scholarly journals Reproducibility and Reliability of Dynamic Ultrasound for Evaluating Tibiofibular Translation in the Sagittal Plane

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Noortje Hagemeijer ◽  
Song Ho Chang ◽  
Jirawat Saengsin ◽  
Gregory Waryasz ◽  
Gino Kerkhoffs ◽  
...  
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Sagittal Plane ◽  
Maximum Force ◽  
P Value ◽  
Ultrasound Probe ◽  
Non Invasive ◽  
Force Application ◽  
Tibiofibular Joint ◽  
Dynamic Ultrasound

Category: Ankle Introduction/Purpose: Syndesmotic instability, when subtle, is challenging to diagnose and requires visualization of the syndesmosis during an applied stress. Ultrasound is a dynamic, non-invasive diagnostic tool that can do so at the point of care, but its reliability and reproducibility remain unclear. The aim of this study is to evaluate reliability and reproducibility of the dynamic use of ultrasonography, a safe and non-invasive imaging technique, for evaluating tibiofibular translation in the sagittal plane. Methods: Patients with no history of injury to either ankle were included in this study. The distal tibiofibular joint was examined using an ultrasound probe placed anteriorly with the patient in supine position, and posteriorly with the patient in prone position. Sagittal fibular translation was simulated by applying an increasing manual force to the fibula in the sagittal plane: 1) in supine position, anterior to posterior (SAP), 2) in prone position, posterior to anterior (PPA), and 3) in prone position, anterior to posterior (PAP) (Figure 1). Two examiners performed the dynamic examination independently to investigate reproducibility of the test. To test for reliability, the relative position of the fibula and tibia were subsequently measured by three observers; with no force application and at maximum force application, defined as the end point at which increased force did not result in additional fibular translation. Interrater reliability was tested using intraclass correlation coefficients (ICC). Results: In total 34 ankles among 17 patients were included, of which 24 ankles were male (71%). Mean subject age was 25.0 ± 5 years. Substantial agreement was found for all measurements. Anterior measurements of the distance between the ultrasound probe and the tibia and fibula demonstrated ICC’s of 0.98 and 0.98, respectively. PPA demonstrated ICC’s of 0.99 and 0.99, and PAP ICC’s of 0.99, and 0.99. To test for reproducibility the mean tibiofibular delta values of SAP, PPA, and PAP in neutral, and after maximum force application were compared between exams. Exam 1 vs exam 2: SAPneutral, coef. -0.001, p-value 0.895. PPAneutral, coef. -0.06, p-value 0.076. PAPneutral, coef. -0.01, p-value 0.957. SAPmaxforce, coef. -0.03, p-value 0.365. PAPmaxforce, coef. <-0.01, p-value 0.910, PPAmaxforce, coef. -0.08, p-value 0.028. Conclusion: Use of dynamic ultrasound is a reliable and accurate technique for measuring changes in sagittal translation of the tibiofibular joint. Substantial variation between right and left ankles of an individual subject is rare, underscoring the significant utility of the contralateral ankle as a control in the injury setting. This test affords a non-invasive means of diagnosing syndesmotic instability in the sagittal plane.

scholarly journals Diagnosing Syndesmotic Instability with Dynamic Ultrasound: Establishing Natural Variations in Normal Motion

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0019
Author(s):  
Noortje Hagemeijer ◽  
Song Ho Chang ◽  
Jirawat Saengsin ◽  
Gregory Waryasz ◽  
Gino Kerkhoffs ◽  
...  
Keyword(s):  
Prone Position ◽  
Applied Stress ◽  
Supine Position ◽  
Sagittal Plane ◽  
Linear Mixed Effect Model ◽  
P Value ◽  
Mixed Effect ◽  
Force Application ◽  
Dynamic Ultrasound ◽  
Left And Right

