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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The atlantoaxial complex is unique due to its anatomy and biomechanics&#46; The first cranial vertebra &#40;atlas&#41; does not have a body as it fuses during the development with the second cervical vertebra &#40;axis&#41; to form the dens axis&#46; Atlas usually develops from three primary ossification centers&#44; including two half-neural arches that begin to ossify as early as during the prenatal stage&#44; and one ossification center in the anterior arch which&#44; in 80&#37; ossifies during 1&#8211;2 years of age&#46; In about 20&#37; the anterior arch begins to ossify already before birth&#46; Half-neural arches fuse together approximately by 3 years&#46; Their fusion with the anterior arch occurs usually by 7 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The published studies dealing with the atlas &#40;C1&#41; have focused primarily on adults&#44; whereas only a few authors have presented exact data on the growth&#44; development and dimensions of the C1 vertebra or its age- or gender-related changes&#46; Piatt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Calvy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> concentrated in their study on atlas ossification and its variants&#46; Rao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> examined age-related morphological characteristics of C1&#44; especially closures of individual synchondroses&#46; Yoganandan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> studied geometrical properties of the C1 vertebra on child dummies used in motor vehicle crashworthiness evaluations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Injuries to the atlas &#40;C1&#41; are very rare in children&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The literature contains primarily only case studies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Jefferson<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported in his original study on 46 fractures of C1&#44; of which only one was sustained by a child&#46; Atlas fractures in the pediatric population are treated predominantly non-operatively&#46; As a result&#44; there is only a limited body of knowledge and facts about operative treatment available in this context&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of the study was&#58; &#40;1&#41; to describe changes in the shape of the atlas during its development from 0 to 18 years of age&#44; including gender and side differences&#59; &#40;2&#41; to assess the dimension essential for identification of the optimal entry point&#59; &#40;3&#41; to determine the age limit for a safe insertion of 3&#46;5-mm screws into the lateral masses according to our own limiting parameters&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We obtained 200 CT scans of the craniocervical junction from the database of the University Hospital in Motol&#44; Prague&#44; performed in patients with a healthy cervical spine at the age of 0&#8211;18 years&#44; in the 2015&#8722;2019 period&#46; Indication for CT examination was craniotrauma&#59; injuries to the cervical spine were excluded&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition&#44; we used 34 first cervical vertebrae &#40;aged 2&#46;5&#8211;18 years&#41; from the collection of the Institute of Anatomy of 1st Faculty of Medicine&#44; Charles University&#44; Prague&#46; We did not succeed in obtaining more pediatric C1 vertebrae even after contacting other institutes of anatomy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Both series were divided&#44; based on the gender and age&#44; into 9 age periods&#58; 0&#8722;1&#44; 1&#8722;2&#44; 2&#8722;3&#44; 3&#8722;4&#44; 4&#8722;6&#44; 6&#8722;9&#44; 9&#8722;12&#44; 12&#8722;15&#44; 15&#8722;18 years of age&#44; with shorter intervals in lower age categories where a majority of changes was expected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The original software xViewer&#44; version 2&#46;7&#46;1 of the Toshiba Aquilion Prime CT scanner was used to measure the lateral mass &#40;LM&#41; width minimum &#40;a&#41;&#44; LM height maximum &#40;b&#41;&#44; LM height minimum &#40;c&#41;&#44; distance from the left to the right medial pedicle &#40;d&#41;&#44; distance from the inner wall of the anterior to the posterior arch &#40;e&#41;&#44; distance from the left to the right transverse process &#40;f&#41;&#44; distance from the anterior tubercle to the posterior tubercle &#40;g&#41;&#44; distance from the inferior pedicle to the inferior LM &#40;h&#41;&#44; distance from the middle line to the midpoint of LM &#40;i&#41;&#44; diameter of the transverse foramen in coronal plane &#40;j&#41;&#44; diameter of the transverse foramen in sagittal plane &#40;k&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The same parameters were measured in a group of C1 vertebrae without patologic findings&#46; We used the digital caliper&#46; The values measured served for calculation of the mean value and the standard deviation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Descriptive statistics were employed to summarize the morphological measurements of the atlas dimensions across the nine distinct age groups and by gender &#40;males and females&#41;&#46; A Kruskal-Wallis test assessed age group differences in C1 dimensions&#46; A Mann&#8211;Whitney U test compared C1 dimensions between males and females within each age group&#44; revealing gender-related variations&#46; Due to low patient numbers in the 0&#8722;1 age group&#44; only descriptive statistics were employed&#46; The statistical significance level was set on 0&#46;05&#46; Statistical analyses were performed using GraphPad Prism version 10&#46;0&#46;0 for Windows &#40;GraphPad Software&#44; Boston&#44; Massachusetts USA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The C1 vertebra reaches its maximum growth rate between 0 and 2 years of age&#44; the atlas then continues to grow until the age of 18 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A&#44; B</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Atlas width &#8211; the distance from the left to the right transverse process &#40;f&#41; more than doubles from birth to maturity&#44; with the highest growth rate between 0 and 1&#160;year of age&#46; Then the growth decelerates&#46; By contrast&#44; the distance from the inner wall of the anterior to the posterior arch &#40;e&#41; is relatively less increased by the age of 18 years &#8211; approximately 1&#46;5 times &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">During growth there occur changes in the shape of the spinal canal at the C1 level&#46; The proportion of dimensions changes with age&#46; The youngest children show a relatively greater distance from the left to the right medial pedicle&#59; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Between 0 and 18 years of age&#44; the lateral mass grows most notably in the LM height minimum parameter &#40;c&#41;&#44; increasing more than three times&#59; the LM height maximum &#40;b&#41; increases more than twice and the increase in the LM width minimum &#40;a&#41; is relatively the smallest &#8211; less than a double &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The diameter of the transverse foramen in the coronal plane &#40;j&#41; remains&#44; throughout the growth&#44; smaller than that in the sagittal plane &#40;k&#41;&#46; As a result&#44; the transverse foramen has a slightly oval shape&#46; The highest growth rate was recorded in both these dimensions in the age category of 0&#8722;1&#160;year &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">For comparison of the right and left sides&#44; we measured the distance from the middle line to the midpoint of LM &#40;i&#41;&#46; No statistically significant difference was found in this parameter in any age category&#46; The growth rate was the highest in the age category of 0&#8722;1&#160;year&#44; then it decelerated and by the age of 18 years it was less than a double &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The distance from the inferior pedicle to the inferior LM &#40;h&#41; triples by the age of 18 years&#46; The highest growth ratio was observed between 0 and 2 years of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">These measurements made on CT scans correlated in a majority of cases with the data obtained from anatomical specimens &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A&#44; B</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">The Kruskal-Wallis test detected statistically significant differences in all the measured parameters across age groups&#44; both for males and females analyzed separately&#46; Therefore&#44; there is evidence to suggest that all the measured parameters exhibit variations with age as a child undergoes growth and development &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> measured CT scans of pediatric atlases in the 0&#8722;14 age group and observed the highest growth rate of the atlas in children aged 0&#8211;2 years&#46; This finding corresponds to our measurements &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; They also point out that further studies are needed to assess whether the atlas continues to grow after 14 years&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> According to Warner et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the ring of C1 reaches about normal adult size by 4 years of age&#46; However&#44; a majority of the parameters we measured&#44; keep increasing until the age of 18 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">According to &#352;tul&#237;k et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> the dimension of C2 dens on a transverse CT scan at the level of the inferior edge of the anterior arch of the atlas is greater in the youngest children&#59; at the age of about 10&#8211;12 years the dimensions become even and the dens has a circular shape&#59; and in older children the anteroposterior dimension of the dens is greater&#46; Due to a close relationship between the atlas and