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MedRxiv : the Preprint Server For... Nov 2023TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including...
PURPOSE
TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering anatomical variations is essential for estimating this risk. Clinicians use the Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of research on its influence on TAVR devices thrombogenicity.
METHODS
A Medtronic Evolut® TAVR device was deployed in three patient models with varying STJ diameters (26, 30, and 34mm) to evaluate its impact on post-deployment hemodynamics and thrombogenicity, employing a novel computational framework combining prosthesis deployment and fluid- structure interaction analysis.
RESULTS
The 30 mm STJ patient case exhibited the best hemodynamic performance: 5.94 mean transvalvular pressure gradient (TPG), 2.64 mean geometric orifice area (GOA), and the lowest mean residence time (T ) - indicating a reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics comparable to the 30 mm STJ, but with a 6% increase in T and elevated platelet stress accumulation.
CONCLUSION
A smaller STJ size impairs adequate expansion of the TAVR stent, which may lead to suboptimal hemodynamic performance. Conversely, a larger STJ size marginally enhances the hemodynamic performance but increases the risk of TAVR leaflet thrombosis. Such analysis can aid pre- procedural planning and minimize the risk of TAVR leaflet thrombosis.
PubMed: 38014278
DOI: 10.1101/2023.11.13.23298476 -
Open Research Europe 2023Ecology and forestry sciences are using an increasing amount of data to address a wide variety of technical and research questions at the local, continental and global...
Ecology and forestry sciences are using an increasing amount of data to address a wide variety of technical and research questions at the local, continental and global scales. However, one type of data remains rare: fine-grain descriptions of large landscapes. Yet, this type of data could help address the scaling issues in ecology and could prove useful for testing forest management strategies and accurately predicting the dynamics of ecosystem services. Here we present three datasets describing three large European landscapes in France, Poland and Slovenia down to the tree level. Tree diameter, height and species data were generated combining field data, vegetation maps and airborne laser scanning (ALS) data following an area-based approach. Together, these landscapes cover more than 100 000 ha and consist of more than 42 million trees of 51 different species. Alongside the data, we provide here a simple method to produce high-resolution descriptions of large landscapes using increasingly available data: inventory and ALS data. We carried out an in-depth evaluation of our workflow including, among other analyses, a leave-one-out cross validation. Overall, the landscapes we generated are in good agreement with the landscapes they aim to reproduce. In the most favourable conditions, the root mean square error (RMSE) of stand basal area (BA) and mean quadratic diameter (Dg) predictions were respectively 5.4 m .ha and 3.9 cm, and the generated main species corresponded to the observed main species in 76.2% of cases.
PubMed: 38288290
DOI: 10.12688/openreseurope.15373.2 -
Langenbeck's Archives of Surgery Dec 2023Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic...
PURPOSE
Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic parathyroidectomy has emerged as a feasible procedure for focused parathyroidectomy. This study aimed to report the experiences of gasless robotic transaxillary parathyroidectomy for primary hyperparathyroidism in a single center.
METHODS
We assessed the data obtained from patients who underwent gasless robotic parathyroidectomy with the transaxillary approach between December 2013 and August 2022 and were diagnosed with primary hyperparathyroidism at our institute. The data included clinical, biochemical, and pathological features and operation time.
RESULTS
Of the 12 patients, 11 were women and one was a man. The median age of the patients was 44.5 years (range: 15-65 years). The median preoperative maximum mass diameters on ultrasonography and neck computed tomography were 1.2 ± 0.5 and 1.1 ± 0.6 cm, respectively. The median size of the postoperative maximum mass diameter in gross pathology was 1.3 ± 0.4 cm. The location of the enlarged parathyroid was left superior in five patients, right inferior in four, left inferior in three, and no right superior in one. In the final pathological examination, all cases were parathyroid adenomas. Only one case experienced a postoperative bleeding complication. At six months from surgery, average of an axillary scar length was 5.85 cm, and an average width was 0.21 cm. The mean operative time was 113 ± 48 min. The mean robot docking and console times were 9 ± 5 and 47 ± 52 min, respectively.
CONCLUSIONS
Robotic transaxillary parathyroidectomy is a feasible technique in select patients with primary hyperparathyroidism and preoperatively localized disease. The gasless robotic transaxillary approach provides procedural safety as well as superior cosmetic results without a neck scar.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Robotics; Parathyroidectomy; Robotic Surgical Procedures; Hyperparathyroidism, Primary; Cicatrix; Postoperative Complications
PubMed: 38103090
DOI: 10.1007/s00423-023-03182-y -
Journal of Biomedical Optics Jan 2024The classification of melasma is critical for correct clinical diagnosis, treatment selection, and postoperative measures. However, preoperative quantitative...
