Comparison of Ultrasound / Anatomical landmark guided technique for superior laryngeal nerve block along with Topical Anesthesia for awake nasal intubation in various Oral& faciomaxillary & Dental surgeries

ABSTRACT:Background: Endotracheal intubation is gold standard of general anesthesia. various oral,Maxillofacial, Dental surgeries are carried out in high-risk patients having chances ofdifficult intubation. If we give sedation or general anesthesia, we can be trapped in criticalairway accidents.Aims & objectives: To access & compare efficacy of anatomical landmark guided/Ultrasound guided superior laryngeal nerve block associated with topical Anesthesia &transtracheal block for awake blind nasal intubation.Method:Group A: Anatomical landmark guided superior laryngeal nerve block given(n=30)Group B: ultrasound guided superior laryngeal nerve block(n=30)In both groups topical Anesthesia & transtracheal block for awake blind nasal intubation wasgiven.Results: upper airway block provide clinical ease to facilitate blind nasal awake intubation.ultrasound guided block has less adverse reactions.Conclusion: Both methods provide good quality of Endotracheal intubation, but ultrasoundguided block is more efficient & scientific method to block superior laryngeal nerve forawake nasal intubation.

F approach algorithm in missing landmark problem / Aproximación al algoritmo F en punto de referencia perdido

SUMMARY: Missing data may occur in every scientific studies. Statistical shape analysis involves methods that use geometric information obtained from objects. The most important input to the use of geometric information in statistical shape analysis is landmarks. Missing data in shape analysis occurs when there is a loss of information about landmark cartesian coordinates. The aim of the study is to propose F approach algorithm for estimating missing landmark coordinates and compare the performance of F approach with generally accepted missing data estimation methods, EM algorithm, PCA based methods such as Bayesian PCA, Nonlinear Estimation by Iterative Partial Least Squares PCA, Inverse non-linear PCA, Probabilistic PCA and regression imputation methods. Landmark counts were taken as 3, 6, 9 and sample sizes were taken as 5, 10, 30, 50, 100 in the simulation study. The data are generated based on multivariate normal distribution with positively defined variance-covariance matrices from isotropic models. In simulation study three different simulation scenarios and simulation based real data are considered with 1000 repetations. The best and the most different result in the performance evaluation according to all sample sizes is the Min (F) criteria of the F approach algorithm proposed in the study. In case of three landmarks which is only the proposed F approach and regression assignment method can be applied, Min (F) criteria give best results.

RESUMEN: Los datos faltantes pueden ocurrir en todos los estudios científicos. El análisis estadístico de formas involucra métodos que utilizan información geométrica obtenida de objetos. La entrada más importante para el uso de información geométrica en el análisis estadístico de formas son los puntos de referencia. Los datos que faltan en el análisis de formas se producen cuando hay una pérdida de información sobre las coordenadas cartesianas históricas. El objetivo del estudio es proponer el algoritmo de enfoque F para estimar las coordenadas de puntos de referencia faltantes y comparar el rendimiento del enfoque F con métodos de estimación de datos faltantes generalmente aceptados, algoritmo EM, métodos basados en PCA como Bayesian PCA, Estimación no lineal por Iterative Partial Least Squares PCA, PCA no lineal inverso, PCA probabilístico y métodos de imputación de regresión. Los recuentos de puntos de referencia se tomaron como 3, 6, 9 y los tamaños de muestra se tomaron como 5, 10, 30, 50, 100 en el estudio de simulación. Los datos se generan en base a una distribución normal multivariada con matrices de varianza-covarianza definidas positivamente a partir de modelos isotrópicos. En el estudio de simulación se consideran tres escenarios de simulación diferentes y se consideran datos reales basados en simulación con 1000 repeticiones. El mejor y más diferente resultado en la evaluación del desempeño según todos los tamaños de muestra es el criterio Min (F) del algoritmo de enfoque F propuesto en el estudio. En el caso de tres puntos de referencia, que es solo el enfoque F propuesto y se puede aplicar el método de asignación de regresión, los criterios Min (F) dan mejores resultados.

Seroprevalence of IgG Antibodies for Dengue among Blood Donors

Dengue fever is endemic India and the prevalence of dengue is on the rise owing to various social and economic factors. Prevalence of asymptomatic dengue infection varies widely from less than 1 % to 80 % in India. Transfusion transmissible dengue has been reported in different parts of the word. Prevalence of subclinical dengue among blood donor poses a threat to the blood supply leading to transfusion transmissible dengue. We wanted to estimate the prevalence of IgG antibodies for Dengue in the blood donor population. METHODSSix hundred and eight whole blood donors were included in the study during the period January 2017 to October 2018. Donor registration and education was done as per the national guidelines. Donors who gave a history of previous dengue or symptoms consistent with dengue were excluded from the study. Serum samples from whole blood donors were tested for IgG antibodies using ELISA technology. RESULTSOf the total of 608 donors, 602 were male donors and 55 % of the donors were in the age group 21 - 30 years. Majority (69 %) of the donors were from urban locations. Anti IgG antibodies for dengue were present in 4.14 % of donors of which 38 % of donors were in the age group 31 - 40 years. Three hundred and eighty-four donors revealed history of fever, myalgia and headache in the past one year. No statistical significance was found between fever, myalgia and the presence of IgG anti-dengue antibodies. CONCLUSIONSThe subclinical or asymptomatic prevalence of dengue infection is low when compared to other studies in other parts of the country. Enquiring into donor history for history of dengue or symptoms of dengue and deferring such donors for a recommended period will prevent transfusion transmissible dengue.

