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Anatomical-radiological and morphometric analysis of the lateral atlantoaxial joint.

The width of the articular space of the lateral atlantoaxial joint was measured to evaluate normal range values and possible variations according to age and sex. The study was based on X-rays of the lateral atlantoaxial joint of 52 females (age range: 18-82 ys) and 50 males (age range: 20-82 ys). The radiograms were taken using a semiautomatic computerized morphometric system (Videoplan II, Image Analysis system-Kontron, Munich, Germany). The articular space width of the lateral atlantoaxial joint was measured on both sides, at the medial, lateral and median levels. The mean value at these levels, on both sides, was calculated. Regression analysis was performed to evaluate the relationships between the width of the articular space at the three different levels and the patient's age and gender. No significant differences were found in the mean values of the articular space width at the three levels as regards gender. However, a significant inverse correlation was found between the articular space width and the patients' age in both males and females. Comparative analysis of regression lines showed that the slope of these lines was not significantly different when the sexes were compared. On the contrary, the intercept of the regression lines at the medial and median levels was significantly higher in the females than in the males; the contrary was encountered at the lateral level. This feature is probably due to the different types of inclination of the articular facets of the axis or of those of the atlas in the two sexes.

Adolescent↗

Radiologic automated diagnosis (RAD).

RAD is a program currently being developed to interpret neuroimages. Given the clinical information usually available on the imaging request, RAD will analyze the scan directly from the data generated by the scanning machine to produce a differential diagnostic list explaining any lesions it discovers. RAD uses a computerized three-dimensional stereotaxic atlas of the nervous system as a model of normal structures in the analysis of scans.

Artificial Intelligence↗

[Bony malformations of the cranio-vertebral junction and its clinical relevance (author's transl)].

A statistical analysis is performed in 86 cases suffering from osseous malformation of the cranio-vertebral junction. The material consists of 71 cases with basilar impression, 8 cases with hypoplasia or absence of the odontoid process, and 7 cases with a congenital atlanto-epistropheal dislocation. The patients are clinically asymptomatic in 23 cases, and are marked by a para-respectively tetraparesis in 28 cases, by bulbar-pontine-cerebellar disorders in 24 cases, and by syringomyelia in 11 cases. A control group is included consisting of 30 cases without neurological symptoms and with a normal radiological finding of the cranio-vertebral region. The following measured values are taken in consideration to perform a statistical calculation using the simple variance analysis: The height of the odontoid process above of McGregor's line, the distance between the back of the odontoid process and the inner limit of the arch of C1, and, concerning the groups with hypoplasia of the odontoid process process and with atlanto-axial dislocation, the narrowing of the spinal canal at the level of C1 dependent on movements of the head. The measured values are referred to the different clinical syndromes and are described and divided according to its statistical significance related to the clinical groups.

Adolescent↗

[Administration of maximal or median doses of drugs in cardiovascular diseases?].

In recent years some specialists recommend to treat patients with cardiovascular diseases with maximal doses of drugs and refer to the results of extensive clinical studies. On critical evaluation of some it seems that the results are not interpreted accurately and that the highest doses of drugs (or combined treatment) do not produce better results than the use of smaller doses. This applies e.g. to the study HOT with felodipine in hypertensive patients and patients with cardiac insufficiency in the ATLAS study with lisinopril and the MERIT-HF study with metoprolol. It applies also the HOPE study with ramipril in secondary prevention in subjects with cardiovascular diseases. Efforts to achieve as low as possible lipid values has also some pitfalls. The author recommends to treat comprehensively all patients and to select maximal doses only in selected subjects.

Cardiovascular Agents↗

Craniofacial imaging informatics and technology development.

PURPOSE: 'Craniofacial imaging informatics' refers to image and related scientific data from the dentomaxillofacial complex, and application of 'informatics techniques' (derived from disciplines such as applied mathematics, computer science and statistics) to understand and organize the information associated with the data. METHOD: Major trends in information technology determine the progress made in craniofacial imaging and informatics. These trends include industry consolidation, disruptive technologies, Moore's law, electronic atlases and on-line databases. Each of these trends is explained and documented, relative to their influence on craniofacial imaging. RESULTS: Craniofacial imaging is influenced by major trends that affect all medical imaging and related informatics applications. The introduction of cone beam craniofacial computed tomography scanners is an example of a disruptive technology entering the field. An important opportunity lies in the integration of biologic knowledge repositories with craniofacial images. CONCLUSION: The progress of craniofacial imaging will continue subject to limitations imposed by the underlying technologies, especially imaging informatics. Disruptive technologies will play a major role in the evolution of this field.