the axis&#44; we examined whether these changes are reflected also in the C1 vertebra&#46; In the youngest children&#44; the distance from the left to the right medial pedicle is slightly greater than the distance from the inner wall of anterior to posterior arch&#46; Around the age of 5 years the dimensions become even and subsequently the distance from the inner wall of anterior to posterior arch predominates &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; This change in proportions of the atlas inside dimensions corresponds with the changes in the C2 dens&#44; although in our study group the dimensions became even much sooner&#46; No such change occurs in the atlas outside dimensions&#59; according to our measurements&#44; the distance from the left to the right transverse process is always greater than the distance from the anterior tubercle to the posterior tubercle &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">These changes are associated with the increasing inside diameter of the spinal canal and the changing size of the spinal cord&#46; Our study group showed gradual changes in the shape of the vertebral foramen at the C1 level&#44; when the anterior space for the dens axis gets gradually narrower than the space in the posterior part of the spinal canal reserved for the spinal cord&#46; This change probably results from the relatively substantial spinal cord in the prenatal period&#44; whereas the space for the dens axis&#44; squeezed between the C1 lateral masses&#44; remains narrower and adapts to the shape of the dens &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; This increases stability of the atlantoaxial articulation&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The knowledge of the shape and size of the transverse foramen is essential for insertion of the LM screw&#46; Therefore&#44; we measured the diameter of the transverse foramen &#8211; the lateral and the anteroposterior dimensions&#44; and their development with growing age&#46; The mean diameter of the transverse foramen &#8211; the anteroposterior dimension&#44; was greater in our group in most cases&#44; as compared to the mean diameter of the transverse foramen &#8211; the lateral dimension &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46; Our findings document that the transverse foramen has mostly a slightly oval shape throughout the period of growth&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">According to Scheuer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> the foramens are usually near to completion by years 3&#8211;4&#46; However&#44; we found in our series open transverse foramens in all age categories up to the age of 18 years&#44; with a majority of them in the youngest age groups&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Chamoun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> measured dimensions of atlases of children aged 1&#46;5&#8211;16 years on 76 CT scans&#46; They found statistically significant differences between boys and girls for 2 measurements&#58; the minimum screw length and the anterior height of the lateral mass&#46; Nevertheless&#44; the authors considered these differences to be clinically insignificant&#46; Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> did not analyze differences between genders&#46; In our series&#44; statistically significant differences can be seen mainly in age categories of 12&#8211;15 years and 15&#8211;18 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; This corresponds to the study by &#352;tul&#237;k et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> who measured C2 in children and found statistically significant differences between boys and girls aged 13 years and more&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Geck et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> measured C1 on CT scans in 50 children aged 2&#8211;6 years and found no statistically significant difference between the right and left sides in any of the parameters measured&#46; Chamoun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found a statistically significant difference between the right and left sides for the maximum medialized screw trajectory and the maximum inferior screw trajectory&#46; Deng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> measured C1 in 10 cadavers in the age group of 6&#8211;8 years and found no statistical differences between the bilateral parameters in this measurement&#46; According to Chen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in most of the indicators no significant difference was observed between the left and right sides&#46; Simsek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> measured 40 anatomic specimens of adults and found no statistically significant difference between the right and the left sides&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">For the sake of the best comparison of the right and left sides&#44; we measured the distance from the middle line to the midpoint of LM &#40;i&#41;&#46; This parameter showed no statistically significant difference in any age category&#46; According to the above mentioned findings&#44; the differences between the right and left sides are minimal&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Identification of the appropriate entry point is crucial for insertion of the LM screw and requires a profound knowledge of the anatomy of the craniocervical junction&#46; Excessively medial placement of the screw poses a risk of damage to the spinal cord&#44; its excessively lateral placement endangers the vertebral artery&#46; An optimal entry point for insertion of the LM screw is reportedly the center of the lateral mass&#46; Goel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> preferred insertion of the screw to the center of the posterior surface of the C1 inferior articular process&#44; 1&#8211;2&#160;mm above the articular facet&#46; Harms and Melcher<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> defined the entry point as a center of the posterior surface of the inferior articular process at the junction of the posterior arch and the lateral mass&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">An important role in insertion of the LM screw is played by the craniocaudal dimension of the lateral mass below the posterior arch&#46; Optimal for identification of an ideal entry point and a safe insertion of the screw is the distance between the inferior pedicle and the inferior LM of more than 3&#46;5&#160;mm&#46; According to our measurements&#44; it occurred in all samples in the age group of 5 and more years&#44; and in some specimens even at a younger age&#46; Therefore&#44; of key importance in this context is preoperative CT examination and a case-by-case assessment of each patient&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The approach to the C1 lateral mass is complicated by the greater occipitalis nerve and venous plexus&#46; Goel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> recommended a sharp dissection of the nerve and bipolar coagulation to control bleeding from the venous plexus&#46; Harms and Melcher<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> preferred to retract the nerve caudally and control bleeding by means of bipolar coagulation in combination with tamponade&#46; &#352;tul&#237;k et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> retracted the greater occipital nerve caudally towards C2 and controlled bleeding by a quick insertion of a screw and compression of the venous plexus with the screw head&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Insertion of a C1 LM screw requires a profound knowledge of the anatomy of the first cervical vertebra and its dimensions&#46; There are numerous studies dealing with dimensions of the atlas in adults&#46; According to Gupta and Goel<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and Wang et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> the measured C1 dimensions allow insertion of a 3&#46;5-mm LM screw in all adults&#46; However&#44; the authors have measured different parameters and their opinions on so-called restrictive parameter&#47;s for insertion of an LM screw vary&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">According to Su et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> the restrictive factor for insertion of an LM screw into an adult C1 vertebra is the minimal LM height &#40;4&#46;4&#8211;9&#46;0&#160;mm&#41;&#46; Chamoun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> measured LM on the sagittal section through the center of the lateral mass anteriorly and posteriorly&#46; In their view&#44; the critical measurement in terms of insertion of an LM screw is the LM width&#44; when only in one case &#40;a 19-month old child&#41; the LM width was less than 4&#160;mm&#46; Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> considered the LM height to be the limiting dimension for insertion of an LM screw&#44; measured as the distance between the midpoint of the upper and lower edges of the lateral mass&#46; In their opinion&#44; a 3&#46;5-mm LM screw can be used in children aged 2 years and more&#46; Geck et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> measured only the C1 LM width and length and&#44; based on their findings&#44; a 3&#46;5-mm LM screw could be used in all of them&#46; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> measured CT scans in 37 children younger than 10 years&#46; The limiting factor for insertion of a 3&#46;5-mm screw into the LM was the entry point height &#40;only in 47&#46;3&#37; of patients this dimension was more than 3&#46;5&#160;mm&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In our view&#44; insertion of a 3&#46;5-mm LM screw is limited by dimensions a &#40;LM width minimum&#41;&#44; b &#40;LM height maximum&#41;&#44; c &#40;LM height minimum&#41;&#46; Dimensions a and b are in all measured specimens greater than 3&#46;5&#160;mm&#44; therefore&#44; dimension c is decisive&#46; From the age of 5 years dimensions c are always 4&#160;mm and more and thus allow a