SIGNIFICANCE
The classification of melasma is critical for correct clinical diagnosis, treatment selection, and postoperative measures. However, preoperative quantitative determination of melasma type remains challenging using conventional Wood's lamp and optical dermoscopy techniques.
AIM
Using photoacoustic microscopy (PAM) to simultaneously obtain the two diagnostic indicators of melanin and blood vessels for melasma classification and perform quantitative analysis to finally achieve accurate classification, rather than relying solely on physicians' experience.
APPROACH
First, the patients were classified by experienced dermatologists with Wood's lamp and optical dermoscopy. Next, the patients were examined using the PAM imaging system. Further, the horizontal section images ( plane) of epidermal melanin and dermal vascular involvement were extracted from the 3D photoacoustic imaging results, which are important basis for PAM to quantitatively classify melasma.
RESULTS
PAM can quantitatively reveal epidermal thickness and dermal vascular morphology in each case and obtain the quantitative diagnostic indicators of melanin and blood vessels. The mean vascular diameter in lesional skin () of epidermal M+V-type was much larger than that in non-lesional skin (), and the mean vascular density in lesional skin was more than three times that in non-lesional skin. Importantly, vascular diameter and density are important parameters for distinguishing M type from M+V type.
CONCLUSIONS
PAM can obtain the data of epidermal thickness, pigment depth, subcutaneous vascular diameter, and vascular density, and realize the dual standard quantitative melasma classification by combining the parameters of melanin and blood vessels. In addition, PAM can provide new diagnostic information for uncertain melasma types and further refine the typing.
Topics: Humans; Microscopy; Melanins; Pilot Projects; Epidermis; Melanosis
PubMed: 37927370
DOI: 10.1117/1.JBO.29.S1.S11504 -
Cureus Nov 2023In India, there is only limited data on studies related to umbilical cord and placental indices in newborn infants. The present study was undertaken to evaluate the...
BACKGROUND
In India, there is only limited data on studies related to umbilical cord and placental indices in newborn infants. The present study was undertaken to evaluate the morphometric analysis of placental and umbilical cord indices and their association with length, weight, and head size in newborns.
MATERIALS AND METHODS
This was a longitudinal cross-sectional study conducted on placentas and fetal measures from 245 women who gave birth during the study period. The placental variables, umbilical cord indices, and neonatal indices were measured. The association between the parameters was done using Pearson's correlation, and p<0.05 was considered statistically significant. Results: The placental weight (p=0.01) and placental volume (p=0.01) showed a significant positive correlation with newborn weight. The mean placental diameter was 16.32 ± 1.54 cm, and there was no significant correlation between placental diameter and infant weight (p=0.232), length (p=0.658), or head circumference (0.842). In addition, there was a significant association between placental diameter, placental volume (p=0.000), and placental weight (p=0.000). There was a significant positive correlation (p<0.05) between ponderable index and birth weight, length, and head circumference.
CONCLUSION
Placental weight and newborn weight were significantly associated in this study. The length of the umbilical cord was found to be related to placental weight. So, placental measurements are reliable indicators for the assessment of fetal wellbeing.
PubMed: 38106776
DOI: 10.7759/cureus.48959 -
Cureus Nov 2023Due to the important functions of the mesencephalon, knowledge of its morphometric characteristics in a healthy population is important for any pathological diagnosis....
INTRODUCTION
Due to the important functions of the mesencephalon, knowledge of its morphometric characteristics in a healthy population is important for any pathological diagnosis. The aim of this study was to determine the specific morphometric values of the mesencephalon in a healthy Turkish population.
METHODS
Magnetic resonance (MR) images of 184 subjects (98 females, 86 males) with a mean age of 47.33 years (range 18 to 85 years) were included in the study. Then, parameter measurements were performed on 1.5 T MR images, and MicroDicom Digital Imaging and Communications in Medicine (DICOM) viewer 2022.1 (MicroDicom Ltd., Sofia, Bulgaria) software program was used for the measurements.
RESULTS
The mean sagittal diameter of the right cerebral peduncle was 17.17±2.03 mm, the mean cross-sectional area of the right cerebral peduncle was 171.75±32.81 mm, the mean transverse diameter of the left cerebral peduncle was 16.60±2.32 mm, sagittal diameter of tectum and tegmentum 17.01±1.57 mm, the cross-sectional area of tectum and tegmentum 223.40±27.37 mm and pontomesencephalic angle 52.03°±10.61°, while in males these values were 18.26±2.38 mm, 182.61±38.57 mm, 17.39±2.57 mm, 17.76±1.90 mm, 237.20±35.94 mm and 56.77°±9.78°, respectively. Except for the mamillopontine distance, there was a statistically significant difference between genders in the other parameters (p<0.05).
