TFO) on the anteroposterior view, and anteroposterior ratio (A/P ratio) on the lateral view were measured. When the syndesmosis was fixed in IR20°, the sensitivity of the TCS, TFO, and A/P ratio for malreduction diagnosis was 92.3% (12/13), 69.2% (9/13), and 100%, respectively. When the syndesmosis was fixed in IR10° malreduction, the sensitivity of the TCS, TFO, and A/P ratio for malreduction diagnosis was 38.4% (5/13), 38.4% (5/13), and 84.6% (11/13); in ER10°, 30.7% (4/13), 76.9% (10/13), and 69.2% (9/13); and in ER20°, 92.3% (12/13), 100% and 92.3% (12/13). In the anatomic reduction, the false-positive rate of the TCF, TFO, and A/P ratio was 7.6% (1/13), 7.6% (1/13), and 0%, respectively. The TFO and A/P ratio exhibited differences between all malreduction groups and the anatomic group. However, the TCS measurements had no statistical difference between the anatomic position and IR10° malreduction (p = .109). On the AP view, the TCS and TFO measurements are not sensitive enough to detect the syndesmosis malreduction. The A/P ratio on the lateral view exhibits better diagnostic utility for syndesmosis malreduction.

A caudal vertebra of a dinosaur (Iguanodontia indet.) is described from Upper Cretaceous (lower Campanian) coastal marine deposits of Izhberda Quarry near Orsk (Orenburg oblast). The vertebra is characterized by a rectangular centrum in the lateral view and transverse processes located at the level of the neurocentral suture. This is the second record of a dinosaur in the region. The previously described dinosaur vertebra from Upper Cretaceous deposits near Orsk (Bogolyubov, 1912) was the first record of a dinosaur from Russia. The caudal vertebra from Izhberda Quarry belonged to a dinosaur about 5 m in length, which may indicate the absence of an island isolation effect in dinosaurs that inhabited the large islands of the Turgai Strait in the Late Cretaceous.

Cervical spine spondylosis is so prevalent in almost all because it is a degenerative disease. Cervical spine spondylosis is a condition caused by the narrowing of the space required for the spinal cord and the nerve roots that pass through the spine to the rest of the body. Suspected cases or warranted cases are advised to avoid trauma or stress to prevent a dreadful complication that is myelopathy. This research is to study and assess the Cervical Spine Canal Body Ratio in healthy individuals and also in patients with myelopathy. The cervical spinal canal and body with disc space ratio are measured using lateral view plain X-ray of the cervical spine, placed over a graph paper. This test was done both in healthy individuals from the age group of twenty-five to thirty-five of female and male. Out of these, twelve patients were with cervical myelopathy. Cervical Spinal canal stenosis may be either congenital or acquired. The content of the canal that is the Spinal cord is more likely to get compromised when the canal is shallow even a minimal trauma or degenerative arthrosis can precipitate myelopathy. In healthy individuals it is unit and when

Background: Radiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC.Methods: The medical records of 63 patients with PC who were treated with compres-sive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both be-fore and after 2 weeks of bracing therapy. The difference between the pre- and post-treat-ment measurements was calculated for both modalities, and these differences were com-pared and analyzed.Results: Based on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p

INTRODUCTION The development of the shape of the shape from childhood to adulthood is a complex continuum. Deviations from this process occur frequently and, especially in asymptomatic patients, do not always include the need for therapeutic intervention. In the current S2-guideline on the juvenile flexible flatfoot, established x‑ray parameters for assessing the flatfoot deformity were judged to be sensitive, whereby no statement was made regarding the value of the parameters among themselves. The aim of the present work is to assess the talometatarsal Index (TMTInd) in comparison to established angle measurements. METHODS Twenty-two feet with and 22 feet without planovalgus deformity (age: 10-14 years) were investigated. Established radiological parameters (lateral view: talocalcaneal angle (TC-lat), calcaneal pitch angle (Calc-B), Costa-Bartani angle (Costa-B), talometatarsal‑I angle (TMTI-lat); dorsoplantar view: talometatarsal-I-basis angle (TMTIB), talonavicular coverage (TNG), calcaneal metatarsal- V angle (Calc-MTV), talocalcaneal angle (TC-dp), and talometatarsal‑I angle (TMTI-dp)) were measured on standardized X‑ray images and compared with the values of the TMTInd. RESULTS All parameters other than Calc-MTV, TC-dp, TC-lat and Calc‑B, showed a statistically significant difference between normal and planovalgus feet, although for almost all values measured (apart from TMTI-lat and TMTInd) there was a large overlap area (>10°) between the two groups. The comparison of TMTInd to all other parameters showed the highest discrimination factor (area-under-the-curve) for the TMTInd in the distinction between the groups. CONCLUSION Compared to conventional radiological parameters, the TMTInd shows the highest validity in the distinction between normal and planovalgus feet and can provide valuable information in clinical decision-making with regard to therapy specification.