safe insertion of 3&#46;5-mm screws into the lateral masses&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The fact that c is less than 3&#46;5&#160;mm does not rule out the possibility of insertion of a 3&#46;5-mm LM screw&#44; but it should be driven into the lateral part of the lateral mass&#46; However&#44; increased attention should be paid to the transverse foramen located close &#40;lateral&#41; to it&#44; that may have various dimensions or anatomical variants&#46; Another risk is posed by the vertebral artery passing lateral to the lateral mass&#46; Therefore&#44; we consider crucial to perform CT examination before each operation and assess each patient on a case-by-case basis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study limitations</span><p id="par0165" class="elsevierStylePara elsevierViewall">The advantage of our study is a high number of CT scans measured&#46; Another benefit is that age and gender were known in all our specimens&#46; A disadvantage is a small number of anatomical specimens and the age of our osteological collection&#44; i&#46;e&#46;&#44; 90 years&#46; This may explain the fact that the mean values measured on anatomical specimens did not always correlate with the values measured on CT scans&#46; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A&#44; B</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">We have documented growth of the atlas throughout the period of 0&#8722;18 years&#44; with the highest growth rate between 0 and 2 years&#46; In addition&#44; we have found out that the atlas not only grows during the development&#44; but also changes its shape&#46; In the youngest children the distance from the left to the right medial pedicle is relatively greater&#44; around the age of 5 years the dimensions become even and subsequently it is the distance from the inner wall of the anterior to the posterior arch which is relatively greater&#46; As a result&#44; the space for the dens axis and the space for the spinal cord are separated by their shapes&#46; The transverse foramen has a slightly oval shape throughout the period of growth&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The distance from the inferior pedicle to the inferior LM exceeds 3&#46;5&#160;mm in all the measured atlases in the age group of 5 and more years&#44; and in some specimens even at a younger age&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The study has proved adequate size of lateral masses for insertion of 3&#46;5-mm screws in all patients from the age of 5 years&#46; In younger children&#44; the patient&#180;s anatomy should be respected and the surgical technique tailored accordingly&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authors contribution</span><p id="par0185" class="elsevierStylePara elsevierViewall">Lucie Salavcov&#225;&#58; Project development&#44; data collection&#44; data analysis&#44; manuscript writing&#44; final approval&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Jan &#352;tul&#237;k&#58; Project development&#44; manuscript editing&#44; final approval&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Vojt&#283;ch &#352;tul&#237;k&#58; Data collection&#44; statistical analysis&#44; manuscript editing&#44; final approval&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Michaela Ryb&#225;rov&#225;&#58; Data collection&#44; manuscript editing&#44; final approval&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">G&#225;bor Geri&#58; Data collection&#44; manuscript writing&#44; final approval&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Ond&#345;ej Na&#328;ka&#58; Project development&#44; manuscript editing&#44; final approval&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">All authors reviewed the manuscript&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This study was supported by Cooperatio project - <span class="elsevierStyleGrantSponsor" id="gs0005">Morphological Disciplines of Medicine&#44; Charles University</span> and by <span class="elsevierStyleGrantSponsor" id="gs0010">Ministry of Health&#44; Czech Republic</span> &#8211; conceptual development of research organisation&#44; Motol University Hospital&#44; Prague&#44; Czech Republic 00064203 - Jan &#352;tul&#237;k&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no competing financial or non-financial interests to declare that are relevant to the content of this article&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Availability of data and material</span><p id="par0230" class="elsevierStylePara elsevierViewall">The data are obtained from institutional collection - Pachner&#180;s osteological collection of the Institute of Anatomy&#44; First Faculty of Medicine&#44; Charles University and from the database of the University Hospital Motol&#44; Charles University&#46; The datasets generated and analysed during the current study are available from the corresponding author on reasonable request&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethics approval</span><p id="par0235" class="elsevierStylePara elsevierViewall">We certify that the study was performer in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Consent to participate</span><p id="par0240" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Consent to publication</span><p id="par0245" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The objective of the study was&#58; &#40;1&#41; to describe changes in the shape of the atlas during growth&#44; including gender and side differences&#59; &#40;2&#41; to assess the dimension essential for identification of the optimal entry point&#59; &#40;3&#41; to determine the age limit for a safe insertion of 3&#46;5-mm screws into the lateral masses according to our own limiting parameters&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Dimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0&#8211;18 years and on 34 anatomical specimens of the first cervical vertebra &#40;aged 2&#46;5&#8211;18 years&#41;&#46; Both series were divided according to the gender and age&#46; The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The atlas reaches its maximum growth rate between 0 and 2 years of age&#44; then the growth decelerates and continues until the age of 18 years&#46; The proportion of dimensions of C1 vertebral foramens changes with age&#46; The youngest children show a relatively greater distance from the left to the right medial pedicle&#59; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater&#46; The transverse foramen has a slightly oval shape throughout the period of growth&#46; Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The study has proved adequate size of lateral masses for insertion of 3&#46;5-mm screws in all patients from the age of 5 years&#46; In younger children&#44; the patient&#180;s anatomy should be respected and the surgical technique tailored accordingly&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio era&#58; &#40;1&#41; describir los cambios en la forma del atlas durante el crecimiento&#44; incluyendo las diferencias de g&#233;nero y de lado&#59; &#40;2&#41; evaluar la dimensi&#243;n esencial para la identificaci&#243;n del punto de entrada &#243;ptimo&#59; &#40;3&#41; determinar el l&#237;mite de edad para una inserci&#243;n segura de tornillos de 3&#44;5&#160;mm en las masas laterales seg&#250;n nuestros propios par&#225;metros limitantes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Las dimensiones del atlas se midieron en 200 TC &#40;tomograf&#237;as computarizadas&#41; de la uni&#243;n craneocervical en individuos de 0 a 18 a&#241;os y en 34 espec&#237;menes anat&#243;micos de la primera v&#233;rtebra cervical &#40;de 2&#44;5 a 18 a&#241;os&#41;&#46; Ambas series se dividieron seg&#250;n el g&#233;nero y la edad&#46; Los valores medidos en las tomograf&#237;as computarizadas se utilizaron para la comparaci&#243;n estad&#237;stica de los datos en ni&#241;os y ni&#241;as y para la comparaci&#243;n de los lados derecho e izquierdo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">El atlas alcanza su tasa de crecimiento m&#225;xima entre los 0 y los 2 a&#241;os de edad&#44; despu&#233;s el crecimiento se desacelera y contin&#250;a hasta los 18 a&#241;os&#46; La proporci&#243;n de las dimensiones de los for&#225;menes vertebrales C1 cambia con la edad&#46; Los ni&#241;os m&#225;s j&#243;venes muestran una distancia relativamente mayor del ped&#237;culo medial izquierdo al derecho&#59; alrededor de los 5 a&#241;os los valores se igualan y posteriormente la distancia de la pared interna del arco anterior al posterior se vuelve relativamente mayor&#46; El foramen transverso tiene una forma ligeramente ovalada durante todo el per&#237;odo de crecimiento&#46; Se observaron diferencias estad&#237;sticamente significativas entre ni&#241;os y ni&#241;as principalmente entre los 12 y los 18 a&#241;os de edad&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">El estudio ha demostrado un tama&#241;o adecuado de las masas laterales para la inserci&#243;n de tornillos de 3&#44;5&#160;mm en todos los pacientes a partir de los 5 a&#241;os de edad&#46; En el caso de ni&#241;os m&#225;s peque&#241;os&#44; es necesario respetar la anatom&#237;a del paciente y adaptar la t&#233;cnica quir&#250;rgica en consecuencia&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Measured diameters of the atlas&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Lateral mass width minimum&#44; &#40;b&#41; lateral mass height maximum&#44; &#40;c&#41; lateral mass height minimum&#44; &#40;d&#41; distance from the left to the right medial pedicle&#44; &#40;e&#41; distance from the inner wall of the anterior to the posterior arch&#44; &#40;f&#41; distance from the left to the right transverse process&#44; &#40;g&#41; - distance from the anterior to the posterior tubercle&#44; &#40;h&#41; distance from the inferior pedicle to the inferior lateral mass&#44; &#40;i&#41; distance from the middle line to the midpoint of lateral mass&#44; &#40;j&#41; diameter of the transverse foramen &#8211; lateral dimension&#44; &#40;k&#41; diameter of the transverse foramen &#8211; anteroposterior dimension&#44; white line &#8211; middle line&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Change of the shape of the spinal canal at the C1 level on CT scans&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Initially&#44; the transverse dimension is greater&#44; followed by a circular shape of the vertebral foramen and finally by the predominant anteroposterior dimension&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Age&#58; a &#8211; 1y &#43;10&#160;m&#44; b &#8211; 5y &#43;2&#160;m&#44; c &#8211; 18y &#43;10&#160;m</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Change of the shape of the spinal canal at the C1 level on anatomical specimens&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Initially&#44; the transverse dimension is greater&#44; followed by a circular shape of the vertebral foramen and finally by the predominant anteroposterior dimension&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Age&#58; a - 2y &#43;2&#160;m&#44; b &#8211; 5y &#43;6&#160;m&#44; c &#8211; 18y</p>"
