Sample records for medial branch block

  1. Technique for CT Fluoroscopy-Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation.

    PubMed

    Amrhein, Timothy J; Joshi, Anand B; Kranz, Peter G

    2016-09-01

    The purpose of this study is to describe the procedure for CT fluoroscopy-guided lumbar medial branch blocks and facet radiofrequency ablation. CT fluoroscopic guidance allows more-precise needle tip positioning and is an alternative method for performing medial branch blocks and facet radiofrequency ablation.

  2. The benefit of therapeutic medial branch blocks after cervical operations.

    PubMed

    Klessinger, Stephan

    2010-01-01

    Persistent neck pain is a common problem after surgery of the cervical spine. No therapy recommendation exists for these patients. The objective of this study was to determine if a therapeutic medial branch block is a rational treatment for patients with postoperative neck pain after cervical spine operations. Retrospective practice audit. Review of charts of all patients who underwent cervical spine operations for degenerative reasons during a time period of 3 years. Patients with persistent postsurgical pain were treated with therapeutic medial branch blocks (local anesthetic and steroid). A positive treatment response was defined if at least 80% reduction of pain could be achieved or if the patient was sufficiently satisfied with the relief. All patients with a minimum follow up time of 6 months were included. Of the 312 operations performed, 128 were artificial disc operations, 125 were stand alone cages, and 59 were fusions with cage and plate. Persistent neck pain occurred in 33.3% of the patients. There was no difference between the patients with neck pain and the whole group of patients. More than half of the patients with neck pain--52.9%--were treated successfully with therapeutic medial branch blocks. Since no further treatment was necessary, the initial treatment was considered successful. Nearly a third--32.2%--of the patients were initially treated successfully, but their pain recurred and further diagnostics and treatments were necessary. In this group of patients, significantly more with double level operations were found (P = 0.003). Patients not responding to the medial branch block were 14.9%. This audit is retrospective and observational, and therefore does not represent a high level of evidence. However, to our knowledge, since this information has not been previously reported and no recommendation for the treatment of post-operative zygapophysial joint pain exists, it appears to be the best available research upon which to recommend treatment

  3. Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D.; Hirsch, Joshua A.

    2017-01-01

    Background:Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design:Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives:To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results:The results showed direct procedural

  4. Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain.

    PubMed

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D; Hirsch, Joshua A

    2017-01-01

    Background: Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design: Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives: To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results: The results showed direct

  5. Effect of Pulsed Radiofrequency Treatment on the Thoracic Medial Branch for Managing Chronic Thoracic Facet Joint Pain Refractory to Medial Branch Block with Local Anesthetics.

    PubMed

    Chang, Min Cheol

    2018-03-01

    To evaluate the effect of pulsed radiofrequency (PRF) stimulation of the thoracic medial branch of the dorsal ramus in patients with chronic thoracic facet joint (TFJ) pain who were refractory to medial branch block (MBB). This was a prospective, observational study. The author retrospectively reviewed data from 72 patients who had received therapeutic MBB with 0.5 mL of 2% lidocaine mixed with 0.5 mL of 0.25% bupivacaine to treat TFJ-origin upper or midback pain. Of these patients, 20 were included to evaluate the effects of PRF on the thoracic medical branch to manage TFJ pain refractory to therapeutic MBB. PRF stimulation was administered at 5 Hz and a 5-millisecond pulsed width for 360 seconds at 45 V. The pain-reducing effect of the PRF procedure was evaluated via the numeric rating scale (NRS) at 1, 2, and 3 months after treatment. Successful pain relief was defined as ≥50% reduction in the NRS score compared with the score before treatment. The NRS scores changed significantly over time (pretreatment, 6.0 ± 1.0; 1 month, 3.3 ± 2.2; 2 months, 3.9 ± 2.1; and 3 months, 4.0 ± 2.2). At 1, 2, and 3 months after the PRF procedure, the NRS scores were significantly reduced compared with the scores before the treatment. Eleven (55%) of 20 patients reported successful pain relief at 3 months after PRF. The author suggests that PRF on the thoracic medial branch is an effective and safe interventional technique for the control of chronic TFJ pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Anatomical analysis of medial branches of dorsal rami of cervical nerves for radiofrequency thermocoagulation.

    PubMed

    Kweon, Tae Dong; Kim, Ji Young; Lee, Hye Yeon; Kim, Myung Hwa; Lee, Youn-Woo

    2014-01-01

    Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation. Twenty cervical specimens were harvested from 20 adult cadavers. The anatomical parameters of the C4-C7 cervical medial branches were measured. The 3-dimensional computed tomography reconstruction images of the bone were also analyzed. Based on cadaveric analysis, most of the cervical dorsal rami gave off 1 medial branch; however, the cervical dorsal rami gave off 2 medial branches in 27%, 15%, 2%, and 0% at the vertebral level C4, C5, C6, and C7, respectively. The diameters of the medial branches varied from 1.0 to 1.2 mm, and the average distance from the notch of inferior articular process to the medial branches was about 2 mm. Most of the bifurcation sites were located at the medial side of the posterior tubercle of the transverse process. On the analysis of 3-dimensional computed tomography reconstruction images, cervical medial branches (C4 to C6) passed through the upper 49% to 53% of a line between the tips of 2 consecutive superior articular processes (anterior line). Also, cervical medial branches passed through the upper 28% to 35% of a line between the midpoints of 2 consecutive facet joints (midline). The present anatomical study may help improve accuracy and safety during radiofrequency denervation of the cervical medial branches.

  7. The Role of Thoracic Medial Branch Blocks in Managing Chronic Mid and Upper Back Pain: A Randomized, Double-Blind, Active-Control Trial with a 2-Year Followup

    PubMed Central

    Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J. E.; Cash, Kimberly A.; Pampati, Vidyasagar; Fellows, Bert

    2012-01-01

    Study Design. A randomized, double-blind, active-control trial. Objective. To determine the clinical effectiveness of therapeutic thoracic facet joint nerve blocks with or without steroids in managing chronic mid back and upper back pain. Summary of Background Data. The prevalence of thoracic facet joint pain has been established as 34% to 42%. Multiple therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include medial branch blocks, radiofrequency neurotomy, and intraarticular injections. Methods. This randomized double-blind active controlled trial was performed in 100 patients with 50 patients in each group who received medial branch blocks with local anesthetic alone or local anesthetic and steroids. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results. Significant improvement with significant pain relief and functional status improvement of 50% or more were observed in 80% of the patients in Group I and 84% of the patients in Group II at 2-year followup. Conclusions. Therapeutic medial branch blocks of thoracic facets with or without steroids may provide a management option for chronic function-limiting thoracic pain of facet joint origin. PMID:22851967

  8. Anatomical medial surfaces with efficient resolution of branches singularities.

    PubMed

    Gil, Debora; Vera, Sergio; Borràs, Agnés; Andaluz, Albert; González Ballester, Miguel A

    2017-01-01

    Medial surfaces are powerful tools for shape description, but their use has been limited due to the sensibility of existing methods to branching artifacts. Medial branching artifacts are associated to perturbations of the object boundary rather than to geometric features. Such instability is a main obstacle for a confident application in shape recognition and description. Medial branches correspond to singularities of the medial surface and, thus, they are problematic for existing morphological and energy-based algorithms. In this paper, we use algebraic geometry concepts in an energy-based approach to compute a medial surface presenting a stable branching topology. We also present an efficient GPU-CPU implementation using standard image processing tools. We show the method computational efficiency and quality on a custom made synthetic database. Finally, we present some results on a medical imaging application for localization of abdominal pathologies. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Bundle Branch Block

    MedlinePlus

    ... known cause. Causes can include: Left bundle branch block Heart attacks (myocardial infarction) Thickened, stiffened or weakened ... myocarditis) High blood pressure (hypertension) Right bundle branch block A heart abnormality that's present at birth (congenital) — ...

  10. ["Habitual" left branch block alternating with 2 "disguised" bracnch block].

    PubMed

    Lévy, S; Jullien, G; Mathieu, P; Mostefa, S; Gérard, R

    1976-10-01

    Two cases of alternating left bundle branch block and "masquerading block" (with left bundle branch morphology in the stnadard leads and right bundle branch block morphology in the precordial leads) were studied by serial tracings and his bundle electrocardiography. In case 1 "the masquerading" block was associated with a first degree AV block related to a prolongation of HV interval. This case is to our knowledge the first cas of alternating bundle branch block in which his bundle activity was recorded in man. In case 2, the patient had atrial fibrilation and His bundle recordings were performed while differents degrees of left bundle branch block were present: The mechanism of the alternation and the concept of "masquerading" block are discussed. It is suggested that this type of block represents a right bundle branch block associated with severe lesions of the "left system".

  11. Morphometry of medial gaps of human brain artery branches.

    PubMed

    Canham, Peter B; Finlay, Helen M

    2004-05-01

    The bifurcation regions of the major human cerebral arteries are vulnerable to the formation of saccular aneurysms. A consistent feature of these bifurcations is a discontinuity of the tunica media at the apex of the flow divider. The objective was to measure the 3-dimensional geometry of these medial gaps or "medial defects." Nineteen bifurcations and 2 junctions of human cerebral arteries branches (from 4 male and 2 female subjects) were formalin-fixed at physiological pressure and processed for longitudinal serial sectioning. The apex and adjacent regions were examined and measurements were made from high-magnification photomicrographs, or projection microscope images, of the gap dimensions at multiple levels through the bifurcation. Plots were made of the width of the media as a function of distance from the apex. The media at each edge of the medial gap widened over a short distance, reaching the full width of the media of the contiguous daughter vessel. Medial gap dimensions were compared with the planar angle of the bifurcation, and a strong negative correlation was found, ie, the acute angled branches have the more prominent medial gaps. A discontinuity of the media at the apex was seen in all the bifurcations examined and was also found in the junction regions of brain arteries. We determined that the gap width is continuous with well-defined dimensions throughout its length and average length-to-width ratio of 6.9. The gaps were generally centered on the prominence of the apical ridge.

  12. Efficacy of pulsed radiofrequency medial branch treatment in low back pain patients.

    PubMed

    Kim, Do Hyoung; Han, Seong Rok; Choi, Chan Young; Sohn, Moon Jun; Lee, Chae Heuck

    2016-04-27

    It was thought that the efficacy of pulsed radiofrequency (PRF) treatment of the medial branch in patients with lower back pain was not as long lasting as that of continuous radiofrequency (CRF) thermo-coagulation techniques. The goal of this study was to determine the efficacy and the long-term effects of PRF treatment of the medial branch in selected low back pain patients. We retrospectively reviewed and analyzed patients with lower back pain who underwent PRF treatment on the medial branch at our institute. Pain relief was evaluated by visual analog scale (VAS) score at pretreatment, 2 weeks, 6 months, 1 year and 2 years post-treatment. Oswestry disability index (ODI) score was evaluated pretreatment and at 2 years post-treatment. We also recorded the satisfaction period after PRF treatment. Twenty-three patients were available for the 2-year follow-up analysis. None of the patients had any side effects or procedure-related complications during the follow up period. The average VAS score declined from 7.1 ± 2.4 pre-treatment to 2.9 ± 2.1 2 weeks post-treatment, 2.6 ± 1.8 at 6 months, 2.8 ± 2.1 at 1 year and 3.0 ± 2.5 at 2 years. The average ODI score decreased from 33.6 ± 13.6 pre-treatment to 15.3 ± 5.7 at 2 years post-treatment. Mean satisfaction period after PRF treatment was 16.6 ± 9.43 months. PRF treatment on the medial branch is an effective and safe treatment option for patients with lower back pain.

  13. Impact of Type of Needle on Incidence of Intravascular Injection During Diagnostic Lumbar Medial Branch Block.

    PubMed

    Joo, Young; Kim, Yong Chul; Lee, Sang Chul; Kim, Hye Young; Park, Keun Suk; Choi, Eun Joo; Moon, Jee Youn

    2016-01-01

    Intravascular (IV) injection of local anesthetics is a potential cause of false-negative results after lumbar medial branch nerve blockade (L-MBB) performed to diagnose facetogenic back pain. The aim of the present study was to identify the relationship between the needle type and the incidence of IV injection in patients undergoing L-MBB using fluoroscopy with digital subtraction imaging (DSI). In this prospective randomized study, we compared the incidence of IV uptake of contrast medium using the Quincke needle and Whitacre needle under real-time DSI during L-MBB. Clinical and demographic factors associated with the occurrence of IV uptake were also investigated. In total, 126 patients were randomized into the Quincke needle group (n = 62) and Whitacre needle group (n = 64). Intravascular uptake of contrast medium was observed in 66 (9.8%) of 671 L-MBB procedures under DSI. The incidence of IV uptake was 13.9% (47/338) using the Quincke needle and 5.7% (19/333) using the Whitacre needle. In the multivariate generalized estimating equations analysis, use of a Quincke needle was related to positive IV injection at a 1.898-fold higher rate than was use of a Whitacre needle (95% confidence interval, 1.025-3.516) and a positive aspiration test predicted IV injection at a 21.735-fold higher rate (95% confidence interval, 11.996-52.258). Lumbar medial branch nerve blockade using the Quincke needle was associated with a 1.9-fold higher rate of IV injection than was L-MBB using the Whitacre needle under DSI. Although further study is needed to confirm the clinical efficacy, Whitacre needles can be considered to reduce the risk of IV injection during L-MBB.

  14. Resolution of long standing tinnitus following radiofrequency ablation of C2-C3 medial branches--a case report.

    PubMed

    Gritsenko, Karina; Caldwell, William; Shaparin, Naum; Vydyanathan, Amaresh; Kosharskyy, Boleslav

    2014-01-01

    Tinnitus is described as an auditory phantom perception analogous to central neuropathic pain. Despite the high prevalence of this debilitating symptom, no intervention is recognized that reliably eliminates tinnitus symptoms; a cause has yet to be determined. A 65-year-old healthy man presented with a 3 year history of left-sided tinnitus. Full workup performed by the primary care physician including blood tests for electrolyte imbalance, consultations by 2 independent otholaryngologists, and imaging did not reveal abnormalities to provide etiology of the tinnitus. No other complaints were noted except for occasional minimal left sided neck pain. Cervical spine x-ray showed degenerative changes with facet hypertrophy more pronounced on the left side. Subsequently, the patient underwent diagnostic left-sided C2-C3 medial branch block, resulting in complete resolution of tinnitus for more than 6 hours. After successful radiofrequency ablation of left C2-C3 medial branches, the patient became asymptomatic. At one year follow-up, he continued to be symptom free. Sparce studies have shown interaction between the somatosensory and auditory system at dorsal cochlear nucleus (DCN), inferior colliculus, and parietal association areas. Upper cervical nerve (C2) electrical stimulation evokes potentials in the DCN, eliciting strong patterns of inhibition and weak excitation of the DCN principal cells. New evidence demonstrated successful transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for treatment of somatic tinnitus in 240 patients. This case indicates that C2-C3 facet arthropathy may cause tinnitus and radiofrequency ablation of C2-C3 medial branches can provide an effective approach not previously considered.

  15. Anatomical risk evaluation of iatrogenic injury to the infrapatellar branch of the saphenous nerve during medial meniscus arthroscopic surgery.

    PubMed

    Koch, Guillaume; Kling, Agathe; Ramamurthy, Nitin; Edalat, Faramarz; Cazzato, Roberto Luigi; Kahn, Jean-Luc; Garnon, Julien; Clavert, Philippe

    2017-06-01

    To determine the relationship of the medial meniscus with the infrapatellar branches of the saphenous nerve, the primary goal is to define and characterize different risk areas for these nerves during medial meniscus surgery. After dissecting 20 embalmed cadaver knees, we defined 7 readily identifiable anatomical landmarks. For each knee, we recorded 2 morphological criteria and 16 measurements. The most common anatomical course is a main trunk that is 8 mm anterior to the tuberculum adductorium and 60 mm posterior to the midpoint of the medial patellar margin. It has two main infrapatellar branches. The nerve division is 23 mm above the joint line. The path is oblique with an angle of 55.5°. The anterior meniscal landmark is 24 mm from the upper branch and 42.5 mm from the lower branch. The posterior meniscal landmark is 55 mm from the upper branch and 38 mm from the lower branch. We defined a common anatomical course for the saphenous nerve and its infrapatellar branches. Then, three different areas were defined at risk for iatrogenic nerve injuries during medial meniscus.

  16. Vascular anatomy of the medial sural artery perforator flap: a new classification system of intra-muscular branching patterns.

    PubMed

    Dusseldorp, Joseph R; Pham, Quy J; Ngo, Quan; Gianoutsos, Mark; Moradi, Pouria

    2014-09-01

    The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap. The main difficulty encountered when raising the MSAP flap is in obtaining adequate pedicle length during intra-muscular dissection. The objective of this study was to determine the pattern of intra-muscular course of the MSAP flap pedicle. 14 cadaveric specimens were dissected and CT angiograms of 84 legs were examined. The intra-muscular branching pattern and depths of the medial sural artery branches were analyzed. The number of perforators, position of the dominant perforator and both intra-muscular and total pedicle length were also recorded and compared to existing anatomical data. Three types of arterial branching pattern were identified within the medial gastrocnemius, demonstrating one (31%), two (59%) or three or more (10%) main branches. A dominant perforator from the medial sural artery was present in 92% of anatomical specimens (13/14). Vertically, the location of the perforator from the popliteal crease was on average 13 cm (±2 cm). Transversely, the perforator originated 2.5 cm (±1 cm) from the posterior midline. Using CT angiography it was possible in 10 consecutive patients to identify a more superficial intra-muscular branch and determine the leg with the optimal branching pattern type for flap harvest. This study is the first to describe the variability of the intra-muscular arterial anatomy of the medial head of gastrocnemius muscle. Surgeons utilizing the MSAP flap option should be aware of the possible branching pattern types and consequently the differing perforator distribution and depths of intra-muscular branches. Routine use of pre-operative CT angiogram may help determine which leg has the most favorable branching pattern type and intra-muscular course for flap harvest. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Utility of nerve conduction studies for diagnosis of injury to the medial branch of the superficial radial nerve.

    PubMed

    Kon, Tomoya; Suzuki, Chieko; Hotta, Ryotaro; Funamizu, Yukihisa; Haga, Rie; Ueno, Tatsuya; Nishijima, Haruo; Arai, Akira; Nunomura, Jinichi; Nukada, Hitoshi; Tomiyama, Masahiko; Baba, Masayuki

    2017-09-01

    The clinical utility of nerve conduction study (NCS) for the distal medial branch of the superficial radial nerve (SRN) has not yet been clarified. Therefore, we investigated the clinical utility of NCS in patients with suspected SRN injury and compared the results with those in healthy control subjects. Bilateral NCS of the medial branch of the SRN was performed in two patients with suspected injury of the medial branch of the SRN, and in 20 healthy control subjects. A surface recording electrode was placed at the medial side of the metacarpophalangeal joint of the thumb. The SRN was then stimulated at a location 12 cm proximal from the recording electrode. The mean sensory nerve action potential in the two patients was significantly lower than that of the controls (6.75 ± 0.92 vs. 23.8 ± 8.2 μV, P  < 0.05). The side-to-side differences in sensory nerve action potential in the two patients were significantly higher than in the controls (55 ± 7.1 vs. 11 ± 7.8%, P  < 0.05). NCS may be useful for diagnosing injury of the medial branch of the SRN.

  18. Right bundle branch block and anterior wall ST elevation myocardial infarction.

    PubMed

    Trofin, Monica; Israel, Carsten W; Barold, S Serge

    2017-09-01

    We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

  19. Masquerading bundle branch block as a presenting manifestation of complete atrioventricular block that caused syncope.

    PubMed

    Jiao, Zhenyu; Tian, Ying; Yang, Xinchun; Liu, Xingpeng

    2017-10-01

    A 59-year-old male patient was admitted with the main complaints of stuffiness and shortness of breath. An ECG from precordial leads on admission showed masquerading bundle branch block. Syncope frequently occurred after admission. During syncope episodes, ECG telemetry showed that the syncope was caused by intermittent complete atrioventricular block, with the longest RR interval lasting for 4.36 s. At the gap of syncope, ECG showed complete right bundle branch block accompanied by alternation of left anterior fascicular block and left posterior fascicular block. The patient was implanted with a dual-chamber permanent pacemaker. Follow-up of 9 months showed no reoccurrence of syncope.

  20. Acute bilateral cerebellar infarction in the territory of the medial branches of posterior inferior cerebellar arteries.

    PubMed

    Gurer, G; Sahin, G; Cekirge, S; Tan, E; Saribas, O

    2001-10-01

    The most frequent type of cerebellar infarcts involved the posterior inferior cerebellar artery (PICA) and superior cerebellar artery territories but bilateral involvement of lateral or medial branches of PICA is extremely rare. In this report, we present a 55-year-old male who admitted to hospital with vomiting, nausea and dizziness. On examination left-sided hemiparesia and ataxic gait were detected. Infarct on bilateral medial branch of PICA artery territories was found out with cranial magnetic resonance imaging (MRI) technique and 99% stenosis of the left vertebral artery was found out with digital subtraction arteriography. The patient was put on heparin treatment. After 3 weeks, his complaints and symptoms had disappeared except for mild gait ataxia.

  1. Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial.

    PubMed

    Bhatia, Nidhi; Sen, Indu Mohini; Mandal, Banashree; Batra, Ankita

    2018-03-29

    Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. This prospective, randomised trial was conducted in 50 ASA I and II male patients≥18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. There was no significant difference in the total postoperative analgesic consumption [group I: 66.04mg; group II: 68.33mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients. Copyright © 2018 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  2. A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report.

    PubMed

    Yildiz, Necmettin; Ardic, Füsun

    2008-04-21

    Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow.

  3. A rare cause of forearm pain: anterior branch of the medial antebrachial cutaneous nerve injury: a case report

    PubMed Central

    2008-01-01

    Introduction Medial antebrachial cutaneous nerve (MACN) neuropathy is reported to be caused by iatrogenic reasons. Although the cases describing the posterior branch of MACN neuropathy are abundant, only one case caused by lipoma has been found to describe the anterior branch of MACN neuropathy in the literature. As for the reason for the forearm pain, we report the only case describing isolated anterior branch of MACN neuropathy which has developed due to repeated minor trauma. Case presentation We report a 37-year-old woman patient with pain in her medial forearm and elbow following the shaking of a rug. Pain and symptoms of dysestesia in the distribution of the right MACN were found. Electrophysiological examination confirmed the normality of the main nerve trunks of the right upper limb and demonstrated abnormalities of the right MACN when compared with the left side. Sensory action potential (SAP) amplitude on the right anterior branch of the MACN was detected to be lower in proportion to the left. In the light of these findings, NSAI drug and physical therapy was performed. Dysestesia and pain were relieved and no recurrence was observed after a follow-up of 14 months. Conclusion MACN neuropathy should be taken into account for the differential diagnosis of the patients with complaints of pain and dysestesia in medial forearm and anteromedial aspect of the elbow. PMID:18426569

  4. Study of the anatomy of the tibial nerve and its branches in the distal medial leg.

    PubMed

    Torres, André Leal Gonçalves; Ferreira, Marcus Castro

    2012-01-01

    Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel. Bilateral dissections were performed on 26 fresh cadavers and the locations of the tibial nerve bifurcation and its branches were measured in millimeters. For the calcaneal branches, the amount and their respective nerves of origin were also analyzed. The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and proximally in 12%. As for the calcaneal branches, the medial presented with one (58%), two (34%) and three (8%) branches, with the most common source occurring in the tibial nerve (90%) and the lower with a single branch per leg and lateral plantar nerve as the most common origin (70%). Level of Evidence, V Expert opinion .

  5. Segmentation of the Aortic Valve Apparatus in 3D Echocardiographic Images: Deformable Modeling of a Branching Medial Structure

    PubMed Central

    Pouch, Alison M.; Tian, Sijie; Takabe, Manabu; Wang, Hongzhi; Yuan, Jiefu; Cheung, Albert T.; Jackson, Benjamin M.; Gorman, Joseph H.; Gorman, Robert C.; Yushkevich, Paul A.

    2015-01-01

    3D echocardiographic (3DE) imaging is a useful tool for assessing the complex geometry of the aortic valve apparatus. Segmentation of this structure in 3DE images is a challenging task that benefits from shape-guided deformable modeling methods, which enable inter-subject statistical shape comparison. Prior work demonstrates the efficacy of using continuous medial representation (cm-rep) as a shape descriptor for valve leaflets. However, its application to the entire aortic valve apparatus is limited since the structure has a branching medial geometry that cannot be explicitly parameterized in the original cm-rep framework. In this work, we show that the aortic valve apparatus can be accurately segmented using a new branching medial modeling paradigm. The segmentation method achieves a mean boundary displacement of 0.6 ± 0.1 mm (approximately one voxel) relative to manual segmentation on 11 3DE images of normal open aortic valves. This study demonstrates a promising approach for quantitative 3DE analysis of aortic valve morphology. PMID:26247062

  6. Laughter-induced left bundle branch block.

    PubMed

    Chow, Grant V; Desai, Dipan; Spragg, David D; Zakaria, Sammy

    2012-10-01

    We present the case of a patient with ischemic heart disease and intermittent left bundle branch block, reproducibly induced by laughter. Following treatment of ischemia with successful deployment of a drug-eluting stent, no further episodes of inducible LBBB were seen. Transient ischemia, exacerbated by elevated intrathoracic pressure during laughter, may have contributed to onset of this phenomenon. © 2012 Wiley Periodicals, Inc.

  7. Study of the anatomy of the tibial nerve and its branches in the distal medial leg

    PubMed Central

    Torres, André Leal Gonçalves; Ferreira, Marcus Castro

    2012-01-01

    Objective Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel. Methods Bilateral dissections were performed on 26 fresh cadavers and the locations of the tibial nerve bifurcation and its branches were measured in millimeters. For the calcaneal branches, the amount and their respective nerves of origin were also analyzed. Results The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and proximally in 12%. As for the calcaneal branches, the medial presented with one (58%), two (34%) and three (8%) branches, with the most common source occurring in the tibial nerve (90%) and the lower with a single branch per leg and lateral plantar nerve as the most common origin (70%). Level of Evidence, V Expert opinion. PMID:24453596

  8. Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion.

    PubMed

    Nieuwveld, D; Mojica, V; Herrera, A E; Pomés, J; Prats, A; Sala-Blanch, X

    2017-04-01

    Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstacle and guiding the needle towards the vessels and pleura. A medial approach, meaning from inside to outside, will avoid these structures. Traditionally the assessment of a successful block is through motor or sensitive responses but a sympathetic fibre block can also be evaluated measuring the changes in humeral artery blood flow, skin temperature and/or perfusion index. To describe the medial approach of the ultrasound-guided costoclavicular block evaluating its development by motor and sensitive response and measurement of sympathetic changes. Description of the technique and administration of 20ml of contrast in a fresh cadaver model, evaluating the distribution with CT-scan and sagittal sections of the anatomic piece. Subsequently in a clinical phase, including 11 patients, we evaluated the establishment of motor, sensitive and sympathetic blocks. We evaluated the sympathetic changes reflected by humeral artery blood flow, skin temperature and distal perfusion index. In the anatomical model the block was conducted without difficulties, showing an adequate periclavicular distribution of the contrast in the CT-scan and in sagittal sections, reaching the interscalenic space as far as the secondary trunks. Successful blocks were observed in 91% of patients after 25minutes. All the parameters reflecting sympathetic block increased significantly. The humeral artery blood flow showed an increase from 108 ± 86 to 188±141ml/min (P=.05), skin temperature from 32.1±2 to 32.8±9°C (P=.03) and perfusion index from 4±3 to 9±5 (P=.003). The medial approach of the ultrasound-guided costoclavicular block is anatomically feasible, with high

  9. Bicarbonate refractory QRS prolongation and left bundle-branch block following escitalopram and lamotrigine overdose: A case report and literature review of toxic left bundle-branch block.

    PubMed

    Farkas, A N; Marcott, M; Yanta, J H; Pizon, A F

    2018-05-02

    Toxic prolongation of the QRS interval most often results from blockade of cardiac voltage-gated sodium channels and manifests on electrocardiogram with a right bundle-branch block-like morphology. Rarely, a left bundle-branch block (LBBB) morphology has been reported. We report a case of transient LBBB resultant from ingestion of lamotrigine and citalopram which was refractory to sodium bicarbonate therapy and eventually resolved spontaneously. Cases of toxic LBBB are less likely to respond to bicarbonate therapy, suggesting that this finding is due to a mechanism other than sodium channel blockade. © 2018 John Wiley & Sons Ltd.

  10. Cerebellar infarction in the territory of the medial branch of the superior cerebellar artery.

    PubMed

    Sohn, Sung-Il; Lee, Hyung; Lee, Seong-Ryong; Baloh, Robert W

    2006-01-10

    The authors studied 14 patients with an isolated cerebellar infarct in the territory of the medial branch of the superior cerebellar artery (MSCA). The most common clinical finding was severe gait ataxia with sudden falling (n = 9) or severe veering (n = 2). Cerebellar dysarthria was found in 8 patients. Eight patients had a mild unilateral limb ataxia. These findings emphasize that MSCA territory cerebellar infarction presented with the prominent gait ataxia and cerebellar dysarthria.

  11. TopMaker: A Technique for Automatic Multi-Block Topology Generation Using the Medial Axis

    NASA Technical Reports Server (NTRS)

    Heidmann, James D. (Technical Monitor); Rigby, David L.

    2004-01-01

    A two-dimensional multi-block topology generation technique has been developed. Very general configurations are addressable by the technique. A configuration is defined by a collection of non-intersecting closed curves, which will be referred to as loops. More than a single loop implies that holes exist in the domain, which poses no problem. This technique requires only the medial vertices and the touch points that define each vertex. From the information about the medial vertices, the connectivity between medial vertices is generated. The physical shape of the medial edge is not required. By applying a few simple rules to each medial edge, the multiblock topology is generated with no user intervention required. The resulting topologies contain only the level of complexity dictated by the configurations. Grid lines remain attached to the boundary except at sharp concave turns where a change in index family is introduced as would be desired. Keeping grid lines attached to the boundary is especially important in the area of computational fluid dynamics where highly clustered grids are used near no-slip boundaries. This technique is simple and robust and can easily be incorporated into the overall grid generation process.

  12. Effect of PR interval prolongation on long-term outcomes in patients with left bundle branch block vs non-left bundle branch block morphologies undergoing cardiac resynchronization therapy.

    PubMed

    Rickard, John; Karim, Mohammad; Baranowski, Bryan; Cantillon, Daniel; Spragg, David; Tang, W H Wilson; Niebauer, Mark; Grimm, Richard; Trulock, Kevin; Wilkoff, Bruce; Varma, Niraj

    2017-10-01

    Although the influence of QRS duration (QRSd) and/or bundle branch block morphology on outcomes of cardiac resynchronization therapy (CRT) have been well studied, the effect of PR interval remains uncertain. The purpose of this study was to evaluate the impact of PR prolongation (PRp) before CRT on long-term outcomes, specifically taking into account bundle branch block morphology and QRSd. We extracted clinical data on consecutive patients undergoing CRT. Multivariate models were constructed to analyze the effect of PRp (≥200 ms) on the combined endpoint of death, heart transplant, or left ventricular assist device. Kaplan-Meier curves were constructed stratifying patients based on bundle branch block and QRSd (dichotomized by 150 ms). Of the 472 patients who met inclusion criteria, 197 (41.7%) had PR interval ≥200 ms. During follow-up (mean 5.1 ± 2.6 years) there were 214 endpoints, of which 109 (23.1%) occurred in patients with PRp. In multivariate analysis, PRp was independently associated with worsened outcomes (hazard ratio 1.34, 95% confidence interval 1.01-1.77, P = .04). When stratified by bundle branch block morphology, PRp was significantly associated with worsened outcomes (log-rank P <.001) in patients with LBBB but not in those with non-LBBB (log-rank P = .55). Among patients with LBBB, stratified by QRSd, patients without PRp had improved outcomes compared to those with PRp independent of QRSd (log-rank P <.001). PRp is an independent predictor of impaired long-term outcome after CRT among patients with LBBB but not in non-LBBB patients. Notably, among LBBB patients, PRp is a more important predictor than QRSd in assessing long-term outcomes. Copyright © 2017. Published by Elsevier Inc.

  13. Abnormal Q waves in right sided chest leads provoked by onset of right bundle-branch block in patients with anteroseptal infarction.

    PubMed Central

    Rosenbaum, M B; Girotti, L A; Lázzari, J O; Halpern, M S; Elizari, M V

    1982-01-01

    In five cases of anteroseptal myocardial infarction complicated by intermittent right bundle-branch block, the onset of right bundle-branch block provoked the appearance of abnormal Q waves in leads V1 and V2, whereas a small initial R wave was present in the same leads during normal conduction. The intermittency of the conduction disturbance indicated that the Q waves were "right bundle-branch block dependent". It was also apparent that right bundle-branch block shifted the electrical location of the infarct towards the right, and made it look much larger. Right bundle-branch block dependent Q waves may arise during the acute stage of an anterior infarct suggesting, fallaciously, that an acute extension has occurred, or during the chronic stage, leading to the erroneous supposition that a new infarct had developed. The abnormal Q waves anteroseptal infarction complicated by fixed right bundle-branch block, though obviously related to the infarct, may be dependent on the right bundle-branch block. PMID:7059400

  14. Effects of an Isolated Complete Right Bundle Branch Block on Mechanical Ventricular Function.

    PubMed

    Zhang, Qin; Xue, Minghua; Li, Zhan; Wang, Haiyan; Zhu, Lei; Liu, Xinling; Meng, Haiyan; Hou, Yinglong

    2015-12-01

    The purpose of this study was to investigate the effects of an isolated complete right bundle branch block on mechanical ventricular function. Two groups of participants were enrolled in this study: a block group, consisting of 98 patients with isolated complete right bundle branch blocks without structural heart disease, and a control group, consisting of 92 healthy adults. The diameter, end-diastolic area, end-systolic area, and right ventricular (RV) fractional area change were obtained to evaluate morphologic and systolic function by 2-dimensional sonographic technology. Systolic and diastolic velocities and time interval parameters were measured to assess mechanical ventricular performance using pulsed wave tissue Doppler imaging. Although there was no significant difference in the RV fractional area change between the patients with blocks and controls, the diameter, end-diastolic area, and end-systolic area of the RV were significantly larger in the patients with blocks (P < .05). In the patients with blocks, the peak velocities during systole and early diastole and the ratio of the peak velocities during early and late diastole decreased. The block group had a prolonged pre-ejection period, electromechanical delay time, and isovolumic relaxation time, a decreased ejection time, and an increased pre-ejection period/ejection time ratio, and the myocardial performance index (Tei index) at the basal RV lateral wall was significantly increased. There were no significant differences in any echocardiographic parameters at different sites of the left ventricle. In patients with isolated complete right bundle branch blocks, systolic and diastolic functions are impaired in the RV, and follow-up is needed. © 2015 by the American Institute of Ultrasound in Medicine.

  15. Wolff-Parkinson-White syndrome type B and left bundle-branch block: electrophysiologic and radionuclide study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Rakovec, P.; Kranjec, I.; Fettich, J.J.

    1985-01-01

    Coinciding left bundle-branch block and Wolff-Parkinson-White syndrome type B, a very rare electrocardiographic occurrence, was found in a patient with dilated cardiomyopathy. Electrophysiologic study revealed eccentric retrograde atrial activation during ventricular pacing, suggesting right-sided accessory pathway. At programmed atrial pacing, effective refractory period of the accessory pathway was 310 ms; at shorter pacing coupling intervals, normal atrioventricular conduction with left bundle-branch block was seen. Left bundle-branch block was seen also with His bundle pacing. Radionuclide phase imaging demonstrated right ventricular phase advance and left ventricular phase delay; both right and left ventricular phase images revealed broad phase distribution histograms. Combinedmore » electrophysiologic and radionuclide investigations are useful to disclose complex conduction abnormalities and their mechanical correlates.« less

  16. The ability of multi-site, multi-depth sacral lateral branch blocks to anesthetize the sacroiliac joint complex.

    PubMed

    Dreyfuss, Paul; Henning, Troy; Malladi, Niriksha; Goldstein, Barry; Bogduk, Nikolai

    2009-01-01

    To determine the physiologic effectiveness of multi-site, multi-depth sacral lateral branch injections. Double-blind, randomized, placebo-controlled study. Outpatient pain management center. Twenty asymptomatic volunteers. The dorsal innervation to the sacroiliac joint (SIJ) is from the L5 dorsal ramus and the S1-3 lateral branches. Multi-site, multi-depth lateral branch blocks were developed to compensate for the complex regional anatomy that limited the effectiveness of single-site, single-depth lateral branch injections. Bilateral multi-site, multi-depth lateral branch green dye injections and subsequent dissection on two cadavers revealed a 91% accuracy with this technique. Session 1: 20 asymptomatic subjects had a 25-g spinal needle probe their interosseous (IO) and dorsal sacroiliac (DSI) ligaments. The inferior dorsal SIJ was entered and capsular distension with contrast medium was performed. Discomfort had to occur with each provocation maneuver and a contained arthrogram was necessary to continue in the study. Session 2: 1 week later; computer randomized, double-blind multi-site, multi-depth lateral branch blocks injections were performed. Ten subjects received active (bupivicaine 0.75%) and 10 subjects received sham (normal saline) multi-site, multi-depth lateral branch injections. Thirty minutes later, provocation testing was repeated with identical methodology used in session 1. Presence or absence of pain for ligamentous probing and SIJ capsular distension. Seventy percent of the active group had an insensate IO and DSI ligaments, and inferior dorsal SIJ vs 0-10% of the sham group. Twenty percent of the active vs 10% of the sham group did not feel repeat capsular distension. Six of seven subjects (86%) retained the ability to feel repeat capsular distension despite an insensate dorsal SIJ complex. Multi-site, multi-depth lateral branch blocks are physiologically effective at a rate of 70%. Multi-site, multi-depth lateral branch blocks do not

  17. Lyme carditis with isolated left bundle branch block and myocarditis successfully treated with oral doxycycline.

    PubMed

    Cunha, Burke A; Elyasi, Maekal; Singh, Prince; Jimada, Ismail

    2018-01-01

    Lyme disease may present with a variety of cardiac manifestations ranging from first degree to third degree heart block. Cardiac involvement with Lyme disease may be asymptomatic, or symptomatic. Atrioventrical conduction abnormalities are the most common manifestation of Lyme carditis. Less common, are alternating right bundle branch block (RBBB) and left bundle branch block (LBBB). We present an interesting case of a young male whose main manifestation of Lyme carditis was isolated LBBB. He also had mild Lyme myocarditis. The patient was successfully treated with oral doxycycline, and his isolated LBBB and myocarditis rapidly resolved.

  18. Right bundle branch block pattern during right ventricular permanent pacing: Is it safe or not?

    PubMed Central

    Erdogan, Okan; Aksu, Feyza

    2007-01-01

    The present case report describes a patient with dual chamber pacemaker whose surface ECG demonstrated paced right bundle branch block pattern suggesting a malpositioned ventricular lead in the left ventricle. However, diagnostic work-up revealed that the lead was appropriately located in the right ventricular apex. Diagnostic maneuvers and clues for differentiating safe right bundle branch block pattern during permanent pacing are thoroughly revisited and discussed within the article. PMID:17684578

  19. Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Post-procedural Pain.

    PubMed

    Arsanious, David; Gage, Emmanuel; Koning, Jonathon; Sarhan, Mazin; Chaiban, Gassan; Almualim, Mohammed; Atallah, Joseph

    2016-01-01

    One of the potential side effects with radiofrequency ablation (RFA) includes painful cutaneous dysesthesias and increased pain due to neuritis or neurogenic inflammation. This pain may require the prescription of opioids or non-opioid analgesics to control post-procedural pain and discomfort. The goal of this study is to compare post-procedural pain scores and post-procedural oral analgesic use in patients receiving continuous thermal radiofrequency ablation versus patients receiving pulsed dose radiofrequency immediately followed by continuous thermal radiofrequency ablation for zygopophaseal joint disease. This is a prospective, double-blinded, randomized, controlled trial. Patients who met all the inclusion criteria and were not subject to any of the exclusion criteria were required to have two positive diagnostic medial branch blocks prior to undergoing randomization, intervention, and analysis. University hospital. Eligible patients were randomized in a 1:1 ratio to either receive thermal radiofrequency ablation alone (standard group) or pulsed dose radiofrequency (PDRF) immediately followed by thermal radiofrequency ablation (investigational group), all of which were performed by a single Board Certified Pain Medicine physician. Post-procedural pain levels between the two groups were assessed using the numerical pain Scale (NPS), and patients were contacted by phone on post-procedural days 1 and 2 in the morning and afternoon regarding the amount of oral analgesic medications used in the first 48 hours following the procedure. Patients who received pulsed dose radiofrequency followed by continuous radiofrequency neurotomy reported statistically significantly lower post-procedural pain scores in the first 24 hours compared to patients who received thermal radiofrequency neurotomy alone. These patients also used less oral analgesic medication in the post-procedural period. These interventions were carried out by one board accredited pain physician at one

  20. Risk of advanced heart block during extradural anaesthesia in patients with right bundle branch block and left anterior hemiblock.

    PubMed

    Coriat, P; Harari, A; Ducardonet, A; Tarot, J P; Viars, P

    1981-05-01

    Electrocardiographic recording by Holter monitoring demonstrated the absence of any modification, however minimal, of the intranodal conduction during surgical procedures under extradural anaesthesia in 20 patients with right bundle branch block (RBBB) and left anterior hemiblock (LAHB) but without symptoms. These data suggest that extradural anaesthesia can be used safely in patients with asymptomatic chronic RBBB and LAHB without prophylactic insertion of pacemakers. However, patients having experienced either syncope or transient Mobitz II second degree AV block are likely to have a trifascicular block and increased risk of advanced heart block during extradural anaesthesia.

  1. Blocking the buccal nerve using two methods of inferior alveolar block injection.

    PubMed

    Aker, F D

    2001-01-01

    The anatomic relations of the buccal nerve branch of the mandibular division of the trigeminal nerve were studied to explain the rationale for the discrepancy in blocking the buccal nerve using two methods of blocking the inferior alveolar nerve, the conventional method and the Gow-Gates method. The conventional method rarely blocks the buccal nerve, while the Gow-Gates method is reported to consistently block the buccal nerve. Eight head and mandibular specimens were dissected to observe the path of buccal nerve and its relationship to the path of needles in the conventional and Gow-Gates techniques. The buccal nerve descends on the medial and then anterior aspect of the deep head of the temporalis muscle (Tdh). At the latter position the buccal nerve enters the retromolar fossa and is encased in a fascial sleeve created by a dense fascial band that spans between the temporalis muscle tendons and the buccinator muscle. At the level of the conventional block injection the buccal nerve was shielded from the path of the needle by the Tdh and the fascial band. In the Gow-Gates block injection, the buccal nerve was exposed on the medial surface of the Tdh, immediately lateral to the path of the needle and proximal to the fascial sleeve. Consequently, the anatomical relations of the buccal nerve in the conventional block method essentially shield the nerve from being bathed by anesthetic solution while in the Gow-Gates method the relations are such that the buccal nerve can be exposed to anesthetic solution and thus blocked, explaining the findings in clinical dentistry. Copyright Wiley-Liss, Inc.

  2. Right bundle branch block as a risk factor for subsequent cardiac events.

    DOT National Transportation Integrated Search

    1990-08-01

    The identification of risk factors for adverse cardiac events is valuable to the certification of airmen. This study examines the importance of right bundle branch block (RBBB) as a risk factor for myocardial infarction (MI), atherosclerotic heart di...

  3. Accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints.

    PubMed

    Siegenthaler, Andreas; Mlekusch, Sabine; Trelle, Sven; Schliessbach, Juerg; Curatolo, Michele; Eichenberger, Urs

    2012-08-01

    Cervical zygapophysial joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints using fluoroscopy as control. Sixty volunteers were studied. Ultrasound-imaging was used to place the needle to the bony target of cervical zygapophysial joint nerve blocks. The levels of needle placement were determined randomly (three levels per volunteer). After ultrasound-guided needle placement and application of 0.2 ml contrast dye, fluoroscopic imaging was performed for later evaluation by a blinded pain physician and considered as gold standard. Raw agreement, chance-corrected agreement κ, and chance-independent agreement Φ between the ultrasound-guided placement and the assessment using fluoroscopy were calculated to quantify accuracy. One hundred eighty needles were placed in 60 volunteers. Raw agreement was 87% (95% CI 81-91%), κ was 0.74 (0.64-0.83), and Φ 0.99 (0.99-0.99). Accuracy varied significantly between the different cervical nerves: it was low for the C7 medial branch, whereas all other levels showed very good accuracy. Ultrasound-imaging is an accurate technique for performing cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.

  4. Left bundle branch block, an old-new entity.

    PubMed

    Breithardt, Günter; Breithardt, Ole-Alexander

    2012-04-01

    Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction, but also in comparison to right bundle branch block which is generally considered to be benign in the absence of an underlying cardiac disorder like congenital heart disease. LBBB may be the first manifestation of a more diffuse myocardial disease. The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11 s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns which can be compensated by biventricular pacing (resynchronization therapy). Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it. Of special interest are patients with LBBB and normal left ventricular dimensions and normal ejection fraction at rest but who may present with an abnormal increase in pulmonary artery pressure during exercise, production of lactate during high-rate pacing, signs of ischemia on myocardial scintigrams (but no coronary artery narrowing), and abnormal ultrastructural findings on myocardial biopsy. For this entity, the term latent cardiomyopathy had been suggested previously.

  5. Localized disruption of Narp in medial prefrontal cortex blocks reinforcer devaluation performance

    PubMed Central

    Johnson, Alexander W.; Han, Sungho; Blouin, Ashley M.; Saini, Jasjit; Worley, Paul F.; During, Matthew J.; Holland, Peter C.; Baraban, Jay M.; Reti, Irving M.

    2010-01-01

    Neuronal activity regulated pentraxin (Narp) is a secreted protein that regulates α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPAR) aggregation and synaptogenesis. Mapping of Narp-positive neurons in brain has revealed it is prominently expressed in several limbic system projection pathways. Consistent with this localization pattern, Narp knockout mice show deficits in using the current value of a reinforcer to guide behavior, a critical function of the limbic system. To help assess whether this behavioral deficit is due to impairment of synaptogenesis during development or in modulating synaptic signaling in the mature brain, we have used a dominant negative Narp viral construct which blocks trafficking of endogenous Narp to axons. Focal injection of this viral construct into the medial prefrontal cortex (mPFC) of adult mice, a region containing Narp-positive projection neurons, blocked reinforcer devaluation. Thus, these results indicate that Narp released from mPFC neurons plays a key role in mediating synaptic changes underlying instrumental reinforcer devaluation. PMID:21127001

  6. [Intermittent left bundle branch block - reversal to normal conduction during general anesthesia].

    PubMed

    Silva, Ana Maria Oliveira Correia da; Silva, Emília Alexandra Gaspar Lima da

    Transient changes in intraoperative cardiac conduction are uncommon. Rare cases of the development or remission of complete left bundle branch block under general and locoregional anesthesia associated with myocardial ischemia, hypertension, tachycardia, and drugs have been reported. Complete left bundle branch block is an important clinical manifestation in some chronic hypertensive patients, which may also be a sign of coronary artery disease, aortic valve disease, or underlying cardiomyopathy. Although usually permanent, it can occur intermittently depending on heart rate (when heart rate exceeds a certain critical value). This is a case of complete left bundle branch block recorded in the preoperative period of urgent surgery that reverted to normal intraoperative conduction under general anesthesia after a decrease in heart rate. It resurfaced, intermittently and in a heart-rate-dependent manner, in the early postoperative period, eventually reverting to normal conduction in a sustained manner during semi-intensive unit monitoring. The test to identify markers of cardiac muscle necrosis was negative. Pain due to the emergency surgical condition and in the early postoperative period may have been the cause of the increase in heart rate up to the critical value, causing blockage. Although the development or remission of this blockade under anesthesia is uncommon, the anesthesiologist should be alert to the possibility of its occurrence. It may be benign; however, the correct diagnosis is very important. The electrocardiographic manifestations may mask or be confused with myocardial ischemia, factors that are especially important in a patient under general anesthesia unable to report the characteristic symptoms of ischemia. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. In-hospital outcome in patients with ST elevation myocardial infarction and right bundle branch block. A sub-study from RENASICA II, a national multicenter registry.

    PubMed

    Juárez-Herrera, Ursulo; Jerjes Sánchez, Carlos; González-Pacheco, Héctor; Martínez-Sánchez, Carlos

    2010-01-01

    Compare in-hospital outcome in patients with ST-elevation myocardial infarction with right versus left bundle branch block. RENASICA II, a national Mexican registry enrolled 8098 patients with final diagnosis of acute coronary syndrome secondary to ischemic heart disease. In 4555 STEMI patients, 545 had bundle branch block, 318 (58.3%) with right and 225 patients with left (41.6%). Both groups were compared in terms of in-hospital outcome through major cardiovascular adverse events; (cardiovascular death, recurrent ischemia and reinfarction). Multivariable analysis was performed to identify in-hospital mortality risk among right and left bundle branch block patients. There were not statistical differences in both groups regarding baseline characteristics, time of ischemia, myocardial infarction location, ventricular dysfunction and reperfusion strategies. In-hospital outcome in bundle branch block group was characterized by a high incidence of major cardiovascular adverse events with a trend to higher mortality in patients with right bundle branch block (OR 1.70, CI 1.19 - 2.42, p < 0.003), compared to left bundle branch block patients. In this sub-study right bundle branch block accompanying ST-elevation myocardial infarction of any location at emergency room presentation was an independent predictor of high in-hospital mortality.

  8. [Intervention among patients with right bundle branch block and left anterior hemiblock. Operatory risk (author's transl)].

    PubMed

    Coriat, P; Harari, A; Tarot, J P; Ducardonnet, A; Viars, P

    1981-01-01

    In order to assess the risk of advanced heart block during anesthesia in patients with right bundle branch block and left anterior hemiblock, 35 consecutive patients were monitored throughout the pre-, intra- and postoperative period. As conventional ECG monitoring may only detect advanced atrioventricular block, patients were monitored according to the Holter method which can easily detect even minor changes of atrioventricular conduction namely slight increased PR interval or dropped P wave. All patients were asymptomatic, in normal sinus rhythm without second degree AV block. Surgical procedures were performed under general anesthesia (n = 15) and epidural anesthesia using lidocaine (n = 20). No episode of second or third degree atrioventricular block occurred. The only modifications observed were rare and transient increase of PR, occurring during surgical procedures in 5 patients, always associated with a sinus bradycardia. They immediately regressed at the termination of the sinus bradycardia either spontaneously or following atropine injection, strongly suggesting the responsability of increased vagal tone. Thus general or epidural anesthesia did not compromise infranodal conduction in any of the observed patients. These data indicate that anesthesia can be safely used without prophylactic preoperative insertion of pacemakers in patients with asymptomatic chronic right bundle branch block and left anterior hemi-block.

  9. Bilateral medial medullary syndrome secondary to Takayasu arteritis.

    PubMed

    Deshpande, Anirudda; Chandran, Vijay; Pai, Aparna; Rao, Suryanarayana; Shetty, Ranjan

    2013-08-13

    Medial medullary syndrome (MMS) is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its branches. In this case report we present a patient who developed MMS secondary to Takayasu arteritis (TA). TA is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of subclavian arteries as well as infarction of the medial medulla bilaterally. To our knowledge this is the first time that MMS has been found to occur secondary to TA.

  10. Posterior Branches of Lumbar Spinal Nerves - Part I: Anatomy and Functional Importance.

    PubMed

    Kozera, Katarzyna; Ciszek, Bogdan

    2016-01-01

    The aim of this paper is to compare anatomic descriptions of posterior branches of the lumbar spinal nerves and, on this basis, present the location of these structures. The majority of anatomy textbooks do not describe these nerves in detail, which may be attributable to the fact that for many years they were regarded as structures of minor clinical importance. The state of knowledge on these nerves has changed within the last 30 years. Attention has been turned to their function and importance for both diagnostic practice and therapy of lower back pain. Summarising the available literature, we may conclude that the medial and lateral branches separate at the junction of the facet joint and the distal upper edge of the transverse process; that the size, course and area supplied differ between the lateral and the medial branch; and that facet joints receive multisegmental innervation. It has been demonstrated that medial branches are smaller than the respective lateral branches and they have a more constant course. Medial branches supply the area from the midline to the facet joint line, while lateral branches innervate tissues lateral to the facet joint. The literature indicates difficulties with determining specific anatomic landmarks relative to which the lateral branch and the distal medial branch can be precisely located. Irritation of sensory fibres within posterior branches of the lumbar spinal nerves may be caused by pathology of facet joints, deformity of the spine or abnormalities due to overloading or injury. The anatomic location and course of posterior branches of spinal nerves should be borne in mind to prevent damaging them during low-invasive analgesic procedures.

  11. [Premature outflow tract ventricular contraction combined with complete bundle branch block: the characteristic electrocardiographic and ablation target potential features].

    PubMed

    Di, C Y; Wan, Z; Li, K; Ding, Y S; Lin, W H

    2017-12-01

    Objective: To explore the characteristics of electrocardiogram(ECG) and target potential features of premature ventricular contraction (PVC) in patients with complete left/right bundle branch block (CL/RBBB) and compare with those without CL/RBBB. Methods: A retrospective analysis was done in 8 outflow tract PVC patients with CL/RBBB, who successfully underwent radiofrequency ablation from August 2009 to June 2017. According to the bundle branch block chamber, patients were divided into the complete right bundle branch block (CRBBB) group ( n= 4) and the complete left bundle branch block (CLBBB) group ( n= 4). The control group were those who successfully underwent ablation at the same position as the above two groups but without CL/RBBB. The characteristics of ECG and target potential features were compared among groups. Results: One case in the CRBBB group was successfully ablated in the great cardiac vein with precordial R/S>1 transition at V(1) and one case in the CLBBB group was successfully ablated in the right coronary cusp with precordial R/S>1 transition at V(2), while other 6 cases were all with precordial R/S>1 transition at lead V(4). Precordial R/S>1 transition was not later than sinus rhythm (SR) in the CLBBB group. No statistical difference was found in the QRS complex duration between SR and PVC in the CL/RBBB patients [(134.38±23.80)ms vs (156.75±25.93)ms, P> 0.05], while statistical difference was shown in the control group [(92.63±5.76)ms vs (140.25±15.97)ms, P< 0.05]. Conclusion: Bundle branch block can lead to misjudgment of PVC origin with CL/RBBB during sinus rhythm, thus the origin chamber of the PVC should be determined according to the mapping and ablation result.

  12. Nerve block of articular branches of the obturator and femoral nerves for the treatment of hip joint pain.

    PubMed

    Yavuz, Ferdi; Yasar, Evren; Ali Taskaynatan, Mehmet; Goktepe, Ahmet Salim; Tan, Arif Kenan

    2013-01-01

    The aim of this retrospective study was to investigate the effectiveness of the nerve block of articular branches of obturator and femoral nerves in patients with intractable pain due to hip osteoarthritis. Twenty patients (8 female and 12 male; with a mean age 53.5 years) were retrospectively identified who had received nerve block of articular branches of obturator and femoral nerves for chronic hip joint pain due to hip osteoarthritis. The outcome measures (visual analogue pain scale, the level of patient satisfaction with nerve block, reduction rate of NSAID using) were assessed before the treatment and at the 1st and 3rd months after injection. Mean reduction in hip joint pain while walking and at night between the baseline and 1st month, and between the baseline and 3rd month were statistically significant (p< 0.05). At the 1st and 3rd months after treatment, the reduction rates of NSAID using were almost 67% and 71%; respectively. At the 1st and 3rd months after treatment, the level of patient satisfaction with nerve block were 73.00 ± 21.23 mm and 73.50 ± 18.14 mm; respectively. We found that nerve blocks of articular branches of obturator and femoral nerves were effective in short- and mid-term for reducing chronic hip joint pain.

  13. Relationship between the Ulnar Nerve and the Branches of the Radial Nerve to the Medial Head of the Triceps Brachii Muscle.

    PubMed

    Sh, Cho; Ih, Chung; Uy, Lee

    2018-05-17

    One branch of the radial nerve to the medial head of the triceps brachii muscle (MHN) has been described as accompanying or joining the ulnar nerve. Mostly two MHN branches have been reported, with some reports of one; however, the topographical anatomy is not well documented. We dissected 52 upper limbs from adult cadavers and found one, two, and three MHN branches in 9.6%, 80.8%, and 9.6% of cases, respectively. The MHN accompanying the ulnar nerve was always the superior MHN. The relationship between the ulnar nerve and the MHN was classified into four types according to whether the MHN was enveloped along with the ulnar nerve in the connective tissue sheath and whether it was in contact with the ulnar nerve. It contacted the ulnar nerve in 75.0% of cases and accompanied it over a mean distance of 73.6 mm (range 36-116 mm). In all cases in which the connective tissue sheath enveloped the branch of the MHN and the ulnar nerve, removing the sheath confirmed that the MHN branch originated from the radial nerve. The detailed findings and anatomical measurements of the MHN in this study will help in identifying its branches during surgical procedures. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

  14. Effects of metabotropic glutamate receptor block on the synaptic transmission and plasticity in the rat medial vestibular nuclei.

    PubMed

    Grassi, S; Malfagia, C; Pettorossi, V E

    1998-11-01

    In rat brainstem slices, we investigated the possible role of metabotropic glutamate receptors in modulating the synaptic transmission within the medial vestibular nuclei, under basal and plasticity inducing conditions. We analysed the effect of the metabotropic glutamate receptor antagonist (R,S)-alpha-methyl-4-carboxyphenylglycine on the amplitude of the field potentials and latency of unitary potentials evoked in the ventral portion of the medial vestibular nuclei by primary vestibular afferent stimulation, and on the induction and maintenance of long-term potentiation, after high-frequency stimulation. Two effects were observed, consisting of a slight increase of the field potentials and reduction of unit latency during the drug infusion, and a further long-lasting development of these modifications after the drug wash-out. The long-term effect depended on N-methyl-D-aspartate receptor activation, as D,L-2-amino-5-phosphonopentanoic acid prevented its development. We suggest that (R,S)-alpha-methyl-4carboxyphenylglycine enhances the vestibular responses and induces N-methyl-D-aspartate-dependent long-term potentiation by increasing glutamate release, through the block of presynaptic metabotropic glutamate receptors which actively inhibit it. The block of these receptors was indirectly supported by the fact that the agonist (1S,3R)-1-aminocyclopentane-1,3-dicarboxylic acid reduced the vestibular responses and blocked the induction of long-term potentiation by high-frequency stimulation. The simultaneous block of metabotropic glutamate receptors facilitating synaptic plasticity, impedes the full expression of the long-term effect throughout the (R,S)-alpha-methyl-4-carboxyphenylglycine infusion. The involvement of such a facilitatory mechanism in the potentiation is supported by its reversible reduction following a second (R,S)-alpha-methyl-4-carboxyphenylglycine infusion. The drug also reduced the expression of potentiation induced by high-frequency stimulation

  15. Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre-Existent Right Bundle Branch Block.

    PubMed

    van Gils, Lennart; Tchetche, Didier; Lhermusier, Thibault; Abawi, Masieh; Dumonteil, Nicolas; Rodriguez Olivares, Ramón; Molina-Martin de Nicolas, Javier; Stella, Pieter R; Carrié, Didier; De Jaegere, Peter P; Van Mieghem, Nicolas M

    2017-03-03

    Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre-existent right bundle branch block and categorize for different transcatheter heart valves. We pooled data on 306 transcatheter aortic valve replacement patients from 4 high-volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post-transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at 30-day and 1-year follow-up was present in 81% at 89%, respectively. Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker dependency remained high during follow-up. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by

  16. New-Onset Left Bundle Branch Block Induced by Transcutaneous Aortic Valve Implantation.

    PubMed

    Massoullié, Grégoire; Bordachar, Pierre; Ellenbogen, Kenneth A; Souteyrand, Géraud; Jean, Frédéric; Combaret, Nicolas; Vorilhon, Charles; Clerfond, Guillaume; Farhat, Mehdi; Ritter, Philippe; Citron, Bernard; Lusson, Jean-R; Motreff, Pascal; Ploux, Sylvain; Eschalier, Romain

    2016-03-01

    New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block. The management of LBBB after TAVI is currently not defined by international societies resulting in individual centers developing their own management strategy. The potential consequences of LBBB are dysrhythmias (atrioventricular block, syncope, and sudden death) and functional (heart failure) complications. Prompt postprocedural recognition and management (permanent pacemaker implantation) of patients prevents the occurrence of potential complications and may constitute the preferred approach in this frail and elderly population despite additional costs and complications of cardiac pacing. Moreover, the expansion of future indications for TAVI necessitates better identification of the predictive factors for the development of LBBB. Indeed, long-term right ventricular pacing may potentially increase the risk of developing heart failure in this population. In conclusion, it is thus imperative to not only develop new aortic prostheses with a less-deleterious impact on the conduction system but also to prescribe appropriate pacing modes in this frail population. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Clinical study of medial area infarction in the region of posterior inferior cerebellar artery.

    PubMed

    Ogawa, Katsuhiko; Suzuki, Yutaka; Oishi, Minoru; Kamei, Satoshi; Shigihara, Shuntaro; Nomura, Yasuyuki

    2013-05-01

    Our objective is to study the neurological characteristics of medial area infarction in the caudal cerebellum. Medial area of the caudal cerebellum is supplied with 2 branches of the posterior inferior cerebellar artery (PICA). The medial hemispheric branch of the PICA distributes to the medial area of the caudal cerebellar hemisphere. The medial branch of the PICA (mPICA) distributes to the inferior vermis. We studied the neurological characteristics of 18 patients with medial area infarction of the caudal cerebellum. The infarction was located in the medial area of the cerebellar hemisphere and vermis (medial ch/vermis) in 11 patients and in the medial area of the cerebellar hemisphere (medial ch) in 7 patients. All the 18 patients showed acute vertigo and disturbance of standing and gait at onset. On admission, the lateropulsion and wide-based gait were present in 13 patients, respectively. Mild ataxia of the extremities was shown in 7 patients. Acute vertigo and unsteadiness were prominent at onset in the 18 patients, although their ataxia of the extremities was mild or none. This result was consistent with the characteristics of medial area infarction of the caudal cerebellum. Comparing the neurological symptoms between the medial ch/vermis group and medial ch group, both lateropulsion and wide-based gait were significantly infrequent in medial ch group. This result indicated that the vermis was spared because the mPICA was not involved in the medial ch group. It is necessary to make a careful diagnosis when we encounter patients who present acute vertigo because truncal and gait ataxia are unremarkable on admission in patients with the medial area infarction of the caudal cerebellum without vermis involvement. Published by Elsevier Inc.

  18. Which test for CAD should be used in patients with left bundle branch block?

    PubMed

    Xu, Bo; Cremer, Paul; Jaber, Wael; Moir, Stuart; Harb, Serge C; Rodriguez, L Leonardo

    2018-03-01

    Exercise stress electrocardiography is unreliable as a test for obstructive coronary artery disease (CAD) if the patient has left bundle branch block. The authors provide an algorithm for using alternative tests: exercise stress echocardiography, dobutamine echocardiography, computed tomographic (CT) angiography, and nuclear myocardial perfusion imaging. Copyright © 2018 Cleveland Clinic.

  19. Is there a prognostic relevance of electrophysiological studies in bundle branch block patients?

    PubMed

    Bogossian, Harilaos; Frommeyer, Gerrit; Göbbert, Kornelius; Hasan, Fuad; Nguyen, Quy Suu; Ninios, Ilias; Mijic, Dejan; Bandorski, Dirk; Hoeltgen, Reinhard; Seyfarth, Melchior; Lemke, Bernd; Eckardt, Lars; Zarse, Markus

    2017-08-01

    The present European guidelines suggest a diagnostic electrophysiological (EP) study to determine indication for cardiac pacing in patients with bundle branch block and unexplained syncope. We evaluated the prognostic relevance of an EP study for mortality and the development of permanent complete atrioventricular (AV) block in patients with symptomatic bifascicular block and first-degree AV block. The HV interval is a poor prognostic marker to predict the development of permanent AV block in patients with symptomatic bifascicular block (BFB) and AV block I°. Thirty consecutive patients (mean age, 74.8 ± 8.6 years; 25 males) with symptomatic BFB and first-degree AV block underwent an EP study before device implantation, according to current guidelines. For 53 ± 31 months, patients underwent yearly follow-up screening for syncope or higher-degree AV block. Thirty patients presented with prolonged HV interval during the EP study (mean, 82.2 ± 20.1 ms; range, 57-142 ms), classified into 3 groups: group 1, <70 ms (mean, 62 ± 4 ms; range, 57-67 ms; n = 7), group 2, >70 to ≤100 ms (mean, 80 ± 8 ms; range, 70-97 ms; n = 18), and group 3, >100 ms (mean, 119 ± 14 ms; range, 107-142 ms; n = 5). According to the guidelines, patients in groups 2 and 3 received a pacemaker. The length of the HV interval was not associated with the later development of third-degree AV block or with increased mortality. Our present study suggests that an indication for pacemaker implantation based solely on a diagnostic EP study with prolongation of the HV interval is not justified. © 2017 Wiley Periodicals, Inc.

  20. Transthoracic Arteriovenous Graft Repair With the Pectoralis (PECS) II Nerve Block for Primary Intraoperative Anesthesia and Postoperative Analgesia: A Case Report.

    PubMed

    Farkas, Gabriel; Weber, Garret; Miller, Jonathon; Xu, Jeff

    2018-05-07

    The PECS II nerve block is a relatively new regional anesthetic technique that targets the medial and lateral pectoral nerves, as well as the lateral cutaneous branches of the intercostal nerves. It has been described for surgical cases involving the breast, as an adjunct or alternative to neuraxial or paravertebral techniques. This case report describes the first successful use of the PECS II nerve block placed using ultrasound guidance as the primary anesthetic and postoperative analgesic in a non-breast-related chest wall surgery.

  1. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

    PubMed Central

    Thapa, Deepak; Ahuja, Vanita

    2014-01-01

    Plantar fasciitis (PF) is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF). Following a diagnostic medial calcaneal nerve (MCN) block at its origin, we observed reduction in verbal numerical rating scale (VNRS) in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF). All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF. PMID:24963184

  2. Comparison of the calculation QRS angle for bundle branch block detection

    NASA Astrophysics Data System (ADS)

    Goeirmanto, L.; Mengko, R.; Rajab, T. L.

    2016-04-01

    QRS angle represent condition of blood circulation in the heart. Normally QRS angle is between -30 until 90 degree. Left Axis Defiation (LAD) and Right Axis Defiation (RAD) are abnormality conditions that lead to Bundle Branch Block. QRS angle is calculated using common method from physicians and compared to mathematical method using difference amplitudos and difference areas. We analyzed the standard 12 lead electrocardiogram data from MITBIH physiobank database. All methods using lead I and lead avF produce similar QRS angle and right QRS axis quadrant. QRS angle from mathematical method using difference areas is close to common method from physician. Mathematical method using difference areas can be used as a trigger for detecting heart condition.

  3. Ultrasound-Guided Selective Versus Conventional Block of the Medial Brachial Cutaneous and the Intercostobrachial Nerves: A Randomized Clinical Trial.

    PubMed

    Magazzeni, Philippe; Jochum, Denis; Iohom, Gabriella; Mekler, Gérard; Albuisson, Eliane; Bouaziz, Hervé

    2018-06-13

    For superficial surgery of anteromedial and posteromedial surfaces of the upper arm, the medial brachial cutaneous nerve (MBCN) and the intercostobrachial nerve (ICBN) must be selectively blocked, in addition to an axillary brachial plexus block. We compared efficacy of ultrasound-guided (USG) versus conventional block of the MBCN and the ICBN. Eighty-four patients, undergoing upper limb surgery, were randomized to receive either USG (n = 42) or conventional (n = 42) block of the MBCN and the ICBN with 1% mepivacaine. Sensory block was evaluated using light-touch on the upper and lower half of the anteromedial and posteromedial surfaces of the upper arm at 5, 10, 15, 20 minutes after nerve blocks. The primary outcome was the proportion of patients who had no sensation in all 4 regions innervated by the MBCN and the ICBN at 20 minutes. Secondary outcomes were onset time of complete anesthesia, volume of local anesthetic, tourniquet tolerance, and quality of ultrasound images. In the USG group, 37 patients (88%) had no sensation at 20 minutes in any of the 4 areas tested versus 8 patients (19%) in the conventional group (P < 0.001). When complete anesthesia was obtained, it occurred within 10 minutes in more than 90% of patients, in both groups. Mean total volumes of local anesthetic used for blocking the MBCN and the ICBN were similar in the 2 groups. Ultrasound images were of good quality in only 20 (47.6%) of 42 patients. Forty-one patients (97.6%) who received USG block were comfortable with the tourniquet versus 16 patients (38.1%) in the conventional group (P < 0.001). Ultrasound guidance improved the efficacy of the MBCN and ICBN blocks. This study was registered at ClinicalTrials.gov, identifier NCT02940847.

  4. [Ultrasound-guided cutaneous intercostal branches nerves block: A good analgesic alternative for gallbladder open surgery].

    PubMed

    Fernández Martín, M T; López Álvarez, S; Mozo Herrera, G; Platero Burgos, J J

    2015-12-01

    Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Mechanical dispersion is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks.

    PubMed

    Stankovic, Ivan; Janicijevic, Aleksandra; Dimic, Aleksandra; Stefanovic, Milica; Vidakovic, Radosav; Putnikovic, Biljana; Neskovic, Aleksandar N

    2018-03-01

    Bundle branch blocks (BBB)-related mechanical dyssynchrony and dispersion may improve patient selection for device therapy, but their effect on the natural history of this patient population is unknown. A total of 155 patients with LVEF ≤ 35% and BBB, not treated with device therapy, were included. Mechanical dyssynchrony was defined as the presence of either septal flash or apical rocking. Contraction duration was assessed as time interval from the electrocardiographic R-(Q-)wave to peak longitudinal strain in each of 17 left ventricular segments. Mechanical dispersion was defined as either the standard deviation of all time intervals (dispersion SD ) or as the difference between the longest and shortest time intervals (dispersion delta ). Patients were followed for cardiac mortality during a median period of 33 months. Mechanical dyssynchrony was not associated with survival. More pronounced mechanical dispersion delta was found in patients with dyssynchrony than in those without. In the multivariate regression analysis, patients' functional class, diabetes mellitus and dispersion delta were independently associated with mortality. Mechanical dispersion, but not dyssynchrony, was independently associated with mortality and it may be useful for risk stratification of patients with heart failure (HF) and BBB. Key Messages Mechanical dispersion, measured by strain echocardiography, is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Mechanical dispersion may be useful for risk stratification of patients with heart failure and bundle branch blocks.

  6. Subclinical ultrasonographic abnormalities of the suspensory ligament branches in National Hunt racehorses.

    PubMed

    Fairburn, A J; Busschers, E; Barr, A R S

    2017-07-01

    Suspensory ligament branch (SLB) desmopathy is a common cause of lameness and an important cause of lost training in the Thoroughbred racing industry. Studies have assessed the impact of insertional injuries of the SLB on the careers of flat racehorses and established the prevalence of subclinical ultrasonographic SLB abnormalities in this population, but little work has investigated SLB injury in National Hunt (NH) racehorses. To investigate the prevalence of subclinical ultrasonographic SLB abnormalities in NH racehorses with no clinical signs or history of SLB injury and to establish the cross-sectional area (CSA) of SLBs in this population. Cross-sectional study using data collected from horses on an NH yard. Ultrasonographic examination of forelimb SLBs in 62 horses on a single NH yard was performed. Images were graded according to a previously reported system. CSA measurements were obtained from transverse images. Nineteen of 62 horses had at least one SLB with grade 2 ultrasonographic abnormalities. Grade 2 ultrasonographic abnormalities occurred more frequently in the medial than the lateral SLB (P = 0.05). The medial SLB insertional CSA was significantly larger (P<0.001) than that of the lateral SLB. Length of time on the yard (and therefore available veterinary history) is variable in this population. One in three NH racehorses without history or clinical signs of SLB injury had at least one SLB with a grade 2 ultrasonographic abnormality. The medial branch was over-represented. The medial SLB insertional CSA is larger than the lateral and thus comparison with the corresponding branch in the contralateral limb is recommended to avoid misdiagnosis of medial SLB enlargement. © 2016 EVJ Ltd.