Databases as Topic↗

[Traumatic atlanto-axial rotatory fixation with lateral mass fracture of the axis].

Traumatic atlanto-axial rotatory fixation (AARF) is a relatively uncommon injury, especially in association with fractures of the axis. The rotatory dislocation and fixation is normally caused by intercalated facet joints of axis and atlas. A traumatic AARF in a 21 year old female is presented with special emphasis on the diagnostic and therapeutic approaches. This high velocity injury was caused by a traffic accident. The trauma service which was initially involved made the correct diagnosis and tried to reduce the dislocation by skull traction during analgesia and sedation, but without success. For further treatment, the patient was referred to a level one trauma center. After completing the diagnostic imaging with MRI and CT for exact delineation of the fracture site and determination of ligament damage, a halo fixation for skull traction was installed. This second attempt was also unsuccessful. Only a closed reduction under general anesthesia with muscle relaxation led to a neutral alignment and congruent joint contact between C1 and C2. Due to the stable fracture site and the intact ligaments, a conservative treatment with a stable collar splint was performed.

Accidents, Traffic↗

Does the presence of a funnel increase the risk of adverse perinatal outcome in a patient with a short cervix?

OBJECTIVE: This study was undertaken to determine whether the presence of a dilated internal os (funneling or beaking) alters the outcome of patients with a short cervix documented by transvaginal ultrasound in the second trimester. STUDY DESIGN: Between January 1998 and May 2004, all singleton pregnancies with a short cervix (< or =2.5 cm) and no funnel between 16 and 24 weeks' gestational age were identified by query and review of the Lehigh Valley Perinatal Ultrasound Database. These no funnel patients were compared with patients with a short cervix and funnel matched in accordance with cervical length and risk factors. Multiple variables of perinatal outcome were identified and compared between the Funnel and No Funnel groups. Correlations between cervical measurements and gestational age at birth were analyzed. RESULTS: Of the 279 patients with a short cervix identified, 82 were singleton with a T-shaped cervix and no funnel and 82 patients matched with a typical Y-shaped funnel. There was no difference between groups with respect to maternal demographics, previous preterm birth (28.1% No Funnel group vs 36.5% Funnel group, P = .3), prior cervical surgery (24.3% vs 22.0 %, P = .8), gestational age at entry (20.5 +/- 2.1 vs 21.1 +/- 2.4 weeks, P = .1), and cervical length (1.9 +/- 0.4 vs 1.8 +/- 0.5 cm , P = .1). The No Funnel group had significantly less readmissions for preterm labor (43.2% vs 67.1 %, P = .004), chorioamnionitis (2.4% vs 23.2 %, P = .0002), abruption (1.2% vs 13.4 %, P = .007), preterm rupture of membranes (6.1% vs 23.4%, P = .002), and cerclage placement (23.2% vs 43 %, P = .008). The neonates in the no funnel group delivered later (36.2% +/- 4.6 vs 33.8 +/- 5.4 weeks , P = .003), and had less morbidity and mortality (17.1% vs 37.8 %, P = .02) compared with the Funnel group. The width and depth of the funnel did not correlate with perinatal outcome. Cervical length ( R(2) = 0.07, P = .02) and cervical funneling as a categorical variable ( r = 0.3, P = .0002) did correlate with earlier delivery. CONCLUSION: The disruption of the internal os, as documented by funneling, is a significant risk factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of the membranes, and serious neonatal morbidity and mortality). Cervical funneling is best measured as a categorical variable (present or absent).

Adult↗

The RESID Database of protein structure modifications.

Because the number of post-translational modifications requiring standardized annotation in the PIR-International Protein Sequence Database was large and steadily increasing, a database of protein structure modifications was constructed in 1993 to assist in producing appropriate feature annotations for covalent binding sites, modified sites and cross-links. In 1995 RESID was publicly released as a PIR-International text database distributed on CD-ROM and accessible through the ATLAS program. In 1998 it was made available on the PIR Web site at http://www-nbrf.georgetown.edu/pir/searchdb++ +.html . The RESID Database includes such information as: systematic and frequently observed alternate names; Chemical s Service registry numbers; atomic formulas and weights; enzyme activities; indicators forN-terminal, C-terminal or peptide chain cross-link modifications; keywords; and literature citations with database cross-references. The RESID Database can be used to predict atomic masses for peptides, and is being enhanced to provide molecular structures for graphical presentation on the PIR Web site using widely available molecular viewing programs.

