Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.814
Filtrar
1.
Artigo em Chinês | MEDLINE | ID: mdl-34628826

RESUMO

Objective:To investigate the morphology of bone markers around the parapharyngeal internal carotid artery and its adjacent relationship. Methods:The imaging date of 30 cases which had normal structure of the skull by CTA were randomly selected. Through maxillary sinus approach, the morphology of peripheral bony landmarks (sphenoid spine, vaginal process of the tympanic bone, tympanic crest) from the parapharyngeal internal carotid artery to the entrance of the internal carotid artery and the adjacent relationship with the parapharyngeal internal carotid artery were observed for imaging anatomy. Results:With the external opening of the internal carotid artery as the reference point, the parapharyngeal internal carotid artery was divided into 10 sides (16.7%) in the direction of atlas and 6 sides(10%) in the direction of temporomandibular joint, 44 sides (73.3%) were close to midline. On 53 sides (88.3%), the morphology of sphenoid spine became triangular shape with upper width and lower width, 6 sides (10%) became irregular type with terminal bifurcation, and 1 side (1.7%) had sphenoid spine missing. The shape of the vaginal process of the tympanic bone (VPTB) was a flat, irregular polygon with a smooth surface and no loss on 60 sides (100%). The tympanic crest (TC) was a continuation of the VPTB to the sphenoid spine. It was located between the sphenoid spine and the VPTB. 51 sides (85%) of the TC and 9 sides (15%) of the TC were missing. The three constituted a special anatomical structure located in front of the internal carotid artery of the parapharyngeal segment, which can be divided into 43 inverted J-types (71.7%) and 17 irregular types (28.3%). Conclusion:The special anatomical area composed of sphenoid spine, vaginal process of the tympanic bone, tympanic crest is closely related to the parapharyngeal internal carotid artery observed by maxillary sinus approach, which is the anatomical basis for endoscopic surgery to find the parapharyngeal internal carotid artery. CTA can provide individualized surgical basis.


Assuntos
Pontos de Referência Anatômicos , Artéria Carótida Interna , Artéria Carótida Interna/diagnóstico por imagem , Endoscopia , Feminino , Humanos , Seio Maxilar , Crânio
2.
PLoS One ; 16(10): e0258341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34634091

RESUMO

The human pelvic canal (true pelvis) functions to support the abdominopelvic organs and serves as a passageway for reproduction (females). Previous research suggests that these two functions work against each other with the expectation that the supportive role results in a narrower pelvic midplane, while fetal passage necessitates a larger opening. In this research, we examine how gut size relates to the size and shape of the true pelvis, which may have implications on how gut size can influence pelvic floor integrity. Pelves and in vivo gut volumes were measured from CT scans of 92 adults (48 female, 44 male). The true pelvis was measured at three obstetrical planes (inlet, midplane, outlet) using 11 3D landmarks. CT volumetry was used to obtain an individual's gut size. Gut volume was compared to the pelvic planes using multiple regression to evaluate the relationship between gut size and the true pelvis. We find that, in males, larger gut sizes are associated with increased mediolateral canal dimensions at the inlet and midplane. In females, we find that larger gut sizes are associated with more medially-projecting ischial spines and an anteroposteriorly longer outlet. We hypothesize that the association of larger guts with increased canal width in males and increased outlet length in females are adaptations to create adequate space for the gut, while more medially projecting ischial spines reduce the risk of pelvic floor disorders in females, despite its possible spatial consequences for fetal passage.