  7. Novel air-injection technique to locate the medial cut end of lacerated canaliculus.

    PubMed

    Liu, Bingqian; Li, Yonghao; Long, Chongde; Wang, Zhonghao; Liang, Xuanwei; Ge, Jian; Wang, Zhichong

    2013-12-01

    Locating the medial cut end of the severed canaliculus is the most difficult aspect of canalicular repair, especially in patients with more medial laceration, severe oedema, persistent errhysis and a narrow canaliculus. Irrigation is a widely used technique to identify the cut end; however, we found that air injected through the intact canaliculus with a straight needle failed to reflux when the common canaliculus or lacrimal sac was not blocked. We describe a simple, safe and efficient air-injection technique to identify the medial cut edge of a lacerated canaliculus. In this method, we initially submersed the medial canthus under normal saline, then injected filtered air through the intact canaliculus using a side port stainless steel probe with a closed round tip. The tip was designed to block the common canaliculus to form a relatively closed system. The efficiency of this novel air-injection technique was equivalent to the traditional technique but does not require the cooperation of the patient to blow air. Using this technique, the medial cut end was successfully identified by locating the air-bubble exit within minutes in 19 cases of mono-canalicular laceration without any complication.

  8. The "safe zone" in medial percutaneous calcaneal pin placement.

    PubMed

    Gamie, Zakareya; Donnelly, Leo; Tsiridis, Eleftherios

    2009-05-01

    Percutaneous pin insertion into the medial calcaneus places a number of structures at risk. Evidence suggests that the greatest risk is to the medial calcaneal nerve (MCN). The medial calcaneal region of 24 cadavers was dissected to determine the major structures at risk. By using four palpable anatomical landmarks, the inferior tip of the medial malleolus (point A), the posterior superior portion of the calcaneal tuberosity (point B), the navicular tuberosity (point C), and the medial process of the calcaneal tuberosity (point D), we attempted to define the safe zone taking into account all possible variables in our dissections including ankle position, side, gender, and possible anatomical variations of the MCN. The commonest arrangement of the MCN was two MCNs that arose independently, one arising before the bifurcation of the tibial nerve and the other arising from the medial plantar nerve. A zone could be defined posterior to 75% of the distance along the lines AB, CD, AD, and CB which would avoid most structures. The posterior branches of the MCN, however, would still be at risk and placing the pin too far posteriorly risks an avulsion fracture. This is the first study to employ four palpable anatomical landmarks to identify a zone to minimize damage to neurovascular structures. It may not be possible, however, to avoid injury of the MCN and consequent sensory loss to the sole of the foot.

  9. The anatomy of the palpebral branch of the infraorbital artery relating to midface lift.

    PubMed

    Hwang, Kun; Kim, Dong Hyun; Huan, Fan; Nam, Yong Seok; Han, Seung Ho

    2011-07-01

    The aim of this study was to elucidate a branch of the infraorbital artery (IOA) crossing the arcus marginalis into the orbit that might be vulnerable during a procedure of midface lift or fat sliding or a transposition in lower blepharoplasty.Eleven orbits of 6 Korean cadavers were dissected after injecting red latex into the external carotid artery. The IOA and nerve were identified. A branch of the IOA running upward was traced. In 28 cases of blow-out fracture, a branch of the IOA crossing the arcus marginalis into the orbit was identified, and the location was measured from each medial and lateral canthus.The palpebral branch of the IOA (PIOA) emerged from the infraorbital foramen and ran superior and lateral to the orbital septum. After passing through the orbital septum near the arcus marginalis, PIOA was distributed to the orbital fat. The palpebral branch of the IOA was identified in 21 (75.0%) of 28 fractured orbits. Twenty orbits had 1 PIOA, and 1 orbit had 2 PIOAs. The location of PIOA from the medial canthus (49.0%) was approximately half of the eye width in average. Most of the PIOAs (91%, 20 of 22 arteries found) were included in the range of 40% to 80% of the eye width from the medial canthus.Knowledge of the anatomic course of the PIOA crossing the arcus marginalis is conducive to cauterizing the vessels, as needed, in the subciliary or transconjunctival approach for lower blepharoplasty.

  10. MRI-guided Focused Ultrasound Ablation of Lumbar Medial Branch Nerve: Feasibility and Safety Study in a Swine Model

    PubMed Central

    Kaye, Elena A; Monette, Sebastien; Srimathveeravalli, Govindarajan; Maybody, Majid; Solomon, Stephen B; Gulati, Amitabh

    2016-01-01

    Purpose About 10–40% of chronic low back pain cases involve facet joints, which are commonly treated with lumbar medial branch (MB) radiofrequency neurotomy. Magnetic Resonance Imaging-guided Focused Ultrasound (MRgFUS), a non-invasive, non-ionizing ablation modality used to treat tumors, neuropathic pain and painful bone metastasis, can also be used to disrupt nerve conduction. This work’s purpose was to study the feasibility and safety of direct MRgFUS ablation of the lumbar MB nerve in acute and subacute swine models. Materials and Methods In vivo MRgFUS ablation was performed in six swine (3 acute and 3 subacute) using a clinical MRgFUS system (ExAblate 2000®; InSightec Ltd., Haifa, Israel) and 3 T MRI scanner (SIGNA; GE Healthcare, Waukesha, WI, USA) combination. Behavioral assessment was performed, and imaging and histology were used to assess the treatment. Results and Conclusions Histological analysis of the in vivo studies confirmed thermal necrosis of the MB nerve could be achieved without damaging the spinal cord or adjacent nerve roots. MRgFUS did not cause changes in the animals’ behavior and ambulation. PMID:27443328

  11. New branched DNA constructs.

    PubMed

    Chandra, Madhavaiah; Keller, Sascha; Gloeckner, Christian; Bornemann, Benjamin; Marx, Andreas

    2007-01-01

    The Watson-Crick base pairing of DNA is an advantageous phenomenon that can be exploited when using DNA as a scaffold for directed self-organization of nanometer-sized objects. Several reports have appeared in the literature that describe the generation of branched DNA (bDNA) with variable numbers of arms that self-assembles into predesigned architectures. These bDNA units are generated by using cleverly designed rigid crossover DNA molecules. Alternatively, bDNA can be generated by using synthetic branch points derived from either nucleoside or non-nucleoside building blocks. Branched DNA has scarcely been explored for use in nanotechnology or from self-assembling perspectives. Herein, we wish to report our results for the synthesis, characterization, and assembling properties of asymmetrical bDNA molecules that are able to generate linear and circular bDNA constructs. Our strategy for the generation of bDNA is based on a branching point that makes use of a novel protecting-group strategy. The bDNA units were generated by means of automated DNA synthesis methods and were used to generate novel objects by employing chemical and biological techniques. The entities generated might be useful building blocks for DNA-based nanobiotechnology.

  12. Combining living anionic polymerization with branching reactions in an iterative fashion to design branched polymers.

    PubMed

    Higashihara, Tomoya; Sugiyama, Kenji; Yoo, Hee-Soo; Hayashi, Mayumi; Hirao, Akira

    2010-06-16

    This paper reviews the precise synthesis of many-armed and multi-compositional star-branched polymers, exact graft (co)polymers, and structurally well-defined dendrimer-like star-branched polymers, which are synthetically difficult, by a commonly-featured iterative methodology combining living anionic polymerization with branched reactions to design branched polymers. The methodology basically involves only two synthetic steps; (a) preparation of a polymeric building block corresponding to each branched polymer and (b) connection of the resulting building unit to another unit. The synthetic steps were repeated in a stepwise fashion several times to successively synthesize a series of well-defined target branched polymers. Copyright © 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Medial Amygdala Lesions Selectively Block Aversive Pavlovian–Instrumental Transfer in Rats

    PubMed Central

    McCue, Margaret G.; LeDoux, Joseph E.; Cain, Christopher K.

    2014-01-01

    Pavlovian conditioned stimuli (CSs) play an important role in the reinforcement and motivation of instrumental active avoidance (AA). Conditioned threats can also invigorate ongoing AA responding [aversive Pavlovian–instrumental transfer (PIT)]. The neural circuits mediating AA are poorly understood, although lesion studies suggest that lateral, basal, and central amygdala nuclei, as well as infralimbic prefrontal cortex, make key, and sometimes opposing, contributions. We recently completed an extensive analysis of brain c-Fos expression in good vs. poor avoiders following an AA test (Martinez et al., 2013, Learning and Memory). This analysis identified medial amygdala (MeA) as a potentially important region for Pavlovian motivation of instrumental actions. MeA is known to mediate defensive responding to innate threats as well as social behaviors, but its role in mediating aversive Pavlovian–instrumental interactions is unknown. We evaluated the effect of MeA lesions on Pavlovian conditioning, Sidman two-way AA conditioning (shuttling) and aversive PIT in rats. Mild footshocks served as the unconditioned stimulus in all conditioning phases. MeA lesions had no effect on AA but blocked the expression of aversive PIT and 22 kHz ultrasonic vocalizations in the AA context. Interestingly, MeA lesions failed to affect Pavlovian freezing to discrete threats but reduced freezing to contextual threats when assessed outside of the AA chamber. These findings differentiate MeA from lateral and central amygdala, as lesions of these nuclei disrupt Pavlovian freezing and aversive PIT, but have opposite effects on AA performance. Taken together, these results suggest that MeA plays a selective role in the motivation of instrumental avoidance by general or uncertain Pavlovian threats. PMID:25278858

  14. Acquired left bundle branch block in an asymptomatic fighter pilot: a case report.

    PubMed

    Newman, D G

    1999-12-01

    This report describes a case of acquired left bundle branch block (LBBB) in an asymptomatic F/A-18 fighter pilot of the Royal Australian Air Force. The previously fit and healthy pilot was found to have LBBB on routine electrocardiographic screening prior to his annual aircrew medical. He was completely asymptomatic, and the only potential etiological factor was a short-lived acute gastrointestinal infectious illness some 4 mo previously. The pilot was extensively investigated with the full range of available diagnostic procedures, including coronary angiography and cardiac biopsy. No cause was determined for his LBBB pattern, and he was assessed as having normal cardiovascular function. The aeromedical disposition of this aviator and the issues involved in determining fitness to fly in such a case are discussed. The importance of thorough clinical investigation and appropriate follow-up are highlighted.

  15. Enhancement of L-valine production in Bacillus licheniformis by blocking three branched pathways.

    PubMed

    Liang, Chengwen; Huo, Yanli; Qi, Gaofu; Wei, Xuetuan; Wang, Qin; Chen, Shouwen

    2015-06-01

    Bacillus licheniformis WX-02 is used for the production of many valuable chemicals. Here, we have sought to improve L-valine production by blocking the metabolic pathways related to branched-chain amino acids. The synthesis genes of L-leucine (leuA) and L-isoleucine (ilvA) were deleted to obtain mutant strains. L-Valine yields of WX-02ΔleuA and WX-02ΔilvA reached 33.2 and 21.1 mmol/l, respectively, which are 22 and 14 times higher than the wild-type WX-02 (1.53 mmol/l). After further deletion of L-lactate dehydrogenase gene (ldh) from WX-02ΔleuA, the productivity reached 0.47 mmol/l h, an increase of 19 %. We provide a possibility to over-produce L-valine using genetically-modified B. licheniformis using remodeling of the biosynthetic pathway to L-valine.

  16. Temporary Medial Upper Eyelid Lagophthalmos after External Dacryocystorhinostomy.

    PubMed

    Haefliger, I O; Meienberg, O; Pimentel de Figueiredo, A R

    2016-04-01

    Background. Report of three cases of medial upper eyelid lagophthalmos as complication of external dacryocystorhinostomy. History and Signs. Shortly after dacryocystorhinostomy (skin incision on the side of the nose), three of ten consecutive patients (28 ± 4 years; mean ± standard deviation), presented with an ipsilateral lagophthalmos of 4 ± 1 mm in voluntary eyelid closure and 6 ± 1 mm in spontaneous blink. The lagophthalmos was due to a selective paresis of the medial part of the orbicularis oculi muscle of the upper eyelid. Patient 1 complained bitterly of dry eye symptoms and of her lagophthalmos. Patient 2 had mild symptoms but became very concerned after peers made her aware of her asymmetric blink. Patient 3 was asymptomatic and did not notice anything particular. Therapy and Outcome. Lagophthalmos resolved spontaneously within three months after surgery, first by improvement of voluntary eyelid closure and then of spontaneous blinking. Conclusions. Temporary lagophthalmos can occur as a complication of external dacryocystorhinostomy, most likely due to damage of the (only recently described) superficial buccal and/or zygomatic branches of the facial nerve that run upward to cross over the medial ligament and innervate the medial part of the orbicularis oculi muscle. Georg Thieme Verlag KG Stuttgart · New York.

  17. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers.

    PubMed

    Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V; Aasvang, Eske K; Lundstrøm, Lars H; Lange, Kai H W

    2015-01-01

    The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle-relaxing effect. The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9-15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512-716 minutes) and 609 minutes (490-724 minutes), respectively. Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.

  18. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery.

    PubMed

    Kerver, A L A; Leliveld, M S; den Hartog, D; Verhofstad, M H J; Kleinrensink, G J

    2013-12-04

    Iatrogenic injury to the infrapatellar branch of the saphenous nerve is a common complication of surgical approaches to the anteromedial side of the knee. A detailed description of the relative anatomic course of the nerve is important to define clinical guidelines and minimize iatrogenic damage during anterior knee surgery. In twenty embalmed knees, the infrapatellar branch of the saphenous nerve was dissected. With use of a computer-assisted surgical anatomy mapping tool, safe and risk zones, as well as the location-dependent direction of the nerve, were calculated. The location of the infrapatellar branch of the saphenous nerve is highly variable, and no definite safe zone could be identified. The infrapatellar branch runs in neither a purely horizontal nor a vertical course. The course of the branch is location-dependent. Medially, it runs a nearly vertical course; medial to the patellar tendon, it has a -45° distal-lateral course; and on the patella and patellar tendon, it runs a close to horizontal-lateral course. Three low risk zones for iatrogenic nerve injury were identified: one is on the medial side of the knee, at the level of the tibial tuberosity, where a -45° oblique incision is least prone to damage the nerves, and two zones are located medial to the patellar apex (cranial and caudal), where close to horizontal incisions are least prone to damage the nerves. The infrapatellar branch of the saphenous nerve is at risk for iatrogenic damage in anteromedial knee surgery, especially when longitudinal incisions are made. There are three low risk zones for a safer anterior approach to the knee. The direction of the infrapatellar branch of the saphenous nerve is location-dependent. To minimize iatrogenic damage to the nerve, the direction of incisions should be parallel to the direction of the nerve when technically possible. These findings suggest that iatrogenic damage of the infrapatellar branch of the saphenous nerve can be minimized in anteromedial

  19. Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks.

    PubMed

    Cho, Hyejin; Lee, Hye-Yeon; Gil, Young-Chun; Choi, Yun-Rak; Yang, Hee-Jun

    2013-10-01

    Understanding of the anatomy of the radial nerve and its branches is vital to the treatment of humeral fracture or the restoration of upper extremity function. In this study, we dissected 40 upper extremities from adult cadavers to locate the course of the radial nerve and the origins and insertions of the branches of the radial nerve using surface landmarks. The radial nerve reached and left the radial groove and pierced the lateral intermuscular septum, at the levels of 46.7, 60.5, and 66.8% from the acromion to the transepicondylar line, respectively. Branches to the long head of the triceps brachii originated in the axilla, and branches to the medial and lateral heads originated in the axilla or in the arm. The muscular attachments to the long, medial, and lateral heads were on average 34.0 mm proximal, 16.4 mm distal, and 19.3 mm proximal to the level of inferior end of the deltoid muscle, respectively. The radial nerve innervated 65.0% of the brachialis muscles. Branches to the brachioradialis and those to the extensor carpi radialis longus arose from the radial nerve above the transepicondylar line. Branches to the extensor carpi radialis brevis usually arose from the deep branch of radial nerve (67.5%); however, in some cases, branches to the extensor carpi radialis brevis arose from either the radial nerve (20.0%) or the superficial branch of the radial nerve (12.5%). Using these data, the course of the radial nerve can be estimated by observing the surface of the arm. Copyright © 2012 Wiley Periodicals, Inc.

  20. Arrhythmogenic Right Ventricular Cardiomyopathy with Multiple Thrombi and Ventricular Tachycardia of Atypical Left Branch Bundle Block Morphology.

    PubMed

    Gong, Shenzhen; Wei, Xin; Liu, Guyue; Wu, Feng; Chen, Xiaoping

    2018-04-06

    A 61-year-old male patient was admitted to our hospital with recurrent palpitations and syncope. Electrocardiography, echocardiography, and contrast-enhanced computed tomography were performed. The patient was diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC) complicated by multiple thrombi, and ventricular tachycardia (VT) without typical left bundle branch block (LBBB) morphology. This case suggests that VT is not always the sole contributor to syncope and death in patients with ARVC, and pulmonary embolism should be considered. Furthermore, VT with typical LBBB morphology is not an absolute necessity as a major criterion for the diagnosis of ARVC when the right heart is extremely enlarged.

  1. Clinical and electrocardiographic presentations of transient trifascicular block in three cats.

    PubMed

    Oxford, Eva M; Giacomazzi, Flavia B; Moïse, N Sydney; Santilli, Roberto A

    2018-06-01

    This report describes transient trifascicular block in three cats presented with lethargy and inappetence, and elevated cardiac troponin I concentrations. The electrocardiogram (ECG) of cat 1 showed a sinus rhythm with pronounced first-degree atrioventricular (AV) block, right bundle branch block, and left anterior fascicular block. The ECG of cat 2 showed truncular left bundle branch block alternating with left anterior fascicular block coupled with prolonged PR intervals, second-degree heart block, and paroxysmal third-degree AV block. The ECG of cat 3 showed first-degree AV block with concomitant right bundle branch block. The diagnosis of trifascicular block was made when paroxysmal third-degree AV block was documented. All cats recovered with medical management within weeks. Each cat resumed a sinus rhythm. Elevated cardiac troponin I concentrations suggested myocarditis that improved. Copyright © 2018 Elsevier B.V. All rights reserved.

  2. Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy.

    PubMed

    Ng, Casey K; Gill, Inderbir S; Patil, Mukul B; Hung, Andrew J; Berger, Andre K; de Castro Abreu, Andre Luis; Nakamoto, Masahiko; Eisenberg, Manuel S; Ukimura, Osamu; Thangathurai, Duraiyah; Aron, Monish; Desai, Mihir M

    2012-01-01

    Robot-assisted and laparoscopic partial nephrectomies (PNs) for medial tumors are technically challenging even with the hilum clamped and, until now, were impossible to perform with the hilum unclamped. Evaluate whether targeted vascular microdissection (VMD) of renal artery branches allows zero-ischemia PN to be performed even for challenging medial tumors. A prospective cohort evaluation of 44 patients with renal masses who underwent robot-assisted or laparoscopic zero-ischemia PN either with anatomic VMD (group 1; n=22) or without anatomic VMD (group 2; n=22) performed by a single surgeon from April 2010 to January 2011. Zero-ischemia PN with VMD incorporates four maneuvers: (1) preoperative computed tomographic reconstruction of renal arterial branch anatomy, (2) anatomic dissection of targeted, tumor-specific tertiary or higher-order renal arterial branches, (3) neurosurgical aneurysm microsurgical bulldog clamp(s) for superselective tumor devascularization, and (4) transient, controlled reduction of blood pressure, if necessary. Baseline, perioperative, and postoperative data were collected prospectively. Group 1 tumors were larger (4.3 vs 2.6 cm; p=0.011), were more often hilar (41% vs 9%; p=0.09), were medial (59% and 23%; p=0.017), were closer to the hilum (1.46 vs 3.26 cm; p=0.0002), and had a lower C index score (2.1 vs 3.9; p=0.004) and higher RENAL nephrometry scores (7.7 vs 6.2; p=0.013). Despite greater complexity, no group 1 tumor required hilar clamping, and perioperative outcomes were similar to those of group 2: operating room time (4.7 and 4.1h), median blood loss (200 and 100ml), surgical margins for cancer (all negative), major complications (0% and 9%), and minor complications (18% and 14%). The median serum creatinine level was similar 2 mo postoperatively (1.2 and 1.3mg/dl). The study was limited by the relatively small sample size. Anatomic targeted dissection and superselective control of tumor-specific renal arterial branches facilitate

  3. Onset of recent exertional dyspnoea in a firefighter with left bundle-branch block

    PubMed Central

    De Rosa, Roberto; Ratti, Gennaro; Lamberti, Monica

    2014-01-01

    Background The presence of a left bundle-branch block (LBBB) among firefighters raises questions about stratifying risk of subsequent cardiovascular events as this conduction disorder may mask underlying coronary artery disease. This report describes the case of a firefighter with a history LBBB with exertional dyspnoea of recent onset after work activity. Case report A 39-year-old male firefighter with LBBB developed exertional dyspnoea after a prolonged session of work. ECG and treadmill test only showed a permanent LBBB; echocardiography and myocardial scintigraphy did not add to this. However, multislice CT (MSCT) showed a significant stenosis in the mid-left anterior descending artery (LAD). Coronary angiography confirmed the stenosis with subsequent placement of a coronary stent. Conclusions An occupational physician should take into account that factors such as age and low cardiovascular risk do not always exclude heart disease, especially when there are conduction system abnormalities that can mask possible coronary artery disease. PMID:25352387

  4. Onset of recent exertional dyspnoea in a firefighter with left bundle-branch block.

    PubMed

    De Rosa, Roberto; Ratti, Gennaro; Lamberti, Monica

    2014-10-28

    The presence of a left bundle-branch block (LBBB) among firefighters raises questions about stratifying risk of subsequent cardiovascular events as this conduction disorder may mask underlying coronary artery disease. This report describes the case of a firefighter with a history LBBB with exertional dyspnoea of recent onset after work activity. A 39-year-old male firefighter with LBBB developed exertional dyspnoea after a prolonged session of work. ECG and treadmill test only showed a permanent LBBB; echocardiography and myocardial scintigraphy did not add to this. However, multislice CT (MSCT) showed a significant stenosis in the mid-left anterior descending artery (LAD). Coronary angiography confirmed the stenosis with subsequent placement of a coronary stent. An occupational physician should take into account that factors such as age and low cardiovascular risk do not always exclude heart disease, especially when there are conduction system abnormalities that can mask possible coronary artery disease. 2014 BMJ Publishing Group Ltd.

  5. Ipsilateral Medial and Lateral Discoid Meniscus with Medial Meniscus Tear

    PubMed Central

    Shimozaki, Kengo; Nakase, Junsuke; Ohashi, Yoshinori; Numata, Hitoaki; Oshima, Takeshi; Takata, Yasushi; Tsuchiya, Hiroyuki

    2016-01-01

    Introduction: Discoid meniscus is a well-documented knee pathology, and there are many cases of medial or lateral discoid meniscus reported in the literature. However, ipsilateral concurrent medial and lateral discoid meniscus is very rare, and only a few cases have been reported. Herein, we report a case of concurrent medial and lateral discoid meniscus. Case Report: A 27-year-old Japanese man complained of pain on medial joint space in his right knee that was diagnosed as a complete medial and lateral discoid meniscus. In magnetic resonance imaging, although the lateral discoid meniscus had no tear, the medial discoid meniscus had a horizontal tear. Arthroscopic examination of his right knee similarly revealed that the medial discoid meniscus had a horizontal tear. In addition, the discoid medial meniscus also had an anomalous insertion to the anterior cruciate ligament, and there was also mild fibrillation of the medial tibial cartilage surface. We performed arthroscopic partial meniscectomy for the torn medial discoid meniscus but not for the asymptomatic lateral discoid meniscus. The latest follow-up at 18 months indicated satisfactory results. Conclusion: We report a rare case of ipsilateral medial and lateral discoid meniscus with medial meniscus tear. The medial discoid meniscus with tear was treated with partial meniscectomy, whereas the lateral discoid meniscus without tear was only followed up. PMID:28164045

  6. The perforating branches of the P1 segment of the posterior cerebral artery.

    PubMed

    Kaya, Ahmet Hilmi; Dagcinar, Adnan; Ulu, Mustafa Onur; Topal, Arif; Bayri, Yasar; Ulus, Aykan; Kopuz, Cem; Sam, Bulent

    2010-01-01

    The perforating branches of the P1 segment of the posterior cerebral artery are vulnerable to injury. Because of their close proximity to the basilar artery, the vulnerability occurs especially during surgical interventions for vascular pathologies such as basilar apex aneurysms. Therefore, extensive knowledge of the microsurgical anatomy of this area is mandatory to prevent poor post-operative outcomes. We microscopically examined 28 P1 segments obtained from 14 adult fresh cadaver brains (6 silicone injected, 8 freshly examined). The P1 segments ranged between 2.8mm and 12.2mm (mean 6.8mm) in length with a mean outer diameter of 1.85 mm (range 0.8-4.5mm). All 94 thalamoperforating branches identified in 27 P1 segments (mean 3.35 branches per segment) arose from the postero-superior aspect of P1 and were the most proximally originating branch in nearly all specimens (96.4%). In addition in 28 P1s, 12 short circumflex arteries (42.8%; mean 0.42 branches per segment), 16 long circumflex arteries (57.1%; mean 0.57 branches per segment) and 10 medial posterior choroidal arteries (35.7%; mean 0.35 branches per segment) were identified and all originated from the posterior or postero-inferior surface of the P1 segment. When the P1 segment had more than one type of branch, it was the short circumflex arteries that were always more proximal in origin than the others. The medial posterior choroidal arteries were always more distal in origin. All three branches were not observed together in any of the P1 segments. The findings in this, and future, anatomical studies may help to reduce the post-surgical morbidity and mortality rates after surgery for posterior circulation aneurysms. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  7. [Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis].

    PubMed

    Lu, Di; Xu, Wei-xing; Ding, Wei-Guo; Guo, Qiao-Feng; Ma, Gou-ping; Zhu, Wei-min

    2013-03-01

    To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis. From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed. Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15

  8. Effect of Medialization Thyroplasty on Glottic Airway Anatomy: Cadaver Model.

    PubMed

    Shinghal, Tulika; Anderson, Jennifer; Chung, Janet; Hong, Aaron; Bharatha, Aditya

    2016-11-01

    The purpose of this study was to investigate the change in airway dimensions after medialization thyroplasty (MT) using a cadaveric model. Helical computerized tomography (CT) was performed before and after placement of a silastic block in human larynges to investigate the effect on airway anatomy at the level of the glottis. Tissue density (TD) of the medialized vocal fold (VF) was documented to understand the effect on tissue displacement. This is a cadaveric study. Thirteen human cadaveric larynges underwent fine-cut CT scan before and after MT was performed using carved blocks in two sizes (small block and large block [LB]). Clientstream software was used to measure laryngeal dimensions: intraglottic volume (IGV), cross-sectional area (CSA), posterior-glottic diameter (PGD), VF density (in Hounsfield units [HUs]), and anterior-posterior diameter (APD). Eight sequential axial sections 0.625 mm cuts) at the level of the true VFs were analyzed. There was a significant decrease between the three conditions for IGV (P < 0.0001) and CSA (P < 0.0001). TD of the VF was increased after MT as indicated by HU increase (P = 0.0003). APD was not significantly changed. PGD was significantly different between the no block to LB placement (P = 0.0012). MT significantly changes the IGV and CSA at the level of the glottis. Density in the true VF was significantly increased. These findings have important implications for understanding volumetric effects of MT. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  9. Reversible chronic acquired complete atrioventricular block.

    PubMed

    Rakovec, P; Milcinski, G; Voga, G; Korsic, L

    1982-01-01

    The return of atrioventricular conduction is reported in a case after nearly four years of complete acquired heart block. After recovery from atrioventricular block, right bundle branch block persisted, but P-R interval and H-V interval were normal. Three months later a relapse of second degree infranodal atrioventricular block was noted. A short review of similar cases from the literature is given.

  10. Infarcts presenting with a combination of medial medullary and posterior inferior cerebellar artery syndromes.

    PubMed

    Lee, Hyung; Baik, Seung Kug

    2004-09-15

    Cerebellar and medial medullary infarctions are well-known vertebrobasilar stroke syndromes. However, their development in a patient with distal vertebral artery occlusion has not been previously reported. A 49-year-old man with longstanding hypertension suddenly developed vertigo, right-sided Horner syndrome, and left-sided weakness. An MRI of the brain showed acute infarcts in the right inferior cerebellum (posterior inferior cerebellar artery territory) and the right upper medial medulla (direct penetrating branches of vertebral artery). Magnetic resonance angiogram showed occlusion of the distal vertebral artery on the right side. Atherothrombotic occlusion of the distal vertebral artery may cause this unusual combination of vertebrobasilar stroke.

  11. Bundle branch block after ablation for Wolff-Parkinson-White syndrome.

    PubMed

    Fuenmayor A, Abdel J; Rodríguez S, Yenny A

    2013-09-20

    Bundle branch block (BBB) is a difficult diagnosis in the Wolff-Parkinson-White syndrome (WPW). We investigated the clinical implications of BBB that appears after performing an accessory pathway (AP) ablation. We studied 199 patients with WPW who were submitted to AP ablation. Thirty (15%) exhibited BBB after the ablation. Twenty-two patients had right BBB and 8 had left BBB. Thirteen patients had right-sided AP and 17 had left-sided AP. They were compared with 82 similar patients without BBB after the AP ablation. Among the patients with BBB, 86.66% showed delays in the middle part of the QRS in the ECG recorded before ablation vs. 18.29% of the patients without BBB (p<0.05) (sensitivity 86%, specificity 81%, positive predictive value 67% and negative predictive value 93%). Forty-four percent of the patients with BBB had BBB morphology during orthodromic tachycardia vs. 10% of the patients without BBB (p<0.05) (sensitivity 44%, specificity 89%, positive predictive value 57% and negative predictive value 82%). No relationship was found between AP location and the site of the BBB. Ejection fraction was normal before (0.61 ± 0.03) and upon completion of follow-up (0.61 ± 0.07). BBB disappeared in 95.3% of the patients. Delays in the middle portion of the QRS may predict BBB after AP ablation. BBB after performing AP ablation is frequent, transient, benign, and not related to either the ablation lesion location or progression to structural heart disease. BBB after AP ablation may be related to cardiac memory. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  12. Electrophysiological evidence of doubly innervated branched muscle fibers in the human brachioradialis muscle.

    PubMed

    Lateva, Zoia C; McGill, Kevin C

    2007-12-01

    Motor-unit action potentials (MUAPs) with unstable satellite (late-latency) components are found in EMG signals from the brachioradialis muscles of normal subjects. We analyzed the morphology and blocking behavior of these MUAPs to determine their anatomical origin. EMG signals were recorded from the brachioradialis muscles of 5 normal subjects during moderate-level isometric contractions. MUAP waveforms, discharge patterns, and blocking were determined using computer-aided EMG decomposition. Twelve MUAPs with unstable satellite potentials were detected, always two together in the same signal. Each MUAP also had a second unstable component associated with its main spike. The blocking behavior of the unstable components depended on how close together the two MUAPs were when they discharged. The latencies and blocking behavior indicate that the unstable components came from branched muscle fibers innervated by two different motoneurons. The satellite potentials were due to action potentials that traveled to the branching point along one branch and back along the other. The blockings were due to action-potential collisions when both motoneurons discharged close together in time. Animal studies suggest that branched muscle fibers may be a normal characteristic of series-fibered muscles. This study adds to our understanding of these muscles in humans.

  13. Medial elbow pain

    PubMed Central

    Barco, Raul; Antuña, Samuel A.

    2017-01-01

    Medial elbow pain is uncommon when compared with lateral elbow pain. Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain. Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain. Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders. Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event. This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies. Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006 PMID:28932488

  14. Branched hybrid vessel: in vitro loaded hydrodynamic forces influence the tissue architecture.

    PubMed

    Kobashi, T; Matsuda, T

    2000-01-01

    This study was conducted to investigate how a continuous load of hydrodynamic stresses influences the tissue architecture of a branched hybrid vessel in vitro. Tubular hybrid medial tissue of small (3 mm) and large (6 mm) diameters, prepared by thermal gelation of a cold mixed solution of bovine smooth muscle cells (SMCs) and type I collagen in glass molds, was assembled into a branched hybrid medial tissue by end-to-side anastomosis. After a 2-week culture period, bovine endothelial cells (ECs) were seeded onto the luminal surface. The branched hybrid vessel was connected to a mock circulatory loop system and tested for two modes of flow: 1) low flow rate for 24 h, 2) high flow rate for 24 or 72 h. After exposure to a low flow rate for 24 h, cobblestone appearance of the ECs was dominant. After exposure to a high flow rate, EC alignment in the direction of flow was observed in the branch region, except at the region of predicted flow separation where ECs retained their polygonal configuration. Elongation of SMCs with no preferential orientation was observed in the case of vessels exposed to a high flow rate for 24 h, and circumferential orientation was prominent in those exposed to a high flow rate for 72 h. On the other hand, collagen fibrils exhibited no preferential orientation in either case. After injection of Evans blue-albumin conjugate into the circulating medium, the luminal surface of the hybrid vessel exposed to a high flow rate for 24 h was examined by confocal laser scanning microscopy. The fluorescence intensity was low at the high shear zone in the branch region, while at the flow separation region it was very high, indicating the increased albumin permeability at the latter region. These findings reflect region-specific tissue architecture in the branch region, in response to the local flow pattern, and may provide an in vitro atherosclerosis model as well as a fundamental basis for the development of functional branched hybrid grafts.

  15. Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

    PubMed

    Barber, F Alan; Getelman, Mark H; Berry, Kathy L

    2017-04-01

    To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

  16. Leading Process Branch Instability in Lis1+/− Nonradially Migrating Interneurons

    PubMed Central

    Gopal, Pallavi P.; Simonet, Jacqueline C.; Shapiro, William

    2010-01-01

    Mammalian forebrain development requires extensive migration, yet the mechanisms through which migrating neurons sense and respond to guidance cues are not well understood. Similar to the axon growth cone, the leading process and branches of neurons may guide migration, but the cytoskeletal events that regulate branching are unknown. We have previously shown that loss of microtubule-associated protein Lis1 reduces branching during migration compared with wild-type neurons. Using time-lapse imaging of Lis1+/− and Lis1+/+ cells migrating from medial ganglionic eminence explant cultures, we show that the branching defect is not due to a failure to initiate branches but a defect in the stabilization of new branches. The leading processes of Lis1+/− neurons have reduced expression of stabilized, acetylated microtubules compared with Lis1+/+ neurons. To determine whether Lis1 modulates branch stability through its role as the noncatalytic β regulatory subunit of platelet-activating factor (PAF) acetylhydrolase 1b, exogenous PAF was applied to wild-type cells. Excess PAF added to wild-type neurons phenocopies the branch instability observed in Lis1+/− neurons, and a PAF antagonist rescues leading process branching in Lis1+/− neurons. These data highlight a role for Lis1, acting through the PAF pathway, in leading process branching and microtubule stabilization. PMID:19861636

  17. Detection of inter-patient left and right bundle branch block heartbeats in ECG using ensemble classifiers

    PubMed Central

    2014-01-01

    Background Left bundle branch block (LBBB) and right bundle branch block (RBBB) not only mask electrocardiogram (ECG) changes that reflect diseases but also indicate important underlying pathology. The timely detection of LBBB and RBBB is critical in the treatment of cardiac diseases. Inter-patient heartbeat classification is based on independent training and testing sets to construct and evaluate a heartbeat classification system. Therefore, a heartbeat classification system with a high performance evaluation possesses a strong predictive capability for unknown data. The aim of this study was to propose a method for inter-patient classification of heartbeats to accurately detect LBBB and RBBB from the normal beat (NORM). Methods This study proposed a heartbeat classification method through a combination of three different types of classifiers: a minimum distance classifier constructed between NORM and LBBB; a weighted linear discriminant classifier between NORM and RBBB based on Bayesian decision making using posterior probabilities; and a linear support vector machine (SVM) between LBBB and RBBB. Each classifier was used with matching features to obtain better classification performance. The final types of the test heartbeats were determined using a majority voting strategy through the combination of class labels from the three classifiers. The optimal parameters for the classifiers were selected using cross-validation on the training set. The effects of different lead configurations on the classification results were assessed, and the performance of these three classifiers was compared for the detection of each pair of heartbeat types. Results The study results showed that a two-lead configuration exhibited better classification results compared with a single-lead configuration. The construction of a classifier with good performance between each pair of heartbeat types significantly improved the heartbeat classification performance. The results showed a

  18. Detection of inter-patient left and right bundle branch block heartbeats in ECG using ensemble classifiers.

    PubMed

    Huang, Huifang; Liu, Jie; Zhu, Qiang; Wang, Ruiping; Hu, Guangshu

    2014-06-05

    Left bundle branch block (LBBB) and right bundle branch block (RBBB) not only mask electrocardiogram (ECG) changes that reflect diseases but also indicate important underlying pathology. The timely detection of LBBB and RBBB is critical in the treatment of cardiac diseases. Inter-patient heartbeat classification is based on independent training and testing sets to construct and evaluate a heartbeat classification system. Therefore, a heartbeat classification system with a high performance evaluation possesses a strong predictive capability for unknown data. The aim of this study was to propose a method for inter-patient classification of heartbeats to accurately detect LBBB and RBBB from the normal beat (NORM). This study proposed a heartbeat classification method through a combination of three different types of classifiers: a minimum distance classifier constructed between NORM and LBBB; a weighted linear discriminant classifier between NORM and RBBB based on Bayesian decision making using posterior probabilities; and a linear support vector machine (SVM) between LBBB and RBBB. Each classifier was used with matching features to obtain better classification performance. The final types of the test heartbeats were determined using a majority voting strategy through the combination of class labels from the three classifiers. The optimal parameters for the classifiers were selected using cross-validation on the training set. The effects of different lead configurations on the classification results were assessed, and the performance of these three classifiers was compared for the detection of each pair of heartbeat types. The study results showed that a two-lead configuration exhibited better classification results compared with a single-lead configuration. The construction of a classifier with good performance between each pair of heartbeat types significantly improved the heartbeat classification performance. The results showed a sensitivity of 91.4% and a positive

  19. Differential Effects of RET and TRKB on Axonal Branching and Survival of Parasympathetic Neurons

    PubMed Central

    Simpson, Julie; Keefe, Julie; Nishi, Rae

    2014-01-01

    Interactions between neurons and their targets of innervation influence many aspects of neural development. To examine how synaptic activity interacts with neurotrophic signaling, we determined the effects of blocking neuromuscular transmission on survival and axonal outgrowth of ciliary neurons from the embryonic chicken ciliary ganglion. Ciliary neurons undergo a period of cell loss due to programmed cell death between embryonic Days (E) 8 and 14 and they innervate the striated muscle of the iris. The nicotinic antagonist d-tubocurarine (dTC) induces an increase in branching measured by counting neurofilament-positive voxels (NF-VU) in the iris between E14–17 while reducing ciliary neuron survival. Blocking ganglionic transmission with dihyro-β-erythroidin and α-methyllycacontine does not mimic dTC. At E8, many trophic factors stimulate neurite outgrowth and branching of neurons placed in cell culture; however, at E13, only GDNF stimulates branching selectively in cultured ciliary neurons. The GDNF-induced branching at E13 could be inhibited by BDNF. Blocking ret signaling in vivo with a dominant negative (dn)ret decreases survival of ciliary and choroid neurons at E14 and prevents dTC induced increases in NF-VU in the iris at E17. Blocking TRKB signaling with dn TRKB increases NF-VU in the iris at E17 and decreases neuronal survival at E17, but not at E14. Thus, RET promotes survival during programmed cell death in the ciliary ganglion and contributes to promoting branching when synaptic transmission is blocked while TRKB inhibits branching and promotes maintenance of neuronal survival. These studies highlight the multifunctional nature of trophic molecule function during neuronal development. PMID:22648743

  20. Trastuzumab (Herceptin)-associated cardiomyopathy presented as new onset of complete left bundle-branch block mimicking acute coronary syndrome: a case report and literature review.

    PubMed

    Tu, Chung-Ming; Chu, Kai-Ming; Yang, Shin-Ping; Cheng, Shu-Mung; Wang, Wen-Been

    2009-09-01

    Trastuzumab (Herceptin) is well documented in reducing suffering and mortality from breast cancer. The clinically most important side effect of Herceptin is cardiotoxicity, which is reported in 2.6% to 4.5% of patients receiving trastuzumab alone and in as many as 27% of patients when trastuzumab is combined with an anthracycline in metastatic disease. We reported the case of a 50-year-old woman who presented to our emergency department (ED) because of chest pain and shortness of breath. On physical examination, holosystolic murmur over apex could be heard. Pulmonary and abdominal examinations were unremarkable. Twelve-lead electrocardiography showed sinus tachycardia and new onset of complete left bundle-branch block. Emergent transthoracic echocardiography revealed generalized hypokinesia of left ventricle and akinesia over interventricular septum and apex. She subsequently underwent immediate coronary angiography that revealed normal coronary angiography, and left ventriculogram revealed generalized hypokinesia with severe left ventricle dysfunction with ejection fraction of 33%. During right heart catheterization and endomyocardial biopsy, cardiac tamponade developed and was successfully relieved by pericardial window. She was discharged event-free 3 weeks later with conservative treatment. Although new onset of complete left bundle-branch block in a patient with chest pain may be acute coronary syndrome, careful review of medicine history is mandatory to avoid unnecessary procedure and complications.

  1. Controlled growth of novel hyper-branched nanostructures in nanoporous alumina membrane.

    PubMed

    Zhang, Junping; Day, Cynthia S; Carroll, David L

    2009-12-07

    This paper proposes a novel approach to fabricate hyper-branched anodic aluminium oxide (AAO) nanostructures with different branches on the vertically-aligned trunk and at the trunk terminal. Silver nanowires with different dimensional and multifunctional complexity have been prepared from this hyper-branched AAO template by varying the electrodeposition time. These kinds of novel nanostructure may be used to build blocks for nanoelectronic and nanophotonic devices.

  2. Whiplash and Whiplash Associated Disorder (WAS)

    MedlinePlus

    ... Patient Education Committee The spine is a long chain of bones, discs, muscles and ligaments that extends ... is to perform an injection called "medial branch block (MBB)," which is discussed below. Disc injury can ...

  3. False-positive defects on exercise 99mTc-sestamibi SPECT imaging, but not on dipyridamole 99mTc-sestamibi SPECT imaging, in a patient with right bundle branch block (RBBB).

    PubMed

    Javadi, Hamid; Jallalat, Sara; Semnani, Shahriar; Mogharrabi, Mehdi; Nabipour, Iraj; Abbaszadeh, Moloud; Assadi, Majid

    2013-01-01

    False-positive findings with myocardial perfusion imaging (MPI) have frequently been identified in the presence of left bundle branch block (LBBB) and tend to lower the accuracy of MPI in individuals with normal coronary angiographs. Pharmacologic stress is recognized as the preferred method for MPI in patients with LBBB. In contrast, very few studies have evaluated the effect of right bundle branch block (RBBB) on MPI, and there is no consensus regarding the selection of pharmacologic versus exercise stress during MPI for the RBBB patient. In this study, we present a 45-year-old man with RBBB, who has a normal coronary artery angiography, but who showed abnormal myocardial perfusion with exercise MPI, and normal perfusion on dipyridamole MPI. The aim of the study is to stimulate awareness that the stress method selected for patients with RBBB can potentially interfere with the accuracy of the data.

  4. Programming Cardiac Resynchronization Therapy for Electrical Synchrony: Reaching Beyond Left Bundle Branch Block and Left Ventricular Activation Delay.

    PubMed

    Varma, Niraj; O'Donnell, David; Bassiouny, Mohammed; Ritter, Philippe; Pappone, Carlo; Mangual, Jan; Cantillon, Daniel; Badie, Nima; Thibault, Bernard; Wisnoskey, Brian

    2018-02-06

    QRS narrowing following cardiac resynchronization therapy with biventricular (BiV) or left ventricular (LV) pacing is likely affected by patient-specific conduction characteristics (PR, qLV, LV-paced propagation interval), making a universal programming strategy likely ineffective. We tested these factors using a novel, device-based algorithm (SyncAV) that automatically adjusts paced atrioventricular delay (default or programmable offset) according to intrinsic atrioventricular conduction. Seventy-five patients undergoing cardiac resynchronization therapy (age 66±11 years; 65% male; 32% with ischemic cardiomyopathy; LV ejection fraction 28±8%; QRS duration 162±16 ms) with intact atrioventricular conduction (PR interval 194±34, range 128-300 ms), left bundle branch block, and optimized LV lead position were studied at implant. QRS duration (QRSd) reduction was compared for the following pacing configurations: nominal simultaneous BiV (Mode I: paced/sensed atrioventricular delay=140/110 ms), BiV+SyncAV with 50 ms offset (Mode II), BiV+SyncAV with offset that minimized QRSd (Mode III), or LV-only pacing+SyncAV with 50 ms offset (Mode IV). The intrinsic QRSd (162±16 ms) was reduced to 142±17 ms (-11.8%) by Mode I, 136±14 ms (-15.6%) by Mode IV, and 132±13 ms (-17.8%) by Mode II. Mode III yielded the shortest overall QRSd (123±12 ms, -23.9% [ P <0.001 versus all modes]) and was the only configuration without QRSd prolongation in any patient. QRS narrowing occurred regardless of QRSd, PR, or LV-paced intervals, or underlying ischemic disease. Post-implant electrical optimization in already well-selected patients with left bundle branch block and optimized LV lead position is facilitated by patient-tailored BiV pacing adjusted to intrinsic atrioventricular timing using an automatic device-based algorithm. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. Outside-In Deep Medial Collateral Ligament Release During Arthroscopic Medial Meniscus Surgery.

    PubMed

    Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel

    2016-08-01

    Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.

  6. Engineered short branched-chain acyl-CoA synthesis in E. coli and acylation of chloramphenicol to branched-chain derivatives.

    PubMed

    Bi, Huiping; Bai, Yanfen; Cai, Tao; Zhuang, Yibin; Liang, Xiaomei; Zhang, Xueli; Liu, Tao; Ma, Yanhe

    2013-12-01

    Short branched-chain acyl-CoAs are important building blocks for a wide variety of pharmaceutically valuable natural products. Escherichia coli has been used as a heterologous host for the production of a variety of natural compounds for many years. In the current study, we engineered synthesis of isobutyryl-CoA and isovaleryl-CoA from glucose in E. coli by integration of the branched-chain α-keto acid dehydrogenase complex from Streptomyces avermitilis. In the presence of the chloramphenicol acetyltransferase (cat) gene, chloramphenicol was converted to both chloramphenicol-3-isobutyrate and chloramphenicol-3-isovalerate by the recombinant E. coli strains, which suggested successful synthesis of isobutyryl-CoA and isovaleryl-CoA. Furthermore, we improved the α-keto acid precursor supply by overexpressing the alsS gene from Bacillus subtilis and the ilvC and ilvD genes from E. coli and thus enhanced the synthesis of short branched-chain acyl-CoAs. By feeding 25 mg/L chloramphenicol, 2.96 ± 0.06 mg/L chloramphenicol-3-isobutyrate and 3.94 ± 0.06 mg/L chloramphenicol-3-isovalerate were generated by the engineered E. coli strain, which indicated efficient biosynthesis of short branched-chain acyl-CoAs. HPLC analysis showed that the most efficient E. coli strain produced 80.77 ± 3.83 nmol/g wet weight isovaleryl-CoA. To our knowledge, this is the first report of production of short branched-chain acyl-CoAs in E. coli and opens a way to biosynthesize various valuable natural compounds based on these special building blocks from renewable carbon sources.

  7. Right bundle branch block without overt heart disease predicts higher risk of pacemaker implantation: the study of atomic-bomb survivors.

    PubMed

    Kusumoto, Saburo; Kawano, Hiroaki; Makita, Naomasa; Ichimaru, Shinichiro; Kaku, Takashi; Haruta, Daisuke; Hida, Ayumi; Sera, Nobuko; Imaizumi, Misa; Nakashima, Eiji; Maemura, Koji; Akahoshi, Masazumi

    2014-06-01

    We investigated the clinical course of complete right bundle branch block (RBBB) or RBBB with axis deviation (AD) in terms of subsequent pacemaker implantation for high-degree atrioventricular (AV) block or sick sinus syndrome (SSS). Among the 16,170 atomic-bomb survivors in our biennial health examination between July 1967 and December 2010, we detected 520 newly-acquired RBBB subjects with no organic heart disease, and selected 1038 age- (at RBBB diagnosis) and sex-matched subjects without RBBB to serve as comparison subjects. Multivariate Cox regression analysis was used to estimate the hazard ratios (HRs) for the risk of pacemaker implantation due to all causes, AV block or SSS between RBBB and comparison subjects and between RBBB subjects with and without AD. The risk of pacemaker implantation for RBBB was 4.79 (95% confidence interval [CI] 1.89-12.58; P=0.001), 3.77 (95% CI, 1.09-13.07; P=0.036), and 6.28 (95% CI, 1.24-31.73, P=0.026) when implantation was for all causes, AV block and SSS, respectively. RBBB subjects with AD had a higher risk for all-cause pacemaker implantation than subjects without AD (HR, 3.03; 95% CI, 1.00-9.13, P=0.049). RBBB subjects with AD were younger than subjects without AD at the time of RBBB diagnosis (59.4±7.6 vs 74.4±3.1 years old, P=0.019), and their progression from diagnosis to pacemaker implantation took longer (15.1±6.6 vs 6.4±3.0 years, P=0.032). RBBB, especially with AD, progresses to AV block and SSS that requires pacemaker implantation; the mechanisms by which the conduction defect progresses differ among patients with and without AD. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Composition of clusters and building blocks in amylopectins from maize mutants deficient in starch synthase III.

    PubMed

    Zhu, Fan; Bertoft, Eric; Seetharaman, Koushik

    2013-12-18

    Branches in amylopectin are distributed along the backbone. Units of the branches are building blocks (smaller) and clusters (larger) based on the distance between branches. In this study, composition of clusters and building blocks of amylopectins from dull1 maize mutants deficient in starch synthase III (SSIII) with a common genetic background (W64A) were characterized and compared with the wild type. Clusters were produced from amylopectins by partial hydrolysis using α-amylase of Bacillus amyloliquefaciens and were subsequently treated with phosphorylase a and β-amylase to produce φ,β-limit dextrins. Clusters were further extensively hydrolyzed with the α-amylase to produce building blocks. Structures of clusters and building blocks were analyzed by diverse chromatographic techniques. The results showed that the dull1 mutation resulted in larger clusters with more singly branched building blocks. The average cluster contained ~5.4 blocks in dull1 mutants and ~4.2 blocks in the wild type. The results are compared with previous results from SSIII-deficient amo1 barley and suggest fundamental differences in the cluster structures.

  9. Posterior medial meniscus detachment: a unique type of medial meniscal tear.

    PubMed

    Rubinstein, Richard A; DeHaan, Alex; Baldwin, James L

    2009-10-01

    Patients with posterior medial meniscal detachment, as determined at knee arthroscopy, were evaluated retrospectively. Mean follow-up was 5.3 years for 8 men and 20 women (30 knees; mean age, 57 years). Most patients had acute onset of pain with a minor specific incident. Seventeen patients were obese, 9 were overweight, and 2 were normal. Eleven of 22 magnetic resonance imaging evaluations detected a tear at the site of the posterior medial meniscus root. Nine of 16 bone scan evaluations showed moderate uptake medially. Arthroscopic treatment included partial medial meniscectomy or meniscal repair. Twelve knees (40%) showed significant progression of arthritis. Of the 7 patients with severe arthritic knees, 5 have subsequently undergone total knee arthroplasty, 1 is considering total knee arthroplasty, and the other has minimal symptoms. Patients should be counseled about the clinical course of posterior medial meniscus detachment and its potential for progressive arthritis in the joint.

  10. Vasovagal Rates in Flouroscopically Guided Interventional Procedures: A Study of Over 8,000 Injections

    PubMed Central

    Kennedy, David J.; Schneider, Byron; Casey, Ellen; Rittenberg, Joshua; Conrad, Bryan; Smuck, Matthew; Plastaras, Christopher T.

    2014-01-01

    Objective To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures. Design Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009. Setting A single academic medical center. Subjects Four thousand one hundred eighty-three subjects undergoing 8,010 consecutive injections. Outcome Measures Pearson's chi-square test was used to determine the relationship between categorical variables. Results A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001). Conclusions vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures. PMID:24118835

  11. Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases.

    PubMed

    Perlas, Anahi; Lobo, Giovanni; Lo, Nick; Brull, Richard; Chan, Vincent W S; Karkhanis, Reena

    2009-01-01

    Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery. After institutional review board approval, the outcome of 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery was reviewed. Real-time ultrasound guidance was used with a high-frequency linear probe. The neurovascular structures were imaged on short axis, and the needle was inserted using an in-plane technique with either a medial-to-lateral or lateral-to-medial orientation. Five hundred ten ultrasound-guided supraclavicular blocks were performed (50 inpatients, 460 outpatients) by 47 different operators at different levels of training over a 24-month period. Successful surgical anesthesia was achieved in 94.6% of patients after a single attempt; 2.8% required local anesthetic supplementation of a single peripheral nerve territory; and 2.6% received an unplanned general anesthetic. No cases of clinically symptomatic pneumothorax developed. Complications included symptomatic hemidiaphragmatic paresis (1%), Horner syndrome (1%), unintended vascular punctures (0.4%), and transient sensory deficits (0.4%). Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.

  12. Accessory branch of median nerve supplying the brachialis muscle: a case report and clinical significance.

    PubMed

    Paraskevas, George; Anastasopoulos, Nikolaos; Nitsa, Zoi; Kitsoulis, Panagiotis; Spyridakis, Ioannis

    2014-12-01

    A very rare case of an accessory branch of the median nerve taking its origin in the region of the right arm was observed to supply the infero-medial portion of the brachialis muscle in a male cadaver. Simultaneously, the ipsilateral musculocutaneous nerve was innervating the muscles of the anterior compartment of the arm. Such an aberrant muscular branch of the median nerve for the brachialis muscle is very rarely reported in the literature. Lesion of the median nerve proximal to the branch's origin site could induce weak flexion of the elbow, whereas injury of the musculocutaneous nerve could lead to misinterpretation of symptoms. We discuss the patterns of brachialis muscle innervation as well as the clinical applications of such a variant.

  13. Three-Level De-Multiplexed Dual-Branch Complex Delta-Sigma Transmitter.

    PubMed

    Arfi, Anis Ben; Elsayed, Fahmi; Aflaki, Pouya M; Morris, Brad; Ghannouchi, Fadhel M

    2018-02-20

    In this paper, a dual-branch topology driven by a Delta-Sigma Modulator (DSM) with a complex quantizer, also known as the Complex Delta Sigma Modulator (CxDSM), with a 3-level quantized output signal is proposed. By de-multiplexing the 3-level Delta-Sigma-quantized signal into two bi-level streams, an efficiency enhancement over the operational frequency range is achieved. The de-multiplexed signals drive a dual-branch amplification block composed of two switch-mode back-to-back power amplifiers working at peak power. A signal processing technique known as quantization noise reduction with In-band Filtering (QNRIF) is applied to each of the de-multiplexed streams to boost the overall performances; particularly the Adjacent Channel Leakage Ratio (ACLR). After amplification, the two branches are combined using a non-isolated combiner, preserving the efficiency of the transmitter. A comprehensive study on the operation of this topology and signal characteristics used to drive the dual-branch Switch-Mode Power Amplifiers (SMPAs) was established. Moreover, this work proposes a highly efficient design of the amplification block based on a back-to-back power topology performing a dynamic load modulation exploiting the non-overlapping properties of the de-multiplexed Complex DSM signal. For experimental validation, the proposed de-multiplexed 3-level Delta-Sigma topology was implemented on the BEEcube™ platform followed by the back-to-back Class-E switch-mode power amplification block. The full transceiver is assessed using a 4th-Generation mobile communications standard LTE (Long Term Evolution) standard 1.4 MHz signal with a peak to average power ratio (PAPR) of 8 dB. The dual-branch topology exhibited a good linearity and a coding efficiency of the transmitter chain higher than 72% across the band of frequency from 1.8 GHz to 2.7 GHz.

  14. Exogenous glutamate induces short and long-term potentiation in the rat medial vestibular nuclei.

    PubMed

    Grassi, S; Frondaroli, A; Pessia, M; Pettorossi, V E

    2001-08-08

    In rat brain stem slices, high concentrations of exogenous glutamate induce long-term potentiation (LTP) of the field potentials evoked in the medial vestibular nuclei (MVN) by vestibular afferent stimulation. At low concentrations, glutamate can also induce short-term potentiation (STP), indicating that LTP and STP are separate events depending on the level of glutamatergic synapse activation. LTP and STP are prevented by blocking NMDA receptors and nitric oxide (NO) synthesis. Conversely, blocking platelet-activating factor (PAF) and group I metabotropic glutamate receptors only prevents the full development of LTP. Moreover, in the presence of blocking agents, glutamate causes transient inhibition, suggesting that when potentiation is impeded, exogenous glutamate can activate presynaptic mechanisms that reduce glutamate release.

  15. Role of an anatomically contoured plate and metal block for balanced stability between the implant and lateral hinge in open-wedge high-tibial osteotomy.

    PubMed

    Jang, Young Woong; Lim, DoHyung; Seo, Hansol; Lee, Myung Chul; Lee, O-Sung; Lee, Yong Seuk

    2018-07-01

    Open-wedge high tibial osteotomy (OWHTO) is a well-established surgical option for medial compartment osteoarthritis of the varus knee. The initial strength of the fixation plate is critical for successful correction maintenance and healing of the osteotomy site. This study was conducted to verify if a newly designed anatomical plate (LCfit) improves the stability of both the medial implant and lateral hinge area, as well as to evaluate how the metal block contributes to both medial and lateral stability. A finite element (FE) tibial model was combined with TomoFix plate, a LCfit plate with and without a metal block. Data analysis was conducted to evaluate the balanced stability, which refers to the enforced lateral stability resulting from redistribution of overall stress. We assessed the balanced stability of the medial implant and lateral hinge area in three cases using the same Sawbones and loads using the tibia FE model. The LCfit plate reduced stress by 23.1% at the lateral hinge compared to the TomoFix plate (TomoFix vs. LCfit: 34.2 ± 23.3 MPa vs. 26.3 ± 17.5 MPa). The LCfit plate with a metal block reduced stress by 40.1% at the medial plate (210.1 ± 64.2 MPa vs. 125.8 ± 65.7 MPa) and by 31.2% (26.3 ± 17.5 MPa vs. 18.1 ± 12.1 MPa) at the lateral hinge area compared to the reduction using the LCfit plate without a metal block. The newly designed fixation system for OWHTO balanced the overall stress distribution and reduced stress at the lateral hinge area compared to that using a conventional fixation system. The addition of the metal block showed additional benefits for balanced stability between the medial implant and lateral hinge area. However, this conclusion could only be drawn using the FE model in this study. Therefore, further clinical studies are necessary to reveal the clinical effect of reduced lateral stress on the occurrence of the lateral hinge fracture and the biologic effect of the metal block on the

  16. TopMaker: Technique Developed for Automatic Multiblock Topology Generation Using the Medial Axis

    NASA Technical Reports Server (NTRS)

    Rigby, David L.

    2004-01-01

    The TopMaker technique was developed in an effort to reduce the time required for grid generation in complex numerical studies. Topology generation accounts for much of the man-hours required for structured multiblock grids. With regard to structured multiblock grids, topology refers to how the blocks are arranged and connected. A two-dimensional multiblock topology generation technique has been developed at the NASA Glenn Research Center. Very general configurations can be addressed by the technique. A configuration is defined by a collection of non-intersecting closed curves, which will be referred to as loops. More than a single loop implies that holes exist in the domain, which poses no problem. This technique requires only the medial vertices and the touch points that define each vertex. From the information about the medial vertices, the connectivity between medial vertices is generated. The physical shape of the medial edge is not required. By applying a few simple rules to each medial edge, a multiblock topology can be generated without user intervention. The resulting topologies contain only the level of complexity dictated by the configurations. Grid lines remain attached to the boundary except at sharp concave turns, where a change in index family is introduced as would be desired. Keeping grid lines attached to the boundary is especially important in computational fluid dynamics, where highly clustered grids are used near no-slip boundaries. This technique is simple and robust and can easily be incorporated into the overall grid-generation process.

  17. [Regional nerve block in facial surgery].

    PubMed

    Gramkow, Christina; Sørensen, Jesper

    2008-02-11

    Regional nerve blocking techniques offer a suitable alternative to local infiltration anaesthesia for facial soft tissue-surgery. Moreover, they present several advantages over general anaesthesia, including smoother recovery, fewer side effects, residual analgesia into the postoperative period, earlier discharge from the recovery room and reduced costs. The branches of the trigeminal nerve and the sensory nerves originating from the upper cervical plexus can be targeted at several anatomical locations. We summarize current knowledge on facial nerve block techniques and recommend ten nerve blocks providing efficient anaesthesia for the entire head and upper-neck region.

  18. Heparan sulfate storage in the cardiac conduction system triggers atrioventricular block.

    PubMed

    Kato, Rie; Miyahara, Hiroaki; Kawano, Tatsuya; Matsuzuka, Atsuko; Noda, Kimiko; Izumi, Tatsuro

    2017-05-01

    To elucidate the novel biological functions of heparan sulfate (HS) by clinic-pathologically studying a patient with paroxysmal atrioventricular (AV) block. A long-surviving male patient with Sanfilippo syndrome type A presented with paroxysmal AV block at age 33years. He then survived another 2.5years after the onset of paroxysmal AV block and pacemaker implantation. His cardiac histopathological examination at autopsy showed HS storage in the cardiac conduction system (CCS), especially in the atrioventricular node (AVN)-His bundle branches. HS storage in the CCS might trigger AV block, arising from below the AVN-His bundle branches. This is the first description to indicate that HS might be an essential constituent of life-long CCS plasticity and that its storage in the CCS results in AV block. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  19. Early memory formation disrupted by atypical PKC inhibitor ZIP in the medial prefrontal cortex but not hippocampus

    PubMed Central

    Evuarherhe, Obaro; Barker, Gareth R. I.; Savalli, Giorgia; Warburton, Elizabeth C.; Brown, Malcolm W.

    2014-01-01

    Atypical isoforms of protein kinase C (aPKCs; particularly protein kinase M zeta: PKMζ) have been hypothesised to be necessary and sufficient for the maintenance of long-term potentiation (LTP) and long term memory by maintaining postsynaptic AMPA receptors via the GluR2 subunit. A myristoylated PKMζ pseudosubstrate peptide (ZIP) blocks PKMζ activity. We examined the actions of ZIP in medial prefrontal cortex (mPFC) and hippocampus in associative recognition memory in rats during early memory formation and memory maintenance. ZIP infusion in either hippocampus or mPFC impaired memory maintenance. However, early memory formation was impaired by ZIP in mPFC but not hippocampus; and blocking GluR2-dependent removal of AMPA receptors did not affect this impairment caused by ZIP in the mPFC. The findings indicate: (i) a difference in the actions of ZIP in hippocampus and medial prefrontal cortex, and (ii) a GluR2-independent target of ZIP (possibly PKCλ) in the mPFC during early memory formation. PMID:24729442

  20. Transient left septal and anterior fascicular block associated with type 1 electrocardiographic Brugada pattern.

    PubMed

    Pérez-Riera, Andrés Ricardo; Barbosa-Barros, Raimundo; Penachini da Costa de Rezende Barbosa, Marianne; Daminello-Raimundo, Rodrigo; de Abreu, Luiz Carlos

    The left septal fascicular block (LSFB) or blockage of the middle fibers of the left bundle branch is probably caused mainly by - in the developed world - the proximal obstruction of the left anterior descending artery (LAD) before its first anterior septal perforator branch (S 1 ). The association of transient LSFB and left anterior fascicular block (LAFB) - left bifascicular block - and the electrocardiographic type 1 Brugada pattern (BrP) has not been described in the literature yet. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Larger medial femoral to tibial condylar dimension may trigger posterior root tear of medial meniscus.

    PubMed

    Chung, Jun Young; Song, Hyung Keun; Jung, Myung Kuk; Oh, Hyeong Tak; Kim, Joon Ho; Yoon, Ji-Sang; Min, Byoung-Hyun

    2016-05-01

    The major meniscal functions are load bearing, load distribution, and shock absorption by increasing the tibiofemoral joint (TFJ) contact area and dissipating axial loads by conversion into hoop stresses. The increased hoop strain stretches the meniscus in outward direction towards radius, causing extrusion, which is associated with the root tear and resultant degenerative osteoarthritis. Since the larger contact area of medial TFJ may increase the hoop stresses, we hypothesized that the larger medial femoral to tibial condylar dimension would contribute to the development of medial meniscus posterior root tear (MMPRT). Thus, the purpose of the study was to assess the relationship between MMPRT and medial femoral to tibial condylar dimension. A case-control study was conducted to compare medial femoral to tibial condylar dimensions of patients with complete MMPRT (n = 59) with those of demography-matched controls (n = 59) during the period from 2010 to 2013. In each patient, MRIs were reviewed and several parameters were measured including articulation width of medial femoral condyle (MFC) at 0°, 30°, 60°, and 90°, medial tibial condyle (MTC) width, degree of meniscal extrusion, and medial femoral to tibial condylar width ratio (MFC/MTC) at 0°, 30°, 60°, and 90°, respectively. Demographic and radiographic data were assessed. A larger medial femoral to tibial condylar dimension was associated with MMPRT at 0° and 30° knee angles. Patients with MFC/MTC greater than 0.9 at 0° also showed about 2.5-fold increase in the chance of MMPRT. Those with meniscal extrusion greater than 3 mm also had about 17.1 times greater chance for the presence of MMPRT accordingly. A larger medial femoral to tibial condylar dimension may be considered as one of the regional contributors to the outbreak of MMPRT, and medial femoral to tibial condylar width ratio greater than 0.9 at 0° knee angle may be considered as a significant risk factor for MMPRT. III.

  2. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis.

    PubMed

    Resorlu, Mustafa; Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-12-01

    This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

  3. Inducible Nitric Oxide Inhibitors Block NMDA Antagonist-Stimulated Motoric Behaviors and Medial Prefrontal Cortical Glutamate Efflux

    PubMed Central

    Bergstrom, Hadley C.; Darvesh, Altaf S.; Berger, S. P.

    2015-01-01

    Nitric oxide (NO) plays a critical role in the motoric and glutamate releasing action of N-methyl-D-aspartate (NMDA)-antagonist stimulants. Earlier studies utilized neuronal nitric oxide synthase inhibitors (nNOS) for studying the neurobehavioral effects of non-competitive NMDA-antagonist stimulants such as dizocilpine (MK-801) and phencyclidine (PCP). This study explores the role of the inducible nitric oxide synthase inhibitors (iNOS) aminoguanidine (AG) and (-)-epigallocatechin-3-gallate (EGCG) in NMDA-antagonist induced motoric behavior and prefrontal cortical glutamate efflux. Adult male rats were administered a dose range of AG, EGCG, or vehicle prior to receiving NMDA antagonists MK-801, PCP, or a conventional psychostimulant (cocaine) and tested for motoric behavior in an open arena. Glutamate in the medial prefrontal cortex (mPFC) was measured using in vivo microdialysis after a combination of AG or EGCG prior to MK-801. Acute administration of AG or EGCG dose-dependently attenuated the locomotor and ataxic properties of MK-801 and PCP. Both AG and EGCG were unable to block the motoric effects of cocaine, indicating the acute pharmacologic action of AG and EGCG is specific to NMDA antagonism and not generalizable to all stimulant class drugs. AG and EGCG normalized MK-801-stimulated mPFC glutamate efflux. These data demonstrate that AG and EGCG attenuates NMDA antagonist-stimulated motoric behavior and cortical glutamate efflux. Our results suggest that EGCG-like polyphenol nutraceuticals (contained in “green tea” and chocolate) may be clinically useful in protecting against the adverse behavioral dissociative and cortical glutamate stimulating effects of NMDA antagonists. Medications that interfere with NMDA antagonists such as MK-801 and PCP have been proposed as treatments for schizophrenia. PMID:26696891

  4. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block.

    PubMed

    Cabeda, Estêvan Vieira; Falcão, Andréa Maria Gomes; Soares, José; Rochitte, Carlos Eduardo; Nomura, César Higa; Ávila, Luiz Francisco Rodrigues; Parga, José Rodrigues

    2015-12-01

    Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution's ethics committee. The patients' mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

  5. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis

    PubMed Central

    Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-01-01

    Abstract Background This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Patients and methods Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Results Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p < 0.001 and p = 0.018, respectively). Significant correlation was observed between medial meniscal tear and bursitis in the medial compartment (p = 0.038). Presence of medial periarticular bursitis was positively correlated with severity of osteoarthritis but exhibited no correlation with chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. Conclusions We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear. PMID:29333118

  6. Traumatic posterior root tear of the medial meniscus in patients with severe medial instability of the knee.

    PubMed

    Ra, Ho Jong; Ha, Jeong Ku; Jang, Ho Su; Kim, Jin Goo

    2015-10-01

    To examine the incidence and diagnostic rate of traumatic medial meniscus posterior root tear associated with severe medial instability and to evaluate the effectiveness of pullout repair. From 2007 to 2011, 51 patients who underwent operation due to multiple ligament injuries including medial collateral ligament rupture were reviewed retrospectively. The International Knee Documentation Committee (IKDC) subjective and Lysholm score were evaluated pre- and postoperatively. Postoperative magnetic resonance imaging (MRI) was performed, and if indicated, a second-look arthroscopic examination was conducted. Fourteen out of 51 patients were associated with severe medial instability. Seven patients were diagnosed with traumatic medial meniscus posterior root tear and underwent arthroscopic pullout repair. Five of them were missed at initial diagnosis using MRI. In seven patients, the mean Lysholm and IKDC subjective scores improved from 74.6 ± 10.3 and 47.6 ± 7.3 to 93.0 ± 3.7 and 91.6 ± 2.6, respectively. All showed complete healing of meniscus root on follow-up MRI and second-look arthroscopy. Medial meniscus posterior root tear may occur in severe medial instability from trauma. It is a common mistake that surgeons may not notice on the diagnosis of those injuries using MRI. Therefore, a high index of suspicion is required for the diagnosis of medial meniscus posterior root tear in this type of injuries. The traumatic medial meniscus posterior root tear could be healed successfully using arthroscopic pullout repair technique. The possibility of the medial meniscus posterior root tear should be considered in severe medial instability and arthroscopic pullout repair can be an effective option for treatment. Case series with no comparison group, Level IV.