Binding Sites↗

Odontoid Lateral Mass Interval (OLMI) asymmetry and rotary subluxation: a retrospective study in cervical spine injury.

The aim of the study was to evaluate the significance of odontoid lateral mass interval (OLMI) asymmetry on open-mouth view, in neck injury patients who have otherwise normal cervical spine x-rays. Thirteen neck injury patients were reviewed. Average age was 23.5 years (range, 16-30 years) and average follow-up was 15 weeks (range, 6-39 weeks). All the patients, referred from the casualty department, had computed tomography (CT) scans because of the OLMI asymmetry to rule out rotary subluxation. Clinically none of the patients had torticollis. CT scans were reported normal except for OLMI asymmetry, in 11 patients. Two patients were reported as having rotary subluxation and one was found, after normal initial plain films, to have an undisplaced lateral mass fracture of the atlas with bony avulsion of the transverse ligament. The average OLMI asymmetry was 3.1 mm (range, 2-4 mm). The authors concluded that although OLMI asymmetry has low sensitivity and specificity for true subluxation or instability, it may be a sign of significant cervical injury and should be evaluated with CT.

Accidents, Traffic↗

Accuracy and reliability of remote retinopathy of prematurity diagnosis.

OBJECTIVE: To determine the accuracy and reliability of retinopathy of prematurity (ROP) diagnosis using remote review of digital images by 3 masked ophthalmologist readers. METHODS: An atlas was compiled of 410 retinal photographs from 163 eyes of 64 low-birth-weight infants taken using a wide-angle digital fundus camera. All the images were independently reviewed by 3 readers, and the diagnosis in each eye was classified into 1 of 4 ordinal categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Findings were compared with a reference standard of dilated indirect ophthalmoscopy with scleral depression performed by an experienced pediatric ophthalmologist. RESULTS: Sensitivities/specificities of the diagnosis of any ROP were 0.845/0.910 for the first reader, 0.816/0.955 for the second reader, and 0.864/0.493 for the third reader. Sensitivities/specificities of the diagnosis of ROP requiring treatment were 0.850/0.960 for the first reader, 0.850/0.973 for the second reader, and 0.900/0.953 for the third reader. When ROP was classified into ordinal categories, the overall weighted kappa for interreader reliability was 0.743. Intrareader reliability for detection of low-risk prethreshold ROP or worse was 100% for all readers. CONCLUSION: The accuracy, interreader reliability, and intrareader reliability of remote diagnosis of clinically relevant ROP based on digital imaging are substantial.

Birth Weight↗

Correlation of PET and qEEG in normal subjects.

Positron emission tomography (PET) and quantitative electroencephalography (qEEG) were obtained in 15 normal male subjects with eyes closed at rest. Correlations between qEEG variables and regional metabolism were examined as an approach to investigating the metabolic and neuroanatomical basis of the generation of the EEG. Analogous to the neurometric approach to qEEG, a normative 2-fluoro-deoxyglucose voxel data base was developed for the PET image. The PET image was transformed to an idealized cylindrical set of coordinates to allow registration with the Talairach stereotactic atlas. PET regions of interest for the thalamus, the left and right temporal lobes, the medial frontal cortex and the dorsolateral prefrontal cortex were defined using Talairach coordinates and correlated to the QEEG. Salient findings included a negative correlation of thalamic metabolism to alpha power and a positive correlation of medial frontal cortical metabolism to delta EEG power. The significance of these findings is discussed with reference to the existing literature on the physiology of the generation of the EEG.

Adult↗

[Instability of the atlantodental joint as a trauma sequela].

In the region of the upper cervical spine a wide variety of morphological and functional positions is possible. This makes diagnosis and expert evaluation of whiplash injuries to the cervical spine very difficult. The problem is discussed with reference to a case report of a so-called whiplash injury. The upper cervical spine must be investigated in flexion and extension by means of MRT and/or CT as soon as possible.

Adult↗

[Introduction to the study of embryonic stages in man].