Morphometric analysis of 3D soft-tissue for sexual dimorphism in human face / Análisis morfométrico de tejidos blandos 3D de dimorfismo sexual en rostro humano

Sexual dimorphism in Homo-sapiens is a phenomenon of a direct product of evolution by natural selection where evolutionary forces acted separately on the sexes which brought about the differences in appearance between male and female such as in shape and size. Advances in morphometrics have skyrocketed the rate of research on sex differences in human and other species. However, the current challenges facing 3D in the acquisition of facial data such as lack of homology, insufficient landmarks to characterize the facial shape and complex computational process for facial point digitization require further study in the domain of sex dimorphism. This study investigates sexual dimorphism in the human face with the application of Automatic Homologous Multi-points Warping (AHMW) for 3D facial landmark by building a template mesh as a reference object which is thereby applied to each of the target mesh on Stirling/ESRC dataset containing 101 subjects (male = 47, female = 54). The semi-landmarks are subjected to sliding along tangents to the curves and surfaces until the bending energy between a template and a target form is minimal. Principal Component Analysis (PCA) is used for feature selection and the features are classified using Linear Discriminant Analysis (LDA) with an accuracy of 99.01 % which demonstrates that the method is robust.

El dimorfismo sexual en el Homo-sapiens es un fenómeno directo de la evolución por selección natural, donde las fuerzas evolutivas actuaron por separado en los sexos, lo que provocó las diferencias en la apariencia entre hombres y mujeres, tal como la forma y tamaño. Los avances en el área de la morfometría, han generado un aumento significativo de las investigaciones en las diferencias de sexo en humanos y otras especies. Sin embargo, los desafíos actuales que enfrenta el 3D en el análisis de datos faciales, como la falta de homología, puntos de referencia insuficientes para caracterizar la forma facial y la complejidad del proceso computacional para la digitalización de puntos faciales, requiere un estudio adicional en el área del dimorfismo sexual. Este estudio investiga el dimorfismo sexual en el rostro humano con la aplicación de la deformación automática de múltiples puntos homólogos para el hito facial 3D, mediante la elaboración de una malla de plantilla como objeto de referencia, y se aplica en cada una de las mallas objetivas en el conjunto de datos Stirling / ESRC que contiene 101 sujetos (hombre = 47, mujer = 54). Los semi-puntos de referencia se deslizan a lo largo de las tangentes a las curvas y superficies hasta que la energía de flexión entre una plantilla y una forma objetivo es mínima. El análisis de componentes principales (PCA) se utiliza para la selección de características y las características se clasifican mediante el análisis discriminante lineal (ADL) con una precisión del 99,01 %, lo que demuestra la validez del método.

Assimetrias da orientação da atenção visuoespacial em Idosos / Visuospatial attention orienting asymmetries in the elderly

A atenção voluntária é assimétrica em sujeitos saudáveis, com favorecimento para o lado direito do espaço. Há evidências de que os idosos apresentam declínio da atenção, o que poderia gerar mudança da assimetria atencional. Objetivamos investigar a assimetria normal da atenção em idosos saudáveis. Vinte idosos (60 a 85 anos) e 20 participantes jovens foram investigados no teste de bissecção de linhas (TBL) e no teste de Landmark (TL). Os resultados apontam ausência de diferenças significativas entre os Grupos e entre Gêneros em ambos os testes para o número de erros e para os desvios em relação ao centro no TBL. Conclui-se que participantes idosos mantêm capacidade de atenção preservada e assimetria normal do fenômeno da orientação da atenção, pelo menos para estes testes

Voluntary attention appears to be asymmetric in healthy subjects, favoring the right side of space. There is evidence that elderly people present a decline in attention, which could lead to change of attentional asymmetry. We aimed to investigate whether the normal asymmetry of attention is altered in healthy older people. Twenty elderly (60 to 85 years old) and 20 young participants were investigated in the line bisection task (LBT) and in the Landmark task (LT). Results indicate absence of significant differences between the Groups and between Genders in both tests for the number of errors and deviations from the center in the LBT. It is concluded that elderly participants maintain preserved attention capacity and normal asymmetry of orienting attention's phenomenon, at least for these tasks

Anatomical Landmark Guided versus Ultrasound-Guided Technique for Subclavian Vein Cannulation in Critically Ill Patients.