  7. Influence of needle position on lumbar segmental nerve root block selectivity.

    PubMed

    Wolff, André P; Groen, Gerbrand J; Wilder-Smith, Oliver H

    2006-01-01

    In patients with chronic low back pain radiating to the leg, segmental nerve root blocks (SNRBs) are performed to predict surgical outcome and identify the putative symptomatic spinal nerve. Epidural spread may lead to false interpretation, affecting clinical decision making. Systematic fluoroscopic analysis of epidural local anesthetic spread and its relationship to needle tip location has not been published to date. Study aims include assessment of epidural local anesthetic spread and its relationship to needle position during fluoroscopy-assisted blocks. Patients scheduled for L4, L5, and S1 blocks were included in this prospective observational study. Under fluoroscopy and electrostimulation, they received 0.5 mL of a mixture containing lidocaine 5 mg and iohexol 75 mg. X-rays with needle tip and contrast were scored for no epidural spread (grade 0), local spread epidurally (grade 1), or to adjacent nerve roots (grade 2). Sixty-five patients were analyzed for epidural spread, 62 for needle position. Grade 1 epidural spread occurred in 47% of L4 and 28% of L5 blocks and grade 2 spread in 3 blocks (5%; L5 n = 1, S1 n = 2). For lumbar blocks, the needle was most frequently found in the lateral upper half of the intervertebral foramen. Epidural spread occurred more frequently with medial needle positions (P = .06). The findings suggest (P = .06) that the risk of grade 1 and 2 lumbar epidural spread, which results in decreased SNRB selectivity, is greater with medial needle positions in the intervertebral foramen. The variability in anatomic position of the dorsal root ganglion necessitates electrostimulation to guide SNRB in addition to fluoroscopy.

  8. [Relevance of nerve blocks in treating and diagnosing low back pain--is the quality decisive?].

    PubMed

    Hildebrandt, J

    2001-12-01

    Diagnostic nerve blocks: The popularity of neural blockade as a diagnostic tool in painful conditions, especially in the spine, is due to features like the unspecific character of spinal pain, the irrelevance of radiological findings and the purely subjective character of pain. It is said that apart from specific causes of pain and clear radicular involvement with obvious neurological deficits and corresponding findings of a prolapsed disc in MRI or CT pictures, a diagnosis of the anatomical cause of the pain can only be established if invasive tests are used [5]. These include zygapophyseal joint blocks, sacroiliacal joint blocks, disc stimulation and nerve root blocks. Under controlled conditions, it has been shown that among patients with chronic nonradicular low back pain, some 10-15% have zygapophyseal joint pain [58], some 15-20% have sacroiliacal joint pain [36, 59] and 40% have pain from internal disc disruption [60]. The diagnostic use of neural blockade rests on three premises. First, pathology causing pain is located in an exact peripheral location, and impulses from this site travel via a unique and consistent neural root. Second, injection of local aneasthetic totally abolishes sensory function of intended nerves and does not affect other nerves. Third, relief of pain after local anaesthetic block is attributable solely to block of the target afferent neural pathway. The validity of these assumptions is limited by complexities of anatomy, physiology, and psychology of pain perception and the effect of local anaesthetics on impulse conduction [28]. Facet joints: The prevalence of zygapophyseal joint pain among patients with low back pain seems to be between 15% and 40% [62], but apparently only 7% of patients have pure facet pain [8, 29]. Facet blockade is achieved either by injection of local anaesthetic into the joint space or around the medial branches of the posterior medial rami of the spinal nerves that innervate the joint. There are several

  9. Complete atrioventricular block following mediastinal irradiation: A report of six cases

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Slama, M.S.; Le Guludec, D.; Sebag, C.

    1991-07-01

    Complete atrioventricular block (AVB) following radiotherapy has been reported rarely, usually after high dose mediastinal irradiation for Hodgkin's disease or lung or breast carcinoma. The authors report six new cases of episodic complete infranodal AVB, requiring permanent pacemaker implantation. The mean age was 48-years old (ranging from 25-60) at the first Adams Stokes attack, mean delay was 12 years after irradiation (10-18), and mean radiation dose was 5,200 rads (4,000-6,500). All patients had abnormal interval electrocardiograms (right bundle branch block in two, left bundle branch block in three, alternating left and right bundle branch block in one). Electrocardiograms during themore » episode of AVB or Holter recordings were consistent with infranodal block in all patients; electrophysiological study performed in five patients confirmed infranodal AVB in four, and one was normal. Pericardial disease was constant, which included pericardial constriction in four patients. Two patients died after failure of pericardiectomy to improve congestive heart failure, due to epicardial, myocardial, and endocardial involvement. Noncardiac mediastinal lesions were present in four cases. Since this delayed complication may occur in patients of such age that the relation between the AVB and the chest irradiation is questionable, they propose the following etiologic criteria; high radiation dose (over 4,000 rads); delay of 10 years or more; abnormal interval tracings; pericardial involvement; and associated cardiac or mediastinal radiation-induced lesions.« less

  10. Role of group II metabotropic glutamate receptors 2/3 and group I metabotropic glutamate receptor 5 in developing rat medial vestibular nuclei.

    PubMed

    Grassi, Silvarosa; Frondaroli, Adele; Pettorossi, Vito Enrico

    2005-08-22

    In brainstem slices from developing rats, metabotropic glutamate receptors mGluR2/3 and mGluR5 play different inhibitory roles in synaptic transmission and plasticity of the medial vestibular nuclei. The mGluR2/3 block (LY341495) reduces the occurrence of long-term depression after vestibular afferent high frequency stimulation at P8-P10, and increases that of long-term potentiation, while the mGluR5 block prevents high frequency stimulation long-term depression. Later on, the receptor block does not influence high frequency stimulation effects. In addition, while mGluR2/3 agonist (APDC) always provokes a transient reduction of synaptic responses, that of mGluR5 (CHPG) induces long-term depression per se at P8-P10. These results show a key role of mGluR5 in inducing high frequency stimulation long-term depression in developing medial vestibular nuclei, while mGluR2/3 modulate synaptic transmission, probably through presynaptic control of glutamate release.

  11. The inhibition of prions through blocking prion conversion by permanently charged branched polyamines of low cytotoxicity.

    PubMed

    Lim, Yong-beom; Mays, Charles E; Kim, Younghwan; Titlow, William B; Ryou, Chongsuk

    2010-03-01

    Branched polyamines are effective in inhibiting prions in a cationic surface charge density dependent manner. However, toxicity associated with branched polyamines, in general, often hampers the successful application of the compounds to treat prion diseases. Here, we report that constitutively maintained cationic properties in branched polyamines reduced the intrinsic toxicity of the compounds while retaining the anti-prion activities. In prion-infected neuroblastoma cells, quaternization of amines in polyethyleneimine (PEI) and polyamidoamine (PAMAM) dendrimers markedly increased the nontoxic concentration ranges of the compounds and still supported, albeit reduced, an appreciable level of anti-prion activity in clearing prions from the infected cells. Furthermore, quaternized PEI was able to degrade prions at acidic pH conditions and inhibit the in vitro prion propagation facilitated by conversion of the normal prion protein isoform to its misfolded counterpart, although such activities were decreased by quaternization. Quaternized PAMAM was least effective in degrading prions but efficiently inhibited prion conversion with the same efficacy as unmodified PAMAM. Our results suggest that quaternization represents an effective strategy for developing nontoxic branched polyamines with potent anti-prion activity. This study highlights the importance of polyamine structural control for developing polyamine-based anti-prion agents and understanding of an action mechanism of quaternized branched polyamines. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  12. Highly-branched anisotropic hybrid nanoparticles at surfaces.

    NASA Astrophysics Data System (ADS)

    Tsukruk, Vladimir

    2009-03-01

    We present a brief overview of our recent studies on combined hybrid anisotropic structures composed of inorganic nanoparticles and highly branched molecules such as modified silsesquioxanes polyhedra cores (POSS) with mixed hydrophobic-hydrophilic tails and silver nanowires with functionalized star block copolymer with embedded gold nanoparticles (nanocobs). We demonstrate two-stage melting of that branched POSS and their ability to form monolayer and multilayered LB structures. On the other hand, we observed that silver-BCP-gold nanocobs display extremely bright Raman scattering caused by surface enhanced Raman effect with very different longitudinal and transversal optical properties as revealed by high-resolution confocal Raman microscopy. To study these hybrid nanostructures we applied combined AFM, SEM, TEM, XPS, SERS, UV-vis, and XR techniques.

  13. The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data.

    PubMed

    Engel, Andrew; Rappard, George; King, Wade; Kennedy, David J

    2016-04-01

    To determine the effectiveness and risks of fluoroscopically-guided cervical medial branch thermal radiofrequency neurotomy (CMBTRFN) for treating chronic neck pain of zygapophysial joint origin. Systematic review of the literature with comprehensive analysis of the published data. Four reviewers formally trained in evidence-based medicine searched the literature on CMBTRFN. Each assessed the methodologies of studies found and appraised the quality of evidence presented. The primary outcomes assessed were 100% relief of pain 6 and 12 months after treatment. Other outcomes were noted if reported. The evidence was evaluated in accordance with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. The searches yielded eight primary publications on the effectiveness of the procedure. The evidence shows a majority of patients were pain free at 6 months and over a third were pain free at 1 year. The number needed to treat for complete pain relief at 6 months is 2. The evidence of effectiveness is of high quality according to the GRADE system. Twelve papers were found reporting unwanted effects, most of which are minor and temporary. No serious complications have ever been reported from procedures performed according to the published guidelines. The evidence of risks is of low quality according to the GRADE system. If performed as described in the International Spine Intervention Society Guidelines, fluoroscopically-guided CMBTRFN is effective for abolishing zygapophysial joint pain and carries only minor risks. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Evaluation of Lumbar Facet Joint Nerve Blocks in Managing Chronic Low Back Pain: A Randomized, Double-Blind, Controlled Trial with a 2-Year Follow-Up

    PubMed Central

    Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J.E.; Cash, Kimberly A.; Pampati, Vidyasagar

    2010-01-01

    Study Design: A randomized, double-blind, controlled trial. Objective: To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin. Summary of Background Data: Lumbar facet joints have been shown as the source of chronic pain in 21% to 41% of low back patients with an average prevalence of 31% utilizing controlled comparative local anesthetic blocks. Intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Methods: The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids. The inclusion criteria was based upon a positive response to diagnostic controlled, comparative local anesthetic lumbar facet joint blocks. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results: Significant improvement with significant pain relief of ≥ 50% and functional improvement of ≥ 40% were observed in 85% in Group 1, and 90% in Group II, at 2-year follow-up. The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks, requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment. Conclusions: Therapeutic lumbar facet joint nerve blocks, with or without steroids, may provide a management option for chronic function-limiting low back pain of facet joint origin. PMID:20567613

  15. A unique combination of anatomy and physiology in cells of the rat paralaminar thalamic nuclei adjacent to the medial geniculate body

    PubMed Central

    Smith, Philip H.; Bartlett, Edward L.; Kowalkowski, Anna

    2010-01-01

    The medial geniculate body (MGB) has three major subdivisions - ventral (MGV), dorsal (MGD) and medial (MGM). MGM is linked with paralaminar nuclei that are situated medial and ventral to MGV/MGD. Paralaminar nuclei have unique inputs and outputs when compared with MGV and MGD and have been linked to circuitry underlying some important functional roles. We recorded intracellularly from cells in the paralaminar nuclei in vitro. We found that they possess an unusual combination of anatomical and physiological features when compared to those reported for “standard” thalamic neurons seen in the MGV/MGD and elsewhere in the thalamus. Compared to MGV/MGD neurons, anatomically, 1) paralaminar cell dendrites can be long, branch sparingly and encompass a much larger area. 2) their dendrites may be smooth but can have well defined spines and 3) their axons can have collaterals that branch locally within the same or nearby paralaminar nuclei. When compared to MGV/MGD neurons physiologically 1) their spikes are larger in amplitude and can be shorter in duration and 2) can have dual afterhyperpolarizations with fast and slow components and 3) they can have a reduction or complete absence of the low threshold, voltage-sensitive calcium conductance that reduces or eliminates the voltage-dependent burst response. We also recorded from cells in the parafascicular nucleus, a nucleus of the posterior intralaminar nuclear group, because they have unusual anatomical features that are similar to some of our paralaminar cells. Like the labeled paralaminar cells, parafascicular cells had physiological features distinguishing them from typical thalamic neurons. PMID:16566009

  16. Anatomical consideration of the occipital cutaneous nerves and artery for the safe treatment of occipital neuralgia.

    PubMed

    Shin, Kang-Jae; Kim, Hong-San; O, Jehoon; Kwon, Hyun-Jin; Yang, Hun-Mu

    2018-05-12

    There is no standardized approach to the greater occipital nerve (GON) block technique for treating occipital neuralgia. The aim of the present study was to validate the previously-suggested guidelines for conventional injection techniques and to provide navigational guidelines for safe GON block. The GON, lesser occipital nerve (LON) and occipital artery (OA) were carefully dissected in the occipital region of embalmed cadavers. Using a 3D digitizer, the GON, LON, and OA were observed on the two reference lines. The distances between the landmarks were recorded and statistically analyzed. On the superior nuchal line, the mean distances between the external occipital protuberance (EOP) and the most medial branch of the GON was 33.5 mm. The mean distance between the EOP and the most medial branch of the OA was 37.4 mm. On the EOP-mastoid process (MP) line, the GON was on the medial third and the LON the lateral third of the EOP-MP line. The safe injection points on the EOP-MP line are about 3 cm from the EOP, 1 cm inferior parallel to the EOP-MP line, and about 3 cm away from the MP. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

  17. Potentiating role of interleukin-1beta (IL-1beta) and IL-1beta type 1 receptors in the medial hypothalamus in defensive rage behavior in the cat.

    PubMed

    Hassanain, M; Bhatt, S; Zalcman, S; Siegel, A

    2005-06-28

    Recently, this laboratory provided evidence that interleukin-1beta (IL-1beta), an immune and brain-derived cytokine, microinjected into the medial hypothalamus, potentiates defensive rage behavior in the cat elicited from the midbrain periaqueductal gray (PAG), and that such effects are blocked by a 5-HT2 receptor antagonist. Since this finding represents the first time that a brain cytokine has been shown to affect defensive rage behavior, the present study replicated and extended these findings by documenting the specific potentiating role played by IL-1beta Type 1 receptor (IL-1RI), and the anatomical relationship between IL-1beta and 5-HT2 receptors in the medial hypothalamus. IL-1beta (10 ng) microinjected into the medial hypothalamus induced two separate phases of facilitation, one at 60 min and another at 180 min, post-injection. In turn, these effects were blocked with pretreatment of the selective IL-1 Type I receptor antagonist (IL-1ra) (10 ng), demonstrating the selectivity of the effects of IL-1beta on medial hypothalamic neurons upon PAG-elicited defensive rage behavior. The next stage of the study utilized immunohistochemical methods to demonstrate that IL-1beta and 5-HT2 receptors were present on the same neurons within regions of the medial hypothalamus where IL-1beta and the IL-1beta receptor antagonists were administered. This provided anatomical evidence suggesting a relationship between IL-1RI and 5-HT2 receptors in the medial hypothalamus that is consistent with the previous pharmacological observations in our laboratory. The overall findings show that activation of IL-1RI in the medial hypothalamus potentiates defensive rage behavior in the cat and that these effects may also be linked to the presence of 5-HT2 receptors on the same groups of neurons in this region of hypothalamus.

  18. The Vehicle Control Systems Branch at the Marshall Space Flight Center

    NASA Technical Reports Server (NTRS)

    Barret, Chris

    1990-01-01

    This paper outlines the responsibility of the Vehicle Control Systems Branch at the Marshall Space Flight Center (MSFC) to analyze, evaluate, define, design, verify, and specify requirements for advanced launch vehicles and related space projects, and to conduct research in advanced flight control concepts. Attention is given to branch responsibilities which include Shuttle-C, Shuttle-C Block II, Shuttle-Z, lunar cargo launch vehicles, Mars cargo launch vehicles, orbital maneuvering vehicle, automatic docking, tethered satellite, aeroassisted flight experiment, and solid rocket booster parachute recovery system design.

  19. The effect of repetitive baseball pitching on medial elbow joint space gapping associated with 2 elbow valgus stressors in high school baseball players.

    PubMed

    Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Hall, Toby; Amemiya, Katsuya; Mori, Yoshihisa

    2018-04-01

    To prevent elbow injury in baseball players, various methods have been used to measure medial elbow joint stability with valgus stress. However, no studies have investigated higher levels of elbow valgus stress. This study investigated medial elbow joint space gapping measured ultrasonically resulting from a 30 N valgus stress vs. gravitational valgus stress after a repetitive throwing task. The study included 25 high school baseball players. Each subject pitched 100 times. The ulnohumeral joint space was measured ultrasonographically, before pitching and after each successive block of 20 pitches, with gravity stress or 30 N valgus stress. Two-way repeated measures analysis of variance and Pearson correlation coefficient analysis were used. The 30 N valgus stress produced significantly greater ulnohumeral joint space gapping than gravity stress before pitching and at each successive 20-pitch block (P < .01). For the 2 stress methods, ulnohumeral joint space gapping increased significantly from baseline after 60 pitches (P < .01). Strong significant correlations were found between the 2 methods for measurement of medial elbow joint space gapping (r = 0.727-0.859, P < .01). Gravity stress and 30 N valgus stress may produce different effects with respect to medial elbow joint space gapping before pitching; however, 30 N valgus stress appears to induce greater mechanical stress, which may be preferable when assessing joint instability but also has the potential to be more aggressive. The present results may indicate that constraining factors to medial elbow joint valgus stress matched typical viscoelastic properties of cyclic creep. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Rate-Related Left Bundle Branch Block and Cardiac Memory in a Patient with Bradycardia: Case Report and Literature Review.

    PubMed

    Seibolt, Luke; Maestas, Camila; Lazkani, Mohamad; Fatima, Umaima; Loli, Akil; Chesser, Michael

    2018-06-19

    Rate-related left bundle branch block (LBBB) is a well-studied phenomenon. Cardiac memory is another physiologic phenomenon in which T-wave abnormalities occur in the absence of ischemia. The association between these two phenomena has been described in several case reports. A literature review was performed through OVID and Pubmed, where at total of 93 cases of rate- related LBBB were identified. Cases were reviewed and data were collected on rates of appearance and disappearance as well as the presence or absence of cardiac memory. There is some overlap in the rate at which LBBB appear. Cardiac memory is associated with rate-related LBBB in several cases but its true prevalence is unknown. Cardiac memory is a phenomenon that is well described in the literature but is often under-recognized in clinical practice. As a consequence of overlooking this phenomenon and not including cardiac memory in the differential when T-wave abnormalities are observed, patients may be subjected to unnecessary invasive diagnostic testing. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Bilateral medial medullary infarction: a systematic review.

    PubMed

    Pongmoragot, Jitphapa; Parthasarathy, Sujatha; Selchen, Daniel; Saposnik, Gustavo

    2013-08-01

    Bilateral infarction of the medial medulla (MMI) is rare. Limited information is available on clinical characteristics, etiology, and prognosis. High-resolution neuroimaging has a major role in elucidating the underlying stroke mechanism. The aim of this systematic review was to analyze the clinical presentations, stroke mechanisms, and outcomes in patients with bilateral MMI. We performed a systematic review of the literature from 1992-2011 that reported on clinical presentations, stroke mechanism, and/or outcomes in patients with magnetic resonance imaging-proven bilateral MMI. Medline, EMBASE, and Web of Science Scholars Portal were searched without language restriction. Two reviewers independently assessed identified studies to determine eligibility, validity, and quality. The primary outcome was inpatient mortality; a secondary outcome was case fatality at 12 months. We identified 138 articles from Medline, EMBASE, and Scholars Portal including the MeSH terms "brainstem infarction," "medulla," and "bilateral." Twenty-nine articles met our inclusion criteria, including a total of 38 cases with bilateral MMI, and included in our study. These 38 patients had a mean age of 62.2 years and were predominately male (74.2%). The most common clinical presentations were motor weakness in 78.4%, dysarthria in 48.6%, and hypoglossal palsy in 40.5%. The most common vascular pathology was vertebral artery atherosclerosis, in 38.5%. The clinical outcome was poor (mortality, 23.8%; dependency, 61.9%). Bilateral medial medullary infarction is a rare stroke syndrome. Clinical presentations were mostly rostral medullary lesions. Large-artery atherosclerosis and branch disease were the most common stroke mechanisms. The clinical outcome was usually poor. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Exercise induced left bundle branch block in isotopic exercise test. Findings and prognostic value.

    PubMed

    Gomez, M V; Lorente Castro, B C; Jané, P; García-Zoghby, L; Martínez-Lorca, A; Pérez, J A

    2018-04-18

    Exercise-induced left bundle branch block (EI-LBBB) is a rare circumstance of unknown significance. The purpose of this paper is to describe the scintigraphic features and the prognostic value of this finding. We reviewed the features of 1,885 patients who had visited our department to undergo GATED-SPECT ergometry to diagnose ischaemic heart disease. Seven patients showed EI-LBBB throughout the exercise testing. Coronary angiography was performed in 4 of them. Patients were followed-up over an average period of time of 30±8 months. The onset of major cardiovascular events was recorded during the follow-up period. The prevalence of EI-LBBB was 0.37%. Six out of 7 patients were women. Myocardial function and perfusion were normal in 3 patients. Three patients had fixed perfusion defects and one patient had a reversible defect. Two out of the 4 patients showing perfusion defects presented a moderate-severe decrease of the left ventricular ejection fraction. None of the 4 patients with perfusion defects were found to have coronary disease on coronary angiography. The prevalence of EI-LBBB among the patients that came to undergo GATED-SPECT ergometry was very low. The finding was more frequent in women. In our series, 2 patients presented non-ischaemic structural heart disease, but no patient was diagnosed with coronary artery disease. In our patients the presence of EI-LBBB did not relate to a greater risk of experiencing a major cardiovascular event. Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Improving proton conduction pathways in di- and triblock copolymer membranes: Branched versus linear side chains

    NASA Astrophysics Data System (ADS)

    Dorenbos, G.

    2017-06-01

    Phase separation within a series of polymer membranes in the presence of water is studied by dissipative particle dynamics. Each polymer contains hydrophobic A beads and hydrophilic C beads. Three parent architectures are constructed from a backbone composed of connected hydrophobic A beads to which short ([C]), long ([A3C]), or symmetrically branched A5[AC][AC] side chains spring off. Three di-block copolymer derivatives are constructed by covalently bonding an A30 block to each parent architecture. Also three tri-blocks with A15 blocks attached to both ends of each parent architecture are modeled. Monte Carlo tracer diffusion calculations through the water containing pores for 1226 morphologies reveal that water diffusion for parent architectures is slowest and diffusion through the di-blocks is fastest. Furthermore, diffusion increases with side chain length and is highest for branched side chains. This is explained by the increase of water pore size with , which is the average number of bonds that A beads are separated from a nearest C bead. Optimization of within the amphiphilic parent architecture is expected to be essential in improving proton conduction in polymer electrolyte membranes.

  4. Distribution of branches in whole starches from maize mutants deficient in starch synthase III.

    PubMed

    Zhu, Fan; Bertoft, Eric; Seetharaman, Koushik

    2014-05-21

    An earlier study explored the possibility of analyzing the distribution of branches directly in native, whole starch without isolating the amylopectin component. The aim of this study was to explore if this approach can be extended to include starch mutants. Whole starches from du1 maize mutants deficient in starch synthase III (SSIII) with amylose content of ∼30-40% were characterized and compared with the wild type of the common genetic background W64A. Clusters were produced from whole starch by hydrolysis with α-amylase of Bacillus amyloliquefaciens. Their compositions of building blocks and chains were analyzed further by complete α-amylolysis and by debranching, respectively, whereafter the products were subjected to gel permeation and anion exchange chromatography. The size and structure of the clusters were compared with those of their isolated amylopectin component. Whereas the whole starch of the wild type sample had a branched structure similar to that of its amylopectin component, the results showed that the du1 mutation resulted in more singly branched building blocks in the whole starch compared to the isolated amylopectin. This suggested that amylose and/or intermediate materials in whole du1 starches likely contributed to the composition of branches. This study explored an alternative procedure to characterize the composition of branches in the whole starch without fractionating the components.

  5. Exploring endoperoxides as a new entry for the synthesis of branched azasugars

    PubMed Central

    Domeyer, Svenja; Bjerregaard, Mark; Johansson, Henrik

    2017-01-01

    A new class of nitrogen-containing endoperoxides were synthesised by a photochemical [4 + 2]-cycloaddition between a diene and singlet oxygen. The endoperoxides were dihydroxylated and protected to provide a series of endoperoxide building blocks for organic synthesis, with potential use as precursors for the synthesis of branched azasugars. Preliminary exploration of the chemistry of these building blocks provided access to a variety of derivatives including tetrahydrofurans, epoxides and protected amino-tetraols. PMID:28487758

  6. 31 CFR 586.519 - Release of certain funds held at overseas branches of U.S. financial institutions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... overseas branches of U.S. financial institutions. 586.519 Section 586.519 Money and Finance: Treasury... of U.S. financial institutions. Specific licenses may be issued on a case-by-case basis to permit the overseas branches of U.S. financial institutions to unblock deposit accounts that were blocked pursuant to...

  7. Bilateral discoid medial menisci: a rare phenomenon

    PubMed Central

    Samal, Puspak; Bhagwat, Kishan; Panigrahi, Tapas; Gopinathan, Nirmalraj

    2014-01-01

    Discoid medial meniscus is a relatively rare pathology of the knee joint, with bilateral cases even rarer. Herein, we report the case of a 25-year-old man diagnosed with discoid medial meniscus in the right knee with a horizontal tear. Increased cupping of the medial condyle of the tibia, widening of the medial joint space and the presence of discoid meniscus in the right knee prompted investigation of the asymptomatic left knee with magnetic resonance imaging. The contralateral asymptomatic knee also showed evidence of discoid medial meniscus. The symptomatic knee was successfully treated by arthroscopic partial meniscectomy, with excellent functional outcome. PMID:25273941

  8. Medial Patella Subluxation: Diagnosis and Treatment

    PubMed Central

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

  9. Rational growth of branched nanowire heterostructures with synthetically encoded properties and function

    PubMed Central

    Jiang, Xiaocheng; Tian, Bozhi; Xiang, Jie; Qian, Fang; Zheng, Gengfeng; Wang, Hongtao; Mai, Liqiang; Lieber, Charles M.

    2011-01-01

    Branched nanostructures represent unique, 3D building blocks for the “bottom-up” paradigm of nanoscale science and technology. Here, we report a rational, multistep approach toward the general synthesis of 3D branched nanowire (NW) heterostructures. Single-crystalline semiconductor, including groups IV, III–V, and II–VI, and metal branches have been selectively grown on core or core/shell NW backbones, with the composition, morphology, and doping of core (core/shell) NWs and branch NWs well controlled during synthesis. Measurements made on the different composition branched NW structures demonstrate encoding of functional p-type/n-type diodes and light-emitting diodes (LEDs) as well as field effect transistors with device function localized at the branch/backbone NW junctions. In addition, multibranch/backbone NW structures were synthesized and used to demonstrate capability to create addressable nanoscale LED arrays, logic circuits, and biological sensors. Our work demonstrates a previously undescribed level of structural and functional complexity in NW materials, and more generally, highlights the potential of bottom-up synthesis to yield increasingly complex functional systems in the future. PMID:21730174

  10. Selective local anesthetic placement using ultrasound guidance and neurostimulation for infraclavicular brachial plexus block.

    PubMed

    Bowens, Clifford; Gupta, Rajnish K; O'Byrne, William T; Schildcrout, Jonathan S; Shi, Yaping; Hawkins, Jermel J; Michaels, Damon R; Berry, James M

    2010-05-01

    In this study, we performed the infraclavicular block with combined ultrasound guidance and neurostimulation to selectively target cords to compare the success rates of placing a single injection of local anesthetic either in a central or peripheral location. Two hundred eighteen patients were enrolled in a consecutive, prospective study. Patients were randomized to injection of local anesthetic either centrally (posterior cord) or peripherally (medial or lateral cord) using ultrasound guidance and neurostimulation. Supervised senior anesthesiology residents or attending anesthesiologists performed the blocks. Both intent-to-treat and treatment-received analyses were used to compare central and peripheral placement efficacy. The overall success rate was significantly higher for the central placements than peripheral placements (96% vs 85%, P = 0.004). Individual cord success rates were as follows: posterior 99%, lateral 92%, and medial 84% (P = 0.001). The central group required attending physician intervention more frequently (27% vs 6%, P < 0.001). Postoperative pain scores of < or =3 were more likely with central placement (100% vs 94%, P = 0.012). Central placement of a single injection of local anesthetic targeted at the posterior cord resulted in a higher success rate for infraclavicular block.

  11. A Systematic Review of Clinical Functional Outcomes After Medial Stabilized Versus Non-Medial Stabilized Total Knee Joint Replacement

    PubMed Central

    Young, Tony; Dowsey, Michelle M.; Pandy, Marcus; Choong, Peter F.

    2018-01-01

    Background Medial stabilized total knee joint replacement (TKJR) construct is designed to closely replicate the kinematics of the knee. Little is known regarding comparison of clinical functional outcomes of patients utilising validated patient reported outcome measures (PROM) after medial stabilized TKJR and other construct designs. Purpose To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a TKJR employing a medial stabilized construct design. Methods The review was performed with a Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) algorithm. The literature search was performed using variouscombinations of keywords. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. Results In the nineteen unique studies identified, there were 2,448 medial stabilized TKJRs implanted in 2,195 participants, there were 1,777 TKJRs with non-medial stabilized design constructs implanted in 1,734 subjects. The final mean Knee Society Score (KSS) value in the medial stabilized group was 89.92 compared to 90.76 in the non-medial stabilized group, with the final KSS mean value difference between the two groups was statistically significant and favored the non-medial stabilized group (SMD 0.21; 95% CI: 0.01 to 0.41; p = 004). The mean difference in the final WOMAC values between the two groups was also statistically significant and favored the medial stabilized group (SMD: −0.27; 95% CI: −0.47 to −0.07; p = 0.009). Moderate to high values (I2) of heterogeneity were observed during the statistical comparison of these functional outcomes. Conclusion Based on the small number of studies with appropriate statistical analysis, we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct. Level of Evidence Level II PMID:29696144

  12. A Systematic Review of Clinical Functional Outcomes After Medial Stabilized Versus Non-Medial Stabilized Total Knee Joint Replacement.

    PubMed

    Young, Tony; Dowsey, Michelle M; Pandy, Marcus; Choong, Peter F

    2018-01-01

    Medial stabilized total knee joint replacement (TKJR) construct is designed to closely replicate the kinematics of the knee. Little is known regarding comparison of clinical functional outcomes of patients utilising validated patient reported outcome measures (PROM) after medial stabilized TKJR and other construct designs. To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a TKJR employing a medial stabilized construct design. The review was performed with a Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) algorithm. The literature search was performed using variouscombinations of keywords. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. In the nineteen unique studies identified, there were 2,448 medial stabilized TKJRs implanted in 2,195 participants, there were 1,777 TKJRs with non-medial stabilized design constructs implanted in 1,734 subjects. The final mean Knee Society Score (KSS) value in the medial stabilized group was 89.92 compared to 90.76 in the non-medial stabilized group, with the final KSS mean value difference between the two groups was statistically significant and favored the non-medial stabilized group (SMD 0.21; 95% CI: 0.01 to 0.41; p = 004). The mean difference in the final WOMAC values between the two groups was also statistically significant and favored the medial stabilized group (SMD: -0.27; 95% CI: -0.47 to -0.07; p = 0.009). Moderate to high values ( I 2 ) of heterogeneity were observed during the statistical comparison of these functional outcomes. Based on the small number of studies with appropriate statistical analysis, we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct. Level II.

  13. Medial cortex activity, self-reflection and depression.

    PubMed

    Johnson, Marcia K; Nolen-Hoeksema, Susan; Mitchell, Karen J; Levin, Yael

    2009-12-01

    Using functional magnetic resonance imaging, we investigated neural activity associated with self-reflection in depressed [current major depressive episode (MDE)] and healthy control participants, focusing on medial cortex areas previously shown to be associated with self-reflection. Both the MDE and healthy control groups showed greater activity in anterior medial cortex (medial frontal gyrus, anterior cingulate gyrus) when cued to think about hopes and aspirations compared with duties and obligations, and greater activity in posterior medial cortex (precuneus, posterior cingulate) when cued to think about duties and obligations (Experiment 1). However, the MDE group showed less activity than controls in the same area of medial frontal cortex when self-referential cues were more ambiguous with respect to valence (Experiment 2), and less deactivation in a non-self-referential condition in both experiments. Furthermore, individual differences in rumination were positively correlated with activity in both anterior and posterior medial cortex during non-self-referential conditions. These results provide converging evidence for a dissociation of anterior and posterior medial cortex depending on the focus of self-relevant thought. They also provide neural evidence consistent with behavioral findings that depression is associated with disruption of positively valenced thoughts in response to ambiguous cues, and difficulty disengaging from self-reflection when it is appropriate to do so.

  14. Medial cortex activity, self-reflection and depression

    PubMed Central

    Nolen-Hoeksema, Susan; Mitchell, Karen J.; Levin, Yael

    2009-01-01

    Using functional magnetic resonance imaging, we investigated neural activity associated with self-reflection in depressed [current major depressive episode (MDE)] and healthy control participants, focusing on medial cortex areas previously shown to be associated with self-reflection. Both the MDE and healthy control groups showed greater activity in anterior medial cortex (medial frontal gyrus, anterior cingulate gyrus) when cued to think about hopes and aspirations compared with duties and obligations, and greater activity in posterior medial cortex (precuneus, posterior cingulate) when cued to think about duties and obligations (Experiment 1). However, the MDE group showed less activity than controls in the same area of medial frontal cortex when self-referential cues were more ambiguous with respect to valence (Experiment 2), and less deactivation in a non-self-referential condition in both experiments. Furthermore, individual differences in rumination were positively correlated with activity in both anterior and posterior medial cortex during non-self-referential conditions. These results provide converging evidence for a dissociation of anterior and posterior medial cortex depending on the focus of self-relevant thought. They also provide neural evidence consistent with behavioral findings that depression is associated with disruption of positively valenced thoughts in response to ambiguous cues, and difficulty disengaging from self-reflection when it is appropriate to do so. PMID:19620180

  15. Cardiac resynchronization therapy with His bundle pacing as a method of treatment of chronic heart failure in patients with permanent atrial fibrillation and left bundle branch block.

    PubMed

    Boczar, Krzysztof; Sławuta, Agnieszka; Ząbek, Andrzej; Dębski, Maciej; Gajek, Jacek; Lelakowski, Jacek; Małecka, Barbara

    CRT is a therapeutic option for patients with heart failure, sinus rhythm, prolonged QRS complex duration and reduced ejection fraction. We present a case of 71-year-old woman with dilated cardiomyopathy, NYHA functional class III and AF. We implanted CRT combined with direct His-bundle pacing. The indication for such a therapy was a left bundle branch block with a QRS complex of 178ms and a left ventricular EF of 15%, left ventricular end-diastolic diameter (LVEDD) of 75mm. After 8months of follow-up the LVEDD was 60mm with EF 35-40%. Copyright © 2017. Published by Elsevier Inc.

  16. Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty.

    PubMed

    Sim, Jae Ang; Lee, Yong Seuk; Kwak, Ji Hoon; Yang, Sang Hoon; Kim, Kwang Hui; Lee, Beom Koo

    2013-12-01

    During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.

  17. Influence of BMI, gender, and sports on pain decrease and medication usage after facet-medial branch neurotomy or SI joint lateral branch cooled RF-neurotomy in case of low back pain: original research in the Austrian population.

    PubMed

    Stelzer, Wolfgang; Stelzer, Valentin; Stelzer, Dominik; Braune, Monika; Duller, Christine

    2017-01-01

    This retrospective original research was designed to illustrate the general outcome after radiofrequency (RF) neurotomy of lumbar medial branch (MB) and posterior ramus of the sacroiliac joint of 160 patients with chronic low back pain (LBP) 1, 6, and 12 months after treatment. Visual Analog Scale (VAS) 0-10 pain scores, quality of life, body mass index (BMI), medication usage, and frequency of physical exercise/sports participation (none, 1-3×/week, more) were collected before the procedure, at 1 month post procedure (n=160), and again at 6 (n=73) and 12 months (n=89) post procedure. A VAS decrease of 4 points on a 10-point scale (from 8 to 4) in the overall group was seen after 6 months and of 4.5 after 12 months. Lower medication usage was reported, with opioids decreased by 40% and nonsteroidal anti-inflammatory drugs (NSAIDs) by 60%. Decreased pain lasted for 12 months. Significantly better outcomes were reported by patients with BMIs <30. No gender-specific differences occurred in the reported decrease in VAS. Analysis of the "no-sports" group versus the more active (1-3 times weekly sports) group showed a better pain decrease after 1 year in the active group. The data suggest RF treatment for chronic LBP that can lead to long-term improvement. Patients with a BMI >30 are less likely to report decreased pain. The better long-term pain relief in the sports participating group is a motivation for the authors to keep the patients in motion.

  18. Dilated cardiomyopathy and left bundle branch block associated with ingestion of colloidal gold and silver is reversed by British antiLewisite and vitamin E: The potential toxicity of metals used as health supplements

    PubMed Central

    Archer, Stephen Lawrence

    2008-01-01

    A case of left bundle branch block and a dilated, nonhypertrophic cardiomyopathy associated with ingestion of colloidal gold and silver as an ‘energy tonic’ is described. The cardiac disease was reversed within two months by a course of dimercaprol (Akorn Inc, USA) (British antiLewisite) and vitamin E. This is the first case of gold and silver cardiomyopathy in humans, and highlights the risks of these colloidal metal ‘health supplements’. PMID:18464946

  19. [SPECIFIC DIAGNOSTIC SIGNIFICANCE OF "RIPPLE SIGN" OF MEDIAL FEMORAL CONDYLE UNDER ARTHROSCOPE IN MEDIAL LONGITUDINAL MENISCAL TEARS].

    PubMed

    Ren Shiyou; Sun, Limang; Chen, Guofei; Jiang, Changqing; Zhang, Xintao; Zhang Wentao

    2015-01-01

    To investigate the reliability of the "ripple sign" on the upper surface of the medial femoral condyle in the diagnosis of medial longitudinal meniscal tears under arthroscope. Between June 2013 and June 2014, 56 patients with knee injuries were included. There were 35 males and 21 females with an average age of 22.2 years (range, 12-38 years). The causes of injury were sports in 40 cases, falling in 10 cases, and traffic accident in 6 cases. The injury was located at the left knee in 22 cases and at the right knee in 34 cases. The disease duration was 10-40 days (mean, 20.2 days). Of 56 patients, 15 cases had simple medial meniscal injury; 41 cases had combined injuries, including anterior cruciate ligament injury in 38 cases, posterior cruciate ligament injury in 2 cases, and patellar dislocation in 1 case. The "ripple sign" was observed under arthroscope before operation. Repair of medial meniscal injury and reconstruction of cruciate ligament were performed. The positive "ripple sign" was seen under arthroscope in all patients, who were diagnosed to have longitudinal meniscal tears, including 23 cases of mild "ripple sign" , 28 cases of moderate "ripple sign", and 5 cases of severe "ripple sign". The "ripple sign" on the upper surface of the medial femoral condyle is a reliable diagnostic evidence of medial longitudinal meniscal tears.

  20. Medial extrusion of the posterior segment of medial meniscus is a sensitive sign for posterior horn tears.

    PubMed

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Yamamoto, Kazufumi; Banno, Tomohiro; Shimizu, Yuta; Matsuyama, Yukihiro

    2014-01-01

    To evaluate medial extrusion of the posterior segment of the medial meniscus in posterior horn tears. This study enrolled 72 patients without medial meniscal tears (group N), 72 patients with medial meniscal tears without posterior horn tears (group PH-), 44 patients with posterior horn tears of the medial meniscus (group PH+). All meniscal tears were confirmed by arthroscopy. Medial extrusion of the middle segment and the posterior segment was measured on coronal MRIs. Extrusions of both middle and posterior segments in groups PH- and PH+ (middle segment; 2.94±1.51 mm for group PH- and 3.75±1.69 mm for group PH+, posterior segment; 1.85±1.82 mm for group PH- and 4.59±2.74 mm for group PH+) were significantly larger than those in group N (middle segment; 2.04±1.20, posterior segment; 1.21±1.86). Both indicators of extrusion in group PH+ were larger than those in group PH-. In the early OA category, neither middle nor posterior segment in group PH- extruded more than in group N. However, only the posterior segment in group PH+ extruded significantly more than in group N. Multiple lineal regression analyses revealed that posterior segment extrusion was strongly correlated with the posterior horn tears (p<0.001) among groups PH- and PH+. The newly presented indicator for extrusion of the posterior segment of the medial meniscus is associated with posterior horn tears in comparison with the extrusion of the middle segment, especially in the early stages of osteoarthritis. Level II--Diagnostic Study. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. Selective Medial Release Technique Using the Pie-Crusting Method for Medial Tightness During Primary Total Knee Arthroplasty.

    PubMed

    Ha, Chul-Won; Park, Yong-Beom; Lee, Choong-Hee; Awe, Soo-Ik; Park, Yong-Geun

    2016-05-01

    The pie-crusting method is popular in releasing lateral tightness during primary total knee arthroplasty (TKA) but is not well described for medial release. We established a selective medial release technique using the pie-crusting technique and investigated the effectiveness and safety of the technique during primary TKA. We retrospectively reviewed 729 primary TKAs with varus deformity between October 2009 and June 2012. Medial tightness in flexion was released by traditional subperiosteal stripping for the anterior portion of the medial collateral ligament (aMCL). Medial tightness in extension was released by the pie crusting for the tight fibers in the posterior portion of the MCL and/or posteromedial corner structures (pMCL/PMCS). Clinical outcomes were evaluated by Knee Society (KS) scores and the Western Ontario and McMaster Universities Osteoarthritis Index. Any complications, including late medial instability that may be related to our surgical technique, were carefully inspected. Among the 729 knees, 170 (23.3%) required subperiosteal stripping for balancing in flexion only, 186 (25.5%) required the pie-crusting for balancing in extension only and 142 (19.5%) required subperiosteal stripping and the pie-crusting for balancing in flexion and extension. The KS knee score was improved from 52.5 to 83.4, KS function score from 58.2 to 91.9, and Western Ontario and McMaster Universities Osteoarthritis Index from 42.7 to 21.8 (P < .001, all). No specific complications related to our technique were identified. The selective medial release technique appears to be an effective and safe method to obtain a balanced mediolateral gap in primary TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model.

    PubMed

    Varela, O; Melone, A; López-Menchaca, R; Sevilla, R; Callejo, D; López-Álvarez, S; Román Fernández, A; García, S; Mantilla, I; Zaballos, M

    2018-06-07

    Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered. Copyright © 2018 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Local anesthetic-induced myotoxicity as a cause of severe trismus after inferior alveolar nerve block.

    PubMed

    Smolka, Wenko; Knoesel, Thomas; Mueller-Lisse, Ullrich

    2018-01-01

    A case of a 60-year-old man with severe trismus after inferior alveolar nerve block is presented. MRI scans as well as histologic examination revealed muscle fibrosis and degeneration of the medial part of the left temporal muscle due to myotoxicity of a local anesthetic agent.

  4. Rod-Coil Block Polyimide Copolymers

    NASA Technical Reports Server (NTRS)

    Meador, Mary Ann B. (Inventor); Kinder, James D. (Inventor)

    2005-01-01

    This invention is a series of rod-coil block polyimide copolymers that are easy to fabricate into mechanically resilient films with acceptable ionic or protonic conductivity at a variety of temperatures. The copolymers consist of short-rigid polyimide rod segments alternating with polyether coil segments. The rods and coil segments can be linear, branched or mixtures of linear and branched segments. The highly incompatible rods and coil segments phase separate, providing nanoscale channels for ion conduction. The polyimide segments provide dimensional and mechanical stability and can be functionalized in a number of ways to provide specialized functions for a given application. These rod-coil black polyimide copolymers are particularly useful in the preparation of ion conductive membranes for use in the manufacture of fuel cells and lithium based polymer batteries.

  5. The activity state of the branched-chain 2-oxo acid dehydrogenase complex in rat tissues.

    PubMed Central

    Wagenmakers, A J; Schepens, J T; Veldhuizen, J A; Veerkamp, J H

    1984-01-01

    An assay is described to define the proportion of the branched-chain 2-oxo acid dehydrogenase complex that is present in the active state in rat tissues. Activities are measured in homogenates in two ways: actual activities, present in tissues, by blocking both the kinase and phosphatase of the enzyme complex during homogenization, preincubation, and incubation with 1-14C-labelled branched-chain 2-oxo acid, and total activities by blocking only the kinase during the 5 min preincubation (necessary for activation). The kinase is blocked by 5 mM-ADP and absence of Mg2+ and the phosphatase by the simultaneous presence of 50 mM-NaF. About 6% of the enzyme is active in skeletal muscle of fed rats, 7% in heart, 20% in diaphragm, 47% in kidney, 60% in brain and 98% in liver. An entirely different assay, which measures activities in crude tissue extracts before and after treatment with a broad-specificity protein phosphatase, gave similar results for heart, liver and kidney. Advantages of our assay with homogenates are the presence of intact mitochondria, the simplicity, the short duration and the high sensitivity. The actual activities measured indicate that the degradation of branched-chain 2-oxo acids predominantly occurs in liver and kidney and is limited in skeletal muscle in the fed state. PMID:6430280

  6. The activity state of the branched-chain 2-oxo acid dehydrogenase complex in rat tissues.

    PubMed

    Wagenmakers, A J; Schepens, J T; Veldhuizen, J A; Veerkamp, J H

    1984-05-15

    An assay is described to define the proportion of the branched-chain 2-oxo acid dehydrogenase complex that is present in the active state in rat tissues. Activities are measured in homogenates in two ways: actual activities, present in tissues, by blocking both the kinase and phosphatase of the enzyme complex during homogenization, preincubation, and incubation with 1-14C-labelled branched-chain 2-oxo acid, and total activities by blocking only the kinase during the 5 min preincubation (necessary for activation). The kinase is blocked by 5 mM-ADP and absence of Mg2+ and the phosphatase by the simultaneous presence of 50 mM-NaF. About 6% of the enzyme is active in skeletal muscle of fed rats, 7% in heart, 20% in diaphragm, 47% in kidney, 60% in brain and 98% in liver. An entirely different assay, which measures activities in crude tissue extracts before and after treatment with a broad-specificity protein phosphatase, gave similar results for heart, liver and kidney. Advantages of our assay with homogenates are the presence of intact mitochondria, the simplicity, the short duration and the high sensitivity. The actual activities measured indicate that the degradation of branched-chain 2-oxo acids predominantly occurs in liver and kidney and is limited in skeletal muscle in the fed state.

  7. The prognostic value of a new left bundle branch block in patients with acute myocardial infarction: A systematic review and meta-analysis.

    PubMed

    Al Rajoub, Belal; Noureddine, Samar; El Chami, Samer; Haidar, Mohamad Hussein; Itani, Bachir; Zaiter, Aida; Akl, Elie A

    To assess the prognostic value of new left bundle branch block (LBBB) in patients with acute myocardial infarction (AMI). LBBB develops in many cardiac conditions, including AMI. The empirical evidence for the contribution of LBBB to mortality in AMI is not consistent. Medline, PubMed, CINAHL, and EMBASE were searched. Inverse variance meta-analysis was performed with odds ratios as the effect estimates. The I 2 statistic and risk of bias were assessed. Eight studies involving 105,861 participants were eligible. New LBBB was associated with higher mortality at 30 days (OR: 2.10, 95% CI 1.27 to 3.48) and 1-year follow up (OR: 2.81, 95% CI 1.64 to 4.80), and increased heart failure risk (OR: 2.64, 95% CI 1.84 to 3.77). AMI patients with new LBBB are a high risk group and must be treated accordingly. Yet, more research is needed given the limitations of studies. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Branch classification: A new mechanism for improving branch predictor performance

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Chang, P.Y.; Hao, E.; Patt, Y.

    There is wide agreement that one of the most significant impediments to the performance of current and future pipelined superscalar processors is the presence of conditional branches in the instruction stream. Speculative execution is one solution to the branch problem, but speculative work is discarded if a branch is mispredicted. For it to be effective, speculative work is discarded if a branch is mispredicted. For it to be effective, speculative execution requires a very accurate branch predictor; 95% accuracy is not good enough. This paper proposes branch classification, a methodology for building more accurate branch predictors. Branch classification allows anmore » individual branch instruction to be associated with the branch predictor best suited to predict its direction. Using this approach, a hybrid branch predictor can be constructed such that each component branch predictor predicts those branches for which it is best suited. To demonstrate the usefulness of branch classification, an example classification scheme is given and a new hybrid predictor is built based on this scheme which achieves a higher prediction accuracy than any branch predictor previously reported in the literature.« less

  9. Endoscopic medial maxillectomy breaking new frontiers.

    PubMed

    Mohanty, Sanjeev; Gopinath, M

    2013-07-01

    Endoscopy has changed the perspective of rhinologist towards the nose. It has revolutionised the surgical management of sinonasal disorders. Sinus surgeries were the first to get the benefit of endoscope. Gradually the domain of endoscopic surgery extended to the management of sino nasal tumours. Traditionally medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach. Endoscopic medial maxillectomy has been advocated by a number of authors in the management of benign sino-nasal tumours. We present our experience of endoscopic medial maxillectomy in the management of sinonasal pathologies.

  10. Arched needle technique for inferior alveolar mandibular nerve block.

    PubMed

    Chakranarayan, Ashish; Mukherjee, B

    2013-03-01

    One of the most commonly used local anesthetic techniques in dentistry is the Fischer's technique for the inferior alveolar nerve block. Incidentally this technique also suffers the maximum failure rate of approximately 35-45%. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space by arching and changing the approach angle of the conventional technique and estimated its efficacy. The needle after the initial insertion is arched and inserted in a manner that it approaches the medial surface of the ramus at an angle almost perpendicular to it. The technique was applied to 100 patients for mandibular molar extraction and the anesthetic effects were assessed. A success rate of 98% was obtained.

  11. Absence of Rapid Propagation through the Purkinje Network as a Potential Cause of Line Block in the Human Heart with Left Bundle Branch Block.

    PubMed

    Okada, Jun-Ichi; Washio, Takumi; Nakagawa, Machiko; Watanabe, Masahiro; Kadooka, Yoshimasa; Kariya, Taro; Yamashita, Hiroshi; Yamada, Yoko; Momomura, Shin-Ichi; Nagai, Ryozo; Hisada, Toshiaki; Sugiura, Seiryo

    2018-01-01

    Background: Cardiac resynchronization therapy is an effective device therapy for heart failure patients with conduction block. However, a problem with this invasive technique is the nearly 30% of non-responders. A number of studies have reported a functional line of block of cardiac excitation propagation in responders. However, this can only be detected using non-contact endocardial mapping. Further, although the line of block is considered a sign of responders to therapy, the mechanism remains unclear. Methods: Herein, we created two patient-specific heart models with conduction block and simulated the propagation of excitation based on a cellmodel of electrophysiology. In one model with a relatively narrow QRS width (176 ms), we modeled the Purkinje network using a thin endocardial layer with rapid conduction. To reproduce a wider QRS complex (200 ms) in the second model, we eliminated the Purkinje network, and we simulated the endocardial mapping by solving the inverse problem according to the actual mapping system. Results: We successfully observed the line of block using non-contact mapping in the model without the rapid propagation of excitation through the Purkinje network, although the excitation in the wall propagated smoothly. This model of slow conduction also reproduced the characteristic properties of the line of block, including dense isochronal lines and fractionated local electrocardiograms. Further, simulation of ventricular pacing from the lateral wall shifted the location of the line of block. By contrast, in the model with the Purkinje network, propagation of excitation in the endocardial map faithfully followed the actual propagation in the wall, without showing the line of block. Finally, switching the mode of propagation between the two models completely reversed these findings. Conclusions: Our simulation data suggest that the absence of rapid propagation of excitation through the Purkinje network is the major cause of the functional line

  12. 18. METAL LIGHT STANDARD, AT NORTH END BLOCK OF EAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. METAL LIGHT STANDARD, AT NORTH END BLOCK OF EAST PARAPET, FROM NORTH, SHOWING ORIGINAL LIGHT STANDARD, WITH REPLACEMENT BRACKET AND COBRA-HEAD LAMP - Fifth Street Viaduct, Spanning Bacon's Quarter Branch Valley on Fifth Street, Richmond, Independent City, VA

  13. Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis.

    PubMed

    Dessery, Yoann; Belzile, Étienne; Turmel, Sylvie; Corbeil, Philippe

    2017-08-01

    There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. To verify if such effects occur in participants with medial knee osteoarthritis. Randomized single-blinded study. Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

  14. The Anatomy of the Medial Patellofemoral Complex.

    PubMed

    Tanaka, Miho J

    2017-06-01

    The term "medial patellofemoral complex" (MPFC) was proposed to describe the static medial stabilizer of the patella, typically referred to as the medial patellofemoral ligament. In light of our increasing understanding of the attachment of its fibers to the quadriceps tendon in addition to the patella, the term MPFC is used in this article. The purpose of this article is to describe and discuss the anatomy of the MPFC.

  15. Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release.

    PubMed

    Park, Young-Sik; Moon, Hong-Kyo; Koh, Yong-Gon; Kim, Yong-Chan; Sim, Dong-Sik; Jo, Seung-Bae; Kwon, Se-Kwang

    2011-08-01

    Posterior root tears of the medial meniscus are frequently encountered and should be repaired if possible to prevent osteoarthritis of the medial compartment. Various surgical techniques have been proposed to repair posterior root tears. The anterior arthroscopic approach can cause an iatrogenic chondral injury due to the narrow medial joint space. The posterior approaches might be technically unfamiliar to many surgeons because they require the establishment of a posteromedial or trans-septal portal. This paper describes the medial collateral ligament pie-crusting release technique for arthroscopic double transosseous pullout repair of posterior root tears of the medial meniscus through the anterior approach to provide the good visualization of the footprint and sufficient working space.

  16. The Effects of Elbow Bracing on Medial Elbow Joint Space Gapping Associated With Repetitive Throwing in High School Baseball Players

    PubMed Central

    Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Takei, Keiichi; Yamamoto, Mitsuru

    2017-01-01

    Background: Throwing athletes risk medial elbow injury from extreme valgus stress generated across the medial elbow during throwing. Braces have been developed to protect the elbow joint; however, no previous study has investigated the effects of elbow bracing on medial elbow joint space gapping associated with repetitive throwing. Hypothesis/Purpose: The purpose of this study was to investigate the effects of elbow bracing on medial elbow joint space gapping during repetitive throwing. Our hypothesis was that an elbow brace may reduce mechanical stress on the elbow by reducing medial elbow joint space gapping. Study Design: Controlled laboratory study. Methods: Twenty-five high school baseball players participated in this study. Each subject pitched 100 times under 2 conditions: control (without elbow brace) and elbow brace. The ulnohumeral joint space was measured ultrasonically before pitching and after every block of 20 pitches. Measurement of the ulnohumeral joint space was carried out using ultrasound with the forearm hanging by the side. Two-way repeated-measures analysis of variance and post hoc tests were used to compare ulnohumeral joint space with repeated pitching and between the elbow brace and control conditions. Results: In the control condition, ulnohumeral joint space after 60 pitches was significantly greater than that before pitching (P < .01). In contrast, in the elbow brace condition, ulnohumeral joint space was not significantly different after repeated pitching. When comparing these 2 conditions, ulnohumeral joint space in the control condition was significantly greater than that in the elbow brace condition after 60 pitches (P < .01). Conclusion: An elbow brace has the effect of preventing medial elbow joint space gapping with repeated throwing when determined ultrasonically by measuring the ulnohumeral joint space under gravity load. Clinical Relevance: An elbow brace worn during baseball pitching practice may help reduce mechanical stress

  17. The Effects of Elbow Bracing on Medial Elbow Joint Space Gapping Associated With Repetitive Throwing in High School Baseball Players.

    PubMed

    Hattori, Hiroshi; Akasaka, Kiyokazu; Otsudo, Takahiro; Takei, Keiichi; Yamamoto, Mitsuru

    2017-04-01

    Throwing athletes risk medial elbow injury from extreme valgus stress generated across the medial elbow during throwing. Braces have been developed to protect the elbow joint; however, no previous study has investigated the effects of elbow bracing on medial elbow joint space gapping associated with repetitive throwing. The purpose of this study was to investigate the effects of elbow bracing on medial elbow joint space gapping during repetitive throwing. Our hypothesis was that an elbow brace may reduce mechanical stress on the elbow by reducing medial elbow joint space gapping. Controlled laboratory study. Twenty-five high school baseball players participated in this study. Each subject pitched 100 times under 2 conditions: control (without elbow brace) and elbow brace. The ulnohumeral joint space was measured ultrasonically before pitching and after every block of 20 pitches. Measurement of the ulnohumeral joint space was carried out using ultrasound with the forearm hanging by the side. Two-way repeated-measures analysis of variance and post hoc tests were used to compare ulnohumeral joint space with repeated pitching and between the elbow brace and control conditions. In the control condition, ulnohumeral joint space after 60 pitches was significantly greater than that before pitching ( P < .01). In contrast, in the elbow brace condition, ulnohumeral joint space was not significantly different after repeated pitching. When comparing these 2 conditions, ulnohumeral joint space in the control condition was significantly greater than that in the elbow brace condition after 60 pitches ( P < .01). An elbow brace has the effect of preventing medial elbow joint space gapping with repeated throwing when determined ultrasonically by measuring the ulnohumeral joint space under gravity load. An elbow brace worn during baseball pitching practice may help reduce mechanical stress on the elbow by reducing medial elbow joint space gapping.

  18. Ultrasound Guided Transversus Thoracic Plane block, Parasternal block and fascial planes hydrodissection for internal mammary post thoracotomy pain syndrome.

    PubMed

    Piraccini, E; Biondi, G; Byrne, H; Calli, M; Bellantonio, D; Musetti, G; Maitan, S

    2018-05-16

    Pectoral Nerves Block (PECS) and Serratus Plane Block (SPB) have been used to treat persistent post-surgical pain after breast and thoracic surgery; however, they cannot block the internal mammary region, so a residual pain may occur in that region. Parasternal block (PSB) and Thoracic Transversus Plane Block (TTP) anaesthetize the anterior branches of T2-6 intercostal nerves thus they can provide analgesia to the internal mammary region. We describe a 60-year-old man suffering from right post-thoracotomy pain syndrome with residual pain located in the internal mammary region after a successful treatment with PECS and SPB. We performed a PSB and TTP and hydrodissection of fascial planes with triamcinolone and Ropivacaine. Pain disappeared and the result was maintained 3 months later. This report suggests that PSB and TTP with local anaesthetic and corticosteroid with hydrodissection of fascial planes might be useful to treat a post thoracotomy pain syndrome located in the internal mammary region. The use of Transversus Thoracic Plane and Parasternal Blocks and fascial planes hydrodissection as a novel therapeutic approach to treat a residual post thoracotomy pain syndrome even when already treated with Pectoral Nerves Block and Serratus Plane Block. © 2018 European Pain Federation - EFIC®.

  19. Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

    PubMed Central

    Guzzini, Matteo; Guidi, Marco; Civitenga, Carolina; Ferri, Germano; Ferretti, Andrea

    2016-01-01

    Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure. Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion. PMID:27064589

  20. Neural signatures of experimentally induced flow experiences identified in a typical fMRI block design with BOLD imaging

    PubMed Central

    Keller, Johannes; Grön, Georg

    2016-01-01

    Previously, experimentally induced flow experiences have been demonstrated with perfusion imaging during activation blocks of 3 min length to accommodate with the putatively slowly evolving “mood” characteristics of flow. Here, we used functional magnetic resonance imaging (fMRI) in a sample of 23 healthy, male participants to investigate flow in the context of a typical fMRI block design with block lengths as short as 30 s. To induce flow, demands of arithmetic tasks were automatically and continuously adjusted to the individual skill level. Compared against conditions of boredom and overload, experience of flow was evident from individuals’ reported subjective experiences and changes in electrodermal activity. Neural activation was relatively increased during flow, particularly in the anterior insula, inferior frontal gyri, basal ganglia and midbrain. Relative activation decreases during flow were observed in medial prefrontal and posterior cingulate cortex, and in the medial temporal lobe including the amygdala. Present findings suggest that even in the context of comparably short activation blocks flow can be reliably experienced and is associated with changes in neural activation of brain regions previously described. Possible mechanisms of interacting brain regions are outlined, awaiting further investigation which should now be possible given the greater temporal resolution compared with previous perfusion imaging. PMID:26508774

  1. Medial Versus Traditional Approach to US-guided TAP Blocks for Open Inguinal Hernia Repair

    ClinicalTrials.gov

    2012-04-30

    Abdominal Muscles/Ultrasonography; Adult; Ambulatory Surgical Procedures; Anesthetics, Local/Administration & Dosage; Ropivacaine/Administration & Dosage; Ropivacaine/Analogs & Derivatives; Hernia, Inguinal/Surgery; Humans; Nerve Block/Methods; Pain Measurement/Methods; Pain, Postoperative/Prevention & Control; Ultrasonography, Interventional

  2. Medial meniscus posterior horn avulsion.

    PubMed

    Marzo, John M

    2009-05-01

    Avulsion of the posterior horn of the medial meniscus can occur from acute trauma or chronic degeneration, leading to meniscus extrusion, articular cartilage loss, osteophyte formation, and medial joint space narrowing. With meniscus extrusion, the meniscus is unable to resist hoop stresses and cannot shield the adjacent articular cartilage from excessive axial load. Over time, this can lead to symptomatic knee osteoarthritis. Patients typically report pain, swelling, mechanical symptoms, and general functional loss. Although nonsurgical care may relieve symptoms, it is unlikely to alter either the natural history of meniscal loss or the fate of the medial compartment. Surgical repair of posterior horn meniscal avulsion is done in an attempt to restore the anatomy and biomechanical function of the meniscus, and to slow or prevent degenerative joint disease. Meniscal transplantation is reserved for salvage situations.

  3. Rheological Design of Sustainable Block Copolymers

    NASA Astrophysics Data System (ADS)

    Mannion, Alexander M.

    Block copolymers are extremely versatile materials that microphase separate to give rise to a rich array of complex behavior, making them the ideal platform for the development of rheologically sophisticated soft matter. In line with growing environmental concerns of conventional plastics from petroleum feedstocks, this work focuses on the rheological design of sustainable block copolymers--those derived from renewable sources and are degradable--based on poly(lactide). Although commercially viable, poly(lactide) has a number of inherent deficiencies that result in a host of challenges that require both creative and practical solutions that are cost-effective and amenable to large-scale production. Specifically, this dissertation looks at applications in which both shear and extensional rheology dictate performance attributes, namely chewing gum, pressure-sensitive adhesives, and polymers for blown film extrusion. Structure-property relationships in the context of block polymer architecture, polymer composition, morphology, and branching are explored in depth. The basic principles and fundamental findings presented in this thesis are applicable to a broader range of substances that incorporate block copolymers for which rheology plays a pivotal role.

  4. The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta-analysis.

    PubMed

    Ando, Tomo; Takagi, Hisato

    2016-09-01

    New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common conduction disturbances after transcatheter aortic valve implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically negative impact after TAVI. To find out, we conducted a systematic literature search of the MEDLINE/PubMed and Embase databases. Observational studies that reported clinical outcomes of NOP-LBBB patients after TAVI were included. The random-effects model was used to combine odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios when available. A total of 4049 patients (807 and 3242 patients with and without NOP-LBBB, respectively) were included. Perioperative (in-hospital or 30-day) and midterm all-cause mortality and midterm cardiovascular mortality were comparable between the groups. The NOP-LBBB patients experienced a higher rate of permanent pacemaker implantation (HR: 2.09, 95% confidence interval: 1.12-3.90, P = 0.021, I(2) = 83%) during midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher permanent pacemaker implantation but did not negatively affect the midterm prognosis. Therefore, careful observation during the follow-up is required. © 2016 Wiley Periodicals, Inc.

  5. Simple model of inhibition of chain-branching combustion processes

    NASA Astrophysics Data System (ADS)

    Babushok, Valeri I.; Gubernov, Vladimir V.; Minaev, Sergei S.; Miroshnichenko, Taisia P.

    2017-11-01

    A simple kinetic model has been suggested to describe the inhibition and extinction of flame propagation in reaction systems with chain-branching reactions typical for hydrocarbon systems. The model is based on the generalised model of the combustion process with chain-branching reaction combined with the one-stage reaction describing the thermal mode of flame propagation with the addition of inhibition reaction steps. Inhibitor addition suppresses the radical overshoot in flame and leads to the change of reaction mode from the chain-branching reaction to a thermal mode of flame propagation. With the increase of inhibitor the transition of chain-branching mode of reaction to the reaction with straight-chains (non-branching chain reaction) is observed. The inhibition part of the model includes a block of three reactions to describe the influence of the inhibitor. The heat losses are incorporated into the model via Newton cooling. The flame extinction is the result of the decreased heat release of inhibited reaction processes and the suppression of radical overshoot with the further decrease of the reaction rate due to the temperature decrease and mixture dilution. A comparison of the results of modelling laminar premixed methane/air flames inhibited by potassium bicarbonate (gas phase model, detailed kinetic model) with the results obtained using the suggested simple model is presented. The calculations with the detailed kinetic model demonstrate the following modes of combustion process: (1) flame propagation with chain-branching reaction (with radical overshoot, inhibitor addition decreases the radical overshoot down to the equilibrium level); (2) saturation of chemical influence of inhibitor, and (3) transition to thermal mode of flame propagation (non-branching chain mode of reaction). The suggested simple kinetic model qualitatively reproduces the modes of flame propagation with the addition of the inhibitor observed using detailed kinetic models.

  6. Medialis pedis flap in the reconstruction of palmar skin defects of the digits: clarifying the anatomy of the medial plantar artery.

    PubMed

    Rodriguez-Vegas, Manuel

    2014-05-01

    Because of its outstanding texture, bulkiness, pliability and sensory recovery, the medialis pedis is an excellent alternative in the reconstruction of complex volar skin defects of the digits in selected patients. However, the surgical flap anatomy related with the medial plantar artery is still somewhat confusing to the point that the different journal articles and anatomy textbooks and atlases use different terminology and are, to some extent, misleading and/or incomplete. The authors report a clinical series of 15 medialis pedis free flaps in the reconstruction of skin defects of the fingers and evaluate their indications in free flap reconstruction of the skin defects of the digits. A review is made of the most relevant journal articles, anatomy textbooks, and atlases that describe the anatomy of the medial plantar artery with a special emphasis on the cutaneous branches that nourish the medialis pedis flap.

  7. Medial orbital wall reconstruction with flexible Ethisorb patches.

    PubMed

    Pohlenz, P; Adler, W; Li, L; Schmelzle, R; Klatt, J

    2013-03-01

    The aim of this study was to analyse the long-term result after reconstruction of the medial orbital wall with a flexible, biodegradable material (Ethisorb). During a period of almost 8 years, 31 patients with a medial orbital wall fracture were analysed retrospectively. Inclusion criteria were patients with a maximum size fracture of the orbital medial wall measuring 1.5-2 cm(2). Exophthalmos, enophthalmos, bulbus motility, diplopia and skin sensation were investigated over a period of 6 months. In all patients, the medial orbital wall was reconstructed with Ethisorb patches. No significant intraoperative complications were detected. No postoperative infection, abscess or seroma was found in any of the patients receiving an Ethisorb patch. The advantage of the semiflexibility of the Ethisorb patch is that it supplies an anatomically correct fit to the orbital medial wall but does not require fixation by screws or the use of sutures. The low rate of reported bulbus motility disturbance, diplopia, exophthalmos and enophthalmos demonstrates acceptable results after medial orbital wall reconstruction using the Ethisorb patch.

  8. Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery: A randomised, open-label feasibility study.

    PubMed

    Ganapathy, Sugantha; Sondekoppam, Rakesh V; Terlecki, Magdalena; Brookes, Jonathan; Das Adhikary, Sanjib; Subramanian, Lakshmimathy

    2015-11-01

    We recently described a lateral-to-medial approach for transversus abdominis plane (LM-TAP) block, which may permit preoperative initiation of the block. Our objective was to evaluate the feasibility of continuous LM-TAP blocks in clinical practice in comparison with thoracic epidural analgesia (TEA). A randomised, open-label study. University Hospital, London Health Sciences Centre, London, Ontario, Canada from July 2008 to August 2012. Fifty adult patients undergoing open abdominal surgery via laparotomy were allocated randomly to receive preoperative catheter-congruent TEA or ultrasound-guided continuous bilateral LM-TAP block for 72 h postoperatively. Reasons for noninclusion were American Society of Anesthesiologists' physical status more than 4, known allergy to study drugs, chronic pain/opioid dependence, spinal abnormalities or psychiatric illness. In the TEA group (n = 24), patient-controlled epidural analgesia was maintained using bupivacaine 0.1% with hydromorphone 10 μg ml⁻¹ after establishment of the initial block. In the LM-TAP group (n = 26), ultrasound-guided LM-TAP catheters were inserted on each side preoperatively after a bolus of 30 ml of ropivacaine 0.5% (20 ml subcostal and 10 ml subumbilical injections on both sides). Analgesia was maintained with an infusion of ropivacaine 0.35% at a rate of 2 to 2.5 ml h⁻¹ through each catheter, along with rescue intravenous patient-controlled analgesia. The primary outcome was pain score on coughing 24 h after the end of surgery. Secondary outcomes were pain scores from 24 to 72 h, intraoperative and postoperative opioid consumption, time to onset of bowel movement and side effect profiles. Mean [95% confidence interval (95% CI)] pain scores at rest ranged from 1. 7 (0.9 to 2.5) to 2.3 (1.1 to 3.4) in TEA vs. 1.5 (0.7 to 2.2) to 2.2 (1.3 to 3.0) in LM-TAP (P = 0.829). The dynamic pain scores ranged from 2.9 (1.5 to 4.4) to 3.8 (2.8 to 4.8) in TEA vs. 3.3 (2.4 to 4

  9. Medial and Lateral Discoid Menisci of Both Knees

    PubMed Central

    Kan, Hiroyuki; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Minami, Ginjiro; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared. PMID:27894182

  10. Persistently active neurons in human medial frontal and medial temporal lobe support working memory

    PubMed Central

    Kamiński, J; Sullivan, S; Chung, JM; Ross, IB; Mamelak, AN; Rutishauser, U

    2017-01-01

    Persistent neural activity is a putative mechanism for the maintenance of working memories. Persistent activity relies on the activity of a distributed network of areas, but the differential contribution of each area remains unclear. We recorded single neurons in the human medial frontal cortex and the medial temporal lobe while subjects held up to three items in memory. We found persistently active neurons in both areas. Persistent activity of hippocampal and amygdala neurons was stimulus-specific, formed stable attractors, and was predictive of memory content. Medial frontal cortex persistent activity, on the other hand, was modulated by memory load and task set but was not stimulus-specific. Trial-by-trial variability in persistent activity in both areas was related to memory strength, because it predicted the speed and accuracy by which stimuli were remembered. This work reveals, in humans, direct evidence for a distributed network of persistently active neurons supporting working memory maintenance. PMID:28218914

  11. Recovery from distal ulnar motor conduction block injury: serial EMG studies.

    PubMed

    Montoya, Liliana; Felice, Kevin J

    2002-07-01

    Acute conduction block injuries often result from nerve compression or trauma. The temporal pattern of clinical, electrophysiologic, and histopathologic changes following these injuries has been extensively studied in experimental animal models but not in humans. Our recent evaluation of a young man with an injury to the deep motor branch of the ulnar nerve following nerve compression from weightlifting exercises provided the opportunity to follow the course and recovery of a severe conduction block injury with sequential nerve conduction studies. The conduction block slowly and completely resolved, as did the clinical deficit, over a 14-week period. The reduction in conduction block occurred at a linear rate of -6.1% per week. Copyright 2002 Wiley Periodicals, Inc.

  12. Colloidal polymers with controlled sequence and branching constructed from magnetic field assembled nanoparticles.

    PubMed

    Bannwarth, Markus B; Utech, Stefanie; Ebert, Sandro; Weitz, David A; Crespy, Daniel; Landfester, Katharina

    2015-03-24

    The assembly of nanoparticles into polymer-like architectures is challenging and usually requires highly defined colloidal building blocks. Here, we show that the broad size-distribution of a simple dispersion of magnetic nanocolloids can be exploited to obtain various polymer-like architectures. The particles are assembled under an external magnetic field and permanently linked by thermal sintering. The remarkable variety of polymer-analogue architectures that arises from this simple process ranges from statistical and block copolymer-like sequencing to branched chains and networks. This library of architectures can be realized by controlling the sequencing of the particles and the junction points via a size-dependent self-assembly of the single building blocks.