CONCLUSION
In conclusion, the findings related to the mesencephalon obtained in this study are presented for the first time in a healthy Turkish population. Especially, the cerebral peduncle cross-sectional area, tectum and tegmentum cross-sectional area, and cerebral peduncle transverse diameter can be evaluated clinically. We believe that knowledge of these values will guide specialists and radiologists in the diagnosis of any pathologic condition. Furthermore, the pontomesencephalic angle and mamillopontine distance have been identified as potentially useful landmarks in the diagnosis of intracranial hypotension and hydrocephalus. In particular, these angles can be measured in patient groups and may be a potential landmark in making an alternative diagnosis.
PubMed: 38094547
DOI: 10.7759/cureus.48708 -
Frontiers in Cardiovascular Medicine 2023The aim of the current study was to investigate the potential relationship between anatomical characteristics of pulmonary veins (PVs) and atrial fibrillation recurrence... (Review)
Review
Relationship between anatomical characteristics of pulmonary veins and atrial fibrillation recurrence after radiofrequency catheter ablation: a systematic review and meta-analysis.
BACKGROUND
The aim of the current study was to investigate the potential relationship between anatomical characteristics of pulmonary veins (PVs) and atrial fibrillation recurrence (AFR) following radiofrequency catheter ablation (RFCA), specifically focusing on PV diameter and cross-sectional orifices index (CSOA). The analysis was based on a comprehensive review of currently available literature, providing valuable insights for the prevention and treatment of AFR.
METHODS
Data was collected from five databases, including PubMed, MEDLINE, EMBASE, and Cochrane, spanning the period from 2004 to October 2022. The search strategy utilized Medical Subject Headings (MeSH) terms related to PV diameter, PV size, PV anatomy, and AFR. Indicators of PV diameter and CSOA from the included studies were collected and analyzed, with Weight mean difference (WMD) and 95% confidence intervals (CIs) representing continuous variables.
RESULTS
The meta-analysis included six studies. The results revealed that patients with AFR had a significant larger mean PV diameter compared to those without AFR (MD 0.33; 95% CI: 0.01, 0.66; = 0.04; = 33.80%). In a meta-analysis of two studies involving a total of 715 participants, we compared the diameters of the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV), right inferior pulmonary vein (RIPV) between patients with AFR and patients without AFR. The results showed that there were no statistically significant differences between the two groups in any of the four data items (all > 0.05). Additionally, the pooled estimate revealed that LSPV-CSOA, LIPV-COSA, RSPV-COSA, and RIPV-CSOA were greater in the AFR group compared to the non-AFR group, but the differences were not statistically significant (all > 0.05).
CONCLUSION
We found evidence supporting the notion that the PV diameter of patients who experienced AFR after RFCA was significantly larger than that of patients without AFR. The findings suggested that the PV diameter could serve as a potential predictor of the risk of AFR following RFCA.
PubMed: 37795484
DOI: 10.3389/fcvm.2023.1235433 -
Frontiers in Cardiovascular Medicine 2023The complex and highly variable three-dimensional anatomy of the left atrial appendage (LAA) makes planning and device sizing for interventional occlusion procedures...
BACKGROUND AND AIMS
The complex and highly variable three-dimensional anatomy of the left atrial appendage (LAA) makes planning and device sizing for interventional occlusion procedures (LAAC) challenging. Several imaging modalities [e.g. echocardiography, multi-slice computed tomography (MSCT)] are used for this purpose. Virtual reality (VR) is an emerging imaging technique to immerse into a three-dimensional left atrium and appendage, offering unprecedented options of visualization and measurement. This study aimed to investigate the feasibility, accuracy and reproducibility of visualizing the LAA in VR for preprocedural planning of LAAC.
METHODS AND RESULTS
Twenty-one patients (79 ± 7 years, 62% male) who underwent LAAC at University Hospital Düsseldorf were included in our study. A dedicated software generated three-dimensional VR models from preprocedural MSCT imaging data. Conventional measurements of LAA dimensions (ostium, landing zone and depth) using a commercially available software were compared to measurements in VR: MSCT and VR ostium min. ( = 0.93), max. (= 0.80) and mean (= 0.88, all < 0.001) diameters as well as landing zone (LZ) min. (= 0.84), max. (= 0.86) and mean diameters (= 0.90, all < 0.001) showed strong correlations. Three-dimensional orientation was judged superior by physicians in VR compared to MSCT ( < 0.05).