Assuntos
Trato Gastrointestinal/fisiologia , Pelve/fisiologia , Adolescente , Adulto , Pontos de Referência Anatômicos , Feminino , Humanos , Masculino , Tamanho do Órgão , Pelve/anatomia & histologia , Análise de Regressão , Adulto Jovem
3.
PLoS One ; 16(10): e0258232, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34613996

RESUMO

The most important precondition for correction of the affected forearm using data from the contralateral side is that the left and right bone features must be similar, in order to develop patient-specific instruments (PSIs) and/or utilize computer-assisted orthopedic surgery (CAOS). The forearm has complex anatomical structure, and most people use their dominant hand more than their less dominant hand, sometimes resulting in asymmetry of the upper limbs. The aim of this study is to investigate differences of the bilateral forearm bones through a quantitative comparison of whole bone parameters including length, volume, bowing, and twisting parameters, and regional shape differences of the forearm bones. In total, 132 bilateral 3D radii and ulnae 3D models were obtained from CT images, whole bone parameters and regional shape were analyzed. Statistically significant differences in whole bone parameters were not shown. Regionally, the radius shows asymmetry in the upper section of the central part to the upper section of the distal part. The ulna shows asymmetry in the lower section of the proximal part to the lower section of the central part. Utilizing contralateral side forearm bones to correct the affected side may be feasible despite regional differences in the forearm bones of around 0.5 mm.


Assuntos
Antebraço/anatomia & histologia , Rádio (Anatomia)/anatomia & histologia , Ulna/anatomia & histologia , Pontos de Referência Anatômicos , Fenômenos Biomecânicos , Feminino , Antebraço/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Reprodutibilidade dos Testes , Ulna/diagnóstico por imagem
4.
Sci Rep ; 11(1): 18404, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526606

RESUMO

For proximal femoral nailing, choosing the proper entry point with the aid of C-arm imaging is crucial. Therefore, obtaining accurate radiological views that facilitate sound identification of the tip of the greater trochanter (GT) is of utmost importance. The aim of this study was to define a radiological view characterised by reproducible radiographic landmarks which will allow the reliable identification of the tip of the GT in the anteroposterior view. Anatomical and radiographic features of 16 cadaveric femurs were analysed. The cortical overlap view (COV), characterised by the radiological overlap of the density line of the piriform fossa and the intertrochanteric crest, was identified. It marks the rotation of the proximal femur at which the GT can be accurately identified and used to determine the desired entry point for a proximal femoral nail. Trainees and fully qualified orthopedic trauma surgeons were asked to identify the correct COV in radiological imaging series. Mean internal rotation of the femur to achieve a COV was 17.5° (range 12.8°-21.8°). In the COV the tip of the GT is the highest visible point and the mean distance from the cortical overlap line to the tip of the GT is 4.45 mm. Intra- and inter-rater reliability was high with ICC(2,k) = 0.932 and ICC(2,k) = 0.987 respectively. Trainees achieved higher rates of correct COV identification than specialists. There was no significant correlation between the internal rotation of the femur to achieve the COV and femoral antetorsion. In conclusion, the COV is a highly reproducible radiological view that is characterised by radiographic landmarks easy to recognise. It allows for accurate identification of the tip of the GT, which can be used by the surgeon as a reference to determine the desired entry point for an intramedullary nail.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Fraturas do Fêmur/cirurgia , Fêmur/anatomia & histologia , Fixação Intramedular de Fraturas/instrumentação , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/cirurgia , Pinos Ortopédicos , Cadáver , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Masculino , Radiografia , Reprodutibilidade dos Testes
5.
Comput Methods Programs Biomed ; 210: 106380, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34478914