  13. Efficient learning mechanisms hold in the social domain and are implemented in the medial prefrontal cortex

    PubMed Central

    Tobler, Philippe N.

    2015-01-01

    When we are learning to associate novel cues with outcomes, learning is more efficient if we take advantage of previously learned associations and thereby avoid redundant learning. The blocking effect represents this sort of efficiency mechanism and refers to the phenomenon in which a novel stimulus is blocked from learning when it is associated with a fully predicted outcome. Although there is sufficient evidence that this effect manifests itself when individuals learn about their own rewards, it remains unclear whether it also does when they learn about others’ rewards. We employed behavioral and neuroimaging methods to address this question. We demonstrate that blocking does indeed occur in the social domain and it does so to a similar degree as observed in the individual domain. On the neural level, activations in the medial prefrontal cortex (mPFC) show a specific contribution to blocking and learning-related prediction errors in the social domain. These findings suggest that the efficiency principle that applies to reward learning in the individual domain also applies to that in the social domain, with the mPFC playing a central role in implementing it. PMID:25326037

  14. The first perforating branch of the deep femoral artery: A reliable recipient vessel for vascularized fibular grafts: An anatomical study.

    PubMed

    Sur, Yoo Joon; Morsy, Mohamed; Mohan, Anita T; Zhu, Lin; Lachman, Nirusha; Saint-Cyr, Michel

    2016-03-01

    Although the perforating branches of the deep femoral artery have been introduced as recipient vessels for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head, comprehensive knowledge of the related anatomy is deficient. The aims of this study were to provide detailed anatomical data for the perforating branches of the deep femoral artery and validate their usefulness as recipient vessels for vascularized fibular grafts. Anatomical dissection was performed on 11 fresh human cadaveric lower extremities. The number, locations, and diameters of the perforating branches were documented. The topographic relationships with the vastus ridge and the tendinous insertion of the gluteus maximus were clarified. The diameters of the perforating branches were compared with those of the ascending branch of the lateral circumflex femoral and the peroneal arteries. The mean number of perforating branches was 3.5. The mean distances from the vastus ridge to the first, second, and third perforating branches were 8.1, 13.7, and 20.4 cm, respectively. The first perforating branch was always located medial to the tendinous insertion of the gluteus maximus, whereas the second perforating branch was always located distal to the gluteus maximus. The mean diameters of the first, second, third, and fourth perforating branches were 3.1, 2.3, 1.6, and 1.2 mm, respectively. The mean diameters of the ascending branch of the lateral circumflex femoral and the peroneal arteries were 2.0 and 3.6 mm, respectively. The first perforating branch of the deep femoral artery is an appropriate alternative recipient vessel for vascularized fibular grafts in the treatment of osteonecrosis of the femoral head. It has a very consistent anatomy with a suitable location and diameter for anastomosis of the peroneal artery. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Proximal Tibia Medial Biplanar Retrotubercle Open Wedge Osteotomy for Varus Knees with Medial Gonarthrosis

    PubMed Central

    Türkmen, İsmail; Esenkaya, İrfan; Ünay, Koray; Türkmensoy, Fatih; Özkut, Afşar Timuçin

    2014-01-01

    Objectives: The purpose of this study is to evaluate the early results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for varus gonarthrosis and compare the results with the literatüre. Methods: The results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for 23 knees of 22 patients with medial gonarthrosis were evaluated clinically and radiologically. Results: Twenty of the patients were female and two were male. Mean age of the patients was 56.24; mean boy mass index was 31.95 and preoperative HSS (Hospital for Special Surgery) score was 68.7. Mean tibiofemoral axis was 186.39° and mean Insall-Salvatti index value was 1.04 preoperatively. Mean follow up period was 30.19 months. Mean HSS score was 86.48, femorotibial anatomic axis angle was 175° and Insall-Salvati index value 1.06 during the last follow-up. The improvement of the HSS score and the femorotibial anatomic axis angle was statistically significant. However, the change in Insall Salvati index values was statistically insignificant. Nonfatal pulmonary embolus in 1 patient, and deep vein thrombosis that occured one year after the procedure in 1 patient, rhabdomyolysis in 1 patient and loss of correction (relapse) in 1 patient were encountered as complications. Conclusion: Our results show that proximal tibia medial biplanar retrotubercle open wedge osteotomy improves the frontal and sagittal plane deformities without changing the patellar tendon length. Hence, possible patellofemoral problems are prevented and the clinical results are improved.

  16. Spatial attention increases high-frequency gamma synchronisation in human medial visual cortex.

    PubMed

    Koelewijn, Loes; Rich, Anina N; Muthukumaraswamy, Suresh D; Singh, Krish D

    2013-10-01

    Visual information processing involves the integration of stimulus and goal-driven information, requiring neuronal communication. Gamma synchronisation is linked to neuronal communication, and is known to be modulated in visual cortex both by stimulus properties and voluntarily-directed attention. Stimulus-driven modulations of gamma activity are particularly associated with early visual areas such as V1, whereas attentional effects are generally localised to higher visual areas such as V4. The absence of a gamma increase in early visual cortex is at odds with robust attentional enhancements found with other measures of neuronal activity in this area. Here we used magnetoencephalography (MEG) to explore the effect of spatial attention on gamma activity in human early visual cortex using a highly effective gamma-inducing stimulus and strong attentional manipulation. In separate blocks, subjects tracked either a parafoveal grating patch that induced gamma activity in contralateral medial visual cortex, or a small line at fixation, effectively attending away from the gamma-inducing grating. Both items were always present, but rotated unpredictably and independently of each other. The rotating grating induced gamma synchronisation in medial visual cortex at 30-70 Hz, and in lateral visual cortex at 60-90 Hz, regardless of whether it was attended. Directing spatial attention to the grating increased gamma synchronisation in medial visual cortex, but only at 60-90 Hz. These results suggest that the generally found increase in gamma activity by spatial attention can be localised to early visual cortex in humans, and that stimulus and goal-driven modulations may be mediated at different frequencies within the gamma range. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Stimulation of the medial amygdala enhances medial preoptic dopamine release: implications for male rat sexual behavior.

    PubMed

    Dominguez, J M; Hull, E M

    2001-11-02

    Increased dopamine (DA) in the medial preoptic area (MPOA) facilitates male sexual behavior. A major source of innervation to the MPOA is the medial amygdala (MeA). We now report that chemical stimulation of the MeA enhanced levels of extracellular MPOA DA in anesthetized male rats. These results suggest that DA activity in the MPOA can be regulated by input from the MeA to the MPOA.

  18. Existing branches correlatively inhibit further branching in Trifolium repens: possible mechanisms

    PubMed Central

    Thomas, R. G.; Hay, M. J. M.

    2011-01-01

    In Trifolium repens removal of any number of existing branches distal to a nodal root stimulates development of axillary buds further along the stem such that the complement of branches distal to a nodal root remains constant. This study aimed to assess possible mechanisms by which existing branches correlatively inhibit the outgrowth of axillary buds distal to them. Treatments were applied to basal branches to evaluate the roles of three postulated inhibitory mechanisms: (I) the transport of a phloem-mobile inhibitory feedback signal from branches into the main stem; (II) the polar flow of auxin from branches into the main stem acting to limit further branch development; or (III) the basal branches functioning as sinks for a net root-derived stimulatory signal (NRS). Results showed that transport of auxin, or of a non-auxin phloem-mobile signal, from basal branches did not influence regulation of correlative inhibition and were consistent with the possibility that the intra-plant distribution of NRS could be involved in the correlative inhibition of distal buds by basal branches. This study supports existing evidence that regulation of branching in T. repens is dominated by a root-derived stimulatory signal, initially distributed via the xylem, the characterization of which will progress the generic understanding of branching regulation. PMID:21071681

  19. An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty.

    PubMed

    Athwal, Kiron K; El Daou, Hadi; Inderhaug, Eivind; Manning, William; Davies, Andrew J; Deehan, David J; Amis, Andrew A

    2017-08-01

    The aim of this study was to quantify the medial soft tissue contributions to stability following constrained condylar (CC) total knee arthroplasty (TKA) and determine whether a medial reconstruction could restore stability to a soft tissue-deficient, CC-TKA knee. Eight cadaveric knees were mounted in a robotic system and tested at 0°, 30°, 60°, and 90° of flexion with ±50 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were transected and their relative contributions to stabilising the applied loads were quantified. After complete medial soft tissue transection, a reconstruction using a semitendinosus tendon graft was performed, and the effect on kinematic behaviour under equivocal conditions was measured. In the CC-TKA knee, the sMCL was the major medial restraint in anterior drawer, internal-external, and valgus rotation. No significant differences were found between the rotational laxities of the reconstructed knee to the pre-deficient state for the arc of motion examined. The relative contribution of the reconstruction was higher in valgus rotation at 60° than the sMCL; otherwise, the contribution of the reconstruction was similar to that of the sMCL. There is contention whether a CC-TKA can function with medial deficiency or more constraint is required. This work has shown that a CC-TKA may not provide enough stability with an absent sMCL. However, in such cases, combining the CC-TKA with a medial soft tissue reconstruction may be considered as an alternative to a hinged implant.

  20. The percutaneous pie-crusting medial release during arthroscopic procedures of the medial meniscus does neither affect valgus laxity nor clinical outcome.

    PubMed

    Jeon, Sang-Woo; Jung, Min; Chun, Yong-Min; Lee, Su-Keon; Jung, Woo Seok; Choi, Chong Hyuk; Kim, Sung-Jae; Kim, Sung-Hwan

    2017-12-28

    To analyze the effect of percutaneous pie-crusting medial release on valgus laxity before and after surgery and on clinical outcomes. Eight-hundred fourteen consecutive patients who underwent an arthroscopic procedure for the medial compartment of the knee were evaluated retrospectively. Sex, age, type of operation (meniscectomy, meniscal repair, and posterior root repair), type of accompanying surgery (none, cartilage procedure, ligament procedure and osteotomy) were documented. Sixty-four patients who underwent percutaneous pie-crusting medial release (release group) and 64 who did not undergo medial release (non-release group) were matched using the propensity score method. Each patient was evaluated for the following variables: degree of valgus laxity on stress radiographs, Lysholm knee score, visual analog scale score, and International Knee Documentation Committee knee score and grade. At the 24-month follow-up, no significant increase in side-to-side differences in the valgus gap was observed in comparison to the preoperative value in the release group [preoperative, - 0.1 ± 1.3 mm; follow-up, - 0.1 ± 1.4 mm; (n.s.)]. The follow-up Lysholm score, visual analog scale score and International Knee Documentation Committee knee score and grade were similar between the two groups. Percutaneous pie-crusting medial release is an additional procedure that can be performed during arthroscopic surgery for patients with a narrow medial joint space of the knee. Percutaneous pie-crusting medial release reduces iatrogenic injury to the cartilage and does not produce any residual valgus laxity of the knee. IV.

  1. Persistent medial foot pain in an adolescent athlete.

    PubMed

    Hensley, Craig P; Reischl, Stephen F

    2013-03-01

    The patient was a 15-year-old adolescent male who was referred to a physical therapist for a chief complaint of worsening right medial foot pain. Given the worsening nature of the patient's right medial foot pain, palpatory findings, and a prior recommendation for computed tomography from a radiologist, the patient was referred to his physician. Subsequent computed tomography imaging of the right foot revealed a nondisplaced fracture through the dorsal-medial aspect of the navicular.

  2. Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity.

    PubMed

    Schreiber, Alberto; Mattavelli, Davide; Ferrari, Marco; Rampinelli, Vittorio; Lancini, Davide; Ravanelli, Marco; Bertazzoni, Giacomo; Rodella, Luigi Fabrizio; Buffoli, Barbara; Doglietto, Francesco; Nicolai, Piero

    2017-10-01

    Endoscopic medial maxillectomies (EMMs) are used to optimize exposure of the maxillary sinus and retromaxillary areas. Although in type D EMM (Sturmann-Canfield procedure) the anterior superior alveolar nerve (ASAN) is always at risk of injury, only 29% of patients complained of alveolar process and dental anesthesia. The purpose of this anatomical study is to assess the neural anastomotic network of the ASAN (ASAN-NAN) and describe different extensions of type D EMMs in a preclinical setting. The ASAN and its medial anastomotic branches (MABs) and lateral anastomotic branches (LABs) were evaluated by cone-beam computerized tomography (CBCT). Five different extensions of type D (D1 to D5) EMMs were identified and nerves at risk of injury in each type were assessed by CBCT. Moreover, quantification of surgical corridors was performed on cadaver heads with a neuronavigation system. Fifty-seven CBCT scans were analyzed. The ASAN would be spared in 16.3% of cases with a type D1 EMM, while it would be injured in the majority of type D2 to D5 resections. At least 1 nerve of the ASAN-NAN was spared in 96.6%, 93%, 74.6%, 0%, and 65.8% of type D1 to D5 EMMs, respectively. Two cadaver heads were dissected and the incremental volume and number of maxillary subsites exposed was assessed in type D1 to D5 EMMs. ASAN function impairment is probably compensated by LABs and MABs. If this hypothesis will be validated in a prospective study on patients, preoperative CBCT evaluation could predict neurological morbidity after type D EMM, and allow tailoring the procedure to minimize impairment of the ASAN-NAN. © 2017 ARS-AAOA, LLC.

  3. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus

    PubMed Central

    Bin Abd Razak, Hamid Rahmatullah; Amit Kanta, Mitra

    2016-01-01

    We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis. PMID:28070434

  4. Efficient learning mechanisms hold in the social domain and are implemented in the medial prefrontal cortex.

    PubMed

    Seid-Fatemi, Azade; Tobler, Philippe N

    2015-05-01

    When we are learning to associate novel cues with outcomes, learning is more efficient if we take advantage of previously learned associations and thereby avoid redundant learning. The blocking effect represents this sort of efficiency mechanism and refers to the phenomenon in which a novel stimulus is blocked from learning when it is associated with a fully predicted outcome. Although there is sufficient evidence that this effect manifests itself when individuals learn about their own rewards, it remains unclear whether it also does when they learn about others' rewards. We employed behavioral and neuroimaging methods to address this question. We demonstrate that blocking does indeed occur in the social domain and it does so to a similar degree as observed in the individual domain. On the neural level, activations in the medial prefrontal cortex (mPFC) show a specific contribution to blocking and learning-related prediction errors in the social domain. These findings suggest that the efficiency principle that applies to reward learning in the individual domain also applies to that in the social domain, with the mPFC playing a central role in implementing it. © The Author (2014). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  5. Two-Dimensional Liquid Chromatography Analysis of Polystyrene/Polybutadiene Block Copolymers.

    PubMed

    Lee, Sanghoon; Choi, Heejae; Chang, Taihyun; Staal, Bastiaan

    2018-05-15

    A detailed characterization of a commercial polystyrene/polybutadiene block copolymer material (Styrolux) was carried out using two-dimensional liquid chromatography (2D-LC). The Styrolux is prepared by statistical linking reaction of two different polystyrene- block-polybutadienyl anion precursors with a multivalent linking agent. Therefore, it is a mixture of a number of branched block copolymers different in molecular weight, composition, and chain architecture. While individual LC analysis, including size exclusion chromatography, interaction chromatography, or liquid chromatography at critical condition, is not good enough to resolve all the polymer species, 2D-LC separations coupling two chromatography methods were able to resolve all polymer species present in the sample; at least 13 block copolymer species and a homopolystyrene blended. Four different 2D-LC analyses combining a different pair of two LC methods provide their characteristic separation results. The separation characteristics of the 2D-LC separations are compared to elucidate the elution characteristics of the block copolymer species.

  6. Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study.

    PubMed

    Roussignol, X; Gauthe, R; Rahali, S; Mandereau, C; Courage, O; Duparc, F

    2015-09-01

    Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment opening after pie-crusting release (PCR) of the superficial medial collateral ligament (sMCL) at its distal insertion on the tibia. The secondary objective was to describe the anatomic relationships at the site of PCR (saphenous nerve, medial saphenous vein). We studied 10 cadaver knees with no history of invasive procedures. The femur was held in a vise with the knee flexed at 45°, and the medial aspect of the knee was dissected. PCR of the sMCL was performed under arthroscopic vision, in the anteroposterior direction, at the distal tibial insertion of the sMCL, along the lower edge of the tibial insertion of the semi-tendinosus tendon. Continuous 300-N valgus stress was applied to the ankle. Opening of the medial tibiofemoral compartment was measured arthroscopically using graduated palpation hooks after sequential PCR of the sMCL. The compartment opened by 1mm after release of the anterior third, 2.3mm after release of the anterior two-thirds, and 3.9mm after subtotal release. A femoral fracture occurred in 1 case, after completion of all measurements. Both the saphenous nerve and the medial saphenous vein were located at a distance from the PCR site in all 10 knees. PCR of the sMCL is chiefly described as a ligament-balancing method during total knee arthroplasty. This procedure is usually performed at the joint line, where it opens the compartment by 4-6mm at the most, with some degree of unpredictability. PCR of the sMCL at its distal tibial insertion provides gradual opening of the compartment, to a maximum value similar to that obtained with PCR at the joint space. The lower edge of the semi-tendinosus tendon is a valuable landmark

  7. Medial meniscus anatomy-from basic science to treatment.

    PubMed

    Śmigielski, Robert; Becker, Roland; Zdanowicz, Urszula; Ciszek, Bogdan

    2015-01-01

    This paper focuses on the anatomical attachment of the medial meniscus. Detailed anatomical dissections have been performed and illustrated. Five zones can be distinguished in regard to the meniscus attachments anatomy: zone 1 (of the anterior root), zone 2 (anteromedial zone), zone 3 (the medial zone), zone 4 (the posterior zone) and the zone 5 (of the posterior root). The understanding of the meniscal anatomy is especially crucial for meniscus repair but also for correct fixation of the anterior and posterior horn of the medial meniscus.

  8. Structure of clusters and building blocks in amylopectin from African rice accessions.

    PubMed

    Gayin, Joseph; Abdel-Aal, El-Sayed M; Marcone, Massimo; Manful, John; Bertoft, Eric

    2016-09-05

    Enzymatic hydrolysis in combination with gel-permeation and anion-exchange chromatography techniques were employed to characterise the composition of clusters and building blocks of amylopectin from two African rice (Oryza glaberrima) accessions-IRGC 103759 and TOG 12440. The samples were compared with one Asian rice (Oryza sativa) sample (cv WITA 4) and one O. sativa×O. glaberrima cross (NERICA 4). The average DP of clusters from the African rice accessions (ARAs) was marginally larger (DP=83) than in WITA 4 (DP=81). However, regarding average number of chains, clusters from the ARAs represented both the smallest and largest clusters. Overall, the result suggested that the structure of clusters in TOG 12440 was dense with short chains and high degree of branching, whereas the situation was the opposite in NERICA 4. IRGC 103759 and WITA 4 possessed clusters with intermediate characteristics. The commonest type of building blocks in all samples was group 2 (single branched dextrins) representing 40.3-49.4% of the blocks, while groups 3-6 were found in successively lower numbers. The average number of building blocks in the clusters was significantly larger in NERICA 4 (5.8) and WITA 4 (5.7) than in IRGC 103759 and TOG 12440 (5.1 and 5.3, respectively). Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. SDF1 regulates leading process branching and speed of migrating interneurons

    PubMed Central

    Lysko, Daniel E.; Putt, Mary; Golden, Jeffrey A.

    2011-01-01

    Cell migration is required for normal embryonic development, yet how cells navigate complex paths while integrating multiple guidance cues remains poorly understood. During brain development, interneurons migrate from the ventral ganglionic eminence to the cerebral cortex within several migratory streams. They must exit these streams to invade the cortical plate. While SDF1-signaling is necessary for normal interneuron stream migration, how they switch from tangential stream migration to invade the cortical plate is unknown. Here we demonstrate that SDF1-signaling reduces interneuron branching frequency by reducing cAMP levels via a Gi-signaling pathway using an in vitro mouse explant system, resulting in the maintenance of stream migration. Blocking SDF1-signaling, or increasing branching frequency, results in stream exit and cortical plate invasion in mouse brain slices. These data support a novel model to understand how migrating interneurons switch from tangential migration to invade the cortical plate in which reducing SDF1-signaling increases leading process branching and slows the migration rate, permitting migrating interneurons to sense cortically directed guidance cues. PMID:21289183

  10. Introgression of a Block of Genome Under Infinitesimal Selection.

    PubMed

    Sachdeva, Himani; Barton, Nicholas H

    2018-06-12

    Adaptive introgression is common in nature and can be driven by selection acting on multiple, linked genes. We explore the effects of polygenic selection on introgression under the infinitesimal model with linkage. This model assumes that the introgressing block has an effectively infinite number of loci, each with an infinitesimal effect on the trait under selection. The block is assumed to introgress under directional selection within a native population that is genetically homogeneous. We use individual-based simulations and a branching process approximation to compute various statistics of the introgressing block, and explore how these depend on parameters such as the map length and initial trait value associated with the introgressing block, the genetic variability along the block, and the strength of selection. Our results show that the introgression dynamics of a block under infinitesimal selection are qualitatively different from the dynamics of neutral introgression. We also find that in the long run, surviving descendant blocks are likely to have intermediate lengths, and clarify how their length is shaped by the interplay between linkage and infinitesimal selection. Our results suggest that it may be difficult to distinguish the long-term introgression of a block of genome with a single strongly selected locus from the introgression of a block with multiple, tightly linked and weakly selected loci. Copyright © 2018, Genetics.

  11. Natural history of medial clavicle fractures.

    PubMed

    Salipas, Andrew; Kimmel, Lara A; Edwards, Elton R; Rakhra, Sandeep; Moaveni, Afshin Kamali

    2016-10-01

    Fractures of the medial third of the clavicle comprise less than 3% of all clavicle fractures. The natural history and optimal management of these rare injuries are unknown. The aim of our study is to describe the demographics, management and outcomes of patients with medial clavicle fractures treated at a Level 1 Trauma Centre. A retrospective review was conducted of patients presenting to our institution between January 2008 and March 2013 with a medial third clavicle fracture. Clinical and radiographic data were recorded including mechanism of injury, fracture pattern and displacement, associated injuries, management and complications. Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOS-E) scores from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Shoulder outcomes were assessed using two patient reported outcomes scores, the American Shoulder and Elbow Society Score (ASES) and the Subjective Shoulder Value (SSV). Sixty eight medial clavicle fractures in 68 patients were evaluated. The majority of patients were male (n=53), with a median age of 53.5 years (interquartile range (IQR) 37.5-74.5 years). The most common mechanism of injury was motor vehicle accident (n=28). The in-hospital mortality rate was 4.4%. The fracture pattern was almost equally distributed between extra articular (n=35) and intra-articular (n=33). Fifty-five fractures (80.9%) had minimal or no displacement. Associated injuries were predominantly thoracic (n=31). All fractures were initially managed non-operatively, with a broad arm sling. Delayed operative fixation was performed for painful atrophic delayed union in two patients (2.9%). Both patients were under 65 years of age and had a severely displaced fracture of the medial clavicle. One intra-operative vascular complication was seen, with no adverse long-term outcome. Follow-up was obtained in 85.0% of the surviving cohort at an average of three years post injury (range 1-6 years). The mean ASES

  12. Branching Search

    NASA Astrophysics Data System (ADS)

    Eliazar, Iddo

    2017-12-01

    Search processes play key roles in various scientific fields. A widespread and effective search-process scheme, which we term Restart Search, is based on the following restart algorithm: i) set a timer and initiate a search task; ii) if the task was completed before the timer expired, then stop; iii) if the timer expired before the task was completed, then go back to the first step and restart the search process anew. In this paper a branching feature is added to the restart algorithm: at every transition from the algorithm's third step to its first step branching takes place, thus multiplying the search effort. This branching feature yields a search-process scheme which we term Branching Search. The running time of Branching Search is analyzed, closed-form results are established, and these results are compared to the coresponding running-time results of Restart Search.

  13. Defining the local nerve blocks for feline distal thoracic limb surgery: a cadaveric study

    PubMed Central

    Enomoto, Masataka; Lascelles, B Duncan X; Gerard, Mathew P

    2016-01-01

    Objectives Though controversial, onychectomy remains a commonly performed distal thoracic limb surgical procedure in cats. Peripheral nerve block techniques have been proposed in cats undergoing onychectomy but evidence of efficacy is lacking. Preliminary tests of the described technique using cadavers resulted in incomplete staining of nerves. The aim of this study was to develop nerve block methods based on cadaveric dissections and test these methods with cadaveric dye injections. Methods Ten pairs of feline thoracic limbs (n = 20) were dissected and superficial branches of the radial nerve (RSbr nn.), median nerve (M n.), dorsal branch of ulnar nerve (UDbr n.), superficial branch of palmar branch of ulnar nerve (UPbrS n.) and deep branch of palmar branch of ulnar nerve (UPbrDp n.) were identified. Based on these dissections, a four-point block was developed and tested using dye injections in another six pairs of feline thoracic limbs (n = 12). Using a 25 G × 5/8 inch needle and 1 ml syringe, 0.07 ml/kg methylene blue was injected at the site of the RSbr nn., 0.04 ml/kg at the injection site of the UDbr n., 0.08 ml/kg at the injection site of the M n. and UPbrS n., and 0.01 ml/kg at the injection site of the UPbrDp n. The length and circumference of each nerve that was stained was measured. Results Positive staining of all nerves was observed in 12/12 limbs. The lengths stained for RSbr nn., M n., UDbr n., UPbrS n. and UPbrDp n. were 34.9 ± 5.3, 26.4 ± 4.8, 29.2 ± 4.0, 39.1 ± 4.3 and 17.5 ± 3.3 mm, respectively. The nerve circumferences stained were 93.8 ± 15.5, 95.8 ± 9.7, 100 ± 0.0, 100 ± 0.0 and 93.8 ± 15.5%, respectively. Conclusions and relevance This described four-point injection method may be an effective perioperative analgesia technique for feline distal thoracic limb procedures. PMID:26250858

  14. Supplemental branched-chain amino acids improve performance and immune response of newly-received feedlot calves

    USDA-ARS?s Scientific Manuscript database

    Supplemental branched-chain AA (BCAA) improved N balance of steers during a simulated pathogen challenge. The objective of this study was to determine the effect of supplemental BCAA on growth and health of newly-received feedlot steers. Steers (n = 120; initial BW = 376 ± 5 kg) were blocked by BW a...

  15. Periorbital and Intraorbital Studies of the Terminal Branches of the Ophthalmic Artery for Periorbital and Glabellar Filler Placements.

    PubMed

    Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

    2017-06-01

    Filler injections for sunken upper eyelid correction and glabellar augmentation at the orbitoglabellar region need to be performed correctly. Precise knowledge of the emerging sites of all terminal branches of the ophthalmic artery is essential for these procedures to be conducted safely. The terminal branches of the ophthalmic artery were studied in both periorbital and intraorbital dissections. The aim of this study was to verify the critical positions of the emerging sites at the orbital septum that may act as potential retrograde channels for filler emboli. In the 40 eyes examined, the branches of the ophthalmic artery were found to emerge from four different sites. Two substantial emerging sites were situated on both sides of the trochlea of the superior oblique muscle. These sites were located at the superior part of the medial orbital rim (SMOR) and are alternatively named as the epitrochlear and the subtrochlear emerging sites. The other two sites can be regarded as accessory emerging sites due to the comparably smaller artery. Dissection of the intraorbital region revealed small periosteal branches of the infraorbital artery which coursed anteriorly on the orbital floor to form anastomoses with the lacrimal artery. In other areas of the orbital floor, no branches extended from the infraorbital artery. In front of the lacrimal gland, very minute branches descended and coursed along both margins of the superior tarsus but did not course outside the lateral orbital rim. A danger zone was located at the SMOR, where the ophthalmic branches emerge to form anastomotic channels. Compression at the trochlea guarantees safe injection of filler, reducing the risk of complication. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  16. Influence of testosterone on synaptic transmission in the rat medial vestibular nuclei: estrogenic and androgenic effects.

    PubMed

    Grassi, S; Frondaroli, A; Di Mauro, M; Pettorossi, V E

    2010-12-15

    In brainstem slices of young male rat, we investigated the influence of the neuroactive steroid testosterone (T) on the synaptic responses by analyzing the field potential evoked in the medial vestibular nucleus (MVN) by vestibular afferent stimulation. T induced three distinct and independent long-term synaptic changes: fast long-lasting potentiation (fLP), slow long-lasting potentiation (sLP) and long-lasting depression (LD). The fLP was mediated by 17β-estradiol (E(2)) since it was abolished by blocking the estrogen receptors (ERs) or the enzyme converting T to E(2). Conversely, sLP and LD were mediated by 5α-dihydrotestosterone (DHT) since they were prevented by blocking the androgen receptors (ARs) or the enzyme converting T to DHT. Therefore, the synaptic effects of T were mediated by its androgenic or estrogenic metabolites. The pathways leading to estrogenic and androgenic conversion of T might be co-localized since, the occurrence of fLP under block of androgenic pathway, and that of sLP and LD under estrogenic block, were higher than those observed without blocks. In case of co-localization, the effect on synaptic transmission should depend on the prevailing enzymatic activity. We conclude that circulating and neuronal T can remarkably influence synaptic responses of the vestibular neurons in different and opposite ways, depending on its conversion to estrogenic or androgenic metabolites. Copyright © 2010 IBRO. Published by Elsevier Ltd. All rights reserved.

  17. Categorization of biologically relevant chemical signals in the medial amygdala

    PubMed Central

    Samuelsen, Chad L.; Meredith, Michael

    2009-01-01

    Many species employ chemical signals to convey messages between members of the same species (conspecific), but chemosignals may also provide information to another species (heterospecific). Here, we found that conspecific chemosignals (male, female mouse urine) increased immediate early gene-protein (IEG) expression in both anterior and posterior medial amygdala of male mice, whereas most heterospecific chemosignals (e.g.: hamster vaginal fluid, steer urine) increased expression only in anterior medial amygdala. This categorization of responses in medial amygdala conforms to our previously reported findings in male hamsters. The same characteristic pattern of IEG expression appears in the medial amygdala of each species in response to conspecific stimuli for that species. These results suggest that the amygdala categorizes stimuli according to the biological relevance for the tested species. Thus, a heterospecific predator (cat collar) stimulus, which elicited behavioral avoidance in mice, increased IEG expression in mouse posterior medial amygdala (like conspecific stimuli). Further analysis suggests reproduction related and potentially threatening stimuli produce increased IEG expression in different sub-regions of posterior medial amygdala (dorsal and ventral, respectively). These patterns of IEG expression in medial amygdala may provide glimpses of a tertiary sorting of chemosensory signals beyond the primary-level selectivity of chemosensory neurons and the secondary sorting in main and accessory olfactory bulbs. PMID:19368822

  18. Isolated medial medullary infarction due to vertebral artery dissection.

    PubMed

    Wakita, M; Matsuoka, H; Hamada, R; Kasuya, J; Osame, M

    2003-12-01

    A 54-year-old man developed left hemiparesis and tactile and deep sensory disturbance following onset of rightside cervical pain. These symptoms resulted from an isolated infarct in the right medial area of the upper medulla oblongata and intracranial vertebral artery (VA) dissection. Atherosclerotic disease of the VA is the most common cause of medial medullary infarction. In past reports of isolated medial medullary infarction, only a few cases involved VA dissection.

  19. [Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery].

    PubMed

    Diéguez García, P; Fajardo Pérez, M; López Álvarez, S; Alfaro de la Torre, P; Pensado Castiñeiras, A P

    2013-01-01

    Several nerve blocks have recently been used for pain treatment in breast surgery. The main objective of our study was to determine the efficacy and safety of ultrasound-assisted blocking of the anterior and lateral cutaneous branches of the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. A prospective observational study was conducted on 30 patients scheduled for non-reconstructive breast and axilla surgery. An intercostal branches block was performed in the mid-axillary line with 0,5% levobupivacaine (3ml in each intercostal space). Clinical efficacy was assessed by standard intraoperative hemodynamic response to surgical stimulus and the need for opioids, and in the postoperative period, by assessing pain intensity as a verbal numerical scale and the need for rescue treatment. We also evaluated the quality of sleep the first night after surgery, any adverse events that occurred, and the satisfaction of patients and surgeons with the anesthetic technique. The intercostal branches block in the mid-axillary line was effective in most cases, with only 2 patients requiring intraoperative opioids, and in one case analgesic rescue was necessary in the postoperative period. The duration of postoperative analgesia was 19±4h. There were no notable adverse events or complications. The satisfaction with the chosen technique was assessed as "very good" in all patients, and by 97% of the surgeons. Intercostal branches block in the mid-axillary line provides adequate intraoperative and postoperative analgesia for non-reconstructive breast and axilla surgery. It is a simple, reproducible technique in most patients of this study, with an easy to understand ultrasound anatomy, in which adequate analgesia could be provided through a single puncture, and may be an alternative to neuroaxial blocks. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights

  20. Branched-chain ketoacids secreted by glioblastoma cells via MCT1 modulate macrophage phenotype.

    PubMed

    Silva, Lidia Santos; Poschet, Gernot; Nonnenmacher, Yannic; Becker, Holger M; Sapcariu, Sean; Gaupel, Ann-Christin; Schlotter, Magdalena; Wu, Yonghe; Kneisel, Niclas; Seiffert, Martina; Hell, Rüdiger; Hiller, Karsten; Lichter, Peter; Radlwimmer, Bernhard

    2017-12-01

    Elevated amino acid catabolism is common to many cancers. Here, we show that glioblastoma are excreting large amounts of branched-chain ketoacids (BCKAs), metabolites of branched-chain amino acid (BCAA) catabolism. We show that efflux of BCKAs, as well as pyruvate, is mediated by the monocarboxylate transporter 1 (MCT1) in glioblastoma. MCT1 locates in close proximity to BCKA-generating branched-chain amino acid transaminase 1, suggesting possible functional interaction of the proteins. Using in vitro models, we demonstrate that tumor-excreted BCKAs can be taken up and re-aminated to BCAAs by tumor-associated macrophages. Furthermore, exposure to BCKAs reduced the phagocytic activity of macrophages. This study provides further evidence for the eminent role of BCAA catabolism in glioblastoma by demonstrating that tumor-excreted BCKAs might have a direct role in tumor immune suppression. Our data further suggest that the anti-proliferative effects of MCT1 knockdown observed by others might be related to the blocked excretion of BCKAs. © 2017 The Authors.

  1. Medial vestibulospinal tract lesions impair sacculo-collic reflexes.

    PubMed

    Kim, Seonhye; Lee, Hak-Seung; Kim, Ji Soo

    2010-05-01

    The medial vestibulospinal tract (VST) is known to mediate the vestibular-evoked myogenic potential (VEMP) in the contracting sternocleidomastoid muscle (SCM). To determine whether disruption of the medial VST in the medulla impairs formation of VEMP, we measured VEMP in 14 patients with medial medullary infarction (MMI). VEMP was induced by a short tone burst and was recorded in contracting SCM while patients turned their heads forcefully to the contralateral side against resistance. Normative data were obtained from 47 healthy volunteers. Seven patients (50%) had abnormal VEMP in the side of the MMI lesion, absent in two, decreased in four, and delayed in two. One patient showed both decreased and delayed response. Of the seven patients with abnormal VEMP, five had the lesions that extended to the dorsal tegmentum while five of the seven patients with normal VEMP showed restricted anteromedial lesions mainly involving the pyramids. Spontaneous nystagmus (4/7, 57%), gaze-evoked nystagmus (6/7, 86%), and ocular tilt reaction/tilt of the subjective visual vertical (4/7, 57%) were frequently observed in the patients with abnormal VEMP. The abnormal VEMP in patients with infarctions involving the medullary tegmentum supports that VEMP is mediated by the medial VST descending within the medial longitudinal fasciculus.

  2. Early Changes in QRS Frequency Following Cardiac Resynchronization Predict Hemodynamic Response in Left Bundle Branch Block Patients.

    PubMed

    Niebauer, Mark J; Rickard, John; Tchou, Patrick J; Varma, Niraj

    2016-05-01

    QRS characteristics are the cornerstone of patient selection in cardiac resynchronization therapy (CRT) and the presence of left bundle branch block (LBBB) and baseline QRS ≥150 milliseconds portends a good outcome. We previously showed that baseline QRS frequency analysis adds predictive value to LBBB alone and have hypothesized that a change in frequency characteristics following CRT may produce additional predictive value. We examined the QRS frequency characteristics of 182 LBBB patients before and soon after CRT. Patients were assigned to responder and nonresponder groups. Responders were defined by a decrease in left ventricular end-systolic volume (LVESV) ≥15% following CRT. We analyzed the QRS in ECG leads I, AVF, and V3 before and soon after CRT using the discrete Fourier transform algorithm. The percentage of total QRS power within discrete frequency intervals before and after CRT was calculated. The reduction in lead V3 power <10 Hz was the best indicator of response. Baseline QRS width was similar between the responders and nonresponders (162.2 ± 17.2 milliseconds vs. 158 ± 22.1 milliseconds, respectively; P = 0.180). Responders exhibited a greater reduction in QRS power <10 Hz (-17.0 ± 11.9% vs. -6.6 ± 12.5%; P < 0.001) and a significant AUC (0.743; P < 0.001). A ≥8% decline in QRS power <10 Hz produced the best predictive values (PPV = 84%, NPV = 59%). Importantly, when patients with baseline QRS <150 milliseconds were compared, the AUC improved (0.892, P < 0.001). Successful CRT produces a significant reduction in QRS power below 10 Hz, particularly when baseline QRS <150 milliseconds. These results indicate that QRS frequency changes after CRT provide additional predictive value to QRS alone. © 2016 Wiley Periodicals, Inc.

  3. Dendrites of medial olivocochlear neurons in mouse.

    PubMed

    Brown, M C; Levine, J L

    2008-06-12

    Stains for acetylcholinesterase (AChE) and retrograde labeling with Fluorogold (FG) were used to study olivocochlear neurons and their dendritic patterns in mice. The two methods gave similar results for location and number of somata. The total number of medial olivocochlear (MOC) neurons in the ventral nucleus of the trapezoid body (VNTB) is about 170 per side. An additional dozen large olivocochlear neurons are located in the dorsal periolivary nucleus (DPO). Dendrites of all of these neurons are long and extend in all directions from the cell bodies, a pattern that contrasts with the sharp frequency tuning of their responses. For VNTB neurons, there were greater numbers of dendrites directed medially than laterally and those directed medially were longer (on average, 25-50% longer). Dendrite extensions were most pronounced for neurons located in the rostral portion of the VNTB. When each dendrite from a single neuron was represented as a vector, and all the vectors summed, the result was also skewed toward the medial direction. DPO neurons, however, had more symmetric dendrites that projected into more dorsal parts of the trapezoid body, suggesting that this small group of olivocochlear neurons has very different physiological properties. Dendrites of both types of neurons were somewhat elongated rostrally, about 20% longer than those directed caudally. These results can be interpreted as extensions of dendrites of olivocochlear neurons toward their synaptic inputs: medially to meet crossing fibers from the cochlear nucleus that are part of the MOC reflex pathway, and rostrally to meet descending inputs from higher centers.

  4. Branches of the Facial Artery.

    PubMed

    Hwang, Kun; Lee, Geun In; Park, Hye Jin

    2015-06-01

    The aim of this study is to review the name of the branches, to review the classification of the branching pattern, and to clarify a presence percentage of each branch of the facial artery, systematically. In a PubMed search, the search terms "facial," AND "artery," AND "classification OR variant OR pattern" were used. The IBM SPSS Statistics 20 system was used for statistical analysis. Among the 500 titles, 18 articles were selected and reviewed systematically. Most of the articles focused on "classification" according to the "terminal branch." Several authors classified the facial artery according to their terminal branches. Most of them, however, did not describe the definition of "terminal branch." There were confusions within the classifications. When the inferior labial artery was absent, 3 different types were used. The "alar branch" or "nasal branch" was used instead of the "lateral nasal branch." The angular branch was used to refer to several different branches. The presence as a percentage of each branch according to the branches in Gray's Anatomy (premasseteric, inferior labial, superior labial, lateral nasal, and angular) varied. No branch was used with 100% consistency. The superior labial branch was most frequently cited (95.7%, 382 arteries in 399 hemifaces). The angular branch (53.9%, 219 arteries in 406 hemifaces) and the premasseteric branch were least frequently cited (53.8%, 43 arteries in 80 hemifaces). There were significant differences among each of the 5 branches (P < 0.05) except between the angular branch and the premasseteric branch and between the superior labial branch and the inferior labial branch. The authors believe identifying the presence percentage of each branch will be helpful for surgical procedures.

  5. TCDD alters medial epithelial cell differentiation during palatogenesis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Abbott, B.D.; Birnbaum, L.S.

    1989-06-15

    2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is a widely distributed, persistent environmental contaminant that is teratogenic in mice, where it induces hydronephrosis and cleft palate. The incidence of clefting has been shown to be dose dependent after exposure on either gestation Day (GD) 10 or 12, although the embryo is more susceptible on GD 12. TCDD-exposed palatal shelves meet but do not fuse, and programmed cell death of the medial epithelial cells is inhibited. The mechanism of action through which TCDD alters the program of medial cell development has not been examined in earlier studies, and it is not known whether the mechanism ismore » the same regardless of the dose or developmental stage of exposure. In this study, C57BL/6N mice, a strain sensitive to TCDD, were dosed orally on GD 10 or 12 with 0, 6, 12, 24, or 30 micrograms/kg body wt, in 10 ml corn oil/kg. Embryonic palatal shelves were examined on GD 14, 15, or 16. The degree of palatal closure, epithelial surface morphology, and cellular ultrastructure, the incorporation of (3H)TdR, the expression of EGF receptors, and the binding of 125I-EGF were assessed. After exposure on GD 10 or 12, TCDD altered the differentiation pathway of the medial epithelial cells. The palatal shelves were of normal size and overall morphology, but fusion of the medial epithelia of the opposing shelves did not occur. TCDD prevented programmed cell death of the medial peridermal cells. The expression of EGF receptors by medial cells continued through Day 16 and the receptors were able to bind ligand. The medial cells differentiated into a stratified, squamous, keratinizing epithelium. The shift in phenotype to an oral-like epithelium occurred after exposure on either GD 10 or 12. At the lower dose (6 micrograms/kg), fewer cleft palates were produced, but those shelves which did respond had a fully expressed shift in differentiation.« less

  6. Treatment of chronic neurogenic cough with in-office superior laryngeal nerve block.

    PubMed

    Simpson, C Blake; Tibbetts, Kathleen M; Loochtan, Michael J; Dominguez, Laura M

    2018-04-18

    Neurogenic cough is believed to result from a sensory neuropathy involving the internal branch of the superior laryngeal nerve (SLN). We present our outcomes for the treatment of neurogenic cough with localized blockade of the internal branch of the SLN. A retrospective chart review of patients who underwent in-office percutaneous SLN block for treatment of neurogenic cough between 2015 and 2017 was conducted. Patient demographics, indications for injection, and response to treatment were recorded and analyzed. Cough severity index (CSI) scores before and after treatment were compared. Twenty-three patients underwent percutaneous blockade of the internal branch of the SLN in the clinic setting, and five patients were excluded for incomplete records. The indication was neurogenic cough as a diagnosis of exclusion. The injectable substance used was a 1:1 mixture of a long-acting particulate corticosteroid and a local anesthetic. Unilateral injections were performed in 13 patients, and five patients underwent bilateral injections. Of the unilateral injections, 10 were left-sided. Patients underwent an average of 2.4 SLN block procedures (range 1-7). Mean follow-up time postinjection was 85.4 days (7-450 days). Cough severity index scores decreased significantly from an average of 26.8 pretreatment to 14.6 posttreatment (P < 0.0001). The SLN block is an effective treatment for neurogenic cough, with average CSI scores significantly improved following injection. Further study is necessary to determine the characteristics of patients' responses to treatment, long-term outcomes, and efficacy of the procedure when compared to placebo and other accepted treatments for neurogenic cough. 4. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  7. The measurement of medial knee gap width using ultrasound.

    PubMed

    Slane, Laura C; Slane, Josh A; Scheys, Lennart

    2017-08-01

    Medial knee instability is a key clinical parameter for assessing ligament injury and arthroplasty success, but current methods for measuring stability are typically either qualitative or involve ionizing radiation. The purpose of this study was to perform a preliminary analysis of whether ultrasound (US) could be used as an alternate approach for quantifying medial instability by comparing an US method with an approach mimicking the current gold standard fluoroscopy method. US data from the medial knee were collected, while cadaveric lower limbs (n = 8) were loaded in valgus (10 Nm). During post-processing, the US gap width was measured by identifying the medial edges of the femur and tibia and computing the gap width between these points. For comparison, mimicked fluoroscopy (mFluoro) images were created from specimen-specific bone models, developed from segmented CT scans, and from kinematic data collected during testing. Then, gap width was measured in the mFluoro images based on two different published approaches with gap width measured either at the most medial or at the most distal aspect of the femur. Gap width increased significantly with loading (p < 0.001), and there were no significant differences between the US method (unloaded: 8.7 ± 2.4 mm, loaded: 10.7 ± 2.2 mm) and the mFluoro method that measured gap width at the medial femur. In terms of the change in gap width with load, no correlation with the change in abduction angle was observed, with no correlation between the various methods. Inter-rater reliability for the US method was high (0.899-0.952). Ultrasound shows promise as a suitable alternative for quantifying medial instability without radiation exposure. However, the outstanding limitations of existing approaches and lack of true ground-truth data require that further validation work is necessary to better understand the clinical viability of an US approach for measuring medial knee gap width.

  8. Do we overestimate left ventricular ejection fraction by two-dimensional echocardiography in patients with left bundle branch block?

    PubMed

    Cabuk, Ali K; Cabuk, Gizem; Sayin, Ahmet; Karamanlioglu, Murat; Kilicaslan, Barış; Ekmekci, Cenk; Solmaz, Hatice; Aslanturk, Omer F; Ozdogan, Oner

    2018-02-01

    Left bundle branch block (LBBB) causes a dyssynchronized contraction of left ventricle. This is a kind of regional wall-motion abnormality and measuring left ventricular ejection fraction (LVEF) by two-dimensional (2D) echocardiography could be less reliable in this particular condition. Our aim was to evaluate the role of dyssynchrony index (SDI), measured by three-dimensional (3D) echocardiography, in assessment of LVEF and left ventricular volumes accurately in patients with LBBB. In this case-control study, we included 52 of 64 enrolled participants (twelve participants with poor image quality were excluded) with LBBB and normal LVEF or nonischemic cardiomyopathy. Left ventricular ejection fraction (LVEF) and left ventricular volumes were assessed by 2D (modified Simpson's rule) and 3D (four beats full volume analysis) echocardiography and the impact of SDI on results were evaluated. In patients with SDI ≥6%, LVEF measurements were significantly different (46.00% [29.50-52.50] vs 37.60% [24.70-45.15], P < .001) between 2D and 3D echocardiography, respectively. In patients with SDI < 6%, there were no significant differences between two modalities in terms of LVEF measurements (54.50% [49.00-59.00] vs 54.25% [40.00-58.25], P = .193). LV diastolic volumes were not significantly different while systolic volumes were underestimated by 2D echocardiography, and this finding was more pronounced when SDI ≥ 6%. In patients with LBBB and high SDI (≥6%), LVEF values were overestimated and systolic volumes were underestimated by 2D echocardiography compared to 3D echocardiography. © 2017 Wiley Periodicals, Inc.

  9. [Anatomical rationale for lingual nerve injury prevention during mandibular block].

    PubMed

    Semkin, V A; Dydikin, S S; Kuzin, A V; Sogacheva, V V

    2015-01-01

    The topographic and anatomical study of lingual nerve structural features was done. It was revealed that during mandibular anesthesia possible lingual nerve injury can occur if puncture needle is lower than 1 cm. of molars occlusal surface level. The position of the lingual nerve varies withmandible movements. At the maximum open mouth lingual nerve is not mobile and is pressed against the inner surface of the mandibular ramus by the medial pterygoid muscle and the temporal muscle tendon. When closing the mouth to 1.25±0.2 cmfrom the physiological maximum, lingual nerve is displaced posteriorly from the internal oblique line of the mandible and gets mobile. On the basis of topographic and anatomic features of the lingual nervestructure the authors recommend the re-do of inferior alveolar nerve block, a semi-closed mouth position or the use the "high block techniques" (Torus anesthesia, Gow-Gates, Vazirani-Akinozi).

  10. Posterior medial meniscus root ligament lesions: MRI classification and associated findings.

    PubMed

    Choi, Ja-Young; Chang, Eric Y; Cunha, Guilherme M; Tafur, Monica; Statum, Sheronda; Chung, Christine B

    2014-12-01

    The purposes of this study were to determine the prevalence of altered MRI appearances of "posterior medial meniscus root ligament (PMMRL)" lesions, introduce a classification of lesion types, and report associated findings. We retrospectively reviewed 419 knee MRI studies to identify the presence of PMMRL lesions. Classification was established on the basis of lesions encountered. The medial compartment was assessed for medial meniscal tears in the meniscus proper, medial meniscal extrusion, insertional PMMRL osseous changes, regional synovitis, osteoarthritis, insufficiency fracture, and cruciate ligament abnormality. PMMRL abnormalities occurred in 28.6% (120/419) of the studies: degeneration, 14.3% (60/419) and tear, 14.3% (60/419). Our classification system included degeneration and tearing. Tearing was categorized as partial or complete with delineation of the point of failure as entheseal, midsubstance, or junction to meniscus. Of all tears, 93.3% (56/60) occurred at the meniscal junction. Univariate analysis revealed significant differences between the knees with and without PMMRL lesions in age, medial meniscal tear, medial meniscal extrusion, insertional PMMRL osseous change, regional synovitis, osteoarthritis, insufficiency fracture (p=0.017), and cruciate ligament degeneration (p<0.001). PMMRL lesions are commonly detected in symptomatic patients. We have introduced an MRI classification system. PMMRL lesions are significantly associated with age, medial meniscal tears, medial meniscal extrusion, insertional PMMRL osseous change, regional synovitis, osteoarthritis, insufficiency fracture, and cruciate ligament degeneration.

  11. Episodic snapping of the medial head of the triceps due to weightlifting.

    PubMed

    Spinner, R J; Wenger, D E; Barry, C J; Goldner, R D

    1999-01-01

    We describe two patients who had episodic elbow snapping and ulnar nerve dysesthesias only after weightlifting. These symptoms would disappear soon afterward. The episodic nature of their complaints and findings led to misdiagnosis. We documented by repeated clinical examinations and magnetic resonance imaging that the presence of these symptoms correlated directly with the finding of intermittent, activity-related snapping of the medial triceps. In both patients, the symptoms disappeared when the medial portion of the triceps migrated medially but did not dislocate over the medial epicondyle with elbow flexion. Thus, a minor change in the configuration of the medial portion of the triceps (fluid accumulation) in the same individual at different times can cause intermittent dislocation of the medial triceps. Previous papers dealing with patients with snapping of the medial triceps describe symptoms exacerbated by athletic activities, but the constant finding of snapping on sequential examinations.

  12. Medial Auditory Thalamus Inactivation Prevents Acquisition and Retention of Eyeblink Conditioning

    ERIC Educational Resources Information Center

    Halverson, Hunter E.; Poremba, Amy; Freeman, John H.

    2008-01-01

    The auditory conditioned stimulus (CS) pathway that is necessary for delay eyeblink conditioning was investigated using reversible inactivation of the medial auditory thalamic nuclei (MATN) consisting of the medial division of the medial geniculate (MGm), suprageniculate (SG), and posterior intralaminar nucleus (PIN). Rats were given saline or…

  13. Input integration around the dendritic branches in hippocampal dentate granule cells.

    PubMed

    Kamijo, Tadanobu Chuyo; Hayakawa, Hirofumi; Fukushima, Yasuhiro; Kubota, Yoshiyuki; Isomura, Yoshikazu; Tsukada, Minoru; Aihara, Takeshi

    2014-08-01

    Recent studies have shown that the dendrites of several neurons are not simple translators but are crucial facilitators of excitatory postsynaptic potential (EPSP) propagation and summation of synaptic inputs to compensate for inherent voltage attenuation. Granule cells (GCs)are located at the gateway for valuable information arriving at the hippocampus from the entorhinal cortex. However, the underlying mechanisms of information integration along the dendrites of GCs in the hippocampus are still unclear. In this study, we investigated the input integration around dendritic branches of GCs in the rat hippocampus. We applied differential spatiotemporal stimulations to the dendrites using a high-speed glutamate-uncaging laser. Our results showed that when two sites close to and equidistant from a branching point were simultaneously stimulated, a nonlinear summation of EPSPs was observed at the soma. In addition, nonlinear summation (facilitation) depended on the stimulus location and was significantly blocked by the application of a voltage-dependent Ca(2+) channel antagonist. These findings suggest that the nonlinear summation of EPSPs around the dendritic branches of hippocampal GCs is a result of voltage-dependent Ca(2+) channel activation and may play a crucial role in the integration of input information.

  14. The medial patellofemoral complex.

    PubMed

    Loeb, Alexander E; Tanaka, Miho J

    2018-06-01

    The purpose of this review is to describe the current understanding of the medial patellofemoral complex, including recent anatomic advances, evaluation of indications for reconstruction with concomitant pathology, and surgical reconstruction techniques. Recent advances in our understanding of MPFC anatomy have found that there are fibers that insert onto the deep quadriceps tendon as well as the patella, thus earning the name "medial patellofemoral complex" to allow for the variability in its anatomy. In MPFC reconstruction, anatomic origin and insertion points and appropriate graft length are critical to prevent overconstraint of the patellofemoral joint. The MPFC is a crucial soft tissue checkrein to lateral patellar translation, and its repair or reconstruction results in good restoration of patellofemoral stability. As our understanding of MPFC anatomy evolves, further studies are needed to apply its relevance in kinematics and surgical applications to its role in maintaining patellar stability.

  15. Results of step-cut medial malleolar osteotomy.

    PubMed

    Thordarson, David B; Kaku, Shawn K

    2006-12-01

    Treatment of certain complex ankle pathology, such as a talar body fracture or osteochondral lesion requiring grafting, can necessitate medial malleolar osteotomy for adequate operative exposure. This paper evaluates the step-cut medial malleolar osteotomy for exposure of the ankle joint. Fourteen patients with intra-articular pathology, including talar body fractures or osteochondral lesions necessitating extensive intra-articular exposure had step-cut malleolar osteotomy. The average age of the patients was 37 (range 20-90) years, and the average followup was 8 months. All 14 patients had an uncomplicated intraoperative course, with excellent exposure of the ankle joint. All patients had prompt healing of the osteotomy by 6 weeks after surgery without loss of reduction. None of the patients had pain at the osteotomy site. Step-cut medial malleolar osteotomy is an excellent, reproducible method for extensive exposure of the talar dome.

  16. Neuromuscular Characteristics of Individuals Displaying Excessive Medial Knee Displacement

    PubMed Central

    Padua, Darin A.; Bell, David R.; Clark, Micheal A.

    2012-01-01

    Context Knee-valgus motion is a potential risk factor for certain lower extremity injuries, including anterior cruciate ligament injury and patellofemoral pain. Identifying neuromuscular characteristics associated with knee-valgus motion, such as hip and lower leg muscle activation, may improve our ability to prevent lower extremity injuries. Objective We hypothesized that hip and lower leg muscle-activation amplitude would differ among individuals displaying knee valgus (medial knee displacement) during a double-legged squat compared with those who did not display knee valgus. We further suggested that the use of a heel lift would alter lower leg muscle activation and frontal-plane knee motion in those demonstrating medial knee displacement. Design Descriptive laboratory study. Setting Research laboratory. Patients or Other Participants A total of 37 healthy participants were assigned to the control (n = 19) or medial-knee-displacement (n = 18) group based on their double-legged squat performance. Main Outcome Measure(s) Muscle-activation amplitude for the gluteus maximus, gluteus medius, adductor magnus, medial and lateral gastrocnemius, and tibialis anterior was measured during 2 double-legged squat tasks. The first task consisted of performing a double-legged squat without a heel lift; the second consisted of performing a double-legged squat task with a 2-in (5.08-cm) lift under the heels. Results Muscle-activation amplitude for the hip adductor, gastrocnemius, and tibialis anterior was greater in those who displayed knee valgus than in those who did not (P < .05). Also, use of heel lifts resulted in decreased activation of the gluteus maximus, hip adductor, gastrocnemius, and tibialis anterior muscles (P < .05). Use of heel lifts also eliminated medially directed frontal-plane knee motion in those displaying medial knee displacement. Conclusions Medial knee displacement during squatting tasks appears to be associated with increased hip-adductor activation and

  17. Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.

    PubMed

    Tam, Samantha; Sun, Hongmei; Sarma, Sisira; Siu, Jennifer; Fung, Kevin; Sowerby, Leigh

    2017-02-20

    Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty. Cost minimization analysis conducted using a decision tree model. A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events. Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626. Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar

  18. Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment.

    PubMed

    Berber, Reshid; Lewis, Charlotte P; Copas, David; Forward, Daren P; Moran, Christopher G

    2014-04-01

    This study demonstrates the utility of a modified postero-medial surgical approach to the knee in treating a series of patients with complex tibial plateau injuries with associated postero-medial and postero-lateral shear fractures. Posterior coronal shear fractures are underappreciated and their clinical relevance has recently been characterised. Less-invasive surgery and indirect reduction techniques are inadequate for treating these coronal plane fractures. Our approach includes an inverted 'L'-shaped incision situated within the posterior flexor knee crease, followed by the retraction or incision of the medial head of the gastrocnemius tendon, while protecting the neurovascular structures. This provides a more extensile exposure, as far as the postero-lateral corner, than previously described. Our case series included eight females and eight males. The average age was 53 years. The majority of these injuries were sustained through high-energy trauma. All patients' fractures were classified as Schatzker grade 4, or above, with a postero-medial split depression. Eight patients had associated postero-lateral corner fractures. Two were open, two had vascular compromise and one had neurological injury. The average time to surgery was 6.4 days (range 0-12), operative time 142 min (range 76-300) and length of stay 17 days (range 7-46). A total of 11 patients were treated using the postero-medial approach alone and in five the treatment was combined with an antero-lateral approach. Two patients suffered a reduced range of movement requiring manipulation and physiotherapy, and three patients had a 5-degree fixed flexion deformity. Two patients developed superficial wound infections treated with antibiotics alone. Anatomical reduction and fracture union was achieved in 15 patients. These are complex fractures to treat, and our modified posterior approach allows direct reduction and optimal positioning of plates to act as buttress devices. It can be extended across the

  19. Resection of Grade III cranial horn tears of the equine medial meniscus alter the contact forces on medial tibial condyle at full extension: an in-vitro cadaveric study.

    PubMed

    Fowlie, Jennifer; Arnoczky, Steven; Lavagnino, Michael; Maerz, Tristan; Stick, John

    2011-12-01

    To evaluate the magnitude and distribution of joint contact pressure on the medial tibial condyle after grade III cranial horn tears of the medial meniscus. Experimental study. Cadaveric equine stifles (n = 6). Cadaveric stifles were mounted in a materials testing system and electronic pressure sensors were placed between the medial tibial condyle and medial meniscus. Specimens were loaded parallel to the longitudinal axis of the tibia to 1800 N at 130°, 140°, 150°, and 160° stifle angle. Peak pressure and contact area were recorded from the contact maps. Testing was repeated after surgical creation of a grade III cranial horn tear of the medial meniscus, and after resection of the simulated tear. In the intact specimens, a significantly smaller contact area was observed at 160° compared with the other angles (P < .05). Creation of a grade III cranial horn tear in the medial meniscus did not significantly alter the pressure or contact area measurements at any stifle angle compared with intact specimens (P > .05). Resection of the tear resulted in significantly higher peak pressures in the central region of the medial tibial condyle at a stifle angle of 160° relative to the intact (P = .026) and torn (P = .012) specimens. Resection of grade III cranial horn tears in the medial meniscus resulted in a central focal region of increased pressure on the medial tibial condyle at 160° stifle angle. © Copyright 2011 by The American College of Veterinary Surgeons.

  20. Sensory Neuron Fates Are Distinguished by a Transcriptional Switch that Regulates Dendrite Branch Stabilization

    PubMed Central

    Smith, Cody J.; O’Brien, Timothy; Chatzigeorgiou, Marios; Spencer, W. Clay; Feingold-Link, Elana; Husson, Steven J.; Hori, Sayaka; Mitani, Shohei; Gottschalk, Alexander; Schafer, William R.; Miller, David M.

    2013-01-01

    SUMMARY Sensory neurons adopt distinct morphologies and functional modalities to mediate responses to specific stimuli. Transcription factors and their downstream effectors orchestrate this outcome but are incompletely defined. Here, we show that different classes of mechanosensory neurons in C. elegans are distinguished by the combined action of the transcription factors MEC-3, AHR-1, and ZAG-1. Low levels of MEC-3 specify the elaborate branching pattern of PVD nociceptors, whereas high MEC-3 is correlated with the simple morphology of AVM and PVM touch neurons. AHR-1 specifies AVM touch neuron fate by elevating MEC-3 while simultaneously blocking expression of nociceptive genes such as the MEC-3 target, the claudin-like membrane protein HPO-30, that promotes the complex dendritic branching pattern of PVD. ZAG-1 exercises a parallel role to prevent PVM from adopting the PVD fate. The conserved dendritic branching function of the Drosophila AHR-1 homolog, Spineless, argues for similar pathways in mammals. PMID:23889932

  1. Running and cocaine both upregulate dynorphin mRNA in medial caudate putamen.

    PubMed

    Werme, M; Thorén, P; Olson, L; Brené, S

    2000-08-01

    Physical activities such as long-distance running can be habit forming and associated with a sense of well-being to a degree that justifies comparison with drug-induced addictive behaviours. To understand molecular similarities and dissimilarities controlling these behaviours in humans we compared the effects of running in running wheels to the effects of chronic cocaine or morphine administration on mRNA levels in brain reward pathways in the inbred Fischer and Lewis rat strains. These strains are both inbred from the Sprague-Dawley strain; Lewis rats display a higher preference towards addictive drugs and running than do Fischer rats. After chronic cocaine or running a similar increase of dynorphin mRNA in medial caudate putamen was found in the Lewis rat, suggesting common neuronal adaptations in this brain region to both cocaine and running. Fischer and Lewis rats both responded to cocaine with increased dynorphin mRNA levels in medial caudate putamen. However, only Lewis rats increased dynorphin mRNA after running, possibly reflecting the much higher degree of running by the Lewis strain as compared to the Fischer strain. Moreover, the running-induced upregulation of dynorphin mRNA was blocked by the opioid receptor antagonist naloxone. We suggest that running increases dynorphin mRNA by a mechanism that involves endogenous opioids. The voluntary wheel-running model in rats might be used to study natural reward and compulsive behaviours and possibly also to screen candidate drugs for treatment of compulsive disorders.

  2. The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: 'SCOPEX', a randomised control trial protocol.

    PubMed

    Hall, Michelle; Hinman, Rana S; Wrigley, Tim V; Roos, Ewa M; Hodges, Paul W; Staples, Margaret; Bennell, Kim L

    2012-11-27

    Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. 62 people aged 30-50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee

  3. A clinical evaluation of alternative fixation techniques for medial malleolus fractures.

    PubMed

    Barnes, Hayley; Cannada, Lisa K; Watson, J Tracy

    2014-09-01

    Medial malleolus fractures have traditionally been managed using partially threaded screws and/or Kirschner wire fixation. Using these conventional techniques, a non-union rate of as high as 20% has been reported. In addition too many patients complaining of prominent hardware as a source of pain post-fixation. This study was designed to assess the outcomes of medial malleolar fixation using a headless compression screw in terms of union rate, the need for hardware removal, and pain over the hardware site. Saint Louis University and Mercy Medical Center, Level 1 Trauma Centers, St. Louis, MO. After IRB approval, we used billing records to identify all patients with ankle fractures involving the medial malleolus. Medical records and radiographs were reviewed to identify patients with medial malleolar fractures treated with headless compression screw fixation. Our inclusion criteria included follow-up until full weight bearing and a healed fracture. Follow-up clinical records and radiographs were reviewed to determine union, complication rate and perception of pain over the site of medial malleolus fixation. Sixty-four ankles were fixed via headless compression screws and 44 had adequate follow-up for additional evaluation. Seven patients had isolated medial malleolar fractures, 23 patients had bimalleolar fractures, and 14 patients had trimalleolar fractures. One patient (2%) required hardware removal due to cellulitis. One patient (2%) had a delayed union, which healed without additional intervention. Ten patients (23%) reported mild discomfort to palpation over the medial malleolus. The median follow-up was 35 weeks (range: 12-208 weeks). There were no screw removals for painful hardware and no cases of non-union. Headless compression screws provide effective compression of medial malleolus fractures and result in good clinical outcomes. The headless compression screw is a beneficial alternative to the conventional methods of medial malleolus fixation. Copyright

  4. Transcaruncular Approach for Treatment of Medial Wall and Large Orbital Blowout Fractures.

    PubMed

    Nguyen, Dennis C; Shahzad, Farooq; Snyder-Warwick, Alison; Patel, Kamlesh B; Woo, Albert S

    2016-03-01

    We evaluate the safety and efficacy of the transcaruncular approach for reconstruction of medial orbital wall fractures and the combined transcaruncular-transconjunctival approach for reconstruction of large orbital defects involving the medial wall and floor. A retrospective review of the clinical and radiographic data of patients who underwent either a transcaruncular or a combined transcaruncular-transconjunctival approach by a single surgeon for orbital fractures between June 2007 and June 2013 was undertaken. Seven patients with isolated medial wall fractures underwent a transcaruncular approach, and nine patients with combined medial wall and floor fractures underwent a transcaruncular-transconjunctival approach with a lateral canthotomy. Reconstruction was performed using a porous polyethylene implant. All patients with isolated medial wall fractures presented with enophthalmos. In the combined medial wall and floor group, five out of eight patients had enophthalmos with two also demonstrating hypoglobus. The size of the medial wall defect on preoperative computed tomography (CT) scan ranged from 2.6 to 4.6 cm(2); the defect size of combined medial wall and floor fractures was 4.5 to 12.7 cm(2). Of the 11 patients in whom postoperative CT scans were obtained, all were noted to have acceptable placement of the implant. All patients had correction of enophthalmos and hypoglobus. One complication was noted, with a retrobulbar hematoma having developed 2 days postoperatively. The transcaruncular approach is a safe and effective method for reconstruction of medial orbital floor fractures. Even large fractures involving the orbital medial wall and floor can be adequately exposed and reconstructed with a combined transcaruncular-transconjunctival-lateral canthotomy approach. The level of evidence of this study is IV (case series with pre/posttest).

  5. Double PCL sign does not always indicate a bucket-handle tear of medial meniscus.

    PubMed

    Liu, Chen; Zheng, Hua Yong; Huang, Yan; Li, Hai Peng; Wu, Han; Sun, Tian Sheng; Yao, Jian Hua

    2016-09-01

    The discoid medial meniscus is an extremely rare anomaly. Bilateral discoid medial menisci are much more rare but intermittently reported. We report the first case of bilateral discoid medial menisci with positive double PCL sign, which typically indicates a bucket-handle tear of medial meniscus. A literature review was also conducted on bilateral discoid medial menisci.

  6. [Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of 
medial meniscus in knee joint].

    PubMed

    Zhu, Weihong; Tang, Qi; Liao, Lele; Li, Ding; Yang, Yang; Chen, You

    2017-09-28

    To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P<0.05) at the 1st day, 5.5 mm and 4.2 mm 
(P<0.05) in the 4th week and 4.8 mm and 4.3 mm (P>0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, P<0.05). Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final follow-up (t=-41.353, P<0.05). Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up (t=-18.792, P<0.05). IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up (t=-38.253, P<0.05).
 Conclusion: Pie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee

  7. Dysphagia in a patient with bilateral medial medullary infarcts.

    PubMed

    Paliwal, Vimal K; Kalita, Jayanti; Misra, Usha K

    2009-09-01

    Bilateral medial medullary infarct is a rare stroke syndrome and only a handful of cases have been described. Dysphagia as a manifestation of medullary infarcts is well recognized but often associated with lateral medullary infarct. Bilateral medial medullary infarcts are commonly associated with severe dysphagia in addition to a number of other signs and symptoms. We describe a patient who had bilateral medial medullary infarct with severe dysphagia in addition to quadriplegia and respiratory difficulty, and analyze infarct topography with respect to dysphagia, risk factors, vascular territories involved, and prognosis in view of previously reported cases.

  8. Modified tension band wiring of medial malleolar ankle fractures.

    PubMed

    Georgiadis, G M; White, D B

    1995-02-01

    Twenty-two displaced medial malleolar ankle fractures that were treated surgically using the modified tension band method of Cleak and Dawson were retrospectively reviewed at an average follow-up of 25 months. The technique involves the use of a screw to anchor a figure-of-eight wire. There were no malreductions and all fractures healed. Problems with the technique included technical errors with hardware placement, medial ankle pain, and asymptomatic wire migration. Despite this, modified tension band wiring remains an acceptable method for fixation of selected displaced medial malleolar fractures. It is especially suited for small fracture fragments and osteoporotic bone.

  9. Delayed appearance of hypaesthesia and paralysis after femoral nerve block

    PubMed Central

    Landgraeber, Stefan; Albrecht, Thomas; Reischuck, Ulrich; von Knoch, Marius

    2012-01-01

    We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible. PMID:22577509

  10. Effects of branch height on leaf gas exchange, branch hydraulic conductance and branch sap flux in open-grown ponderosa pine.

    PubMed

    Hubbard, Robert M; Bond, Barbara J; Senock, Randy S; Ryan, Michael G

    2002-06-01

    Recent studies have shown that stomata respond to changes in hydraulic conductance of the flow path from soil to leaf. In open-grown tall trees, branches of different heights may have different hydraulic conductances because of differences in path length and growth. We determined if leaf gas exchange, branch sap flux, leaf specific hydraulic conductance, foliar carbon isotope composition (delta13C) and ratios of leaf area to sapwood area within branches were dependent on branch height (10 and 25 m) within the crowns of four open-grown ponderosa pine (Pinus ponderosa Laws.) trees. We found no difference in leaf gas exchange or leaf specific hydraulic conductance from soil to leaf between the upper and lower canopy of our study trees. Branch sap flux per unit leaf area and per unit sapwood area did not differ between the 10- and 25-m canopy positions; however, branch sap flux per unit sapwood area at the 25-m position had consistently lower values. Branches at the 25-m canopy position had lower leaf to sapwood area ratios (0.17 m2 cm-2) compared with branches at the 10-m position (0.27 m2 cm-2) (P = 0.03). Leaf specific conductance of branches in the upper crown did not differ from that in the lower crown. Other studies at our site indicate lower hydraulic conductance, sap flux, whole-tree canopy conductance and photosynthesis in old trees compared with young trees. This study suggests that height alone may not explain these differences.

  11. The medial tibial stress syndrome. A cause of shin splints.

    PubMed

    Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

    1982-01-01

    The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

  12. Ultrastructure of medial rectus muscles in patients with intermittent exotropia.

    PubMed

    Yao, J; Wang, X; Ren, H; Liu, G; Lu, P

    2016-01-01

    PURPOSE To study the ultrastructure of the medial rectus in patients with intermittent exotropia at different ages.PATIENTS AND METHODS The medial recti were harvested surgically from 20 patients with intermittent exotropia. Patients were divided into adolescent (age<18 years, n=10) and adult groups (age >18 years, n=10). The normal control group included five patients without strabismus and undergoing eye enucleation. Hematoxylin and eosin staining and transmission electron microscopy were used to visualize the medial recti. Western blot was used to determine the levels of myosin and actin.RESULTS Varying fiber thickness, atrophy, and misalignment of the medial recti were visualized under optical microscope in patients with exotropia. Electron microscopy revealed sarcomere destruction, myofilament disintegration, unclear dark and light bands, collagen proliferation, and fibrosis. The adolescent group manifested significantly higher levels of myosin and actin than the adult group (P<0.05).CONCLUSION Younger patients with intermittent exotropia show stronger contraction of the medial recti compared with older patients. Our findings suggest that childhood was the appropriate time for surgery as the benefit of the intervention was better than in adulthood.

