3D biometrics for hindfoot alignment using Weight Bearing CT

Category: Hindfoot Introduction/Purpose: Hindfoot alignment is an important reference for foot and ankle surgery, and the Foot Ankle Offset (FAO) using semi-automatic software has been reported as a valuable hindfoot alignment measurement in weightbearing CT(WBCT). The objective was to assess the clinical relevance and reproducibility of the FAO value for hindfoot alignment and compare it with previous findings. Methods: A prospective study was conducted, with ethics committee approval. Patients were included, clinically examined and divided into 3 groups: normal alignment (Group 1), valgus (Group 2), varus (Group 3). A continuous series of 140 feet (71 patients) were referred from September to December 2017 (65 normal, 41 valgus, and 34 varus). All patients had a bilateral weight bearing CT, and the FAO values were recorded. The long axial view angle(HAct)was measured on Digitally Reconstructed Radiographs (DRR) as comparison. All values were measured and compared by two different investigators. The reproducibility of FAO and HAct were calculated using intraclass correlation coefficients(ICCs) and regression analysis was conducted to study the correlation between the two methods. Results: In Group 1, the mean value for FAO/HAct was 1.69%±2.58%/4.13±2.67, in Group 2, the FAO/HAct was 7.46%±3.18%/9.00±3.43; in Group 3 the values were -6.11%±4.55%/-7.49±6.06. The intra- and interobserver reliability were 0.991/0.992 and 0.976/0.976. There was a good linear correlation between HAct and FAO (R2=0.778, and the regression slope was 1.083. Conclusion: The use of weightbearing CT can help characterize hindfoot alignment objectively using WBCT. The present study is the first prospective comparative assessment of this technology and shows that FAO has good repeatability, and it correlates well with clinical examination,, X ray findings and previous literature. The FAO is a clinically relevant and reproducible method for measuring hindfoot alignment.

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3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

Foot & Ankle International ◽

10.1177/1071100719835492 ◽

2019 ◽

Vol 40 (6) ◽

pp. 720-726 ◽

Cited By ~ 24

Author(s):

Jian Zhong Zhang ◽

François Lintz ◽

Alessio Bernasconi ◽

Shu Zhang ◽

Keyword(s):

Computed Tomography ◽

Comparative Study ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Mean Values ◽

Intraclass Correlation Coefficients ◽

Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

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Adult validation of a self-administered tablet audiometer

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-019-0385-0 ◽

2019 ◽

Vol 48 (1) ◽

Cited By ~ 1

Author(s):

Mark Bastianelli ◽

Amy E. Mark ◽

Arran McAfee ◽

David Schramm ◽

Renée Lefrançois ◽

...

Keyword(s):

Word Recognition ◽

Pure Tone ◽

Intraclass Correlation ◽

Female Group ◽

Internal Reliability ◽

Link Type ◽

Group 3 ◽

Recognition Testing ◽

Group 2 ◽

Group 1

Abstract Background There is evidence to suggest that rates of hearing loss are increasing more rapidly than the capacity of traditional audiometry resources for screening. A novel innovation in tablet, self-administered portable audiometry has been proposed as a solution to this discordance. The primary objective of this study was to validate a tablet audiometer with adult patients in a clinical setting. Secondarily, word recognition with a tablet audiometer was compared against conventional audiometry. Methods Three distinct prospective adult cohorts underwent testing. In group 1 and group 2 testing with the automated tablet audiometer was compared to standard sound booth audiometry. In Group 1, participants’ pure tone thresholds were measured with an automated tablet audiometer in a quiet clinic exam room. In Group 2, participants completed monosyllabic word recognition testing using the NU-6 word lists. In Group 3, internal reliability was tested by having participants perform two automated tablet audiometric evaluation in sequence. Results Group 1 included 40 patients mean age was 54.7 ± 18.4 years old and 60% female; Group 2 included 44 participants mean age was 55.2 ± 14.8 years old and 68.2% female; Group 3 included 40 participants with mean age of 39.4 + 15.9 years old and 60.5% female. In Group 1, compared to standard audiometry, 95.7% (95% CI: 92.6–98.9%) of thresholds were within 10 dB. In Group 2, comparing word recognition results, 96.2% (95% CI: 89.5–98.7%) were clinically equivalent and within a critical difference range. In Group 3, One-way Intraclass Correlation for agreement for the both left- and right-ear pure tone average was 0.98. The mean difference between repeat assessments was 0 (SD = 2.1) in the left ear, and 0.1 (SD = 1.1) in the right ear. Conclusion Puretone audiometry and word recognition testing appears valid when performed by non-healthcare experts using a tablet audiometer outside a sound booth in a quiet environment. Trial registration ClinicalTrials.gov Identifier: NCT02761798. Registered April, 2016 < https://clinicaltrials.gov/ct2/show/NCT02761798>