The internationally accepted Carnegie system of 23 developmental stages for the embryonic period proper (the first 8 post-ovulatory weeks) is outlined. At the end of this period the human embryo measures about 30 mm in C.-R. length. Some common misusages are noted, e.g., arabic numerals should be used for the states and the term "horizon" is obsolete; embryonic length is not a stage; STREETER's ages were based on the macaque and do not apply to the human. The introduction includes a discussion of the Carnegie Embryological Collection, the embryonic period, developmental stages, and finally a guide to embryonic staging in the human. An atlas of photographs of external views of embryos at the various Carnegie states is provided. Stages 1 to 8 (the presomite period, up to about 18 days) are described briefly and illustrated with photographs and photomicrographs. Stages 9 to 12 (the somitic period, about 20 to 26 days) and stages 13 to 23 (the postsomitic period, 4 to 8 post-ovulatory weeks) are summarized with reference to both external and internal development, and illustrated with photographs of the external appearances. In addition to (A) certain references cited in the introduction and in the text, the bibliography includes : (B) an annotated list of general works on staged human embryos, (C) an annotated list of selected examples of stages 1 to 15, and (D) an annotated list of references to information concerning staged embryos arranged according to the various systems of the body.

Bibliographies as Topic↗

Anatomical and electrophysiological validation of an atlas for neurosurgical planning.

Digital brain atlases can be used in conjunction with magnetic resonance imaging (MRI) and computed tomography (CT) for planning and guidance during neurosurgery. Digital atlases are advantageous, since they can be warped nonlinearly to fit each patient's unique anatomy. Two atlas-to-patient warping techniques are compared in this paper. The first technique uses an MRI template as an intermediary to estimate a nonlinear atlas-to-patient transformation. The second, is novel, and uses a pseudo-MRI volume, derived from the voxel-label-atlas, to estimate the atlas-to-patient transformation directly. Manual segmentations and functional data are used to validate the two methods.

Brain↗

Is the Greulich and Pyle atlas still valid for Dutch Caucasian children today?

BACKGROUND: In our Paediatric Radiology Department, the Greulich and Pyle technique is used to assess skeletal age. Several authors have raised questions with regard to the applicability of this technique in a contemporary paediatric and adolescent population. OBJECTIVE: To compare skeletal age and calendar age in a healthy Dutch Caucasian population in order to test the applicability in this specific population. MATERIALS AND METHODS: For this study we enrolled 278 Dutch Caucasian boys (age range 5.0-19.5 years, mean 12.6 years) and 294 Dutch Caucasian girls (age range 5.2-19.9 years, mean 12.2 years). Radiographs of the left hand were scored according to the Greulich and Pyle atlas by two investigators. RESULTS: Intra-observer coefficient of variation of duplicate assessment of skeletal age for investigator 1 (resident) was 2.4 % and for investigator 2 (radiologist) was 1.5 %. We found no significant systematic differences between the two observers regarding variability and levels of measurement, and the agreement was good. There was a strongly significant correlation between skeletal and calendar age rgirls = 0.974 and rboys = 0.979 (P < 0.001). On average, calendar age preceded skeletal age by a small amount (1.7 months in girls and 3.3 months in boys, both P < 0.001). CONCLUSIONS: The reliability of the Greulich and Pyle atlas in our study corresponds well with previously reported studies. Based on our data, we conclude that the Greulich and Pyle atlas is still applicable in Dutch Caucasian children and adolescents.

Adolescent↗

Palpatory diagnosis of plagiocephaly.

INTRODUCTION: The term plagiocephaly, from the Greek plagios (oblique) and kephalê (head), means distortion of the head, and refers clinically to cranial asymmetry. Cranial Osteopathy, since it was first proposed, has focussed upon the diagnosis and treatment of birth trauma and cranial asymmetries, and consequently specific therapy for plagiocephalic deformities has been described. Osteopathic manipulation also has been proposed as a treatment for torticollis, a condition associated with plagiocephaly. For these reasons, we decided to look at the mechanics of the occipital bone and the adjacent atlas and bones of the cranial base, in relation to functional plagiocephaly. METHODS: The records of 649 children seen in an osteopathic practice in Lyon, France, were reviewed retrospectively, in compliance with the legal requirements of the Commission Nationale de l'Informatique et des Libertés (CRIL) and the Helsinki accord, for gender, age at presentation, birth history, obstetrical data (breech presentation, vacuum extraction, forceps delivery or Caesarean section), presenting complaint, side of posterior plagiocephaly, side of frontal plagiocephaly, torticollis, motion pattern of the occipital bone upon the atlas, and motion pattern of the spheno-occipital synchondrosis. RESULTS: We found significant correlations between plagiocephaly (right/left) and primipara (P=0.024), use of forceps (P=0.055) and extractor suction (P=0.055). Correlations were also found between flattening of the occiput (right/left) and lateral strain of the spheno-occipital synchondrosis (P=0.002) and between plagiocephaly (right/left) and occipito-atlantal motion (P=0.000). CONCLUSION: We found a significant correlation between the lateral strain pattern of the spheno-occipital synchondrosis and plagiocephaly and between rotational dysfunction of the occiput upon the atlas and the side of posterior plagiocephaly. We suggest that thorough neonatal osteopathic examination can identify individuals predisposed to develop posterior plagiocephaly.