  13. Entanglement branching operator

    NASA Astrophysics Data System (ADS)

    Harada, Kenji

    2018-01-01

    We introduce an entanglement branching operator to split a composite entanglement flow in a tensor network which is a promising theoretical tool for many-body systems. We can optimize an entanglement branching operator by solving a minimization problem based on squeezing operators. The entanglement branching is a new useful operation to manipulate a tensor network. For example, finding a particular entanglement structure by an entanglement branching operator, we can improve a higher-order tensor renormalization group method to catch a proper renormalization flow in a tensor network space. This new method yields a new type of tensor network states. The second example is a many-body decomposition of a tensor by using an entanglement branching operator. We can use it for a perfect disentangling among tensors. Applying a many-body decomposition recursively, we conceptually derive projected entangled pair states from quantum states that satisfy the area law of entanglement entropy.

  14. Anatomy of Atrioventricular Node Artery and Pattern of Dominancy in Normal Coronary Subject: A Comparison between Individuals with and without Isolated Right Bundle Branch Block

    PubMed Central

    Kazemisaeid, Ali; Pakbaz, Marziyeh; Yaminisharif, Ahmad; Davoodi, Gholamreza; Lotfi Tokaldany, Masoumeh; Hakki Kazazi, Elham

    2012-01-01

    Background: Isolated right bundle branch block (RBBB) is a common finding in the general population. The atrioventricular node (AVN) artery contributes to the blood supply of the right bundle branch. Our hypothesis was that the anatomy of the AVN artery and the pattern of dominancy differ between subjects with and without RBBB. Methods: We retrospectively studied the coronary angiography of 92 patients with RBBB and 184 age- and gender-matched controls without RBBB. All the subjects had angiographically proven normal coronary arteries. The dominant circulation and precise origin of the AVN artery were determined in each subject. Obtained data were compared between the two study groups. Results: There was no significant difference between the two groups in terms of dominancy (p value = 0.200). Origination of the AVN artery from the right circulatory system was more common in both groups, but this pattern was more prevalent in the cases than in the controls (p value = 0.021). There was a great variation of the AVN artery origin. In the total study population, the AVN artery was more commonly separated from a non crux origin than from the crux area. The prevalence of the non-crux origination of the AVN artery was significantly higher in the cases than in the controls (p value < 0.001). While the origination of the AVN artery from the right circulatory system was more common in both groups, the prevalence of the right origin of the AVN artery was significantly higher in the cases than in the controls. We observed that the AVN artery most commonly originated from the dominant artery but not necessarily from the crux. Conclusion: The anatomy of the AVN artery but not the pattern of dominancy is somewhat different in subjects with RBBB compared with normal individuals. PMID:23323077

  15. Anatomy of Atrioventricular Node Artery and Pattern of Dominancy in Normal Coronary Subject: A Comparison between Individuals with and without Isolated Right Bundle Branch Block.

    PubMed

    Kazemisaeid, Ali; Pakbaz, Marziyeh; Yaminisharif, Ahmad; Davoodi, Gholamreza; Lotfi Tokaldany, Masoumeh; Hakki Kazazi, Elham

    2012-11-01

    Isolated right bundle branch block (RBBB) is a common finding in the general population. The atrioventricular node (AVN) artery contributes to the blood supply of the right bundle branch. Our hypothesis was that the anatomy of the AVN artery and the pattern of dominancy differ between subjects with and without RBBB. We retrospectively studied the coronary angiography of 92 patients with RBBB and 184 age- and gender-matched controls without RBBB. All the subjects had angiographically proven normal coronary arteries. The dominant circulation and precise origin of the AVN artery were determined in each subject. Obtained data were compared between the two study groups. There was no significant difference between the two groups in terms of dominancy (p value = 0.200). Origination of the AVN artery from the right circulatory system was more common in both groups, but this pattern was more prevalent in the cases than in the controls (p value = 0.021). There was a great variation of the AVN artery origin. In the total study population, the AVN artery was more commonly separated from a non crux origin than from the crux area. The prevalence of the non-crux origination of the AVN artery was significantly higher in the cases than in the controls (p value < 0.001). While the origination of the AVN artery from the right circulatory system was more common in both groups, the prevalence of the right origin of the AVN artery was significantly higher in the cases than in the controls. We observed that the AVN artery most commonly originated from the dominant artery but not necessarily from the crux. The anatomy of the AVN artery but not the pattern of dominancy is somewhat different in subjects with RBBB compared with normal individuals.

  16. Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus.

    PubMed

    Mantovani, Alessandro; Rigolon, Riccardo; Pichiri, Isabella; Bonapace, Stefano; Morani, Giovanni; Zoppini, Giacomo; Bonora, Enzo; Targher, Giovanni

    2017-01-01

    Recent studies suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiac tachyarrhythmias (mainly atrial fibrillation) in patients with and without type 2 diabetes mellitus. The aim of this study was to examine whether an association also exists between NAFLD and heart block. We have retrospectively evaluated a hospital-based cohort of 751 patients with type 2 diabetes discharged from our Division of Diabetes and Endocrinology during years 2007-2014. Standard electrocardiograms were performed on all patients. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced hepatic fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis markers. Overall, 524 (69.8%) patients had NAFLD and 202 (26.9%) had heart block (defined as at least one block among first-degree atrio-ventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block) on electrocardiograms. Patients with NAFLD had a remarkably higher prevalence of any persistent heart block than those without NAFLD (31.3% vs. 16.7%, p<0.001); this prevalence was particularly increased among those with higher FIB-4 score. NAFLD was associated with a threefold increased risk of prevalent heart block (adjusted-odds ratio 3.04, 95% CI 1.81-5.10), independently of age, sex, hypertension, prior ischemic heart disease, hemoglobin A1c, microvascular complication status, use of medications and other potentially confounding factors. In conclusion, this is the largest cross-sectional study to show that NAFLD and its severity are independently associated with an increased risk of prevalent heart block in hospitalized patients with type 2 diabetes.

  17. Extracranial-intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery: A case report.

    PubMed

    Huang, Yabo; Wang, Zhong; Han, Qingdong

    2018-06-01

    Tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery (ICA) of intracranial segments has been rarely presented. Effective treatment as to the complex lesions may be complicated. Tumor resection and cerebrovascular protection should be both taken into consideration. We presented one case of medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments. The patient suffered hyperthyroidism, mirror-image dextrocardia and congenital heart disease atrial septal defect simultaneously. Before the neurosurgical treatment , the colleagues of department of cardiac surgery, anesthesiology and respiratory medicine agreed on our plan of resecting the tumor following the comprehensive evaluation of basal clinical conditions in the patient. For reducing the bleeding intraoperatively, the interventional branch performed digital subtraction angiography(DSA) and found collateral anastomosis between the supplying vessels of left middle meningeal arteries and anterior choroid arteries. No preoperative interventional embolization was determined considering the risk of cerebral ischemia. The following subtotal resection of medial sphenoid ridge meningioma and left extracranial-intracranial bypass were carried out. Additionally, ipsilateral decompressive craniectomy was done. Post-operative imaging Computed tomography (CT), Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated subtotal resection of tumor and bypass patency. The patient was discharged with the right limbs of muscle strength of grade IV. The muscle strength of the patient returned to grade V after 6 months of follow-up. Comprehensive treatment of tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments is

  18. Effects of active feedback gait retraining to produce a medial weight transfer at the foot in subjects with symptomatic medial knee osteoarthritis.

    PubMed

    Erhart-Hledik, Jennifer C; Asay, Jessica L; Clancy, Caitlin; Chu, Constance R; Andriacchi, Thomas P

    2017-10-01

    This study aimed to determine if active feedback gait retraining to produce a medial weight transfer at the foot significantly reduces the knee adduction moment in subjects with medial compartment knee osteoarthritis. Secondarily, changes in peak knee flexion moment, frontal plane knee and ankle kinematics, and center of pressure were investigated. Ten individuals with medial compartment knee osteoarthritis (9 males; age: 65.3 ± 9.8 years; BMI: 27.8 ± 3.0 kg/m 2 ) were tested at self-selected normal and fast speeds in two conditions: Intervention, with an active feedback device attached to the shoe of their more affected leg, and control, with the device de-activated. Kinematics and kinetics were assessed using a motion capture system and force plate. The first peak, second peak, and impulse of the knee adduction moment were significantly reduced by 6.0%, 13.9%, and 9.2%, respectively, at normal speed, with reductions of 10.7% and 8.6% in first peak and impulse at fast speed, respectively, with the active feedback system, with no significant effect on the peak knee flexion moment. Significant reductions in peak varus knee angle and medialized center of pressure in the first half of stance were observed, with reductions in peak varus knee angle associated with reductions in the knee adduction moment. This study demonstrated that active feedback to produce a medial weight-bearing shift at the foot reduces the peaks and impulse of the knee adduction moment in patients with medial compartment knee osteoarthritis. Future research should determine the long-term effect of the active feedback intervention on joint loading, pain, and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2251-2259, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. The origin of the medial circumflex femoral artery: a meta-analysis and proposal of a new classification system.

    PubMed

    Tomaszewski, Krzysztof A; Henry, Brandon M; Vikse, Jens; Roy, Joyeeta; Pękala, Przemysław A; Svensen, Maren; Guay, Daniel L; Saganiak, Karolina; Walocha, Jerzy A

    2016-01-01

    Background and Objectives. The medial circumflex femoral artery (MCFA) is a common branch of the deep femoral artery (DFA) responsible for supplying the femoral head and the greater trochanteric fossa. The prevalence rates of MCFA origin, its branching patterns and its distance to the mid-inguinal point (MIP) vary significantly throughout the literature. The aim of this study was to determine the true prevalence of these characteristics and to study their associated anatomical and clinical relevance. Methods. A search of the major electronic databases Pubmed, EMBASE, Scopus, ScienceDirect, Web of Science, SciELO, BIOSIS, and CNKI was performed to identify all articles reporting data on the origin of the MCFA, its branching patterns and its distance to the MIP. No data or language restriction was set. Additionally, an extensive search of the references of all relevant articles was performed. All data on origin, branching and distance to MIP was extracted and pooled into a meta-analysis using MetaXL v2.0. Results. A total of 38 (36 cadaveric and 2 imaging) studies (n = 4,351 lower limbs) were included into the meta-analysis. The pooled prevalence of the MCFA originating from the DFA was 64.6% (95% CI [58.0-71.5]), while the pooled prevalence of the MCFA originating from the CFA was 32.2% (95% CI [25.9-39.1]). The CFA-derived MCFA was found to originate as a single branch in 81.1% (95% CI [70.1-91.7]) of cases with a mean pooled distance of 50.14 mm (95% CI [42.50-57.78]) from the MIP. Conclusion. The MCFA's variability must be taken into account by surgeons, especially during orthopedic interventions in the region of the hip to prevent iatrogenic injury to the circulation of the femoral head. Based on our analysis, we present a new proposed classification system for origin of the MCFA.

  20. The Anatomic Midpoint of the Attachment of the Medial Patellofemoral Complex.

    PubMed

    Tanaka, Miho J; Voss, Andreas; Fulkerson, John P

    2016-07-20

    The medial patellofemoral ligament varies in attachment of its fibers to the patella and vastus intermedius tendon. Our aim was to identify and describe its anatomic midpoint. To account for the variability of the attachment site, we refer to it as the medial patellofemoral complex. Using AutoCAD software, we identified the midpoint of the medial patellofemoral complex attachment on photographs of 31 cadaveric knee dissections. The midpoint was referenced relative to the superior articular surface of the patella (P1) and was described in terms of the percentage of the patellar articular length distal to this point. A second point, at the junction of the medial border of the vastus intermedius tendon with the superior articular border of the patella, was identified (P2). The distances of the midpoint to P1 and P2 were calculated and were compared using paired t tests. Twenty-five images had appropriate quality and landmarks for digital analysis. The midpoint of the medial patellofemoral complex was located a mean (and standard deviation) of 2.3% ± 15.8% of the patellar articular length distal to the superior pole and was at or proximal to P1 in 12 knees. In all knees, the midpoint was at or proximal to P2. After exclusion of 2 knees with vastus intermedius tendon attachments only, the medial patellofemoral complex midpoint was closer to P2 (5.3% ± 8.6% of the patellar articular length) than to P1 (9.3% ± 8.5% of the patellar articular length) (p = 0.06). The midpoint of the medial patellofemoral complex was 2.3% of the articular length distal to the superior pole of the patella. Additionally, we describe an anatomic landmark at the junction of the medial border of the vastus intermedius tendon and the articular border of the patella that approximates the midpoint of this complex. Our study shows that the anatomic midpoint of the attachment of the medial patellofemoral complex is proximal to the junction of the medial vastus intermedius tendon and the articular

  1. Changes in articular cartilage following arthroscopic partial medial meniscectomy.

    PubMed

    Eichinger, Martin; Schocke, Michael; Hoser, Christian; Fink, Christian; Mayr, Raul; Rosenberger, Ralf E

    2016-05-01

    To examine degenerative changes in all cartilage surfaces of the knee following arthroscopic partial medial meniscectomy. For this prospective cohort study, 14 patients (five female) with a mean age of 47.9 ± 12.9 years who had undergone isolated arthroscopic partial medial meniscectomy were evaluated. Cartilage-sensitive magnetic resonance imaging (MRI) scans were acquired from the operated knees before the index operations, as well as at 6, 12, and 24 months after surgery. The MRI scans were assessed for the prevalence, severity, and size of cartilage degenerations. The clinical outcome was assessed using the SF-36 physical and mental component score and the International Knee Documentation Committee Knee Evaluation Form and was correlated with radiological findings. There was a significant increase in the severity of cartilage lesions in the medial tibial plateau (P = 0.019), as well as a trend towards an increase in the lateral tibial plateau. The size of the cartilage lesions increased significantly in the medial femoral condyle (P = 0.005) and lateral femoral condyle (P = 0.029), as well as in the patella (P = 0.019). Functional outcome scores improved significantly throughout the follow-up period. There was no correlation between cartilage wear and functional outcome. Arthroscopic partial medial meniscectomy is associated with adverse effects on articular cartilage and may lead to an increase in the severity and size of cartilage lesions. Post-operative cartilage wear predominantly affected the medial compartment and also affected the other compartments of the knee. Strategies to reduce subsequent osteoarthritic changes need to involve all compartments of the knee. IV.

  2. Involvement of serotonin 2A receptor activation in modulating medial prefrontal cortex and amygdala neuronal activation during novelty-exposure.

    PubMed

    Hervig, Mona El-Sayed; Jensen, Nadja Cecilie Hvid; Rasmussen, Nadja Bredo; Rydbirk, Rasmus; Olesen, Mikkel Vestergaard; Hay-Schmidt, Anders; Pakkenberg, Bente; Aznar, Susana

    2017-05-30

    The medial prefrontal cortex (PFC) plays a major role in executive function by exerting a top-down control onto subcortical areas. Novelty-induced frontal cortex activation is 5-HT 2A receptor (5-HT 2A R) dependent. Here, we further investigated how blockade of 5-HT 2A Rs in mice exposed to a novel open-field arena affects medial PFC activation and basolateral amygdala (BLA) reactivity. We used c-Fos immunoreactivity (IR) as a marker of neuronal activation and stereological quantification for obtaining the total number of c-Fos-IR neurons as a measure of regional activation. We further examined the impact of 5-HT 2A R blockade on the striatal-projecting BLA neurons. Systemic administration of ketanserin (0.5mg/kg) prior to novel open-field exposure resulted in reduced total numbers of c-Fos-IR cells in dorsomedial PFC areas and the BLA. Moreover, there was a positive correlation between the relative time spent in the centre of the open-field and BLA c-Fos-IR in the ketanserin-treated animals. Unilateral medial PFC lesions blocked this effect, ascertaining an involvement of this frontal cortex area. On the other hand, medial PFC lesioning exacerbated the more anxiogenic-like behaviour of the ketanserin-treated animals, upholding its involvement in modulating averseness. Ketanserin did not affect the number of activated striatal-projecting BLA neurons (measured by number of Cholera Toxin b (CTb) retrograde labelled neurons also being c-Fos-IR) following CTb injection in the ventral striatum. These results support a role of 5-HT 2A R activation in modulating mPFC and BLA activation during exposure to a novel environment, which may be interrelated. Conversely, 5-HT 2A R blockade does not seem to affect the amygdala-striatal projection. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial meniscectomy: ‘SCOPEX’ a randomised control trial protocol

    PubMed Central

    2012-01-01

    Background Meniscectomy is a risk factor for knee osteoarthritis, with increased medial joint loading a likely contributor to the development and progression of knee osteoarthritis in this group. Therefore, post-surgical rehabilitation or interventions that reduce medial knee joint loading have the potential to reduce the risk of developing or progressing osteoarthritis. The primary purpose of this randomised, assessor-blind controlled trial is to determine the effects of a home-based, physiotherapist-supervised neuromuscular exercise program on medial knee joint load during functional tasks in people who have recently undergone a partial medial meniscectomy. Methods/design 62 people aged 30–50 years who have undergone an arthroscopic partial medial meniscectomy within the previous 3 to 12 months will be recruited and randomly assigned to a neuromuscular exercise or control group using concealed allocation. The neuromuscular exercise group will attend 8 supervised exercise sessions with a physiotherapist and will perform 6 exercises at home, at least 3 times per week for 12 weeks. The control group will not receive the neuromuscular training program. Blinded assessment will be performed at baseline and immediately following the 12-week intervention. The primary outcomes are change in the peak external knee adduction moment measured by 3-dimensional analysis during normal paced walking and one-leg rise. Secondary outcomes include the change in peak external knee adduction moment during fast pace walking and one-leg hop and change in the knee adduction moment impulse during walking, one-leg rise and one-leg hop, knee and hip muscle strength, electromyographic muscle activation patterns, objective measures of physical function, as well as self-reported measures of physical function and symptoms and additional biomechanical parameters. Discussion The findings from this trial will provide evidence regarding the effect of a home-based, physiotherapist

  4. Effects of disrupting medial prefrontal cortex GABA transmission on decision-making in a rodent gambling task.

    PubMed

    Paine, T A; O'Hara, A; Plaut, B; Lowes, D C

    2015-05-01

    Decision-making is a complex cognitive process that is mediated, in part, by subregions of the medial prefrontal cortex (PFC). Decision-making is impaired in a number of psychiatric conditions including schizophrenia. Notably, people with schizophrenia exhibit reductions in GABA function in the same PFC areas that are implicated in decision-making. For example, expression of the GABA-synthesizing enzyme GAD67 is reduced in the dorsolateral PFC of people with schizophrenia. The goal of this experiment was to determine whether disrupting cortical GABA transmission impairs decision-making using a rodent gambling task (rGT). Rats were trained on the rGT until they reached stable performance and then were implanted with guide cannulae aimed at the medial PFC. Following recovery, the effects of intra-PFC infusions of the GABAA receptor antagonist bicuculline methiodide (BMI) or the GABA synthesis inhibitor L-allylglycine (LAG) on performance on the rGT were assessed. Intracortical infusions of BMI (25 ng/μl/side), but not LAG (10 μg/μl/side), altered decision-making. Following BMI infusions, rats made fewer advantageous choices. Follow-up experiments suggested that the change in decision-making was due to a change in the sensitivity to the punishments, rather than a change in the sensitivity to reward magnitudes, associated with each outcome. LAG infusions increased premature responding, a measure of response inhibition, but did not affect decision-making. Blocking GABAA receptors, but not inhibiting cortical GABA synthesis, within the medial PFC affects decision-making in the rGT. These data provide proof-of-concept evidence that disruptions in GABA transmission can contribute to the decision-making deficits in schizophrenia.

  5. Pseudoaneurysm of the articular branch of the descending genicular artery following double-bundle anterior cruciate ligament reconstruction.

    PubMed

    Tsubosaka, Masanori; Matsushita, Takehiko; Kuroda, Ryosuke; Matsumoto, Tomoyuki; Kurosaka, Masahiro

    2017-09-01

    This report describes a case of a pseudoaneurysm of the articular branch of the descending genicular artery following double-bundle anterior cruciate ligament (ACL) reconstruction. An 18-year-old male received double-bundle ACL reconstruction. During ACL reconstruction, a far anteromedial portal was created for femoral tunnel drilling. The patient presented with pulsatile swelling on the medial side of the knee on the second post-operative day. The pseudoaneurysm was diagnosed using contrast computed tomography and Doppler ultrasonography and was subsequently treated by embolization with a microcatheter. Although a vascular injury is a very rare complication of knee arthroscopy, it should be considered a possibility in patients who undergo such procedures. V.

  6. Common medial frontal mechanisms of adaptive control in humans and rodents

    PubMed Central

    Frank, Michael J.; Laubach, Mark

    2013-01-01

    In this report, we describe how common brain networks within the medial frontal cortex facilitate adaptive behavioral control in rodents and humans. We demonstrate that low frequency oscillations below 12 Hz are dramatically modulated after errors in humans over mid-frontal cortex and in rats within prelimbic and anterior cingulate regions of medial frontal cortex. These oscillations were phase-locked between medial frontal cortex and motor areas in both rats and humans. In rats, single neurons that encoded prior behavioral outcomes were phase-coherent with low-frequency field oscillations particularly after errors. Inactivating medial frontal regions in rats led to impaired behavioral adjustments after errors, eliminated the differential expression of low frequency oscillations after errors, and increased low-frequency spike-field coupling within motor cortex. Our results describe a novel mechanism for behavioral adaptation via low-frequency oscillations and elucidate how medial frontal networks synchronize brain activity to guide performance. PMID:24141310

  7. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

    PubMed Central

    2016-01-01

    Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient. PMID:27656305

  8. Etiology and Treatment of Delayed-Onset Medial Malleolar Pain Following Total Ankle Arthroplasty.

    PubMed

    Lundeen, Gregory A; Dunaway, Linda J

    2016-08-01

    Total ankle arthroplasty (TAA) has become a successful treatment for end-stage ankle arthritis. Some patients may still have pain or may present with new pain. Suggested sources of medial pain include tibialis posterior tendonitis, impingement, or medial malleolar stress fracture. Etiology and treatment remain unclear. The objective of our study was to evaluate patients with delayed-onset medial malleolar pain following TAA who underwent treatment with percutaneous medial malleolar screw placement and propose an etiology. Patients who had undergone TAA at our institution were reviewed and those with medial malleolar pain were identified. Clinical and radiographic examinations were performed pre- and postoperatively. Radiographs were compared with those from a cohort of controls without a history of medial pain. All affected patients failed conservative therapy and were treated with percutaneous placement of medial malleolar screws positioned from the malleolar tip and extending proximally beyond the tibial component. Postoperatively, patients were placed in an ace wrap and allowed to be weightbearing to tolerance, except for 1 patient initially restricted to partial weightbearing. Visual analog scale (VAS) scores were recorded. Seventy-four (74) patients underwent TAA by the corresponding author. All (100%) were female with an average age of 66 (range, 57-73) years. Average follow-up since screw placement was 21.4 (range, 10-41) months. Six (8.1%) underwent placement of 2 percutaneous medial malleolar screws. Patients presented with pain an average of 12 (range, 4-24) months postoperatively and underwent screw placement an average of 2.8 (range, 1-6) months after presentation. At the time of TAA, none had a coronal plane deformity and none underwent a deltoid ligament release as part of balancing. All (100%) patients had pain and swelling directly over the medial malleolus prior to screw placement. Postoperatively, 1 (17%) had mild pain clinically at this site and

  9. Ultrasound-guided genicular nerve block for pain control after total knee replacement: Preliminary case series and technical note.

    PubMed

    González Sotelo, V; Maculé, F; Minguell, J; Bergé, R; Franco, C; Sala-Blanch, X

    2017-12-01

    Total knee arthroplasty (TKA) is an operation with moderate to severe postoperative pain. The Fast-Track models employ local infiltration techniques with anaesthetics at high volumes (100-150ml). We proposed a genicular nerve block with low volume of local anaesthetic. The aim of our study is to evaluate the periarticular distribution of these blocks in a fresh cadaver model and to describe the technique in a preliminary group of patients submitted to TKA. In the anatomical phase, 4 genicular nerves (superior medial, superior lateral, inferior medial and inferior lateral) were blocked with 4ml of local anaesthetic with iodinated contrast and methylene blue in each (16ml in total). It was performed on a fresh cadaver and the distribution of the injected medium was evaluated by means of a CT-scan and coronal anatomical sections on both knees. The clinical phase included 12 patients scheduled for TKA. Ultrasound-guided block of the 4 genicular nerves was performed preoperatively and their clinical efficacy evaluated by assessing pain after the reversal of the spinal block and at 12h after the block. Pain was measured using the numerical scale and the need for rescue analgesia was evaluated. A wide periarticular distribution of contrast was observed by CT-scan, which was later evaluated in the coronal sections. The distribution followed the joint capsule without entering the joint, both in the femur and in the tibia. The pain after the reversal of the subarachnoid block was 2±1, requiring rescue analgesia in 42% of the patients. At 12h, the pain according to the numerical scale was 4±1, 33% required rescue analgesia. The administration of 4ml of local anaesthetic at the level of the 4 genicular nerves of the knee produces a wide periarticular distribution. Our preliminary data in a series of 12 patients undergoing TKA seems to be clinically effective. Nevertheless, extensive case series and comparative studies with local infiltration techniques with anaesthetics are

  10. Medial malleolar stress fracture secondary to chronic ankle impingement.

    PubMed

    Jowett, Andrew J L; Birks, Christopher L; Blackney, Mark C

    2008-07-01

    Medial malleolar stress fractures are uncommon even in the sporting population. We believe that stress fractures of the medial malleolus may be the end stage of chronic anteromedial ankle impingement in elite running and jumping athletes. We present five cases of elite athletes who presented to our institution with stress fractures of the medial malleolus over a 3-year period (2004 to 2007). In each case preoperative imaging revealed an anteromedial bony spur on the tibia. All fractures were internally fixed and at the same sitting had arthroscopic debridement of the bony spur. All fractures united without further intervention, average time to union was 10.2 (range, 6 to 16) weeks. At most recent review (average, 18 months; range, 8 to 37 months), all patients had resumed sporting activity to their previous level. No patient had suffered a recurrent fracture of the medial malleolus. We believe this region of impingement to be important in the development of the stress fracture and should be addressed at the time of fracture fixation.

  11. Temporal characteristics of Punjabi word-medial singletons and geminates.

    PubMed

    Hussain, Qandeel

    2015-10-01

    Many studies have investigated the temporal characteristics of the word-medial singletons and geminates in Indo-Aryan languages. However, little is known about the acoustic cues distinguishing between the word-medial singletons and geminates of Punjabi. The present study examines the temporal characteristics of Punjabi word-medial singleton and geminate stops in a C1V1C2V2 template. The results from five Punjabi speakers showed that, unlike previous studies of Indo-Aryan languages, the durations of C2 and V2 are the most important acoustic correlates of singleton and geminate stops in Punjabi. These findings therefore point towards the cross-linguistic differences in the acoustic correlates of singletons and geminates.

  12. Endoscopic partial medial maxillectomy with mucosal flap for maxillary sinus mucoceles.

    PubMed

    Durr, Megan L; Goldberg, Andrew N

    2014-01-01

    To describe a technique of endoscopic medial maxillectomy with mucosal flap for postoperative maxillary sinus mucoceles and to present a case series of subjects who underwent this procedure. This case series includes four subjects with postoperative maxillary sinus mucoceles who underwent resection via endoscopic partial medial maxillectomy with a mucosal flap. We will discuss the clinical presentation, imaging characteristics, operative details, and outcomes. Four subjects are included in this study. The average age at the time of medial maxillectomy was 52 years (range 35-65 years). Three subjects (75%) were female. One subject (25%) had bilateral postoperative maxillary sinus mucoceles. Two subjects (50%) had unilateral right sided mucoceles, and the remaining subject had a unilateral left sided mucocele. All subjects had a history of multiple sinus procedures for chronic sinusitis including Caldwell-Luc procedures ipsilateral to the postoperative mucocele. All subjects underwent endoscopic medial maxillectomy without complication and were symptom free at the last follow up appointment, average 24 months (range 3-71 months) after medial maxillectomy. For postoperative maxillary sinus mucoceles in locations that are difficult to access via the middle meatus antrostomy, we recommend endoscopic medial maxillectomy with mucosal flap. Our preliminary experience with four subjects demonstrates complete resolution of symptoms after this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Increased expression of c-fos in the medial preoptic area after mating in male rats: role of afferent inputs from the medial amygdala and midbrain central tegmental field.

    PubMed

    Baum, M J; Everitt, B J

    1992-10-01

    Immunocytochemical methods were used to localize the protein product of the immediate-early gene, c-fos, in male rats after exposure to, or direct physical interaction with, oestrous females. Increasing amounts of physical contact with a female, with resultant olfactory-vomeronasal and/or genital-somatosensory inputs, caused corresponding increments in c-fos expression in the medial preoptic area, the caudal part of the bed nucleus of the stria terminalis, the medial amygdala, and the midbrain central tegmental field. Males bearing unilateral electrothermal lesions of the olfactory peduncle showed a significant reduction in c-fos expression in the ipsilateral medial amygdala, but not in other structures, provided their coital interaction with oestrous females was restricted to mount-thrust and occasional intromissive patterns due to repeated application of lidocaine anaesthetic to the penis. No such lateralization of c-fos expression occurred in other males with unilateral olfactory lesions which were allowed to intromit and ejaculate with a female. These results suggest that olfactory inputs, possibly of vomeronasal origin, contribute to the activation of c-fos in the medial amygdala. However, lesion-induced deficits in this type of afferent input to the nervous system appear to be readily compensated for by the genital somatosensory input derived from repeated intromissions. Unilateral excitotoxic lesions of the medial preoptic area, made by infusing quinolinic acid, failed to reduce c-fos expression in the ipsilateral or contralateral medial amygdala or central tegmental field following ejaculation. By contrast, combined, unilateral excitotoxic lesions of the medial amygdala and the central tegmental field significantly reduced c-fos expression in the ipsilateral bed nucleus of the stria terminalis and medial preoptic area after mating; no such asymmetry in c-fos expression occurred when lesions were restricted to either the medial amygdala or central tegmental

  14. Role of TCP Gene BRANCHED1 in the Control of Shoot Branching in Arabidopsis.

    PubMed

    Poza-Carrión, César; Aguilar-Martínez, José Antonio; Cubas, Pilar

    2007-11-01

    Branching patterns are major determinants of plant architecture. They depend both on leaf phillotaxy (branch primordia are formed in the axils of leaves) and on the decision of buds to grow out to give a branch or to remain dormant. In Arabidopsis, several genes involved in the long-distance signalling of the control of branch outgrowth have been identified. However, the genes acting inside the buds to cause growth arrest remained unknown until now. In the February issue of Plant Cell we have described the function of BRANCHED1 (BRC1), an Arabidopsis gene coding for a plant-specific transcription factor of the TCP family that is expressed in the buds and prevents their development. Loss of BRC1 function leads to accelerated AM initiation, precocious progression of bud development and excess of shoot branching. BRC1 transcription is affected by endogenous and environmental signals controlling branching and we have shown that BRC1 function mediates the response to these stimuli. Therefore we have proposed that BRC1 function represents the point at which signals controlling branching are integrated within axillary buds.

  15. Systematic review of medial versus lateral survivorship in unicompartmental knee arthroplasty.

    PubMed

    van der List, J P; McDonald, L S; Pearle, A D

    2015-12-01

    Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies. A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship. The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p=0.133) but was significantly higher at ten years (90.5 vs. 84.1, p=0.015). This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. ELIGULUM-A Regulates Lateral Branch and Leaf Development in Barley1[OPEN

    PubMed Central

    Haaning, Allison; Bilgic, Hatice

    2018-01-01

    The shoot apical and axillary meristems control shoot development, effectively influencing lateral branch and leaf formation. The barley (Hordeum vulgare) uniculm2 (cul2) mutation blocks axillary meristem development, and mutant plants lack lateral branches (tillers) that normally develop from the crown. A genetic screen for cul2 suppressors recovered two recessive alleles of ELIGULUM-A (ELI-A) that partially rescued the cul2 tillering phenotype. Mutations in ELI-A produce shorter plants with fewer tillers and disrupt the leaf blade-sheath boundary, producing liguleless leaves and reduced secondary cell wall development in stems and leaves. ELI-A is predicted to encode an unannotated protein containing an RNaseH-like domain that is conserved in land plants. ELI-A transcripts accumulate at the preligule boundary, the developing ligule, leaf margins, cells destined to develop secondary cell walls, and cells surrounding leaf vascular bundles. Recent studies have identified regulatory similarities between boundary development in leaves and lateral organs. Interestingly, we observed ELI-A transcripts at the preligule boundary, suggesting that ELI-A contributes to boundary formation between the blade and sheath. However, we did not observe ELI-A transcripts at the axillary meristem boundary in leaf axils, suggesting that ELI-A is not involved in boundary development for axillary meristem development. Our results show that ELI-A contributes to leaf and lateral branch development by acting as a boundary gene during ligule development but not during lateral branch development. PMID:29440592

  17. White matter integrity of the medial forebrain bundle and attention and working memory deficits following traumatic brain injury.

    PubMed

    Owens, Jacqueline A; Spitz, Gershon; Ponsford, Jennie L; Dymowski, Alicia R; Ferris, Nicholas; Willmott, Catherine

    2017-02-01

    The medial forebrain bundle (MFB) contains ascending catecholamine fibers that project to the prefrontal cortex (PFC). Damage to these fibers following traumatic brain injury (TBI) may alter extracellular catecholamine levels in the PFC and impede attention and working memory ability. This study investigated white matter microstructure of the medial MFB, specifically the supero-lateral branch (slMFB), following TBI, and its association with performance on attention and working memory tasks. Neuropsychological measures of attention and working memory were administered to 20 moderate-severe participants with TBI (posttraumatic amnesia M  = 40.05 ± 37.10 days, median time since injury 10.48 months, range 3.72-87.49) and 20 healthy controls. Probabilistic tractography was used to obtain fractional anisotropy (FA) and mean diffusivity (MD) values for 17 participants with TBI and 20 healthy controls. When compared to controls, participants with TBI were found to have significantly lower FA ( p  < .001) and higher MD ( p  < .001) slMFB values, and they were slower to complete tasks including Trail Making Task-A, Hayling, selective attention task, n -back, and Symbol Digit Modalities Test. This study was the first to demonstrate microstructural white matter damage within the slMFB following TBI. However, no evidence was found for an association of alterations to this tract and performance on attentional tasks.

  18. Present-day kinematics of the Danakil block (southern Red Sea-Afar) constrained by GPS

    NASA Astrophysics Data System (ADS)

    Ladron de Guevara, R.; Jonsson, S.; Ruch, J.; Doubre, C.; Reilinger, R. E.; Ogubazghi, G.; Floyd, M.; Vasyura-Bathke, H.

    2017-12-01

    The rifting of the Arabian plate from the Nubian and Somalian plates is primarily accommodated by seismic and magmatic activity along two rift arms of the Afar triple junction (the Red Sea and Gulf of Aden rifts). The spatial distribution of active deformation in the Afar region have been constrained with geodetic observations. However, the plate boundary configuration in which this deformation occurs is still not fully understood. South of 17°N, the Red Sea rift is composed of two parallel and overlapping rift branches separated by the Danakil block. The distribution of the extension across these two overlapping rifts, their potential connection through a transform fault zone and the counterclockwise rotation of the Danakil block have not yet been fully resolved. Here we analyze new GPS observations from the Danakil block, the Gulf of Zula area (Eritrea) and Afar (Ethiopia) together with previous geodetic survey data to better constrain the plate kinematics and active deformation of the region. The new data has been collected in 2016 and add up to 5 years to the existing geodetic observations (going back to 2000). Our improved GPS velocity field shows differences with previously modeled GPS velocities, suggesting that the rate and rotation of the Danakil block need to be updated. The new velocity field also shows that the plate-boundary strain is accommodated by broad deformation zones rather than across sharp boundaries between tectonic blocks. To better determine the spatial distribution of the strain, we first implement a rigid block model to constrain the overall regional plate kinematics and to isolate the plate-boundary deformation at the western boundary of the Danakil block. We then study whether the recent southern Red Sea rifting events have caused detectable changes in observed GPS velocities and if the observations can be used to constrain the scale of this offshore rift activity. Finally, we investigate different geometries of transform faults that

  19. Association of medial meniscal extrusion with medial tibial osteophyte distance detected by T2 mapping MRI in patients with early-stage knee osteoarthritis.

    PubMed

    Hada, Shinnosuke; Ishijima, Muneaki; Kaneko, Haruka; Kinoshita, Mayuko; Liu, Lizu; Sadatsuki, Ryo; Futami, Ippei; Yusup, Anwajan; Takamura, Tomohiro; Arita, Hitoshi; Shiozawa, Jun; Aoki, Takako; Takazawa, Yuji; Ikeda, Hiroshi; Aoki, Shigeki; Kurosawa, Hisashi; Okada, Yasunori; Kaneko, Kazuo

    2017-09-12

    Medial meniscal extrusion (MME) is associated with progression of medial knee osteoarthritis (OA), but no or little information is available for relationships between MME and osteophytes, which are found in cartilage and bone parts. Because of the limitation in detectability of the cartilage part of osteophytes by radiography or conventional magnetic resonance imaging (MRI), the rate of development and size of osteophytes appear to have been underestimated. Because T2 mapping MRI may enable us to evaluate the cartilage part of osteophytes, we aimed to examine the association between MME and OA-related changes, including osteophytes, by using conventional and T2 mapping MRI. Patients with early-stage knee OA (n = 50) were examined. MRI-detected OA-related changes, in addition to MME, were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. T2 values of the medial meniscus and osteophytes were measured on T2 mapping images. Osteophytes surgically removed from patients with end-stage knee OA were histologically analyzed and compared with findings derived by radiography and MRI. Medial side osteophytes were detected by T2 mapping MRI in 98% of patients with early-stage knee OA, although the detection rate was 48% by conventional MRI and 40% by radiography. Among the OA-related changes, medial tibial osteophyte distance was most closely associated with MME, as determined by multiple logistic regression analysis, in the patients with early-stage knee OA (β = 0.711, p < 0.001). T2 values of the medial meniscus were directly correlated with MME in patients with early-stage knee OA, who showed ≥ 3 mm of MME (r = 0.58, p = 0.003). The accuracy of osteophyte evaluation by T2 mapping MRI was confirmed by histological analysis of the osteophytes removed from patients with end-stage knee OA. Our study demonstrates that medial tibial osteophyte evaluated by T2 mapping MRI is frequently observed in the patients with early-stage knee

  20. Medial tibial pain. A prospective study of its cause among military recruits.

    PubMed

    Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z

    1986-12-01

    In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

  1. Comparative techniques of medial rectus muscle retraction for endoscopic exposure of the medial intraconal space.

    PubMed

    Lin, Giant C; Freitag, Suzanne K; Kocharyan, Armine; Yoon, Michael K; Lefebvre, Daniel R; Bleier, Benjamin S

    2016-05-01

    The medial rectus muscle (MRM) is the medial boundary to the intraconal space of the orbit, and retraction of the MRM is oftentimes necessary for endoscopic removal of intraconal tumors, e.g., orbital hemangioma. We evaluated each of the reported methods of MRM retraction for endoscopic orbital surgery and quantified the degree of intraconal exposure conferred by each method. Eight orbits from four cadaver heads were dissected. In each orbit, medial orbital decompression was performed and the MRM was retracted by using four previously described techniques: (1) external MRM retraction at the globe insertion point by using vessel loop (external group), (2) transseptal MRM retraction by using vessel loop (transseptal group), (3) transchoanal retraction of the MRM by using vessel loop (choanal group), and (4) transseptal four-handed technique by using double ball retraction by a second surgeon (transseptal double ball group). The length, height, and area of exposure of the medial intraconal space were quantified and compared. The average ± standard deviation (SD) anterior-posterior exposures for the external group, transseptal group, and transseptal double ball group were 17.51 ± 3.39 mm, 16.59 ± 4.16 mm, and 18.0 ± 15.25 mm, respectively. The choanal group provided significantly less exposure (12.39 ± 3.44 mm, p = 0.049) than the other groups. The average ± SD vertical exposures for the transseptal group, choanal group, and transseptal double ball group were 12.53 ± 4.38 mm, 13.05 ± 5.86 mm, and 13.57 ± 3.74 mm, respectively. The external group provided significantly less exposure (4.51 ± 1.56 mm, p = 0.0072) than the other groups. The transseptal and transseptal double ball groups provided the greatest total access by surface area (58.88 ± 26.96 mm(2) and 62.94 ± 34.74 mm(2), respectively) compared with the external and choanal groups (34.82 ± 23.37 mm(2) and 43.10 ± 23.68 mm(2), respectively). Although the transseptal trajectory of MRM retraction was

  2. Medial Meniscal Extrusion Relates to Cartilage Loss in Specific Femorotibial Subregions- Data from the Osteoarthritis Initiative

    PubMed Central

    Bloecker, K.; Wirth, W.; Guermazi, A.; Hunter, DJ; Resch, H.; Hochreiter, J.; Eckstein, F.

    2015-01-01

    Objective Medial meniscal extrusion is known to be related to structural progression of knee OA. However, it is unclear whether medial meniscal extrusion is more strongly associated with cartilage loss in certain medial femorotibial subregions than to others. Methods Segmentation of the medial tibial and femoral cartilage (baseline; 1-year follow-up) and the medial meniscus (baseline) was performed in 60 participants with frequent knee pain (age 61.3±9.2y, BMI 31.3±3.9 kg/m2) and with unilateral medial radiographic joint space narrowing (JSN) grade 1–3, using double echo steady state MR-images. Medial meniscal extrusion distance and extrusion area (%) between the external meniscal and tibial margin at baseline, and longitudinal medial cartilage loss in eight anatomical subregions were determined. Results A significant association (Pearson correlation coefficient) was seen between medial meniscus extrusion area in JSN knees and cartilage loss over one year throughout the entire medial femorotibial compartment. The strongest correlation was with cartilage loss in the external medial tibia (r=−0.34 [p<0.01] in JSN, and r=−0.30 [p=0.02] in noJSN knees). Conclusion Medial meniscus extrusion was associated with subsequent medial cartilage loss. The external medial tibial cartilage may be particularly vulnerable to thinning once the meniscus extrudes and its surface is “exposed” to direct, non-physiological, cartilage-cartilage contact. PMID:25988986

  3. Pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy.

    PubMed

    Lee, Kee Byoung; Song, Si Young; Kwon, Duck Joo; Shin, Jun; Paik, Sang Hoon

    2009-09-01

    We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization.

  4. Pseudoaneurysm of the Medial Superior Genicular Artery after Arthroscopic Partial Meniscectomy

    PubMed Central

    Lee, Kee Byoung; Kwon, Duck Joo; Shin, Jun; Paik, Sang Hoon

    2009-01-01

    We describe a case of 43-year-old man who had a pseudoaneurysm of the medial superior genicular artery after arthroscopic partial meniscectomy with standard anterolateral and anteromedial portals. Pseudoaneurysm of the medial superior genicular artery has been reported at the previous superomedial portal site after arthroscopy. Described herein is a unique case that involved the medial superior genicular artery at the previous anteromedial portal site after arthroscopy. The pseudoaneurysm was successfully treated with transcatheter embolization. PMID:19885054

  5. ERG voltage-gated K+ channels regulate excitability and discharge dynamics of the medial vestibular nucleus neurones

    PubMed Central

    Pessia, Mauro; Servettini, Ilenio; Panichi, Roberto; Guasti, Leonardo; Grassi, Silvarosa; Arcangeli, Annarosa; Wanke, Enzo; Pettorossi, Vito Enrico

    2008-01-01

    The discharge properties of the medial vestibular nucleus neurones (MVNn) critically depend on the activity of several ion channel types. In this study we show, immunohistochemically, that the voltage-gated K+ channels ERG1A, ERG1B, ERG2 and ERG3 are highly expressed within the vestibular nuclei of P10 and P60 mice. The role played by these channels in the spike-generating mechanisms of the MVNn and in temporal information processing was investigated electrophysiologically from mouse brain slices, in vitro, by analysing the spontaneous discharge and the response to square-, ramp- and sinusoid-like intracellular DC current injections in extracellular and whole-cell patch-clamp studies. We show that more than half of the recorded MVNn were responsive to ERG channel block (WAY-123,398, E4031), displaying an increase in spontaneous activity and discharge irregularity. The response to step and ramp current injection was also modified by ERG block showing a reduction of first spike latency, enhancement of discharge rate and reduction of the slow spike-frequency adaptation process. ERG channels influence the interspike slope without affecting the spike shape. Moreover, in response to sinusoid-like current, ERG channel block caused frequency-dependent gain enhancement and phase-lead shift. Taken together, the data demonstrate that ERG channels control the excitability of MVNn, their discharge regularity and probably their resonance properties. PMID:18718985

  6. ERG voltage-gated K+ channels regulate excitability and discharge dynamics of the medial vestibular nucleus neurones.

    PubMed

    Pessia, Mauro; Servettini, Ilenio; Panichi, Roberto; Guasti, Leonardo; Grassi, Silvarosa; Arcangeli, Annarosa; Wanke, Enzo; Pettorossi, Vito Enrico

    2008-10-15

    The discharge properties of the medial vestibular nucleus neurones (MVNn) critically depend on the activity of several ion channel types. In this study we show, immunohistochemically, that the voltage-gated K(+) channels ERG1A, ERG1B, ERG2 and ERG3 are highly expressed within the vestibular nuclei of P10 and P60 mice. The role played by these channels in the spike-generating mechanisms of the MVNn and in temporal information processing was investigated electrophysiologically from mouse brain slices, in vitro, by analysing the spontaneous discharge and the response to square-, ramp- and sinusoid-like intracellular DC current injections in extracellular and whole-cell patch-clamp studies. We show that more than half of the recorded MVNn were responsive to ERG channel block (WAY-123,398, E4031), displaying an increase in spontaneous activity and discharge irregularity. The response to step and ramp current injection was also modified by ERG block showing a reduction of first spike latency, enhancement of discharge rate and reduction of the slow spike-frequency adaptation process. ERG channels influence the interspike slope without affecting the spike shape. Moreover, in response to sinusoid-like current, ERG channel block caused frequency-dependent gain enhancement and phase-lead shift. Taken together, the data demonstrate that ERG channels control the excitability of MVNn, their discharge regularity and probably their resonance properties.

  7. Dissociating medial frontal and posterior cingulate activity during self-reflection.

    PubMed

    Johnson, Marcia K; Raye, Carol L; Mitchell, Karen J; Touryan, Sharon R; Greene, Erich J; Nolen-Hoeksema, Susan

    2006-06-01

    Motivationally significant agendas guide perception, thought and behaviour, helping one to define a 'self' and to regulate interactions with the environment. To investigate neural correlates of thinking about such agendas, we asked participants to think about their hopes and aspirations (promotion focus) or their duties and obligations (prevention focus) during functional magnetic resonance imaging and compared these self-reflection conditions with a distraction condition in which participants thought about non-self-relevant items. Self-reflection resulted in greater activity than distraction in dorsomedial frontal/anterior cingulate cortex and posterior cingulate cortex/precuneus, consistent with previous findings of activity in these areas during self-relevant thought. For additional medial areas, we report new evidence of a double dissociation of function between medial prefrontal/anterior cingulate cortex, which showed relatively greater activity to thinking about hopes and aspirations, and posterior cingulate cortex/precuneus, which showed relatively greater activity to thinking about duties and obligations. One possibility is that activity in medial prefrontal cortex is associated with instrumental or agentic self-reflection, whereas posterior medial cortex is associated with experiential self-reflection. Another, not necessarily mutually exclusive, possibility is that medial prefrontal cortex is associated with a more inward-directed focus, while posterior cingulate is associated with a more outward-directed, social or contextual focus.

  8. Dissociating medial frontal and posterior cingulate activity during self-reflection

    PubMed Central

    Johnson, Marcia K.; Raye, Carol L.; Mitchell, Karen J.; Touryan, Sharon R.; Greene, Erich J.; Nolen-Hoeksema, Susan

    2006-01-01

    Motivationally significant agendas guide perception, thought and behaviour, helping one to define a ‘self’ and to regulate interactions with the environment. To investigate neural correlates of thinking about such agendas, we asked participants to think about their hopes and aspirations (promotion focus) or their duties and obligations (prevention focus) during functional magnetic resonance imaging and compared these self-reflection conditions with a distraction condition in which participants thought about non-self-relevant items. Self-reflection resulted in greater activity than distraction in dorsomedial frontal/anterior cingulate cortex and posterior cingulate cortex/precuneus, consistent with previous findings of activity in these areas during self-relevant thought. For additional medial areas, we report new evidence of a double dissociation of function between medial prefrontal/anterior cingulate cortex, which showed relatively greater activity to thinking about hopes and aspirations, and posterior cingulate cortex/precuneus, which showed relatively greater activity to thinking about duties and obligations. One possibility is that activity in medial prefrontal cortex is associated with instrumental or agentic self-reflection, whereas posterior medial cortex is associated with experiential self-reflection. Another, not necessarily mutually exclusive, possibility is that medial prefrontal cortex is associated with a more inward-directed focus, while posterior cingulate is associated with a more outward-directed, social or contextual focus. PMID:18574518

  9. The "moving valgus stress test" for medial collateral ligament tears of the elbow.

    PubMed

    O'Driscoll, Shawn W M; Lawton, Richard L; Smith, Adam M

    2005-02-01

    The diagnosis of a painful partial tear of the medial collateral ligament in overhead-throwing athletes is challenging, even for experienced elbow surgeons and despite the use of sophisticated imaging techniques. The "moving valgus stress test" is an accurate physical examination technique for diagnosis of medial collateral ligament attenuation in the elbow. Cohort study (diagnosis); Level of evidence, 2. Twenty-one patients underwent surgical intervention for medial elbow pain due to medial collateral ligament insufficiency or other abnormality of chronic valgus overload, and they were assessed preoperatively with an examination called the moving valgus stress test. To perform the moving valgus stress test, the examiner applies and maintains a constant moderate valgus torque to the fully flexed elbow and then quickly extends the elbow. The test is positive if the medial elbow pain is reproduced at the medial collateral ligament and is at maximum between 120 degrees and 70 degrees. The moving valgus stress test was highly sensitive (100%, 17 of 17 patients) and specific (75%, 3 of 4 patients) when compared to assessment of the medial collateral ligament by surgical exploration or arthroscopic valgus stress testing. The mean shear range (ie, the arc within which pain was produced with the moving valgus stress test) was 120 degrees to 70 degrees. The mean angle at which pain was at a maximum was 90 degrees of elbow flexion. The moving valgus stress test is an accurate physical examination technique that, when performed and interpreted correctly, is highly sensitive for medial elbow pain arising from the medial collateral ligament.

  10. Fiber Tracts of the Medial and Inferior Surfaces of the Cerebrum.

    PubMed

    Baydin, Serhat; Gungor, Abuzer; Tanriover, Necmettin; Baran, Oguz; Middlebrooks, Erik H; Rhoton, Albert L

    2017-02-01

    Fiber dissection studies of the cerebrum have focused on the lateral surface. No comparable detailed studies have been done on the medial and inferior surfaces. The object of this study was to examine the fiber tracts, cortical, and subcortical structures of the medial and inferior aspects of the brain important in planning operative approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum. Twenty formalin-fixed human hemispheres (10 brains) were examined by fiber dissection technique under ×6-×40 magnifications. The superior longitudinal fasciculus I, cingulum, inferior longitudinal fasciculus, uncinate fasciculus, optic radiations, tapetum, and callosal fibers were dissected step by step from medial to lateral, exposing the nucleus accumbens, subthalamic nucleus, red nucleus, and central midline structures (fornix, stria medullaris, and stria terminalis). Finally, the central core structures were dissected from medial to lateral. Understanding the fiber network underlying the medial and inferior aspects of the brain is important in surgical planning for approaches along the interhemispheric fissure, parafalcine area, and basal surfaces of the cerebrum. Copyright © 2016. Published by Elsevier Inc.

  11. Materials Test Branch

    NASA Technical Reports Server (NTRS)

    Gordon, Gail

    2012-01-01

    The Materials Test Branch resides at Marshall Space Flight Center's Materials and Processing laboratory and has a long history of supporting NASA programs from Mercury to the recently retired Space Shuttle. The Materials Test Branch supports its customers by supplying materials testing expertise in a wide range of applications. The Materials Test Branch is divided into three Teams, The Chemistry Team, The Tribology Team and the Mechanical Test Team. Our mission and goal is to provide world-class engineering excellence in materials testing with a special emphasis on customer service.

  12. Pediatric obesity and walking duration increase medial tibiofemoral compartment contact forces.

    PubMed

    Lerner, Zachary F; Board, Wayne J; Browning, Raymond C

    2016-01-01

    With the high prevalence of pediatric obesity there is a need for structured physical activity during childhood. However, altered tibiofemoral loading during physical activity in obese children likely contribute to their increased risk of orthopedic disorders of the knee. The goal of this study was to determine the effects of pediatric obesity and walking duration on medial and lateral tibiofemoral contact forces. We collected experimental biomechanics data during treadmill walking at 1 m•s(-1) for 20 min in 10 obese and 10 healthy-weight 8-12 year-olds. We created subject-specific musculoskeletal models using radiographic measures of tibiofemoral alignment and centers-of-pressure, and predicted medial and lateral tibiofemoral contact forces at the beginning and end of each trial. Obesity and walking duration affected tibiofemoral loading. At the beginning of the trail, the average percent of the total load passing through the medial compartment during stance was 85% in the obese children and 63% in the healthy-weight children; at the end of the trial, the medial distribution was 90% in the obese children and 72% in the healthy-weight children. Medial compartment loading rates were 1.78 times greater in the obese participants. The medial compartment loading rate increased 17% in both groups at the end compared to the beginning of the trial (p = 0.001). We found a strong linear relationship between body-fat percentage and the medial-lateral load distribution (r(2) = 0.79). Altered tibiofemoral loading during walking in obese children may contribute to their increased risk of knee pain and pathology. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  13. LayTracks3D: A new approach for meshing general solids using medial axis transform

    DOE PAGES

    Quadros, William Roshan

    2015-08-22

    This study presents an extension of the all-quad meshing algorithm called LayTracks to generate high quality hex-dominant meshes of general solids. LayTracks3D uses the mapping between the Medial Axis (MA) and the boundary of the 3D domain to decompose complex 3D domains into simpler domains called Tracks. Tracks in 3D have no branches and are symmetric, non-intersecting, orthogonal to the boundary, and the shortest path from the MA to the boundary. These properties of tracks result in desired meshes with near cube shape elements at the boundary, structured mesh along the boundary normal with any irregular nodes restricted to themore » MA, and sharp boundary feature preservation. The algorithm has been tested on a few industrial CAD models and hex-dominant meshes are shown in the Results section. Work is underway to extend LayTracks3D to generate all-hex meshes.« less

  14. A Non-canonical Reticular-Limbic Central Auditory Pathway via Medial Septum Contributes to Fear Conditioning.

    PubMed

    Zhang, Guang-Wei; Sun, Wen-Jian; Zingg, Brian; Shen, Li; He, Jufang; Xiong, Ying; Tao, Huizhong W; Zhang, Li I

    2018-01-17

    In the mammalian brain, auditory information is known to be processed along a central ascending pathway leading to auditory cortex (AC). Whether there exist any major pathways beyond this canonical auditory neuraxis remains unclear. In awake mice, we found that auditory responses in entorhinal cortex (EC) cannot be explained by a previously proposed relay from AC based on response properties. By combining anatomical tracing and optogenetic/pharmacological manipulations, we discovered that EC received auditory input primarily from the medial septum (MS), rather than AC. A previously uncharacterized auditory pathway was then revealed: it branched from the cochlear nucleus, and via caudal pontine reticular nucleus, pontine central gray, and MS, reached EC. Neurons along this non-canonical auditory pathway responded selectively to high-intensity broadband noise, but not pure tones. Disruption of the pathway resulted in an impairment of specifically noise-cued fear conditioning. This reticular-limbic pathway may thus function in processing aversive acoustic signals. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. NCO Production Management Branch

    Science.gov Websites

    Climate Climate Prediction Climate Archives Weather Safety Storm Ready NOAA Central Library Photo Library Management Branch Production Management Branch About the Production Management Branch NCO REQUEST FOR CHANGE (RFC) DATABASE ACCESS NCO Request For Change (RFC) Archive [For INTERNAL Use Only] NCO Request For

  16. Electrophysiological evidence during episodic prospection implicates medial prefrontal and bilateral middle temporal gyrus.

    PubMed

    Hsu, Chia-Fen; Sonuga-Barke, Edmund J S

    2016-08-01

    fMRI studies have implicated the medial prefrontal cortex and medial temporal lobe, components of the default mode network (DMN), in episodic prospection. This study compared quantitative EEG localized to these DMN regions during prospection and during resting and while waiting for rewards. EEG was recorded in twenty-two adults while they were asked to (i) envision future monetary episodes; (ii) wait for rewards and (iii) rest. Activation sources were localized to core DMN regions. EEG power and phase coherence were compared across conditions. Prospection, compared to resting and waiting, was associated with reduced power in the medial prefrontal gyrus and increased power in the bilateral medial temporal gyrus across frequency bands as well as greater phase synchrony between these regions in the delta band. The current quantitative EEG analysis confirms prior fMRI research suggesting that medial prefrontal and medial temporal gyrus interactions are central to the capacity for episodic prospection. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Inverted distal clavicle anatomic locking plate for displaced medial clavicle fracture.

    PubMed

    Wang, Yong; Jiang, Jiannong; Dou, Bin; Zhang, Panjun

    2015-09-01

    Fractures of the medial clavicle are rare injuries. Recently, open reduction and internal fixation has been recommended for displaced medial clavicle fractures in order to prevent non-union and dysfunction. Because of the rarity of this injury, the optimal fixation device has not yet been established. In this report, we describe a case of a 40-year-old male patient who sustained a significantly displaced medial clavicle fracture treated by open reduction and internal fixation using an inverted distal clavicle anatomic locking plate. At the 12 months follow-up, the patient recovered well, had returned to pre-injury job, and was quite satisfied with the outcome. Internal fixation of medial clavicle fracture using an inverted distal clavicle anatomic locking plate of the ipsilateral side appears to be a good treatment option.

  18. Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery.

    PubMed

    Izumi, Ken; Fujikawa, Masakazu; Tashima, Hiroki; Saito, Takuya; Sotsuka, Yohei; Tomita, Koichi; Hosokawa, Ko

    2013-11-01

    Recent advances in perforator flap surgical techniques have allowed for safe and reliable autologous tissue transfer with minimal donor-site morbidity. Between April 2012 and January 2013, we performed immediate breast reconstruction using free medial circumflex femoral artery perforator (MCFAP) flaps in 15 patients after breast-conserving surgery. The flaps were harvested from patients in the lithotomy position, while a second surgical team simultaneously conducted tumour resection. Of the 15 procedures performed, three flaps were dissected as true perforator flaps, while 12 flaps were dissected as muscle-sparing perforator flaps. The mean flap weight was 138.5 g (range, 77-230 g) and the mean pedicle length was 5.7 cm (range, 3.0-9.0 cm). Recipient vessels for anastomosis were serratus branches in 10 patients, internal mammary vessels in three patients and thoracodorsal vessels in two patients. The mean duration of surgery was 6.74 h (range, 5.65-9.45 h). There were no major complications requiring surgical intervention. Researchers observed partial flap necrosis, which manifested as small firm lesions in two patients, as well as local wound infection and dehiscence in one patient, which resolved spontaneously. There were no instances of donor-site seroma formation or lymphoedema in any of the patients. An objective assessment of postoperative photographs showed that cosmetic results were mostly satisfactory. Donor-site scars along the medial groin crease were inconspicuous and readily concealed by clothing. Given its reliable vascularity and minimal donor-site morbidity, the free MCFAP flap can be a good alternative for partial breast reconstruction after breast-conserving surgery. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. Decreased knee adduction moment does not guarantee decreased medial contact force during gait.

    PubMed

    Walter, Jonathan P; D'Lima, Darryl D; Colwell, Clifford W; Fregly, Benjamin J

    2010-10-01

    Excessive contact force is believed to contribute to the development of medial compartment knee osteoarthritis. The external knee adduction moment (KAM) has been identified as a surrogate measure for medial contact force during gait, with an abnormally large peak value being linked to increased pain and rate of disease progression. This study used in vivo gait data collected from a subject with a force-measuring knee implant to assess whether KAM decreases accurately predict corresponding decreases in medial contact force. Changes in both quantities generated via gait modification were analyzed statistically relative to the subject's normal gait. The two gait modifications were a "medial thrust" gait involving knee medialization during stance phase and a "walking pole" gait involving use of bilateral walking poles. Reductions in the first (largest) peak of the KAM (32-33%) did not correspond to reductions in the first peak of the medial contact force. In contrast, reductions in the second peak and angular impulse of the KAM (15-47%) corresponded to reductions in the second peak and impulse of the medial contact force (12-42%). Calculated reductions in both KAM peaks were highly sensitive to rotation of the shank reference frame about the superior-inferior axis of the shank. Both peaks of medial contact force were best predicted by a combination of peak values of the external KAM and peak absolute values of the external knee flexion moment (R(2) = 0.93). Future studies that evaluate the effectiveness of gait modifications for offloading the medial compartment of the knee should consider the combined effect of these two knee moments. Published by Wiley Periodicals, Inc. J Orthop Res 28:1348-1354, 2010.

  20. A combinatorial optogenetic approach to medial habenula function

    NASA Astrophysics Data System (ADS)

    Turner, Eric E.; Hsu, Yun-Wei; Wang, Si; Morton, Glenn; Zeng, Hongkui

    2013-03-01

    The habenula is a brain region found in all vertebrate species. It consists of medial and lateral subnuclei which make complex descending connections to the brainstem. Although the medial habenula (MHb) and its projection, the fasciculus retroflexus (FR), have been recognized for decades, their function remains obscure. The small size of the MHb in rodents, and the cellular and molecular complexity of this region, have made it difficult to study the function of this region with high specificity. Here we describe a Cre-mediated genetic system for expressing the microbial opsin channelrhodopsin (ChR2) specifically in the dorsal (dMHb) and ventral (vMHb) medial habenula. Genetically targeted expression of ChR2 allows MHb neurons to be selectively activated with light in acute brain slices with electrophysiological readouts, and in vivo by means of custom-built fiber optic cannulas. These tools will allow highly specific studies of MHb circuitry and the role of the MHb in behaviors related to addiction and mood regulation.

  1. Volition and conflict in human medial frontal cortex.

    PubMed

    Nachev, Parashkev; Rees, Geraint; Parton, Andrew; Kennard, Christopher; Husain, Masud

    2005-01-26

    Controversy surrounds the role of human medial frontal cortex in controlling actions. Although damage to this area leads to severe difficulties in spontaneously initiating actions, the precise mechanisms underlying such "volitional" deficits remain to be established. Previous studies have implicated the medial frontal cortex in conflict monitoring and the control of voluntary action, suggesting that these key processes are functionally related or share neural substrates. Here, we combine a novel behavioral paradigm with functional imaging of the oculomotor system to reveal, for the first time, a functional subdivision of the pre-supplementary motor area (pre-SMA) into anatomically distinct areas that respond exclusively to either volition or conflict. We also demonstrate that activity in the supplementary eye field (SEF) distinguishes between success and failure in changing voluntary action plans during conflict, suggesting a role for the SEF in implementing the resolution of conflicting actions. We propose a functional architecture of human medial frontal cortex that incorporates the generation of action plans and the resolution of conflict.

  2. Bilateral medial medullary infarction due to bilateral vertebral artery dissection.

    PubMed

    Fukuda, Masafumi; Aiba, Toyotaka; Takahashi, Sho

    2004-03-01

    We describe a 52-year-old woman who experienced transient motor weakness and numbness of the left extremities and presented 2 days later with severe hemiparesis and sensory impairment of the right extremities and right lingual palsy. Magnetic resonance imaging (MRI) revealed bilateral upper medial medullary infarction, primarily in the left ventral portion. The findings of both three-dimensional (3D) computed tomographic and conventional angiography suggested dissection of both intracranial vertebral arteries (VAs). Medial medullary infarction is generally caused by atherosclerosis within a VA or anterior spinal artery. This is the first report of bilateral medial medullary infarction due to dissection of both intracranial VAs.

  3. Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy.

    PubMed

    Terrier, Alexandre; Levrero Florencio, Francesc; Rüdiger, Hannes A

    2014-10-01

    Medialization of the cup with a respective increase in femoral offset has been proposed in THA to increase abductor moment arms. Insofar as there are potential disadvantages to cup medialization, it is important to ascertain whether the purported biomechanical benefits of cup medialization are large enough to warrant the downsides; to date, studies regarding this question have disagreed. The purpose of this study was to quantify the effect of cup medialization with a compensatory increase in femoral offset compared with anatomic reconstruction for patients undergoing THA. We tested the hypothesis that there is a (linear) correlation between preoperative anatomic parameters and muscle moment arm increase caused by cup medialization. Fifteen patients undergoing THA were selected, covering a typical range of preoperative femoral offsets. For each patient, a finite element model was built based on a preoperative CT scan. The model included the pelvis, femur, gluteus minimus, medius, and maximus. Two reconstructions were compared: (1) anatomic position of the acetabular center of rotation, and (2) cup medialization compensated by an increase in the femoral offset. Passive abduction-adduction and flexion-extension were simulated in the range of normal gait. Muscle moment arms were evaluated and correlated to preoperative femoral offset, acetabular offset, height of the greater trochanter (relative to femoral center of rotation), and femoral antetorsion angle. The increase of muscle moment arms caused by cup medialization varied among patients. Muscle moment arms increase by 10% to 85% of the amount of cup medialization for abduction-adduction and from -35% (decrease) to 50% for flexion-extension. The change in moment arm was inversely correlated (R(2) = 0.588, p = 0.001) to femoral antetorsion (anteversion), such that patients with less femoral antetorsion gained more in terms of hip muscle moments. No linear correlation was observed between changes in moment arm and

  4. Dynamic Changes in Acetylcholine Output in the Medial Striatum during Place Reversal Learning

    ERIC Educational Resources Information Center

    Ragozzino, Michael E.; Choi, Daniel

    2004-01-01

    The present studies explored the role of the medial striatum in learning when task contingencies change. Experiment 1 examined whether the medial striatum is involved in place reversal learning. Testing occurred in a modified cross-maze across two consecutive sessions. Injections of the local anesthetic, bupivacaine, into the medial striatum, did…

  5. The Notch ligand Delta-like 4 negatively regulates endothelial tip cell formation and vessel branching

    PubMed Central

    Suchting, Steven; Freitas, Catarina; le Noble, Ferdinand; Benedito, Rui; Bréant, Christiane; Duarte, Antonio; Eichmann, Anne

    2007-01-01

    Delta-like 4 (Dll4) is a transmembrane ligand for Notch receptors that is expressed in arterial blood vessels and sprouting endothelial cells. Here we show that Dll4 regulates vessel branching during development by inhibiting endothelial tip cell formation. Heterozygous deletion of dll4 or pharmacological inhibition of Notch signaling using γ-secretase inhibitor revealed a striking vascular phenotype, with greatly increased numbers of filopodia-extending endothelial tip cells and increased expression of tip cell marker genes compared with controls. Filopodia extension in dll4+/− retinal vessels required the vascular growth factor VEGF and was inhibited when VEGF signaling was blocked. Although VEGF expression was not significantly altered in dll4+/− retinas, dll4+/− vessels showed increased expression of VEGF receptor 2 and decreased expression of VEGF receptor 1 compared with wild-type, suggesting they could be more responsive to VEGF stimulation. In addition, expression of dll4 in wild-type tip cells was itself decreased when VEGF signaling was blocked, indicating that dll4 may act downstream of VEGF as a “brake” on VEGF-mediated angiogenic sprouting. Taken together, these data reveal Dll4 as a negative regulator of vascular sprouting and vessel branching that is required for normal vascular network formation during development. PMID:17296941

  6. The Notch ligand Delta-like 4 negatively regulates endothelial tip cell formation and vessel branching.

    PubMed

    Suchting, Steven; Freitas, Catarina; le Noble, Ferdinand; Benedito, Rui; Bréant, Christiane; Duarte, Antonio; Eichmann, Anne

    2007-02-27

    Delta-like 4 (Dll4) is a transmembrane ligand for Notch receptors that is expressed in arterial blood vessels and sprouting endothelial cells. Here we show that Dll4 regulates vessel branching during development by inhibiting endothelial tip cell formation. Heterozygous deletion of dll4 or pharmacological inhibition of Notch signaling using gamma-secretase inhibitor revealed a striking vascular phenotype, with greatly increased numbers of filopodia-extending endothelial tip cells and increased expression of tip cell marker genes compared with controls. Filopodia extension in dll4(+/-) retinal vessels required the vascular growth factor VEGF and was inhibited when VEGF signaling was blocked. Although VEGF expression was not significantly altered in dll4(+/-) retinas, dll4(+/-) vessels showed increased expression of VEGF receptor 2 and decreased expression of VEGF receptor 1 compared with wild-type, suggesting they could be more responsive to VEGF stimulation. In addition, expression of dll4 in wild-type tip cells was itself decreased when VEGF signaling was blocked, indicating that dll4 may act downstream of VEGF as a "brake" on VEGF-mediated angiogenic sprouting. Taken together, these data reveal Dll4 as a negative regulator of vascular sprouting and vessel branching that is required for normal vascular network formation during development.

  7. Hydrologic and hydraulic analyses at Akin Branch and Cayce Valley Branch, Columbia, Tennessee

    USGS Publications Warehouse

    Outlaw, George S.

    1993-01-01

    The U.S. Geological Survey, in cooperation with the City of Columbia, Tennessee, conducted hydrologic and hydraulic analyses at Akin Branch and Cayce Valley Branch in the Little Bigby Creek watershed, Columbia, Tennessee, from 1990 through 1991. Results of the analyses can be used by city planners in the development of plans to replace several deteriorating and inadequate drainage structures. Akin Branch and Cayce Valley Branch drain small watersheds of 1.69 and 1.04 square miles, respectively. Flood discharges for 5-, lo-, and 25-year recurrence-interval storm events were calculated at the stream mouths using flood-frequency relations developed for use at small urban streams in Tennessee. For each stream, flood discharges at locations upstream from the mouth were calculated by subdividing the watershed and assigning a percentage of the discharge at the mouth, based on drainage area, to each subarea. Flood profiles for the selected recurrence-interval flood discharges were simulated for Akin Branch and Cayce Valley Branch for existing conditions and conditions that might exist if drainage improvements such as larger culverts and bridges and channel improvements are constructed. The results of the simulations were used to predict changes in flood elevations that might result from such drainage improvements. Analyses indicate that reductions in existing flood elevations of as much as 2.1 feet for the 5-year flood at some sites on Akin Branch and as much as 3.8 feet for the 5-year flood at some sites on Cayce Valley Branch might be expected with the drainage improvements.

  8. Fine-Branched Ridges

    NASA Image and Video Library

    2015-10-14

    This image from NASA Mars Reconnaissance Orbiter spacecraft shows numerous branching ridges with various degrees of sinuosity. These branching forms resemble tributaries funneling and draining into larger channel trunks towards the upper portion of the scene. The raised relief of these branching ridges suggests that these are ancient channels are inverted due to lithification and cementation of the riverbed sediment, which made it more resistant to erosion than the surrounding material. Wind-blown bedforms are abundant and resemble small ridges that are aligned in an approximately north-south direction. http://photojournal.jpl.nasa.gov/catalog/PIA20006

  9. Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB-TAVI Study.