Category: Ankle Introduction/Purpose: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. Ultrasound is a dynamic, non-invasive diagnostic tool that can achieve this at the point of care, although accurate assessment requires better understanding of normal physiologic motion. The aim of this study is to assess normal distal tibiofibular motion in the sagittal plane using ultrasound during applied stress. Methods: Patients with no history of injury to either ankle were included in this study. The distal tibiofibular joint was examined using an ultrasound probe placed anteriorly with the patient in supine position and posteriorly with the patient in prone position. Sagittal fibular translation was simulated by applying an increasing manual force to the fibula in the sagittal plane: 1) in the supine position, anterior to posterior (SAP), 2) in the prone position, posterior to anterior (PPA), and 3) in the prone position, anterior to posterior (PAP) (Figure 1). The relative position of the fibula and tibia were subsequently measured without force application and then at maximum force application, defined as the end point at which increased force did not result in additional fibular translation. Fibular displacement in cm was thereafter calculated. A linear mixed effect model was built for analysis, wherein subject, examiner, experiment and side were random factors. Results: A total of 34 ankles were included. Mean age was 25.0±5 years and 71% were male. After adjusting for gender and side, the model showed that the application of force led to fibular motion in the sagittal plane for each measurement technique. SAP, coef. 0.06 [0.06-0.07], p-value < 0.001. PPA, coef. 0.04 [0.03-0.05], p-value < 0.001. PAP, coef. -0.16 [-0.17- -0.15], p-value < 0.001. The model also showed similar fibular motion values for left and right measurements, SAP p-value 0.589, PPA p-value 0.236, PAP p-value 0.104. Fibular movement values also were not influenced by gender, SAP p-value 0.348, PPA p-value 0.613, PAP p-value 0.714. Conclusion: Alterations of syndesmotic motion in the sagittal plane can be successfully identified using dynamic ultrasound under stressed conditions. On average, 0.6 mm of A to P translation and 0.4 mm of P to A translation were found. Equivalent translation values between the left and right side in each patient underscores that, in the injured setting, the contralateral ankle may be used as a reliable control. This establishes a normal value for ultrasound examination of the syndesmosis, allowing future studies examining the injured state.

scholarly journals Percutaneous Nephrolithotomy in Supine versus Prone Position in Tertiary Hospital in Mysore: A Prospective Cohort Study

2021 ◽  
Author(s):  
Ravikumar Banavase Ramesh ◽  
R Vijayakumar ◽  
V Manjunath ◽  
Abhilash Gautham ◽  
Amruthraj Gowda
Keyword(s):  
Cohort Study ◽  
Prone Position ◽  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Surgical Outcomes ◽  
Operative Time ◽  
P Value ◽  
Vas Score ◽  
Stone Free Rate ◽  
Free Rate

Introduction: Percutaneous Nephrolithotomy (PCNL) is a procedure of choice for large renal calculi. It is a common urological procedure. PCNL can be performed in various positions. Aim: To determine the surgical outcomes in patients undergoing PCNL in supine and prone positions. Materials and Methods: A cohort study was conducted on patients with renal and upper ureteral stones who underwent PCNL in either prone or supine position between August 2019 to August 2020 at Urology Department, JSS Hospital, Mysuru. Supine PCNL was done in the flank Free Oblique Supine Modified Lithotomy (FOSML) position. All the procedures were performed under fluoroscopy guidance. Surgical outcomes including operative time, length of hospital stay, Stone Free Rate (SFR), radiation dose, and postoperative complications were evaluated. The collected data was tabulated and frequency (n) and percentage (%) analysis was performed. The Chi-square test was used to find the level of significance. Results: A total of 70 patients were included in the study and out of which 35 patients were in the supine (46.37±14.73 years, 28 males and 7 females) and 35 patients (47.54±12.45 years, 23 males and 12 females) were in the prone PCNL groups. Statistically significant difference was observed in the mean operating time in the supine and prone PCNL groups (81.43 vs 127.71 minutes; p-value=0.001), with a higher stone-free rate (94.29% vs 91.43%; p-value=0.643) observed in the supine PCNL group. One patient in supine group had postoperative sepsis and one patient in prone group had bleeding requiring transfusion. The Visual Analog Scale (VAS) score in supine PCNL was (5.08±0.32) less than in prone group (8.03±0.40) (p-value <0.001). Conclusion: PCNL in the supine position compared with the prone position demonstrates significantly lower operative time with similar SFR and lower VAS score.