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NYD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NYD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NYD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;7&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;7 &#40;0&#44;7&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;1 &#40;1&#44;0&#8722;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;1 &#40;09&#8722;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8722;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8722;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;4 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;7 &#40;2&#44;5&#8722;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">265 &#40;2&#44;6&#8722;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;5 &#40;5&#44;2&#8722;5&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;45 &#40;3&#44;4&#8722;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;5&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;75 &#40;0&#44;6&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;1 &#40;0&#44;8&#8722;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;05 &#40;1&#44;0&#8722;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;35 &#40;0&#44;3&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;3&#8722;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;3&#8722;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;65 &#40;2&#44;3&#8722;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;45 &#40;2&#44;0&#8722;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;6 &#40;4&#44;8&#8722;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2 &#40;2&#44;8&#8722;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">p&#160;&#61;</span>&#160;0&#44;0238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8722;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;85 &#40;0&#44;8&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;8&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;2 &#40;1&#44;2&#8722;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;45 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;35 &#40;0&#44;3&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;35 &#40;0&#44;3&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;65 &#40;1&#44;6&#8722;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;35 &#40;0&#44;3&#8722;0&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;65 &#40;2&#44;6&#8722;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#44;75 &#40;5&#44;6&#8722;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;4 &#40;3&#44;4&#8722;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8722;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;7&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;7&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;35 &#40;1&#44;1&#8722;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5 &#40;1&#44;2&#8722;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45 &#40;0&#44;4&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;85 &#40;1&#44;8&#8722;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;85 &#40;1&#44;8&#8722;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45 &#40;0&#44;3-0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;55 &#40;0&#44;5&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;55 &#40;0&#44;5&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;5&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#40;2&#44;8&#8722;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;2&#44;7&#8722;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;25 &#40;5&#44;8&#8722;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#40;3&#44;4&#8722;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;7&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;6&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#40;1&#44;1&#8722;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3 &#40;1&#44;2&#8722;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;3&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;5&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#40;1&#44;7&#8722;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#40;1&#44;6&#8722;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;4 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;5&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;5&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;2&#44;5&#8722;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;2&#44;8&#8722;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;0 &#40;5&#44;8&#8722;6&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;6 &#40;3&#44;6&#8722;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;8 &#40;6&#44;1&#8722;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;9 &#40;3&#44;4&#8722;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8722;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;8&#8722;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;85 &#40;0&#44;7&#8722;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#40;1&#44;5&#8722;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8722;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;3&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;95 &#40;1&#44;6&#8722;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9 &#40;1&#44;7&#8722;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;5&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7 &#40;0&#44;5&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;65 &#40;0&#44;5&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#40;2&#44;4&#8722;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;15 &#40;2&#44;9&#8722;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;15 &#40;6&#44;5&#8722;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;1 &#40;3&#44;8&#8722;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;7&#8722;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;9 &#40;0&#44;7&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;1&#44;5&#8722;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8722;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;4&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;3&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;3&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9 &#40;1&#44;7&#8722;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9 &#40;1&#44;7&#8722;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5 &#40;0&#44;5&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;6 &#40;0&#44;5&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;2&#44;4&#8722;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#40;2&#44;6&#8722;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;9 &#40;6&#44;4&#8722;7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;9 &#40;3&#44;6&#8722;4&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">p&#160;&#61;</span>&#160;0&#44;0317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#8722;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;1 &#40;0&#44;9&#8722;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;75 &#40;0&#44;6&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;3&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;65 &#40;0&#44;5&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;6&#8722;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;5&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;7 &#40;0&#44;5&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;1 &#40;2&#44;7&#8722;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;35 &#40;3&#44;5&#8722;4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;1 &#40;0&#44;9&#8722;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;6&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;7 &#40;0&#44;5-1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;0 &#40;2&#44;7&#8722;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;3 &#40;2&#44;9&#8722;3&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#44;4 &#40;7&#44;0&#8722;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;1 &#40;3&#44;8&#8722;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">p&#160;&#61;</span>&#160;0&#44;0080&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0250" class="elsevierStylePara elsevierViewall">The authors wish to thank Ludmila B&#233;barov&#225;&#44; Ph&#46;D&#46; for her assistance with the editing of the manuscript&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed&#46; Results from such research can potentially increase mankind&#39;s overall knowledge that can then improve patient care&#46; Therefore&#44; these donors and their families deserve our highest gratitude&#46;</p>"
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Clinical Research
Pediatric atlas anatomy and its implications for fracture treatment: an anatomical and radiological study
Anatomía del atlas pediátrico y sus implicaciones en el tratamiento de fracturas: un estudio anatómico y radiológico
Lucie Salavcováa,b, Jan Štulíka, Vojtěch Štulíka, Michaela Rybárováa,b, Gábor Geria, Ondřej Naňkab,
Autor para correspondencia
ondrej.nanka@lf1.cuni.cz

Corresponding author.