    PubMed

    Massoullié, Grégoire; Bordachar, Pierre; Irles, Didier; Caussin, Christophe; Da Costa, Antoine; Defaye, Pascal; Jean, Frédéric; Mechulan, Alexis; Mondoly, Pierre; Souteyrand, Géraud; Pereira, Bruno; Ploux, Sylvain; Eschalier, Romain

    2016-10-26

    Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His-ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV <70 ms) will be implanted with a loop recorder device with remote monitoring of cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and implanted device follow-up will also be performed at 3, 6 and 12 months. The primary objective is to assess the efficacy and safety of a decisional algorithm based on electrophysiological study and remote monitoring of CIEDs in the prediction of high-grade conduction disturbances in patients with LBBB after TAVI. The primary end point is to compare the incidence (rate and time to onset) of high-grade conduction disturbances in patients with LBBB after TAVI between the two groups at 12 months. Given the proportion of high-grade conduction disturbances (20-40%), a sample of 200 subjects will allow a margin of error of 6-7%. The LBBB-TAVI Study has been in an active recruiting phase since September 2015 (21 patients already included). Local ethics committee authorisation was obtained in May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. NCT02482844; Pre-results. Published by the BMJ Publishing Group Limited. For

  10. Increased GABA Levels in Medial Prefrontal Cortex of Young Adults with Narcolepsy

    PubMed Central

    Kim, Seog Ju; Lyoo, In Kyoon; Lee, Yujin S.; Sung, Young Hoon; Kim, Hengjun J.; Kim, Jihyun H.; Kim, Kye Hyun; Jeong, Do-Un

    2008-01-01

    Study Objectives: To explore absolute concentrations of brain metabolites including gamma amino-butyric acid (GABA) in the medial prefrontal cortex and basal ganglia of young adults with narcolepsy. Design: Proton magnetic resonance (MR) spectroscopy centered on the medial prefrontal cortex and the basal ganglia was acquired. The absolute concentrations of brain metabolites including GABA and glutamate were assessed and compared between narcoleptic patients and healthy comparison subjects. Setting: Sleep and Chronobiology Center at Seoul National University Hospital; A high strength 3.0 Tesla MR scanner in the Department of Radiology at Seoul National University Hospital. Patients or Participants: Seventeen young adults with a sole diagnosis of HLA DQB1 0602 positive narcolepsy with cataplexy (25.1 ± 4.6 years old) and 17 healthy comparison subjects (26.8 ± 4.8 years old). Interventions: N/A. Measurements and Results: Relative to comparison subjects, narcoleptic patients had higher GABA concentration in the medial prefrontal cortex (t = 4.10, P <0.001). Narcoleptic patients with nocturnal sleep disturbance had higher GABA concentration in the medial prefrontal cortex than those without nocturnal sleep disturbance (t = 2.45, P= 0.03), but had lower GABA concentration than comparison subjects (t = 2.30, P = 0.03). Conclusions: The current study reports that young adults with narcolepsy had a higher GABA concentration in the medial prefrontal cortex, which was more prominent in patients without nocturnal sleep disturbance. Our findings suggest that the medial prefrontal GABA level may be increased in narcolepsy, and the increased medial prefrontal GABA might be a compensatory mechanism to reduce nocturnal sleep disturbances in narcolepsy. Citation: Kim SJ; Lyoo IK; Lee YS; Sung YH; Kim HJ; Kim JH; Kim KH; Jeong DU. Increased GABA levels in medial prefrontal cortex of young adults with narcolepsy. SLEEP 2008;31(3):342-347. PMID:18363310

  11. [SECOT consensus on medial femorotibial osteoarthritis].

    PubMed

    Moreno, A; Silvestre, A; Carpintero, P

    2013-01-01

    A consensus, prepared by SECOT, is presented on the management of medial knee compartment osteoarthritis, in order to establish clinical criteria and recommendations directed at unifying the criteria in its management, dealing with the factors involved in the pathogenesis of medial femorotibial knee osteoarthritis, the usefulness of diagnostic imaging techniques, and the usefulness of arthroscopy. Conservative and surgical treatments are also analysed. The experts consulted showed a consensus (agreed or disagreed) in 65.8% of the items considered, leaving 14items where no consensus was found, which included the aetiopathogenesis of the osteoarthritis, the value of NMR in degenerative disease, the usefulness of COX-2 and the chondroprotective drugs, as well as on the ideal valgus tibial osteotomy technique. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  12. Geranylgeranyl Diphosphate Synthase Modulates Fetal Lung Branching Morphogenesis Possibly through Controlling K-Ras Prenylation.

    PubMed

    Jia, Wen-Jun; Jiang, Shan; Tang, Qiao-Li; Shen, Di; Xue, Bin; Ning, Wen; Li, Chao-Jun

    2016-06-01

    G proteins play essential roles in regulating fetal lung development, and any defects in their expression or function (eg, activation or posttranslational modification) can lead to lung developmental malformation. Geranylgeranyl diphosphate synthase (GGPPS) can modulate protein prenylation that is required for protein membrane-anchoring and activation. Here, we report that GGPPS regulates fetal lung branching morphogenesis possibly through controlling K-Ras prenylation during fetal lung development. GGPPS was continuously expressed in lung epithelium throughout whole fetal lung development. Specific deletion of geranylgeranyl diphosphate synthase 1 (Ggps1) in lung epithelium during fetal lung development resulted in neonatal respiratory distress syndrome-like disease. The knockout mice died at postnatal day 1 of respiratory failure, and the lungs showed compensatory pneumonectasis, pulmonary atelectasis, and hyaline membranes. Subsequently, we proved that lung malformations in Ggps1-deficient mice resulted from the failure of fetal lung branching morphogenesis. Further investigation revealed Ggps1 deletion blocked K-Ras geranylgeranylation and extracellular signal-related kinase 1 or 2/mitogen-activated protein kinase signaling, which in turn disturbed fibroblast growth factor 10 regulation on fetal lung branching morphogenesis. Collectively, our data suggest that GGPPS is essential for maintaining fetal lung branching morphogenesis, which is possibly through regulating K-Ras prenylation. Copyright © 2016 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  13. An Anatomical Assessment of Branch Abscission and Branch-base Hydraulic Architecture in the Endangered Wollemia nobilis

    PubMed Central

    Burrows, G. E.; Meagher, P. F.; Heady, R. D.

    2007-01-01

    Background and Aims The branch-base xylem structure of the endangered Wollemia nobilis was anatomically investigated. Wollemia nobilis is probably the only extant tree species that produces only first-order branches and where all branches are cleanly abscised. An investigation was carried out to see if these unusual features might influence branch-base xylem structure and water supply to the foliage. Methods The xylem was sectioned at various distances along the branch bases of 6-year-old saplings. Huber values and relative theoretical hydraulic conductivities were calculated for various regions of the branch base. Key Results The most proximal branch base featured a pronounced xylem constriction. The constriction had only 14–31 % (average 21 %) of the cross-sectional area and 20–42 % (average 28 %) of the theoretical hydraulic conductivity of the more distal branch xylem. Wollemia nobilis had extremely low Huber values for a conifer. Conclusions The branch-base xylem constriction would appear to facilitate branch abscission, while the associated Huber values show that W. nobilis supplies a relatively large leaf area through a relatively small diameter ‘pipe’. It is tempting to suggest that the pronounced decline of W. nobilis in the Tertiary is related to its unusual branch-base structure but physiological studies of whole plant conductance are still needed. PMID:17272303

  14. Lesions of the medial prefrontal cortex cause maladaptive sexual behavior in male rats.

    PubMed

    Davis, Jon F; Loos, Maarten; Di Sebastiano, Andrea R; Brown, Jennifer L; Lehman, Michael N; Coolen, Lique M

    2010-06-15

    An inability to inhibit behaviors once they become maladaptive is a component of several psychiatric illnesses, and the medial prefrontal cortex (mPFC) was identified as a potential mediator of behavioral inhibition. The current study tested if the mPFC is involved in inhibition of sexual behavior when associated with aversive outcomes. Using male rats, effects of lesions of the infralimbic and prelimbic areas of the mPFC on expression of sexual behavior and ability to inhibit mating were tested using a paradigm of copulation-contingent aversion. Medial prefrontal cortex lesions did not alter expression of sexual behavior. In contrast, mPFC lesions completely blocked the acquisition of sex-aversion conditioning and lesioned animals continued to mate, in contrast to the robust behavioral inhibition toward copulation in mPFC intact male animals, resulting in only 22% of intact male animals continuing to mate. However, rats with mPFC lesions were capable of forming a conditioned place preference to sexual reward and conditioned place aversion for lithium chloride, suggesting that these lesions did not alter associative learning or sensitivity for lithium chloride. The current study indicates that animals with mPFC lesions are likely capable of forming the associations with aversive outcomes of their behavior but lack the ability to suppress seeking of sexual reward in the face of aversive consequences. These data may contribute to a better understanding of a common pathology underlying impulse control disorders, as compulsive sexual behavior has a high prevalence of comorbidity with psychiatric disorders and Parkinson's disease.

  15. Disruption of the Aortic Elastic Lamina and Medial Calcification Share Genetic Determinants in Mice

    PubMed Central

    Wang, Susanna S.; Martin, Lisa J.; Schadt, Eric E.; Meng, Haijin; Wang, Xuping; Zhao, Wei; Ingram-Drake, Leslie; Nebohacova, Martina; Mehrabian, Margarete; Drake, Thomas A.; Lusis, Aldons J.

    2010-01-01

    Background Disruption of the elastic lamina, as an early indicator of aneurysm formation, and vascular calcification frequently occur together in atherosclerotic lesions of humans. Methods and Results We now report evidence of shared genetic basis for disruption of the elastic lamina (medial disruption) and medial calcification in an F2 mouse intercross between C57BL/6J and C3H/HeJ on a hyperlipidemic apolipoprotein E (ApoE−/−) null background. We identified 3 quantitative trait loci (QTLs) on chromosomes 6, 13, and 18, which are common to both traits, and 2 additional QTLs for medial calcification on chromosomes 3 and 7. Medial disruption, including severe disruptions leading to aneurysm formation, and medial calcification were highly correlated and occurred concomitantly in the cross. The chromosome 18 locus showed a striking male sex-specificity for both traits. To identify candidate genes, we integrated data from microarray analysis, genetic segregation, and clinical traits. The chromosome 7 locus contains the Abcc6 gene, known to mediate myocardial calcification. Using transgenic complementation, we show that Abcc6 also contributes to aortic medial calcification. Conclusions Our data indicate that calcification, though possibly contributory, does not always lead to medial disruption and that in addition to aneurysm formation, medial disruption may be the precursor to calcification. PMID:20031637

  16. Quinone reduction via secondary B-branch electron transfer in mutant bacterial reaction centers.

    PubMed

    Laible, Philip D; Kirmaier, Christine; Udawatte, Chandani S M; Hofman, Samuel J; Holten, Dewey; Hanson, Deborah K

    2003-02-18

    Symmetry-related branches of electron-transfer cofactors-initiating with a primary electron donor (P) and terminating in quinone acceptors (Q)-are common features of photosynthetic reaction centers (RC). Experimental observations show activity of only one of them-the A branch-in wild-type bacterial RCs. In a mutant RC, we now demonstrate that electron transfer can occur along the entire, normally inactive B-branch pathway to reduce the terminal acceptor Q(B) on the time scale of nanoseconds. The transmembrane charge-separated state P(+)Q(B)(-) is created in this manner in a Rhodobacter capsulatus RC containing the F(L181)Y-Y(M208)F-L(M212)H-W(M250)V mutations (YFHV). The W(M250)V mutation quantitatively blocks binding of Q(A), thereby eliminating Q(B) reduction via the normal A-branch pathway. Full occupancy of the Q(B) site by the native UQ(10) is ensured (without the necessity of reconstitution by exogenous quinone) by purification of RCs with the mild detergent, Deriphat 160-C. The lifetime of P(+)Q(B)(-) in the YFHV mutant RC is >6 s (at pH 8.0, 298 K). This charge-separated state is not formed upon addition of competitive inhibitors of Q(B) binding (terbutryn or stigmatellin). Furthermore, this lifetime is much longer than the value of approximately 1-1.5 s found when P(+)Q(B)(-) is produced in the wild-type RC by A-side activity alone. Collectively, these results demonstrate that P(+)Q(B)(-) is formed solely by activity of the B-branch carriers in the YFHV RC. In comparison, P(+)Q(B)(-) can form by either the A or B branches in the YFH RC, as indicated by the biexponential lifetimes of approximately 1 and approximately 6-10 s. These findings suggest that P(+)Q(B)(-) states formed via the two branches are distinct and that P(+)Q(B)(-) formed by the B side does not decay via the normal (indirect) pathway that utilizes the A-side cofactors when present. These differences may report on structural and energetic factors that further distinguish the functional

  17. Radiotherapy as a cause of complete atrioventricular block in Hodgkin's disease. An electrophysiological-pathological correlation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cohen, S.I.; Bharati, S.; Glass, J.

    1981-04-01

    A 20-year-old man contracted Hodgkin's disease and was treated with mantle radiotherapy. Heart block developed 11 years later. Electrocardiograms revealed predominant atrioventricular (AV) block and occasional AV conduction. Intracardiac electrograms demonstrated that the site of AV block was above the level of the His bundle. A permanent transvenous pacemaker was implanted. Seven months later the patient died of complications from cryptococcal meningitis. Pathological study of the heart revealed marked arteriosclerosis with fibrosis of the epicardium, myocardium, and endocardium. Examination of the conduction system revealed extensive arteriolosclerosis of the sinoatrial node and its approaches. In addition, there was marked fibrosis ofmore » the approaches to the AV node, the AV bundle, and both bundle branches. There was no evidence of Hodgkin's disease. This case documents the rare occurrence of AV block due to tissue destruction by radiotherapy. There was a good correlation between block proximal to the His bundle recording site and fibrosis of the approaches to the AV node.« less

  18. Radiotherapy as a cause of complete atrioventricular block in Hodgkin's disease: an electrophysiological-pathological correlation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cohen, S.I.; Bharati, S.; Glass, J.

    1981-04-01

    A 20-year-old man contracted Hodgkin's disease and was treated with mantle radiotherapy. Heart block developed 11 years later. Electrocardiograms revealed predominant atrioventricular (AV) block and occasional AV conduction. Intracardiac electrograms demonstrated that the site of AV block was above the level of the His bundle. A permanent transvenous pacemaker was implanted. Seven months later the patient died of complications from cryptococcal meningitis. Pathological study of the heart revealed marked arteriosclerosis with fibrosis of the epicardium, myocardium, and endocardium. Examination of the conduction system revealed extensive arteriolosclerosis of the sinoatrial node and its approaches. In addition, there was marked fibrosis ofmore » the approaches to the AV node, the AV bundle, and both bundle branches. There was no evidence of Hodgkin's disease. This case documents the rare occurrence of AV block due to tissue destruction by radiotherapy. There was a good correlation between block proximal to the His bundle recording site and fibrosis of the approaches to the AV node.« less

  19. "A Tale of Two Planes": Deep Versus Superficial Serratus Plane Block for Postmastectomy Pain Syndrome.

    PubMed

    Piracha, Mohammad M; Thorp, Stephen L; Puttanniah, Vinay; Gulati, Amitabh

    Postmastectomy pain syndrome (PMPS) is a significant burden for breast cancer survivors. Although multiple therapies have been described, an evolving field of serratus anterior plane blocks has been described in this population. We describe the addition of the deep serratus anterior plane block (DSPB) for PMPS. Four patients with history of PMPS underwent DSPB for anterior chest wall pain. A retrospective review of these patients' outcomes was obtained through postprocedure interviews. Three of the patients previously had a superficial serratus anterior plane block, which was not as efficacious as the DSPB. The fourth patient had a superficial serratus anterior plane that was difficult to separate with hydrodissection but had improved pain control with a DSPB. We illustrate 4 patients who have benefitted from a DSPB and describe indications that this block may be more efficacious than a superficial serratus plane block. Further study is recommended to understand the intercostal nerve branches within the lateral and anterior muscular chest wall planes.

  20. The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players.

    PubMed

    Xu, Huan; Wang, Pin; Ye, Zhuo'er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

    2016-01-01

    Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

  1. The Contingency of Cocaine Administration Accounts for Structural and Functional Medial Prefrontal Deficits and Increased Adrenocortical Activation

    PubMed Central

    Anderson, Rachel M.; Cosme, Caitlin V.; Glanz, Ryan M.; Miller, Mary C.; Romig-Martin, Sara A.; LaLumiere, Ryan T.

    2015-01-01

    The prelimbic region (PL) of the medial prefrontal cortex (mPFC) is implicated in the relapse of drug-seeking behavior. Optimal mPFC functioning relies on synaptic connections involving dendritic spines in pyramidal neurons, whereas prefrontal dysfunction resulting from elevated glucocorticoids, stress, aging, and mental illness are each linked to decreased apical dendritic branching and spine density in pyramidal neurons in these cortical fields. The fact that cocaine use induces activation of the stress-responsive hypothalamo-pituitary-adrenal axis raises the possibility that cocaine-related impairments in mPFC functioning may be manifested by similar changes in neuronal architecture in mPFC. Nevertheless, previous studies have generally identified increases, rather than decreases, in structural plasticity in mPFC after cocaine self-administration. Here, we use 3D imaging and analysis of dendritic spine morphometry to show that chronic cocaine self-administration leads to mild decreases of apical dendritic branching, prominent dendritic spine attrition in PL pyramidal neurons, and working memory deficits. Importantly, these impairments were largely accounted for in groups of rats that self-administered cocaine compared with yoked-cocaine- and saline-matched counterparts. Follow-up experiments failed to demonstrate any effects of either experimenter-administered cocaine or food self-administration on structural alterations in PL neurons. Finally, we verified that the cocaine self-administration group was distinguished by more protracted increases in adrenocortical activity compared with yoked-cocaine- and saline-matched controls. These studies suggest a mechanism whereby increased adrenocortical activity resulting from chronic cocaine self-administration may contribute to regressive prefrontal structural and functional plasticity. SIGNIFICANCE STATEMENT Stress, aging, and mental illness are each linked to decreased prefrontal plasticity. Here, we show that chronic

  2. Ecological divergence and medial cuneiform morphology in gorillas.

    PubMed

    Tocheri, Matthew W; Solhan, Christyna R; Orr, Caley M; Femiani, John; Frohlich, Bruno; Groves, Colin P; Harcourt-Smith, William E; Richmond, Brian G; Shoelson, Brett; Jungers, William L

    2011-02-01

    Gorillas are more closely related to each other than to any other extant primate and are all terrestrial knuckle-walkers, but taxa differ along a gradient of dietary strategies and the frequency of arboreality in their behavioral repertoire. In this study, we test the hypothesis that medial cuneiform morphology falls on a morphocline in gorillas that tracks function related to hallucial abduction ability and relative frequency of arboreality. This morphocline predicts that western gorillas, being the most arboreal, should display a medial cuneiform anatomy that reflects the greatest hallucial abduction ability, followed by grauer gorillas, and then by mountain gorillas. Using a three-dimensional methodology to measure angles between articular surfaces, relative articular and nonarticular areas, and the curvatures of the hallucial articular surface, the functional predictions are partially confirmed in separating western gorillas from both eastern gorillas. Western gorillas are characterized by a more medially oriented, proportionately larger, and more mediolaterally curved hallucial facet than are eastern gorillas. These characteristics follow the predictions for a more prehensile hallux in western gorillas relative to a more stable, plantigrade hallux in eastern gorillas. The characteristics that distinguish eastern gorilla taxa from one another appear unrelated to hallucial abduction ability or frequency of arboreality. In total, this reexamination of medial cuneiform morphology suggests differentiation between eastern and western gorillas due to a longstanding ecological divergence and more recent and possibly non-adaptive differences between eastern taxa. Published by Elsevier Ltd.

  3. Vesicle-mediated growth of tubular branches and centimeter-long microtubes from a single molecule.

    PubMed

    Abbas, Abdennour; Brimer, Andrew; Tian, Limei; d'Avignon, D André; Hameed, Abdulrahman Shahul; Vittal, Jagadese J; Singamaneni, Srikanth

    2013-08-12

    The mechanism by which small molecules assemble into microscale tubular structures in aqueous solution remains poorly understood, particularly when the initial building blocks are non-amphiphilic molecules and no surfactant is used. It is here shown how a subnanometric molecule, namely p-aminothiophenol (p-ATP), prepared in normal water with a small amount of ethanol, spontaneously assembles into a new class of nanovesicle. Due to Brownian motion, these nanostructures rapidly grow into micrometric vesicles and start budding to yield macroscale tubular branches with a remarkable growth rate of ∼20 μm s⁻¹. A real-time visualization by optical microscopy reveals that tubular growth proceeds by vesicle walk and fusion on the apex (growth cone) and sides of the branches and ultimately leads to the generation of centimeter-long microtubes. This unprecedented growth mechanism is triggered by a pH-activated proton switch and maintained by hydrogen bonding. The vesicle fusion-mediated synthesis suggests that functional microtubes with biological properties can be efficiently prepared with a mixture of appropriate diaminophenyl blocks and the desired macromolecule. The reversibility, timescale, and very high yield (90%) of this synthetic approach make it a valuable model for the investigation of hierarchical and structural transition between organized assemblies with different size scales and morphologies. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  4. Phonatory Effects of Type I Thyroplasty Implant Shape and Depth of Medialization in Unilateral Vocal Fold Paralysis

    PubMed Central

    Orestes, Michael I.; Neubauer, Juergen; Sofer, Elazar; Salinas, Jonathon; Chhetri, Dinesh K.

    2015-01-01

    Objectives/Hypothesis Medialization thyroplasty (MT) is commonly used to treat glottic insufficiency. In this study, we investigated the phonatory effects of MT implant medialization depth and medial surface shape. Methods Recurrent laryngeal nerve (RLN) and vagal paralysis were simulated in an in vivo canine. A type 1 MT was performed using a silicone elastomer implant with variable medialization depths and medial surface shapes: rectangular, V-shaped, divergent, and convergent. The effects on phonation onset flow/pressure relationships and acoustics were measured. Results Increasing depth of medialization led to improvements in fundamental frequency (F0) range and normalization of the slope of pressure/flow relationship toward baseline activation conditions. The effects of implant medial shape also depended on depth of medialization. Outcome measures were similar among the implants at smaller medialization depths. With large medialization depths and vagal paralysis conditions, the divergent implant maintained pressure/flow relationship closer to baseline. The vagal paralysis conditions also demonstrated decreased fundamental frequency range and worse flow/pressure relationship compared to RLN paralysis. Conclusions The depth and medial shape of a medialization laryngoplasty (ML) implant significantly affect both the F0 range and aerodynamic power required for phonation. These effects become more notable with increasing depth of medialization. The study also illustrates that ML is less effective in vagal paralysis compared to RLN paralysis. PMID:25046146

  5. Lateral Meniscal Allograft Transplant via a Medial Approach Leads to Less Extrusion.

    PubMed

    Choi, Nam-Hong; Choi, Jeong-Ki; Yang, Bong-Seok; Lee, Doe-Hyun; Victoroff, Brian N

    2017-10-01

    Accurate positioning of the bony bridge is crucial to prevent extrusion of meniscal allografts after transplant. However, oblique or lateralized placement of the bony bridge of the lateral meniscal allograft may occur due to technical error or a limited visual field. The patellar tendon may be an obstacle to approaching the anterior horn of the lateral meniscus, resulting in a laterally placed allograft. Therefore, lateral meniscal transplant through a medial arthrotomy would be an alternative approach. However, no report exists regarding allograft extrusion when comparing medial and lateral arthrotomy techniques in lateral meniscal transplants. Extrusion of the midbody of the allograft is less severe and the rotation of the bony bridge is less oblique in lateral meniscal allograft transplants through the medial parapatellar approach than those through the lateral approach. Cohort study; Level of evidence, 3. A bony bridge was used to perform 55 lateral meniscal transplants through either a medial or a lateral arthrotomy. Thirty-two allografts were transplanted through a medial arthrotomy and 23 were transplanted through a lateral arthrotomy, not randomly. Because correct positioning of the bony trough through the medial arthrotomy was easier than that through the lateral arthrotomy, the method of the arthrotomy was changed for the latter. The procedure for both groups was identical except for the arthrotomy technique, and rehabilitation was identical for both groups. Follow-up magnetic resonance imaging was conducted for all patients to measure the postoperative extrusion and obliquity of the bony bridge of the allograft. On the coronal view, extrusion was measured as the distance between the outer edge of the articular cartilage of the lateral tibial plateau and the outer edge of the meniscal allograft. On the axial view, a line (line B) was drawn along the longitudinal axis of the bony bridge. The posterior tibial condylar tangential line was drawn between the

  6. Does Medial Meniscal Allograft Transplantation With the Bone-Plug Technique Restore the Anatomic Location of the Native Medial Meniscus?

    PubMed

    Kim, Nam-Ki; Bin, Seong-Il; Kim, Jong-Min; Lee, Chang-Rack

    2015-12-01

    Previous work has shown the importance of restoring the normal structure of the native meniscus with meniscal allograft transplantation. The purpose of this study was to compare the anatomic positions of the anterior horn and posterior horn between the preoperative medial meniscus and the postoperative meniscal allograft after medial meniscal allograft transplantation with the bone-plug technique. The hypothesis was that the bone-plug technique could restore the preoperative structure of the native medial meniscus. Case series; Level of evidence, 4. Between December 1999 and December 2013, a total of 59 patients (49 male, 10 female) underwent medial meniscal allograft transplantation by use of the bone-plug technique. The anatomic positions of both horns in the native medial meniscus and in the meniscal allograft were measured via MRI. The percentage reference method was used to measure the locations of both horns. On coronal MRI, the mean absolute distance of the posterior horn from the lateral border of the tibial plateau changed from 45.2 ± 3.3 to 48.1 ± 4.2 mm (P < .05), and the percentage distance of the posterior horn changed from 59.6% to 63.0% (P < .05). On sagittal MRI, the mean absolute distance of the posterior horn from the anterior reference point changed from 40.3 ± 3.0 to 42.0 ± 3.5 mm (P < .05), and the mean percentage distance of the posterior horn changed from 76.5% to 79.4% (P <.05). On coronal MRI, the mean absolute distance of the anterior horn from the lateral border of the tibial plateau changed from 41.3 ± 4.2 to 48.5 ± 5.6 mm (P < .05), and the mean percentage distance of the anterior horn changed from 54.5% to 63.8% (P < .05). On sagittal MRI, the mean absolute distance of the anterior horn from the anterior reference point changed from 5.5 ± 1.0 to 9.9 ± 2.9 mm (P < .05), and the mean percentage distance of the anterior horn changed from 10.6% to 19.0% (P < .05). Despite attempts to place the meniscal allograft in the same

  7. Inhomogeneity of block copolymers at the interface of an immiscible polymer blend

    NASA Astrophysics Data System (ADS)

    Ryu, Ji Ho; Kim, YongJoo; Lee, Won Bo

    2018-04-01

    We present the effects of structure and stiffness of block copolymers on the interfacial properties of an immiscible homopolymer blend. Diblock and two-arm grafted copolymers with variation in stiffness are modeled using coarse-grained molecular dynamics to compare the compatibilization efficiency, i.e., reduction of interfacial tension. Overall, grafted copolymers are located more compactly at the interface and show better compatibilization efficiency than diblock copolymers. In addition, an increase in the stiffness for one of the blocks of the diblock copolymers causes unusual inhomogeneous interfacial coverage due to bundle formation. However, an increase in the stiffness for one of blocks of the grafted copolymers prevents the bundle formation due to the branched chain. As a result, homogeneous interfacial coverage of homopolymer blends is realized with significant reduction of interfacial tension which makes grafted copolymer a better candidate for the compatibilizer of immiscible homopolymer blend.

  8. Earthquake bursts and fault branching: lessons from the Carmel fault branch (CFB) of the Dead Sea Transform (DST)

    NASA Astrophysics Data System (ADS)

    Agnon, A.; Rockwell, T. K.; Stein, S.; Raphael, K.

    2017-12-01

    The DST, accommodating most of the displacement across the boundary zone between the Arabian and Sinai plates, is an ideal plate boundary on which to study earthquake sequences because of 1) a long (>2 kyr) record of historical earthquakes (corroborated and extended several millennia back with ancient ruins); 2) deformed sediments and rockfalls, offering datable archives of strong shaking at various distances from the fault, spanning 300 kyr; 3) a moderate fault slip rate, allowing separation and dating of individual earthquakes for comparison to the historical record, and 4) a growing body of paleoseismic trench data on both timing and displacement across some sectors of the fault. Here we explore the role of a secondary fault branch on clustering using a new approach for the analysis of earthquake bursts. The CFZ is a ≥100 km long shear zone, branching northwestward from the N-S trending Jordan Valley segment of the DST. GPS monitoring of the CFZ indicates a slip rate of <1 mm/yr, absorbing up to 20% of the slip between Arabia Plate and the Sinai-Levant Block across the DST. CFZ seismicity is recorded by three datasets with different time scales and maximum magnitudes: 1) Instrumental seismicity, M≤5.3 (1984); 2) Historic documents suggesting a M>6 event in 363 CE, with ruins distributed up to 100 km from the CFZ; 3) 5 ka cave deposits showing damage greater than from any subsequent earthquake, implying 6The CFZ branch events interact with ruptures on the main DST. At 5 ka destruction was widespread along the DST. The 363 CE earthquake was accompanied by another event in the Arava Valley. The pair skipped the 100 km long Dead Sea segment of the DST. An earlier pair in the northern Levant preceded that pair by several decades: 303 & 347 CE, following a two-century long quiescence, and a harbinger for a shaky millennium. We suggest that the 363 CE pair reflects a rare state that enables a CFZ rupture. This oblique branch is unfavorably oriented for slip under

  9. Analysis of interface crack branching

    NASA Technical Reports Server (NTRS)

    Ballarini, R.; Mukai, D. J.; Miller, G. R.

    1989-01-01

    A solution is presented for the problem of a finite length crack branching off the interface between two bonded dissimilar isotropic materials. Results are presented in terms of the ratio of the energy release rate of a branched interface crack to the energy release rate of a straight interface crack with the same total length. It is found that this ratio reaches a maximum when the interface crack branches into the softer material. Longer branches tend to have smaller maximum energy release rate ratio angles indicating that all else being equal, a branch crack will tend to turn back parallel to the interface as it grows.

  10. Rod/Coil Block Copolyimides for Ion-Conducting Membranes

    NASA Technical Reports Server (NTRS)

    Meador, Mary Ann B.; Kinder, James D.

    2003-01-01

    Rod/coil block copolyimides that exhibit high levels of ionic conduction can be made into diverse products, including dimensionally stable solid electrolyte membranes that function well over wide temperature ranges in fuel cells and in lithium-ion electrochemical cells. These rod/coil block copolyimides were invented to overcome the limitations of polymers now used to make such membranes. They could also be useful in other electrochemical and perhaps some optical applications, as described below. The membranes of amorphous polyethylene oxide (PEO) now used in lithium-ion cells have acceptably large ionic conductivities only at temperatures above 60 C, precluding use in what would otherwise be many potential applications at lower temperatures. PEO is difficult to process, and, except at the highest molecular weights it is not very dimensionally stable. It would be desirable to operate fuel cells at temperatures above 80 C to take advantage of better kinetics of redox reactions and to reduce contamination of catalysts. Unfortunately, proton-conduction performance of a typical perfluorosulfonic polymer membrane now used as a solid electrolyte in a fuel cell decreases with increasing temperature above 80 C because of loss of water from within the membrane. The loss of water has been attributed to the hydrophobic nature of the polymer backbone. In addition, perfluorosulfonic polymers are expensive and are not sufficiently stable for long-term use. Rod/coil block copolyimides are so named because each molecule of such a polymer comprises short polyimide rod segments alternating with flexible polyether coil segments (see figure). The rods and coils can be linear, branched, or mixtures of linear and branched. A unique feature of these polymers is that the rods and coils are highly incompatible, giving rise to a phase separation with a high degree of ordering that creates nanoscale channels in which ions can travel freely. The conduction of ions can occur in the coil phase

  11. Lateral trunk lean and medializing the knee as gait strategies for knee osteoarthritis.

    PubMed

    Gerbrands, T A; Pisters, M F; Theeven, P J R; Verschueren, S; Vanwanseele, B

    2017-01-01

    To determine (1) if Medial Thrust or Trunk Lean reduces the knee adduction moment (EKAM) the most during gait in patients with medial knee osteoarthritis, (2) if the best overall strategy is the most effective for each patient and (3) if these strategies affect ankle and hip kinetics. Thirty patients with symptomatic medial knee osteoarthritis underwent 3-dimensional gait analysis. Participants received verbal instructions on two gait strategies (Trunk Lean and Medial Thrust) in randomized order after comfortable walking was recorded. The peaks and impulse of the EKAM and strategy-specific kinematic and kinetic variables were calculated for all conditions. Early stance EKAM peak was significantly reduced during Medial Thrust (-29%). During Trunk Lean, early and late stance EKAM peak and EKAM impulse reduced significantly (38%, 21% and -25%, respectively). In 79% of the subjects, the Trunk Lean condition was significantly more effective in reducing EKAM peak than Medial Thrust. Peak ankle dorsi and plantar flexion, knee flexion and hip extension and adduction moments were not significantly increased. Medial Thrust and Trunk Lean reduced the EKAM during gait in patients with knee osteoarthritis. Individual selection of the most effective gait modification strategy seems vital to optimally reduce dynamic knee loading during gait. No detrimental effects on external ankle and hip moments or knee flexion moments were found for these conditions. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. An efficient mechanism for enhancing the thermoelectricity of nanoribbons by blocking phonon transport in 2D materials.

    PubMed

    Liu, Yue-Yang; Zeng, Yu-Jia; Jia, Pin-Zhen; Cao, Xuan-Hao; Jiang, Xiangwei; Chen, Ke-Qiu

    2018-07-11

    Inspired by the novel mechanism of reducing thermal conductivity by local phonon resonance instead of by inducing structural defects, we investigate the effect of side branching on the thermoelectric properties of [Formula: see text] nanoribbons, and prove that side branching is a highly efficient mechanism for enhancing the thermoelectricity of different kinds of nanoribbons. For both armchair and zigzag [Formula: see text] nanoribbons, the side branches result in not only significant blocking of phonon transport but also notable increase of the Seebeck coefficient. Consequently, the thermoelectric figure of merit of the armchair [Formula: see text] nanoribbon is boosted from 0.72 to as high as 1.93, and the originally non-thermoelectric metallic zigzag [Formula: see text] nanoribbon is turned into a thermoelectric material due to the appearance of the band gap induced by the side branches. These results mean that the mechanism of branching is not only very efficient, but also takes effect regardless of the original properties of the nanoribbons, and thus will hold great promise for its application in the thermoelectric field.

  13. Bilateral Vocal Fold Medialization: A Treatment for Abductor Spasmodic Dysphonia.

    PubMed

    Dewan, Karuna; Berke, Gerald S

    2017-11-10

    Abductor spasmodic dysphonia, a difficult-to-treat laryngologic condition, is characterized by spasms causing the vocal folds to remain abducted despite efforts to adduct them during phonation. Traditional treatment for abductor spasmodic dysphonia-botulinum toxin injection into the posterior cricoarytenoid muscle-can be both technically challenging and uncomfortable. Due to the difficulty of needle placement, it is often unsuccessful. The purpose of this investigation is to present a previously undescribed treatment for abductor spasmodic dysphonia-bilateral vocal fold medialization. A retrospective case review of all cases of abductor spasmodic dysphonia treated in a tertiary care laryngology practice with bilateral vocal fold medialization over a 10-year period was performed. The Voice Handicap Index and the Voice-Related Quality of Life surveys were utilized to assess patient satisfaction with voice outcome. Six patients with abductor spasmodic dysphonia treated with bilateral vocal fold medialization were identified. Disease severity ranged from mild to severe. All six patients reported statistically significant improvement in nearly all Voice Handicap Index and Voice-Related Quality of Life parameters. They reported fewer voice breaks and greater ease of communication. Results were noted immediately and symptoms continue to be well controlled for many years following medialization. Bilateral vocal fold medialization is a safe and effective treatment for abductor spasmodic dysphonia. It is performed under local anesthesia and provides phonation improvement in the short and long term. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  14. Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children.

    PubMed

    Gourineni, Prasad; Gupta, Asheesh

    2011-10-01

    Tillaux and Triplane fractures occur in children predominantly from external rotation mechanism. We hypothesized that in displaced fractures, the talus would shift laterally along with the distal fibula and the distal tibial epiphyseal fragment increasing the medial joint space. Consecutive cases evaluated retrospectively. Level I and Level II centers. Twenty-two skeletally immature patients with 14 displaced Triplane fractures and eight displaced Tillaux fractures were evaluated for medial joint space widening. Measurement of fracture displacement and medial joint space widening before and after intervention. Thirteen Triplane and six Tillaux fractures (86%) showed medial space widening of 1 to 9 mm and equal to the amount of fracture displacement. Reduction of the fracture reduced the medial space to normal. There were no known complications. Medial space widening of the ankle may be a sign of ankle fracture displacement. Anatomic reduction of the fracture reduces the medial space and may improve the results in Tillaux and Triplane fractures.

  15. [Croatian Medical Association--Branch Zagreb].

    PubMed

    Kaić, Zvonimir; Sain, Snjezana; Gulić, Mirjana; Mahovlić, Vjekoslav; Krznarić, Zeljko

    2014-01-01

    The available literature shows us that "Druztvo ljeciteljah u Zagrebus (the Society of Healers in Zagreb) was founded as far back as the year 1845 by a total of thirteen members. This data allows us to follow the role of doctors and health workers in Zagreb through their everyday profession, research, organizational and social work as well as management through a period of over one hundred to seventy years. The Branch Zagreb was active before the official establishment of subsidiaries of CMA which is evident from the minutes of the regular annual assembly of the Croatian Medical Association on 21 March 1948. Until the end of 1956, there was no clear division of labor, functions and competencies between the Branch and the Main Board. Their actions were instead consolidated and the Branch operated within and under the name of Croatian Medical Association. In that year the Branch became independent. The Branch Zagreb is the largest and one of the most active branches of the Croatian Medical Association. At the moment, the Branch brings together 3621 members, regular members--doctors of medicine (2497), doctors of dental medicine (384), retired physicians (710), and associate members (30 specialists with higher education who are not doctors). The Branch is especially accomplished in its activities in the area of professional development of its members and therefore organizes a series of scientific conferences in the framework of continuous education of physicians, allowing its members to acquire necessary points for the extension of their operating license. The choir "Zagrebacki lijecnici pjevaci" (Zagreb Physicians' Choir) of the Croatian Medical Music Society of the CMA and its activities are inseparable from the Branch Zagreb. The Branch is firmly linked to the parent body, the CMA, and thus has a visible impact on the strategy and the activities of the Association as a whole. Most professional societies of the CMA have their headquarters in Zagreb and this is

  16. Volition and conflict in human medial frontal cortex

    PubMed Central

    Nachev, Parashkev; Rees, Geraint; Parton, Andrew; Kennard, Christopher; Husain, Masud

    2009-01-01

    Summary Controversy surrounds the role of human medial frontal cortex in controlling actions[1-5]. Although damage to this area leads to severe difficulties in spontaneously initiating actions[6], the precise mechanisms underlying such ‘volitional’ deficits remain to be established. Previous studies have implicated the medial frontal cortex in conflict monitoring[7-10] and the control of voluntary action[11, 12], suggesting that these key processes are functionally related or share neural substrates. Here we combine a novel behavioural paradigm with functional imaging of the oculomotor system to reveal for the first time a functional subdivision of the pre-supplementary motor area (pre-SMA) into anatomically distinct areas responding exclusively to volition or to conflict. We also demonstrate that activity in the supplementary eye field (SEF) distinguishes between success and failure in changing voluntary action plans during conflict, suggesting a role for the SEF in implementing the resolution of conflicting actions. We propose a functional architecture of human medial frontal cortex that incorporates the generation of action plans and the resolution of conflict. PMID:15668167

  17. Medial Tibial Stress Shielding: A Limitation of Cobalt Chromium Tibial Baseplates.

    PubMed

    Martin, J Ryan; Watts, Chad D; Levy, Daniel L; Kim, Raymond H

    2017-02-01

    Stress shielding is a well-recognized complication associated with total knee arthroplasty. However, this phenomenon has not been thoroughly described. Specifically, no study to our knowledge has evaluated the radiographic impact of utilizing various tibial component compositions on tibial stress shielding. We retrospectively reviewed 3 cohorts of 50 patients that had a preoperative varus deformity and were implanted with a titanium, cobalt chromium (CoCr), or an all polyethylene tibial implant. A radiographic comparative analysis was performed to evaluate the amount of medial tibial bone loss in each cohort. In addition, a clinical outcomes analysis was performed on the 3 cohorts. The CoCr was noted to have a statistically significant increase in medial tibial bone loss compared with the other 2 cohorts. The all polyethylene cohort had a statistically significantly higher final Knee Society Score and was associated with the least amount of stress shielding. The CoCr tray is the most rigid of 3 implants that were compared in this study. Interestingly, this cohort had the highest amount of medial tibial bone loss. In addition, 1 patient in the CoCr cohort had medial soft tissue irritation which was attributed to a prominent medial tibial tray which required revision surgery to mitigate the symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Medial prefrontal cortex supports source memory accuracy for self-referenced items

    PubMed Central

    Leshikar, Eric D.; Duarte, Audrey

    2013-01-01

    Previous behavioral work suggests that processing information in relation to the self enhances subsequent item recognition. Neuroimaging evidence further suggests that regions along the cortical midline, particularly those of the medial prefrontal cortex, underlie this benefit. There has been little work to date, however, on the effects of self-referential encoding on source memory accuracy or whether the medial prefrontal cortex might contribute to source memory for self-referenced materials. In the current study, we used fMRI to measure neural activity while participants studied and subsequently retrieved pictures of common objects superimposed on one of two background scenes (sources) under either self-reference or self-external encoding instructions. Both item recognition and source recognition were better for objects encoded self-referentially than self-externally. Neural activity predictive of source accuracy was observed in the medial prefrontal cortex (BA 10) at the time of study for self-referentially but not self-externally encoded objects. The results of this experiment suggest that processing information in relation to the self leads to a mnemonic benefit for source level features, and that activity in the medial prefrontal cortex contributes to this source memory benefit. This evidence expands the purported role that the medial prefrontal cortex plays in self-referencing. PMID:21936739

  19. Medial prefrontal cortex supports source memory accuracy for self-referenced items.

    PubMed

    Leshikar, Eric D; Duarte, Audrey

    2012-01-01

    Previous behavioral work suggests that processing information in relation to the self enhances subsequent item recognition. Neuroimaging evidence further suggests that regions along the cortical midline, particularly those of the medial prefrontal cortex (PFC), underlie this benefit. There has been little work to date, however, on the effects of self-referential encoding on source memory accuracy or whether the medial PFC might contribute to source memory for self-referenced materials. In the current study, we used fMRI to measure neural activity while participants studied and subsequently retrieved pictures of common objects superimposed on one of two background scenes (sources) under either self-reference or self-external encoding instructions. Both item recognition and source recognition were better for objects encoded self-referentially than self-externally. Neural activity predictive of source accuracy was observed in the medial PFC (Brodmann area 10) at the time of study for self-referentially but not self-externally encoded objects. The results of this experiment suggest that processing information in relation to the self leads to a mnemonic benefit for source level features, and that activity in the medial PFC contributes to this source memory benefit. This evidence expands the purported role that the medial PFC plays in self-referencing.

  20. Aging, self-referencing, and medial prefrontal cortex.

    PubMed

    Gutchess, Angela H; Kensinger, Elizabeth A; Schacter, Daniel L

    2007-01-01

    The lateral prefrontal cortex undergoes both structural and functional changes with healthy aging. In contrast, there is little structural change in the medial prefrontal cortex, but relatively little is known about the functional changes to this region with age. Using an event-related fMRI design, we investigated the response of medial prefrontal cortex during self-referencing in order to compare age groups on a task that young and elderly perform similarly and that is known to actively engage the region in young adults. Nineteen young (M age = 23) and seventeen elderly (M age = 72) judged whether adjectives described themselves, another person, or were presented in upper case. We assessed the overlap in activations between young and elderly for the self-reference effect (self vs. other person), and found that both groups engage medial prefrontal cortex and mid-cingulate during self-referencing. The only cerebral differences between the groups in self versus other personality assessment were found in somatosensory and motor-related areas. In contrast, age-related modulations were found in the cerebral network recruited for emotional valence processing. Elderly (but not young) showed increased activity in the dorsal prefrontal cortex for positive relative to negative items, which could reflect an increase in controlled processing of positive information for elderly adults.

  1. The potential effect of anatomic relationship between the femur and the tibia on medial meniscus tears.

    PubMed

    Bozkurt, Murat; Unlu, Serhan; Cay, Nurdan; Apaydin, Nihal; Dogan, Metin

    2014-10-01

    The anatomic and the kinematical relationships between the femur and the tibia have been previously examined in both normal and diseased knees. However, less attention has been directed to the effect of these relationships on the meniscal diseases. Therefore, we aimed to investigate the impact of femorotibial incongruence on both lateral and medial meniscal tears. A total of 100 images obtained from MRI of 100 patients (39 males and 61 females) were included in the study. Diameters of the medial and the lateral femoral condyles, thicknesses of the menisci, and diameters of the medial and the lateral tibial articular surfaces were measured. The medial meniscus tear was detected in 40 (40 %) patients. However, no lateral meniscus tear was found. Significant relationships were found between the diameters of the posterior medial femoral condyle and the medial tibial superior articular surface and between the diameters of the posterior lateral femoral condyle and the lateral tibial superior articular surface. The mean values for the diameter of the medial condyle of the femur, the lateral condyle of the femur, the medial superior articular surface of the tibia, and the lateral superior articular surface of the tibia were found to be significantly higher in cases with meniscus tear compared to cases without meniscus tear. However, no significant difference was present regarding the thicknesses of the medial and the lateral menisci. A positive relationship between the diameter of the posterior medial femoral condyle and the tibial medial superior articular surface was found in cases with (n = 40) (r (2) = 0.208, p = 0.003) and without tear (n = 60) (r (2) = 0.182, p = 0.001). In addition, a significant positive relationship was found between the diameter of the posterior medial femoral condyle and the medial tibial superior articular surface in cases with and without tear. The impact of femorotibial incongruence on the medial meniscus tear is important for

  2. Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.

    PubMed

    Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-Ichi

    2017-06-18

    To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

  3. Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study

    PubMed Central

    Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-ichi

    2017-01-01

    AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau. PMID:28660141

  4. Pullout failure strength of the posterior horn of the medial meniscus with root ligament tear.

    PubMed

    Kim, Young-Mo; Joo, Yong-Bum

    2013-07-01

    To evaluate the reparability of the posterior horn of the medial meniscus with root ligament tear by measuring the actual pullout failure strength of a simple vertical suture of an arthroscopic subtotal meniscectomized posterior horn of the medial meniscus. From November 2009 to May 2010, nine posterior horns of the medial meniscus specimens were collected from arthroscopic subtotal meniscectomy performed as a treatment for root ligament rupture of the posterior horn of the medial meniscus. Simple vertical sutures were performed on the specimens, and pullout failure load was tested with a biaxial servohydraulic testing machine (Model 8874; Instron Corp., Norwood, MA, USA). The degree of degeneration, extrusion, and medial displacement of the medial meniscus were evaluated with magnetic resonance imaging (MRI). The Kellgren-Lawrence classification was used in standing plain radiography, and mechanical alignment was measured using orthoroentgenography. Tear morphology was classified into ligament proper type or meniscoligamentous junctional type according to the site of the torn root ligament of the posterior horn of the medial meniscus during arthroscopy. The mean pullout failure strength of the posterior horn of the medial meniscus was 71.6 ± 23.2 N (range, 41.4-107.7 N). The degree of degeneration of the posterior horn of the medial meniscus on MRI showed statistically significant correlation with pullout failure strength and Kellgren-Lawrence classification. Pullout failure strength showed correlation with mechanical alignment and Kellgren-Lawrence classification (P < 0.05). The measurement of pullout failure strength of the posterior horn of the medial meniscus with root ligament tear showed a degree of repairability. The degree of degeneration of the posterior horn of the medial meniscus on MRI showed a significant correlation with the pullout failure strength. The pullout failure strength was also not only correlated with the degree of degeneration of the

  5. Functional specialization of medial auditory belt cortex in the alert rhesus monkey.

    PubMed

    Kusmierek, Pawel; Rauschecker, Josef P

    2009-09-01

    Responses of neural units in two areas of the medial auditory belt (middle medial area [MM] and rostral medial area [RM]) were tested with tones, noise bursts, monkey calls (MC), and environmental sounds (ES) in microelectrode recordings from two alert rhesus monkeys. For comparison, recordings were also performed from two core areas (primary auditory area [A1] and rostral area [R]) of the auditory cortex. All four fields showed cochleotopic organization, with best (center) frequency [BF(c)] gradients running in opposite directions in A1 and MM than in R and RM. The medial belt was characterized by a stronger preference for band-pass noise than for pure tones found medially to the core areas. Response latencies were shorter for the two more posterior (middle) areas MM and A1 than for the two rostral areas R and RM, reaching values as low as 6 ms for high BF(c) in MM and A1, and strongly depended on BF(c). The medial belt areas exhibited a higher selectivity to all stimuli, in particular to noise bursts, than the core areas. An increased selectivity to tones and noise bursts was also found in the anterior fields; the opposite was true for highly temporally modulated ES. Analysis of the structure of neural responses revealed that neurons were driven by low-level acoustic features in all fields. Thus medial belt areas RM and MM have to be considered early stages of auditory cortical processing. The anteroposterior difference in temporal processing indices suggests that R and RM may belong to a different hierarchical level or a different computational network than A1 and MM.

  6. [Tibial periostitis ("medial tibial stress syndrome")].

    PubMed

    Fournier, Pierre-Etienne

    2003-06-01

    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  7. Does medial tenderness predict deep deltoid ligament incompetence in supination-external rotation type ankle fractures?

    PubMed

    DeAngelis, Nicola A; Eskander, Mark S; French, Bruce G

    2007-04-01

    To identify whether medial tenderness is a predictor of deep deltoid ligament incompetence in supination-external rotation ankle fractures. All Weber B lateral malleolar fractures with normal medial clear space over a 9 month period were prospectively included in the study. Fracture patterns not consistent with a supination-external rotation mechanism were excluded. High-volume tertiary care referral center and Level I trauma center. Fifty-five skeletally mature patients with a Weber B lateral malleolar fracture and normal medial clear space presenting to our institution were included. All study patients had ankle anteroposterior, lateral, and mortise radiographs. Each patient was seen and evaluated by an orthopedic specialist and the mechanism of injury was recorded. Each patient was assessed for tenderness to palpation in the region of the deltoid ligament and then had an external rotation stress mortise radiograph. Correlating medial tenderness with deep deltoid competence as measured by stress radiographs. Thirteen patients (23.6%) were tender medially and had a positive external rotation stress radiograph. Thirteen patients (23.6%) were tender medially and had a negative external rotation stress radiograph. Nineteen patients (34.5%) were nontender medially and had a negative external rotation stress radiograph. Ten patients (18.2%) were nontender medially and had a positive external rotation stress radiograph. We calculated a chi statistic of 2.37 as well as the associated P value of 0.12. Medial tenderness as a measure of deep deltoid ligament incompetence had a sensitivity of 57%, a specificity of 59%, a positive predictive value of 50%, a negative predictive value of 66%, and an accuracy of 42%. There was no statistical significance between the presence of medial tenderness and deep deltoid ligament incompetence. There is a 25% chance of the fracture in question with medial tenderness having a positive external rotation stress and a 25% chance the fracture

  8. Prevalence and clinical significance of left bundle branch block according to classical or strict definition criteria in permanent pacemaker patients.

    PubMed

    Mazza, Andrea; Bendini, Maria Grazia; De Cristofaro, Raffaele; Lovecchio, Mariolina; Valsecchi, Sergio; Leggio, Massimo; Boriani, Giuseppe

    2017-06-01

    Previous studies have shown that the presence of left bundle branch block (LBBB) is associated with an increased risk of cardiac mortality and heart failure (HF). Recently, new criteria to define strict LBBB have been proposed: QRS duration ≥140 ms for men and ≥130 ms for women, along with mid-QRS notching or slurring in ≥2 contiguous leads. We assessed the prevalence and prognostic significance of LBBB according to classical (QRS duration ≥120ms) and strict criteria in permanent pacemaker patients. We retrospectively enrolled 723 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center from July 2002 to December 2014. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded. LBBB was reported in 54 (7%) patients, and strict-LBBB in 15 (2%) patients. During a median follow-up of 48 months (range, 18-92 months), 147 (20%) patients reached the combined endpoint of death or HF hospitalization. Patients with LBBB and those with strict-LBBB displayed significantly higher rates of death or HF hospitalization (log-rank test, all P < 0.0001). In particular, strict-LBBB was associated with the worst outcome. The presence of LBBB according to classical definition criteria (hazard ratio [HR] = 1.98, confidence interval [CI]: 1.23-3.19, P = 0.005) and to strict criteria (HR = 2.20; CI: 1.04-4.65; P = 0.039) were both confirmed as independent predictors of death or HF hospitalization after adjustment for relevant clinical covariates. Among patients who had undergone standard pacemaker implantation, the prevalence of LBBB was 7% according to classical definition criteria and 2% according to strict criteria. The presence of LBBB, and particularly of strict-LBBB, at the baseline predicted a poor outcome in terms of death or HF hospitalization. © 2017 Wiley Periodicals, Inc.

  9. Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study.

    PubMed

    Ghosh, Sanjib Kumar; Raheja, Shashi; Tuli, Anita

    2013-09-01

    Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso-planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63-0.92) and that of medio-lateral width was 0.78 (95% CI, 0.62-0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso-plantar thickness is >12.8 mm and medio-lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected. Copyright © 2012 Wiley Periodicals, Inc.

  10. Medial Frontal Event-Related Potentials and Reward Prediction: Do Responses Matter?

    ERIC Educational Resources Information Center

    Martin, Laura E.; Potts, Geoffrey F.

    2011-01-01

    Medial frontal event-related potentials (ERPs) following rewarding feedback index outcome evaluation. The majority of studies examining the feedback related medial frontal negativity (MFN) employ active tasks during which participants' responses impact their feedback, however, the MFN has been elicited during passive tasks. Many of the studies…

  11. Complications in posteromedial arthroscopic suture of the medial meniscus.

    PubMed

    Jan, N; Sonnery-Cottet, B; Fayard, J-M; Kajetanek, C; Thaunat, M

    2016-12-01

    All-inside posteromedial suture for lesions of the posterior horn of the medial meniscus in anterior cruciate ligament (ACL) repair provides effective freshening and good healing. The posteromedial portal provides satisfactory healing rates without increasing morbidity or complications rates. Intra- and postoperative complications were collected for a consecutive single-center series of 132 patients undergoing posteromedial hook suture of the medial meniscus in ACL repair. Meniscal healing was assessed as the rate of recurrence of symptomatic medial meniscus lesions (Barret criteria) and on revision surgery, if any, in terms of the aspect and extent of the iterative lesion. The severity of any sensory disorder was assessed by questionnaire. The intraoperative complications rate was 1.5% (2 saphenous vein punctures). At a mean 31months (range, 28-35months), there was no loss to follow-up. Twelve patients (9%) showed symptomatic recurrence of the medial meniscus lesion, requiring 10 repeat surgeries. In 6 cases (4.5%), the iterative lesion involved a smaller, more central part of the meniscus anterior to the sutures, of "postage-stamp" effect, possibly implicating the suture hook and/or non-absorbable sutures. There were no cases of infection or fistula. Postoperative hematoma occurred in 7% of patients. In total, 1.8% reported dysesthesia areas equal to or greater than the size of a credit card (45cm 2 ). Some retears, or "partial failures", may implicate a new lesion caused by the suture hook and possibly prolonged by non-resorbable sutures. Hematoma and sensory disorder rates were comparable to those reported in isolated ACL repair without posteromedial portal. The present results show that posteromedial arthroscopic hook suture in posterior medial meniscus tear provides good healing rates without increased morbidity due to the supplementary portal. IV. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Randomized branch sampling

    Treesearch

    Harry T. Valentine

    2002-01-01

    Randomized branch sampling (RBS) is a special application of multistage probability sampling (see Sampling, environmental), which was developed originally by Jessen [3] to estimate fruit counts on individual orchard trees. In general, the method can be used to obtain estimates of many different attributes of trees or other branched plants. The usual objective of RBS is...

  13. Synthesis of Triamino Acid Building Blocks with Different Lipophilicities

    PubMed Central

    Maity, Jyotirmoy; Honcharenko, Dmytro; Strömberg, Roger

    2015-01-01

    To obtain different amino acids with varying lipophilicity and that can carry up to three positive charges we have developed a number of new triamino acid building blocks. One set of building blocks was achieved by aminoethyl extension, via reductive amination, of the side chain of ortnithine, diaminopropanoic and diaminobutanoic acid. A second set of triamino acids with the aminoethyl extension having hydrocarbon side chains was synthesized from diaminobutanoic acid. The aldehydes needed for the extension by reductive amination were synthesized from the corresponding Fmoc-L-2-amino fatty acids in two steps. Reductive amination of these compounds with Boc-L-Dab-OH gave the C4-C8 alkyl-branched triamino acids. All triamino acids were subsequently Boc-protected at the formed secondary amine to make the monomers appropriate for the N-terminus position when performing Fmoc-based solid-phase peptide synthesis. PMID:25876040

  14. Cam impingement of the posterior femoral condyle in medial meniscal tears.

    PubMed

    Suganuma, Jun; Mochizuki, Ryuta; Yamaguchi, Kenji; Inoue, Yutaka; Yamabe, Eikou; Ueda, Yoshiyuki; Fujinaka, Tarou

    2010-02-01

    The aim of this study was to compare the results of meniscal repair of the medial meniscus with or without decompression of the posterior segment of the medial meniscus for the treatment of posteromedial tibiofemoral incongruence at full flexion (PMTFI), which induces deformation of the posterior segment on sagittal magnetic resonance imaging (MRI). For more than 2 years, we followed up 27 patients with PMTFI who were classified into the following 2 groups. Group 1 included 8 patients (5 male joints and 3 female joints) with a medial meniscal tear with instability at the site of the tear who underwent meniscal repair. The mean age was 23.6 years. Group 2 included 19 patients (16 male joints and 3 female joints) who had a meniscal tear with instability at the site of the tear and underwent meniscal repair and decompression. The mean age was 26.5 years. In decompression of the posterior segment, redundant bone tissue on the most proximal part of the medial femoral condyle was excised. The patients were assessed by use of the Lysholm score, sagittal MRI at full flexion, and arthroscopic examination. There were no statistical differences in mean Lysholm score between the 2 groups before surgery, but the mean score in group 2 was significantly higher than that in group 1 after surgery. Meniscal deformation of the posterior segment at full flexion on MRI disappeared in all cases after decompression. On second-look arthroscopy, the rate of complete healing at the site of the tear was 0% in group 1 but 57% in group 2, and it was significantly different between these groups. The addition of decompression of the posterior segment of the medial meniscus to meniscal repair of knee joints with PMTFI allowed more room for the medial meniscus to accommodate and improved both function of the knee joint and the rate of success of repair of isolated medial meniscal tears in patients who regularly performed full knee flexion. (c) 2010 Arthroscopy Association of North America

  15. The Role of Medial Frontal Cortex in Action Anticipation in Professional Badminton Players

    PubMed Central

    Xu, Huan; Wang, Pin; Ye, Zhuo’er; Di, Xin; Xu, Guiping; Mo, Lei; Lin, Huiyan; Rao, Hengyi; Jin, Hua

    2016-01-01

    Some studies show that the medial frontal cortex is associated with more skilled action anticipation, while similar findings are not observed in some other studies, possibly due to the stimuli employed and the participants used as the control group. In addition, no studies have investigated whether there is any functional connectivity between the medial frontal cortex and other brain regions in more skilled action anticipation. Therefore, the present study aimed to re-investigate how the medial frontal cortex is involved in more skilled action anticipation by circumventing the limitations of previous research and to investigate that the medial frontal cortex functionally connected with other brain regions involved in action processing in more skilled action anticipation. To this end, professional badminton players and novices were asked to anticipate the landing position of the shuttlecock while watching badminton match videos or to judge the gender of the players in the matches. The video clips ended right at the point that the shuttlecock and the racket came into contact to reduce the effect of information about the trajectory of the shuttlecock. Novices who lacked training and watching experience were recruited for the control group to reduce the effect of sport-related experience on the medial frontal cortex. Blood oxygenation level-dependent activation was assessed by means of functional magnetic resonance imaging. Compared to novices, badminton players exhibited stronger activation in the left medial frontal cortex during action anticipation and greater functional connectivity between left medial frontal cortex and some other brain regions (e.g., right posterior cingulate cortex). Therefore, the present study supports the position that the medial frontal cortex plays a role in more skilled action anticipation and that there is a specific brain network for more skilled action anticipation that involves right posterior cingulate cortex, right fusiform gyrus

  16. Transnasal endoscopic medial maxillectomy in recurrent maxillary sinus inverted papilloma.

    PubMed

    Kamel, Reda H; Abdel Fattah, Ahmed F; Awad, Ayman G

    2014-12-01

    Maxillary sinus inverted papilloma entails medial maxillectomy and is associated with high incidence of recurrence. To study the impact of prior surgery on recurrence rate after transnasal endoscopic medial maxillectomy. Eighteen patients with primary and 33 with recurrent maxillary sinus inverted papilloma underwent transnasal endoscopic medial maxillectomy. Caldwell-Luc operation was the primary surgery in 12 patients, transnasal endoscopic resection in 20, and midfacial degloving technique in one. The follow-up period ranged between 2 to 19.5 years with an average of 8.8 years. Recurrence was detected in 8/51 maxillary sinus inverted papilloma patients (15.7 %), 1/18 of primary cases (5.5 %), 7/33 of recurrent cases (21.2 %); 3/20 of the transnasal endoscopic resection group (15%) and 4/12 of the Caldwell-Luc group (33.3%). Redo transnasal endoscopic medial maxillectomy was followed by a single recurrence in the Caldwell-Luc group (25%), and no recurrence in the other groups. Recurrence is more common in recurrent maxillary sinus inverted papilloma than primary lesions. Recurrent maxillary sinus inverted papilloma after Caldwell-Luc operation has higher incidence of recurrence than after transnasal endoscopic resection.

  17. Septal and Anterior Reverse Mismatch of Myocardial Perfusion and Metabolism in Patients With Coronary Artery Disease and Left Bundle Branch Block

    PubMed Central

    Wang, Jian-Guang; Fang, Wei; Yang, Min-Fu; Tian, Yue-Qin; Zhang, Xiao-Li; Shen, Rui; Sun, Xiao-Xin; Guo, Feng; Wang, Dao-Yu; He, Zuo-Xiang

    2015-01-01

    Abstract The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD). Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated. The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026). In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval. PMID:25997045

  18. Characteristics and prognosis of medial epicondylar fragmentation of the humerus in male junior tennis players.

    PubMed

    Harada, Mikio; Takahara, Masatoshi; Maruyama, Masahiro; Takagi, Michiaki

    2014-10-01

    Although medial epicondylar fragmentation of the humerus is a reported elbow injury in junior tennis players, there have been only a few studies on this entity, and none have investigated the characteristics and prognosis of medial epicondylar fragmentation. Forty-one male junior tennis players, aged 11 to 14 years (mean, 13 years), underwent elbow examination by ultrasonography. Elbow re-examination was performed in subjects with medial epicondylar fragmentation at an average of 20 months (12-30 months) after the initial examination. On examination, 9 subjects (22%) had elbow pain. Ultrasonography showed that 6 subjects (15%) had medial epicondylar fragmentation, all of whom had elbow pain. Medial epicondylar fragmentation was present in 5 (38%) of 13 subjects aged 11 to 12 years and in 1 (4%) of 28 aged 13 to 14 years. More subjects aged 11 to 12 years had medial epicondylar fragmentation (P = .0084). All 6 subjects with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, although ultrasonography showed that 5 developed bone union and 1 had nonunion, 3 subjects (50%) reported elbow pain. Our results demonstrated that subjects aged 11 to 12 years had a high frequency (38%) of medial epicondylar fragmentation. Although medial epicondylar fragmentation was the main cause of elbow pain (67%) at the initial elbow examination, all 6 players with medial epicondylar fragmentation continued to play tennis between the initial elbow examination and the re-examination. At re-examination, 5 subjects presented spontaneous bone union (83%), but 3 subjects (50%) reported elbow pain. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Effects of the medial or basolateral amygdala upon social anxiety and social recognition in mice.

    PubMed

    Wang, Yu; Zhao, Shanshan; Liu, Xu; Fu, Qunying

    2014-01-01

    Though social anxiety and social recognition have been studied extensively, the roles of the medial or basolateral amygdala in the control of social anxiety and social recognition remain to be determined. This study investigated the effects of excitotoxic bilateral medial or basolateral amygdala lesions upon social anxiety and social recognition in-mice. Animals at 9 weeks of age were given bilateral medial or basolateral amygdala lesions via infusion of N-methyl- D-aspartate and then were used for behavioral tests: anxiety-related tests (including open-field test, light-dark test, and elevated-plus maze test), social behavior test in a novel environment, social recognition test, and flavor recognition test. Medial or basolateral amygdala-lesioned mice showed lower levels of anxiety and increased social behaviors in a novel environment. Destruction of the medial or basolateral amygdala neurons impaired social recognition but not flavor recognition. The medial or basolateral amygdala is involved in the control of anxiety-related behavior (social anxiety and social behaviors) in mice. Moreover, both the medial and the basolateral amygdala are essential for social recognition but not flavor recognition in mice.

  20. Medial Meniscus Root Tear in the Middle Aged Patient: A Case Based Review

    PubMed Central

    Carreau, Joseph H.

    2017-01-01

    Abstract Biomechanical studies have shown that medial meniscal root tears result in meniscal extrusion and increased tibiofemoral joint contact pressures, which can accelerate the progression of arthritis. Repair is generally recommended for acute injuries in the young, active patient population. The far more common presentation however, is a subacute root tear with medial meniscal extrusion in a middle aged patient. Coexisting arthritis is common in this population and complicates decision making. Treatment should be based on the severity of the underlying arthritis. In cases of early or minimal arthritis, root repair is ideal to improve symptoms and restore meniscal function. In patients with moderate or severe medial compartment arthritis, medial unloader bracing or injections can be tried initially. When non-operative treatment fails, high tibial osteotomy or arthroplasty is recommended. Long term clinical studies are needed to determine the natural history of medial meniscal root tears in middle aged patients and the best surgical option. PMID:28852346

  1. Change in desorption mechanism from pore blocking to cavitation with temperature for nitrogen in ordered silica with cagelike pores.

    PubMed

    Morishige, Kunimitsu; Tateishi, Masayoshi; Hirose, Fumi; Aramaki, Kenji

    2006-10-24

    To verify pore blocking controlled desorption in ink-bottle pores, we measured the temperature dependence of the adsorption-desorption isotherms of nitrogen on four kinds of KIT-5 samples with expanded cavities hydrothermally treated for different periods of time at 393 K. In the samples, almost spherical cavities are arranged in a face-centered cubic array and the cavities are connected through small channels. The pore size of the channels increased with an increase in the hydrothermal treatment time. At lower temperatures a steep desorption branch changed to a gradual one as the hydrothermal treatment was prolonged. For the sample hydrothermally treated only for 1 day, the rectangular hysteresis loop shrank gradually with increasing temperature while keeping its shape. The temperature dependence of the evaporation pressure observed was identical with that expected for cavitation-controlled desorption. On the other hand, for the samples hydrothermally treated for long times, the gradual desorption branch became a sharp one with increasing temperature. This strongly suggests that the desorption mechanism is altered from pore blocking to cavitation with temperature. Application of percolation theory to the pore blocking controlled desorption observed here is discussed.

  2. Proximo-distal patellar position in three small dog breeds with medial patellar luxation.

    PubMed

    Wangdee, C; Theyse, L F H; Hazewinkel, H A W

    2015-01-01

    Medial patellar luxation is thought to be associated with a high proximal position of the patella in the trochlear groove. To determine whether the ratio of patellar ligament length and patellar length (L:P) is influenced by the stifle angle (75°, 96°, 113°, 130°, and 148°) in small dog breeds and to compare the L:P ratio in dogs of three small dog breeds with and without medial patellar luxation. A mediolateral radiograph of the stifle joint was used to measure the L:P ratio in the stifle joints of dogs of three small breeds with and without medial patellar luxation. The L:P ratio was evaluated at five stifle angles (75°, 96°, 113°, 130°, and 148°) in 14 cadavers (26 stifle joints) of small dog breeds in order to identify the best stifle angle to measure the L:P ratio. Then the mean ± SD L:P ratio was calculated for normal stifles and stifles with medial patellar luxation grades 1, 2, and 3 in 194 Pomeranians, 74 Chihuahuas, and 41 Toy or Standard Poodles. The L:P ratio was the same for all five stifle angles in the cadavers (p = 0.195). It was also not significantly different in the three breeds (p = 0.135), in normal and medial patellar luxation-affected stifles overall (p = 0.354), and in normal and medial patellar luxation-affected joints within each breed (p = 0.19). We conclude that a proximo-distal patellar position is not associated with medial patellar luxation in Pomeranians, Chihuahuas, and Toy or Standard Poodles. Thus a longer patellar ligament length does not play a role in the pathophysiology of medial patellar luxation in these small dog breeds.

  3. Epidural abscess treated with a medial supraorbital craniotomy through an incision in the eyebrow. Case report.

    PubMed

    Rosen, David S; Shafizadeh, Stephen; Baroody, Fuad M; Yamini, Bakhtiar

    2008-02-01

    The authors describe a medial supraorbital craniotomy performed through a medial eyebrow skin incision to approach an epidural abscess located in the medial anterior fossa of the skull. An 8-year-old boy presented with fevers and facial swelling. Imaging demonstrated pansinusitis and an epidural fluid collection adjacent to the frontal sinus. A medial supraorbital craniotomy was performed to access and drain the epidural abscess. The supraorbital nerve laterally and the supratrochlear nerve medially were preserved by incising the frontalis muscle vertically, parallel to the course of the nerves, and dissecting the subperiosteal plane to mobilize the nerves. This approach may be a useful access corridor for other lesions located near the medial anterior fossa.

  4. Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures.

    PubMed

    Hughes, Meghan; Dua, Karan; O'Hara, Nathan N; Brighton, Brian K; Ganley, Theodore J; Hennrikus, William L; Herman, Martin J; Hyman, Joshua E; Lawrence, J Todd; Mehlman, Charles T; Noonan, Kenneth J; Otsuka, Norman Y; Schwend, Richard M; Shrader, M Wade; Smith, Brian G; Sponseller, Paul D; Abzug, Joshua M

    2017-10-18

    Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on

  5. Variations in medial-lateral hamstring force and force ratio influence tibiofemoral kinematics.

    PubMed

    Shalhoub, Sami; Fitzwater, Fallon G; Cyr, Adam J; Maletsky, Lorin P

    2016-10-01

    A change in hamstring strength and activation is typically seen after injuries or invasive surgeries such as anterior cruciate reconstruction or total knee replacement. While many studies have investigated the influence of isometric increases in hamstring load on knee joint kinematics, few have quantified the change in kinematics due to a variation in medial to lateral hamstring force ratio. This study examined the changes in knee joint kinematics on eight cadaveric knees during an open-chain deep knee bend for six different loading configurations: five loaded hamstring configurations that varied the ratio of a total load of 175 N between the semimembranosus and biceps femoris and one with no loads on the hamstring. The anterior-posterior translation of the medial and lateral femoral condyles' lowest points along proximal-distal axis of the tibia, the axial rotation of the tibia, and the quadriceps load were measured at each flexion angle. Unloading the hamstring shifted the medial and lateral lowest points posteriorly and increased tibial internal rotation. The influence of unloading hamstrings on quadriceps load was small in early flexion and increased with knee flexion. The loading configuration with the highest lateral hamstrings force resulted in the most posterior translation of the medial lowest point, most anterior translation of the lateral lowest point, and the highest tibial external rotation of the five loading configurations. As the medial hamstring force ratio increased, the medial lowest point shifted anteriorly, the lateral lowest point shifted posteriorly, and the tibia rotated more internally. The results of this study, demonstrate that variation in medial-lateral hamstrings force and force ratio influence tibiofemoral transverse kinematics and quadriceps loads required to extend the knee. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1707-1715, 2016. © 2016 Orthopaedic Research Society. Published by

  6. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

    PubMed

    Hein, Christopher N; Deperio, Jennifer Gurske; Ehrensberger, Mark T; Marzo, John M

    2011-06-01

    Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect. Copyright © 2010 Elsevier B.V. All rights reserved.