A STUDY OF ENDOMETRIAL THICKNESS IN TRANS VAGINAL SONOGRAPHY IN RELATION WITH HISTOPATHOLOGY REPORT IN DILATION & CURRATAGE IN AUB WOMEN

2019 ◽  
pp. 1-2
Keyword(s):  
Comparative Study ◽  
Endometrial Thickness ◽  
P Value ◽  
First Line ◽  
Non Invasive ◽  
Dilation And Curettage ◽  
Study Results ◽  
Vaginal Sonography ◽  
In Trans

A study of of endometrial thickness on TVS in relation with histopathology report on dilation and curettage. AIM AND OBJECTIVE-To set a cut off limit of endometrial thickness on TVS for differtiating between normal and abnormal endometrium. MATERIAL AND METHOD-hospital based comparative study. RESULTS-TVS is non invasive ,simple first line procedure in AUB women. Mean endometrial thickness in normal endometrial group was 8.00±2.44 mm and in abnormal endometrial group was 15.16±33 mm.The difference was found highly significant (p value<.001)

Influence of submaximal isometric contractions of the hamstrings on electromyography activity and force while functioning as hip extensors

2020 ◽  
pp. 1-8
Author(s):  
Dasom Oh ◽  
Wootaek Lim
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Isometric Contraction ◽  
Muscle Length ◽  
Biceps Femoris ◽  
Emg Activity ◽  
Isometric Contractions ◽  
Significant Difference ◽  
Extension Force ◽  
Long Head

BACKGROUND: Although the medial and lateral hamstrings are clearly distinct anatomically and have different functions in the transverse plane, they are often considered as one muscle during rehabilitation. OBJECTIVE: The purpose of the study was to compare the electromyographic (EMG) activity between the prone position and the supine position during maximal isometric contraction and to additionally confirm the effect of submaximal isometric contractions on EMG activity of medial and lateral hamstrings, and force. METHODS: In the prone position, EMG activities of the long head of biceps femoris (BFLH) and semitendinosus (ST) were measured during the maximal isometric contraction. In the supine position, hip extension force with EMG activity were measured during the maximal and the submaximal isometric contractions. RESULTS: EMG activity in the prone position was significantly decreased in the supine position. In the supine position, there was a significant difference between the BFLH and ST during the maximal isometric contraction, but not during the submaximal isometric contractions. CONCLUSIONS: The dependence on the hamstrings could be relatively lower during hip extensions. When the medial and lateral hamstrings are considered separately, the lateral hamstrings may show a more active response, with increased muscle length, in clinical practice.

MO794EVALUATION OF THE BONE ELASTIC STRUCTURE IN PERSONS WITH AND WITHOUT CHRONIC KIDNEY DISEASE ON DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Pietro Manuel Ferraro ◽  
Alessandra Nicolosi ◽  
Alessandro Naticchia ◽  
Nicola Panocchia ◽  
Giuseppe Grandaliano ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Linear Regression ◽  
Bone Structure ◽  
Bone Fractures ◽  
Elastic Structure ◽  
Absolute Difference ◽  
P Value ◽  
Non Invasive ◽  
Age And Sex

Abstract Background and Aims Chronic kidney disease is a frequent condition, characterized, especially in its more advanced stages, by an array of derangements in bone structure and density, resulting in a higher rate of bone fractures. Current strategies to monitor the bone status and assess the risk of bone fractures in CKD patients are limited. The Bone Elastic Structure (BES) test is a recently-developed non-invasive tool that measures the elastic characteristics of the trabecular bone by simulating the application of loads on a virtual biopsy obtained from radiographic images of the proximal epiphyses in the patient’s hand fingers. The simulation results are combined to obtain a parameter defined Bone Structure Index (BSI). The aim of our study is to explore whether the BES test could be a useful monitoring tool of bone status in patients with CKD on dialysis by exploring whether such patients have different BSI values compared with persons without CKD. Method The BES test was performed on a sample of 41 patients undergoing chronic hemodialysis (HD) and the BSI compared with a group of 374 persons with normal renal function who had undergone the BES test in previous studies. Differences in BSI and 95% confidence intervals (CIs) between the two groups were obtained and tested for statistical significance with a linear regression model including BSI as the dependent variable and kidney status (HD vs no HD) as the independent variable, adjusted for age and sex. Subgroup effects were explored by including interaction terms (age x kidney status, age x sex, kidney status x sex) in the model. Finally, to further remove the potential confounding by age and sex, each HD patient was individually matched with up to 4 non-HD participants based on sex and age (with a 5-year caliper) and a matched analysis was conducted on BSI values. Results Average (SD) age was 64 (17) years in the HD group and 60 (12) years in the non-HD group, with a prevalence of males of 49% and 16%, respectively. The individual values of BSI divided by kidney status and sex in Figure. The multivariate linear regression model showed that, after adjustment for age and sex, the BSI in the HD group was significantly lower compared with the non-HD group (HD 145, 95% CI 140, 154; non-HD 179, 95% CI 177, 181; absolute difference −32, 95% CI −40, −25; p-value &lt; 0.001). There was no significant interaction between age, sex and kidney status on BSI values (all p-values &gt; 0.05). Individual matching was successful for 36 out of 41 HD patients, who were matched to 127 non-HD participants; matched analysis confirmed the results (absolute difference −31, 95% CI −40, −23; p-value &lt; 0.001). Conclusion The output of a non-invasive tool to determine the bone elastic structure appeared to be strongly associated with kidney function after control for differences in age and sex. Further studies are needed to determine the potential application of the BES test in patients with CKD.