RESUMO

BACKGROUND AND OBJECTIVES: Craniometric landmarks are essential in many biomedical applications, such as morphometric analysis or forensic identification. The process of locating landmarks is usually a manual and slow task, highly influenced by fatigue, skills and the experience of the practitioner. Localization errors are propagated and magnified in subsequent steps, which can result in incorrect measurements or assumptions. Thereby, standardization, reliability and reproducibility lay the foundations for the necessary accuracy in subsequent measurements or anatomical analysis. In this paper, we present an automatic method to annotate 3D surface skull models taking into account anatomical and geometrical features. METHODS: The proposed method follows a hybrid structure where a deformable template is used to initialize the landmark positions. Then, a refinement stage is applied using prior anatomical knowledge to ensure a correct placement. Our proposal is validated over thirty 3D skull scans of male Caucasians, acquired by hand-held surface scanning, and a set of 58 craniometric landmarks. A statistical analysis was carried out to analyze the inter- and intra-observer variability of manual annotations and the automatic results, along with a visual assessment of the final results. RESULTS: Inter-observer errors show significant differences, which are reflected in the expert consensus used as reference. The average localization error was 2.19±1.5 mm when comparing the automatic landmarks to the reference location. The subsequent visual analysis confirmed the reliability of the refinement method for most landmarks. CONCLUSIONS: Repeated manual annotations show a high variability depending on both skills and expertise of the observer, and landmarks' location and characteristics. In contrast, the automatic method provides an accurate, robust and reproducible alternative to the tedious and error-prone task of manual landmarking.


Assuntos
Imageamento Tridimensional , Crânio , Pontos de Referência Anatômicos/diagnóstico por imagem , Cefalometria , Humanos , Masculino , Reprodutibilidade dos Testes , Projetos de Pesquisa , Crânio/diagnóstico por imagem
6.
Comput Biol Med ; 137: 104819, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507153

RESUMO

Fundamental principle in improving Dental and Orthodontic treatments is the ability to quantitatively assess and cross-compare their outcomes. Such assessments require calculating distances and angles from 3D coordinates of dental landmarks. The costly and repetitive task of hand-labelling dental models hinder studies requiring large sample size to penetrate statistical noise. We have developed techniques and a software implementing these techniques to map out automatically, 3D dental scans. This process is divided into consecutive steps - determining a model's orientation, separating and identifying the individual tooth and finding landmarks on each tooth - described in this paper. The examples to demonstrate the techniques, software and discussions on remaining issues are provided as well. The software is originally designed to automate Modified Huddard Bodemham (MHB) landmarking for assessing cleft lip/palate patients. Currently only MHB landmarks are supported, however it is extendable to any predetermined landmarks. The software, coupled with intra-oral scanning innovation, should supersede the arduous and error prone plaster model and calipers approach to Dental research, and provide a stepping-stone towards automation of routine clinical assessments such as "index of orthodontic treatment need" (IOTN).


Assuntos
Fenda Labial , Fissura Palatina , Pontos de Referência Anatômicos , Modelos Dentários , Humanos , Imageamento Tridimensional , Reprodutibilidade dos Testes , Software
7.
AJR Am J Roentgenol ; 217(4): 800-812, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34505543

RESUMO

The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.


Assuntos
Imageamento por Ressonância Magnética , Distúrbios do Assoalho Pélvico/diagnóstico por imagem , Algoritmos , Pontos de Referência Anatômicos , Meios de Contraste , Defecação , Humanos , Comunicação Interdisciplinar , Imageamento por Ressonância Magnética/métodos , Educação de Pacientes como Assunto , Distúrbios do Assoalho Pélvico/fisiopatologia
8.
Anesth Analg ; 133(5): 1288-1295, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517392