Background: Central Venous Access (CVA) is acommon requirement in the critically ill patient for avariety of indications including Central VenousPressure (CVP) monitoring, haemodialysis, placementof pulmonary artery catheters, cardiac pacing and foradministration of drugs especially vasoactive,chemotherapy agents and parenteral nutrition.Traditionally, Central Venous Catheter (CVC)placement is performed using Landmark (LM)technique and is associated with complications likearterial puncture, pneumothorax, hemothorax, airembolism, catheter embolism, and cardiac arrhythmias.Use of Ultrasound (US) is currently indicated forvarious clinical situations to reduce complication rate ofLM technique. Aim and Objectives: The purpose of thisstudy was to determine whether US guidance couldimprove the success rate, number of attempts, and rateof acute complications like inadvertent arterialpuncture, hematoma formation, and pneumothorax ofsubclavian venous catheterization. Material andMethods: Sixty patients in need of central venouscatheter were prospectively randomized in two groupsof 30 each. In the LM group patients were catheterizedusing the LM method and in US group patients werecatheterized by real-time US-guidance. Number ofattempts, success rate, access time and complicationslike accidental subclavian artery puncture, haematomaformation, pneumothorax, were recorded. p values<0.05 were considered statistically significant. Results:In the US group 30 (100%) of patients were successfullycannulated with the US guidance while the landmarktechnique was successful in 26 (86.66%) of patients. Inthe US group the success on first attempt was 83.33 %which was a significantly higher from 56.67% achievedin the LM group (p=0.025). The average number ofattempts for successful cannulation in the US group was1.16 ± 0.4, while in the LM group it was 1.56 ± 0.9 withstatistically significant difference (p=0.046). Accesstime was 27.26 ± 04.62 seconds in the US group, whilethe access time was significantly more in the LM group36.56 ± 17.35 seconds (p=0.0062). Conclusion: USguidance during subclavian vein catheterizationincreases overall and first attempt success, improvesaccess time with reduced average number of attemptsand complications.

Interobserver reliability on landmark-guided sacroiliac joint injection among 5th year residency in Orthopedic and Traumatology Department Faculty of Medicine Brawijaya University Malang, Indonesia

Background: The most common misdiagnosed low backpain is result from the sacroiliac joint. There are a lot of methods we can use to treat it such as steroid injection. This method can be done by using landmark-guided technique or image-guided. Unfortunately, not all hospital in this country has the same facility to do image-guided technique using fluoroscopy to do the injection. Therefore, landmark-guided technique still could be used for the treatment of choice.Methods: In this research, authors did injection on sacroiliac joint of 7 preserved cadavers, on both sacroiliac joint, injection were done by 2 operators, which both are 5th- year residents of Orthopedic and Traumatology Department using 2 coloring markers, therefore each of operator got 14 injection spots. Operator  1 uses methyl red, and operator 2 uses methylene blue. The success of the injection evaluated visually. If operator 1 achieved the injection, the sacroiliac joint would be bright red coloured. If operator 2 achieved the injection, the sacroiliac joint would be blue coloured. If both operator achieved the injection on the same joint, the mixture of both will be dark green coloured.Results: The result shown the success of both operator in doing injection for the sacroiliac joint is 9 joints (32.14%). There were 5  joints (17.86%) done by operator 1, and  4 joints (14.28%) done by operator 2. Operator 1 failed on 9 (32.14%) joints and operator 2 failed on 10 (35.72%) . The data was statistically analysed using Fisher Exact Test, result in p value 0.500 (p >0.05).Conclusions: In conclusion there is no significantly different the success of the injection between operator 1 and 2. The failure of the injection on sacroiliac joint could be affected by many factors such as injection technique, and anatomy variations of the sample.

Chinese nomination for the lip and perioral morphological aesthetic subunits and aesthetic landmarks / 中华整形外科杂志

Objective@#To summarize and update the terminology of the lip and perioral morphological aesthetic subunits and aesthetic landmarks in the domestic medical aesthetics field.@*Methods@#36 English literatures, 13 Chinese literatures, 3 foreign academic compositions, 2 domestic academic compositions, 1 domestic medical aesthetics textbook, and 14 websites of the medical aesthetic field have been included. We summarized the commonly seen terminology of the lip and perioral morphological aesthetic subunits and aesthetic landmarks. Moreover, for the aesthetic subunits and aesthetic landmarks which are commonly used in clinical practice but have not yet been named in Chinese term are named following the current Chinese terminology rule. We summarized not only the terminology of lips but also the anatomical acknowledge of the commonly used aesthetic subunits.@*Results@#There are 17 standard nomenclatures for aesthetic subunits, 8 standard nomenclatures with abbreviations for aesthetic surface landmarks, 20 standard terms for aesthetic measurement and distance. Moreover, we named 5 aesthetic subunits and 6 aesthetic surface landmarks for which there are no standard Chinese medical terms.@*Conclusions@#The standard terminology for the aesthetic subunits and landmarks is the foundation for the lip and perioral measurement and evaluation. Besides, it also provides a reference basis for the development of lip cosmetic and perioral rejuvenation treatment programs.

