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Abstract Background Open reduction and internal fixation have been frequently applied for displaced midshaft clavicular fracture. Plate and screw fixation of clavicular fractures could provide rigid fixation and rotational control. Proper implant positioning in surgical fixation is critical to prevent iatrogenic complications. Fluoroscopy plays an important role in the intraoperative evaluation of implants. This study aimed to introduce a new fluoroscopic projection to evaluate the positioning of plates and screws. Methods Adult patients with a diagnosis of acute displaced midshaft clavicular fracture were included in this study. The slope angle of the midshaft clavicle was measured on sagittal reconstructions of preoperative computed tomography (CT) scans. The incidence of screw revision based on intraoperative standard posteroanterior (PA) and PA 25° cephalic skyline projections was compared. The interobserver agreement for the two projections was calculated. Results Twenty-nine patients with midshaft clavicular fractures were enrolled from January 2020 to June 2021. The PA 25° skyline projection could clearly display the tangential line of the plate and inferior border of the clavicle. The slope angle on the superior surface of the midshaft clavicle was 26.0 ± 5.8° (range: 18.5–38.3°). The incidence of screw revision using the PA projection (72.4%) was significantly different from that using the PA 25° skyline projection (34.5%) (P < 0.05). The concordance of the screw revision rate based on the standard PA and PA 25° skyline projections was strong, with kappa coefficients of 0.680 (95% CI: 0.394–0.968) and 0.776 (95% CI: 0.537–0.998). Conclusion The PA 25° skyline projection corresponds to the slope angle of the midshaft clavicle. It can provide more accurate information regarding the proper screw length and be applied as a routine method for intraoperative evaluation.

OBJECTIVES: The study aimed to compare the effects of quadhelix and nickel-titanium (NiTi) expander appliances on lower facial height, to quantify, and evaluate dentoalveolar and orthopedic changes in transverse plane, respectively, to estimate the difference in changes between these two appliances. MATERIALS AND METHODS: Twenty patients, ten for the quadhelix and NiTi expander in the two-appliance group, respectively, participated in this study. A total of 8 readings, 1 for clinical facial height, 2 for model analysis, and 5 for posteroanterior cephalometric analysis were recorded. The statistical tests used were, Student's unpaired and paired t-tests. RESULTS: Both appliances individually, produced statistically highly significant (p < 0.01) expansion every month in both premolar and molar areas with more uniform expansion for quadhelix and less expansion in NiTi palatal expander in the premolar region initially. The skeletal to dental change ratio showed that there was more dental change than skeletal with no inter-appliance differences statistically while assessing the PA cephalometric readings. CONCLUSIONS: This study infers that both appliances are equally efficacious maxillary expanders, which are primarily dentoalveolar and not skeletal (p < 0.05).

This study aimed to evaluate the relation between buccally displaced canine and nasal septum deviation. 822 individuals (mean age 12,91±2,21; 469 female, 353 male) were divided into has buccally displaced canine (n=411) and has no buccally displaced group (n=411). Intra-oral photographs were used to evaluate the position of displaced canine. Posteroanterior radiographs were used to determine the deviated nasal septum. A Chi-square test was used for analyzing the variables. While the incidence of septum deviation is 70.1% in individuals with buccal ectopic canine, the rate of septum deviation in individuals with canine teeth in normal position is 40.6%. A statistically significant relationship was found between the presence of canine in the ectopic position in the buccal and the deviation of the septum(p=0,000). In the intraoral examination, it can be estimated that there may also be a nasal septum deviation when the buccal ectopic canine is found. It should be kept in mind that patients may be directed to the medical doctor to prevent problems that may occur in the long term as a result of the nasal septum deviation.