RESUMO

BACKGROUND: Accurate identification of the cricothyroid membrane is crucial for successful cricothyroidotomy. The aim of this study was to compare the conventional downward and modified upward laryngeal handshake techniques in terms of accuracy to identify the cricothyroid membrane in nonobese female patients. METHODS: In 198 anesthetized female patients, the cricothyroid membrane was identified by either the conventional downward laryngeal handshake technique (n = 99) or the modified upward laryngeal handshake technique (n = 99). According to the conventional downward laryngeal handshake technique, the cricothyroid membrane was identified by palpating the neck downward from the greater cornu of the hyoid bone, thyroid laminae, and cricoid cartilage. According to the modified upward laryngeal handshake technique, the cricothyroid membrane was located by moving up from the sternal notch. The primary outcome was the accuracy of identifying the cricothyroid membrane. Secondary outcomes included the accuracy of midline identification and time taken to locate what participants believed to be the cricothyroid membrane. The primary and secondary outcomes according to the technique were analyzed using generalized estimating equations. RESULTS: The cricothyroid membrane could be identified more accurately by the modified upward laryngeal handshake technique than by the conventional downward technique (84% vs 56%, respectively; odds ratio [OR], 4.36; 95% confidence interval [CI], 2.13-8.93; P < .001). Identification of the midline was also more accurate by the modified laryngeal handshake than by the conventional technique (96% vs 83%, respectively; OR, 4.98; 95% CI, 1.65-15.01; P = .004). The time taken to identify the cricothyroid membrane was not different between the conventional and modified techniques (20.2 [16.2-26.6] seconds vs 19.0 [14.5-26.4] seconds, respectively; P = .83). CONCLUSIONS: The modified upward laryngeal handshake technique that involved tracing the trachea and laryngeal structures upward from the sternal notch was more accurate in identifying the cricothyroid membrane than the conventional downward technique in anesthetized female patients.


Assuntos
Cartilagem Cricoide/anatomia & histologia , Palpação , Cartilagem Tireóidea/anatomia & histologia , Adulto , Idoso , Pontos de Referência Anatômicos , Anestesia Geral , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Seul , Fatores Sexuais
9.
Biomed Res Int ; 2021: 9978588, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34423041

RESUMO

Purpose: This study explored the effects of genioplasty (Gep) and anterior subapical osteotomy of the maxilla and mandible (ASOMx+ASOMd) on the pharyngeal airway dimensions of patients with bimaxillary protrusion (BiP). Method: Thirty-two patients were divided into 2 groups. Group 1 received ASOMx+ASOMd, and group 2 received ASOMx+ASOMd+Gep. The cephalograms of the patients were collected before surgery and 2 months after surgery. Changes in the landmarks, related cephalometric angles (gonial, SN-GoGn, Y-axis, and SN-C2C4 angles), and 2 pharyngeal airway dimensions (uvulo-pharyngeal airway [UOP] and tongue-pharyngeal airway [TOP]) were analyzed. Results: Before surgery, the parameters (incisor superius, incisor inferius, menton, most superior and anterior point of the hyoid bone, tip of the uvula, inferoanterior point on the second cervical vertebra, and inferoanterior point on the fourth cervical vertebra) and measured angles (SNA, SNB, ANB, gonial, SN-GoGn, Y-axis, and C4C2-SN) of both groups showed no significant differences. Following ASOMx, the patients in groups 1 and 2 exhibited a setback by 7.0 and 6.6 mm, respectively. After ASOMd, groups 1 and 2 exhibited 4.9 and 5.3 mm setbacks, respectively. No significant difference in the amount of setback was observed between groups 1 and 2. The postoperative horizontal and vertical positions of Me in group 2 were significantly forward by 6.1 mm and upward by 1.5 mm, respectively. Regarding pharyngeal airway dimensions, TOP was decreased in group 1 (1.7 mm) and group 2 (1.3 mm). In the postoperative Pearson correlation coefficient test, the horizontal and vertical positions of Me showed no significant correlation with TOP in both groups. Therefore, Gep did not prevent the reduction of TOP in group 2. Conclusion: After bimaxillary anterior subapical osteotomy, the TOP of patients with BiP was decreased, and this situation was unavoidable, regardless of whether Gep was performed.


Assuntos
Mentoplastia/métodos , Má Oclusão/cirurgia , Osteotomia Mandibular/métodos , Osteotomia Maxilar/métodos , Faringe/anatomia & histologia , Adulto , Pontos de Referência Anatômicos , Cefalometria , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
10.
PLoS One ; 16(8): e0255174, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347837

RESUMO

Implicit in the k-means algorithm is a way to assign a value, or utility, to a cluster of points. It works by taking the centroid of the points and the value of the cluster is the sum of distances from the centroid to each point in the cluster. The aim in this paper is to introduce an alternative way to assign a value to a cluster. Motivation is provided. Moreover, whereas the k-means algorithm does not have a natural way to determine k if it is unknown, we can use our method of evaluating a cluster to find good clusters in a sequential manner. The idea uses optimizations over permutations and clusters are set by the cyclic groups; generated by the Hungarian algorithm.