Evaluation of Transient Elastography in Prediction Of De novo Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nadia abdelaty Abdelkader ◽  
Moustafa Hamed Abdelaleem ◽  
Mohammed El-Gharib Abo El- maaty ◽  
Heba Ismail Aly ◽  
Sayed Ahmed Sayed
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transient Elastography ◽  
P Value ◽  
Hepatic Decompensation ◽  
Non Invasive ◽  
Prediction Of Mortality ◽  
The Mean ◽  
One Year

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common malignancy worldwide and it is also a common cause of death in patients with chronic liver disease. The curative treatment options for HCC that are currently available are surgical resection, liver transplantation and radiofrequency ablation .Despite progressive improvements in the efficacy of RFA, the survival of patients with HCC who undergo RFA remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after RFA. Aim of the work To evaluate the role of transient elastography (as an indirect indicator to degree of liver fibrosis) in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation in hepatitis C related hepatocellular carcinoma .And to compare between transient elastography and other non invasive fibrosis indices in prediction of denovo recurrence of hepatocellular carcinoma after radiofrequency ablation hepatitis C related hepatocellular carcinoma Patients and methods This prospective cohrt study was conducted on hepatocellular carcinoma patient, who underwent radiofrequency ablation in Tropical Medicine Department in Eldemerdash and Ain Shams Specialized Hospital, HCC clinic Ain Shams University Hospitals, Cairo, Egypt between march, 2017 and May, 2019. Data of the patient, who underwent radiofrequency ablation during the study period, were reviewed and the patients who fulfilled the inclusion criteria were enrolled into this study. The patients who fulfilled the inclusion criteria and underwent radiofrequency ablation were followed up for 12 months. Results TE revealed 28 patients with F4 and only 2 patients with F3, the mean measurement of liver stiffness was (22.45 ± 10.36) KPa. There was a significant negative correlation between LS and denovo recurrence of HCC (mean of LS in patients with complete response was 17.19 ± 3.32 and the mean of LS in patient with denovo recurrence was 36,94 ± 5.93,with the The best cut off value ≥24.65 (p value &lt; 0.001)). There was no significant correlation between CDC, FIB4, API scores and denovo recurrence of HCC. Also it was found that the LS was significantly associated with prediction of manifestation of hepatic decompensation after RFA (means of LS in patient without manifestation decompensation after RFA (p value &lt;0.001) .Regarding prediction of mortality, LS at cut off value &gt; 42 .75 (p value = 0,031) was significantly associated with prediction of mortality after one year of RFA. As regard serum non invasive fibrosis indices our results showed correlation between FIB4 score and hepatic decompensation after one year of intervention (the mean of FIB4 score in patients ascites and jaundice was 6.05 ± 4.71 (p value = 0.05) ).Therewas no statistically significant correlation between CDS and API with hepatic decompensation after RFA .As regard role of serum non invasive fibrosis indices in prediction of mortality after RFA, FIB4 score, CDS and API were statistically non significant. Conclusion Our data suggest that LS measurement is a useful predictor of HCC de novorecurrence overall survival and possibility of hepatic decompensation after RFA

scholarly journals High-Flow Nasal Cannula and Prone Positioning in Awake Patients with COVID-19 Related Respiratory Failure: An Observational Study.