a Department of Spinal Surgery, First Faculty of Medicine, University Hospital Motol, Charles University, Czech Republic
b Institute of Anatomy, First Faculty of Medicine, Charles University, Czech Republic
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Change of the shape of the spinal canal at the C1 level on CT scans&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Initially&#44; the transverse dimension is greater&#44; followed by a circular shape of the vertebral foramen and finally by the predominant anteroposterior dimension&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Age&#58; a &#8211; 1y &#43;10&#160;m&#44; b &#8211; 5y &#43;2&#160;m&#44; c &#8211; 18y &#43;10&#160;m</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The atlantoaxial complex is unique due to its anatomy and biomechanics&#46; The first cranial vertebra &#40;atlas&#41; does not have a body as it fuses during the development with the second cervical vertebra &#40;axis&#41; to form the dens axis&#46; Atlas usually develops from three primary ossification centers&#44; including two half-neural arches that begin to ossify as early as during the prenatal stage&#44; and one ossification center in the anterior arch which&#44; in 80&#37; ossifies during 1&#8211;2 years of age&#46; In about 20&#37; the anterior arch begins to ossify already before birth&#46; Half-neural arches fuse together approximately by 3 years&#46; Their fusion with the anterior arch occurs usually by 7 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The published studies dealing with the atlas &#40;C1&#41; have focused primarily on adults&#44; whereas only a few authors have presented exact data on the growth&#44; development and dimensions of the C1 vertebra or its age- or gender-related changes&#46; Piatt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Calvy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> concentrated in their study on atlas ossification and its variants&#46; Rao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> examined age-related morphological characteristics of C1&#44; especially closures of individual synchondroses&#46; Yoganandan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> studied geometrical properties of the C1 vertebra on child dummies used in motor vehicle crashworthiness evaluations&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Injuries to the atlas &#40;C1&#41; are very rare in children&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The literature contains primarily only case studies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Jefferson<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported in his original study on 46 fractures of C1&#44; of which only one was sustained by a child&#46; Atlas fractures in the pediatric population are treated predominantly non-operatively&#46; As a result&#44; there is only a limited body of knowledge and facts about operative treatment available in this context&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The objective of the study was&#58; &#40;1&#41; to describe changes in the shape of the atlas during its development from 0 to 18 years of age&#44; including gender and side differences&#59; &#40;2&#41; to assess the dimension essential for identification of the optimal entry point&#59; &#40;3&#41; to determine the age limit for a safe insertion of 3&#46;5-mm screws into the lateral masses according to our own limiting parameters&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We obtained 200 CT scans of the craniocervical junction from the database of the University Hospital in Motol&#44; Prague&#44; performed in patients with a healthy cervical spine at the age of 0&#8211;18 years&#44; in the 2015&#8722;2019 period&#46; Indication for CT examination was craniotrauma&#59; injuries to the cervical spine were excluded&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition&#44; we used 34 first cervical vertebrae &#40;aged 2&#46;5&#8211;18 years&#41; from the collection of the Institute of Anatomy of 1st Faculty of Medicine&#44; Charles University&#44; Prague&#46; We did not succeed in obtaining more pediatric C1 vertebrae even after contacting other institutes of anatomy&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Both series were divided&#44; based on the gender and age&#44; into 9 age periods&#58; 0&#8722;1&#44; 1&#8722;2&#44; 2&#8722;3&#44; 3&#8722;4&#44; 4&#8722;6&#44; 6&#8722;9&#44; 9&#8722;12&#44; 12&#8722;15&#44; 15&#8722;18 years of age&#44; with shorter intervals in lower age categories where a majority of changes was expected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The original software xViewer&#44; version 2&#46;7&#46;1 of the Toshiba Aquilion Prime CT scanner was used to measure the lateral mass &#40;LM&#41; width minimum &#40;a&#41;&#44; LM height maximum &#40;b&#41;&#44; LM height minimum &#40;c&#41;&#44; distance from the left to the right medial pedicle &#40;d&#41;&#44; distance from the inner wall of the anterior to the posterior arch &#40;e&#41;&#44; distance from the left to the right transverse process &#40;f&#41;&#44; distance from the anterior tubercle to the posterior tubercle &#40;g&#41;&#44; distance from the inferior pedicle to the inferior LM &#40;h&#41;&#44; distance from the middle line to the midpoint of LM &#40;i&#41;&#44; diameter of the transverse foramen in coronal plane &#40;j&#41;&#44; diameter of the transverse foramen in sagittal plane &#40;k&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The same parameters were measured in a group of C1 vertebrae without patologic findings&#46; We used the digital caliper&#46; The values measured served for calculation of the mean value and the standard deviation&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Descriptive statistics were employed to summarize the morphological measurements of the atlas dimensions across the nine distinct age groups and by gender &#40;males and females&#41;&#46; A Kruskal-Wallis test assessed age group differences in C1 dimensions&#46; A Mann&#8211;Whitney U test compared C1 dimensions between males and females within each age group&#44; revealing gender-related variations&#46; Due to low patient numbers in the 0&#8722;1 age group&#44; only descriptive statistics were employed&#46; The statistical significance level was set on 0&#46;05&#46; Statistical analyses were performed using GraphPad Prism version 10&#46;0&#46;0 for Windows &#40;GraphPad Software&#44; Boston&#44; Massachusetts USA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The C1 vertebra reaches its maximum growth rate between 0 and 2 years of age&#44; the atlas then continues to grow until the age of 18 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A&#44; B</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Atlas width &#8211; the distance from the left to the right transverse process &#40;f&#41; more than doubles from birth to maturity&#44; with the highest growth rate between 0 and 1&#160;year of age&#46; Then the growth decelerates&#46; By contrast&#44; the distance from the inner wall of the anterior to the posterior arch &#40;e&#41; is relatively less increased by the age of 18 years &#8211; approximately 1&#46;5 times &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">During growth there occur changes in the shape of the spinal canal at the C1 level&#46; The proportion of dimensions changes with age&#46; The youngest children show a relatively greater distance from the left to the right medial pedicle&#59; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Between 0 and 18 years of age&#44; the lateral mass grows most notably in the LM height minimum parameter &#40;c&#41;&#44; increasing more than three times&#59; the LM height maximum &#40;b&#41; increases more than twice and the increase in the LM width minimum &#40;a&#41; is relatively the smallest &#8211; less than a double &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The diameter of the transverse foramen in the coronal plane &#40;j&#41; remains&#44; throughout the growth&#44; smaller than that in the sagittal plane &#40;k&#41;&#46; As a result&#44; the transverse foramen has a slightly oval shape&#46; The highest growth rate was recorded in both these dimensions in the age category of 0&#8722;1&#160;year &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">For comparison of the right and left sides&#44; we measured the distance from the middle line to the midpoint of LM &#40;i&#41;&#46; No statistically significant difference was found in this parameter in any age category&#46; The growth rate was the highest in the age category of 0&#8722;1&#160;year&#44; then it decelerated and by the age of 18 years it was less than a double &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The distance from the inferior pedicle to the inferior LM &#40;h&#41; triples by the age of 18 years&#46; The highest growth ratio was observed between 0 and 2 years of age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">These measurements made on CT scans correlated in a majority of cases with the data obtained from anatomical specimens &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A&#44; B</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">The Kruskal-Wallis test detected statistically significant differences in all the measured parameters across age groups&#44; both for males and females analyzed separately&#46; Therefore&#44; there is evidence to suggest that all the measured parameters exhibit variations with age as a child undergoes growth and development &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> measured CT scans of pediatric atlases in the 0&#8722;14 age group and observed the highest growth rate of the atlas in children aged 0&#8211;2 years&#46; This finding corresponds to our measurements &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; They also point out that