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Influence of postoperative alignment on clinical outcome following medial open-wedge osteotomy for medial gonarthrosis in patients with underlying varus deformity

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00149 ◽

2017 ◽

Vol 5 (4_suppl4) ◽

pp. 2325967117S0014

Author(s):

Lisa Hohloch ◽

Julian Mehl ◽

Philipp Niemeyer ◽

Norbert Südkamp ◽

Gerrit Bode

Keyword(s):

Tibial Plateau ◽

Weight Bearing ◽

Cartilage Damage ◽

Varus Deformity ◽

Intersection Point ◽

Medial Compartment ◽

Group 3 ◽

Group 2 ◽

Axis Correction ◽

Group 1

Aims and Objectives: High tibial osteotomy (HTO) has gained more and more importance in the treatment of cartilage damage of the medial compartment with concurrent varus deformity. Concerning the extent of axis correction, various different views exist. The aim of this study was to evaluate the effect of the degree of axis correction on the functional outcome in patients suffering from cartilage damage of the medial compartment and undergoing a valgus HTO. Materials and Methods: From January 2005 to December 2013 there were 156 patients suffering from cartilage damage of the medial compartment and an underlying varus deformity who were treated by a biplanar valgus HTO. According to the degree of axis correction - mirrored by the position of the intersection point of the weight bearing line and the tibial plateau - patients were allocated to different groups. For this purpose 3 adjacent areas respectively comprising 5% of the tibial plateau were defined. Limits of those areas were set as follows: with the medial border representing the 0%-point and the lateral border representing the 100%-point, the 3 areas were separated according to their intersection point (group 1 50-55%, group 2 55-60%, group 3 > 60%). For comparison of the functional outcomes, standardized measures and scores were used (pre-OP: VAS, Lysholm; post-OP: VAS, Lysholm, KOOS, IKDC). Analysis of the pre- and post-operatively recorded X-Rays was effected by means of a planning software (mediCAD\, Hectec GmbH, Germany), statistical analysis was carried out with the aid of SPSS Statistics 21.0 (IBM Corp., Armonk, USA.). A p-value of 0.05 was considered statistically significant. Results: 39 patients were allocated to group 1, 49 patients to group 2, 68 to group 3. Concerning mean follow up, age, gender, height, weight and pre-operative VAS there were no statistically significant differences (p>0,05). Thus, patients in each group were of a homogenous constitution. Regarding outcome parameters, group 1 showed significantly higher results. They reached statistical significance when comparing results of the Lysholm score (83,50±15,41 vs. 68,64±23,31 vs. 61,36±30,58), KOOSpain (89,93±9,62 vs. 77,15±15,37 vs. 74,24±21,05), KOOS (81,25±9,20 vs. 72,63±17,38 vs. 66,45± 19,29), KOOS4 (77,89±10,69 vs. 69,56±18,21 vs. 63,28±19,35) and VAS post-OP (1,88±1,73 vs. 2,36±0,92 vs. 3,45±2,84). A positive correlation between height and KOOSpain (Pearson correlation 0,181) KOOSadl (PC 0,239), KOOSsport (PC 0,213) and KOOS5 (0,196)was calculated . A negative correlation existed between age and Lysholm Post (PC -0,207), KOOSpain (PC 0,190), KOOSadl (PC -0,231) and KOOSges (PC -0,161) Conclusion: Valgus HTO of varus deformity in patients with concomitant cartilage damage of the medial compartment is highly efficient regarding functional outcome. Precise preoperative planning regarding individual factors in each patient is mandatory as correction to a neutral weight bearing axis or only mild overcorrection seem to be beneficial in comparison to larger correction angles.

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Measuring standing hindfoot alignment: reliability of different approaches in conventional x-ray and cone-beam CT

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03904-1 ◽

2021 ◽

Author(s):

Leonard Simon Brandenburg ◽

Markus Siegel ◽

Jakob Neubauer ◽

Johanna Merz ◽

Gerrit Bode ◽

...