  7. Medial maxillectomy in recalcitrant sinusitis: when, why and how?

    PubMed

    Konstantinidis, Iordanis; Constantinidis, Jannis

    2014-02-01

    We reviewed all journal articles relevant to endoscopic medial maxillectomy in patients with recalcitrant chronic maxillary sinusitis in order to present all indications, the underlying pathophysiology and the developed surgical techniques. Despite the high success rate of middle meatal antrostomy, cases with persistent maxillary sinus disease exist and often need a more extended endoscopic procedure for the better control of the disease. Such surgical option uses gravity for better sinus drainage and offers better saline irrigation, local application of medications and follow-up inspection. An endoscopic medial maxillectomy and its modified forms offer a wider surgical field and access to all 'difficult' areas of the maxillary sinus. Patients with previous limited endoscopic sinus surgery or extended open surgery, cystic fibrosis, extensive mucoceles, allergic fungal sinusitis, odontogenic infections, foreign bodies and so on may suffer from recurrent disease requiring an endoscopic medial maxillectomy. Depending on the disease, various modifications of the procedure can be performed preserving the anterior buttress, nasolacrimal duct and inferior turbinate if possible.

  8. Quantum Image Steganography and Steganalysis Based On LSQu-Blocks Image Information Concealing Algorithm

    NASA Astrophysics Data System (ADS)

    A. AL-Salhi, Yahya E.; Lu, Songfeng

    2016-08-01

    Quantum steganography can solve some problems that are considered inefficient in image information concealing. It researches on Quantum image information concealing to have been widely exploited in recent years. Quantum image information concealing can be categorized into quantum image digital blocking, quantum image stereography, anonymity and other branches. Least significant bit (LSB) information concealing plays vital roles in the classical world because many image information concealing algorithms are designed based on it. Firstly, based on the novel enhanced quantum representation (NEQR), image uniform blocks clustering around the concrete the least significant Qu-block (LSQB) information concealing algorithm for quantum image steganography is presented. Secondly, a clustering algorithm is proposed to optimize the concealment of important data. Finally, we used Con-Steg algorithm to conceal the clustered image blocks. Information concealing located on the Fourier domain of an image can achieve the security of image information, thus we further discuss the Fourier domain LSQu-block information concealing algorithm for quantum image based on Quantum Fourier Transforms. In our algorithms, the corresponding unitary Transformations are designed to realize the aim of concealing the secret information to the least significant Qu-block representing color of the quantum cover image. Finally, the procedures of extracting the secret information are illustrated. Quantum image LSQu-block image information concealing algorithm can be applied in many fields according to different needs.

  9. Evaluation of popliteal artery branching patterns and a new subclassification of the 'usual' branching pattern.

    PubMed

    Celtikci, Pinar; Ergun, Onur; Durmaz, Hasan Ali; Conkbayir, Isik; Hekimoglu, Baki

    2017-09-01

    To determine the frequency of popliteal artery branching variations in a wide study cohort and to investigate the relationship between these variations and infrapopliteal peripheral arterial disease (PAD). A subclassification was proposed for the most encountered type I-A, utilizing tibio-fibular trunk (TFT) length. A total number of 1184 lower extremity digital subtraction angiography (DSA) studies of 669 patients were evaluated. Following exclusion, 863 lower extremity DSA studies (431 right, 432 left) of 545 patients were enrolled. Popliteal artery branching type, patency of anterior tibial artery (ATA), fibular artery (FA) and posterior tibial artery (PTA) in each extremity and TFT length for type I-A extremities were recorded. Percentages of branching patterns, mean length and cut-off value of TFT and incidence of PAD in different types of branching were calculated. Type I-A was the most common type of branching (81.3%). Frequency of branching pattern variation was 18.7%, the most common variation category was category III (12.2%) and the most common variation type was type III-A (5.6%). ATA and PTA had higher percentages of PAD in extremities with variant branching types. Cut-off value of 3 cm for TFT length was proposed in order to subclassify type I-A. Our study cohort presents a higher incidence of popliteal artery branching variations. Some branching variations might have effect on the involvement pattern of the infrapopliteal arteries by PAD. We propose a subclassification for type I-A; type I-A-S (TFT < 3 cm) and type I-A-L (TFT ≥ 3 cm) which might have impact on interventional procedures.

  10. Avulsion of the anterior medial meniscus root: case report and surgical technique.

    PubMed

    Feucht, Matthias J; Minzlaff, Philipp; Saier, Tim; Lenich, Andreas; Imhoff, Andreas B; Hinterwimmer, Stefan

    2015-01-01

    Injuries of the meniscus roots have become increasingly recognised as a serious pathology of the knee joint. However, the current available literature focuses primarily on posterior meniscus root tears. In this article, a case with an isolated avulsion of the anterior medial meniscus root is presented, and a new arthroscopic technique to treat this type of injury is described. The anterior horn of the medial meniscus was sutured with a double-looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. This technique may also be useful to treat avulsion injuries of the anterolateral or posteromedial meniscus root, and symptomatic subluxation of the medial meniscus in case of a variant insertion anatomy with an absent attachment of the anterior horn of the medial meniscus to the tibial plateau. Level of evidence V.

  11. EMG and mechanical changes during sprint starts at different front block obliquities.

    PubMed

    Guissard, N; Duchateau, J; Hainaut, K

    1992-11-01

    The effect of decreased front block obliquity on start velocity was studied during sprint starts. The electromyographic (EMG) activity of the medial gastrocnemius (MG), the soleus (Sol), and the vastus medialis (VM) was recorded and analyzed at a 70 degrees, a 50 degrees, and a 30 degrees angle between the foot plate surface and the horizontal. Integrated EMGs (IEMG) were compared with muscle length changes in the MG and Sol in relation to foot and knee movements. The results indicate that decreasing front block obliquity significantly (P < 0.05) increases the start velocity without any change to the total duration of the pushing phase and the overall EMG activity. This improvement in sprint start performance is associated with the enhanced contribution of the MG during eccentric and concentric phases of calf muscles contraction. In the "set position" the initial length of MG and Sol is increased at 50 degrees and 30 degrees as compared with 70 degrees. The subsequent stretch-shortening cycle is improved and contributes more effectively to the speed of the muscle shortening. Moreover, lengthening these muscles during the eccentric phase stretches the muscle spindles, and the reflex activities that contribute to the observed increase in the MG IEMG, are present when the slope of the block is reduced. The results indicate that decreasing front block obliquity induces neural and mechanical modifications that contribute to increasing the sprint start velocity without any increase in the duration of the pushing phase.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Medial versus lateral supraspinatus tendon properties: implications for double-row rotator cuff repair.

    PubMed

    Wang, Vincent M; Wang, Fan Chia; McNickle, Allison G; Friel, Nicole A; Yanke, Adam B; Chubinskaya, Susan; Romeo, Anthony A; Verma, Nikhil N; Cole, Brian J

    2010-12-01

    Rotator cuff repair retear rates range from 25% to 90%, necessitating methods to improve repair strength. Although numerous laboratory studies have compared single-row with double-row fixation properties, little is known regarding regional (ie, medial vs lateral) suture retention properties in intact and torn tendons. A torn supraspinatus tendon will have reduced suture retention properties on the lateral aspect of the tendon compared with the more medial musculotendinous junction. Controlled laboratory study. Human supraspinatus tendons (torn and intact) were randomly assigned for suture retention mechanical testing, ultrastructural collagen fibril analysis, or histologic testing after suture pullout testing. For biomechanical evaluation, sutures were placed either at the musculotendinous junction (medial) or 10 mm from the free margin (lateral), and tendons were elongated to failure. Collagen fibril assessments were performed using transmission electron microscopy. Intact tendons showed no regional differences with respect to suture retention properties. In contrast, among torn tendons, the medial region exhibited significantly higher stiffness and work values relative to the lateral region. For the lateral region, work to 10-mm displacement (1592 ± 261 N-mm) and maximum load (265 ± 44 N) for intact tendons were significantly higher (P < .05) than that of torn tendons (1086 ± 388 N-mm and 177 ± 71 N, respectively). For medial suture placement, maximum load, stiffness, and work of intact and torn tendons were similar (P > .05). Regression analyses for the intact and torn groups revealed generally low correlations between donor age and the 3 biomechanical indices. For both intact and torn tendons, the mean fibril diameter and area density were greater in the medial region relative to the lateral (P ≤ .05). In the lateral tendon, but not the medial region, torn specimens showed a significantly lower fibril area fraction (48.3% ± 3.8%) than intact specimens

  13. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees.

    PubMed

    Yuuki, Arata; Muneta, Takeshi; Ohara, Toshiyuki; Sekiya, Ichiro; Koga, Hideyuki

    2017-03-01

    Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees. One hundred and nineteen patients with unilateral ACL-injured knees were included. Lateral/medial knee instability was assessed with varus/valgus stress X-ray examination for both injured and uninjured knees by measuring varus/valgus angle, lateral/medial joint opening, and lateral/medial joint opening index. Manual knee instability tests for ACL were evaluated to investigate associations between lateral/medial knee instability and anterior and/or rotational instabilities. Patients' backgrounds were evaluated to identify relevant factors for lateral/medial knee instability. Damage on the lateral collateral ligament (LCL) on MRI was also evaluated. All parameters regarding lateral knee instability in injured knees were significantly greater than in uninjured knees. There were significant correlations between lateral knee instability and the Lachman test as well as the pivot shift test. Patients with LCL damage had significantly greater lateral joint opening than those without LCL damage on MRI. Sensitivity of LCL damage on MRI to lateral joint opening was 100%, while its specificity was 36%. No other relevant factors were identified. In medial knee instability, there were also correlations between medial knee instability and the Lachman test/pivot shift test. However, the correlations were weak and other parameters were not significant. Lateral knee instability was greater in ACL-deficient knees than in uninjured knees. Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI, whereas MRI had low specificity to lateral knee instability. On the other hand, the association of medial knee

  14. Why Do Medial Unicompartmental Knee Arthroplasties Fail Today?

    PubMed

    van der List, Jelle P; Zuiderbaan, Hendrik A; Pearle, Andrew D

    2016-05-01

    Failure rates are higher in medial unicompartmental knee arthroplasty (UKA) than total knee arthroplasty. To improve these failure rates, it is important to understand why medial UKA fail. Because individual studies lack power to show failure modes, a systematic review was performed to assess medial UKA failure modes. Furthermore, we compared cohort studies with registry-based studies, early with midterm and late failures and fixed-bearing with mobile-bearing implants. Databases of PubMed, EMBASE, and Cochrane and annual registries were searched for medial UKA failures. Studies were included when they reported >25 failures or when they reported early (<5 years), midterm (5-10 years), or late failures (>10 years). Thirty-seven cohort studies (4 level II studies and 33 level III studies) and 2 registry-based studies were included. A total of 3967 overall failures, 388 time-dependent failures, and 1305 implant design failures were identified. Aseptic loosening (36%) and osteoarthritis (OA) progression (20%) were the most common failure modes. Aseptic loosening (26%) was most common early failure mode, whereas OA progression was more commonly seen in midterm and late failures (38% and 40%, respectively). Polyethylene wear (12%) and instability (12%) were more common in fixed-bearing implants, whereas pain (14%) and bearing dislocation (11%) were more common in mobile-bearing implants. This level III systematic review identified aseptic loosening and OA progression as the major failure modes. Aseptic loosening was the main failure mode in early years and mobile-bearing implants, whereas OA progression caused most failures in late years and fixed-bearing implants. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The control of branching morphogenesis

    PubMed Central

    Iber, Dagmar; Menshykau, Denis

    2013-01-01

    Many organs of higher organisms are heavily branched structures and arise by an apparently similar process of branching morphogenesis. Yet the regulatory components and local interactions that have been identified differ greatly in these organs. It is an open question whether the regulatory processes work according to a common principle and how far physical and geometrical constraints determine the branching process. Here, we review the known regulatory factors and physical constraints in lung, kidney, pancreas, prostate, mammary gland and salivary gland branching morphogenesis, and describe the models that have been formulated to analyse their impacts. PMID:24004663

  16. Robot-Assisted Medial Compartment Arthroplasty Following Remote Patellectomy: A Case Report

    PubMed Central

    Kouk, Shalen; Kalbian, Irene; Wolfe, Elizabeth; Strickland, Sabrina M

    2018-01-01

    Introduction: Total patellectomies are uncommon procedures that are reserved as salvage treatment for severely comminuted fractures of the patella. Due to the alteration of normal joint mechanics, these patients present later on in life with degenerative cartilage damage to the femorotibial joint and altered extensor mechanism. There are very few reports of unicondylar knee arthroplasties following previous patellectomy and none that specifically address robot-assisted unicompartmental knee arthroplasty. A recent case report by Pang et al. described the use of minimally invasive fixed-bearing unicondylar knee arthroplasty in a patellectomized patient with moderate medial compartment osteoarthritis. Our report details a case with more significant chondral loss along with patellar tendon subluxation. Case Report: This is a case report of a patient with severe medial compartment osteoarthritis after a patellectomy following a motor vehicle collision. After failing conservative treatment, the patient underwent a medial MAKOplasty with complete resolution of arthritic pain. Conclusion: Significant pain relief and improved knee function can be achieved with MAKOPlasty partial knee resurfacing system in a previously patellectomized patient with severe medial compartment osteoarthritis. PMID:29854684

  17. Hyperbranched PEGmethacrylate linear pDMAEMA block copolymer as an efficient non-viral gene delivery vector.

    PubMed

    Mathew, Asha; Cao, Hongliang; Collin, Estelle; Wang, Wenxin; Pandit, Abhay

    2012-09-15

    A unique hyperbranched polymeric system with a linear poly-2-dimethylaminoethyl methacrylate (pDMAEMA) block and a hyperbranched polyethylene glycol methyl ether methacrylate (PEGMEMA) and ethylene dimethacrylate (EGDMA) block was designed and synthesized via deactivation enhanced atom transfer radical polymerisation (DE-ATRP) for efficient gene delivery. Using this unique structure, with a linear pDMAEMA block, which efficiently binds to plasmid DNA (pDNA) and hyperbranched polyethylene glycol (PEG) based block as a protective shell, we were able to maintain high transfection levels without sacrificing cellular viability even at high doses. The transfection capability and cytotoxicity of the polymers over a range of pDNA concentration were analysed and the results were compared to commercially available transfection vectors such as polyethylene imine (branched PEI, 25 kDa), partially degraded poly(amido amine)dendrimer (dPAMAM; commercial name: SuperFect(®)) in fibroblasts and adipose tissue derived stem cells (ADSCs). Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Theoretical study of the self-assembly of Janus Bottlebrush Polymers from A-Branch-B Diblock Macromonomers

    NASA Astrophysics Data System (ADS)

    Gadelrab, Karim; Alexander-Katz, Alfredo; LaboratoryTheoretical Soft Materials Team

    The self-assembly of block copolymers BCP has provided an impressive control over the nanoscale structure of soft matter. While the main focus of the research in the field has been directed towards simple linear diblocks, the development of advanced polymer architecture provided improved performance and access to new structures. In particular, bottlebrush BCPs (BBCPs) have interesting characteristics due to their dense functionality, high molecular weight, low levels of entanglement, and tendency to efficiently undergo rapid bulk phase separation. In this work, we are interested in theoretically studying the self-assembly of Janus-type ``A-branch-B'' BBCPs where A and B blocks can phase separate with the bottlebrush polymer backbone serving as the interface between the two blocks. Hence, the polymer backbone adds an extra constraint on the equilibrium spacing between neighboring linear diblock chains. In this regard, the segment length of the backbone separating the AB junctions has a direct effect of the observed domain spacing and effective segregation strength of the AB blocks. We employ self-consistent field theoretic SCFT simulations to capture the effect of volume fraction of different constituents and construct a phase diagram of the accessible morphologies of these BBCPs.

  19. Model-based branching point detection in single-cell data by K-branches clustering

    PubMed Central

    Chlis, Nikolaos K.; Wolf, F. Alexander; Theis, Fabian J.

    2017-01-01

    Abstract Motivation The identification of heterogeneities in cell populations by utilizing single-cell technologies such as single-cell RNA-Seq, enables inference of cellular development and lineage trees. Several methods have been proposed for such inference from high-dimensional single-cell data. They typically assign each cell to a branch in a differentiation trajectory. However, they commonly assume specific geometries such as tree-like developmental hierarchies and lack statistically sound methods to decide on the number of branching events. Results We present K-Branches, a solution to the above problem by locally fitting half-lines to single-cell data, introducing a clustering algorithm similar to K-Means. These halflines are proxies for branches in the differentiation trajectory of cells. We propose a modified version of the GAP statistic for model selection, in order to decide on the number of lines that best describe the data locally. In this manner, we identify the location and number of subgroups of cells that are associated with branching events and full differentiation, respectively. We evaluate the performance of our method on single-cell RNA-Seq data describing the differentiation of myeloid progenitors during hematopoiesis, single-cell qPCR data of mouse blastocyst development, single-cell qPCR data of human myeloid monocytic leukemia and artificial data. Availability and implementation An R implementation of K-Branches is freely available at https://github.com/theislab/kbranches. Contact fabian.theis@helmholtz-muenchen.de Supplementary information Supplementary data are available at Bioinformatics online. PMID:28582478

  20. Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy.

    PubMed

    Bull, Patrick E; Berlet, Gregory C; Canini, Cameron; Hyer, Christopher F

    2016-06-01

    Access to the medial half of the talus can be challenging even with an osteotomy. Although several techniques are presented in the literature, critical evaluation of fixation, union, and alignment is lacking. The chevron medial malleolar osteotomy provides advantages of perpendicular instrumentation access and wide exposure to the medial talus. Postoperative displacement resulting in malunion, and possibly provoking ankle osteoarthritis, is a known complication. The present study describes our experience with the osteotomy. A consecutive series cohort of 50 bi-plane chevron osteotomies performed from 2004 to 2013 were evaluated. Forty-six were secured using 2 lag screws, and 4 were secured using 2 lag screws and a medial buttress plate. Radiographic studies performed at 2, 6, and 12 weeks and at final follow-up were analyzed for postoperative displacement, malunion, non-union, and hardware-related complications. At initial postoperative follow-up, 47 of 50 had adequate radiographs for review, and 18 of 47 (38.3%) showed some displacement when compared to the initial osteotomy fixation position. By final follow-up, 15 of 50 (30.0%) had measurable incongruence. Hardware removal was performed in 13 (26.0%) cases at an average of 2.4 years postoperation. Bi-plane medial malleolar chevron osteotomy fixed with 2 lag screws showed a 30.0% malunion rate with an average of 2 mm of incongruence on final follow-up radiographs, which is higher than what has been reported in the literature. In our practice, we now use a buttress plate and more recently have eliminated postoperative osteotomy displacement. Level IV, retrospective case series. © The Author(s) 2016.

  1. Medial-row failure after arthroscopic double-row rotator cuff repair.

    PubMed

    Yamakado, Kotaro; Katsuo, Shin-ichi; Mizuno, Katsunori; Arakawa, Hitoshi; Hayashi, Seigaku

    2010-03-01

    We report 4 cases of medial-row failure after double-row arthroscopic rotator cuff repair (ARCR) without arthroscopic subacromial decompression (ASAD), in which there was pullout of mattress sutures of the medial row and knots were caught between the cuff and the greater tuberosity. Between October 2006 and January 2008, 49 patients underwent double-row ARCR. During this period, ASAD was not performed with ARCR. Revision arthroscopy was performed in 8 patients because of ongoing symptoms after the index operation. In 4 of 8 patients the medial rotator cuff failed; the tendon appeared to be avulsed at the medial row, and there were exposed knots on the bony surface of the rotator cuff footprint. It appeared that the knots were caught between the cuff and the greater tuberosity. Three retear cuffs were revised with the arthroscopic transtendon technique, and one was revised with a single-row technique after completing the tear. ASAD was performed in all patients. Three of the four patients showed improvement of symptoms and returned to their preinjury occupation. Impingement of pullout knots may be a source of pain after double-row rotator cuff repair. Copyright 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Cationic PAMAM dendrimers as pore-blocking binary toxin inhibitors.

    PubMed

    Förstner, Philip; Bayer, Fabienne; Kalu, Nnanya; Felsen, Susanne; Förtsch, Christina; Aloufi, Abrar; Ng, David Y W; Weil, Tanja; Nestorovich, Ekaterina M; Barth, Holger

    2014-07-14

    Dendrimers are unique highly branched macromolecules with numerous groundbreaking biomedical applications under development. Here we identified poly(amido amine) (PAMAM) dendrimers as novel blockers for the pore-forming B components of the binary anthrax toxin (PA63) and Clostridium botulinum C2 toxin (C2IIa). These pores are essential for delivery of the enzymatic A components of the internalized toxins from endosomes into the cytosol of target cells. We demonstrate that at low μM concentrations cationic PAMAM dendrimers block PA63 and C2IIa to inhibit channel-mediated transport of the A components, thereby protecting HeLa and Vero cells from intoxication. By channel reconstitution and high-resolution current recording, we show that the PAMAM dendrimers obstruct transmembrane PA63 and C2IIa pores in planar lipid bilayers at nM concentrations. These findings suggest a new potential role for the PAMAM dendrimers as effective polyvalent channel-blocking inhibitors, which can protect human target cells from intoxication with binary toxins from pathogenic bacteria.

  3. Biogeochemical generation of dissolved inorganic carbon and nitrogen in the North Branch of inner Changjiang Estuary in a dry season

    NASA Astrophysics Data System (ADS)

    Zhai, Wei-Dong; Yan, Xiu-Li; Qi, Di

    2017-10-01

    We investigated the surface water carbonate system, nutrients, and relevant hydrochemical parameters in the inner Changjiang (Yangtze River) Estuary in early spring 2009 and 2010. The two surveys were carried out shortly after spring-tide days, and covered both the channel-like South Branch and the freshwater-blocked North Branch. In the North Branch, with a water residence time of approximately one month, we detected remarkable partial pressures of CO2 (pCO2) of 930-1518 μatm with a salinity range of 4.5-17.4, which were substantially higher than the South Branch pCO2 values of 700-1100 μatm at salinities of less than 0.88. The North Branch pCO2 distribution pattern is unique compared with many other estuaries where aquatic pCO2 normally declines with salinity increase. Furthermore, the biogeochemical additions of ammonium (7.4-65.7 μmol kg-1) and alkalinity (196-695 μmol kg-1) were identified in salinities between 4 and 16 in the North Branch. Based on field data analyses and simplified stoichiometric equations, we suggest that the relatively high North Branch pCO2 values and estuarine additions of dissolved inorganic nitrogen/carbon in the mid-salinity area were strongly associated with each other. These signals were primarily controlled by biogeochemical processes in the North Branch, combining biogenic organic matter decomposition (i.e. respiration), ammonia oxidation, CaCO3 dissolution, and CO2 degassing. In the upper reach of the South Branch, notable salinity values of 0.20-0.88 were detected, indicating saltwater spillover from the North Branch. These spillover waters had minor contributions (1.5-6.9%) to the springtime nutrient, dissolved inorganic carbon, and alkalinity export fluxes from Changjiang to the adjacent East China Sea. This is the first attempt to understand the biogeochemical controls of the unique pCO2 distributions in the North Branch, and to evaluate the effects of saltwater spillover from the North Branch on dry-season export fluxes

  4. Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery.

    PubMed

    Kockelkoren, Remko; Vos, Annelotte; Van Hecke, Wim; Vink, Aryan; Bleys, Ronald L A W; Verdoorn, Daphne; Mali, Willem P Th M; Hendrikse, Jeroen; Koek, Huiberdina L; de Jong, Pim A; De Vis, Jill B

    2017-01-01

    Intracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial calcification). Intimal and medial calcifications are thought to have a different pathogenesis and clinical consequences and can only be distinguished through ex vivo histological analysis. Therefore, our aim was to develop CT scoring method to distinguish intimal and medial iICA calcification in vivo. First, in both iICAs of 16 cerebral autopsy patients the intimal and/or medial calcification area was histologically assessed (142 slides). Brain CT images of these patients were matched to the corresponding histological slides to develop a CT score that determines intimal or medial calcification dominance. Second, performance of the CT score was assessed in these 16 patients. Third, reproducibility was tested in a separate cohort. First, CT features of the score were circularity (absent, dot(s), <90°, 90-270° or 270-360°), thickness (absent, ≥1.5mm, or <1.5mm), and morphology (indistinguishable, irregular/patchy or continuous). A high sum of features represented medial and a lower sum intimal calcifications. Second, in the 16 patients the concordance between the CT score and the dominant calcification type was reasonable. Third, the score showed good reproducibility (kappa: 0.72 proportion of agreement: 0.82) between the categories intimal, medial or absent/indistinguishable. The developed CT score shows good reproducibility and can differentiate reasonably well between intimal and medial calcification dominance in the iICA, allowing for further (epidemiological) studies on iICA calcification.

  5. Preoperative Patellofemoral Chondromalacia is Not a Contraindication for Fixed-Bearing Medial Unicompartmental Knee Arthroplasty.

    PubMed

    Adams, Alexander J; Kazarian, Gregory S; Lonner, Jess H

    2017-06-01

    Patellofemoral chondromalacia (PFCM) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA), but there is limited data assessing PFCM's impact on the results of fixed-bearing UKA. Our objective was to assess the impact of medial patellar and/or medial trochlear PFCM on overall and patellofemoral-specific 2-year outcomes after fixed-bearing medial UKA. Intraoperative notes defined the presence and location of PFCM during fixed bearing medial UKA. Outcome measures included the New Knee Society Score (NKSS), Kneeling Ability Score (KAS) and Forgotten Joint Score (FJS-12). Thirty-one knees with PFCM (PFCM group), and 52 knees without PFCM (N-PFCM group) were included for analysis. Mann-Whitney U tests assessed the statistical significance of observed differences, and a Bonferroni correction was applied, adjusting threshold for significance to P = .005. At minimum follow-up of 2 years, no statistical differences were detected between the N-PFCM and PFCM groups in the postoperative NKSS (159 vs 157, P = .731), preoperative to postoperative NKSS change (P = .447), FJS-12 (70.5 vs 67.6, P = .471), or KAS (71% vs 65%, P = .217). Patients with isolated patellar chondromalacia (n = 13) demonstrated trends toward worse outcomes according to NKSS (147, P = .198), FJS-12 (58, P = .094), and KAS (46%, P = .018), but were statistically insignificant. No failures occurred in either group. Functional outcomes of fixed-bearing medial UKA are not adversely impacted by the presence of PFCM involving the medial patellar facet and/or medial or central trochlea. Further follow-up is needed to determine longer-term implications of fixed-bearing medial UKA in patients with PFCM. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The JCR:LA-cp rat: a novel rodent model of cystic medial necrosis.

    PubMed

    Pung, Yuh Fen; Chilian, William M; Bennett, Martin R; Figg, Nichola; Kamarulzaman, Mohd Hamzah

    2017-03-01

    Although there are multiple rodent models of the metabolic syndrome, very few develop vascular complications. In contrast, the JCR:LA-cp rat develops both metabolic syndrome and early atherosclerosis in predisposed areas. However, the pathology of the normal vessel wall has not been described. We examined JCR:LA control (+/+) or cp/cp rats fed normal chow diet for 6 or 18 mo. JCR:LA-cp rats developed multiple features of advanced cystic medial necrosis including "cysts," increased collagen formation and proteoglycan deposition around cysts, apoptosis of vascular smooth muscle cells, and spotty medial calcification. These appearances began within 6 mo and were extensive by 18 mo. JCR:LA-cp rats had reduced medial cellularity, increased medial thickness, and vessel hypoxia that was most marked in the adventitia. In conclusion, the normal chow-fed JCR:LA-cp rat represents a novel rodent model of cystic medial necrosis, associated with multiple metabolic abnormalities, vascular smooth muscle cell apoptosis, and vessel hypoxia. NEW & NOTEWORTHY Triggers for cystic medial necrosis (CMN) have been difficult to study due to lack of animal models to recapitulate the pathologies seen in humans. Our study is the first description of CMN in the rat. Thus the JCR:LA-cp rat represents a useful model to investigate the underlying molecular changes leading to the development of CMN. Copyright © 2017 the American Physiological Society.

  7. Vegetation survey of PEN Branch wetlands

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    A survey was conducted of vegetation along Pen Branch Creek at Savannah River Site (SRS) in support of K-Reactor restart. Plants were identified to species by overstory, understory, shrub, and groundcover strata. Abundance was also characterized and richness and diversity calculated. Based on woody species basal area, the Pen Branch delta was the most impacted, followed by the sections between the reactor and the delta. Species richness for shrub and groundcover strata were also lowest in the delta. No endangered plant species were found. Three upland pine areas were also sampled. In support of K Reactor restart, this report summarizesmore » a study of the wetland vegetation along Pen Branch. Reactor effluent enters Indian Grove Branch and then flows into Pen Branch and the Pen Branch Delta.« less

  8. Vegetation survey of PEN Branch wetlands

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Not Available

    1991-01-01

    A survey was conducted of vegetation along Pen Branch Creek at Savannah River Site (SRS) in support of K-Reactor restart. Plants were identified to species by overstory, understory, shrub, and groundcover strata. Abundance was also characterized and richness and diversity calculated. Based on woody species basal area, the Pen Branch delta was the most impacted, followed by the sections between the reactor and the delta. Species richness for shrub and groundcover strata were also lowest in the delta. No endangered plant species were found. Three upland pine areas were also sampled. In support of K Reactor restart, this report summarizesmore » a study of the wetland vegetation along Pen Branch. Reactor effluent enters Indian Grove Branch and then flows into Pen Branch and the Pen Branch Delta.« less

  9. Complications with the MICRA TPS Pacemaker System: Persistent Complete Heart Block and Late Capture Failure.

    PubMed

    Holm, Niels; Müller, Andreas; Zbinden, Rainer

    2017-04-01

    A Medtronic MICRA transcatheter pacing system (Medtronic, Minneapolis, MN, USA) was implanted in an 86-year-old patient with sick sinus syndrome and left bundle branch block after transfemoral aortic valve implantation. During implantation she developed a persistent complete heart block due to manipulation with the large-bore delivery catheter. Two weeks later, acute pacemaker dysfunction occurred due to massive increase of pacing threshold and impedance without obvious pacemaker dislocation or myocardial perforation. Recurrent capture failure was seen with pacing output set at 5 V/1.0 ms. Hence, microdislocation or fixation of the tines in the right ventricular trabeculae has to be assumed. © 2016 Wiley Periodicals, Inc.

  10. Digital map of posterior cerebral artery infarcts associated with posterior cerebral artery trunk and branch occlusion.

    PubMed

    Phan, Thanh G; Fong, Ashley C; Donnan, Geoffrey; Reutens, David C

    2007-06-01

    Knowledge of the extent and distribution of infarcts of the posterior cerebral artery (PCA) may give insight into the limits of the arterial territory and infarct mechanism. We describe the creation of a digital atlas of PCA infarcts associated with PCA branch and trunk occlusion by magnetic resonance imaging techniques. Infarcts were manually segmented on T(2)-weighted magnetic resonance images obtained >24 hours after stroke onset. The images were linearly registered into a common stereotaxic coordinate space. The segmented images were averaged to yield the probability of involvement by infarction at each voxel. Comparisons were made with existing maps of the PCA territory. Thirty patients with a median age of 61 years (range, 22 to 86 years) were studied. In the digital atlas of the PCA, the highest frequency of infarction was within the medial temporal lobe and lingual gyrus (probability=0.60 to 0.70). The mean and maximal PCA infarct volumes were 55.1 and 128.9 cm(3), respectively. Comparison with published maps showed greater agreement in the anterior and medial boundaries of the PCA territory compared with its posterior and lateral boundaries. We have created a probabilistic digital atlas of the PCA based on subacute magnetic resonance scans. This approach is useful for establishing the spatial distribution of strokes in a given cerebral arterial territory and determining the regions within the arterial territory that are at greatest risk of infarction.

  11. Altered medial temporal activation related to local glutamate levels in subjects with prodromal signs of psychosis.

    PubMed

    Valli, Isabel; Stone, James; Mechelli, Andrea; Bhattacharyya, Sagnik; Raffin, Marie; Allen, Paul; Fusar-Poli, Paolo; Lythgoe, David; O'Gorman, Ruth; Seal, Marc; McGuire, Philip

    2011-01-01

    Both medial temporal cortical dysfunction and perturbed glutamatergic neurotransmission are regarded as fundamental pathophysiological features of psychosis. However, although animal models of psychosis suggest that these two abnormalities are interrelated, their relationship in humans has yet to be investigated. We used a combination of functional magnetic resonance imaging and magnetic resonance spectroscopy to investigate the relationship between medial temporal activation during an episodic memory task and local glutamate levels in 22 individuals with an at-risk mental state for psychosis and 14 healthy volunteers. We observed a significant between-group difference in the coupling of medial temporal activation with local glutamate levels. In control subjects, medial temporal activation during episodic encoding was positively associated with medial temporal glutamate. However, in the clinical population, medial temporal activation was reduced, and the relationship with glutamate was absent. In individuals at high risk of psychosis, medial temporal dysfunction seemed related to a loss of the normal relationship with local glutamate levels. This study provides the first evidence that links medial temporal dysfunction with the central glutamate system in humans and is consistent with evidence that drugs that modulate glutamatergic transmission might be useful in the treatment of psychosis. Copyright © 2011 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. Longitudinal Effects of Ketamine on Dendritic Architecture In Vivo in the Mouse Medial Frontal Cortex123

    PubMed Central

    Phoumthipphavong, Victoria; Barthas, Florent; Hassett, Samantha

    2016-01-01

    Abstract A single subanesthetic dose of ketamine, an NMDA receptor antagonist, leads to fast-acting antidepressant effects. In rodent models, systemic ketamine is associated with higher dendritic spine density in the prefrontal cortex, reflecting structural remodeling that may underlie the behavioral changes. However, turnover of dendritic spines is a dynamic process in vivo, and the longitudinal effects of ketamine on structural plasticity remain unclear. The purpose of the current study is to use subcellular resolution optical imaging to determine the time course of dendritic alterations in vivo following systemic ketamine administration in mice. We used two-photon microscopy to visualize repeatedly the same set of dendritic branches in the mouse medial frontal cortex (MFC) before and after a single injection of ketamine or saline. Compared to controls, ketamine-injected mice had higher dendritic spine density in MFC for up to 2 weeks. This prolonged increase in spine density was driven by an elevated spine formation rate, and not by changes in the spine elimination rate. A fraction of the new spines following ketamine injection was persistent, which is indicative of functional synapses. In a few cases, we also observed retraction of distal apical tuft branches on the day immediately after ketamine administration. These results indicate that following systemic ketamine administration, certain dendritic inputs in MFC are removed immediately, while others are added gradually. These dynamic structural modifications are consistent with a model of ketamine action in which the net effect is a rebalancing of synaptic inputs received by frontal cortical neurons. PMID:27066532

  13. What to do with medialized tympanostomy tubes? A survey of pediatric otolaryngologists.

    PubMed

    Bezdjian, Aren; Jiang, Joanna; Maby, Alexandra; Daniel, Sam J

    2018-01-01

    Tympanostomy tube placement is the most common surgical procedure performed in children. Medial migration of a tympanostomy tube is a rare occurrence where the tube migrates into the middle ear cavity as opposed to its normal extrusion into the external auditory canal. Whether medialized tympanostomy tubes should be surgically removed in asymptomatic patients is controversial. The objective of this study was to determine experience and management approach of medialized tympanostomy tubes among pediatric otolaryngologists. A 12-question cross-section survey was designed and distributed to the American Society of Pediatric Otolaryngology (ASPO) members. The survey study was granted McGill University institutional review board and ASPO research committee approval. The survey data were filtered and cross-tabulated. Descriptive statistics were generated. 128 pediatric otolaryngologists completed the 12-question survey. The majority of respondents had experienced at least one case of medialized tympanostomy tube (90.6%). The majority of patients (82.0%) were asymptomatic. 74 out of 128 respondents (57.8%) indicated that they would not remove a medialized tube in an asymptomatic patient. However, 7.0% of those respondents clarified that they would proceed to surgical removal if the patient were undergoing general anesthesia for another surgery. 30.5% of respondents indicated that they would surgically remove the tube even if the patient were asymptomatic. 6.3% of respondents indicated that opted management in children would be based on a shared decision with parents. Most respondents (80.5%) did not experience complications with surgical removal nor with elected observation. There is no consensus among pediatric otolaryngologists regarding the necessity of surgically removing a medialized tympanostomy tube in asymptomatic patients. The survey suggests that both options are acceptable. If observation is chosen, it is important that parents are well informed of the

  14. Medial gastrocnemius myoelectric control of a robotic ankle exoskeleton.

    PubMed

    Kinnaird, Catherine R; Ferris, Daniel P

    2009-02-01

    A previous study from our laboratory showed that when soleus electromyography was used to control the amount of plantar flexion assistance from a robotic ankle exoskeleton, subjects significantly reduced their soleus activity to quickly return to normal gait kinematics. We speculated that subjects were primarily responding to the local mechanical assistance of the exoskeleton rather than directly attempting to reduce exoskeleton mechanical power via decreases in soleus activity. To test this observation we studied ten healthy subjects walking on a treadmill at 1.25 m/s while wearing a robotic exoskeleton proportionally controlled by medial gastrocnemius activation. We hypothesized that subjects would primarily decrease soleus activity due to its synergistic mechanics with the exoskeleton. Subjects decreased medial gastrocnemius recruitment by 12% ( p < 0.05 ) but decreased soleus recruitment by 27% ( p < 0.05). In agreement with our hypothesis, the primary reduction in muscle activity was not for the control muscle (medial gastrocnemius) but for the anatomical synergist to the exoskeleton (soleus). These findings indicate that anatomical morphology needs to be considered carefully when designing software and hardware for robotic exoskeletons.

  15. Case report: comprehensive management of medial tibial stress syndrome

    PubMed Central

    Krenner, Bernard John

    2002-01-01

    Abstract Activity or exercise-induced leg pain is a common complication among competitive and “weekend warrior” athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of “shin splints,” one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. “Active” rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness. PMID:19674573

  16. Ultrasound-guided approach for axillary brachial plexus, femoral nerve, and sciatic nerve blocks in dogs.

    PubMed

    Campoy, Luis; Bezuidenhout, Abraham J; Gleed, Robin D; Martin-Flores, Manuel; Raw, Robert M; Santare, Carrie L; Jay, Ariane R; Wang, Annie L

    2010-03-01

    To describe an ultrasound-guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Prospective experimental trial. Four hound-cross dogs aged 2 +/- 0 years (mean +/- SD) weighing 30 +/- 5 kg and four Beagles aged 2 +/- 0 years and weighing 8.5 +/- 0.5 kg. Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation-guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Ultrasound-guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.

  17. Posterior medial meniscus-femoral insertion into the anterior cruciate ligament. A case report.

    PubMed

    Bhargava, A; Ferrari, D A

    1998-03-01

    Medial meniscal anomalies are rare. The anterior horn insertion into the anterior cruciate ligament is the most common. In the course of an arthroscopy for torn lateral meniscus, an anomalous band in continuity with the posterior horn of the medial meniscus was observed to insert into the anterior cruciate ligament. Although the tibial portion of the anterior cruciate was redundant, the anomalous band provided tension to the anterior cruciate ligament and a negative pivot shift. A previously unreported posterior medial meniscal femoral insertion is described.

  18. Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

    PubMed

    Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

    2016-01-01

    Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright

  19. Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syndrome.

    PubMed

    Sheehan, Frances T; Borotikar, Bhushan S; Behnam, Abrahm J; Alter, Katharine E

    2012-07-01

    A potential source of patellofemoral pain, one of the most common problems of the knee, is believed to be altered patellofemoral kinematics due to a force imbalance around the knee. Although no definitive etiology for this imbalance has been found, a weak vastus medialis is considered a primary factor. Therefore, this study's purpose was to determine how the loss of vastus medialis obliquus force alters three-dimensional in vivo knee joint kinematics during a volitional extension task. Eighteen asymptomatic female subjects with no history of knee pain or pathology participated in this IRB approved study. Patellofemoral and tibiofemoral kinematics were derived from velocity data acquired using dynamic cine-phase contrast MRI. The same kinematics were then acquired immediately after administering a motor branch block to the vastus medialis obliquus using 3-5ml of 1% lidocaine. A repeated measures analysis of variance was used to test the null hypothesis that the post- and pre-injection kinematics were no different. The null hypothesis was rejected for patellofemoral lateral shift (P=0.003, max change=1.8mm, standard deviation=1.7mm), tibiofemoral lateral shift (P<0.001, max change=2.1mm, standard deviation=2.9mm), and tibiofemoral external rotation (P<0.001, max change=3.7°, standard deviation=4.4°). The loss of vastus medialis obliquus function produced kinematic changes that mirrored the axial plane kinematics seen in individuals with patellofemoral pain, but could not account for the full extent of these changes. Thus, vastus medialis weakness is likely a major factor in, but not the sole source of, altered patellofemoral kinematics in such individuals. Published by Elsevier Ltd.

  20. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee.

    PubMed

    Lee, Stephen J; Aadalen, Kirk J; Malaviya, Prasanna; Lorenz, Eric P; Hayden, Jennifer K; Farr, Jack; Kang, Richard W; Cole, Brian J

    2006-08-01

    There is no consensus regarding the extent of meniscectomy leading to deleterious effects on tibiofemoral contact mechanics. The meniscus aids in optimizing tibiofemoral contact mechanics, increasing contact area, and decreasing contact stress. Controlled laboratory study. Twelve fresh-frozen human cadaveric knees each underwent 15 separate testing conditions-5 serial 20-mm posterior medial meniscectomy conditions (intact, 50% radial width, 75% radial width, segmental, and total meniscectomy) at 3 flexion angles (0 degrees , 30 degrees , and 60 degrees )-under an 1800-N axial load. Tekscan sensors were used to measure total force and medial force, contact area, mean contact stress, and peak contact stress. All posterior medial meniscectomy conditions resulted in significantly decreased contact areas and increased mean and peak contact stresses compared with the intact state (P < .05). The changes in contact mechanics after segmental and total posterior medial meniscectomies were not statistically different (P > .05). Incremental changes in contact area and mean contact stress increased as more peripheral portions of the medial meniscus were removed, whereas peak contact stresses exhibited similar incremental changes throughout all meniscectomy conditions. The meniscus is a crucial load-bearing structure, optimizing contact area and minimizing contact stress. Loss of hoop tension (ie, segmental meniscectomy) is equivalent to total meniscectomy in load-bearing terms. The peripheral portion of the medial meniscus provides a greater contribution to increasing contact areas and decreasing mean contact stresses than does the central portion, whereas peak contact stresses increase proportionally to the amount of meniscus removed. Because the degree of meniscectomy leading to clinically significant outcomes is unknown, a prudent strategy is to preserve the greatest amount of meniscus possible.

  1. The figure-of-eight radix nasi flap for medial canthal defects.

    PubMed

    Seyhan, Tamer

    2010-09-01

    Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars. Copyright 2009 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  2. Structural Mechanics and Dynamics Branch

    NASA Technical Reports Server (NTRS)

    Stefko, George

    2003-01-01

    The 2002 annual report of the Structural Mechanics and Dynamics Branch reflects the majority of the work performed by the branch staff during the 2002 calendar year. Its purpose is to give a brief review of the branch s technical accomplishments. The Structural Mechanics and Dynamics Branch develops innovative computational tools, benchmark experimental data, and solutions to long-term barrier problems in the areas of propulsion aeroelasticity, active and passive damping, engine vibration control, rotor dynamics, magnetic suspension, structural mechanics, probabilistics, smart structures, engine system dynamics, and engine containment. Furthermore, the branch is developing a compact, nonpolluting, bearingless electric machine with electric power supplied by fuel cells for future "more electric" aircraft. An ultra-high-power-density machine that can generate projected power densities of 50 hp/lb or more, in comparison to conventional electric machines, which generate usually 0.2 hp/lb, is under development for application to electric drives for propulsive fans or propellers. In the future, propulsion and power systems will need to be lighter, to operate at higher temperatures, and to be more reliable in order to achieve higher performance and economic viability. The Structural Mechanics and Dynamics Branch is working to achieve these complex, challenging goals.

  3. A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging.

    PubMed

    Furumatsu, Takayuki; Fujii, Masataka; Kodama, Yuya; Ozaki, Toshifumi

    2017-07-01

    The posterior root ligament of the medial meniscus (MM) has a critical role in regulating the MM movement. An accurate diagnosis of the MM posterior root tear (MMPRT) using magnetic resonance imaging (MRI) is important for preventing sequential osteoarthritis following the MMPRT. However, diagnosis of the MMPRT is relatively difficult even after using several characteristic MRI findings. The aim of this study was to identify a useful meniscal body sign of the MMPRT for improving diagnostic MRI reading. Eighty-five patients who underwent surgical treatments for the MMPRT (39 knees) and other types of MM tears (49 knees) were included. The presence of characteristic MRI findings such as cleft sign, ghost sign, radial tear sign, medial extrusion sign, and new meniscal body shape-oriented "giraffe neck sign" was evaluated in 120 MRI examinations. Giraffe neck signs were observed in 81.7% of the MMPRTs and in 3.3% of other MM tears. Cleft, ghost, and radial tear signs were highly positive in the MMPRTs compared with other MM tears. Medial extrusion signs were frequently observed in both groups. Coexistence rates of any 2 MRI signs, except for medial extrusion sign, were 91.7% in the MMPRT group and 5% in other MM tears. This study demonstrated that a new characteristic MRI finding "giraffe neck sign" was observed in 81.7% of the MMPRT. Our results suggest that the combination of giraffe neck, cleft, ghost, and radial tear signs may be important for an accurate diagnostic MRI reading of the MMPRT. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  4. Proximally pedicled medial plantar flap based on superficial venous system alone for venous drainage.

    PubMed

    Wright, Thomas C; Mossaad, Bassem M; Chummun, Shaheel; Khan, Umraz; Chapman, Thomas W L

    2013-07-01

    The proximally pedicled medial plantar flap is well described for coverage of wounds around the ankle and heel. This flap is usually based on the deep venae comitantes for venous drainage, with the superficial veins divided during dissection. Usually any disruption of the deep venous system of the flap would result in abandoning this choice of flap. Venous congestion is a recognised complication of medial plantar flaps. The patient described in this case report had a medial ankle defect with exposed bone, for which a proximally pedicled medial plantar flap was used. As we raised the flap, both venae comitantes of the medial planter artery were found to be disrupted. The flap was raised based on the superficial veins draining into the great saphenous, as the only system for venous drainage, with no evidence of venous congestion. The flap was successfully transposed into the defect and healed with no complications. The proximally pedicled medial plantar flap can safely rely on the superficial venous system alone for drainage. In addition, preserving the superficial veins minimise the risk of venous congestion in this flap. We recommend preservation of superficial venous system when possible. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. [A case of bilateral medial medullary infarction caused by unilateral vertebral artery dissection].

    PubMed

    Akimoto, Takayoshi; Hara, Makoto; Saito, Mari; Takahashi, Keiko; Kamei, Satoshi

    2015-01-01

    A 34-year-old man developed right neck pain. Several hours later, he felt numbness of his extremities and presented at our hospital. He developed right hemiparesis and hypoesthesia of the right extremities. A few hours later, upbeat nystagmus and dysarthria appeared along with a sensory disturbance that spread to all extremities, and right hemiparesis progressed to tetraplegia. Brain MR diffusion-weighted images revealed a high-intensity lesion in the bilateral medial medulla oblongata and we diagnosed this bilateral medial medullary infarction. Three dimentional CT angiography revealed dissection of the right VA. We administered intravenous argatroban, edaravone, glycerin and oral clopidogrel. He was assessed as having modified Rankin scale 4 and was transferred to another hospital for rehabilitation on day 30. When the medial medulla oblongata is supplied by the unilateral VA, a unilateral VA dissection can cause bilateral medial medullary infarction.

  6. Adding a PECS II block for proximal arm arteriovenous access - a randomised study.

    PubMed

    Quek, K H; Low, E Y; Tan, Y R; Ong, A S C; Tang, T Y; Kam, J W; Kiew, A S C

    2018-05-01

    Brachial plexus block is often utilised for proximal arm arteriovenous access creation. However, the medial upper arm and axilla are often inadequately anaesthetised, requiring repeated, intraoperative local anaesthetic supplementation, or conversion into general anaesthesia. We hypothesised that the addition of a PECS II block would improve anaesthesia and analgesia for proximal arm arteriovenous access surgery. In this prospective, double-blinded, randomised proof-of-concept study, 36 consenting adults with end-stage renal disease aged between 21 and 90 years received either a combined supraclavicular and PECS II block (Group PECS, n = 18), or combined supraclavicular and sham block (Group SCB, n = 18) for proximal arm arteriovenous access surgery. Primary outcome was whether patients required intraoperative local anaesthetic supplementation by the surgeon. In Group PECS, 33.3% (6/18) needed local anaesthetic supplementation vs. 100% (18/18) in Group SCB. Group SCB had three times (RR 3.0, 95% CI 1.6-5.8; P < 0.001) the risk of requiring intraoperative local anaesthetic supplementation. Group PECS required lower volume of supplemental local anaesthetic compared to Group SCB (0.0 ml, IQR 0.0-6.3 ml vs. 15.0 ml, IQR 7.4-17.8 ml; P < 0.001). Group SCB had twice [RR 2.2, 95% CI 1.1-4.4; (P = 0.019)] the risk of needing additional sedation or analgesia. There were no significant differences between the groups with respect to postoperative visual analogue scale pain scores, time to first rescue analgesia or patient satisfaction. The results suggest that adding a PECS II block to a supraclavicular block improves regional anaesthesia for patients with end-stage renal disease undergoing proximal arm arteriovenous access surgery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  7. Structural dynamics branch research and accomplishments

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Summaries are presented of fiscal year 1989 research highlights from the Structural Dynamics Branch at NASA Lewis Research Center. Highlights from the branch's major work areas include aeroelasticity, vibration control, dynamic systems, and computation structural methods. A listing of the fiscal year 1989 branch publications is given.

  8. Research program of the Geodynamics Branch

    NASA Technical Reports Server (NTRS)

    Kahn, W. D. (Editor); Cohen, S. C. (Editor); Boccucci, B. S. (Editor)

    1986-01-01

    This report is the Fourth Annual Summary of the Research Program of the Geodynamics Branch. The branch is located within the Laboratory for Terrestrial Physics of the Space and Earth Sciences Directorate of the Goddard Space Flight Center. The research activities of the branch staff cover a broad spectrum of geoscience disciplines including: tectonophysics, space geodesy, geopotential field modeling, and dynamic oceanography. The NASA programs which are supported by the work described in this document include the Geodynamics and Ocean Programs, the Crustal Dynamics Project and the proposed Ocean Topography Experiment (TOPEX). The reports highlight the investigations conducted by the Geodynamics Branch staff during calendar year 1985. The individual papers are grouped into chapters on Crustal Movements and Solid Earth Dynamics, Gravity Field Modeling and Sensing Techniques, and Sea Surface Topography. Further information on the activities of the branch or the particular research efforts described herein can be obtained through the branch office or from individual staff members.

  9. Medial joint line bone bruising at MRI complicating acute ankle inversion injury: what is its clinical significance?

    PubMed

    Chan, V O; Moran, D E; Shine, S; Eustace, S J

    2013-10-01

    To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury. Forty-five patients who underwent ankle magnetic resonance imaging (MRI) within 2 weeks of acute ankle inversion injury were included in this prospective study. Integrity of the lateral collateral ligament complex, presence of medial joint line bone bruising, tibio-talar joint effusion, and soft-tissue swelling were documented. Clinical follow-up at 6 months was carried out to determine the impact of injury on length of time out of work, delay in return to normal walking, delay in return to sports activity, and persistence of medial joint line pain. Thirty-seven patients had tears of the anterior talofibular ligament (ATFL). Twenty-six patients had medial joint line bone bruising with altered marrow signal at the medial aspect of the talus and congruent surface of the medial malleolus. A complete ATFL tear was seen in 92% of the patients with medial joint line bone bruising (p = 0.05). Patients with an ATFL tear and medial joint line bone bruising had a longer delay in return to normal walking (p = 0.0002), longer delay in return to sports activity (p = 0.0001), and persistent medial joint line pain (p = 0.0003). There was no statistically significant difference in outcome for the eight patients without ATFL tears. Medial joint line bone bruising following an acute ankle inversion injury was significantly associated with a complete ATFL tear, longer delay in the return to normal walking and sports activity, as well as persistent medial joint line pain. Its presence should prompt detailed assessment of the lateral collateral ligament complex, particularly the ATFL. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  10. Usefulness of StereoEEG-based tailored surgery for medial temporal lobe epilepsy. Preliminary results in 11 patients.

    PubMed

    Kubota, Yuichi; Ochiai, Taku; Hori, Tomokatsu; Kawamata, Takakazu

    2017-07-01

    Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing the appropriate surgical approach remain uncertain. This article reports 11 consecutive cases in which electrophysiological findings of stereoelectroencephalography (SEEG) were used to determine the optimal surgical approach. Eleven consecutive patients with MTLE underwent SEEG evaluation and were placed in either the medial or the medial+lateral group based on the findings. Patients in the medial group underwent SAH using the subtemporal approach, and patients in the medial+lateral group underwent SEEG-guided anterior temporal lobectomy. SEEG findings were also compared with other examinations including flumazenil (FMZ)-positron emission tomography (PET), fluorine-18 labeled fluorodeoxyglucose (FDG)-PET, and magnetoencephalography (MEG). Results were evaluated to determine which examinations most consistently identified the epileptogenic zone. Of the 11 cases, 4 patients were placed in the medial group, and 7 patients in the medial+lateral group. Of patients, 90.9% were classified in class I of the Engel Epilepsy Surgery Outcome Scale, while 72.7% were classified in class I by the International League Against Epilepsy (ILAE) system. Analyzed by group, 100% of the medial group experienced an Engel class I outcome in the medial group, compared to 85.7% in the medial+lateral group. SEEG findings were comparable with FDG-PET results (10 of 11, 91%). Tailored surgery guided by SEEG is an electrophysiologically feasible treatment for MTLE that can result in favorable outcomes. Although seizures are thought to originate in the medial temporal lobe in MTLE, it is important for involvement of the lateral temporal cortex to be also considered in some cases. Copyright © 2017. Published by Elsevier B.V.

  11. [Branches of the National Institute of Hygiene].

    PubMed

    Gromulska, Marta

    2008-01-01

    National Epidemiological Institute (National Institute of Hygiene, from 7th September 1923) was established in 1918 in Warsaw and acted at national level. Its actions in the field of diseases combat were supported by bacteriological stations and vaccine production in voivodeship cities, which were taken charge of by the state, and names "National Epidemiological Institutes". According to the ministers resolution from 6th July 1921,Epidemiological Institutes were merged to National Central Epidemiological Institutes (PZH), the epidemiological institutes outside Warsaw were named branches, which were to be located in every voivodeship city, according to the initial organizational resolutions. There were country branches of NCEI in: Cracow, Lwów, Lódź, Toruń, Lublin, and Wilno in the period 1919-1923. New branches in Poznań (1925), Gdynia(1934), Katowice (Voivodeship Institute of Hygiene (1936), Luck (1937), Stanisławów (1937), Kielce(1938), and Brześć/Bug (Municipal Station acting as branch of National Central Epidemiological Institute. Branches were subordinated to NCEI-PZH) in Warsaw where action plans and unified research and diagnostic method were established and annual meeting of the country branches managers took place. All branches cooperated with hospitals, national health services, district general practitioners and administration structure in control of infectious diseases. In 1938, the post of branch inspector was established, the first of whom was Feliks Przesmycki PhD. Branches cooperated also with University of Cracow, University of Lwów and University of Wilno. In 1935, National Institutes of Food Research was incorporated in PZH, Water Department was established, and these areas of activity began to develop in the branches accordingly. In 1938 there were 13 branches of PZH, and each had three divisions: bacteriological, food research and water research. Three branches in Cracow, Kielce and Lublin worked during World War II under German

  12. 30 CFR 56.6403 - Branch circuits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Electric Blasting § 56.6403 Branch circuits. (a) If electric blasting includes the use of branch circuits, each... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Branch circuits. 56.6403 Section 56.6403...

  13. 17 CFR 166.4 - Branch offices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Branch offices. 166.4 Section 166.4 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION CUSTOMER PROTECTION RULES § 166.4 Branch offices. Each branch office of each Commission registrant must use the name of the...

  14. Branch Input Resistance and Steady Attenuation for Input to One Branch of a Dendritic Neuron Model

    PubMed Central

    Rall, Wilfrid; Rinzel, John

    1973-01-01

    Mathematical solutions and numerical illustrations are presented for the steady-state distribution of membrane potential in an extensively branched neuron model, when steady electric current is injected into only one dendritic branch. Explicit expressions are obtained for input resistance at the branch input site and for voltage attenuation from the input site to the soma; expressions for AC steady-state input impedance and attenuation are also presented. The theoretical model assumes passive membrane properties and the equivalent cylinder constraint on branch diameters. Numerical examples illustrate how branch input resistance and steady attenuation depend upon the following: the number of dendritic trees, the orders of dendritic branching, the electrotonic length of the dendritic trees, the location of the dendritic input site, and the input resistance at the soma. The application to cat spinal motoneurons, and to other neuron types, is discussed. The effect of a large dendritic input resistance upon the amount of local membrane depolarization at the synaptic site, and upon the amount of depolarization reaching the soma, is illustrated and discussed; simple proportionality with input resistance does not hold, in general. Also, branch input resistance is shown to exceed the input resistance at the soma by an amount that is always less than the sum of core resistances along the path from the input site to the soma. PMID:4715583

  15. Hyper-branched CdTe nanostructures based on the self-assembling of quantum dots and their optical properties.

    PubMed

    Pan, Ling-Yun; Pan, Gen-Cai; Zhang, Yong-Lai; Gao, Bing-Rong; Dai, Zhen-Wen

    2013-02-01

    As the priority of interconnects and active components in nanoscale optical and electronic devices, three-dimensional hyper-branched nanostructures came into focus of research. Recently, a novel crystallization route, named as "nonclassical crystallization," has been reported for three-dimensional nanostructuring. In this process, Quantum dots are used as building blocks for the construction of the whole hyper-branched structures instead of ions or single-molecules in conventional crystallization. The specialty of these nanostructures is the inheritability of pristine quantum dots' physical integrity because of their polycrystalline structures, such as quantum confinement effect and thus the luminescence. Moreover, since a longer diffusion length could exist in polycrystalline nanostructures due to the dramatically decreased distance between pristine quantum dots, the exciton-exciton interaction would be different with well dispersed quantum dots and single crystal nanostructures. This may be a benefit for electron transport in solar cell application. Therefore, it is very necessary to investigate the exciton-exciton interaction in such kind of polycrystalline nanostructures and their optical properites for solar cell application. In this research, we report a novel CdTe hyper-branched nanostructures based on self-assembly of CdTe quantum dots. Each branch shows polycrystalline with pristine quantum dots as the building units. Both steady state and time-resolved spectroscopy were performed to investigate the properties of carrier transport. Steady state optical properties of pristine quantum dots are well inherited by formed structures. While a suppressed multi-exciton recombination rate was observed. This result supports the percolation of carriers through the branches' network.

  16. Medial Orbitofrontal Neurons Preferentially Signal Cues Predicting Changes in Reward during Unblocking

    PubMed Central

    Lopatina, Nina; McDannald, Michael A.; Styer, Clay V.; Peterson, Jacob F.; Sadacca, Brian F.; Cheer, Joseph F.

    2016-01-01

    The orbitofrontal cortex (OFC) has been broadly implicated in the ability to use the current value of expected outcomes to guide behavior. Although value correlates have been prominently reported in lateral OFC, they are more often associated with more medial areas. Further, recent studies in primates have suggested a dissociation in which the lateral OFC is involved in credit assignment and representation of reward identity and more medial areas are critical to representing value. Previously, we used unblocking to test more specifically what information about outcomes is represented by OFC neurons in rats; consistent with the proposed dichotomy between the lateral and medial OFC, we found relatively little linear value coding in the lateral OFC (Lopatina et al., 2015). Here we have repeated this experiment, recording in the medial OFC, to test whether such value signals might be found there. Neurons were recorded in an unblocking task as rats learned about cues that signaled either more, less, or the same amount of reward. We found that medial OFC neurons acquired responses to these cues; however, these responses did not signal different reward values across cues. Surprisingly, we found that cells developed responses to cues predicting a change, particularly a decrease, in reward value. This is consistent with a special role for medial OFC in representing current value to support devaluation/revaluation sensitive changes in behavior. SIGNIFICANCE STATEMENT This study uniquely examines encoding in rodent mOFC at the single-unit level in response to cues that predict more, less, or no change in reward in rats during training in a Pavlovian unblocking task, finding more cells responding to change-predictive cues and stronger activity in response to cues predictive of less reward. PMID:27511013

  17. Damage Tolerance Assessment Branch

    NASA Technical Reports Server (NTRS)

    Walker, James L.

    2013-01-01

    The Damage Tolerance Assessment Branch evaluates the ability of a structure to perform reliably throughout its service life in the presence of a defect, crack, or other form of damage. Such assessment is fundamental to the use of structural materials and requires an integral blend of materials engineering, fracture testing and analysis, and nondestructive evaluation. The vision of the Branch is to increase the safety of manned space flight by improving the fracture control and the associated nondestructive evaluation processes through development and application of standards, guidelines, advanced test and analytical methods. The Branch also strives to assist and solve non-aerospace related NDE and damage tolerance problems, providing consultation, prototyping and inspection services.

  18. 39 CFR 241.2 - Stations and branches.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... number, letter or name. As a general rule, branches are named. (2) Stations and branches transact... 39 Postal Service 1 2012-07-01 2012-07-01 false Stations and branches. 241.2 Section 241.2 Postal... DISCONTINUANCE § 241.2 Stations and branches. (a) Description. (1) Stations are established within the corporate...

  19. 39 CFR 241.2 - Stations and branches.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... number, letter or name. As a general rule, branches are named. (2) Stations and branches transact... 39 Postal Service 1 2013-07-01 2013-07-01 false Stations and branches. 241.2 Section 241.2 Postal... DISCONTINUANCE § 241.2 Stations and branches. (a) Description. (1) Stations are established within the corporate...

  20. 39 CFR 241.2 - Stations and branches.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... number, letter or name. As a general rule, branches are named. (2) Stations and branches transact... 39 Postal Service 1 2014-07-01 2014-07-01 false Stations and branches. 241.2 Section 241.2 Postal... DISCONTINUANCE § 241.2 Stations and branches. (a) Description. (1) Stations are established within the corporate...

  1. 39 CFR 241.2 - Stations and branches.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... number, letter or name. As a general rule, branches are named. (2) Stations and branches transact... 39 Postal Service 1 2011-07-01 2011-07-01 false Stations and branches. 241.2 Section 241.2 Postal... DISCONTINUANCE § 241.2 Stations and branches. (a) Description. (1) Stations are established within the corporate...

  2. 39 CFR 241.2 - Stations and branches.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... number, letter or name. As a general rule, branches are named. (2) Stations and branches transact... 39 Postal Service 1 2010-07-01 2010-07-01 false Stations and branches. 241.2 Section 241.2 Postal... DISCONTINUANCE § 241.2 Stations and branches. (a) Description. (1) Stations are established within the corporate...

  3. GABAergic Projections from the Medial Septum Selectively Inhibit Interneurons in the Medial Entorhinal Cortex

    PubMed Central

    Gonzalez-Sulser, Alfredo; Parthier, Daniel; Candela, Antonio; McClure, Christina; Pastoll, Hugh; Garden, Derek; Sürmeli, Gülşen

    2014-01-01

    The medial septum (MS) is required for theta rhythmic oscillations and grid cell firing in the medial entorhinal cortex (MEC). While GABAergic, glutamatergic, and cholinergic neurons project from the MS to the MEC, their synaptic targets are unknown. To investigate whether MS neurons innervate specific layers and cell types in the MEC, we expressed channelrhodopsin-2 in mouse MS neurons and used patch-clamp recording in brain slices to determine the response to light activation of identified cells in the MEC. Following activation of MS axons, we observed fast monosynaptic GABAergic IPSPs in the majority (>60%) of fast-spiking (FS) and low-threshold-spiking (LTS) interneurons in all layers of the MEC, but in only 1.5% of nonstellate principal cells (NSPCs) and in no stellate cells. We also observed fast glutamatergic responses to MS activation in a minority (<5%) of NSPCs, FS, and LTS interneurons. During stimulation of MS inputs at theta frequency (10 Hz), the amplitude of GABAergic IPSPs was maintained, and spike output from LTS and FS interneurons was entrained at low (25–60 Hz) and high (60–180 Hz) gamma frequencies, respectively. By demonstrating cell type-specific targeting of the GABAergic projection from the MS to the MEC, our results support the idea that the MS controls theta frequency activity in the MEC through coordination of inhibitory circuits. PMID:25505326

  4. LOCAL ORTHOGONAL CUTTING METHOD FOR COMPUTING MEDIAL CURVES AND ITS BIOMEDICAL APPLICATIONS

    PubMed Central

    Einstein, Daniel R.; Dyedov, Vladimir

    2010-01-01

    Medial curves have a wide range of applications in geometric modeling and analysis (such as shape matching) and biomedical engineering (such as morphometry and computer assisted surgery). The computation of medial curves poses significant challenges, both in terms of theoretical analysis and practical efficiency and reliability. In this paper, we propose a definition and analysis of medial curves and also describe an efficient and robust method called local orthogonal cutting (LOC) for computing medial curves. Our approach is based on three key concepts: a local orthogonal decomposition of objects into substructures, a differential geometry concept called the interior center of curvature (ICC), and integrated stability and consistency tests. These concepts lend themselves to robust numerical techniques and result in an algorithm that is efficient and noise resistant. We illustrate the effectiveness and robustness of our approach with some highly complex, large-scale, noisy biomedical geometries derived from medical images, including lung airways and blood vessels. We also present comparisons of our method with some existing methods. PMID:20628546

  5. Local Orthogonal Cutting Method for Computing Medial Curves and Its Biomedical Applications

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jiao, Xiangmin; Einstein, Daniel R.; Dyedov, Volodymyr

    2010-03-24

    Medial curves have a wide range of applications in geometric modeling and analysis (such as shape matching) and biomedical engineering (such as morphometry and computer assisted surgery). The computation of medial curves poses significant challenges, both in terms of theoretical analysis and practical efficiency and reliability. In this paper, we propose a definition and analysis of medial curves and also describe an efficient and robust method for computing medial curves. Our approach is based on three key concepts: a local orthogonal decomposition of objects into substructures, a differential geometry concept called the interior center of curvature (ICC), and integrated stabilitymore » and consistency tests. These concepts lend themselves to robust numerical techniques including eigenvalue analysis, weighted least squares approximations, and numerical minimization, resulting in an algorithm that is efficient and noise resistant. We illustrate the effectiveness and robustness of our approach with some highly complex, large-scale, noisy biomedical geometries derived from medical images, including lung airways and blood vessels. We also present comparisons of our method with some existing methods.« less

  6. Radial tears associated with cleavage tears of the medial meniscus in athletes.

    PubMed

    Kidron, Amos; Thein, Rafael

    2002-03-01

    To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Retrospective review. Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. All 11 patients returned to their former levels of activity after adequate surgery. When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.

  7. Pediatric Glial Heterotopia in the Medial Canthus.

    PubMed

    Kim, Soung Min; Amponsah, Emmanuel Kofi; Eo, Mi Young; Cho, Yun Ju; Lee, Suk Keun

    2017-11-01

    Glial heterotopias are rare, benign, congenital, midline, and nonteratomatous extracranial glial tissue. They may be confused as encephalocele or dermoid cysts and are mostly present in the nose.An 8-month-old African female child presented with a slow growing paranasal mass. The mass had been present at the left upper medial canthus since birth and had slowly and progressively enlarged. There was no communication between the mass and the cranial cavity during the operational procedure. The mass was immunohistochemically positive for S-100 protein as well as for glial fibrillary acidic protein, but negative for proliferating cell nuclear antigen. This suggested that the mass was composed of benign glial tissues with many astrocytes.The purpose of this report is to demonstrate the first patient with pediatric glial heterotopic tissue in the medial canthus and to report the clinical importance of its immunohistochemical findings.

  8. Axonal synapse sorting in medial entorhinal cortex

    NASA Astrophysics Data System (ADS)

    Schmidt, Helene; Gour, Anjali; Straehle, Jakob; Boergens, Kevin M.; Brecht, Michael; Helmstaedter, Moritz

    2017-09-01

    Research on neuronal connectivity in the cerebral cortex has focused on the existence and strength of synapses between neurons, and their location on the cell bodies and dendrites of postsynaptic neurons. The synaptic architecture of individual presynaptic axonal trees, however, remains largely unknown. Here we used dense reconstructions from three-dimensional electron microscopy in rats to study the synaptic organization of local presynaptic axons in layer 2 of the medial entorhinal cortex, the site of grid-like spatial representations. We observe path-length-dependent axonal synapse sorting, such that axons of excitatory neurons sequentially target inhibitory neurons followed by excitatory neurons. Connectivity analysis revealed a cellular feedforward inhibition circuit involving wide, myelinated inhibitory axons and dendritic synapse clustering. Simulations show that this high-precision circuit can control the propagation of synchronized activity in the medial entorhinal cortex, which is known for temporally precise discharges.

  9. Efficacy and Safety of a Novel Three-Step Medial Release Technique in Varus Total Knee Arthroplasty.

    PubMed

    Kim, Min Woo; Koh, In Jun; Kim, Ju Hwan; Jung, Jae Jong; In, Yong

    2015-09-01

    We investigated the efficacy and safety of our novel three-step medial release technique in varus total knee arthroplasty (TKA) over time. Two hundred sixty seven consecutive varus TKAs were performed by applying the algorithmic release technique which consisted of sequential release of the deep medial collateral ligament (step 1), the semimembranosus (step 2), and multiple needle puncturing of the superficial medial collateral ligament (step 3). One hundred seventeen, 114, and 36 knees were balanced after step 1, 2, and 3 releases, respectively. There were no significant differences in changes of medial and lateral laxities between groups in over a year. Our novel stepwise medial release technique was efficacious and safe in balancing varus knees during TKA. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Isolated medial meniscal tear in a Border Collie.

    PubMed

    Ridge, P A

    2006-01-01

    A three-year-old, female Border Collie was successfully treated for an isolated, torn, medial meniscus by arthroscopic meniscal tear resection. The dog returned to agility competition without recurrence of lameness.