2021 ◽  
Author(s):  
Fekri Abroug ◽  
Zeineb Hammouda ◽  
Manel Lahmar ◽  
Wiem Nouira ◽  
Syrine Maatouk ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Prone Position ◽  
Supine Position ◽  
Early Response ◽  
High Flow ◽  
Nasal Cannula ◽  
Youden Index ◽  
Prone Positioning ◽  
High Flow Nasal Cannula

Abstract Background: We report an observational study on the use of High-flow nasal cannula (HFNC) and awake prone position in patients with Covid-19 related severe ARF.Methods: chart analysis of consecutive patients with confirmed Covid-19 and severe ARF (PaO2/FiO2 ratio <150) who received HFNC. Patients were systematically encouraged to lie in the prone position if tolerated. We calculated initial ROX index (the ratio of SpO2/FIO2 to respiratory rate) while in supine position and at the end of the first HFNC session whether in prone or supine position, and their difference (delta ROX). The success/failure of HFNC (need for intubation) was recorded. Predictors of HFNC failure were identified using ROC curve and logistic regression.Results: HFNC was administered to 213 out of 360 patients with COVID-19 related severe ARF (71% male, median age:59 years (IQR:50-68), median PaO2/FIO2: 104(73-143). At the start of HFNC, median ROX index was 4(3.4-5). Among included patients, 178 (83.5%) could tolerate prone position and had a median of 4.4(2-6) prone sessions during a median of 10(4-16) hours/day each, for a median of 4(2-7) days. Overall, HFNC failure occurred in 61 patients (28.1%) with similar proportions in patients who had HFNC in prone position and in patients who did not tolerate prone position (29% and 26%, respectively; relative risk:1.14. 95%CI:0.62-2.1). In the prediction of HFNC outcome, AUC was highest for delta ROX (AUC=0.83); AUC for baseline ROX (0.71), PaO2/FiO2 (0.73), and SpO2 (0.67), were significantly lower. The delta ROX cut-off ≤1.8 had the best Youden index indicating the best combination of sensitivity (0.89) and specificity (0.61) with a PLR (2.33) and a NLR (0.17) to predict HFNC failure. Logistic regression disclosed the following predictors of HFNC failure: delta ROX: RR=0.44, 95%CI=0.32-0.62; p-0.0001); baseline ROX index: RR=0.58, 95% CI:0.39-0.85, p=0.005); SOFA score (RR=1.6 for each point; 95%CI: 1.1-2.2, p=0.007); and PaO2/FiO2 at admission: RR=0.96, 95%CI=0.94-0.99). Prone position was not related to HFNC success.CONCLUSION: Awake HFNC in prone position is feasible in most patients with severe hypoxemic COVID-19. Indicators of ARF severity and the early response to HFNC, rather than prone position are independently associated with HFNC outcome.

scholarly journals Weight Bearing CT and Relative Orientation of Foot Bones: Effect of Loading and Heeled Shoes

2020 ◽  
pp. 10-14
Author(s):  
Sandu Elena Cerasela ◽  
Caravaggi Paolo ◽  
Durante Stefano
Keyword(s):  
Sagittal Plane ◽  
Cone Beam Ct ◽  
Young Subject ◽  
Weight Bearing ◽  
Cone Beam ◽  
Non Invasive ◽  
Foot Bones ◽  
Healthy Young Subject ◽  
Foot Posture ◽  
Metatarsophalangeal Joints

The purpose of this article is to determine the orientation and relative position of the foot bones in Weight Bearing CT, highlighting the effect of the load and the shoe with the heel. Thanks to a Cone Beam CT (OnSight 3D Extremity System, Carestream) equipment, three scans of the foot of a healthy young subject were carried out in three conditions: "unloading", "loading", and wearing a shoe with "heel". In order to assess the accuracy of the articular angles of the foot through non-invasive measurements, a measurement was performed by Gait-Analysis with passive markers in the same conditions. The effect of the "load" resulted in a significant alteration of the foot posture especially in the sagittal plane, with crushing of the longitudinal medial arch. The heeled shoe involves enormous deformations at the level of the metatarsophalangeal joints and the ankle.

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