further studies are needed to assess whether the atlas continues to grow after 14 years&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> According to Warner et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> the ring of C1 reaches about normal adult size by 4 years of age&#46; However&#44; a majority of the parameters we measured&#44; keep increasing until the age of 18 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">According to &#352;tul&#237;k et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> the dimension of C2 dens on a transverse CT scan at the level of the inferior edge of the anterior arch of the atlas is greater in the youngest children&#59; at the age of about 10&#8211;12 years the dimensions become even and the dens has a circular shape&#59; and in older children the anteroposterior dimension of the dens is greater&#46; Due to a close relationship between the atlas and the axis&#44; we examined whether these changes are reflected also in the C1 vertebra&#46; In the youngest children&#44; the distance from the left to the right medial pedicle is slightly greater than the distance from the inner wall of anterior to posterior arch&#46; Around the age of 5 years the dimensions become even and subsequently the distance from the inner wall of anterior to posterior arch predominates &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; This change in proportions of the atlas inside dimensions corresponds with the changes in the C2 dens&#44; although in our study group the dimensions became even much sooner&#46; No such change occurs in the atlas outside dimensions&#59; according to our measurements&#44; the distance from the left to the right transverse process is always greater than the distance from the anterior tubercle to the posterior tubercle &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">These changes are associated with the increasing inside diameter of the spinal canal and the changing size of the spinal cord&#46; Our study group showed gradual changes in the shape of the vertebral foramen at the C1 level&#44; when the anterior space for the dens axis gets gradually narrower than the space in the posterior part of the spinal canal reserved for the spinal cord&#46; This change probably results from the relatively substantial spinal cord in the prenatal period&#44; whereas the space for the dens axis&#44; squeezed between the C1 lateral masses&#44; remains narrower and adapts to the shape of the dens &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; This increases stability of the atlantoaxial articulation&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The knowledge of the shape and size of the transverse foramen is essential for insertion of the LM screw&#46; Therefore&#44; we measured the diameter of the transverse foramen &#8211; the lateral and the anteroposterior dimensions&#44; and their development with growing age&#46; The mean diameter of the transverse foramen &#8211; the anteroposterior dimension&#44; was greater in our group in most cases&#44; as compared to the mean diameter of the transverse foramen &#8211; the lateral dimension &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A</a>&#41;&#46; Our findings document that the transverse foramen has mostly a slightly oval shape throughout the period of growth&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">According to Scheuer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> the foramens are usually near to completion by years 3&#8211;4&#46; However&#44; we found in our series open transverse foramens in all age categories up to the age of 18 years&#44; with a majority of them in the youngest age groups&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Chamoun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> measured dimensions of atlases of children aged 1&#46;5&#8211;16 years on 76 CT scans&#46; They found statistically significant differences between boys and girls for 2 measurements&#58; the minimum screw length and the anterior height of the lateral mass&#46; Nevertheless&#44; the authors considered these differences to be clinically insignificant&#46; Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> did not analyze differences between genders&#46; In our series&#44; statistically significant differences can be seen mainly in age categories of 12&#8211;15 years and 15&#8211;18 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; This corresponds to the study by &#352;tul&#237;k et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> who measured C2 in children and found statistically significant differences between boys and girls aged 13 years and more&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Geck et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> measured C1 on CT scans in 50 children aged 2&#8211;6 years and found no statistically significant difference between the right and left sides in any of the parameters measured&#46; Chamoun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> found a statistically significant difference between the right and left sides for the maximum medialized screw trajectory and the maximum inferior screw trajectory&#46; Deng et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> measured C1 in 10 cadavers in the age group of 6&#8211;8 years and found no statistical differences between the bilateral parameters in this measurement&#46; According to Chen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in most of the indicators no significant difference was observed between the left and right sides&#46; Simsek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> measured 40 anatomic specimens of adults and found no statistically significant difference between the right and the left sides&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">For the sake of the best comparison of the right and left sides&#44; we measured the distance from the middle line to the midpoint of LM &#40;i&#41;&#46; This parameter showed no statistically significant difference in any age category&#46; According to the above mentioned findings&#44; the differences between the right and left sides are minimal&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Identification of the appropriate entry point is crucial for insertion of the LM screw and requires a profound knowledge of the anatomy of the craniocervical junction&#46; Excessively medial placement of the screw poses a risk of damage to the spinal cord&#44; its excessively lateral placement endangers the vertebral artery&#46; An optimal entry point for insertion of the LM screw is reportedly the center of the lateral mass&#46; Goel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> preferred insertion of the screw to the center of the posterior surface of the C1 inferior articular process&#44; 1&#8211;2&#160;mm above the articular facet&#46; Harms and Melcher<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> defined the entry point as a center of the posterior surface of the inferior articular process at the junction of the posterior arch and the lateral mass&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">An important role in insertion of the LM screw is played by the craniocaudal dimension of the lateral mass below the posterior arch&#46; Optimal for identification of an ideal entry point and a safe insertion of the screw is the distance between the inferior pedicle and the inferior LM of more than 3&#46;5&#160;mm&#46; According to our measurements&#44; it occurred in all samples in the age group of 5 and more years&#44; and in some specimens even at a younger age&#46; Therefore&#44; of key importance in this context is preoperative CT examination and a case-by-case assessment of each patient&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The approach to the C1 lateral mass is complicated by the greater occipitalis nerve and venous plexus&#46; Goel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> recommended a sharp dissection of the nerve and bipolar coagulation to control bleeding from the venous plexus&#46; Harms and Melcher<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> preferred to retract the nerve caudally and control bleeding by means of bipolar coagulation in combination with tamponade&#46; &#352;tul&#237;k et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> retracted the greater occipital nerve caudally towards C2 and controlled bleeding by a quick insertion of a screw and compression of the venous plexus with the screw head&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Insertion of a C1 LM screw requires a profound knowledge of the anatomy of the first cervical vertebra and its dimensions&#46; There are numerous studies dealing with dimensions of the atlas in adults&#46; According to Gupta and Goel<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and Wang et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> the measured C1 dimensions allow insertion of a 3&#46;5-mm LM screw in all adults&#46; However&#44; the authors have measured different parameters and their opinions on so-called restrictive parameter&#47;s for insertion of an LM screw vary&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">According to Su et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> the restrictive factor for insertion of an LM screw into an adult C1 vertebra is the minimal LM height &#40;4&#46;4&#8211;9&#46;0&#160;mm&#41;&#46; Chamoun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> measured LM on the sagittal section through the center of the lateral mass anteriorly and posteriorly&#46; In their view&#44; the critical measurement in terms of insertion of an LM screw is the LM width&#44; when only in one case &#40;a 19-month old child&#41; the LM width was less than 4&#160;mm&#46; Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> considered the LM height to be the