Benefits of lateral cephalogram during landmark identification on posteroanterior cephalograms / 대한치과교정학회지

OBJECTIVE: Precise identification of landmarks on posteroanterior (PA) cephalograms is necessary when evaluating lateral problems such as facial asymmetry. The aim of the present study was to investigate whether the use of lateral (LA) cephalograms can reduce errors in landmark identification on PA cephalograms. METHODS: Five examiners identified 16 landmarks (Cg, N, ANS, GT, Me, RO, Lo, FM, Z, Or, Zyg, Cd, NC, Ms, M, and Ag) on 32 PA cephalograms with and without LA cephalograms at the same time. The positions of the landmarks were recorded and saved in the horizontal and vertical direction. The mean errors and standard deviation of landmarks location according to the use of LA cephalograms were compared for each landmark. RESULTS: Relatively small errors were found for ANS, Me, Ms, and Ag, while relatively large errors were found for N, GT, Z, Or, and Cd. No significant difference was found between the horizontal and vertical errors for Z and Or, while large vertical errors were found for N, GT, and Cd. The value of identification error was lower when the landmarks were identified using LA cephalograms. Statistically significant error reductions were found at N and Cd with LA cephalograms, especially in the vertical direction. CONCLUSIONS: The use of LA cephalograms during identification of landmarks on PA cephalograms could help reduce identification errors.

Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction

PURPOSE: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. MATERIALS AND METHODS: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. RESULTS: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. CONCLUSIONS: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

Modified bony landmark measurement to deal with leg length discrepancy during total hip arthroplasty / 中华创伤骨科杂志

Objective To evaluate the clinical application of modified bony landmark measurement ( MBLM ) to deal with leg length discrepancy ( LLD ) during total hip arthroplasty ( THA ). Methods We retrospectively analyzed the 36 patients in whom MBLM was used to deal with LLD during THA from January 2014 to May 2015 at Department of Orthopaedics, The Second Hospital of Fuzhou. They were 17 men and 19 women, aged from 42 to 78 years ( average, 68.7 ± 10.1 years ). They were divided into 3 groups according to their pre-operative LLD value ( d ) : 16 cases in group A with d≤10 mm, 11 cases in group B with 10 mm ＜d≤20 mm and 9 cases in group C with d ＞ 20 mm. After the sizes of prosthetic cup and femoral component and the location of implant were determined using preoperative X-ray, a special formula was used to calculate the prosthetic length of femoral head neck and the osteotomy area at the femoral neck. MBLM was used to measure the leg lengths before hip joint dislocation and after placement of the hip implant. The neck length and depth of the femoral component was adjusted according to the measurements. Post-operative X-ray was used to measure the LLD ( d'). The value of MBLM in judgment of LLD during THA was assessed by comparison of d and d' and analysis of distribution of d' . Results The postoperative d' ( 6.0 ± 3.0 mm) was signifi-cantly shorter than the preoperative d ( 11.0 ± 5.0 mm) ( t＝5.145, P ＜0.001 ). There were 30 cases with d' ≤ 10 mm, 6 cases with 10 mm ＜d'≤ 20 mm and 0 case with d' ＞ 20 mm. The cases with d'≤ 10 mm were significantly more than those with d ≤ 10 mm and the cases with d' ＞ 20 mm significantly fewer than those with d ＞ 20 mm ( χ2＝15.500, P＝0.000 ) . Conclusion MBLM used during THA is a reliable method to judge the leg lengths so that LLD can be effectively reduced after THA.

Radiographic measurement for orientation relationships and changing regulations of pedicle screw entry point and posterior bony landmarks in middle-upper thoracic vertebrae of adults / 第二军医大学学报

Objective To explore the orientation relationships and changing rules of pedicle screw entry point (PSEP) on the posterior bony landmarks in middle-upper thoracic vertebrae in adults by measuring parameters of 3-D reconstruction CT images. Methods CT images of the middle-upper thoracic vertebrae from 30 healthy adults were used for 3-D reconstruction to observe the anatomical characteristics of posterior bony landmarks, including transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina. The following basic parameters, including PSEP-to-midline distance (PMD), transverse process-lamina concave-to-midline distance (CMD) and half lamina width (HLW), and target parameters, including PSEP-to-transverse process-lamina concave distance (PCD), entry point location ratio (EPLR) and PSEP-to-superior ridge of transverse process distance (PRD) were determined on reconstructed CT images from T1 to T10. The differences of bilateral measurements of all parameters and the differences of basic parameters were analyzed, and the changing rules of target parameters measurements from T1 to T10 were summarized. Results The transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina of middle-upper thoracic vertebral characterized by obvious and constant anatomical marks with less proliferative. The left and right PMD, CMD, HLW, PCD, EPLR, and PRD were (14.14±2.63) mm and (14.59±2.58) mm, (10.45±2.12) mm and (10.51±2.02) mm, (16.30±1.48) mm and (16.39±1.61) mm, (4.56±1.03) mm and (4.47±0.94) mm, 0.35±0.26 and 0.33±0.30, and (-1.62±1.90) mm and (-1.63±1.44) mm, respectively. There was no significant difference in the measured values between the two sides of the above parameters (P>0.05). Except that the difference between PMD and HLW in T2 was not significant (P>0.05), the differences between basic parameters in the other segments were statistically significant (P<0.05). PCD of T1 to T10 showed a trend of decrease first and then significant increases in T1, T2, T9, and T10 compared with in T3-T8 (P<0.05). EPLR of T1-T10 showed a trend of increase first and then decrease, in which EPLR in T1, T2 and T3 were significantly lower than in the following any segments (P<0.01), and in the T4-T6 and T10 were significantly lower than in T7-T9 (P<0.01). PRD of T1-T10 showed a trend of increase first and then decrease, in which the PRD in T1, T2 and T3 were significantly lower than in the following any segments, and in the T4-T6 were lower than T7-T10 (P<0.01). Conclusion There is constant orientation relationship and changing rules of PSEP in the middle-upper thoracic vertebrae on the posterior bony landmarks, such as transverse process-lamina concave, superior ridge of transverse process and outer edge of the lamina, and it can serve as a new clinical choice.