Atlanto-Occipital Joint↗

An evaluation of a colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys.

OBJECTIVE: To test the validity of a colour food photography atlas for quantifying portion size eaten compared with weighed foods. DESIGN: The colour food photography atlas was prepared by cooking, weighing and taking digital photographs of three portion sizes of 434 foods and beverages typical of the Italian diet. SUBJECTS AND INTERVENTIONS: In all, 448 male and female volunteers aged 6-60 y from a wide variety of social backgrounds completed 9075 assessments of food portions eaten at lunch and dinner in relation to a set of colour food photographs during 8 weeks of investigation. The amounts of foods eaten by individuals in five different cafeterias in Pavia, Northern Italy, were weighed by trained investigators at the time of serving and, within 5-10 min of the end of the meal, each subject was asked to quantify all foods consumed with reference to one of the three food photographs or in terms of virtual portions among those shown in the photographs. RESULTS: Multiple regression analysis shows that weights of portion sizes chosen from the set of photographs are significantly associated (P<0.05) to weights of eaten portions (beta=0.81; R(2)=0.70) and are independent of age, gender and BMI. The differences between mean weights of the portions chosen by individuals from photographs and mean weights of eaten foods are significant for all food categories (P<0.05), except for bread. However, because of the very large number of observations, the mean differences are very small (range: from +23.2 g (+11.2%) for first courses to -1.3 g (-2.7%) for bread). Bland-Altman plots show that first courses limits of agreement are wide because the dispersion is increasing while weights are rising. CONCLUSIONS: The use of a series of three photographs and virtual portion sizes being associated with relatively small errors, our findings support the validity of using this colour food photography atlas as a tool for quantifying food portion size in epidemiological dietary surveys on different age groups of Italian subjects.

Adolescent↗

Elevated circulating IL-8 correlates with poor prognosis in urological cancers: a meta-analysis and bioinformatic validation.

BACKGROUND: Interleukin-8 (IL-8) is a key cytokine that has been implicated in multiple aspects of cancer progression and therapeutic resistance. Elevated levels of circulating IL-8&#xa0;(cIL-8) have been implicated in adverse clinical outcomes among patients with urological cancers. However, definitive evidence consolidating these observations remains lacking. The present study aims to synthesize the existing research findings to provide a comprehensive, evidence-based reference for clinical practice. METHODS: A systematic literature search was conducted to identify relevant studies that reported on the prognostic impact of cIL-8 levels in urological cancer patients. Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were extracted and pooled to estimate the overall effect. Furthermore, Kaplan-Meier's survival analyses were conducted using RNA-seq data from The Cancer Genome Atlas (TCGA) through the Gene Expression Profiling Interactive Analysis 2 (GEPIA 2) online tool to validate the observed associations. RESULTS: A total of 19 cohorts encompassing 2740 patients from 12 studies were included in the meta-analysis. The findings revealed that elevated cIL-8 levels were significantly associated with inferior OS (HR: 1.86; 95% confidence intervals (CI): 1.72-2.02) and PFS (HR: 1.59; 95%CI: 1.25-2.03) in patients with urological cancers. The consistency and validity of these results were further supported by survival analyses performed using the GEPIA 2 tool. CONCLUSIONS: This study, which is the first meta-analysis to systematically examine the prognostic significance of cIL-8 in urological cancers, supported by bioinformatics validation, confirms that elevated cIL-8 levels serve as a potential biomarker for predicting adverse outcomes. Our findings underscore the importance of targeting IL-8 as a therapeutic strategy to overcome treatment resistance and improve outcomes for urological cancer patients. Further research into IL-8-targeted therapies and their integration into clinical practice is urgently needed to enhance the treatment landscape for urological cancers.

Humans↗