CONCLUSION
Virtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation. Further studies need to explore additional benefits of three-dimensional visualization for operators in preprocedural planning.
PubMed: 37727301
DOI: 10.3389/fcvm.2023.1188571 -
Romanian Journal of Ophthalmology 2023To measure changes in posterior corneal curvature after steep axis phacoemulsification and investigate the possibility of its effect on SIA. This was a prospective...
To measure changes in posterior corneal curvature after steep axis phacoemulsification and investigate the possibility of its effect on SIA. This was a prospective longitudinal study on 60 consecutive eyes of age-related cataract with regular astigmatism and absence of co-morbidities undergoing uneventful cataract surgeries with main incision at steep meridian. Preoperative and 4 weeks postoperative measurements of anterior and posterior corneal curvatures using Scheimpflug based corneal topographer were performed. Posterior corneal curvature was assessed at 3, 5- and 7-mm diameters. The study found a statistically significant change in posterior corneal K1, K2 and mean astigmatism in all zones (3, 5 and 7 mm) at 4 weeks postoperative, when compared to preoperative readings. Posterior keratometry is likely to be an important determinant of Surgically Induced Astigmatism (SIA) and should be factored in for refractive cataract surgery.
Topics: Humans; Phacoemulsification; Prospective Studies; Astigmatism; Longitudinal Studies; Lens Implantation, Intraocular; Cornea; Cataract
PubMed: 37876511
DOI: 10.22336/rjo.2023.45 -
The International Journal of... Jul 2023The cross-sectional shape of the aortic root is cloverleaf, not circular, raising controversy regarding how best to measure its radiographic "diameter" for aortic event...
The cross-sectional shape of the aortic root is cloverleaf, not circular, raising controversy regarding how best to measure its radiographic "diameter" for aortic event prediction. We mathematically extended the law of Laplace to estimate aortic wall stress within this cloverleaf region, simultaneously identifying a new metric of aortic root dimension that can be applied to clinical measurement of the aortic root and sinuses of Valsalva on clinical computerized tomographic scans. Enforcing equilibrium between blood pressure and wall stress, finite element computations were performed to evaluate the mathematical derivation. The resulting Laplace diameter was compared with existing methods of aortic root measurement across four patient groups: non-syndromic aneurysm, bicuspid aortic valve, Marfan syndrome, and non-dilated root patients (total 106 patients, 62 M, 44 F). (1) Wall stress: Mean wall stress at the depth of the sinuses followed this equation: Wall stress = BP × Circumscribing circle diameter/(2 × Aortic wall thickness). Therefore, the diameter of the circle enclosing the root cloverleaf, that is, twice the distance between the center, where the sinus-to-commissure lines coincide, and the depth of the sinuses, may replace diameter in the Laplace relation for a cloverleaf cross-section (or any shaped cross-section with two or more planes of symmetry). This mathematically derived result was verified by computational finite element analyses. (2) Diameters: CT scan measurements showed a significant difference between this new metric, the Laplace diameter, and the sinus-to-commissure, mid-sinus-to-mid-sinus, and coronal measurements in all four groups (p-value < 0.05). The average Laplace diameter measurements differed significantly from the other measurements in all patient groups. Among the various possible measurements within the aortic root, the diameter of the circumscribing circle, enclosing the cloverleaf, represents the diameter most closely related to wall stress. This diameter is larger than the other measurements, indicating an underestimation of wall stress by prior measurements, and otherwise provides an unbiased, convenient, consistent, physics-based measurement for clinical use. "Diameter" applies to circles. Our mathematical derivation of an extension of the law of Laplace, from circular to cloverleaf cross-sectional geometries of the aortic root, has implications for measurement of aortic root "diameter." The suggested method is as follows: (1) the "center" of the aortic root is identified by drawing three sinus-to-commissure lines. The intersection of these three lines identifies the "center" of the cloverleaf. (2) The largest radius from this center point to any of the sinuses is identified as the "radius" of the aortic root. (3) This radius is doubled to give the "diameter" of the aortic root. We find that this diameter best corresponds to maximal wall stress in the aortic root. Please note that this diameter defines the smallest circle that completely encloses the cloverleaf shape, touching the depths of all three sinuses.
Topics: Humans; Aorta, Thoracic; Predictive Value of Tests; Aorta; Bicuspid Aortic Valve Disease; Blood Pressure; Aortic Valve
PubMed: 37046157
DOI: 10.1007/s10554-023-02847-5