Novel Landmark for Cervical Pedicle Screw Insertion Point from Computed Tomography-Based Study

STUDY DESIGN: Cross-sectional study. PURPOSE: The purpose of this study was to evaluate a novel landmark for the cervical pedicle screw insertion point. OVERVIEW OF LITERATURE: To improve the accuracy of pedicle screw placement, several studies have employed the lateral mass, lateral vertical notch, and/or inferior articular process as landmarks; however, we often encounter patients in whom we cannot identify accurate insertion points for pedicle screws using these landmarks because of degenerative changes in the facet joints. The superomedial edge of the lamina is less affected by degenerative changes, and we hypothesized that it could be a new landmark for identifying an accurate cervical pedicle screw insertion point. METHODS: A total of 327 consecutive patients, who had undergone neck computed tomographic scanning for determination of neck disease in our institute, were included in the study. At first, the line was drawn parallel to the superior border of the pedicle in the sagittal plane and parallel to the vertical body in the coronal plane. The line was moved downward in 1-mm increments to the inferior border of the pedicle. We determined whether the line passing through the superomedial edge of the lamina (termed the “N-line”) was located between the superior and inferior borders of the pedicle in the sagittal plane. RESULTS: The percentages of N-lines located between the superior and inferior borders of the pedicle were 100% at C3, 100% at C4, 99% at C5, 96% at C6, and 97% at C7. The lower cervical spine has the higher N-line location. CONCLUSIONS: The N-line was frequently located at the level of the pedicle of each cervical spine in the sagittal plane. The superomedial edge of the lamina could be a new landmark for the insertion point of the cervical pedicle screw.

THE FAILING HEART: NEW MODALITIES OF TREATMENT

In the last 40 years, pharmacological therapy for chronic heart failure has rapidly expanded beyond diuretics and digoxin. Standard pharmacological therapy includes beta blockers and renin-angiotensin-aldosterone system antagonists. Even with existing contemporary pharmacological therapy, which has substantially improved outcomes, prognosis is fairly poor. The treatment of heart failure continues to evolve with the integration of the results from landmark clinical trials into contemporary therapy. Development of novel therapeutic strategies for the treatment of this disease is crucial. Some of these new approaches will be briefly discussed.

Variación de patrones morfológicos craneofaciales en relaciones esqueléticas Clase I, II y III / Variation of craniofacial morphological patterns in Class I, II, and III skeletal relationships

Introducción: tradicionalmente, los estudios de variaciones morfológicas de componentes craneofaciales para clasificar relaciones esqueléticas han considerado análisis univariados y multivariados mediante variables como distancias, ángulos y planos referenciales. Sin embargo, estos métodos no explican cambios generales de forma y proporcionan una descripción parcial y localizada de estas relaciones. En tanto, los métodos basados en Morfometría Geométrica (MG) en dos o tres dimensiones (2D o 3D,) permiten una comprensión detallada y un examen más sensible de variables. El objetivo fue identificar la variación de patrones morfológicos de la estructura CraneofacialGeneral(CFG) en relaciones esqueléticas I, II y III, utilizando MG-2D. Métodos: se hizo un estudio prospectivo mediante muestreo no probabilístico. Se tomaron 272 radiografías laterales de cráneo (140 hombres/132 mujeres) de individuos colombianos entre 17 y 25 años, y se determinó el error intraexaminador considerando la prueba F-ANOVA como estadístico de prueba. Se hizo Análisis Generalizado de Procrustes (AGP) y detección de datos atípicos por Cuantil Adaptativo. La variación en tamaño se analizó con prueba Kruskal-Wallis, considerando la matriz de Tamaño Centroide (CS) y las diferencias conformacionales con MANOVA. La identificación de patrones craneofaciales se determinó mediante Análisis de Componentes Principales (ACP) y Conglomerados/K-medias. Resultados: en la estructura CFG se encontraron diferencias conformacionales y una capacidad de buena clasificación del 89% (Clase I), 89% (Clase II) y 91% (Clase III). Se identificaron cuatro patrones craneofaciales; tres evidenciaron relaciones esqueléticas clásicas, y el otro identificó un nuevo grupo combinado de Clase I/II. Conclusiones: las diferencias morfológicas en los cuatro patrones identificados fueron evidentes, la MG permitió una visualización explicativa de patrones de variación morfológica, localizando sitios reales en donde ocurren cambios en tamaño y conformación.