limiting dimension for insertion of an LM screw&#44; measured as the distance between the midpoint of the upper and lower edges of the lateral mass&#46; In their opinion&#44; a 3&#46;5-mm LM screw can be used in children aged 2 years and more&#46; Geck et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> measured only the C1 LM width and length and&#44; based on their findings&#44; a 3&#46;5-mm LM screw could be used in all of them&#46; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> measured CT scans in 37 children younger than 10 years&#46; The limiting factor for insertion of a 3&#46;5-mm screw into the LM was the entry point height &#40;only in 47&#46;3&#37; of patients this dimension was more than 3&#46;5&#160;mm&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In our view&#44; insertion of a 3&#46;5-mm LM screw is limited by dimensions a &#40;LM width minimum&#41;&#44; b &#40;LM height maximum&#41;&#44; c &#40;LM height minimum&#41;&#46; Dimensions a and b are in all measured specimens greater than 3&#46;5&#160;mm&#44; therefore&#44; dimension c is decisive&#46; From the age of 5 years dimensions c are always 4&#160;mm and more and thus allow a safe insertion of 3&#46;5-mm screws into the lateral masses&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The fact that c is less than 3&#46;5&#160;mm does not rule out the possibility of insertion of a 3&#46;5-mm LM screw&#44; but it should be driven into the lateral part of the lateral mass&#46; However&#44; increased attention should be paid to the transverse foramen located close &#40;lateral&#41; to it&#44; that may have various dimensions or anatomical variants&#46; Another risk is posed by the vertebral artery passing lateral to the lateral mass&#46; Therefore&#44; we consider crucial to perform CT examination before each operation and assess each patient on a case-by-case basis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study limitations</span><p id="par0165" class="elsevierStylePara elsevierViewall">The advantage of our study is a high number of CT scans measured&#46; Another benefit is that age and gender were known in all our specimens&#46; A disadvantage is a small number of anatomical specimens and the age of our osteological collection&#44; i&#46;e&#46;&#44; 90 years&#46; This may explain the fact that the mean values measured on anatomical specimens did not always correlate with the values measured on CT scans&#46; &#40;<a class="elsevierStyleCrossRef" href="#sec0080">Appendix A&#44; B</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">We have documented growth of the atlas throughout the period of 0&#8722;18 years&#44; with the highest growth rate between 0 and 2 years&#46; In addition&#44; we have found out that the atlas not only grows during the development&#44; but also changes its shape&#46; In the youngest children the distance from the left to the right medial pedicle is relatively greater&#44; around the age of 5 years the dimensions become even and subsequently it is the distance from the inner wall of the anterior to the posterior arch which is relatively greater&#46; As a result&#44; the space for the dens axis and the space for the spinal cord are separated by their shapes&#46; The transverse foramen has a slightly oval shape throughout the period of growth&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The distance from the inferior pedicle to the inferior LM exceeds 3&#46;5&#160;mm in all the measured atlases in the age group of 5 and more years&#44; and in some specimens even at a younger age&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The study has proved adequate size of lateral masses for insertion of 3&#46;5-mm screws in all patients from the age of 5 years&#46; In younger children&#44; the patient&#180;s anatomy should be respected and the surgical technique tailored accordingly&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authors contribution</span><p id="par0185" class="elsevierStylePara elsevierViewall">Lucie Salavcov&#225;&#58; Project development&#44; data collection&#44; data analysis&#44; manuscript writing&#44; final approval&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Jan &#352;tul&#237;k&#58; Project development&#44; manuscript editing&#44; final approval&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Vojt&#283;ch &#352;tul&#237;k&#58; Data collection&#44; statistical analysis&#44; manuscript editing&#44; final approval&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Michaela Ryb&#225;rov&#225;&#58; Data collection&#44; manuscript editing&#44; final approval&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">G&#225;bor Geri&#58; Data collection&#44; manuscript writing&#44; final approval&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Ond&#345;ej Na&#328;ka&#58; Project development&#44; manuscript editing&#44; final approval&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">All authors reviewed the manuscript&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This study was supported by Cooperatio project - <span class="elsevierStyleGrantSponsor" id="gs0005">Morphological Disciplines of Medicine&#44; Charles University</span> and by <span class="elsevierStyleGrantSponsor" id="gs0010">Ministry of Health&#44; Czech Republic</span> &#8211; conceptual development of research organisation&#44; Motol University Hospital&#44; Prague&#44; Czech Republic 00064203 - Jan &#352;tul&#237;k&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors have no competing financial or non-financial interests to declare that are relevant to the content of this article&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Availability of data and material</span><p id="par0230" class="elsevierStylePara elsevierViewall">The data are obtained from institutional collection - Pachner&#180;s osteological collection of the Institute of Anatomy&#44; First Faculty of Medicine&#44; Charles University and from the database of the University Hospital Motol&#44; Charles University&#46; The datasets generated and analysed during the current study are available from the corresponding author on reasonable request&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethics approval</span><p id="par0235" class="elsevierStylePara elsevierViewall">We certify that the study was performer in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Consent to participate</span><p id="par0240" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Consent to publication</span><p id="par0245" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The objective of the study was&#58; &#40;1&#41; to describe changes in the shape of the atlas during growth&#44; including gender and side differences&#59; &#40;2&#41; to assess the dimension essential for identification of the optimal entry point&#59; &#40;3&#41; to determine the age limit for a safe insertion of 3&#46;5-mm screws into the lateral masses according to our own limiting parameters&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Dimensions of the atlas were measured on 200 CT scans of the craniocervical junction in individuals aged 0&#8211;18 years and on 34 anatomical specimens of the first cervical vertebra &#40;aged 2&#46;5&#8211;18 years&#41;&#46; Both series were divided according to the gender and age&#46; The values measured on CT scans were used for statistical comparison of data in boys and girls and comparison of the right and left sides&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The atlas reaches its maximum growth rate between 0 and 2 years of age&#44; then the growth decelerates and continues until the age of 18 years&#46; The proportion of dimensions of C1 vertebral foramens changes with age&#46; The youngest children show a relatively greater distance from the left to the right medial pedicle&#59; around the age of 5 the values get even and subsequently the distance from the inner wall of anterior to posterior arch gets relatively greater&#46; The transverse foramen has a slightly oval shape throughout the period of growth&#46; Statistically significant differences between boys and girls were observed primarily between 12 and 18 years of age&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The study has proved adequate size of lateral masses for insertion of 3&#46;5-mm screws in all patients from the age of 5 years&#46; In younger children&#44; the patient&#180;s anatomy should be respected and the surgical technique tailored accordingly&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio era&#58; &#40;1&#41; describir los cambios en la forma del atlas durante el crecimiento&#44; incluyendo las diferencias de g&#233;nero y de lado&#59; &#40;2&#41; evaluar la dimensi&#243;n esencial para la identificaci&#243;n del punto de entrada &#243;ptimo&#59; &#40;3&#41; determinar el l&#237;mite de edad para una inserci&#243;n segura de tornillos de 3&#44;5&#160;mm en las masas laterales seg&#250;n nuestros propios par&#225;metros limitantes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Las dimensiones del atlas se midieron en 200 TC &#40;tomograf&#237;as computarizadas&#41; de la uni&#243;n craneocervical en individuos de 0 a 18 a&#241;os y en 34 espec&#237;menes anat&#243;micos de la primera v&#233;rtebra cervical &#40;de 2&#44;5 a 18 a&#241;os&#41;&#46; Ambas series se dividieron seg&#250;n el g&#233;nero y la edad&#46; Los valores medidos en las tomograf&#237;as computarizadas se utilizaron para la comparaci&#243;n estad&#237;stica de los datos en ni&#241;os y ni&#241;as y para la comparaci&#243;n de los lados derecho e izquierdo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">El atlas alcanza su tasa de crecimiento m&#225;xima entre los 0 y los 2 a&#241;os de edad&#44; despu&#233;s el crecimiento se desacelera y contin&#250;a hasta los 18 a&#241;os&#46; La proporci&#243;n de las dimensiones de los for&#225;menes vertebrales C1 cambia con la edad&#46; Los