Background/purpose The purposes of this study were to develop smile measurements for lateral and oblique view photographs to help in orthodontic analysis and treatment planning, to quantitatively evaluate the relationship between smile esthetics and different types of malocclusion using lateral and oblique view photographs, to identify the cephalometric factors affecting smile measurements. Materials and methods Patients who came to orthodontic department of a university hospital from 2014 to 2017 and met the inclusion criteria were included and divided into three groups according to Angle's classification. Thirteen variables were measured for cephalometric analysis. Twenty-one variables were developed and measured on pretreatment photographs for lateral and oblique smile analysis. ANOVA and Scheffe post hoc test were used to compare cephalometric and smile variables among three groups. Multiple linear regression analysis was performed to identify cephalometric factors affecting smile measurements. Results Three-hundred and ninety patients (287 females, 103 males) with mean age of 24.5 ± 7.6 years reached the criteria. All cephalometric variables differed significantly among three groups. Except for maxillary teeth exposure number, visible maxillary width, and lip thickness ratio, all smile variables differed significantly. Smile characteristics had significant correlation with some cephalometric measurements. Conclusion Smile patterns on the lateral and oblique view photographs can be affected by different types of malocclusion. Therefore, we suggest to include lateral and oblique smile view photographs in the data collection for orthodontic treatment planning.

Background: Recently, a lateral-view dual X-ray absorptiometry (DXA) scanning method for measuring leg total, lean, and fat masses demonstrated accuracy vs the standard whole-body frontal DXA scanning view on the GE Lunar iDXA. The current study examined the lateral scanning method's agreement using a Hologic Horizon A DXA scanner. Methodology: Thirty healthy college-age participants (16 female; Xage = 21.5 ± 1.7 yr) received 3 DXA scans (1 whole-body, 2 lateral leg scans) to quantify leg composition in the frontal and lateral plane. To mark regions of interest for postscan analysis, metallic markers were placed at 60% of the length above and below each leg's lateral epicondyle. Using lateral subject positioning, leg composition was measured with participants lying on their right and left sides. Paired t tests examined the lateral DXA scanning method's agreement when quantifying total, fat, and lean masses, bone mineral content, and bone mineral density compared to measurements of equal area in the whole-body frontal scanning view. Results: Comparisons of frontal and lateral view DXA scan measurements for right leg total mass (7.12 ± 0.91kg vs 6.39 ± 0.85kg), fat mass (1.70 ± 0.44kg vs 1.36 ± 0.33kg), lean mass (5.14 ± 1.05kg vs 4.77 ± 0.92kg), bone mineral content (0.28 ± 0.06kg vs 0.23 ± 0.05kg), and bone mineral density (1.39 ± 0.14g/cm2vs 1.36 ± 0.15g/cm2), respectively, were significantly different (p

To investigate the capability of intra-operative fluoroscopy to determine the reduction quality of intertrochanteric fractures and to determine which view (anteroposterior [AP] or lateral) can better predict the reduction quality. A retrospective analysis of 128 patients with intertrochanteric fractures. Two observers were asked to independently evaluate the quality of reduction (positive or non-positive support) based on intra-operative fluoroscopy (AP and lateral view). Results based on CT scans were considered as the gold standard. Sensitivity, specificity, percentage of correct interpretations, and agreement were calculated. At the first reading, sensitivity, false-negative rate, specificity, false-positive rate, and percentage of correct interpretations were 86.1%, 13.9%, 69.4%, 30.6%, and 79.7% for junior resident and 81.0%, 19.0%, 67.3%, 32.7%, and 75.8% for senior resident (all p > 0.05). It was highly predictive of a reliable cortical support when cortical position in AP view was consistent with that in lateral view (85/85, 100% for junior, and 86/86, 100% for senior). Lateral view was generally predictive of a final cortical support when the position between AP and lateral view was inconsistent (90.7% [39/43] vs 9.3% [4/43] for junior, p

Hanging ala is one of the alar-columellar discrepancies encountered in a rhinoplasty procedure among the Asian population. The principle of lifting both the ala effectively while keeping its symmetry remains a challenge. The arrow tip technique is designed to address the bilateral hanging ala which allows greater alar mobility and lifting effect, producing a desirable outcome of the overall nasal feature. This retrospective review is aimed to analyse the effectiveness of the proposed alar surgical technique and assesses the possible complications that require revision surgery. Fifteen Asian patients underwent the ‘arrow tip technique’ alar surgery in conjunction of a rhinoplasty procedure in a single-centre 3-year study for bilateral hanging ala. Pre- and post-operative clinical and photographic nasal analyses were performed for changes of alar vertical height on lateral and frontal views. On the frontal view, the mean percentage of alar shortening was 13.11%, 95%CI [11.46%, 14.76%]. On the lateral view, the mean percentage of alar shortening was 20.36%, 95%CI [19.01%, 21.71%]. The mean frontal-lateral alar shortening was − 7.25%, 95%CI [− 8.76%, − 5.74%]. Two patients required revision surgery for scars (13.3%) and another for nostril asymmetry (6%). This innovative technique is effective, safe and predictable in correcting the hanging ala. Understanding the relevance of performing an effective alar surgery through safe surgical landmarks, the use of full-thickness skin grafts and taking proper precautions can avoid the unnecessary fear of the complications of an external approach to an alar surgery such as scarring, bleeding, alar asymmetry and recurrence. Level of evidence: Level IV, therapeutic study.

A new freshwater rotifer Cephalodella changdensis sp. nov. discovered in two locations in Changde, Hunan, China, is described morphologically. The new species is characterized by body shape moderately elongate, double eyespots frontally, toes conical and almost straight, about one fourth of total length, trophi type B (classification after Wulfert, 1937), rami asymmetrical with a pair of long alulae, fulcrum inverted T-shaped (ventral/dorsal view) with dorsally directed distal projection (lateral view), and manubria asymmetrical, left one slightly longer and stronger, with J-shaped or crutch-shaped posterior ends.