Abstract Chest x‐ray (CXR) examination is a common first‐line, non‐invasive, and rapid screening method in clinical examinations. The posteroanterior (PA) and anteroposterior (AP) view modes can both be used to detect related cardiopulmonary diseases, such as pneumonitis, tuberculosis, pulmonary fibrosis, lung tumors, and cardiomegaly. Compared with cardiac computed tomography and cardiac magnetic resonance imaging methods, CXR examination has a short scanning duration and costs less, and is suitable for routine and follow‐up health examinations. Cardiomegaly is an asymptomatic disease in the early stage and cannot be detected through electrocardiography measurements. Thus, early cardiomegaly classes detections, such as cardiac hypertrophy and ventricular dilatation, can help make decisions regarding drug treatments and surgeries. In addition, an automatic assistive tool is required to differentiate between normal individuals and those with cardiomegaly to address the problem of manual inspection and labor shortage. Hence, PA view‐based CXR classification is used to develop a deep learning (DL)‐based high‐dimensional multiple regression analysis (MRA) model for CXR image classification in rapid cardiomegaly screening. This multilayer network model uses a two‐channel three‐layer convolution‐normalization‐pooling process with two‐dimensional (2D) multi convolution operations to enhance images and to extract feature patterns; and then a one‐dimensional feature conversion is used to estimate the four coordinate points of the maximal horizontal cardiac diameter (MHCD) and maximal horizontal thoracic diameter (MHTD), which can be used to estimate cardiothoracic ratio and detect cardiomegaly. For experimental tests, the training and testing datasets are collected from the National Institutes of Health CXR Image Database (Clinical Center, USA), and 10‐fold cross‐validation was used for model evaluation in terms of precision (%), recall (%), accuracy (%), and F1 score. These indexes are used to evaluate the feasibility of the proposed MRA estimator. In addition, the performances of the proposed model are compared with those of conventional DL‐based multilayer classifiers.

Aim: There are wide variations in placement of extra-alveolar bone screws that can occur in angulation, the height of placement, and other operator-related factors. The aim of this study is to comparatively evaluate the position of bilaterally placed infrazygomatic crest (IZC) mini-implants factors such as height, angulation, the length outside the bone, if any sinus penetration and the depth of penetration into the sinus. Materials and Methods: The study is a retrospective pilot study collected from the hospital records over the time period study was conducted. Posteroanterior cephalograms taken for patients after bilateral placement of IZC were collected. The comparison of the variations in placement for the right and left side was done. Results: There is wide variation among the sample and comparison to the right and left sides in the same sample. The height of placement above the buccal tube ranged from 7 to 8 mm. There were wide variations in angulation of the implant to the buccal bone ranging from 15° to up to 50°. Of the total size of the IZC mini-implant 6-7 mm of the implant was left outside the bone and an average of 2.5 mm of sinus penetration was commonly observed. Conclusion: Postplacement assessment of IZC can be done with a posteroanterior cephalogram. The implant was placed at a height of 6-10 mm above the buccal tube; there were wide variations in angulations between right and left side; 4-7 mm of the mini-implant did not engage the IZC, and there was a high incidence of sinus penetration ranging from 1 mm to 3.5 mm.

When doctors are fatigued, they often make diagnostic errors. Similarly, pharmacists may also make mistakes in dispensing medication. Therefore, object segmentation plays a vital role in many healthcare-related areas, such as symptom analysis in biomedical imaging and drug classification. However, many traditional deep-learning algorithms use a single view of an image for segmentation or classification. When the image is blurry or incomplete, these algorithms fail to segment the pathological area or the shape of the drugs accurately, which can then affect subsequent treatment plans. Consequently, we propose the Fuzzy DBNet, which combines the dual butterfly network and the fuzzy ASPP in a deep-learning network and processes images from both sides of an object simultaneously. Our experiments used multi-category pill and lung X-ray datasets for training. The average Dice coefficient of our proposed model reached 95.05% in multi-pill segmentation and 97.05% in lung segmentation. The results showed that our proposed model outperformed other state-of-the-art networks in both applications, demonstrating that our model can use multiple views of an image to obtain image segmentation or identification.

The purpose of this study was to compare the efficacy of botulinum toxin (BoNT) in masseter muscle reduction depending on the amount of chin deviation. Exploring distinctive effects of BoNT relative to the characteristics of facial asymmetry will aid in planning and predicting treatment outcomes. Sixteen adult volunteers were classified into two groups according to the degree of menton deviation observed in posteroanterior cephalograms. Eight had a menton deviation of 3 mm or more and the other eight had less than 3 mm. A total of 25 Units of BoNT was injected into the unilateral masseter muscle of the prominent side for each participant. Changes in the volume and bulkiest height of the lower face on each side were measured with a 3D laser scan at four time points: before and 4, 8, and 12 weeks after the injection. Two-way mixed ANOVA was employed for analyses. The volume and bulkiest height of the injected side decreased over time in both types of asymmetry, with significant differences at each time point. The reductions in the volume and bulkiest height were significantly greater in subjects without chin deviation. The reductions in the volume and bulkiest height of the lower face using BoNT are more effective for subjects without chin deviation.