ni&#241;os m&#225;s j&#243;venes muestran una distancia relativamente mayor del ped&#237;culo medial izquierdo al derecho&#59; alrededor de los 5 a&#241;os los valores se igualan y posteriormente la distancia de la pared interna del arco anterior al posterior se vuelve relativamente mayor&#46; El foramen transverso tiene una forma ligeramente ovalada durante todo el per&#237;odo de crecimiento&#46; Se observaron diferencias estad&#237;sticamente significativas entre ni&#241;os y ni&#241;as principalmente entre los 12 y los 18 a&#241;os de edad&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">El estudio ha demostrado un tama&#241;o adecuado de las masas laterales para la inserci&#243;n de tornillos de 3&#44;5&#160;mm en todos los pacientes a partir de los 5 a&#241;os de edad&#46; En el caso de ni&#241;os m&#225;s peque&#241;os&#44; es necesario respetar la anatom&#237;a del paciente y adaptar la t&#233;cnica quir&#250;rgica en consecuencia&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Measured diameters of the atlas&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Lateral mass width minimum&#44; &#40;b&#41; lateral mass height maximum&#44; &#40;c&#41; lateral mass height minimum&#44; &#40;d&#41; distance from the left to the right medial pedicle&#44; &#40;e&#41; distance from the inner wall of the anterior to the posterior arch&#44; &#40;f&#41; distance from the left to the right transverse process&#44; &#40;g&#41; - distance from the anterior to the posterior tubercle&#44; &#40;h&#41; distance from the inferior pedicle to the inferior lateral mass&#44; &#40;i&#41; distance from the middle line to the midpoint of lateral mass&#44; &#40;j&#41; diameter of the transverse foramen &#8211; lateral dimension&#44; &#40;k&#41; diameter of the transverse foramen &#8211; anteroposterior dimension&#44; white line &#8211; middle line&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Change of the shape of the spinal canal at the C1 level on CT scans&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Initially&#44; the transverse dimension is greater&#44; followed by a circular shape of the vertebral foramen and finally by the predominant anteroposterior dimension&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Age&#58; a &#8211; 1y &#43;10&#160;m&#44; b &#8211; 5y &#43;2&#160;m&#44; c &#8211; 18y &#43;10&#160;m</p>"
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        "etiqueta" => "Fig&#46; 3"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Change of the shape of the spinal canal at the C1 level on anatomical specimens&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Initially&#44; the transverse dimension is greater&#44; followed by a circular shape of the vertebral foramen and finally by the predominant anteroposterior dimension&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Age&#58; a - 2y &#43;2&#160;m&#44; b &#8211; 5y &#43;6&#160;m&#44; c &#8211; 18y</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">N &#8211; number&#44; a &#8211; lateral mass width minimum&#44; b &#8211; lateral mass height maximum&#44; c &#8211; lateral mass height minimum&#44; d &#8211; distance from the left to the right medial pedicle&#44; e &#8211; distance from the inner wall of the anterior to the posterior arch&#44; f &#8211; distance from the left to the right transverse process&#44; g - distance from the anterior to the posterior tubercle&#44; h &#8211; distance from the inferior pedicle to the inferior lateral mass&#44; i &#8211; distance from the middle line to the midpoint of lateral mass&#44; j &#8211; diameter of the transverse foramen &#8211; lateral dimension&#44; k &#8211; diameter of the transverse foramen &#8211; anteroposterior dimension&#44; NYD - not yet developed&#44; ns - not significant&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Units of measurement &#8211; milimeter &#40;mm&#41;&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Values are reported as median &#40;min - max value&#41;&#46; Mann - Whitney U test was used to test inter-sex differences&#44; level of significance was set at 0&#46;05&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">No statistical anylsis was used for age group 0&#8722;1 due to small sample size&#44; instead values of all patients are listed &#40;n&#160;&#61;&#160;3&#41;&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;65 &#40;2&#44;3&#8722;3&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;6 &#40;4&#44;8&#8722;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;2 &#40;2&#44;8&#8722;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">p&#160;&#61;</span>&#160;0&#44;0238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&#8722;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;85 &#40;0&#44;8&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;8&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;2 &#40;1&#44;2&#8722;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;25 &#40;1&#44;2&#8722;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;75 &#40;2&#44;7&#8722;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#44;0 &#40;5&#44;9&#8722;6&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;55 &#40;3&#44;5&#8722;3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;75 &#40;0&#44;7&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;65 &#40;1&#44;6&#8722;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4-0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;65 &#40;2&#44;6&#8722;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;7 &#40;2&#44;4&#8722;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;75 &#40;5&#44;6&#8722;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;4 &#40;3&#44;4&#8722;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#8722;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;7&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;7&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;35 &#40;1&#44;1&#8722;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;5 &#40;1&#44;2&#8722;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;45 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;45 &#40;0&#44;4&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;4 &#40;0&#44;3&#8722;0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;85 &#40;1&#44;8&#8722;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;85 &#40;1&#44;8&#8722;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;45 &#40;0&#44;3-0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;55 &#40;0&#44;5&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;55 &#40;0&#44;5&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;6 &#40;0&#44;5&#8722;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;0 &#40;2&#44;8&#8722;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;8 &#40;2&#44;7&#8722;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">6&#44;25 &#40;5&#44;8&#8722;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#40;3&#44;4&#8722;3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;7&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;8 &#40;0&#44;6&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;45 &#40;1&#44;2&#8722;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;85 &#40;2&#44;4&#8722;3&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9 &#40;2&#44;5&#8722;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;8 &#40;6&#44;1&#8722;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;9 &#40;3&#44;4&#8722;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ns&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8722;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;8&#8722;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;85 &#40;0&#44;7&#8722;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;5&#8722;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8722;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;3&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;95 &#40;1&#44;6&#8722;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;7&#8722;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;6 &#40;0&#44;4&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;6 &#40;0&#44;5&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;7 &#40;0&#44;5&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;65 &#40;0&#44;5&#8722;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#44;0 &#40;2&#44;4&#8722;3&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#44;15 &#40;2&#44;9&#8722;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#44;15 &#40;6&#44;5&#8722;8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#44;1 &#40;3&#44;8&#8722;4&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;7&#8722;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;9 &#40;0&#44;7&#8722;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;5&#8722;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;4&#8722;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;6 &#40;0&#44;4&#8722;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;5 &#40;0&#44;4&#8722;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">median &#40;min - max value&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mann - Whitney U test&nbsp;\t\t\t\t\t\t\n
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0250" class="elsevierStylePara elsevierViewall">The authors wish to thank Ludmila B&#233;barov&#225;&#44; Ph&#46;D&#46; for her assistance with the editing of the manuscript&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed&#46; Results from such research can potentially increase mankind&#39;s overall knowledge that can then improve patient care&#46; Therefore&#44; these donors and their families deserve our highest gratitude&#46;</p>"
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Información del artículo
ISSN: 25298496
Idioma original: Inglés
DOI:10.1016/j.neucie.2024.01.001
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