Assuntos
Algoritmos , Pontos de Referência Anatômicos , Animais , Análise por Conglomerados , Simulação por Computador , Hungria , Análise de Componente Principal , Ratos
11.
Sports Med Arthrosc Rev ; 29(3): e18-e23, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398117

RESUMO

A basic understanding of meniscal anatomy and biomechanics is important for physicians evaluating knee injuries and surgeons treating meniscal injuries. This chapter provides a concise review of meniscal anatomy and biomechanics relevant for the evaluation and treatment of meniscus injuries. Anatomic landmarks relevant for meniscal root repair and transplant are discussed, along with the gross, microscopic, vascular, and neuroanatomy of the menisci.


Assuntos
Meniscos Tibiais/anatomia & histologia , Meniscos Tibiais/fisiologia , Pontos de Referência Anatômicos/anatomia & histologia , Fenômenos Biomecânicos/fisiologia , Humanos , Ilustração Médica , Meniscos Tibiais/cirurgia , Movimentos dos Órgãos/fisiologia , Tamanho do Órgão , Lesões do Menisco Tibial/diagnóstico
13.
J Am Heart Assoc ; 10(15): e019334, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34278802

RESUMO

Background The pathogenesis of transposition of the great arteries (TGA) as a congenital heart defect of the outflow tract with discordant ventriculoarterial connections remains an enigma. TGA usually have parallel great arteries suggesting that deficient torsion of the embryonic arterial heart pole might cause discordant ventriculoarterial connections. It has been speculated that deficient elongation of the embryonic outflow tract might prevent its normal torsion resulting in TGA. The aim of our study was to clarify whether the intrapericardial portions of the great arteries in human patients with TGA might be indeed shorter than in normal hearts. Methods and Results Thirty-four newborns with simple TGA and 35 newborns with normal hearts were analyzed by using images of the outflow tract in their echocardiograms and the following defined lengths of the great arteries were measured: aortic length 1, (AoL-1) and aortic length 2 (AoL-2) = distance between left and right aortic valve level and origin of the brachiocephalic artery, respectively. Pulmonary trunk length 1 (PTL-1) and pulmonary trunk length 2 (PTL 2) = distance between left and right pulmonary valve level and origin of left and right pulmonary artery, respectively. All measurements of the AoL were significantly shorter in TGA compared to normal hearts (AoL-1: 1.6±0.2 versus 2.05±0.1; P<0.0001; AoL-2: 1.55±0.2 versus 2.13±0.1; P<0.0001). With regard to the pulmonary trunk (PT), PTL-1 and PTL-2 were found to be shorter and longer, respectively, in TGA compared with normal hearts, reflecting the differences in the spatial arrangement of the PT between the 2 groups as in TGA the PT is showing a mirror image of the normal anatomy. However, the overall length of the PT between the 2 groups did not differ. Conclusions Our data demonstrate that, compared with normal newborns, the ascending aorta is significantly shorter in newborns with TGA whereas the overall length of the PT does not differ between the 2 groups. This finding is in accord with the animal model-based hypothesis that TGA may result from a growth deficit at the arterial pole of the embryonic heart.