Keyword(s):

Linear Regression ◽

Cone Beam Ct ◽

Contact Point ◽

Weight Bearing ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Tibial Shaft ◽

Hindfoot Alignment ◽

Intraclass Correlation Coefficients ◽

Heel Contact

Abstract Introduction Currently there is no consensus how hindfoot alignment (HA) should be assessed in CBCT scans. The aim of this study is to investigate how the reliability is affected by the anatomical structures chosen for the measurement. Materials and methods Datasets consisting of a Saltzman View (SV) and a CBCT of the same foot were acquired prospectively and independently assessed by five raters regarding HA. In SVs the HA was estimated as follows: transversal shift between tibial shaft axis and heel contact point (1); angle between tibial shaft axis and a tangent at the medial (2) or lateral (3) calcaneal wall. In CBCT the HA was estimated as follows: transversal shift between the centre of the talus and the heel contact point (4); angle between a perpendicular line and a tangent at the medial (5) or lateral (6) calcaneal wall; angle between the distal tibial surface and a tangent at the medial calcaneal wall (7). Intraclass correlation coefficients (ICC) were calculated to assess inter-rater reliability. A linear regression was performed to compare the different measurement regarding their correlation. Results 32 patients were included in the study. The ICCs for the measurements 1–7 were as follows: (1) 0.924 [95% CI 0.876–0.959] (2) 0.533 [95% CI 0.377–0.692], (3) 0.553 [95% CI 0.399–0.708], (4) 0.930 [95% CI 0.866–0.962], (5) 0.00 [95% CI − 0.111 to 0.096], (6) 0.00 [95% CI − 0.103 to 0.111], (7) 0.152 [95% CI 0.027–0.330]. A linear regression between measurement 1 and 4 showed a correlation of 0.272 (p = 0.036). Conclusions It could be shown that reliability of measuring HA depends on the investigated anatomical structure. Placing a tangent along the calcaneus (2, 3, 5, 6, 7) was shown to be unreliable, whereas determining the weight-bearing heel point (1, 4) appeared to be a reliable approach. The correlation of the measurement workflows is significant (p = 0.036), but too weak (0.272) to be used clinically.

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Topographic Analysis of the Distal Femoral Condyle Articular Cartilage Surface: Adequacy of the Graft from Opposite Condyles of the Same or Different Size for the Osteochondral Allograft Transplantation

Cartilage ◽

10.1177/1947603517752056 ◽

2018 ◽

Vol 10 (2) ◽

pp. 205-213 ◽

Cited By ~ 5

Author(s):

Adam B. Yanke ◽

Atsushi Urita ◽

Jason J. Shin ◽

Greg L. Cvetanovich ◽

Erin K. Moran ◽

...

Keyword(s):

Femoral Condyle ◽

Weight Bearing ◽

Osteochondral Allograft ◽

Topographic Analysis ◽

Cloud Models ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Group 1

Objective To analyze the topography of the opposite condyle to treat focal femoral condyle articular defects with an osteochondral allograft (OCA). Design Three groups were created: Group 1, same condyle with same width; Group 2, opposite condyle with same width; Group 3, opposite condyle with different width. Computed tomography (CT) of 22 cadaveric femoral hemi-condyles was used to create 3-dimensional CT models that were exported into point-cloud models. Three zones of the donor condyle (anterior, middle, and posterior) were quantified. Four defect sizes were created (15, 18, 23, 25 mm) at the weight-bearing region. The defect was moved throughout each donor condyle zone and the least distance was calculated, defined as the shortest distance between the defect and the donor condyle. Results The mean least distance increased with larger defect size in all groups, yet there was a less than 0.2 mm difference in the least distance among defect sizes. The 15, 18, and 23 mm defect models in Group 1 exhibited greater least distances at the anterior than middle and posterior zones. The 15 mm defect model exhibited greater least distance at the anterior zone than posterior zone in Group 3. However, there was a less than 0.05 mm difference in the mean least distance between zones. There was no significant difference in the least distance between groups. Conclusion OCAs from opposite condyles yield similar topographic matching to OCAs from the same condyles, suggesting that opposite condyles can be utilized. Clinical correlation and outcomes are necessary.

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Reliability of Hindfoot Alignment Using Weightbearing CT Semi Automatic Software

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000058 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Francois Lintz ◽

Matthew Welck ◽

Alessio Bernasconi ◽

James Thornton ◽

Nicholas Cullen ◽

...