  11. Stable, polymer-directed and SPION-nucleated magnetic amphiphilic block copolymer nanoprecipitates with readily reversible assembly in magnetic fields

    NASA Astrophysics Data System (ADS)

    Giardiello, Marco; Hatton, Fiona L.; Slater, Rebecca A.; Chambon, Pierre; North, Jocelyn; Peacock, Anita K.; He, Tao; McDonald, Tom O.; Owen, Andrew; Rannard, Steve P.

    2016-03-01

    The formation of inorganic-organic magnetic nanocomposites using reactive chemistry often leads to a loss of super-paramagnetisim when conducted in the presence of iron oxide nanoparticles. We present here a low energy and chemically-mild process of co-nanoprecipitation using SPIONs and homopolymers or amphiphilic block copolymers, of varying architecture and hydrophilic/hydrophobic balance, which efficiently generates near monodisperse SPION-containing polymer nanoparticles with complete retention of magnetism, and highly reversible aggregation and redispersion behaviour. When linear and branched block copolymers with inherent water-solubility are used, a SPION-directed nanoprecipitation mechanism appears to dominate the nanoparticle formation presenting new opportunities for tailoring and scaling highly functional systems for a range of applications.The formation of inorganic-organic magnetic nanocomposites using reactive chemistry often leads to a loss of super-paramagnetisim when conducted in the presence of iron oxide nanoparticles. We present here a low energy and chemically-mild process of co-nanoprecipitation using SPIONs and homopolymers or amphiphilic block copolymers, of varying architecture and hydrophilic/hydrophobic balance, which efficiently generates near monodisperse SPION-containing polymer nanoparticles with complete retention of magnetism, and highly reversible aggregation and redispersion behaviour. When linear and branched block copolymers with inherent water-solubility are used, a SPION-directed nanoprecipitation mechanism appears to dominate the nanoparticle formation presenting new opportunities for tailoring and scaling highly functional systems for a range of applications. Electronic supplementary information (ESI) available: Additional experimental details, NMR spectra, GPC chromatograms, kinetics experiments, graphs of nanopreciptate aggregation and cycling studies and SPION characterisation. See DOI: 10.1039/c6nr00788k

  12. Comparison of the coracoid and retroclavicular approaches for ultrasound-guided infraclavicular brachial plexus block.

    PubMed

    Kavrut Ozturk, Nilgun; Kavakli, Ali Sait

    2017-08-01

    This prospective randomized study compared the coracoid and retroclavicular approaches to ultrasound-guided infraclavicular brachial plexus block (IBPB) in terms of needle tip and shaft visibility and quality of block. We hypothesized that the retroclavicular approach would increase needle tip and shaft visibility and decrease the number of needle passes compared to the coracoid approach. A total of 100 adult patients who received IBPB block for upper limb surgery were randomized into two groups: a coracoid approach group (group C) and a retroclavicular approach group (group R). In group C, the needle was inserted 2 cm medial and 2 cm inferior to the coracoid process and directed from ventral to dorsal. In group R, the needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. All ultrasound images were digitally stored for analysis. The primary aim of the present study was to compare needle tip and shaft visibility between the coracoid approach and retroclavicular approach in patients undergoing upper limb surgery. The secondary aim was to investigate differences between the two groups in the number of needle passes, sensory and motor block success rates, surgical success rate, block performance time, block performance-related pain, patient satisfaction, use of supplemental local anesthetic and analgesic, and complications. Needle tip visibility and needle shaft visibility were significantly better in group R (p = 0.040, p = 0.032, respectively). Block performance time and anesthesia-related time were significantly shorter in group R (p = 0.022, p = 0.038, respectively). Number of needle passes was significantly lower in group R (p = 0.044). Paresthesia during block performance was significantly higher in group C (p = 0.045). There were no statistically significant differences between the two groups in terms of sensory or motor block success, surgical success, block-related pain, and patient satisfaction

  13. Physical examination and imaging of medial collateral ligament and posteromedial corner of the knee.

    PubMed

    Craft, Jason A; Kurzweil, Peter R

    2015-06-01

    The medial collateral ligament (MCL) is the most commonly injured knee ligament. Most will heal well with nonoperative treatment. However, not all medial knee injuries are the same. A detailed physical examination can help determine the severity of the medial-sided injury. When combined with advanced imaging, the examination will delineate damage to associated medial knee structures, including the location of MCL damage, posteromedial capsule injuries, and combined cruciate injuries. Failure to recognize MCL injuries that may be prone to chronic laxity can lead to significant disability, joint damage, and failure of concomitant cruciate ligament reconstructions. Magnetic resonance imaging is the mainstay of diagnostic imaging, with coronal sequences allowing full assessment of the MCL complex. Tangential views aid in the diagnosis of concomitant injuries. Stress radiography can play a role in evaluating MCL healing and subtle chronic laxity. Ultrasonography is also gaining acceptance as a means to assess MCL injuries. Use of a detailed examination and advanced imaging will allow optimal treatment of medial knee injuries and improve clinical outcomes.

  14. Anatomy of the Corrugator Muscle.

    PubMed

    Hwang, Kun; Lee, Jung Hun; Lim, Hee Joong

    2017-03-01

    The aim of this article is to systematically review the anatomy and action of the corrugator muscle. PubMed and Scopus were searched using the terms "corrugator" AND "anatomy." Among the 60 full texts from the 145 relevant abstracts, 34 articles without sufficient content were excluded and 4 articles drawn from the reference lists were added. Among the 30 articles analyzed (721 hemifaces), 28% classified by oblique head and transverse head, and 72% did not. Corrugator originated mostly from the medial supraorbital rim (45%), followed by the medial frontal bone (31%), the medial infraorbital rim (17%), and the upper nasal process (7%). Corrugator extended through the frontalis and orbicularis oculi (41%), only the frontalis (41%), or only the orbicularis oculi (18%). Corrugator ran superolaterally (59%), or laterally (41%). Corrugators inserted mostly to the middle of the eyebrow (57%), or the medial half of the eyebrow (36%), but also to the glabella region (7%). The length of the corrugator ranged 38 to 53 mm. The transverse head (23.38 mm) was longer than the oblique head (19.75 mm). Corrugator was thicker at the medial canthus than at the midpupillary line. Corrugator was innervated by the temporal branch of the facial nerve (66%), the zygomatic branch (17%), or the angular nerve (zygomatic branch and buccal branch, 17%). Supraorbital nerve (60%) or supratrochlear nerve (40%) penetrated the corrugator. The action was depressing, pulling the eyebrow medially (91%), or with medial eyebrow elevation and lateral eyebrow depression (9%). Surgeons must keep this anatomy in mind during surgical procedures.

  15. Contrasting medial moraine development at adjacent temperate, maritime glaciers: Fox and Franz Josef Glaciers, South Westland, New Zealand

    NASA Astrophysics Data System (ADS)

    Brook, Martin; Hagg, Wilfried; Winkler, Stefan

    2017-08-01

    Medial moraines form important pathways for sediment transportation in valley glaciers. Despite the existence of well-defined medial moraines on several glaciers in the New Zealand Southern Alps, medial moraines there have hitherto escaped attention. The evolving morphology and debris content of medial moraines on Franz Josef Glacier and Fox Glacier on the western flank of the Southern Alps is the focus of this study. These temperate maritime glaciers exhibit accumulation zones of multiple basins that feed narrow tongues flowing down steep valleys and terminate 400 m above sea level. The medial moraines at both glaciers become very prominent in the lower ablation zones, where the medial moraines widen, and develop steeper flanks coeval with an increase in relative relief. Medial moraine growth appears somewhat self-limiting in that relief and slope angle increase eventually lead to transport of debris away from the medial moraine by mass-movement-related processes. Despite similarities in overall morphologies, a key contrast in medial moraine formation exists between the two glaciers. At Fox Glacier, the medial moraine consists of angular rockfall-derived debris, folded to varying degrees along flow-parallel axes throughout the tongue. The debris originates above the ELA, coalesces at flow-unit boundaries, and takes a medium/high level transport pathway before subsequently emerging at point-sources aligned with gently dipping fold hinges near the snout. In contrast at Franz Josef Glacier, the medial moraine emerges farther down-glacier immediately below a prominent rock knob. Clasts show a mix of angular to rounded shapes representing high level transport and subglacially transported materials, the latter facies possibly also elevated by supraglacial routing of subglacial meltwater. Our observations confirm that a variety of different debris sources, transport pathways, and structural glaciological processes can interact to form medial moraines within New Zealand

  16. Releasing the circumferential fixation of the medial meniscus does not affect its kinematics.

    PubMed

    Vrancken, A C T; van Tienen, T G; Hannink, G; Janssen, D; Verdonschot, N; Buma, P

    2014-12-01

    Meniscal functioning depends on the fixation between the meniscal horns and the surrounding tissues. It is unknown, however, whether the integration between the outer circumference of the medial meniscus and the knee capsule/medial collateral ligament also influences the biomechanical behavior of the meniscus. Therefore, we aimed to determine whether detaching and resuturing the circumferential fixation of the medial meniscus influence its kinematic pattern. Human cadaveric knee joints were flexed (0°-30°-60°-90°) in a knee loading rig, in neutral orientation and under internal and external tibial torques. Roentgen stereophotogrammetric analysis was used to determine the motion of the meniscus in anteroposterior (AP) and mediolateral (ML) directions. Three fixation conditions were evaluated: (I) intact, (II) detached and (III) resutured. Detaching and resuturing the circumferential fixation did not alter the meniscal motion pattern in either the AP or ML direction. Applying an additional internal tibial torque caused the medial meniscus to move slightly anteriorly, and an external torque caused a little posterior translation with respect to the neutral situation. These patterns did not change when the circumferential fixation condition was altered. This study demonstrated that the motion pattern of the medial meniscus is independent of its fixation to the knee capsule and medial collateral ligament. The outcomes of this study can be deployed to design the fixation strategy of a permanent meniscus prosthesis. As peripheral fixation is a complicated step during meniscal replacement, the surgical procedure is considerably simplified when non-resorbable implants do not require circumferential fixation. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. 7 CFR 51.578 - Branch.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., CERTIFICATION, AND STANDARDS) United States Standards for Celery Definitions § 51.578 Branch. Branch means the leaf of a stalk and consists of the edible stem-like portion and the tops or leaf blades. ...

  18. 7 CFR 51.578 - Branch.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., CERTIFICATION, AND STANDARDS) United States Standards for Celery Definitions § 51.578 Branch. Branch means the leaf of a stalk and consists of the edible stem-like portion and the tops or leaf blades. ...

  19. The operative outcomes of displaced medial-end clavicle fractures.

    PubMed

    Sidhu, Verinder S; Hermans, Deborah; Duckworth, David G

    2015-11-01

    Nonoperative treatment of displaced medial clavicle fractures often leads to poor functional outcomes and painful nonunions. This study investigates the functional outcomes of patients undergoing operative fixation of these fractures. We investigated 27 patients undergoing operative fixation of a medial clavicle fracture; 24 had an acute, displaced fracture and 3 had fixation for nonunions. Preoperative radiographs or computed tomography scans were obtained, and data collected included age, sex, mechanism of injury, and fixation method. Follow-up included physical examination and radiographs for assessment of union; Disabilities of the Arm, Shoulder, and Hand scores at 12 months; and the recording of complications. The median age was 37 years (interquartile range, 17-47 years). There were 26 male patients and one female patient included, with 7 physeal injuries and 20 adult injuries. The most common mechanism of fracture was vehicular accident (n = 15). Three patients had operations for nonunions and 2 for a periprosthetic fracture medial to an existing plate. The fracture was fixed with plate and screws in 19 cases and with transosseous sutures in 8 cases. The median Disabilities of the Arm, Shoulder, and Hand score at 12 months was 0.4 (interquartile range, 0-5.0), with a union rate of 100% at 12 months. All patients had full shoulder range of motion at final follow-up and were able to return to preinjury occupational activities. There were no significant complications. Operative fixation of displaced medial clavicle fractures results in anatomic reconstruction and excellent functional outcomes, even in the setting of fixation performed for symptomatic nonunion. Early intervention can minimize the risk of painful nonunion. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  20. Differential effects of unilateral lesions in the medial amygdala on spontaneous and induced ovulation.

    PubMed

    Sanchez, M A; Dominguez, R

    1995-01-01

    The possible existence of asymmetry in the control of ovulation by the medial amygdala was explored. Unilateral lesions of the medial amygdala were performed on each day of the estrous cycle. The estral index diminished in almost all animals with a lesion in the right side of medial amygdala. Lesions of the right medial amygdala, when performed on diestrus-1, resulted in a significant decrease in the number of rats ovulating compared to controls (4/8 vs. 8/8, p < 0.05). In ovulating animals a significant reduction in the number of ova shed by the left ovary was found (2.2 +/- 0.8 vs. 6.3 +/- 0.8, p < 0.05). Lesions of the stria terminalis performed on diestrus-1 did not affect ovulation. In a second experiment, administration of GnRH did not restore ovulation in rats with lesions of the right medial amygdala. However, sequential injections of PMSG-hCG did result in ovulation by all members of a group of lesioned animals. In this last condition a significant decrease in the number of ova shed by the right ovary was found compared to animals in the lesion-only condition (1.5 +/- 0.5 vs. 6.0 +/- 1.5, p < 0.05). These data suggest that control of ovulation by the medial amygdala is asymmetric and varies during the estrous cycle.

  1. 12 CFR 545.92 - Branch offices.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Branch offices. 545.92 Section 545.92 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY FEDERAL SAVINGS ASSOCIATIONS-OPERATIONS § 545.92 Branch offices. (a) Definition. A branch office of a Federal savings association (“you”) is any...

  2. Gender moderates the association between dorsal medial prefrontal cortex volume and depressive symptoms in a subclinical sample.

    PubMed

    Carlson, Joshua M; Depetro, Emily; Maxwell, Joshua; Harmon-Jones, Eddie; Hajcak, Greg

    2015-08-30

    Major depressive disorder is associated with lower medial prefrontal cortex volumes. The role that gender might play in moderating this relationship and what particular medial prefrontal cortex subregion(s) might be implicated is unclear. Magnetic resonance imaging was used to assess dorsal, ventral, and anterior cingulate regions of the medial prefrontal cortex in a normative sample of male and female adults. The Depression, Anxiety, and Stress Scale (DASS) was used to measure these three variables. Voxel-based morphometry was used to test for correlations between medial prefrontal gray matter volume and depressive traits. The dorsal medial frontal cortex was correlated with greater levels of depression, but not anxiety and stress. Gender moderates this effect: in males greater levels of depression were associated with lower dorsal medial prefrontal volumes, but in females no relationship was observed. The results indicate that even within a non-clinical sample, male participants with higher levels of depressive traits tend to have lower levels of gray matter volume in the dorsal medial prefrontal cortex. Our finding is consistent with low dorsal medial prefrontal volume contributing to the development of depression in males. Future longitudinal work is needed to substantiate this possibility. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. [Examination and treatment of a loose medial coronoid process in dogs].

    PubMed

    Hazewinkel, H A; Voorhout, G

    1986-12-15

    An ununited medial coronoid process (MCP) is the most common developmental disturbance in the elbow joint of young dogs of large and medium-sized breeds. The clinical and radiological symptoms of ununited medial coronoid processes in thirty-nine dogs are reported, the presence of an ununited medial coronoid process being established by arthrotomy in these cases. Lameness was observed for the first time in these dogs, mainly Rottweilers, Retrievers and Berner Sennenhunde, and more often male dogs than bitches, when they were from four to six months of age. They showed lameness ranging from slight to severe, and the leg was frequently held in a position of abduction and outward rotation. The elbow joints involved often showed abnormal accumulations of fluid, hyperflexion and/or hyperextension being painful. Osteophytes, only occurring along the proximal border of the anconeal process, could be well assessed on the mediolateral radiographs. The appearance of the MCP, varying from normal to ununited, could best be evaluated in the mediolateral and anteroposterior medial oblique radiographs. These two radiographs were also of value in diagnosing an ununited anconeal process which was present at the same time as osteochondrosis of the medial condyle of the humerus in two dogs. The clinical symptoms were not associated with radiologically perceptible changes in some cases. Arthrotomy of the elbows showed that the entire apex or otherwise one or several fragments of the MCP, which are often wedged between the radius and ulna in these cases, may break off. Rapid post-operative improvement of locomotion is frequently reported. Preventive and diagnostic procedures carried out to make possible early institution of surgical treatment are discussed.

  4. Directed branch growth in aligned nanowire arrays.

    PubMed

    Beaudry, Allan L; LaForge, Joshua M; Tucker, Ryan T; Sorge, Jason B; Adamski, Nicholas L; Li, Peng; Taschuk, Michael T; Brett, Michael J

    2014-01-01

    Branch growth is directed along two, three, or four in-plane directions in vertically aligned nanowire arrays using vapor-liquid-solid glancing angle deposition (VLS-GLAD) flux engineering. In this work, a dynamically controlled collimated vapor flux guides branch placement during the self-catalyzed epitaxial growth of branched indium tin oxide nanowire arrays. The flux is positioned to grow branches on select nanowire facets, enabling fabrication of aligned nanotree arrays with L-, T-, or X-branching. In addition, a flux motion algorithm is designed to selectively elongate branches along one in-plane axis. Nanotrees are found to be aligned across large areas by X-ray diffraction pole figure analysis and through branch length and orientation measurements collected over 140 μm(2) from scanning electron microscopy images for each array. The pathway to guided assembly of nanowire architectures with controlled interconnectivity in three-dimensions using VLS-GLAD is discussed.

  5. Medial elbow injury in young throwing athletes

    PubMed Central

    Gregory, Bonnie; Nyland, John

    2013-01-01

    Summary This report reviews the anatomy, overhead throwing biomechanics, injury mechanism and incidence, physical examination and diagnosis, diagnostic imaging and conservative treatment of medial elbow injuries in young throwing athletes. Based on the information a clinical management decision-making algorithm is presented. PMID:23888291

  6. Affective Aprosodia from a Medial Frontal Stroke

    ERIC Educational Resources Information Center

    Heilman, Kenneth M.; Leon, Susan A.; Rosenbek, John C.

    2004-01-01

    Background and objectives: Whereas injury to the left hemisphere induces aphasia, injury to the right hemisphere's perisylvian region induces an impairment of emotional speech prosody (affective aprosodia). Left-sided medial frontal lesions are associated with reduced verbal fluency with relatively intact comprehension and repetition…

  7. Turing mechanism underlying a branching model for lung morphogenesis.

    PubMed

    Xu, Hui; Sun, Mingzhu; Zhao, Xin

    2017-01-01

    The mammalian lung develops through branching morphogenesis. Two primary forms of branching, which occur in order, in the lung have been identified: tip bifurcation and side branching. However, the mechanisms of lung branching morphogenesis remain to be explored. In our previous study, a biological mechanism was presented for lung branching pattern formation through a branching model. Here, we provide a mathematical mechanism underlying the branching patterns. By decoupling the branching model, we demonstrated the existence of Turing instability. We performed Turing instability analysis to reveal the mathematical mechanism of the branching patterns. Our simulation results show that the Turing patterns underlying the branching patterns are spot patterns that exhibit high local morphogen concentration. The high local morphogen concentration induces the growth of branching. Furthermore, we found that the sparse spot patterns underlie the tip bifurcation patterns, while the dense spot patterns underlies the side branching patterns. The dispersion relation analysis shows that the Turing wavelength affects the branching structure. As the wavelength decreases, the spot patterns change from sparse to dense, the rate of tip bifurcation decreases and side branching eventually occurs instead. In the process of transformation, there may exists hybrid branching that mixes tip bifurcation and side branching. Since experimental studies have reported that branching mode switching from side branching to tip bifurcation in the lung is under genetic control, our simulation results suggest that genes control the switch of the branching mode by regulating the Turing wavelength. Our results provide a novel insight into and understanding of the formation of branching patterns in the lung and other biological systems.

  8. Reversible online control of habitual behavior by optogenetic perturbation of medial prefrontal cortex

    PubMed Central

    Smith, Kyle S.; Virkud, Arti; Deisseroth, Karl; Graybiel, Ann M.

    2012-01-01

    Habits tend to form slowly but, once formed, can have great stability. We probed these temporal characteristics of habitual behaviors by intervening optogenetically in forebrain habit circuits as rats performed well-ingrained habitual runs in a T-maze. We trained rats to perform a maze habit, confirmed the habitual behavior by devaluation tests, and then, during the maze runs (ca. 3 s), we disrupted population activity in a small region in the medial prefrontal cortex, the infralimbic cortex. In accordance with evidence that this region is necessary for the expression of habits, we found that this cortical disruption blocked habitual behavior. Notably, however, this blockade of habitual performance occurred on line, within an average of three trials (ca. 9 s of inhibition), and as soon as during the first trial (<3 s). During subsequent weeks of training, the rats acquired a new behavioral pattern. When we again imposed the same cortical perturbation, the rats regained the suppressed maze-running that typified the original habit, and, simultaneously, the more recently acquired habit was blocked. These online changes occurred within an average of two trials (ca. 6 s of infralimbic inhibition). Measured changes in generalized performance ability and motivation to consume reward were unaffected. This immediate toggling between breaking old habits and returning to them demonstrates that even semiautomatic behaviors are under cortical control and that this control occurs online, second by second. These temporal characteristics define a framework for uncovering cellular transitions between fixed and flexible behaviors, and corresponding disturbances in pathologies. PMID:23112197

  9. Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus.

    PubMed

    Wang, Hong-De; Li, Tong; Gao, Shi-Jun

    2017-10-30

    Discoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals. Three improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal. This technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found. This improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less

  10. Repair of the posterior root of the medial meniscus.

    PubMed

    Jones, Christopher; Reddy, Sudheer; Ma, C Benjamin

    2010-01-01

    Tears of the posterior root of the medial meniscus are becoming increasingly recognized. Early identification and treatment of these tears help halt the progression of cartilage degeneration and osteoarthritis of the knee. Repair of these tears is essential for recreating the hoop stress of the medial meniscus. In this note, we describe a successful arthroscopic technique to repair this lesion. A posteromedial portal is established by which two 2-0 PDS sutures are placed through the meniscus root and pulled down through a trans-tibial tunnel and fixed using an EndoButton distally along the anterolateral cortex of the tibia. This has been performed successfully in five patients with no complications.

  11. Quantitative Analysis of Electro-Anatomical Maps: Application to an Experimental Model of Left Bundle Branch Block/Cardiac Resynchronization Therapy

    PubMed Central

    Duchateau, Nicolas; Kostantyn Butakov, Constantine Butakoff; Andreu, David; Fernández-Armenta, Juan; Bijnens, Bart; Berruezo, Antonio; Sitges, Marta; Camara, Oscar

    2017-01-01

    Electro-anatomical maps (EAMs) are commonly acquired in clinical routine for guiding ablation therapies. They provide voltage and activation time information on a 3-D anatomical mesh representation, making them useful for analyzing the electrical activation patterns in specific pathologies. However, the variability between the different acquisitions and anatomies hampers the comparison between different maps. This paper presents two contributions for the analysis of electrical patterns in EAM data from biventricular surfaces of cardiac chambers. The first contribution is an integrated automatic 2-D disk representation (2-D bull’s eye plot) of the left ventricle (LV) and right ventricle (RV) obtained with a quasi-conformal mapping from the 3-D EAM meshes, that allows an analysis of cardiac resynchronization therapy (CRT) lead positioning, interpretation of global (total activation time), and local indices (local activation time (LAT), surrogates of conduction velocity, inter-ventricular, and transmural delays) that characterize changes in the electrical activation pattern. The second contribution is a set of indices derived from the electrical activation: speed maps, computed from LAT values, to study the electrical wave propagation, and histograms of isochrones to analyze regional electrical heterogeneities in the ventricles. We have applied the proposed methods to look for the underlying physiological mechanisms of left bundle branch block (LBBB) and CRT, with the goal of optimizing the therapy by improving CRT response. To better illustrate the benefits of the proposed tools, we created a set of synthetically generated and fully controlled activation patterns, where the proposed representation and indices were validated. Then, the proposed analysis tools are used to analyze EAM data from an experimental swine model of induced LBBB with an implanted CRT device. We have analyzed and compared the electrical activation patterns at baseline, LBBB, and CRT stages in

  12. Computed tomographic assessment of the causal factors of unsuccessful medialization thyroplasty.

    PubMed

    Iwahashi, Toshihiko; Ogawa, Makoto; Hosokawa, Kiyohito; Mochizuki, Ryuichi; Inohara, Hidenori

    2015-03-01

    The present results demonstrate that a small implant size, undercorrection of the vocal fold, antero-posterior implant malposition, and the use of expanded polytetrafluoroethylene (ePTFE) are the primary factors that cause a poor outcome of medialization thyroplasty (MT). To assess the postoperative laryngeal condition using computed tomography (CT) in patients with unilateral vocal fold paralysis who underwent MT alone, and to identify the primary causal factors in terms of the surgical procedures that affect the outcomes of MT. Twenty-two patients who underwent MT alone were divided into two groups based on either the maximal phonation time or the perceived vocal breathiness. Two laryngologists assessed the postoperative laryngeal CT images during sustained vowel phonation and judged whether there were abnormalities of the arytenoid cartilage position, window position, implant size, and implant position, as well as the degree of correction of the vocal fold. As implant material, a silicone block, ePTFE, and hydroxyapatite had been inserted in 2, 9, and 11 patients, respectively. Comparisons of the prevalence of abnormalities in the abovementioned factors between the different outcomes and between the types of material used for the implant were performed. Twelve patients with a poor outcome and 10 with a good outcome showed 36 and 18 abnormal findings identified by either of the two laryngologists, respectively. In the poor outcome group, a smaller implant size and undercorrection of the vocal fold showed both high kappa values and a significantly higher prevalence than those in the good outcome group (p < 0.001 and p < 0.05), respectively. The comparison between material types demonstrated that the sheet-like material (ePTFE) group exhibited a significantly higher prevalence of undercorrection than the block-like material group (p < 0.05).

  13. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

  14. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

  15. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

  16. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling.

    PubMed

    Dobson, Laura E; Musa, Tarique A; Uddin, Akhlaque; Fairbairn, Timothy A; Bebb, Owen J; Swoboda, Peter P; Haaf, Philip; Foley, James; Garg, Pankaj; Fent, Graham J; Malkin, Christopher J; Blackman, Daniel J; Plein, Sven; Greenwood, John P

    2017-02-22

    Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m 2 , p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB

  17. Dissociable patterns of medial prefrontal and amygdala activity to face identity versus emotion in bipolar disorder.

    PubMed

    Keener, M T; Fournier, J C; Mullin, B C; Kronhaus, D; Perlman, S B; LaBarbara, E; Almeida, J C; Phillips, M L

    2012-09-01

    Individuals with bipolar disorder demonstrate abnormal social function. Neuroimaging studies in bipolar disorder have shown functional abnormalities in neural circuitry supporting face emotion processing, but have not examined face identity processing, a key component of social function. We aimed to elucidate functional abnormalities in neural circuitry supporting face emotion and face identity processing in bipolar disorder. Twenty-seven individuals with bipolar disorder I currently euthymic and 27 healthy controls participated in an implicit face processing, block-design paradigm. Participants labeled color flashes that were superimposed on dynamically changing background faces comprising morphs either from neutral to prototypical emotion (happy, sad, angry and fearful) or from one identity to another identity depicting a neutral face. Whole-brain and amygdala region-of-interest (ROI) activities were compared between groups. There was no significant between-group difference looking across both emerging face emotion and identity. During processing of all emerging emotions, euthymic individuals with bipolar disorder showed significantly greater amygdala activity. During facial identity and also happy face processing, euthymic individuals with bipolar disorder showed significantly greater amygdala and medial prefrontal cortical activity compared with controls. This is the first study to examine neural circuitry supporting face identity and face emotion processing in bipolar disorder. Our findings of abnormally elevated activity in amygdala and medial prefrontal cortex (mPFC) during face identity and happy face emotion processing suggest functional abnormalities in key regions previously implicated in social processing. This may be of future importance toward examining the abnormal self-related processing, grandiosity and social dysfunction seen in bipolar disorder.

  18. The sensory territory of the lateral cutaneous nerve of the thigh as determined by anatomic dissections and ultrasound-guided blocks.

    PubMed

    Corujo, Alejandro; Franco, Carlo D; Williams, James M

    2012-01-01

    A femoral block sometimes fails to provide complete sensory anesthesia of the anterior aspect of middle and distal thigh, and a block of the lateral cutaneous nerve of the thigh (LCN) is often necessary to supplement it. The goal of this study was to demonstrate, both in the anatomy laboratory and in the clinical setting, a possible contribution of the LCN to the innervation of the anterior thigh. This was a prospective, observational study, including anatomic dissections and a clinical section in which 22 patients received an ultrasound-guided block of the LCN. The resulting area of anesthesia was determined 15 minutes later using pinprick examination. In 1 of 3 thigh dissections, we found a dominant LCN innervating most of the anterior aspect of the middle and distal thigh, areas that are usually attributed to the femoral nerve. In the clinical part of the study, 10 patients (45.5%) developed an area of anesthesia that extended to the medial aspect of the thigh and distally to the patella. Our results, coming from a small sample, seem to indicate that the LCN may contribute to the innervation of the anterior thigh in some cases. A block of the LCN could be considered when a femoral block has failed to produce the expected area of anesthesia.

  19. Guide to the Seattle Archives Branch.

    ERIC Educational Resources Information Center

    Hobbs, Richard, Comp.

    The guide presents an overview of the textual and microfilmed records located at the Seattle Branch of the National Archives of the United States. Established in 1969, the Seattle Archives Branch is one of 11 branches which preserve and make available for research those U.S. Government records of permanent value created and maintained by Federal…

  20. The Effects of a Branch Campus

    ERIC Educational Resources Information Center

    Lien, Donald; Wang, Yaqin

    2012-01-01

    We examine the effects of a branch campus on the social welfare of the host country and the foreign university. Overall, we find that a branch campus increases both the domestic social welfare (measured by the aggregate student utility) and the tuition revenue of the foreign university. The effect of a branch campus on the brain drain is…

  1. Dynamic Crack Branching - A Photoelastic Evaluation,

    DTIC Science & Technology

    1982-05-01

    0.41 mPai and a 0.18 MPa, and predicted a theoretical kinking angle of 84°whichagreed well with experimentally measured angle. After crack kinking...Consistent crack branching’at KIb = 2.04 MPaI -i- and r = 1.3 mm verified this crack branching criterion. The crack branching angle predicted by--.’ DD

  2. Recruitment of the Rhesus soleus and medial gastrocnemius before, during and after spaceflight

    NASA Technical Reports Server (NTRS)

    Roy, R. R.; Hodgson, J. A.; Aragon, J.; Day, M. K.; Kozlovskaya, I.; Edgerton, V. R.

    1996-01-01

    Electromyograms were recorded from the soleus and medial gastrocnemius muscles and tendon force from the medial gastrocnemius muscle of 2 juvenile Rhesus monkeys before, during and after Cosmos flight 2229 and of ground control animals. Recording sessions were made while the Rhesus were performing a foot pedal motor task. Preflight testing indicated normal patterns of recruitment between the soleus and medial gastrocnemius, i.e. a higher level of recruitment of the soleus compared to the medial gastrocnemius during the task. Recording began two days into the spaceflight and showed that the media gastrocnemius was recruited preferentially over the soleus. This observation persisted throughout the flight and for the 2 week period of postflight testing. These data indicate a significant change in the relative recruitment of slow and fast extensor muscles under microgravity conditions. The appearance of clonic-like activity in one muscle of each Rhesus during flight further suggests a reorganization in the neuromotor system in a microgravity environment.

  3. Correlation between the knee adduction torque and medial contact force for a variety of gait patterns.

    PubMed

    Zhao, Dong; Banks, Scott A; Mitchell, Kim H; D'Lima, Darryl D; Colwell, Clifford W; Fregly, Benjamin J

    2007-06-01

    The external knee adduction torque has been proposed as a surrogate measure for medial compartment load during gait. However, a direct link between these two quantities has not been demonstrated using in vivo measurement of medial compartment load. This study uses in vivo data collected from a single subject with an instrumented knee implant to evaluate this link. The subject performed five different overground gait motions (normal, fast, slow, wide, and toe-out) with simultaneous collection of instrumented implant, video motion, and ground reaction data. For each trial, the knee adduction torque was measured externally while the total axial force applied to the tibial insert was measured internally. Based on data collected from the same subject performing treadmill gait under fluoroscopic motion analysis, a regression equation was developed to calculate medial contact force from the implant load cell measurements. Correlation analyses were performed for the stance phase and entire gait cycle to quantify the relationship between the knee adduction torque and both the medial contact force and the medial to total contact force ratio. When the entire gait cycle was analyzed, R(2) for medial contact force was 0.77 when all gait trials were analyzed together and between 0.69 and 0.93 when each gait trial was analyzed separately (p < 0.001 in all cases). For medial to total force ratio, R(2) was 0.69 for all trials together and between 0.54 and 0.90 for each trial separately (p < 0.001 in all cases). When only the stance phase was analyzed, R(2) values were slightly lower. These results support the hypothesis that the knee adduction torque is highly correlated with medial compartment contact force and medial to total force ratio during gait. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  4. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.

    PubMed

    Choi, Chul-Jun; Choi, Yun-Jin; Lee, Jae-Jeong; Choi, Chong-Hyuk

    2010-12-01

    The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Of these cases, 248 (64.1%) with MRI were reviewed. Arthroscopic findings were reviewed for the type of tear and medial compartment cartilage lesion. Root tear was defined as a radial tear in the posterior horn of the medial meniscus near the tibial spine (i.e., within 5 mm of the root attachment). An MRI scan of the knee was used to evaluate the presence and extent of meniscal extrusion. Meniscal extrusion of 3 mm or greater was considered pathologic. Arthroscopic findings were compared with respect to the extent of meniscal extrusion. There were 98 male patients and 150 female patients. The mean age was 53.5 years (range, 15 to 81 years). The results showed 127 cases (51.2%) in which the medial meniscus had meniscal extrusion of 3 mm or greater. Posterior root tears were found in 66 (26.6%) of the 248 knees. The mean meniscal extrusion in patients with root tear was 3.8 ± 1.4 mm, whereas the mean extrusion of those who had no root tear was 2.7 ± 1.3 mm. We found an association between pathologic meniscal extrusion and root tear (P < .001). Meniscal extrusion showed a low positive predictive value (39%) and specificity (58%) with regard to the meniscal root tear. Meniscal extrusion was also significantly correlated with severity of chondral lesions (P < .001). Considerable extrusion (≥3 mm) can be associated with tearing of the medial meniscus root and chondral lesion of the medial femoral condyle. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. [Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

    PubMed

    Qian, Yue-Nan; Liu, Fang; Dong, Yi-Long; Cai, Chun-Yuan

    2018-03-25

    To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  6. Modified parton branching model for multi-particle production in hadronic collisions: Application to SUSY particle branching

    NASA Astrophysics Data System (ADS)

    Yuanyuan, Zhang

    The stochastic branching model of multi-particle productions in high energy collision has theoretical basis in perturbative QCD, and also successfully describes the experimental data for a wide energy range. However, over the years, little attention has been put on the branching model for supersymmetric (SUSY) particles. In this thesis, a stochastic branching model has been built to describe the pure supersymmetric particle jets evolution. This model is a modified two-phase stochastic branching process, or more precisely a two phase Simple Birth Process plus Poisson Process. The general case that the jets contain both ordinary particle jets and supersymmetric particle jets has also been investigated. We get the multiplicity distribution of the general case, which contains a Hypergeometric function in its expression. We apply this new multiplicity distribution to the current experimental data of pp collision at center of mass energy √s = 0.9, 2.36, 7 TeV. The fitting shows the supersymmetric particles haven't participate branching at current collision energy.

  7. Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears.

    PubMed

    Choi, Chul-Jun; Choi, Yun-Jin; Song, In-Bum; Choi, Chong-Hyuk

    2011-06-01

    The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.

  8. Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography.

    PubMed

    Hwang, In-Chang; Cho, Goo-Yeong; Yoon, Yeonyee E; Park, Jin Joo

    2018-01-01

    The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography. A total of 269 patients with LBBB (mean age, 69.5 ± 10.9 years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters. During a median of 27.5 months (interquartile range, 12.8-43.9 months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS > -12.2%, global circumferential strain > -11.8%, and twist < 6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344-16.413; P = .015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>-12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS. Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters. Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  9. Cationic PAMAM Dendrimers as Pore-Blocking Binary Toxin Inhibitors

    PubMed Central

    2015-01-01

    Dendrimers are unique highly branched macromolecules with numerous groundbreaking biomedical applications under development. Here we identified poly(amido amine) (PAMAM) dendrimers as novel blockers for the pore-forming B components of the binary anthrax toxin (PA63) and Clostridium botulinum C2 toxin (C2IIa). These pores are essential for delivery of the enzymatic A components of the internalized toxins from endosomes into the cytosol of target cells. We demonstrate that at low μM concentrations cationic PAMAM dendrimers block PA63 and C2IIa to inhibit channel-mediated transport of the A components, thereby protecting HeLa and Vero cells from intoxication. By channel reconstitution and high-resolution current recording, we show that the PAMAM dendrimers obstruct transmembrane PA63 and C2IIa pores in planar lipid bilayers at nM concentrations. These findings suggest a new potential role for the PAMAM dendrimers as effective polyvalent channel-blocking inhibitors, which can protect human target cells from intoxication with binary toxins from pathogenic bacteria. PMID:24954629

  10. A clinical sign to detect root avulsions of the posterior horn of the medial meniscus.

    PubMed

    Seil, Romain; Dück, Klaus; Pape, Dietrich

    2011-12-01

    The goal of the present report was to describe a new clinical sign to make a clinical diagnosis of meniscal extrusion related to medial meniscal root avulsion. Description of an easy clinical sign to detect extrusion of the medial meniscus at the anteromedial joint line. A varus stress test was applied in full extension before and after transosseous repair of an isolated traumatic avulsion of the posterior root of the medial meniscus in a 21-year-old patient. The clinical sign was verified by sectioning of the meniscotibial ligament during knee arthroplasty surgery in 3 patients. With a deficient posterior root, the clinical sign was positive, showing anteromedial extrusion under varus stress. After repair and at clinical follow-up, extrusion was normalized. Making the clinical diagnosis of medial meniscus extrusion after knee injury by applying a simple varus stress test to the knee and palpating the anteromedial meniscal extrusion might help physicians to suspect a medial meniscus root tear in the early stages after the injury as well as to evaluate its reduction after repair. A varus stress test in full extension should be performed systematically in patients where a root tear of the medial meniscus is suspected as well as after surgery to evaluate the success of the repair.

  11. Age-Group Differences in Medial Cortex Activity Associated with Thinking About Self-Relevant Agendas

    PubMed Central

    Mitchell, Karen J.; Raye, Carol L.; Ebner, Natalie C.; Tubridy, Shannon M.; Frankel, Hillary; Johnson, Marcia K.

    2009-01-01

    This functional magnetic resonance imaging (fMRI) study compared young and older adults’ brain activity as they thought about motivationally self-relevant agendas (hopes and aspirations, duties and obligations) and concrete control items (e.g., shape of USA). Young adults’ activity replicated a double dissociation (Johnson et al., 2006): an area of medial frontal gyrus/anterior cingulate cortex was most active during hopes and aspirations trials and an area of medial posterior cortex, primarily posterior cingulate, was most active during duties and obligations trials. Compared to young adults, older adults showed attenuated responses in medial cortex, especially in medial prefrontal cortex, with both less activity during self-relevant trials and less deactivation during control trials. The fMRI data, together with post-scan reports and the behavioral literature on age-group differences in motivational orientation, suggest that the differences in medial cortex seen in this study reflect young and older adults’ focus on different information during motivationally self-relevant thought. Differences also may be related to an age-associated deficit in controlled cognitive processes that are engaged by complex self-reflection and mediated by prefrontal cortex. PMID:19485660

  12. Ultra-Tuning of the Rare-Earth fcu-MOF Aperture Size for Selective Molecular Exclusion of Branched Paraffins.

    PubMed

    Assen, Ayalew H; Belmabkhout, Youssef; Adil, Karim; Bhatt, Prashant M; Xue, Dong-Xu; Jiang, Hao; Eddaoudi, Mohamed

    2015-11-23

    Using isoreticular chemistry allows the design and construction of a new rare-earth metal (RE) fcu-MOF with a suitable aperture size for practical steric adsorptive separations. The judicious choice of a relatively short organic building block, namely fumarate, to bridge the 12-connected RE hexanuclear clusters has afforded the contraction of the well-defined RE-fcu-MOF triangular window aperture, the sole access to the two interconnected octahedral and tetrahedral cages. The newly constructed RE (Y(3+) and Tb(3+)) fcu-MOF analogues display unprecedented total exclusion of branched paraffins from normal paraffins. The resultant window aperture size of about 4.7 Å, regarded as a sorbate-size cut-off, enabled a complete sieving of branched paraffins from normal paraffins. The results are supported by collective single gas and mixed gas/vapor adsorption and calorimetric studies. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Structure-based design and mechanisms of allosteric inhibitors for mitochondrial branched-chain α-ketoacid dehydrogenase kinase

    PubMed Central

    Qi, Xiangbing; Gui, Wen-Jun; Morlock, Lorraine K.; Wallace, Amy L.; Ahmed, Kamran; Laxman, Sunil; Campeau, Philippe M.; Lee, Brendan H.; Hutson, Susan M.; Tu, Benjamin P.; Williams, Noelle S.; Tambar, Uttam K.; Wynn, R. Max; Chuang, David T.

    2013-01-01

    The branched-chain amino acids (BCAAs) leucine, isoleucine, and valine are elevated in maple syrup urine disease, heart failure, obesity, and type 2 diabetes. BCAA homeostasis is controlled by the mitochondrial branched-chain α-ketoacid dehydrogenase complex (BCKDC), which is negatively regulated by the specific BCKD kinase (BDK). Here, we used structure-based design to develop a BDK inhibitor, (S)-α-chloro-phenylpropionic acid [(S)-CPP]. Crystal structures of the BDK-(S)-CPP complex show that (S)-CPP binds to a unique allosteric site in the N-terminal domain, triggering helix movements in BDK. These conformational changes are communicated to the lipoyl-binding pocket, which nullifies BDK activity by blocking its binding to the BCKDC core. Administration of (S)-CPP to mice leads to the full activation and dephosphorylation of BCKDC with significant reduction in plasma BCAA concentrations. The results buttress the concept of targeting mitochondrial BDK as a pharmacological approach to mitigate BCAA accumulation in metabolic diseases and heart failure. PMID:23716694

  14. How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces.

    PubMed

    Lerner, Zachary F; DeMers, Matthew S; Delp, Scott L; Browning, Raymond C

    2015-02-26

    Understanding degeneration of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Musculoskeletal models can estimate medial/lateral tibiofemoral compartment contact forces, yet anthropometric differences between individuals make accurate predictions challenging. We developed a full-body OpenSim musculoskeletal model with a knee joint that incorporates subject-specific tibiofemoral alignment (i.e. knee varus-valgus) and geometry (i.e. contact locations). We tested the accuracy of our model and determined the importance of these subject-specific parameters by comparing estimated to measured medial and lateral contact forces during walking in an individual with an instrumented knee replacement and post-operative genu valgum (6°). The errors in the predictions of the first peak medial and lateral contact force were 12.4% and 11.9%, respectively, for a model with subject-specific tibiofemoral alignment and contact locations determined through radiographic analysis, vs. 63.1% and 42.0%, respectively, for a model with generic parameters. We found that each degree of tibiofemoral alignment deviation altered the first peak medial compartment contact force by 51N (r(2)=0.99), while each millimeter of medial-lateral translation of the compartment contact point locations altered the first peak medial compartment contact force by 41N (r(2)=0.99). The model, available at www.simtk.org/home/med-lat-knee/, enables the specification of subject-specific joint alignment and compartment contact locations to more accurately estimate medial and lateral tibiofemoral contact forces in individuals with non-neutral alignment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. How Tibiofemoral Alignment and Contact Locations Affect Predictions of Medial and Lateral Tibiofemoral Contact Forces

    PubMed Central

    Lerner, Zachary F.; DeMers, Matthew S.; Delp, Scott L.; Browning, Raymond C.

    2015-01-01

    Understanding degeneration of biological and prosthetic knee joints requires knowledge of the in-vivo loading environment during activities of daily living. Musculoskeletal models can estimate medial/lateral tibiofemoral compartment contact forces, yet anthropometric differences between individuals make accurate predictions challenging. We developed a full-body OpenSim musculoskeletal model with a knee joint that incorporates subject-specific tibiofemoral alignment (i.e. knee varus-valgus) and geometry (i.e. contact locations). We tested the accuracy of our model and determined the importance of these subject-specific parameters by comparing estimated to measured medial and lateral contact forces during walking in an individual with an instrumented knee replacement and post-operative genu valgum (6°). The errors in the predictions of the first peak medial and lateral contact force were 12.4% and 11.9%, respectively, for a model with subject-specific tibiofemoral alignment and contact locations determined via radiographic analysis, vs. 63.1% and 42.0%, respectively, for a model with generic parameters. We found that each degree of tibiofemoral alignment deviation altered the first peak medial compartment contact force by 51N (r2=0.99), while each millimeter of medial-lateral translation of the compartment contact point locations altered the first peak medial compartment contact force by 41N (r2=0.99). The model, available at www.simtk.org/home/med-lat-knee/, enables the specification of subject-specific joint alignment and compartment contact locations to more accurately estimate medial and lateral tibiofemoral contact forces in individuals with non-neutral alignment. PMID:25595425

  16. Tree Branching: Leonardo da Vinci's Rule versus Biomechanical Models

    PubMed Central

    Minamino, Ryoko; Tateno, Masaki

    2014-01-01

    This study examined Leonardo da Vinci's rule (i.e., the sum of the cross-sectional area of all tree branches above a branching point at any height is equal to the cross-sectional area of the trunk or the branch immediately below the branching point) using simulations based on two biomechanical models: the uniform stress and elastic similarity models. Model calculations of the daughter/mother ratio (i.e., the ratio of the total cross-sectional area of the daughter branches to the cross-sectional area of the mother branch at the branching point) showed that both biomechanical models agreed with da Vinci's rule when the branching angles of daughter branches and the weights of lateral daughter branches were small; however, the models deviated from da Vinci's rule as the weights and/or the branching angles of lateral daughter branches increased. The calculated values of the two models were largely similar but differed in some ways. Field measurements of Fagus crenata and Abies homolepis also fit this trend, wherein models deviated from da Vinci's rule with increasing relative weights of lateral daughter branches. However, this deviation was small for a branching pattern in nature, where empirical measurements were taken under realistic measurement conditions; thus, da Vinci's rule did not critically contradict the biomechanical models in the case of real branching patterns, though the model calculations described the contradiction between da Vinci's rule and the biomechanical models. The field data for Fagus crenata fit the uniform stress model best, indicating that stress uniformity is the key constraint of branch morphology in Fagus crenata rather than elastic similarity or da Vinci's rule. On the other hand, mechanical constraints are not necessarily significant in the morphology of Abies homolepis branches, depending on the number of daughter branches. Rather, these branches were often in agreement with da Vinci's rule. PMID:24714065

  17. Tree branching: Leonardo da Vinci's rule versus biomechanical models.

    PubMed

    Minamino, Ryoko; Tateno, Masaki

    2014-01-01

    This study examined Leonardo da Vinci's rule (i.e., the sum of the cross-sectional area of all tree branches above a branching point at any height is equal to the cross-sectional area of the trunk or the branch immediately below the branching point) using simulations based on two biomechanical models: the uniform stress and elastic similarity models. Model calculations of the daughter/mother ratio (i.e., the ratio of the total cross-sectional area of the daughter branches to the cross-sectional area of the mother branch at the branching point) showed that both biomechanical models agreed with da Vinci's rule when the branching angles of daughter branches and the weights of lateral daughter branches were small; however, the models deviated from da Vinci's rule as the weights and/or the branching angles of lateral daughter branches increased. The calculated values of the two models were largely similar but differed in some ways. Field measurements of Fagus crenata and Abies homolepis also fit this trend, wherein models deviated from da Vinci's rule with increasing relative weights of lateral daughter branches. However, this deviation was small for a branching pattern in nature, where empirical measurements were taken under realistic measurement conditions; thus, da Vinci's rule did not critically contradict the biomechanical models in the case of real branching patterns, though the model calculations described the contradiction between da Vinci's rule and the biomechanical models. The field data for Fagus crenata fit the uniform stress model best, indicating that stress uniformity is the key constraint of branch morphology in Fagus crenata rather than elastic similarity or da Vinci's rule. On the other hand, mechanical constraints are not necessarily significant in the morphology of Abies homolepis branches, depending on the number of daughter branches. Rather, these branches were often in agreement with da Vinci's rule.

  18. Cravity modulation of the moss Tortula modica branching

    NASA Astrophysics Data System (ADS)

    Khorkavtsiv, Yaroslava; Kit, Nadja

    Among various abiotic factors the sensor system of plants constantly perceives light and gravitation impulses and reacts on their action by photo- and gravitropisms. Tropisms play fundamental part in ontogenesis and determination of plant forms. Essentially important question is how light initiating phototropic bending modulates gravitropism. In contrast to flower plants, red light is phototropically active for mosses, and phytochromic system controls initiation of apical growth, branching and photomorphogenesis of mosses. The aim of this investigation was to analyse cell branching of protonemata Tortula modica Zander depending on the direction of light and gravitation vector. The influence of light and gravitation on the form of protonemal turf T. modica, branching and the angle of lateral branches relative to axis of mother cell growth has been investigated. As moss protonemata is not branched in the darkness, light is necessary for branching activation. Minimally low intensity of the red light (0.2 mmol (.) m (-2) ({) .}sec (-1) ) induced branching without visual display of phototropic growth. It has been established that unidirectional action of light and gravitation intensifies branching, and, on the contrary, perpendicularly oriented vectors of factors weaken branches formation. Besides, parallel oriented vectors initiated branching from both cell sides, but oppositely directed vectors initiated branching only from one side. Clinostate rotation the change of the vector gravity and causes uniform cell branching, hence, light and gravitation mutually influence the branching system form of the protonemata cell. It has been shown that the angle of lateral branches in darkness does not depend on the direction of light and gravitation action. After lighting the local growth of the cell wall took place mainly under the angle 90 (o) to the axes of mother cell growth. Then the angle gradually decreased and in 3-4 cell divisions the lateral branch grew under the angle

  19. Additional chain-branching pathways in the low-temperature oxidation of branched alkanes

    DOE PAGES

    Wang, Zhandong; Zhang, Lidong; Moshammer, Kai; ...

    2015-12-31

    Chain-branching reactions represent a general motif in chemistry, encountered in atmospheric chemistry, combustion, polymerization, and photochemistry; the nature and amount of radicals generated by chain-branching are decisive for the reaction progress, its energy signature, and the time towards its completion. In this study, experimental evidence for two new types of chain-branching reactions is presented, based upon detection of highly oxidized multifunctional molecules (HOM) formed during the gas-phase low-temperature oxidation of a branched alkane under conditions relevant to combustion. The oxidation of 2,5-dimethylhexane (DMH) in a jet-stirred reactor (JSR) was studied using synchrotron vacuum ultra-violet photoionization molecular beam mass spectrometry (SVUV-PI-MBMS).more » Specifically, species with four and five oxygen atoms were probed, having molecular formulas of C 8H 14O 4 (e.g., diketo-hydroperoxide/keto-hydroperoxy cyclic ether) and C 8H 16O 5 (e.g., keto-dihydroperoxide/dihydroperoxy cyclic ether), respectively. The formation of C 8H 16O 5 species involves alternative isomerization of OOQOOH radicals via intramolecular H-atom migration, followed by third O 2 addition, intramolecular isomerization, and OH release; C 8H 14O 4 species are proposed to result from subsequent reactions of C 8H 16O 5 species. The mechanistic pathways involving these species are related to those proposed as a source of low-volatility highly oxygenated species in Earth's troposphere. At the higher temperatures relevant to auto-ignition, they can result in a net increase of hydroxyl radical production, so these are additional radical chain-branching pathways for ignition. Furthermore, the results presented herein extend the conceptual basis of reaction mechanisms used to predict the reaction behavior of ignition, and have implications on atmospheric gas-phase chemistry and the oxidative stability of organic substances.« less

  20. Retrograde amnesia in patients with hippocampal, medial temporal, temporal lobe, or frontal pathology.

    PubMed

    Bright, Peter; Buckman, Joseph; Fradera, Alex; Yoshimasu, Haruo; Colchester, Alan C F; Kopelman, Michael D

    2006-01-01

    There is considerable controversy concerning the theoretical basis of retrograde amnesia (R.A.). In the present paper, we compare medial temporal, medial plus lateral temporal, and frontal lesion patients on a new autobiographical memory task and measures of the more semantic aspects of memory (famous faces and news events). Only those patients with damage extending beyond the medial temporal cortex into the lateral temporal regions showed severe impairment on free recall remote memory tasks, and this held for both the autobiographical and the more semantic memory tests. However, on t-test analysis, the medial temporal group was impaired in retrieving recent autobiographical memories. Within the medial temporal group, those patients who had combined hippocampal and parahippocampal atrophy (H+) on quantified MRI performed somewhat worse on the semantic tasks than those with atrophy confined to the hippocampi (H-), but scores were very similar on autobiographical episodic recall. Correlational analyses with regional MRI volumes showed that lateral temporal volume was correlated significantly with performance on all three retrograde amnesia tests. The findings are discussed in terms of consolidation, reconsolidation, and multiple trace theory: We suggest that a widely distributed network of regions underlies the retrieval of past memories, and that the extent of lateral temporal damage appears to be critical to the emergence of a severe remote memory impairment.

  1. Endoscopic modified medial maxillectomy for odontogenic cysts and tumours.

    PubMed

    Nakayama, Tsugihama; Otori, Nobuyoshi; Asaka, Daiya; Okushi, Tetsushi; Haruna, Shin-ichi

    2014-12-01

    Odontogenic maxillary cysts and tumours originate from the tooth root and have traditionally been treated through an intraoral approach. Here, we report the efficacy and utility of endoscopic modified medial maxillectomy (EMMM) for the treatment of odontogenic maxillary cysts and a tumour. We undertook EMMM under general anaesthesia in six patients: four had radicular cysts, one had a dentigerous cyst, and one had a keratocystic odontogenic tumour. The cysts and tumours were completely excised and the inferior turbinate and nasolacrimal duct were preserved in all patients. There were no peri- or postoperative complications, and no incidences of recurrence. Endoscopic modified medial maxillectomy appears to be an effective and safe technique for treating odontogenic cysts and tumours.

  2. Role of Modified Endoscopic Medial Maxillectomy in Persistent Chronic Maxillary Sinusitis

    PubMed Central

    Thulasidas, Ponnaiah; Vaidyanathan, Venkatraman

    2014-01-01

    Introduction Functional endoscopic sinus surgery has a long-term high rate of success for symptomatic improvement in patients with medically refractory chronic rhinosinusitis. As the popularity of the technique continues to grow, however, so does the population of patients with postsurgical persistent sinus disease, especially in those with a large window for ventilation and drainage. In addition, chronic infections of the sinuses especially fungal sinusitis have a higher incidence of recurrence even though a wide maxillary ostium had been performed earlier. This subset of patients often represents a challenge to the otorhinolaryngologist. Objectives To identify the patients with chronic recalcitrant maxillary sinusitis and devise treatment protocols for this subset of patients. Methods A retrospective review was done of all patients with persistent maxillary sinus disease who had undergone modified endoscopic medial maxillectomy between 2009 and 2012. We studied patient demographics, previous surgical history, and follow-up details and categorized the types of endoscopic medial maxillectomies performed in different disease situations. Results We performed modified endoscopic medial maxillectomies in 37 maxillary sinuses of 24 patients. The average age was 43.83 years. Average follow-up was 14.58 months. All patients had good disease control in postoperative visits with no clinical evidence of recurrences. Conclusion Modified endoscopic medial maxillectomy appears to be an effective surgery for treatment of chronic, recalcitrant maxillary sinusitis. PMID:25992084

  3. Detection of defects in formed sheet metal using medial axis transformation

    NASA Astrophysics Data System (ADS)

    Murmu, Naresh C.; Velgan, Roman

    2003-05-01

    In the metal forming processes, the sheet metals are often prone to various defects such as thinning, dents, wrinkles etc. In the present manufacturing environments with ever increasing demand of higher quality, detecting the defects of formed sheet metal using an effective and objective inspection system is the foremost norm to remain competitive in market. The defect detection using optical techniques aspire to satisfy its needs to be non-contact and fast. However, the main difficulties to achieve this goal remain essentially on the development of efficient evaluation technique and accurate interpretation of extracted data. The defect like thinning is detected by evaluating the deviations of the thickness in the formed sheet metal against its nominal value. The present evaluation procedure for determination of thickness applied on the measurements data is not without deficiency. To improve this procedure, a new evaluation approach based on medial axis transformation is proposed here. The formed sheet metals are digitized using fringe projection systems in different orientations, and afterwards registered into one coordinate frame. The medial axis transformation (MAT) is applied on the point clouds, generating the point clouds of MAT. This data is further processed and medial surface is determined. The thinning defect is detected by evaluating local wall thickness and other defects like wrinkles are determined using the shape recognition on the medial surface. The applied algorithm is simple, fast and robust.

  4. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique.

    PubMed

    Harner, Christopher D; Mauro, Craig S; Lesniak, Bryson P; Romanowski, James R

    2009-10-01

    Tears of the posterior root of the medial meniscus are becoming increasingly recognized. They can cause rapidly progressive arthritis, yet their biomechanical effects are not understood. The goal of this study was to determine the effects of posterior root tears of the medial meniscus and their repairs on tibiofemoral joint contact pressure and kinematics. Nine fresh-frozen cadaver knees were used. An axial load of 1000 N was applied with a custom testing jig at each of four knee-flexion angles: 0 degrees , 30 degrees , 60 degrees , and 90 degrees . The knees were otherwise unconstrained. Four conditions were tested: (1) intact, (2) a posterior root tear of the medial meniscus, (3) a repaired posterior root tear, and (4) a total medial meniscectomy. Fuji pressure-sensitive film was used to record the contact pressure and area for each testing condition. Kinematic data were obtained by using a robotic arm to record the position of the knees for each loading condition. Three-dimensional knee kinematics were analyzed with custom programs with use of previously described transformations. The measured variables were axial rotation, varus angulation, lateral translation, and anterior translation. In the medial compartment, a posterior root tear of the medial meniscus caused a 25% increase in peak contact pressure compared with that found in the intact condition (p < 0.001). Repair restored the peak contact pressure to normal. No difference was detected between the peak contact pressure after the total medial meniscectomy and that associated with the root tear. The peak contact pressure in the lateral compartment after the total medial meniscectomy was up to 13% greater than that for all other conditions (p = 0.026). Significant increases in external rotation and lateral tibial translation, compared with the values in the intact knee, were observed in association with the posterior root tear (2.98 degrees and 0.84 mm, respectively) and the meniscectomy (4.45 degrees and 0

  5. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  6. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  7. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  8. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  9. Person-specific theory of mind in medial pFC.

    PubMed

    Welborn, B Locke; Lieberman, Matthew D

    2015-01-01

    Although research on theory of mind has strongly implicated the dorsomedial pFC (incuding medial BA 8 and BA 9), the unique contributions of medial pFC (MPFC; corresponding to medial BA 10) to mentalizing remain uncertain. The extant literature has considered the possibility that these regions may be specialized for self-related cognition or for reasoning about close others, but evidence for both accounts has been inconclusive. We propose a novel theoretical framework: MPFC selectively implements "person-specific theories of mind" (ToMp) representing the unique, idiosyncratic traits or attributes of well-known individuals. To test this hypothesis, we used fMRI to assess MPFC responses in Democratic and Republican participants as they evaluated more or less subjectively well-known political figures. Consistent with the ToMp account, MPFC showed greater activity to subjectively well-known targets, irrespective of participants' reported feelings of closeness or similarity. MPFC also demonstrated greater activity on trials in which targets (whether politicians or oneself) were judged to be relatively idiosyncratic, making a generic theory of mind inapplicable. These results suggest that MPFC may supplement the generic theory of mind process, with which dorsomedial pFC has been associated, by contributing mentalizing capacities tuned to individuated representations of specific well-known others.

  10. Branch Width and Height Influence the Incorporation of Branches into Foraging Trails and Travel Speed in Leafcutter Ants Atta cephalotes (L.) (Hymenoptera: Formicidae).

    PubMed

    Freeman, B M; Chaves-Campos, J

    2016-06-01

    Fallen branches are often incorporated into Atta cephalotes (L.) foraging trails to optimize leaf tissue transport rates and economize trail maintenance. Recent studies in lowlands show laden A. cephalotes travel faster across fallen branches than on ground, but more slowly ascending or descending a branch. The latter is likely because (1) it is difficult to travel up or downhill and (2) bottlenecks occur when branches are narrower than preceding trail. Hence, both branch height and width should determine whether branches decrease net travel times, but no study has evaluated it yet. Laden A. cephalotes were timed in relation to branch width and height across segments preceding, accessing, across, and departing a fallen branch in the highlands of Costa Rica. Ants traveled faster on branches than on cleared segments of trunk-trail, but accelerated when ascending or descending the branch-likely because of the absence of bottlenecks during the day in the highlands. Branch size did not affect ant speed in observed branches; the majority of which (22/24) varied from 11 to 120 mm in both height and width (average 66 mm in both cases). To determine whether ants exclude branches outside this range, ants were offered the choice between branches within this range and branches that were taller/wider than 120 mm. Ants strongly preferred the former. Our results indicate that A. cephalotes can adjust their speed to compensate for the difficulty of traveling on branch slopes. More generally, branch size should be considered when studying ant foraging efficiency.

  11. Arthroscopic Medial Meniscus Posterior Root Reconstruction Using Auto-Gracilis Tendon.

    PubMed

    Lee, Dhong Won; Haque, Russel; Chung, Kyu Sung; Kim, Jin Goo

    2017-08-01

    There have been several techniques to repair the medial meniscus posterior root tears (MMPRTs) with the goal of restoring the anatomic and firm fixation of the meniscal root to bone. Many anatomic studies about the menisci also have been developed, so a better understanding of the anatomy could help surgeons perform correct fixation of the MMPRTs. The meniscal roots have ligament-like structures that firmly attach the menisci to the tibial plateau, and this structural concept is important to restore normal biomechanics after anatomic root repair. We present arthroscopic transtibial medial meniscus posterior root reconstruction using auto-gracilis tendon.

  12. Nervous branch passing through an accessory canal in the sphenozygomatic suture: the temporal branch of the zygomatic nerve.

    PubMed

    Akita, K; Shimokawa, T; Tsunoda, A; Sato, T

    2002-05-01

    A nervous branch which passes through a small canal in the sphenozygomatic suture is sometimes observed during dissection. To examine the origin, course and distribution of this nervous branch, 42 head halves of 21 Japanese cadavers (11 males, 10 females) and 142 head halves of 71 human dry skulls were used. The branch was observed in seven sides (16.7%); it originated from the communication between the lacrimal nerve and the zygomaticotemporal branch of the zygomatic nerve or from the trunk of the zygomatic nerve. In two head halves (4.8%), the branch pierced the anterior part of the temporalis muscle during its course to the skin of the anterior part of the temple. The small canal in the suture was observed in 31 head halves (21.8%) of the dry skulls. Although this nervous branch is inconstantly observed, it should be called the temporal branch of the zygomatic nerve according to the constant positional relationship to the sphenoid and zygomatic bones. According to its origin, course and distribution, this nervous branch may be considered to be influential in zygomatic and retro-orbital pain due to entrapment and tension from the temporalis muscle and/or the narrow bony canal. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0027-4.

  13. Effect of Posterior Horn Medial Meniscus Root Tear on In Vivo Knee Kinematics.

    PubMed

    Marsh, Chelsea A; Martin, Daniel E; Harner, Christopher D; Tashman, Scott

    2014-07-01

    Medial meniscus root tear (MMRT) is a recently recognized yet frequently missed meniscal tear pattern that biomechanically creates an environment approaching meniscal deficiency. The purpose of this study was to assess the effect of MMRT on tibiofemoral kinematics and arthrokinematics during daily activities by comparing the injured knees of subjects with isolated MMRT to their uninjured contralateral knees. The hypothesis was that the injured knee will demonstrate significantly more lateral tibial translation and adduction than the uninjured knee, and that the medial compartment will exhibit significantly different arthrokinematics than the lateral compartment in the affected limb. Cross-sectional study; Level of evidence, 3. Seven subjects with isolated MMRT were recruited and volumetric, density-based 3-dimensional models of their distal femurs and proximal tibia were created from computed tomography scans. High-speed, biplane radiographs were obtained of both their affected and unaffected knees. Moving 3-dimensional models of tibiofemoral kinematics were calculated using model-based tracking to assess overall kinematic variables and specific measures of tibiofemoral joint contact. The affected knees of the subjects were then compared to their unaffected contralateral knees. Affected knees demonstrated significantly more lateral tibial translation than the uninjured contralateral limb in all dynamic activities. Additionally, the medial compartment displayed greater amounts of mobility than the lateral compartment in the injured limbs. This study suggests that MMRT causes significant changes in in vivo knee kinematics and arthrokinematics and that the magnitude of these changes is influenced by dynamic task difficulty. Medial meniscus root tears lead to significant changes in joint arthrokinematics, with increased lateral tibial translation and greater medial compartment excursion. With complete root tears, essentially 100% of circumferential fibers are lost

  14. Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON§ Project

    PubMed Central

    Peloso, Paul M; Khan, Mahweesh; Gross, Anita R; Carlesso, Lisa; Santaguida, Lina; Lowcock, Janet; MacDermid, Joy C; Walton, Dave; Goldsmith, Charlie H; Langevin, Pierre; Shi, Qiyun

    2013-01-01

    Objectives: To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. Search Strategy: Computerized databases and grey literature were searched from 2006 to 2012. Selection Criteria: Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. Main Results: We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; Reviewers' Conclusions: While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain. PMID:24155805

  15. Root avulsion of the posterior horn of the medial meniscus in skeletally immature patients.

    PubMed

    Sonnery-Cottet, Bertrand; Mortati, Rafael; Archbold, Pooler; Gadea, François; Clechet, Julien; Thaunat, Mathieu

    2014-12-01

    Meniscal root avulsion has been predominantly reported in an adult population but little is known about this meniscal lesion in children and adolescents. The of this article is to describe the clinical symptoms and a new MRI sign of a medial meniscus posterior root avulsion in skeletally immature patients, and to report the arthroscopic procedure for its reinsertion in the presence of open physes. We report two skeletally immature patients who had a medial meniscus posterior root avulsion [MMPRA]. Diagnosis of a MMPRA was suspected on MRI by intense T2 hypersignal located at the postero-medial part of the tibial plateau reflecting trabecular bone oedema ("Bone bruise") at the level of the medial meniscal posterior root attachment. Arthroscopic reduction and fixation of the posterior root of the medial meniscus with transosseous sutures was performed. The patients returned to sport at the end of 6 months without residual symptoms. At one year, the radiographs showed no modification of the physis. Healing of the medial meniscal posterior root was noted on MRI. In a skeletally immature patient it is important that this rare meniscal lesion is diagnosed early and adequately treated. We emphasize the importance of the indirect MRI signs that can lead a clinician to suspect the diagnosis of MMPRA. The aim of the surgery was to restore the anatomical footprint of the meniscal root and to re-establish its function thus preventing future chondral damage without damage to the tibial physeal growth plate. Level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Tibial avulsion fracture of the posterior root of the medial meniscus in children.

    PubMed

    Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

    2014-01-01

    Few reports have described avulsion fractures of the posterior root of the medial meniscus in skeletally immature patients. This lesion should not be overlooked as it damages the load absorptive (distributive) function of the meniscus, increasing the risk of cartilage degeneration. Two cases of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures with a good clinical result at 2-years follow-up, and in one case, the avulsion was found at re-arthroscopy after 6 weeks to have healed.

  17. A Branch Meeting in Avon

    ERIC Educational Resources Information Center

    Vaughan, Kathryn; Coles, Alf

    2011-01-01

    The Association of Teachers of Mathematics (ATM) exists for, and is run by, its members. Branch meetings are so much more than the "grass roots" of the association--it can be a powerhouse of inspiration and creativity. In this article, the authors provide commentaries on a recent branch meeting.

  18. Synthesis and macrophage activation of lentinan-mimic branched amino polysaccharides: curdlans having N-Acetyl-d-glucosamine branches.

    PubMed

    Kurita, Keisuke; Matsumura, Yuriko; Takahara, Hiroki; Hatta, Kiyoshige; Shimojoh, Manabu

    2011-06-13

    N-Acetyl-d-glucosamine branches were incorporated at the C-6 position of curdlan, a linear β-1,3-d-glucan, and the resulting nonnatural branched polysaccharides were evaluated in terms of the immunomodulation activities in comparison with lentinan, a β-1,3-d-glucan having d-glucose branches at C-6. To incorporate the amino sugar branches, we conducted a series of regioselective protection-deprotections of curdlan involving triphenylmethylation at C-6, phenylcarbamoylation at C-2 and C-4, and detriphenylmethylation. Subsequent glycosylation with a d-glucosamine-derived oxazoline, followed by deprotection gave rise to the branched curdlans with various substitution degrees. The products exhibited remarkable solubility in both organic solvents and water. Their immunomodulation activities were determined using mouse macrophagelike cells, and the secretions of both the tumor necrosis factor and nitric oxide proved to be significantly higher than those with lentinan. These results conclude that the amino sugar/curdlan hybrid materials are promising as a new type of polysaccharide immunoadjuvants useful for cancer chemotherapy.

  19. Wind-Induced Reconfigurations in Flexible Branched Trees

    NASA Astrophysics Data System (ADS)

    Ojo, Oluwafemi; Shoele, Kourosh

    2017-11-01

    Wind induced stresses are the major mechanical cause of failure in trees. We know that the branching mechanism has an important effect on the stress distribution and stability of a tree in the wind. Eloy in PRL 2011, showed that Leonardo da Vinci's original observation which states the total cross section of branches is conserved across branching nodes is the best configuration for resisting wind-induced fracture in rigid trees. However, prediction of the fracture risk and pattern of a tree is also a function of their reconfiguration capabilities and how they mitigate large wind-induced stresses. In this studies through developing an efficient numerical simulation of flexible branched trees, we explore the role of the tree flexibility on the optimal branching. Our results show that the probability of a tree breaking at any point depends on both the cross-section changes in the branching nodes and the level of tree flexibility. It is found that the branching mechanism based on Leonardo da Vinci's original observation leads to a uniform stress distribution over a wide range of flexibilities but the pattern changes for more flexible systems.

  20. Multi-parameter analysis of titanium vocal fold medializing implant in an excised larynx model

    PubMed Central

    Witt, Rachel E.; Hoffman, Matthew R.; Friedrich, Gerhard; Rieves, Adam L.; Schoepke, Benjamin J.; Jiang, Jack J.

    2010-01-01

    Objective Evaluate the efficacy of the titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis (UVFP) based on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup. Methods Measurements were recorded on eight excised canine larynges with simulated UVFP before and after medialization with the TVFMI. Results Phonation threshold flow (PTF) and phonation threshold power (PTW) decreased significantly after medialization (p<0.001; p=0.008). Phonation threshold pressure (PTP) also decreased, but this difference was not significant (p=0.081). Percent jitter and percent shimmer decreased significantly after medialization (p=0.005; p=0.034). Signal to noise ratio (SNR) increased significantly (p=0.05). Differences in mucosal wave characteristics were discernable, but not significant. Phase difference between the normal and paralyzed vocal fold and amplitude of the paralyzed vocal fold decreased (p=0.15; p=0.78). Glottal gap decreased significantly (p=0.004). Conclusions The TVFMI was effective in achieving vocal fold medialization, improving vocal aerodynamic and acoustic characteristics of phonation significantly and mucosal wave characteristics discernibly. This study provides objective, quantitative support for the use of the TVFMI in improving vocal function in patients with unilateral vocal fold paralysis. PMID:20336924