Assuntos
Aorta/diagnóstico por imagem , Tronco Braquiocefálico/diagnóstico por imagem , Ecocardiografia , Artéria Pulmonar/diagnóstico por imagem , Transposição dos Grandes Vasos/diagnóstico por imagem , Pontos de Referência Anatômicos , Animais , Aorta/anormalidades , Tronco Braquiocefálico/anormalidades , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Artéria Pulmonar/anormalidades , Estudos Retrospectivos
14.
J Orthop Surg Res ; 16(1): 436, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229682

RESUMO

BACKGROUND: The objectives of this study were to investigate the anatomic morphology of patellar ridge using computed tomography-based three-dimensional (3D) computer models and to assess the center of the patellar ridge after virtual resections. METHODS: We selected 80 patients, 40 males (age, 33.2±6.8 years) and 40 females (age, 30.6±7.2 years), who were slightly symptomatic with soft tissue injury of the knee joint. The right or left knees were scanned by computed tomography (CT). The CT data of 160 knees was used to construct 3D computer models by image analysis software (Mimics). Variables such as the angle between the patellar ridge and patellar long axis, the distance between the center of the patellar ridge and the center of patellar cut after virtual resections were measured. We detect differences between the sides and genders with the 3D computer models by Student's t test. Simple linear regression and correlation test was used to correlate the patellar ridge center to the center of the patellar cut. RESULTS: According to the available data, there were significant gender differences in the length and width of patellar cut after virtual resections even with strict control for the height and weight of the patients. The angle between the patellar ridge and the patellar long axis was 11.24° ± 3.62°. The angle in male patients was 10.17° ± 4.82°, and it was 12.28°± 3.78° in female patients. The morphological difference was statistically significant (P < 0.05). After using the subchondral method to virtually resect the patellae, with reference to the center of the patellar cut, the center of the patellar ridge lies superiorly and medially in 88.75%, inferiorly and medially in 8.75%, laterally and superiorly in 2.5%, and in no case laterally and inferiorly. The intra-observer reliability regarding the dimensional measurements was excellent in this study. CONCLUSIONS: Advances in 3D computer models had resulted in the availability of preoperative measurement and virtual planning. The anthropometric dimensions of this study could provide general information for guiding surgical management of the patella in total knee arthroplasty (TKA) and were useful in designing patellar implants. CLINICAL RELEVANCE: The placement of the patellar component during TKA differs from one patella to another. The anatomic morphology information of the patellar ridge is helpful for surgeons to perform patellar resurfacing in TKA.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Pontos de Referência Anatômicos/diagnóstico por imagem , Imageamento Tridimensional , Patela/anatomia & histologia , Patela/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Artroplastia do Joelho/métodos , Simulação por Computador , Feminino , Humanos , Masculino , Fatores Sexuais
15.
Surg Radiol Anat ; 43(9): 1527-1535, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34080063

RESUMO

PURPOSE: The present study aims to provide a step-by-step procedural and anatomical familiarization guide for transverse plane ultrasound (US)-guided caudal epidural (CE) injection. METHODS: The study cohort consisted of 23 chronic low back pain patients (23-67 years old) previously unresponsive to conservative management. A transverse plane US-guided CE injection was performed, with each procedure step documenting and emphasizing sonographic anatomy. Several Thiel's method fixed cadaveric specimen dissections were also performed to demonstrate relevant CE injection-related anatomy. RESULTS: The sacral hiatus location can be estimated by visually forming an equilateral triangle between the posterior superior iliac spines and the sacral apex (trigonum sacrale). Follow-up palpation locates the sacral cornua, guiding transducer placement visualizing over the paired cornua 'bull frog's eye's appearance, with the epidural space visualized as a hypoechoic line, between the eyes. Then, 2-3 ml of 1% lidocaine is injected subcutaneously at the mid-point between the sacral cornua and superficial to the posterior sacrococcygeal ligament (SCL). Although keeping the cornua, superficial posterior SCL and epidural space in view, the needle is slowly advanced to the epidural space at around a 20 degree cephalad angle till the tip becomes visible. Expansion of the epidural space is monitored under the transverse sacral ligament as the injectant is slowly introduced. CONCLUSION: The present study demonstrated the anatomical landmarks necessary for the transverse ultrasound caudal epidural technique and that the cornua, superficial posterior SCL, CE space, and other relevant sacral hiatal anatomy are well visualized with this technique.