Keyword(s):

Gaussian Distribution ◽

Normal Population ◽

Interobserver Reliability ◽

Weight Bearing ◽

Mean Value ◽

Measurement Tool ◽

Hindfoot Alignment ◽

Clinically Normal ◽

Automatic Software ◽

Weightbearing Ct

Category: Ankle, Hindfoot, Imaging Introduction/Purpose: Hindfoot Alignment (HA) on 2D radiographs presents anatomical and operator-related bias. In this study, weightbearing CT (WBCT) was used to measure HA using a semi-automatic software which gives HA as a value of Foot Ankle Offset (FAO) after selecting four landmarks (weight bearing points of first and fifth Metatarsals, Calcaneus and center of the ankle joint). We assessed the intra and interobserver reproducibility and the distribution of FAO values in a series of datasets from clinically normal, varus and valgus cases. We hypothesized that reproducibility would be excellent. Furthermore, FAO in normals should have a Gaussian distribution and be significantly different to the varus and valgus groups. Methods: In this level 3, retrospective comparative study, WBCT (PedCAT ®, CurveBeam LLC, Warrington, PA, USA) datasets were obtained from an existing database. The 135 feet were assessed by a senior foot and ankle surgeon as normal, varus or valgus (57, 38 and 40 respectively). Two surgeon investigators (one senior and one trainee) independently analyzed each case using a semi-automatic HA measurement tool (TALAS ™, CurveBeam LLC, Warrington, PA, USA). A third, independent investigator conducted the statistical analysis using Stata® Software. Results: The overall intraoberver and interobserver reliability were 0.99 ± 0.002 and 0.97 ± 0.02 respectively. In normal cases, mean value for FAO was 2.38% ± 2.96, whereas in varus and valgus cases mean was -11.67% ± 6.90 and 11.47% ± 5.79, respectively (p<0.001). The normal population had a Gaussian distribution with a Kolmogorov-Smirnov test > 0.8 Conclusion: This study reports excellent reliability and discriminative power of a semi-automatic 3D measurement tool for Hindfoot Alignment in WBCT.

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Intraobserver and Interobserver Reliability of Cone Beam Weightbearing Semiautomatic Three- Dimensional Measurements in Symptomatic Pes Cavovarus

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00106 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0010

Author(s):

Alessio Bernasconi ◽

Lucy Cooper ◽

Shirley Lyle ◽

Shelain Patel ◽

Nicholas Cullen ◽

...

Keyword(s):

Computed Tomography ◽

Subgroup Analysis ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Three Dimensional ◽

Correlation Coefficients ◽

Varus Deformity ◽

Cone Beam ◽

Foot And Ankle ◽

Hindfoot Alignment

Category: Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Pes cavovarus is a three-dimensional complex foot deformity variably involving a varus hindfoot, high longitudinal arch and forefoot adduction. Two-dimensional radiographs may be flawed by rotational bias and operator-related bias, while standard computed tomography (CT) cannot be perfomed in loading conditions. Three-dimensional (3D) cone beam weightbearing computed tomography (WBCT) may overcome these drawbacks, obtaining physiological weightbearing images with low-dose radiation. New 3D semiautomatic tools have been proposed to measure hindfoot alignment, but reliability in pes cavovarus has never been tested. The aim of this study was to assess intra and interobserver reliability of 3D biometrics on WBCT imaging in pes cavovarus. Our hypothesis was that foot and ankle offset, calcaneal offset and hindfoot angle were reliable measures regardless of type and severity of deformity. Methods: Cone beam WBCT anonymised datasets from 34 pes cavovarus (PC) (17 neurological, 17 non-neurological) and 17 normal feet were retrospectively reviewed. All WBCTs were performed during routine investigation. Inclusion criteria consisted of no previous ipsilateral foot/ankle surgery and ability to heel weightbear. Three foot and ankle surgeons (blinded to patient diagnosis) independently measured the following variables on 51 feet: foot and ankle offset (FAO), calcaneal offset (CO) and hindfoot angle (HA) using dedicated software. Each observer repeated all measurements two-weeks apart. The Shapiro–Wilk test was used to assess normality of data distribution. The Pearson or Spearman correlation test and Intraclass Correlation Coefficients (ICCs) and were used to assess intra and interobserver reliability, respectively. Subgroup analysis was performed to assess whether clinical diagnosis (neurological PC, non-neurological PC, normal controls) or severity of varus deformity (4 groups based on FAOs 25th, 50th and 75th centiles) could affect reliability of FAO measurements. Results: Intra and interobserver reliability for FAO (r= 0.98; ICC: 0.98), CO (r=0.94; ICC 0.89) and HA measurements (r=0.93; ICC:0.89) were excellent. Subgroup analysis showed that FAOs intra and interobserver reliability remained excellent in neurological PC (r= 0.96; ICC: 0.97), non-neurological PC (r=0.95; ICC: 0.96) and normal feet (r=-0.97; ICC: 0.94). Also, intraobserver (r=0.95, r=0.76, r=0.82 and r=0.92 for FAO >0%, from -7% to 0%, from -13% to -7%, and <-13%, respectively) and interobserver reliability for FAO measurements (ICC: 0.78, ICC: 0.76, ICC: 0.85 and ICC: 0.92) scored excellent regardless of the deformity. Conclusion: This study confirms that three-dimensional semiautomatic tools used on weightbearing CT datasets have excellent intra and interobserver reliability in the assessment of hindfoot alignment in pes cavovarus. The nature and severity of the deformity does not affect the reliability of the measurements. This infers that these 3D biometric tools on WBCT images can be reliably used in severe neurological cavovarus feet to evaluate and monitor cavovarus deformity and assess response to intervention.