Palpitations, chest tightness, and shortness of breath are early indications of cardiomegaly, which is an asymptomatic disease. Their causes and treatment strategies are different due to differing indications. Hence, early screening of cardiomegaly levels can be used to make a strategy for administering drugs and surgical treatments. In this study, we will establish a multilayer one-dimensional (1D) convolutional neural network (CNN)-based classifier for automatic cardiomegaly level screening based on chest X-ray (CXR) image classification in frontal posteroanterior view. Using two-round 1D convolutional processes in the convolutional pooling layer, two-dimensional (2D) feature maps can be converted into feature signals, which can enhance their characteristics for identifying normal condition and cardiomegaly levels. In the classification layer, a classifier based on gray relational analysis, which has a straightforward mathematical operation, is used to screen the cardiomegaly levels. Based on the collected datasets from the National Institutes of Health CXR image database, the proposed multilayer 1D CNN-based classifier with K-fold cross-validation has promising results for the intended medical purpose, with precision of 97.80%, recall of 98.20%, accuracy of 98.00%, and F1 score of 0.9799.

•Posterior surgery was less invasive and fewer complications compared to combined posteroanterior surgery.•Pedicle screws and bone grafting were recommended to prevent kyphotic deformity in posterior surgery.•During a long-term follow-up period, no recurrence of these neurogenic tumor was found. The goal of this study was to compare the clinical outcomes of posterior surgery with combined laminectomy and thoracoscopic surgery for treating dumbbell-type thoracic cord tumors. We retrospectively analyzed 32 cases of dumbbell-type thoracic cord tumors treated by two surgical procedures in our center from February 2003 to July 2013. Group A cases (n = 12) underwent posterior surgery followed by laminectomy, costotransversectomy and instrumentation; Group B cases (n = 20) underwent posterior laminectomy and anterior video-assisted thoracoscopic surgery in a single-stage procedure. Operation time, blood loss, hospitalization, recovery of neurological function, and complications were compared between the two groups. Complete surgical excision was achieved in both groups. All patients were followed up for an average of 7.4 ± 2.8 years (range, 3–13). At the final follow-up visit, there was no tumor recurrence and no differences in neurological results between the two groups (P > 0.05). However, the average operative duration, blood loss, hospitalization, and rate of complications were significantly lower in Group A compared to Group B (P < 0.05). Both posterior surgery and the posterior surgery combined with anterior thoracoscopic surgery were effective for removing dumbbell-type thoracic cord tumors. However, posterior surgery alone was associated with reduced operative duration and rate of complications compared to the combined surgical approach.

Aim: Studies have been done in diversified population, demonstrating the uniqueness of frontal sinus; data related to the Indian population are less. Thus, the present study was aimed to determine the frontal sinus measurement and to assess its forensic application in the Indian population. Materials and Methods: A total of 400 individuals with Indian origin (21-30 years) were included in the study. The digitized posteroanterior skull radiographs were obtained and was transferred to Adobe® CS4 extended to measure the dimensions of frontal sinus and orbit for 12 parameters. Statistical Analysis: A descriptive statistical analysis was performed. Results: The descriptive statistics showed the presence of bilateral frontal sinus in 87.7% and bilateral absence in 8.0% of the individuals and the absence of left and right frontal sinus in 3.3% and 1%, respectively. Maximum population showed high asymmetry index (64.7%); the right side frontal sinus (height, 59.3% and width, 40.8%) was superior to the left side in both males and females. The partial septa among the Indian population were absent for maximum population (55.2%), and supraorbital cells of the frontal sinuses were present on both sides among the Indian population. Conclusion: The observation of the present study suggests that the frontal sinus is highly asymmetrical and unique to the individual and hence can be effectively used in personal identification method in forensic anthropology.