Assuntos
Espaço Epidural/anatomia & histologia , Injeções Epidurais , Dor Lombar/tratamento farmacológico , Ultrassonografia de Intervenção , Adulto , Idoso , Pontos de Referência Anatômicos , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Plast Reconstr Surg ; 148(1): 162-169, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181613

RESUMO

BACKGROUND: Despite the wide range of cleft lip morphology, consistent scales to categorize preoperative severity do not exist. Machine learning has been used to increase accuracy and efficiency in detection and rating of multiple conditions, yet it has not been applied to cleft disease. The authors tested a machine learning approach to automatically detect and measure facial landmarks and assign severity grades using preoperative photographs. METHODS: Preoperative images were collected from 800 unilateral cleft lip patients, manually annotated for cleft-specific landmarks, and rated using a previously validated severity scale by eight expert reviewers. Five convolutional neural network models were trained for landmark detection and severity grade assignment. Mean squared error loss and Pearson correlation coefficient for cleft width ratio, nostril width ratio, and severity grade assignment were calculated. RESULTS: All five models performed well in landmark detection and severity grade assignment, with the largest and most complex model, Residual Network, performing best (mean squared error, 24.41; cleft width ratio correlation, 0.943; nostril width ratio correlation, 0.879; severity correlation, 0.892). The mobile device-compatible network, MobileNet, also showed a high degree of accuracy (mean squared error, 36.66; cleft width ratio correlation, 0.901; nostril width ratio correlation, 0.705; severity correlation, 0.860). CONCLUSIONS: Machine learning models demonstrate the ability to accurately measure facial features and assign severity grades according to validated scales. Such models hold promise for the creation of a simple, automated approach to classifying cleft lip morphology. Further potential exists for a mobile telephone-based application to provide real-time feedback to improve clinical decision making and patient counseling.


Assuntos
Fenda Labial/diagnóstico , Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Nariz/anormalidades , Índice de Gravidade de Doença , Pontos de Referência Anatômicos , Reconhecimento Facial Automatizado/métodos , Fenda Labial/complicações , Fenda Labial/cirurgia , Tomada de Decisão Clínica , Aconselhamento , Conjuntos de Dados como Assunto , Estudos de Viabilidade , Humanos , Aplicativos Móveis , Nariz/diagnóstico por imagem , Nariz/cirurgia , Fotografação , Período Pré-Operatório , Consulta Remota , Rinoplastia
17.
Orthop Surg ; 13(5): 1682-1693, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34142453

RESUMO

Total knee arthroplasty is an effective treatment for end-stage knee osteoarthritis. The tibial platform osteotomy must take full account of the coronal plane, the sagittal plane, and the rotational alignment of the tibial prosthesis. During surgery, individual differences in the coronal alignment of the tibia need to be taken into account as poor alignment after surgery can lead to rapid wear of the tibial platform, reducing the longevity of the prosthesis and adversely affecting quality of life. Intraoperative tibial osteotomies are often performed using extramedullary alignment. When an extramedullary alignment approach is used, the proximal tibial osteotomy guide is usually placed in the medial third of the tibial tuberosity. There is no consensus on the most reliable anatomical landmarks or axes for achieving distal tibial coronary alignment. Anatomical points or reference axes that are highly reproducible and precise need to be identified. From available data it appears that most surgeons use the extensor hallucis longus tendon, the second metatarsal, and the anterior tibial cortex to determine the distal localization point. However, its accuracy has not been confirmed in clinical and radiographic data, and the alignment concept and preoperative planning for total knee arthroplasty has paid more attention to rotational alignment, but there are few studies on the coronal alignment of the tibia. This article reviews the recent use of the distal tibial coronal osteotomy reference point in total knee arthroplasty. However, due to there being only a small number of studies available, the evidence collected is insufficient to prove that a certain reference axis has obvious advantages and a combination of different reference points is needed to achieve the ideal lower extremity force line angle.