Introduction: the studies on morphological variations of craniofacial components to classify skeletal relationships have traditionally included univariate and multivariate analysis using variables such as distances, angles, and reference planes. However, these methods fail to explain general changes in shape and provide partial localized descriptions of these relationships. Whereas methods using two- or threedimensional (2D or 3D) Geometric Morphometrics (GM) allow a detailed understanding and a more sensitive test of variables. The objective of this study was to identify morphological pattern variations of the Overall Craniofacial Structure (OCS) in skeletal relationships I, II, and III using GM-2D. Methods: this was a prospective study using non-probability sampling. It implied taking 272 lateral radiographs of the head of Colombian individuals (140 males/132 females) aged 17 to 25 years, determining intra-examiner error and using F-ANOVA as statistic test. Generalized Procrustes Analysis (GPA) was conducted as well as atypical data detection by Adaptive Quantile. Size variation was analyzed by the Kruskal-Wallis test considering Centroid Size matrix (CS) and conformational differences were analyzed with MANOVA. Craniofacial patterns were identified by Principal Components Analysis (PCA) and K-means/cluster. Results: the OCS showed conformational differences and a good classification capacity of 89% (Class I), 89% (Class II), and 91% (Class III). Four craniofacial patterns were identified; three of them showed typical skeletal relationships and the other pointed out to a new Class I/II combined group. Conclusions: the morphological differences in the four identified patterns were evident; GM allowed an explanatory display of morphological variation patterns, identifying actual sites where changes in size and shape take place.

Anthropometric landmarks for posterior cruciate ligament reconstruction in anatomical position / Referencias antropométricas para la reconstrucción del ligamento cruzado posterior en posición anatómica

To determine viable anatomical landmarks allowing for accurate femoral and tibial tunnel placement in anatomical position during posterior cruciate ligament (PCL) reconstruction. Ten knees were dissected to analyze femoral and tibial PCL insertion measurements and the features specific to the PCL and its fascicles. The clock hands system was used to measure femoral insertions. The meniscus and anterior cruciate ligament (ACL) were used as landmarks to measure tibial insertions. The PCL and its corresponding fascicle characteristics were determined by its femoral insertion, central portion and tibial insertion. The mean lengths between the central point of the PCL footprint and the articular cartilage border at 12:00 h were 17.23 mm (±3.94) and 17.73 mm (±4.11) for the right and left knees, respectively. The anterior-posterior mean lengths for the PCL were 11.94 mm (±5.08) between the posterior PCL border and the anterior PCL border. The mean lengths were 33.52 mm (±3.49) from the medial border of the lateral meniscus to the lateral PCL border and 32.24 mm (±2.28) from the medial border of the medial meniscus to the medial PCL border. From the anteroposterior viewpoint, the anterolateral fascicle is greater than the posteromedial one in its femoral and tibial insertions and in its central portion. A quantitative data collection summary was conducted with different PCL variables, along with its fascicles and their various femoral and tibial bony landmarks. Various measurements were obtained, indicating the high functionality shared by the PCL fascicles. Lengths reported for insertions are practical landmarks for the locations of femoral and tibial tunnels during posterior cruciate ligament plasty. We must take into account native PCL form to avoid oversizing the graft during reconstruction and to avoid a possible clamping of the graft with the surrounding structures.

El propósito del estudio fue determinar referencias anatómicas viables para la correcta colocación de los túneles femorales y tibiales en posición anatómica durante la reconstrucción del ligamento cruzado posterior (LCP). Se utilizaron 10 rodillas, las cuales fueron disecadas para analizar las mediciones de la inserción femoral y tibial del LCP, sus fascículos y estructuras adyacentes. Se utilizó el sistema de las manecillas del reloj para la medición de las inserciones femorales. Los meniscos y el ligamento cruzado anterior (LCA) fueron utilizados como referencias para la medición de las inserciones tibiales. El LCP y las características de sus fascículos correspondientes fueron determinados por su inserción femoral, porción central e inserción tibial. La media de la longitud entre la porción central de la huella dejada por el LCP y el margen anterior del cartílago femoral a las 12:00 h fue de (±3.94) y 17,73 mm (±4,11) para la rodilla derecha e izquierda, respectivamente. La longitudes del LCP fueron de 11,94 mm (±5,08) entre el margen posterior del LCP y el margen anterior del LCP. La media fue de 33,52 mm (±3,49) desde el margen medial del menisco lateral al margen lateral del LCP y de 32,24 mm (±2,28) del margen medial del menisco medial al margen medial del LCP. Desde el punto de visión anteroposterior, el fascículo anterolateral es mayor que el posteromedial tanto en su inserción femoral como en el punto central e inserción tibial. Se analizó una colección cuantitativa de bases de datos con distintas variables del LCP, así como de sus fascículos y sus inserciones femorales y tibiales. Se obtuvieron varias medidas, indicando la alta funcionalidad compartida por los fascículos del LCP. Las inserciones reportadas son referencias prácticas para la localización de los túneles tibiales y femorales durante la plastía del ligamento cruzado posterior.