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Normal Variation and Instability Values of the Tibiofibular Joint on Weightbearing CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00196 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0019

Author(s):

Noortje Hagemeijer ◽

Song Ho Chang ◽

Mohamed Abdelaziz Elghazy ◽

Gregory Waryasz ◽

Daniel Guss ◽

...

Keyword(s):

Internal Control ◽

Interobserver Reliability ◽

Weight Bearing ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Ankle Injury ◽

P Value ◽

Uninjured Side ◽

Tibiofibular Joint ◽

Value Range

Category: Ankle Introduction/Purpose: Prompt management of syndesmotic instability is critical for optimizing clinical outcome, but subtle injuries may be difficult to diagnose. Application of modern imaging modalities such as weight bearing CT (WBCT) may better identify such injuries by virtue of assessing the distal tibiofibular articulation under physiologic load. The aim of this study was to evaluate the distal tibiofibular articulation using WBCT among patients with known syndesmotic instability and compare these findings with their uninjured contralateral sides, and thereafter corroborate such measurement differences with patients devoid of any syndesmotic injury. Methods: Patients with unilateral syndesmotic instability requiring surgical fixation (n=12) underwent bilateral ankle WBCT that incorporated the entire foot. A separate cohort of patients without ankle injury also underwent bilateral ankle WBCT for assessment of either a Lisfranc injury or forefoot condition (n=24). All WBCT imaging was performed preoperatively. A set of five axial plane tibiofibular joint measurements including one angular measurement were standardly assessed one cm above the tibial plafond. Values were recorded by two independent observers to assess for interobserver reliability scores. Interpretation of the intraclass correlation coefficients was carried out according to the guidelines proposed by Shrout: 0.00-0.10 virtually none, 0.11-0.40 slight, 0.41-0.60 fair, 0.61-0.80 moderate, 0.81 -1.00 substantial. Results: Among the control population without ankle injury, no differences were found between bilateral measurements (p-value range 0.172 - 0.961). Among those with known unilateral syndesmotic instability, values differed between the injured and uninjured side in five of six measurements— including syndesmotic area, direct anterior-, middle-, and posterior- difference, and sagittal translation (p <0.001, <0.001, <0.001, <0.001, 0.039, respectively). Those same measurements also differed when comparing the left-right delta values between uninjured and injured patients (p <0.001, 0.002, <0.001, <0.001, and 0.042, respectively). Fibular rotation differed neither in direct nor delta comparisons (p=0.460 and 0.271 respectively). Substantial agreement was found for all measurements except for sagittal translation, which had only slight agreement. Conclusion: This study highlights the ability of WBCT to effectively differentiate syndesmotic diastasis and fibular translation among patients with surgically-confirmed syndesmotic instability as compared to those without syndesmotic instability. It also underscores the importance of using the contralateral, uninjured side as a valid internal control. Additional studies are necessary to better understand the role of WBCT in prospectively diagnosing more subtle cases of syndesmotic instability among patients for whom the diagnosis remains in question.

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Interobserver Reliability Using the Phonetic Level Evaluation With Severely and Profoundly Hearing-Impaired Children

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3405.989 ◽

1991 ◽

Vol 34 (5) ◽

pp. 989-999 ◽

Cited By ~ 6

Author(s):

Stephanie Shaw ◽

Truman E. Coggins

Keyword(s):

Interrater Reliability ◽

Interobserver Reliability ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Hearing Impaired ◽

Intraclass Correlation Coefficients ◽

Assessment Measure ◽

Impaired Children ◽

Speech Assessment ◽

Hearing Impaired Children

This study examines whether observers reliably categorize selected speech production behaviors in hearing-impaired children. A group of experienced speech-language pathologists was trained to score the elicited imitations of 5 profoundly and 5 severely hearing-impaired subjects using the Phonetic Level Evaluation (Ling, 1976). Interrater reliability was calculated using intraclass correlation coefficients. Overall, the magnitude of the coefficients was found to be considerably below what would be accepted in published behavioral research. Failure to obtain acceptably high levels of reliability suggests that the Phonetic Level Evaluation may not yet be an accurate and objective speech assessment measure for hearing-impaired children.

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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