Assuntos
Pontos de Referência Anatômicos , Artroplastia do Joelho/métodos , Prótese do Joelho , Osteotomia/métodos , Ajuste de Prótese , Tíbia/cirurgia , Humanos
18.
J Plast Reconstr Aesthet Surg ; 74(11): 2925-2932, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34148834

RESUMO

BACKGROUND: Loss of knee extension causes significant impairment. Though nerve-based reconstruction is preferable in cases of femoral nerve palsy or injury, these surgeries are not always appropriate if the pathology involves the quadriceps muscles or presentation too late for muscle reinnervation. Muscle transfers are another option that has been underutilized in the lower extremity. We describe the successful restoration of knee extension by adductor magnus muscle transfer without functional donor morbidity, along with anatomical considerations. METHODS: Ten fresh frozen cadaveric lower limbs were dissected at the groin and thigh. In addition, three patients presented with femoral nerve palsy for which nerve-based reconstruction was not appropriate because of late presentation. In these patients, adductor magnus muscle transfers were performed, along with sartorius, gracilis, and tensor fasciae latae transfers if available and healthy. RESULTS: In cadavers, the pedicle for the adductor magnus is at the level of the gracilis and adequate for muscle transfer, with sufficient weavable tendon length. The only major structure at risk is the femoral neurovascular bundle, which is in a reliable anatomic position. Two patients recovered 4/5 active knee extension and ambulation without assistive devices. A third required reoperation for a loosened tendon weave, after which the noted improved stability and strength with ambulation but did not regain strong active knee extension and continued to require a cane. CONCLUSIONS: We present a novel reconstructive approach for loss of quadriceps function in patients, which yields good clinical outcomes, with anatomic and technical details to demonstrate the utility of this technique. Ongoing evaluation of optimal technique and rehabilitation to maximize functional outcomes is still needed.


Assuntos
Neuropatia Femoral/cirurgia , Articulação do Joelho/inervação , Articulação do Joelho/cirurgia , Músculo Esquelético/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transferência Tendinosa/métodos , Pontos de Referência Anatômicos , Cadáver , Humanos , Músculo Esquelético/anatomia & histologia , Amplitude de Movimento Articular
19.
IEEE Trans Image Process ; 30: 5313-5326, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34038362

RESUMO

In this paper, we propose a structure-coherent deep feature learning method for face alignment. Unlike most existing face alignment methods which overlook the facial structure cues, we explicitly exploit the relation among facial landmarks to make the detector robust to hard cases such as occlusion and large pose. Specifically, we leverage a landmark-graph relational network to enforce the structural relationships among landmarks. We consider the facial landmarks as structural graph nodes and carefully design the neighborhood to passing features among the most related nodes. Our method dynamically adapts the weights of node neighborhood to eliminate distracted information from noisy nodes, such as occluded landmark point. Moreover, different from most previous works which only tend to penalize the landmarks absolute position during the training, we propose a relative location loss to enhance the information of relative location of landmarks. This relative location supervision further regularizes the facial structure. Our approach considers the interactions among facial landmarks and can be easily implemented on top of any convolutional backbone to boost the performance. Extensive experiments on three popular benchmarks, including WFLW, COFW and 300W, demonstrate the effectiveness of the proposed method. In particular, due to explicit structure modeling, our approach is especially robust to challenging cases resulting in impressive low failure rate on COFW and WFLW datasets. The model and code are publicly available at https://github.com/BeierZhu/Sturcture-Coherency-Face-Alignment.


Assuntos
Reconhecimento Facial Automatizado/métodos , Aprendizado Profundo , Face/anatomia & histologia , Pontos de Referência Anatômicos/anatomia & histologia , Bases de Dados Factuais , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...