A Comparison of Hand Traced Conventional Lateral Cephalogram with Digital Lateral Cephalogram Using Different Calibration Techniques of Dolphin Imaging (Version 11.5).

Objective:The purpose of the study was to evaluate and compare hand tracings on conventional lateral cephalograms with different calibration techniques available in dolphin imaging on digital lateral cephalogram. Materials and Methods:50 Conventional lateral cephalogram and 50 digital lateral cephalogram were taken in (NHP) at same period of timeon the same patient. Two angular measurements Facial Axis Angle and ANB angle two linear measurements Sella to Nasion and Sella to articulare have been taken. The digital images were traced by calibration 3 techniques Ruler, DPI and Land mark available in Dolphin Imaging Software Version 11.5.The conventional were traced on lead acetate paper and data has been collected.Results: In measurement of Facial Axis Angle conventional when compared with different calibration techniques Ruler Land Mark technique show <0.001significantvalue. In measurement of ANB angle shows no significant values. In measurement of S-N length Ruler compared with DPI has shown significant p value <0.001. DPI compared with conventional shows 0.001. S-AR length has shown significant value p value 0.006, DPI compared with Landmark shows 0.007,Landmark compared with conventional shows 0.003. Conclusion: According to our study conventional when compared with calibration techniques ruler has show only one significant value DPI and land mark has shown two significant values so our study conclude that using ruler is the better option for calibration of digital radiograph. As ruler is more accurate to conventional we compare DPI and Landmark techniques to ruler, landmark shows less variation with ruler so according to our study the second option for calibration of digital radiograph is landmark and last option comes DPI.

A study on the validity of reference points for edentulous patient / 대한치과보철학회지

PURPOSE: The purpose of this study was to evaluate the validity of reference points for edentulous patient by examining the correlation of teeth and face, and intraoral anatomic landmarks. MATERIALS AND METHODS: We examined a facial outline, length, bizygomatic width, nasion - gnathion length, glabella - nasion distance in 270 men and 280 women satisfied with inclusion criteria from Seoul National School of Dentistry. The shape of maxillary central incisor, mesiodistal crown width and length of maxillary 6 incisors, distance from incisive papilla to labial surface of maxillary central incisor, and perpendicular distance from incisive papilla to intercanine line were measured in the stone model. We analyzed the ratio and relevant relation statistically. RESULTS: The probability on having the same shape of face and the relative same shape maxillary incisor was 55.56% and 46.43% for men and women. The facial length proved to be a more valuable measurement in women in the tooth selection. The ratio of bizygomatic width to mesiodistal width of maxillary central incisor, and the ratio of bizygomatic width to width of maxillary 6 incisors were 16.8 : 1 and 3.0 : 1 and were positively correlated with each other. The distance of the canines from the maxillary incisal papilla was 1.33+/-1.28 mm. The distance between the center of the incisal papilla and the labial surface of their maxillary central incisor was 9.23+/-1.20 mm. CONCLUSION: It was showed that anatomical reference points in tooth selection and arrangement for edentulous patient are useful and have validity in our limited study.

Accuracy of Classical Anatomical Landmark Technique ( Anterior, Central, and Posterior Approach) for Internal Jugular Vein by Ultra-sound Technique / 医学研究杂志

Objective To explore the accuracy rate of classical anatomical landmark technique ( anterior , central , and posterior ap-proach) for internal jugular vein (IJV) by ultrasound technique.Methods Sixty-four patients with selective operation were included in this study.The anesthetist marked the anterior approach , central approach, and posterior approach for internal jugular vein at 0°(neu-ral), 30°,and 80°of head rotation, respectively.The accuracy of each anatomical landmark were examined by other anesthetist with ul -trasound technique .Results The accuracy rate of anterior approach and central approach were significantly higher than posterior ap -proach at 0°of head rotation, respectively.The accuracy rate of anterior approach was higher than posterior approach at 30°of head rota-tion.The accuracy rate was similar among anterior , central, and posterior approach at 80°of head rotation.Conclusion The accuracy rate was different in different approach of anatomical landmark for internal jugular vein .

Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques / Bloqueio dos nervos ílio-hipogástrico/ilioinguinal em correção de hérnia inguinal para tratamento da dor no pós-operatório: comparação entre a técnica de marcos anatômicos e a guiada por ultrassom / Bloqueo de los nervios ileohipogástrico/ilioinguinal en corrección de hernia inguinal para el tratamiento del dolor en el postoperatorio: comparación entre la técnica de marcas anatómicas y la guiada por ultrasonido

Objectives: The purpose of this study is to compare the efficacy of iliohypogastric/ilioinguinal nerve blocks performed with the ultrasound guided and the anatomical landmark techniques for postoperative pain management in cases of adult inguinal herniorrhaphy. Methods: 40 patients, ASA I-II status were randomized into two groups equally: in Group AN (anatomical landmark technique) and in Group ultrasound (ultrasound guided technique), iliohypogastric/ilioinguinal nerve block was performed with 20 ml of 0.5% levobupivacaine prior to surgery with the specified techniques. Pain score in postoperative assessment, first mobilization time, duration of hospital stay, score of postoperative analgesia satisfaction, opioid induced side effects and complications related to block were assessed for 24 h postoperatively. Results: VAS scores at rest in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.01 or p < 0.001). VAS scores at movement in the recovery room and all the clinical follow-up points were found significantly less in Group ultrasound (p < 0.001 in all time points). While duration of hospital stay and the first mobilization time were being found significantly shorter, analgesia satisfaction scores were found significantly higher in ultrasound Group (p < 0.05, p < 0.001, p < 0.001 respectively). Conclusion: According to our study, US guided iliohypogastric/ilioinguinal nerve block in adult inguinal herniorrhaphies provides a more effective analgesia and higher satisfaction of analgesia than iliohypogastric/ilioinguinal nerve block with the anatomical landmark technique. Moreover, it may be suggested that the observation of anatomical structures with the US may increase the success of the block, and minimize the block-related complications. .

Objetivo: Comparar a eficácia de bloqueios dos nervos ílio-hipogástrico/ilioinguinal feitos com a técnica guiada por ultrassom e a de marcos anatômicos para o manejo da dor no pós-operatório em casos de herniorrafia inguinal em adultos. Métodos: Foram randomicamente divididos 40 pacientes, estado físico ASA I-II, em dois grupos iguais: nos grupos AN (técnica de marcos anatômicos) e US (técnica guiada por ultrassom), o bloqueio dos nervos ílio-hipogástrico/ilioinguinal foi feito com 20 mL de levobupivacaína a 0,5% antes da cirurgia com as técnicas especificadas. Escore de dor na avaliação pós-operatória, tempo de primeira mobilização, tempo de internação hospitalar, escore de satisfação com a analgesia no pós-operatório, efeitos colaterais induzidos por opiáceos e complicações relacionadas ao bloqueio foram avaliados durante 24 horas de pós-operatório. Resultados: Escores EVAem repouso na sala de recuperação e todos os valores clínicos durante o acompanhamento foram significativamente menores no grupo ultrassom (p < 0,01 ou p < 0,001). Escores EVA em movimento na sala de recuperação e todos os valores clínicos durante o acompanhamento foram significativamente menores no grupo ultrassom (p < 0,001 em todos os tempos avaliados). Enquanto os tempos de internação e da primeira mobilização foram significativa-mente menores, os índices de satisfação com a analgesia foram significativamente maiores no grupo ultrasom (p<0,05, p< 0,001, p< 0,001, respectivamente). Conclusão: De acordo com o nosso estudo, o bloqueio dos nervos ílio-hipogástrico/ilioinguinal guiado por US em herniorrafias inguinais em adultos proporciona uma analgesia mais eficaz e maior satisfação com a analgesia ...

Objetivo: El objetivo de este estudio fue comparar la eficacia de bloqueos de los nervios ileohipogástrico/ilioinguinal realizados con la técnica guiada por ultrasonido y la de marca anatómicas para el manejo del dolor en el postoperatorio en casos de herniorrafia inguinal en adultos. Métodos: 40 pacientes, estado físico ASA I-II, fueron aleatoriamente divididos en 2 grupos iguales: grupos con técnica de marcas anatómicas) y grupo con técnica guiada por ultrasonido. El bloqueo de los nervios iliohipogástrico/ilioinguinal fue realizado con 20 mL de levobupivacaína al 0,5% antes de la cirugía con las técnicas especificadas. La puntuación de dolor en la evaluación postoperatoria, tiempo de primera movilización, tiempo de ingreso hospitalario, puntuación de satisfacción con la analgesia en el postoperatorio, efectos colaterales inducidos por opiáceos y complicaciones relacionadas con el bloqueo fueron evaluados durante 24 h de postoperatorio. Resultados: Las puntuaciones EVA en reposo en la sala de recuperación y todos los valores clínicos durante el seguimiento fueron significativamente menores en el grupo con técnica guiada por ultrasonido (p < 0,01 o p < 0,001). Las puntuaciones EVA en movimiento en la sala de recuperación y todos los valores clínicos durante el seguimiento fueron significativamente menores en el grupo con técnica guiada por ultrasonido (p < 0,001 en todos los tiempos calculados). Mientras que los tiempos de ingreso y de la primera movilización fueron significativamente menores, los índices de satisfacción con la analgesia fueron significativamente mayores en el grupo ultrasonido (p < 0,05; p < 0,001; p < 0,001 respectivamente). Conclusión: De acuerdo con nuestro estudio, el bloqueo de los nervios iliohipogástrico/ilioinguinal guiado por ultrasonido en herniorrafias ...